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  • 1.
    Gheorghiade, Mihai
    et al.
    Northwestern University Feinberg School of Medicine, Chicago, USA.
    Greene, Stephen J
    Duke University Medical Center, Durham, North Carolina, USA.
    Butler, Javed
    Stony Brook University, Stony Brook, New York, USA.
    Filippatos, Gerasimos
    Athens University Hospital Attikon and Kapodistrian University of Athens, Athens, Greece.
    Lam, Carolyn S P
    National Health Center, Singapore and Duke, National University of Singapore, Singapore.
    Maggioni, Aldo P
    Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy.
    Ponikowski, Piotr
    Medical University, Wroclaw, Poland.
    Shah, Sanjiv J
    Northwestern University Feinberg School of Medicine, Chicago, USA.
    Solomon, Scott D
    Brigham and Women's Hospital Boston, Massachusetts, USA.
    Kraigher-Krainer, Elisabeth
    Charite University Medicine Berlin-Campus Virchow Klinikum, Berlin, Germany.
    Samano, Eliana T
    Bayer, Sao Paulo, Brazil.
    Müller, Katharina
    Bauer Pharma, Wuppertal, Germany.
    Roessig, Lothar
    Bauer Pharma, Wuppertal, Germany.
    Burkert, Pieske
    Charité University Medicine Berlin–Campus Virchow Klinikum and German Heart Center Berlin, Germany.
    Effect of Vericiguat, a Soluble Guanylate Cyclase Stimulator, on Natriuretic Peptide Levels in Patients With Worsening Chronic Heart Failure and Reduced Ejection Fraction: The SOCRATES-REDUCED Randomized Trial.2015In: Journal of the American Medical Association (JAMA), ISSN 0098-7484, E-ISSN 1538-3598, Vol. 314, no 21, 2251-2262 p.Article in journal (Refereed)
    Abstract [en]

    IMPORTANCE: Worsening chronic heart failure (HF) is a major public health problem.

    OBJECTIVE: To determine the optimal dose and tolerability of vericiguat, a soluble guanylate cyclase stimulator, in patients with worsening chronic HF and reduced left ventricular ejection fraction (LVEF).

    DESIGN, SETTING, AND PARTICIPANTS: Dose-finding phase 2 study that randomized 456 patients across Europe, North America, and Asia between November 2013 and January 2015, with follow-up ending June 2015. Patients were clinically stable with LVEF less than 45% within 4 weeks of a worsening chronic HF event, defined as worsening signs and symptoms of congestion and elevated natriuretic peptide level requiring hospitalization or outpatient intravenous diuretic.

    INTERVENTIONS: Placebo (n = 92) or 1 of 4 daily target doses of oral vericiguat (1.25 mg [n = 91], 2.5 mg [n = 91], 5 mg [n = 91], 10 mg [n = 91]) for 12 weeks.

    MAIN OUTCOMES AND MEASURES: The primary end point was change from baseline to week 12 in log-transformed level of N-terminal pro-B-type natriuretic peptide (NT-proBNP). The primary analysis specified pooled comparison of the 3 highest-dose vericiguat groups with placebo, and secondary analysis evaluated a dose-response relationship with vericiguat and the primary end point.

    RESULTS: Overall, 351 patients (77.0%) completed treatment with the study drug with valid 12-week NT-proBNP levels and no major protocol deviation and were eligible for primary end point evaluation. In primary analysis, change in log-transformed NT-proBNP levels from baseline to week 12 was not significantly different between the pooled vericiguat group (log-transformed: baseline, 7.969; 12 weeks, 7.567; difference, -0.402; geometric means: baseline, 2890 pg/mL; 12 weeks, 1932 pg/mL) and placebo (log-transformed: baseline, 8.283; 12 weeks, 8.002; difference, -0.280; geometric means: baseline, 3955 pg/mL; 12 weeks, 2988 pg/mL) (difference of means, -0.122; 90% CI, -0.32 to 0.07; ratio of geometric means, 0.885, 90% CI, 0.73-1.08; P = .15). The exploratory secondary analysis suggested a dose-response relationship whereby higher vericiguat doses were associated with greater reductions in NT-proBNP level (P < .02). Rates of any adverse event were 77.2% and 71.4% among the placebo and 10-mg vericiguat groups, respectively.

    CONCLUSIONS AND RELEVANCE: Among patients with worsening chronic HF and reduced LVEF, compared with placebo, vericiguat did not have a statistically significant effect on change in NT-proBNP level at 12 weeks but was well-tolerated. Further clinical trials of vericiguat based on the dose-response relationship in this study are needed to determine the potential role of this drug for patients with worsening chronic HF.

    TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01951625.

  • 2.
    Galiè, Nazzareno
    et al.
    University of Bologna, Italy.
    Barberà, Joan A
    University of Barcelona and Biomedical Research Networking Center on Respiratory Diseases, Madrid, Spain.
    Frost, Adaani E
    Baylor College of Medicine, Houston, USA.
    Ghofrani, Hossein-Ardeschir
    University of Giessen and Marbury Lung Center, Giessen, Germany.
    Hoeper, Marius M
    Hanover Medical School and German Center of Lung Research, Hanover, Germany.
    McLaughlin, Vallerie V
    University of Michigan, USA.
    Peacock, Andrew J
    Regional Heart and Lung Center, Glasgow, Scotland.
    Simonneau, Gérald
    University Paris-Sud, Paris, France.
    Vachiery, Jean-Luc
    Hospital Erasme, Brussels, Belgium.
    Grünig, Ekkehard
    University Hospital Heidelberg, Heidelberg, Germany.
    Oudiz, Ronald J
    UCLA Medical Center, Torrance,USA.
    Vonk-Noordegraaf, Anton
    University Medical Center, Amsterdam, Netherlands.
    White, R James
    University of Rochester, NY, USA.
    Blair, Christiana
    Gilead Sciences, Foster City.
    Gillies, Hunter
    Gilead Sciences, Foster City.
    Miller, Karen L
    Gilead Sciences, Foster City.
    Harris, Julia H N
    GlaxoSmith Kline, Uxbridge, UK.
    Langley, Jonathan
    GlaxoSmith Kline, Uxbridge, UK.
    Rubin, Lewis J
    University of California at San Diego, USA.
    Initial Use of Ambrisentan plus Tadalafil in Pulmonary Arterial Hypertension2015In: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 373, no 9Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Data on the effect of initial combination therapy with ambrisentan and tadalafil on long-term outcomes in patients with pulmonary arterial hypertension are scarce.

    METHODS: In this event-driven, double-blind study, we randomly assigned, in a 2:1:1 ratio, participants with World Health Organization functional class II or III symptoms of pulmonary arterial hypertension who had not previously received treatment to receive initial combination therapy with 10 mg of ambrisentan plus 40 mg of tadalafil (combination-therapy group), 10 mg of ambrisentan plus placebo (ambrisentan-monotherapy group), or 40 mg of tadalafil plus placebo (tadalafil-monotherapy group), all administered once daily. The primary end point in a time-to-event analysis was the first event of clinical failure, which was defined as the first occurrence of a composite of death, hospitalization for worsening pulmonary arterial hypertension, disease progression, or unsatisfactory long-term clinical response.

    RESULTS: The primary analysis included 500 participants; 253 were assigned to the combination-therapy group, 126 to the ambrisentan-monotherapy group, and 121 to the tadalafil-monotherapy group. A primary end-point event occurred in 18%, 34%, and 28% of the participants in these groups, respectively, and in 31% of the pooled-monotherapy group (the two monotherapy groups combined). The hazard ratio for the primary end point in the combination-therapy group versus the pooled-monotherapy group was 0.50 (95% confidence interval [CI], 0.35 to 0.72; P<0.001). At week 24, the combination-therapy group had greater reductions from baseline in N-terminal pro-brain natriuretic peptide levels than did the pooled-monotherapy group (mean change, -67.2% vs. -50.4%; P<0.001), as well as a higher percentage of patients with a satisfactory clinical response (39% vs. 29%; odds ratio, 1.56 [95% CI, 1.05 to 2.32]; P=0.03) and a greater improvement in the 6-minute walk distance (median change from baseline, 48.98 m vs. 23.80 m; P<0.001). The adverse events that occurred more frequently in the combination-therapy group than in either monotherapy group included peripheral edema, headache, nasal congestion, and anemia.

    CONCLUSIONS: Among participants with pulmonary arterial hypertension who had not received previous treatment, initial combination therapy with ambrisentan and tadalafil resulted in a significantly lower risk of clinical-failure events than the risk with ambrisentan or tadalafil monotherapy. (Funded by Gilead Sciences and GlaxoSmithKline; AMBITION ClinicalTrials.gov number, NCT01178073.).

  • 3.
    Wang, Lei
    Linköping University, Department of Computer and Information Science. Linköping University, Faculty of Science & Engineering.
    GUI test automation for Qt application2015Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    GUI test automation is a popular and interesting subject in the testing industry. Many companies plan to start test automation projects in order to implement efficient, less expensive software testing. However, there are challenges for the testing team who lack experience performing GUI tests automation. Many GUI test automation projects have ended in failure due to mistakes made during the early stages of the project.

    The major work of this thesis is to find a solution to the challenges of establishing new test automation projects and determine an appropriate method to build GUI tests automation. Due to the particularity of GUI tests automation, keyword driven test approach is introduced in this thesis. The advantages and disadvantages are shown by undertaking comparison with the Record and replay testing method and the data driven testing method. The research also includes a feasibility study of GUI tests automation. The analysis report points out which kinds of test projects should be automated and which kinds should not be automated.

    Test automation tool selection is a critical step for an test automation project. This thesis shows the correct procedure for selecting a testing tool and explains the strategies of testing tool selection. It also summaries the mistakes made during the tool selection process. Several classical types of testing tools which support Qt software testing are compared and evaluated. Based on the in-depth analysis and comparison of testing tools, the thesis explains how the different tools fit with the different test projects.

    The implementation procedure of a test automation is demonstrated in this thesis. The procedure includes test case design and testing framework implementation. The test script is created based on the structure of a keyword driven test framework. The thesis also discusses several interesting topics related to GUI tests automation for future research.

  • 4. Klompstra, Leonie
    et al.
    Jaarsma, TinyStrömberg, Anna
    Playing exergames by heart failure patients.2013Conference proceedings (editor) (Refereed)
    Abstract [en]

    Purpose: Regular daily exercise is recognized as important in patients with heart failure (HF), but adherence to exercise recommendations is low. It is important to search for alternative approaches to motivate patients with HF to be more active. The use of exergames (games to improve physical exercise) might be an encouragement for HF patients, especially for people who may be reluctant to engage in more traditional forms of exercise, such as going to the gym or take a walk outside. The aim of this study is to assess the self-reported time playing on the Wii exergame platform when patients get access to the Wii at home for 12 weeks and the factors related to the time playing.

    Methods: As part of a feasibility study, the Wii was installed in the home of HF patients for a period of 12 weeks and patients were instructed to exergame 20 minutes a day (e.g. virtual bowling or tennis). Patients completed a diary which contained questions about the amount of minutes exergaming, heart failure symptoms and perceived exertion. At baseline and 12 weeks the physical capacity was assessed by 6minute walking test. We compared patients who played more than the median amount of minutes on the Wii with patients who played less than the median time.

    Results:  Thirty-two HF patients (age 64 ± 14, 10 female) were included. The mean time exergaming was 28 (±13) minutes a day (median of 27 minutes). Two patients stopped exergaming during the study. Men played more minutes a day on the Wii (31 minutes) than women (20 minutes), (t =2.243, p <.033) which could not be explained by age. Both male and female patients decreased in time exergaming, comparing the first 6 weeks access to the Wii with the last 6 weeks, but no differences were found in the amount of minutes decrease in exergaming (-5±9) between man and women. Patients who played more than the median time were significant lower educated, had a lower NYHA class and had more often grandchildren than patients who exergamed less than the median time.  No association could be found between the groups in exercise capacity, motivation, self-efficacy, symptoms experience, perceived exertion with time exergaming.

    Conclusion: Patients with HF played a considerable time active games on the Wii during 12 months of access to the Wii. Although women exergamed less than men, they did not decrease more in playing then men during the study. Patients who increased more than the median amount of minutes exergaming had a lower educational level, lower NYHA class, and more patients had grandchildren than patients who exergamed less. Access to exergames seem to be a promising to keep HF patients motivated to be active and to provide social facilitation with grandchildren. 

  • 5. Klompstra, Leonie
    et al.
    Jaarsma, TinyStrömberg, Anna
    Gender differences in participation motives for exercise and exergaming in heart failure patients.2014Conference proceedings (editor) (Refereed)
    Abstract [en]

    Purpose: Regular daily exercise is recognized as important in patients with heart failure (HF). The use of exergames (games to improve physical exercise) might be an encouragement for HF patients, especially for people who may be reluctant to engage in more traditional forms of exercise. It is known that participation motives are important factors in able to become more physical active. Therefore the purpose of this study is to examine gender differences in participation motives before access to an exergame computer and the exercise motives after access to an exergame computer at home.

    Methods: The Wii was installed in the home of HF patients for a period of 12 weeks and patients were instructed to exergame 20 minutes a day (e.g. virtual bowling or tennis). Patients completed a questionnaire on baseline and 12 weeks which included the exercise motivation index (EMI), which measured participation motives. The EMI consists of 15 statements; each statement is followed by a five-point verbal rating from 0 (not important) to 4 (extremely important). Chi-square test was performed to look in gender in participation motives of the EMI and the ESE. P-values<.05 was considered significant.

    Results:  Thirty-two HF patients (age 64 ± 14, 10 female) were included. The exercise motives which scored important or extremely important on baseline were: ‘I want to be in better shape so that my clothes sit better’, ‘I want the ageing process to slow down and feel younger’, ‘Exercise increases my overall well-being’ and ‘I want to be healthier and live longer’. After 12 weeks access to the Nintendo Wii only the participation motive: ‘I want to be healthier and perhaps life longer’ scored important or extremely inportant. Gender differences were found in participation motives at baseline. Female patients significant agreed more on 6 participation motives compared to men: I want to be in better shape so my clothes fit better (3 vs 1), I am proud of myself when I exercise regularly (3 vs 1), I want to look good (2 vs. 1), I want to be as active as my family and my friends (2 vs 1), I feel successful when I am on better shape (3 vs 1) and I want to feel less physical vulnerable (3 vs 1). At 12 weeks there were fewer differences in participation motives. Difference were found where women agreed more on 2 participation motives than men: I want to be as active as my family and my friends (2 vs 1) and People who are in good shape will be admired, I want to be admired too (2 vs 1).

    Conclusion: This study shows gender differences in the participation motives in becoming physical active and exergaming. Women have more participation motives than men. After 12 weeks access to the Nintendo Wii we found less difference in the participation motives between men and women. Gender differences in participation motives in exergaming were due to social facilitation and I want to be admired, where women agreed more than men. 

  • 6.
    Gustavsson, Johan
    Linköping University, Department of Computer and Information Science, Software and Systems. Zenterio.
    A Comparative Study of Automated Test Explorers2015Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    With modern computer systems becoming more and more complicated, theimportance of rigorous testing to ensure the quality of the product increases.This, however, means that the cost to perform tests also increases. In orderto address this problem, a lot of research has been conducted during thelast years to find a more automated way of testing software systems. Inthis thesis, different algorithms to automatically explore and test a systemhave been implemented and evaluated. In addition to this, a second setof algorithms have been implemented with the objective to isolate whichinteractions with the system were responsible for a failure. These algorithmswere also evaluated and compared against each other. In the first evaluationtwo explorers, which I called DeBruijn and LStarExplorer, were consideredsuperior to the other. The first used a DeBruijn sequence to brute forcea solution while the second used the L*-algorithm to build an FSM overthe system under test. This FSM could then be used to provide a moreaccurate description for when the failure occurred. The result from thesecond evaluation were two reducers which both tried to recreate a failureby first applying interactions performed just before the failure occurred. Ifthis was not successful, they tried interactions further and further away, untilthe failure was triggered. In addition to this, the thesis contains descriptionsabout the framework used to run the different strategies.

  • 7.
    Stenbeck, Marcus
    Linköping University, Department of Science and Technology, Media and Information Technology. Linköping University, The Institute of Technology.
    Automatisk testning av WebGL på mobil- och desktopenheter2014Independent thesis Advanced level (professional degree), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    WebGL is a standard for drawing graphics in a web browser. Currently it isn’t widely understood how consistently WebGL performs across a majority of the de- vices that support it. Determining if an image looks correct to a human observer is an interesting problem. The solution for this is useful when developing WebGL applications, since a developer could make better informed decisions during de- velopment. The differences in capability between WebGL implementations are studied, and a few factors are selected that likely will contribute to variations in the rendered output. These factors are found by studying the WebGL specification documen- tation, and in the cases where it is ambiguous, further, authorative sources have contributed to the choice of factors studied. A prototype testing system is developed, including a tool for simulating imple- mentation differences. Two image processing algorithms are evaluated for their suitability in an automatic testing system. For testing, four test cases are devel- oped. The testing system is run with the test cases on wide range of devices, both mobile and desktop. The results show that image processing is not suitable alone the source for deter- mining a test success or failure. However, some promise is shown in using image processing as one component in a fully automatic testing system. Furthermore, developing test cases that perform as the test constructor intends is proven to be a challenge in itself.

  • 8. Kato, Naoko
    et al.
    Kinugawa, Koichiro
    Ito, Naomi
    Yao, Atsushi
    Watanabe, Masafumi
    Imai, Yasushi
    Takeda, Norihiko
    Hatano, Masaru
    Kazuma, Keiko
    Adherence to self-care behavior and factors related to this behavior among patients with heart failure in Japan2009In: Heart & Lung, ISSN 0147-9563, E-ISSN 1527-3288, Vol. 38, no 5, 398-409 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Adherence to self-care behavior is important for patients with heart failure (HF) to prevent exacerbation of HF. The aim of this study was to evaluate adherence, identify associated factors, and clarify the impact of previous HF hospitalizations on adherence in outpatients with HF. METHODS: A total of 116 outpatients completed a questionnaire, including the Japanese version of the European Heart Failure Self-Care Behavior Scale, to assess adherence. RESULTS: Regardless of previous hospitalizations, adherence to seek help if HF worsened was poor. Multivariate analysis adjusted for age and brain natriuretic peptide showed that diabetes mellitus and being employed were independent predictors of poorer adherence to self-care behavior (P = .03, P = .02, respectively), but the experience of previous HF hospitalizations was not a predictor. CONCLUSIONS: Self-care strategies for HF should target patients with diabetes mellitus and employed patients. Further study is necessary to develop effective programs for such patients.

  • 9.
    Karalekas, Panagiotis
    Linköping University, Department of Physics, Chemistry and Biology, Biology. Linköping University, The Institute of Technology.
    Is S100A1 involved in the programming effects of fetal hypoxia on cardiac function in chickens?2014Independent thesis Basic level (degree of Bachelor), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Prolonged prenatal hypoxia has shown to cause fetal growth restriction inchickens due to restricted oxygen to the somatic tissue. The body goes through a critical periodof development. Insults during this critical period may have lifelong effects on the individual.Currently heart failure is treated either with symptomatic therapy using diuretics or by targetingthe renin-angiotensin-aldosterone system. Developing new successful treatments is importantwith the aging population and the increased rate of heart failure. Previous studies have shownsystolic contractile dysfunction in 5 week old broiler chicken hearts when the eggs have beenincubated in hypoxia until hatching. S100A1 in cardiomyocytes regulates the calcium-controllednetwork which plays a big role in cardiac contractility and in this study, using qPCR on S100A1(GOI), GADPH and β-actin to try and determine if the changes made to the heart while the fetusis developing is due to a lack of S100A1 expression resulting in a decreased handling of Ca2+uptake which causes contractile dysfunction A Roche Lightcycler 480 was used together with theRoche template running triplets of each sample at 15-15-15 seconds for 45 cycles No statisticalsignificance was observed between the control group and the experimental group. However inthis study only S100A1 gene is being considered but a better understanding of the whole S100family might give a better understanding of mechanisms causing the progressive deterioration ofcardiac function

  • 10.
    Home, P.D.
    et al.
    Newcastle Diabetes Centre, Newcastle University, Newcastle upon Tyne, United Kingdom.
    Pocock, S.J.
    Medical Statistics Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom.
    Beck-Nielsen, H.
    Department of Endocrinology and Metabolism, Odense, Denmark.
    Curtis, P.S.
    GlaxoSmithKline Research and Development, Greenford, United Kingdom.
    Gomis, R.
    Hospital Clinic, University of Barcelona, Barcelona, Spain.
    Hanefeld, M.
    Zentrum für Klinische Studien Forschungsbereich Endokrinologie und Stoffwechsel, Dresden, Germany.
    Jones, N.P.
    GlaxoSmithKline Research and Development, Harlow, United Kingdom.
    Komajda, M.
    Université Pierre et Marie Curie Paris 6, Hôpital Pitié-Salpêtrière, Département de Cardiologie, Paris, France.
    McMurray, J.J.
    British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom.
    Rosiglitazone evaluated for cardiovascular outcomes in oral agent combination therapy for type 2 diabetes (RECORD): a multicentre, randomised, open-label trial2009In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 373, no 9681, 2125-2135 p.Article in journal (Refereed)
    Abstract [en]

    Background: Rosiglitazone is an insulin sensitiser used in combination with metformin, a sulfonylurea, or both, for lowering blood glucose in people with type 2 diabetes. We assessed cardiovascular outcomes after addition of rosiglitazone to either metformin or sulfonylurea compared with the combination of the two over 5-7 years of follow-up. We also assessed comparative safety. Methods: In a multicentre, open-label trial, 4447 patients with type 2 diabetes on metformin or sulfonylurea monotherapy with mean haemoglobin A 1c (HbA 1c) of 7·9% were randomly assigned to addition of rosiglitazone (n=2220) or to a combination of metformin and sulfonylurea (active control group, n=2227). The primary endpoint was cardiovascular hospitalisation or cardiovascular death, with a hazard ratio (HR) non-inferiority margin of 1·20. Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00379769. Findings: 321 people in the rosiglitazone group and 323 in the active control group experienced the primary outcome during a mean 5·5-year follow-up, meeting the criterion of non-inferiority (HR 0·99, 95% CI 0·85-1·16). HR was 0·84 (0·59-1·18) for cardiovascular death, 1·14 (0·80-1·63) for myocardial infarction, and 0·72 (0·49-1·06) for stroke. Heart failure causing admission to hospital or death occurred in 61 people in the rosiglitazone group and 29 in the active control group (HR 2·10, 1·35-3·27, risk difference per 1000 person-years 2·6, 1·1-4·1). Upper and distal lower limb fracture rates were increased mainly in women randomly assigned to rosiglitazone. Mean HbA 1c was lower in the rosiglitazone group than in the control group at 5 years. Interpretation: Addition of rosiglitazone to glucose-lowering therapy in people with type 2 diabetes is confirmed to increase the risk of heart failure and of some fractures, mainly in women. Although the data are inconclusive about any possible effect on myocardial infarction, rosiglitazone does not increase the risk of overall cardiovascular morbidity or mortality compared with standard glucose-lowering drugs. Funding: GlaxoSmithKline plc, UK. © 2009 Elsevier Ltd. All rights reserved.

  • 11.
    Minya, Kristoffer
    Linköping University, Department of Computer and Information Science, Statistics. Linköping University, The Institute of Technology.
    Överlevnadsanalys i tjänsteverksamhet: Tidspåverkan i överklagandeprocessen på Migrationsverket2014Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    The Swedish Migration Board is an agency that review applications from individuals who wish to seek shelter, have citizenship, study or want to work in Sweden. In recent time there has been a large increase in applications and the time for which a decision is made has increased. Each type of application (such as citizenship) is a process consisting of several stages. How the decision is going through these steps is called flow. The Swedish Migration Board would therefore like to increase their flow efficiency. When the decision is made and the person has take part of it but is not satisfied, he can appeal. This is one of the most complex processes at the Board. The aim is to analyze how long this process will take and what steps in the process affects the time. One step (which was later found to have a significant effect on time) is opinions. This is when the court requests information on what the person is appealing has to say about why he is appealing. To analyze this, two methods were relevant, accelerated failure time (AFT) and the multi-state models (MSM). One can predict time to event (AFT), the other to analyze the effect of time-manipulation (MSM) in the flow. Opinions early in the process is crucial to how quickly an appeal get judgment while the number of opinions increases the time enormously. There are other factors that affect the time but not so much as opinions. The flow efficiency can be increased by taking time to write an informative opinion which allows the court need not to ask for more opinions.

  • 12.
    Grujicic, Misel
    et al.
    Linköping University, Department of Management and Engineering, Business Administration. Linköping University, Faculty of Arts and Sciences.
    Madsen, Anna
    Linköping University, Department of Management and Engineering, Business Administration. Linköping University, Faculty of Arts and Sciences.
    Återhämtningsprocessen hos en svensk livsmedelsproducent efter ett allvarligt produktfel: En studie av Findus hantering av ”Hästköttsskandalen” under våren 20132014Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    This study deals with a Swedish company in a food industry that got affected by product failure, which led to consumer trust crisis followed by media and was needed to be managed. Situation had a negative impact on company’s trademark, which acquired long recovery work by the company. Study is following a case example of Findus problems with having horse meat in their meat product that was supposed to contain beef meat. Study aims to research how the company dealt with situation, through crisis communication and recovery strategies. This study has conducted two content analyses, one for traditional media and one for blogs (social media channel), one participating observation at Findus production facilities and also conducted one qualitative interview with Findus. The study has been conducted with a slightly deductive approach and is a qualitative study in a constructionist way.

  • 13.
    Karlsson, Daniel
    Linköping University, Department of Management and Engineering, Business Administration. Linköping University, Faculty of Arts and Sciences.
    Varumärkesvård i tider av kris: En fallstudie om återhämtning till följd av ett produktfel2013Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    This study is about how a swedish brand within the food industry that experiences a crisis following a product failure. It focuses on three areas following the crisis and these are crisis management, recovery strategies and brand management. This study seeks to explain how these areas interact in relation to massive exposure to mass media and how they interact restore the brand's potential loss of reputation. This study was conducted as a case study with a deductive and qualitative approach. The data gathered to this study was mainly based on newspaper articles and complemented with semi-structured interviews with twelve local retailers of the brand.

  • 14.
    Hegart, Ellinor
    et al.
    Linköping University, Department of Management and Engineering. Linköping University, Faculty of Arts and Sciences.
    Högberg, Alexander
    Linköping University, Department of Management and Engineering. Linköping University, Faculty of Arts and Sciences.
    Ny kutym eller ny kostym?: Etableringsreformen ur ett nyinstitutionellt ekonomiskt perspektiv2013Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    The aim of the study is to assess the compliance between the goals and the results of the Establishment reform, which entered into force on December 1st 2010, and the role of the participant called the Introduction guide. This assessment is done on the basis of the goals in the proposition from the Swedish government 2009/10:60 Nyanlända invandrares arbetsmarknadsetablering – egenansvar med professionellt stöd. In addition the obstacles to achieving the goals are highlighted. The study is based on reports and other documents from public bodies that are supplemented by, amongst others, the primary data of the study. This primary data consists of interviews with four employees at the Public Employment Service and four Introduction guides in Linköping and Norrköping as well as of mail correspondence with the Public Employment Service at a central level. The results are interpreted using New Institutional Economic Theory, focusing on the theories by Douglass North.The study shows, among other things, that the differences between various establishment activities have diminished, and that there is a stronger labour market focus now that the Public Employment Service has taken over the responsibility from the municipalities. However, the Establishment reform does suffer from a lack of individually adapted establishment activities as well from a failure in collaboration and coordination. This ultimately afflicts the new arrivals, which are already facing high barriers while trying to become a part of the Swedish society. External factors also affect the establishment process and the possibilities for new arrivals. It is foremost the living situation that is affecting different lead times and limiting the immigrants possibilities to participate in establishment activities.The economic incentives for the Introduction guides to fill their intended function are too low and the guides are primarily providing social support for the new arrivals instead of labour market oriented activities. Innovations as a result of competition are largely absent. The system contains various flaws that allow for flippant or opportunistic Introduction guides, which in turn lowers the quality of the Establishment work and worsens the new arrivals’ chances of getting established on the labour market.

  • 15.
    Andersson, Jan-Erik
    Linköping University, Department of Science and Technology. Linköping University, The Institute of Technology.
    Ammunition for measurements2005Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    The proximity fuzed 3P ammunition is programmed during the loading of the piece to the desired operation mode. To guarantee that the ammunition receives the programming signals correctly and thus being able to eliminate the programming as a source of errors in the event of a possible failure there is a need to evaluate the process of loading.

    Such an evaluation of possible programming errors could be performed with an ammunition for measurements. An ammunition for mesurements would be based on complete 3P electronics and additional electronics for the evaluation of theprocess of loading.

    The task for the master thesis has been to develop a lab-system to aid in the development of an ammunition for measurements.

    This thesis describes with a introductory litterature study the work to create a lab-system. The constructed lab-system is based on an evaluation card including among other things a digital signal processor from the Blackfin family from Analog Devices. Tests and measurements show that the work has resulted in a well functioning lab-system, which meets the requirements of the task. In conclusion the thesis also describes comprehensively the remaining work to create a complete ammunition for measurements with the aid of the lab-system.

  • 16.
    Palmqvist, Jan
    Linköping University, Department of Electrical Engineering, Automatic Control. Linköping University, The Institute of Technology.
    Failure Detection in Integrated Navigation Systems1996In: Proceedings of Reglermöte 1996, 1996, 143-146 p.Conference paper (Other academic)
  • 17.
    Fazle Rabbi, Ahmed
    et al.
    Linköping University, Department of Management and Engineering, Environmental Technology and Management. Linköping University, The Institute of Technology.
    Hossain, Rubayet
    Linköping University, Department of Management and Engineering, Environmental Technology and Management. Linköping University, The Institute of Technology.
    Analyzing the gap between Swedish governmental export support programs and cleantech firm’s expectations2013Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Given the present situation of environmental problems, clean technologies or cleantech is considered a way of reaching global sustainability and at the same time also seen as an engine of economic growth and fulfilling commitments to social and environmental welfare. Under this background, Swedish cleantech sector have not achieved that much commercial success yet that they are supposed to be while maintaining a reputation of top technological innovative country. The Swedish cleantech sector is dominated by small medium-sized firms (SMEs) and often limited to resources at their disposition. Thus, the Swedish government has designed various policies and export support programs to promote this sector but somehow firms could not reach up to them. Hence, it has become necessary to study the Swedish cleantech firms in order to analyze the existing gap. The purpose of this study is to run an investigation about individual cleantech firms and analyze how they are experiencing Swedish governmental export support programs. On the other hand, this study has also tried to find out what firms really expect from these programs so that it will help to reduce the gap.

    Based on the study of four cases and one independent interview, the study has shown two different scenarios. In one hand, micro level SMEs specially which are in initial phase of their internationalization process cannot reach up to governmental export support programs due to high acquiring cost and inflexible pre-requirements. On the other hand, small level SMEs which are in mature phase of their internationalization process have faced completely reverse experience than initial phase micro firms but not satisfied with the provided service quality. The study has also revealed that firms with relatively new technology face problems to get support from governmental agencies due to uncertain market performance. The study has further showed, this is not always the high acquiring cost and inflexible conditions, participation in governmental export support programs is also depend on firm’s owns mindset and their business strategy. So, in order to reduce the gap between Swedish governmental export support programs and cleantech firms’ expectations, the studied firms have suggested to implement a proper business model that fits into each type of firms’ needs based on their position in the internationalization process, create a separate institution or agency and Science Park that only deals with cleantech firms issues, and co-operation among the different state cleantech firms and the universities.

  • 18.
    Sjöberg Lind, Ylva
    et al.
    Östergötlands Läns Landsting, Center for Disaster Medicine and Traumatology.
    Lind, Monica P.
    Uppsala University, Sweden .
    Salihovic, Samira
    Örebro University, Sweden .
    van Bavel, Bert
    Örebro University, Sweden .
    Lind, Lars
    Uppsala University, Sweden .
    Circulating levels of persistent organic pollutants (POPs) are associated with left ventricular systolic and diastolic dysfunction in the elderly2013In: Environmental Research, ISSN 0013-9351, E-ISSN 1096-0953, Vol. 123, 39-45 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND OBJECTIVE:

    Major risk factors for congestive heart failure (CHF) are myocardial infarction, hypertension, diabetes, atrial fibrillation, smoking, left ventricular hypertrophy (LVH) and obesity. However, since these risk factors only explain part of the risk of CHF, we investigated whether persistent organic pollutants (POPs) might also play a role.

    METHODS:

    In the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study, left ventricular ejection fraction, (EF), E/A-ratio and isovolumic relaxation time (IVRT), were determined by echocardiography and serum samples of 21 POPs were analyzed in serum measured by high-resolution chromatography coupled to high-resolution mass spectrometry (HRGC/HRMS) in 998 subjects all aged 70 years.

    RESULTS:

    In this cross-sectional analysis, high levels of several of the polychlorinated biphenyls (PCB congeners 99, 118, 105, 138, 153, and 180) and octachlorodibenzo-p-dioxin (OCDD) were significantly related to a decreased EF. Some POPs were also related to a decreased E/A-ratio (PCBs 206 and 209). All the results were adjusted for gender, hypertension, diabetes, smoking, LVH and BMI, and subjects with myocardial infarction or atrial fibrillation were excluded from the analysis.

    CONCLUSIONS:

    Circulating levels of POPs were related to impairments in both left ventricular systolic and diastolic function independently of major congestive heart failure risk factors, suggesting a possible role of POPs in heart failure.

  • 19.
    Gebremeskel Tesfaye, Helen
    et al.
    Linköping University, Department of Management and Engineering, Business Administration. Linköping University, Faculty of Arts and Sciences.
    Nguyen, Thi Hong Nhung
    Linköping University, Department of Management and Engineering, Business Administration. Linköping University, Faculty of Arts and Sciences.
    Incumbent firms and Response to Disruptive Innovation through Value Network Management: Lessons from Eastman Kodak‟s failure in the digital era2012Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    AbstractTitle: Incumbent firms and Response to Disruptive Innovation through Value Network Management - Lessons from Eastman Kodak‟s failure in the digital eraAuthors: Helen Gebremeskel Tesfaye & Thi Hong Nhung NguyenSupervisor: Marie BengtssonBackgroundThe question of why incumbent or established firms get into difficulties when they are faced with disruptive innovations has been extensively researched and discussed by many authors. Many explanations given for such failure seem to take “inside-out” approach by focusing on problems of organizational inertia, complacency, lack of insight and incompetence. On the other hand, Christensen‟s (1997; 2003) explanation takes an “outside-in” approach by focusing on the role of established firms‟ value network, particularly mainstream customers, as a determining factor to what incumbent firms can and cannot do.Purpose(i) Examine comprehensively the impacts of the value network on the incumbent firms when they are challenged by the arrival of disruptive innovations; (ii) Developing a model for the incumbent firms to recognize and manage effectively changes occurring in the value network in the face of disruptive innovations; and (iii) Gain a new insight into Kodak‟s failure in the reign of digital technology from the value network management perspective.DefinitionsDisruptive Innovation: Disruptive innovations in this study are considered as new products based on new technologies and which provide different attributes or product characteristics than what the company‟s mainstream or established customer segments historically value, while at the same time bringing new performance attributes to the market.iiValue Network: Value network is the context or environment within which a firm identifies and responds to customers‟ needs, solves problems, procures input, reacts to competitors and strives for profit.ResultsA Value Network Management model is developed for the incumbent firms to recognize and manage effectively changes occurring in the value network caused by the arrival of disruptive innovations. More specifically, the model aims at helping firms to overcome insight and action inertia and to choose the right partners among various new actors entering the value network. This model is iterative in essence and incorporates steps of searching/scanning, value network analysis and partner selection on the basis of appropriate role selection in the value network.

  • 20.
    Haider, Raja Umair
    Linköping University, Department of Electrical Engineering, Communication Systems. Linköping University, The Institute of Technology.
    Fault Detection in WLAN Location Fingerprinting Systems Using Smartphone Inertial Sensors2012Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Indoor positioning is a rapidly growing research area, enabling new innovative location-aware applications and user-oriented services. Location Fingerprinting (LF) is the positioning technique of coupling a physical location with observed radio signal measurements. In the terms of indoor LF using Wireless Local Area Network (WLAN) it refers to the use of network measurements from the WLAN Access Points (APs) to tag known locations. A data set is created containing reference fingerprints for the area of interest and is known as a radio map. A radio map can later be used to find a user's location in the area of interest. WLAN infrastructures are vulnerable to many kinds of faults and malicious attacks, including, an attacker jamming the signal from an AP, or an AP becoming unavailable during positioning due to power outage. These faults can be collectively characterized as an AP-failure. In LF positioning systems, AP-failure faults can significantly degrade the performance of a LF system due to the difference between the current fingerprints and radio map created with all APs being available. It is desirable to detect such faulty APs, in order to take actions towards fault-mitigation and restoration, in case of a malicious attack. In this work, we have developed a fault detection algorithm that uses inertial sensors (i.e., accelerometer, magnetometer) available in smartphones to detect AP-failure faults in LF systems. Inertial Measurement Unit (IMU) has become an integral part of all high-end smartphones. IMU can be used to infer location information on the smartphone. The main idea is to have two parallel position streams, the LF positioning and the IMU positioning, and to compare the mean positioning error between the two. Since IMU positioning is fairly accurate once provided with starting coordinates, we use it to detect abnormal behaviour in LF positioning system, such as highly erroneous estimates signifying an AP-failure fault present in the system. The performance of the proposed detection algorithm is evaluated with several real-life AP-related faults. The proposed algorithm exhibits low probability of false alarms in the detection of faulty APs. The conclusion is that using IMU based positioning is an effective and robust solution in terms of fault detection in LF systems.

  • 21.
    Diószegi, Attila
    et al.
    Department of Mechanical Engineering and Industrial Organisation / Component Technology, Jönköping University, Jönköping.
    Fourlakidis, Vasilios
    Department of Mechanical Engineering and Industrial Organisation / Component Technology, Jönköping University, Jönköping.
    Svensson, Ingvar L
    Department of Mechanical Engineering and Industrial Organisation / Component Technology, Jönköping University, Jönköping.
    Microstructure and tensile properties of grey cast iron2004Report (Other academic)
    Abstract [en]

    Gray cast iron is a widely used construction material with a unique combination of properties such as very good thermal conductivity, vibration damping ability, and good machinability. The production method of casting is convenient to achieve a near final shape of complex geometries. A significant use of this beneficial construction materials can be found in diesel engine components, including cylinder heads, cylinder blocks and piston rings. Environmental and economic factors necessitate the development and optimization of engine components. The present paper summarizes a study of major process and material parameters to maximize and optimize the mechanical properties under static load of grey cast iron.

    The tensile strength of grey cast iron has been discussed by revealing the fracture mechanism of the material at failure. The ultimate tensile strength is clearly the result of the intimate collaboration between the graphite flake and the primary phases. Several parameters, including the graphi te morphology, carbon content, inoculation, and cooling conditions during solidification influence the ultimate tensile strength by affecting the equilibrium between the major constituents and cracks in the metallic matrix. A model to predict the ultimate tensile strength is developed based on the interpretation of the stress intensity behaviour in a eutectic cell.

  • 22.
    Alhowaidi, Mohammad
    Linköping University, Department of Computer and Information Science, ESLAB - Embedded Systems Laboratory. Linköping University, The Institute of Technology.
    Real-Time Systems with Radiation-Hardened Processors: A GPU-based Framework to Explore Tradeoffs2012Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Radiation-hardened processors are designed to be resilient against soft errorsbut such processors are slower than Commercial Off-The-Shelf (COTS)processors as well significantly costlier. In order to mitigate the high costs,software techniques such as task re-executions must be deployed together withadequately hardened processors to provide reliability. This leads to a huge designspace comprising of the hardening level of the processors and the numberof re-executions of each task in the system. Each configuration in this designspace represents a tradeoff between processor load, reliability and costs.

    The reliability comes at the price of higher costs due to higher levels of hardeningand performance degradation due to hardening or due to re-executions.Thus, the tradeoffs between performance, reliability and costs must be carefullystudied. Pertinent questions that arise in such a design scenario are — (i)how many times a task must be re-executed and (ii) what should be hardeninglevel? — such that the system reliability is satisfied.

    In order to evaluate such tradeoffs efficiently, in this thesis, we proposenovel framework that harnesses the computational power of Graphics ProcessingUnits (GPUs). Our framework is based on a system failure probabilityanalysis that connects the probability of failure of tasks to the overall systemreliability. Based on characteristics of this probabilistic analysis as well asreal-time deadlines, we derive bounds on the design space to prune infeasiblesolutions. Finally, we illustrate the benefits of our proposed framework withseveral experiments

  • 23.
    Bahmai, Masoud
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Lean Implementation in Rosti AB: Improvement Opportunities and Challenges2012Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Lean production has become a widespread production system to address the need of being more productive. Since three decades ago that some big automotive manufacturers started to adopt lean, many SME’s has adopt it and enjoy the outcomes. Literature have investigated the successful implementation of lean in these organizations, yet, very few papers have addressed the challenges toward adopting lean.

    In this thesis research a plastic package manufacturer is chosen as the case of study to implement some initiatives of lean production and study the challenges and outcomes of lean adoption. The efforts during the making the changes were focused on adopting the SMED and Root-Cause Analysis techniques, and also to reduce defect rate in one of the products.

    The findings indicate before any effort to implement lean production techniques, some social issues must be considered to reduce the risk of failure. The Rosti AB case indicated that promoting motivation among operators and resolving mistrust between managers and operators is essential to encourage them to participate in improvement changes.

    In order to promote motivation and eliminate mistrust to encourage operators to participate in improvement changes it is necessary to empower them in decision makings in improvement implementations.

  • 24.
    Alm, Kalle
    Linköping University, Department of Management and Engineering, Law and Legal Philosophy. Linköping University, Faculty of Arts and Sciences.
    Konsultens ansvar för skada på byggnad med oventilerad fasad2012Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    During the later part of the 1900´s and the early part of the 21st century an increasing number of Swedish buildings have sustained damages because of moisture. These damages can be traced back to the usage of the ”Exterior Insulation and finishing system” or ”EIFS” when constructing the outer facade. The main problem when using the EIFS method, is that the facade becomes very susceptible towards moisture. The issue with moisture was completely unknown to the Swedish construction industry, until 2007, when a report from the Swedish National Testing Institute (SP) was released which addressed the problems. The question now arises who, in the construction industry, is to be held liable for these damages.

    In accordance with the standardized contracts that are being used in the construction industry, a fault for which the contractor is liable, only occurs if the contractor has built the construction in such a way that is not in compliance with the contract established between the parties, e.g. the construction differs from blue prints etc. This means that the contractor only is liable for damages which have occurred due to the contractors failure to build the construction in accordance with the contract. Therefore it is of importance to investigate whether the building designer is liable or not. The standardized contracts used for building designers, only regulate the outer limits of the designer ´s liability. Therefore it becomes very important to analyse what the designer has to have done in order to fulfil his duties as a professional. If the designer has not acted in accordance with the duties that are incumbent upon him as a professional, it is reasonable to believe that he has been negligent when designing a facade with the EIFS-method.

    The thesis aims to present the duties that are incumbent upon the designer as a professional, and to determine whether the designer has fulfilled these duties when designing a building using the EIFSmethod. The thesis also aims to investigate whether the designer can be held liable towards other parties than the contracting party.

  • 25.
    Bothe, Wolfgang
    et al.
    Stanford University School of Medicine, USA.
    Kuhl, Elllen
    Stanford University School of Medicine, USA.
    Kvitting, John-Peder Escobar
    Stanford University School of Medicine, USA.
    Rausch, Manuel K.
    Stanford University School of Medicine, USA.
    Göktepe, Serdar
    Stanford University School of Medicine, USA.
    Swanson, Julia C.
    Stanford University School of Medicine, USA.
    Farahmandnia, Saideh
    Stanford University School of Medicine, USA.
    Ingels, Neil B.
    Research Institute, Palo Alto Medical Foundation, USA.
    Miller, D. Craig
    Stanford University School of Medicine, USA.
    Rigid, complete annuloplasty rings increase anterior mitral leaflet strain in normal beating ovine heart2011In: Circulation, ISSN 0009-7322, E-ISSN 1524-4539, Vol. 124, S81-S96 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Annuloplasty ring or band implantation during surgical mitral valve repair perturbs mitral annular dimensions, dynamics, and shape, which have been associated with changes in anterior mitral leaflet (AML) strain patterns and suboptimal long-term repair durability. We hypothesized that rigid rings with nonphysiological three-dimensional shapes, but not saddle-shaped rigid rings or flexible bands, increase AML strains.

    METHODS AND RESULTS:

    Sheep had 23 radiopaque markers inserted: 7 along the anterior mitral annulus and 16 equally spaced on the AML. True-sized Cosgrove-Edwards flexible, partial band (n=12), rigid, complete St Jude Medical rigid saddle-shaped (n=12), Carpentier-Edwards Physio (n=12), Edwards IMR ETlogix (n=11), and Edwards GeoForm (n=12) annuloplasty rings were implanted in a releasable fashion. Under acute open-chest conditions, 4-dimensional marker coordinates were obtained using biplane videofluoroscopy along with hemodynamic parameters with the ring inserted and after release. Marker coordinates were triangulated, and the largest maximum principal AML strains were determined during isovolumetric relaxation. No relevant changes in hemodynamics occurred. Compared with the respective control state, strains increased significantly with rigid saddle-shaped annuloplasty ring, Carpentier-Edwards Physio, Edwards IMR ETlogix, and Edwards GeoForm (0.14 ± 0.05 versus 0.16 ± 0.05, P=0.024, 0.15 ± 0.03 versus 0.18 ± 0.04, P=0.020, 0.11 ± 0.05 versus 0.14 ± 0.05, P=0.042, and 0.13 ± 0.05 versus 0.16 ± 0.05, P=0.009), but not with Cosgrove-Edwards band (0.15 ± 0.05 versus 0.15 ± 0.04, P=0.973).

    CONCLUSIONS:

    Regardless of three-dimensional shape, rigid, complete annuloplasty rings, but not a flexible, partial band, increased AML strains in the normal beating ovine heart. Clinical studies are needed to determine whether annuloplasty rings affect AML strains in patients, and, if so, whether ring-induced perturbations in leaflet strain states are linked to repair failure.

  • 26.
    Taret, Benjamin
    Linköping University, Department of Management and Engineering, Quality Technology and Management.
    Process improvement during production ramp up: a case study of manufacturing process validation during MI09 contract at Bombardier Transportation2011Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Production ramp up corresponds to « the period between the end of the production development and the full capacity utilization ». The manufacturing process often does not work perfectly during this early time of the new product production and some adjustments are necessary to obtain full capacity utilization. In order to assess the

    assembly process during this period, the train manufacturer Bombardier Transportation has created an improvement process called “VPI” (which stands for “Validation du Processus Industriel” or “Validation of the manufacturing process” in English). Its purpose is to “validate the material and the documentation for every movement independently” in order to ensure quality of final product and safety of the workers. It aims at detecting and solving rapidly safety problems and deviation from the normal process.

    This thesis is a case study of VPI during MI09 contract (new trains for ¨Paris subway). It aims at assessing VPI framework and identifies possible causes of the delay in validation of MI09 production process. Four main MI09 production line specificities have been identified: long assembly time, low production volume, system complexity and process variability. VPI framework meets partially these production line prerequisites. VPI is a process that allows systematizing problems detection, formalizing the improvement process and managing a high number of problems with a clear view of the VPI validation. The most important drawbacks of the VPI seem to be the lack of problems detection after the initial observation, problem definition framework and root cause analysis. Four reasons could explain the delays during the realization of VPI on MI09 contract: undetected problems, normal treatment timeframe for the improvements, inadequate objectives and lack of framework to select the best solution to solve problems. VPI may be improved by including root cause analysis, better problem definition and knowledge management between contracts. However, these methods are time consuming and a prioritization of the problem should be made. FMEA (Failure Mode and Effect Analysis) methodology may help to identify the problem on which the VPI should focus on.

     

     

  • 27.
    Johansson, Johnny
    Linköping University, Department of Management and Engineering, Solid Mechanics.
    Weld Analysis in Combustion Chambers Subjected to Thermo-Mechanical Fatigue Load Conditions2011Independent thesis Advanced level (degree of Master (One Year)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    At cyclic operation of gas turbines, components are subjected to thermo-mechanical fatigue (TMF) due to the high temperature gradients that arises. In this thesis life assessment of welds in combustion chambers are at focus. Siemens Industrial Turbomachinery AB uses a method they call the HQ-method to estimate the TMF life of components, but how well this estimation work with welds have not been investigated before and is therefore unclear. Because of this unclearness, an additional reduction factor is used take this into account.

    The goal of this thesis is to conduct a study of welds in the combustion chambers to get an overview of welds that are present, and to identify eventual problems with those. Furthermore, an analysis of a selected weld is performed and the results are evaluated by using the HQ-method.

    For this analysis, a TIG weld on a test specimen of Hastelloy X is selected as both the weld method and the material are commonly used in combustion chambers. The specimen is chosen due to the possibility to verify the results using a test rig designed for TMF-tests.

    The results show that the HQ-method, with the assumptions made today, yields a life of welds considered very low compared with the base metal. Also the location of the most severely loaded point is questionable. Further investigations also show that residual stresses in the weld relax quickly and the creep rate of the weld does not make any particular difference to expected life.

    To verify the results and clarify some questions it is therefore suggested that the commenced investigation continues with real tests on the weld. As the results show that the creep rate is unimportant to the fatigue life, the parameter should be ruled out from the investigation and the objective should instead be to find the accurate yield strength of the weld, and study if failure occurs in or outside the weld.

  • 28.
    Skoglund, Anders
    Linköping University, Department of Computer and Information Science.
    Comparing Asynchronous and Synchronous Approaches to Knowledge Processing2011Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    This thesis presents a comparison between the synchronous and asynchronous model of computation in the area of knowledge processing. Focus lies on evaluating if a synchronous approach to knowledge processing is possible and practical. This has been done by implementing the reconfigurable fault diagnosis framework FlexDx using the synchronous programming language SIGNAL, a language designed to be used in embedded real-time systems. FlexDx have previously been implemented using the asynchronous knowledge processing middleware DyKnow, from which an example system with multiple failure scenarios consisting of input signals and results were available. Matlab code for many algorithms in FlexDx from the existing implementation could also be reused.

    The SIGNAL implementation was tested using one of the available scenarios and the results matched the expected results from the DyKnow implementation almost perfectly.

    The synchronous aspect of the new implementation was not a problem as the behavior of all parts of FlexDx that had to be reimplemented easily could be described synchronously. However, using SIGNAL for this purpose proved to be both complicated and cumbersome. This was partly because of the strict declarative coding style, but mostly because of limitations of SIGNAL and the POLYCHRONY compiler. Two such limitations caused most of the problems that were encountered. First, SIGNAL does not support dynamic arrays and all iteration constructs require that the number of iterations is determined at compile time. This could be overcome by using external types and processes, the method used in SIGNAL to import code written in other languages, to implement the needed functionality in C++ and Matlab. Second, the POLYCHRONY compiler provides very limited feedback that can be used to correct non-trivial coding errors, making the task of programming with SIGNAL far more complicated than necessary.

    While it is clear that a synchronous approach to knowledge processing works well, it is not practical to write a working implementation of FlexDx using only SIGNAL. Because of the limitations of SIGNAL a large part of the system had to be implemented using other languages.

  • 29.
    Lundengård, Karin
    Linköping University, Department of Physics, Chemistry and Biology.
    De- and Resensitisation of Cardiac β-Adrenergic Receptor Signaling: A Modelling Approach2011Independent thesis Advanced level (degree of Master (Two Years)), 40 credits / 60 HE creditsStudent thesis
    Abstract [en]

    Desensitisation is defined as a failure of a signaling pathway to respond to chronic or repeated stimulation. The β-adrenergic receptor signaling pathway of the healthy adult heart is known to desensitise, and then regain the sensitivity to stimulation if given enough time to rest between stimulations (resensitisation). The fetal heart does not desensitise, and in animal models of heart failure, a permanent desensitisation have been observed. No isolated element of the signaling pathway have yet been proven to be the sole modulator of the desensitisation behavior. Therefore a mathematical model of the signaling pathway has been constructed, minimized against theoretical desensitisation data and tested for resensitisation. The minimal models and the original model were capable of describing the theoretical de- and resensitisation of the pathway, and only one receptor type with three states was required in the minimal models, but one feedback from the kinases either to phosphorylation of the receptor or to breakdown of cAMP. The original model was also capable of describing experimental data of contraction force from chicken cardiac tissue. The cardiac tissue displays the peak behavior of the desensitisation when stimulated with ISO for ten minutes, and resensitises in less than 5 minutes.

  • 30.
    Hansson, Fredrik
    Linköping University, Department of Electrical Engineering, Information Coding.
    System Integrity for Smartphones: A security evaluation of iOS and BlackBerry OS2011Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Smartphones are one of the most popular technology gadgets on the market today. The number of devices in the world is growing incredibly fast and they have today taken an important place in many person's everyday life. They are small, powerful, always connected to the Internet and they are usually containing a lot of personal information such as contact lists, pictures and stored passwords. They are sometimes even used as login tokens for Internet bank services and web sites. Smartphones are, undoubtedly, incredible devices! But are smartphones secure and is stored information safe? Can and should these devices be trusted to keep sensitive information and personal secrets? Every single day newspapers and researcher warns about new smartphone malwares and other security breaches regarding smartphones. So, are smartphones safe to use or are they a spy's best friend in order to surveil a person? Can a user do anything to make the device more secure and safe enough to use it in a secure manner? All these questions are exactly what this paper is about!

    This paper is addressing two popular smartphone platforms, iOS and BlackBerry OS, in order to evaluate how secure these systems are, what risks that occur when using them and how to harden the platform security to make these platforms as secure and safe to use as possible. Another aim of this paper is to discuss and give suggestions on how a separate and dedicated hardware token can be used to improve the platform security even further. In order to evaluate the security level of these platforms, a risk and threat analysis has been made as well as some practical testing to actually test what can be done. The test part consists mostly of a proof-of-concept spyware application implemented for iOS and an IMSI-catcher used to eavesdrop on calls by using a rogue GSM base transceiver station.

    The implemented spyware was able to access and transfer sensitive data from the device to a server without notifying the user about it. The rogue base station attack was even scarier since with only a few days work and equipment for less than $1500 can smartphones be tricked to connect to a rogue base station and all outgoing calls can be intercepted and recorded. The risk analysis resulted in not less than 19 identified risks with mixed severity of the impact. Some configurations and usage recommendation is given in order to prevent or mitigate these risks to make the usage of these platforms safer. The aim of suggesting how a hardware token can be used to strengthening these platforms have been a bit of failure since no really working suggestion has been possible to give. It is a result of that these systems are tightly closed for modification by third parties, and such modifications are needed in order to implement a working hardware token. However, a few partial suggestions for how such a token can work are given.

    The result of this work indicates that neither iOS nor BlackBerry OS is entirely secure and both need to be configured and used in a correct way to be safe for the user. The benefits of a hardware token should be huge for these systems but the implementations that are possible to do is not enough and it might not be of interest to implement a hardware token for these systems at the moment. Some of the identified risks require the attacker to have physical access to the device and this can only be prevented if the user is careful and acts wisely. So, if you want to use high technology gadgets such as smartphones, be sure to be a smart user!

  • 31.
    Ingelsson, Urban
    et al.
    Linköping University, Department of Computer and Information Science, ESLAB - Embedded Systems Laboratory.
    Chang, Shih-Yen
    Linköping University, Department of Computer and Information Science, ESLAB - Embedded Systems Laboratory.
    Larsson, Erik
    Linköping University, Department of Computer and Information Science, ESLAB - Embedded Systems Laboratory.
    Cost Reduction of Wear-Out Monitoring by Measurement Point Selection2011In: The 11th Swedish System-on-Chip Conference, Varberg, Sweden, May 2-3, 2011, 2011Conference paper (Other academic)
    Abstract [en]

    Early failure rates have increased due to reduced feature dimensions and electromigration wear-out. Periodic delay measurements can be employed to estimate the state of wear-out. Including delay measurement sensors on-chip is costly. Therefore, a method is proposed to reduce the number of measurement points. The method identi?es wear-out sensitive interconnects and selects a small number of measurement points to target the identi?ed interconnects. The method is demonstrated on ISCAS85 benchmark ICs.

  • 32.
    Mehrpouyan, Hoda
    Linköping University, Department of Computer and Information Science.
    Model-Based Hazard Analysis of Undesirable Environmental and Components Interaction2011Independent thesis Advanced level (degree of Master (Two Years)), 30 credits / 45 HE creditsStudent thesis
    Abstract [en]

    Identifying the detrimental effect of environmental factors and subsystem interactions are one of themost challenging aspects of early hazard assessment in the design of complex safety critical systems.Therefore, a complete understanding of potential failure effects before the catastrophe happens is a verydifficult task. The thesis proposes a model-based hazard analysis procedure for early identification ofpotential safety issues caused by unexpected environmental factors and subsystem interactions within acomplex safety critical system. The proposed methodology maps hazard and vulnerability modes tospecific components in the system and analyzes the hazard propagation paths for risk control andprotection strategies. The main advantage of the proposed method is the ability to provide the designerswith means to use low-fidelity, high level models to identify hazardous interactions. Using thistechnique, designers can examine the collective impacts of environmental and subsystem risks onoverall system during early stages of design and develop a hazard mitigation strategy.

  • 33.
    Rutaganda, Remmy
    Linköping University, Department of Computer and Information Science.
    Automated Model-Based Reliability Prediction and Fault Tree Analysis2011Independent thesis Basic level (degree of Bachelor), 10,5 credits / 16 HE creditsStudent thesis
    Abstract [en]

    This work was undertaken as a final year project in Computer Engineering, within the Department of Computer and Information Science at Linköping University.

    At the Department of Computer and Information Science, work oriented at testing and analyzing applications is developed to provide solution approaches to problems that arise in system product development. One of the current applications being developed is the ‘Systemics Analyst’. The purpose of the application is to facilitate for system developers with an analysis tool permitting insights on system reliability, system critical components, how to improve the system and the consequences as well as risks of a system failure.

    The purpose of the present thesis was to enhance the ‘Systemics Analyst application’ by incorporating an ‘automated model-based reliability prediction’ and ‘fault tree analysis’ modules. This enables reliability prediction and fault tree analysis diagrams to be generated automatically from the data files and relieves the system developer from manual creation of the diagrams.

    The enhanced Systemics Analyst application managed to present the results in respective models using the new incorporated functionality.

    To accomplish the above tasks, ‘Systemics Analyst application’ was integrated with a library that handles automated model-based reliability prediction and fault tree analysis, which is described in this thesis. The reader will be guided through the steps that are performed to accomplish the tasks with illustrating figures, methods and code examples in order to provide a closer vision of the work performed.

  • 34.
    Frid, Jonas
    Linköping University, Department of Electrical Engineering, Information Coding.
    Security Critical Systems in Software2010Independent thesis Advanced level (degree of Master (One Year)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Sectra Communications is today developing cryptographic products for high assurance environments with rigorous requirements on separation between encrypted and un-encrypted data. This separation has traditionally been achieved through the use of physically distinct hardware components, leading to larger products which require more power and cost more to produce compared to systems where lower assurance is required.

    An alternative to hardware separation has emerged thanks to a new class of operating systems based on the "separation kernel" concept, which offers verifiable separation between software components running on the same processor comparable to that of physical separation. The purpose of this thesis was to investigate the feasibility in developing a product based on a separation kernel and which possibilities and problems with security evaluation would arise.

    In the thesis, a literature study was performed covering publications on the separation kernel from a historical and technical perspective, and the development and current status on the subject of software evaluation. Additionally, a software crypto demonstrator was partly implemented in the separation kernel based Green Hills Integrity operating system.

    The thesis shows that the separation kernel concept has matured significantly and it is indeed feasible to begin using this class of operating systems within a near future. Aside from the obvious advantages with smaller amounts of hardware, it would give greater flexibility in development and potential for more fine-grained division of functions. On the other hand, it puts new demands on developers and there is also a need for additional research about some evaluation aspects, failure resistance and performance.

  • 35.
    Svanström, Lina
    et al.
    Linköping University, Department of Management and Engineering, Business Administration .
    Frank, Oskar
    Linköping University, Department of Management and Engineering, Business Administration .
    Projektledning i offentlig sektor: En studie av strategi i ESF-finansierade projekt2010Independent thesis Advanced level (degree of Master (One Year)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Background and problem: 40 percent of EU’s total budget goes to an area called “Sustainable development”, which is foremost represented by EU’s regional politic. The regional politic is developed to decrease the economic and social differences between the regions I EU and in that way contribute to a more harmonious development. This is done by local interaction projects between municipalities, authorities and companies. In the public sector though, there is different demands on project owners, project managers and other stakeholders than in the private sector. This is, amongst others, due to diffuse and conflicting goals, which can lead to a total failure for the project.

    Objective: The objective of this study is to analyze how project managers within the public sector handle the interactional uncertainty in projects and to show the different possibilities that project managers have to create an effective coordination and cooperation to achieve the goal of the project.

    Method: This study is based on a qualitative research with interviews of six project managers.

    Conclusions: This study has revealed that many interactional projects in the public sector exists in an interactional environment with a high vertical uncertainty, which foremost has led to an extensive demand on reports to ESF. The vertical uncertainty should be possible to decrease by the project manager and the stakeholders working through the goals together. To further decrease this uncertainty the project manager and ESF should form an early and open dialog for setting goals and to facilitate the transparency of the project for ESF. In this study it has also come to light that the projects have a high horizontal uncertainty. We consider it crucial for the project to create a stable foundation, both for the economical result and for being able to reach the goal of the project. To achieve this, we consider written agreements to be important to avoid key stakeholders from pulling out. Another way of decreasing the horizontal uncertainty is to create a need among the important stakeholders so that they see the project as a necessary complementing resource to their organization. It is also important that the project manager is aware of the different uncertainties that he/she has to maneuver in the project and how these can be limited with different strategies like contracts and cooptation. It has also come to light that the organizations of the stakeholders are lacking knowledge and awareness of the projects, which is why anchoring of the project’s missions and intentions should be carried out in greater extent in these organizations.

  • 36. Luttik, Marie Louise
    et al.
    Jaarsma, Tiny
    Veeger, Nic
    Tijssen, Jan
    Sanderman, Robbert
    van Veldhuisen, Dirk J
    Caregiver burden in partners of Heart Failure patients; limited influence of disease severity.2007In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 9, no 6-7, 695-701 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In complying with required life style changes Heart Failure (HF) patients often depend on their partners. However providing care may cause burden and affect the health of these partners. The aim of this study was to investigate determinants of caregiver burden in order to identify caregivers who are at risk. METHODS: Using a cross-sectional design, caregiver burden and potential determinants were measured in partners of HF patients. Demographic and clinical data were assessed in HF patients, partners completed questionnaires on caregiver burden (the Caregiver Reaction Assessment, CRA), caregiving tasks performed, physical and mental health status and quality of the marital relationship. RESULTS: In total 357 partners (75% female, mean age 67 years) participated. The physical health status of HF patients was only significantly associated with two domains of caregiver burden, 'disruption of daily schedule' (p<0.01) and 'loss of physical strength' (p<0.01). No associations were found with age, co-morbidity and LVEF. All domains of the CRA were mainly associated with the partner's own mental health (p<0.01) and with providing personal care to HF patients (p<0.01). Gender differences were only found with regard to the domain of 'feeling a lack of family support'. CONCLUSION: The assessment of caregiver burden should focus on the mental strength of partners. Furthermore when assistance in personal care is needed, additional support, either informal or professional, may be indicated.

  • 37. Wong, Liza S M
    et al.
    Huzen, Jardi
    van der Harst, Pim
    de Boer, Rudolf A
    Codd, Veryan
    Westenbrink, B Daan
    Benus, Germaine F J D
    Voors, Adriaan A
    van Gilst, Wiek H
    Samani, Nilesh J
    Jaarsma, Tiny
    van Veldhuisen, Dirk J
    Anaemia is associated with shorter leucocyte telomere length in patients with chronic heart failure.2010In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 12, no 4, 348-53 p.Article in journal (Refereed)
    Abstract [en]

    AIMS: Anaemia is highly prevalent and associated with poor prognosis in patients with chronic heart failure (CHF). Reduced erythroid proliferation capacity of haematopoietic progenitor cells is associated with reduced telomere length, a marker of cellular ageing. We hypothesize that short telomere length contributes to the susceptibility to develop anaemia in patients with CHF. METHODS AND RESULTS: We studied 875 CHF patients, of whom 254 (29%) fulfilled the WHO criteria of anaemia. Telomere length in DNA from peripheral leucocytes was measured with real-time quantitative polymerase chain reaction. Age, gender, and baseline differences adjusted telomere length was correlated with haemoglobin levels (partial r = 0.130; P = 0.011). One standard deviation shorter telomere length was associated with an increased risk of having anaemia [odds ratio (OR), 1.31; 95% confidence interval (CI), 1.12-1.53; P = 0.001]. This observation was not affected by adjustment for potential confounders (OR, 1.38; 95% CI, 1.05-1.81; P = 0.021 after adjustment for age, gender, erythropoietin levels, renal function, left ventricular ejection fraction, age of CHF onset, blood pressure, history of stroke, diabetes, and B-type natriuretic peptide levels). CONCLUSION: Shorter telomere length increases the odds of having anaemia in CHF patients. This finding supports the hypothesis that cellular ageing in CHF contributes to the susceptibility to develop anaemia.

  • 38. Jaarsma, Tiny
    et al.
    Lesman-Leegte, Ivonne
    Hillege, Hans L
    Veeger, Nic J
    Sanderman, Robbert
    van Veldhuisen, Dirk J
    Depression and the usefulness of a disease management program in heart failure: insights from the COACH (Coordinating study evaluating Outcomes of Advising and Counseling in Heart failure) study.2010In: Journal of the American College of Cardiology, ISSN 0735-1097, E-ISSN 1558-3597, Vol. 55, no 17, 1837-43 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Our aim was to study the possible role of depressive symptoms in the effectiveness of a disease management program (DMP) in heart failure (HF) patients. BACKGROUND: Disease management programs are recommended in current HF guidelines, but certain patient groups, such as those with depression, might be less responsive to such programs. METHODS: From the data of a large multicenter study, in which we examined the effect of a DMP in HF patients, we investigated a potential interaction between depressive symptoms at baseline and the effect of such a program. RESULTS: Of the 958 HF patients (37% female; age 71 +/- 11 years; New York Heart Association functional class II to IV), 377 (39%) reported depressive symptoms at baseline. During 18 months of follow-up, the primary end point (composite of all-cause mortality and HF readmission) occurred in 39% of the nondepressed patients and 42% of depressed patients. In the overall sample, there was no significant effect of DMP on the composite primary end point. The effect of the DMP was significantly different in nondepressed than in depressed HF patients. A significant effect modification by depressive symptoms was observed in evaluating the effect of the DMP on all-cause mortality and HF readmission (p = 0.03). In patients without depressive symptoms, DMP resulted in a trend for lower incidence of the primary end point (hazard ratio: 0.8, 95% confidence interval: 0.61 to 1.04), whereas the reverse was observed in patients with depressive symptoms (hazard ratio: 1.3, 95% confidence interval: 0.95 to 1.98). CONCLUSIONS: Depressive symptoms in patients with HF have a major effect on the usefulness of DMP. Identification of depressive symptoms before enrollment in a DMP might lead to more accurate use of a DMP, because depressive patients might not benefit from a general program. (Netherlands Heart Foundation Coordinating study evaluating Outcomes of Advising and Counselling in Heart Failure; ISRCTN98675639).

  • 39. Luttik, Marie Louise
    et al.
    Lesman-Leegte, I
    Jaarsma, Tiny
    Quality of life and depressive symptoms in heart failure patients and their partners: the impact of role and gender.2009In: Journal of Cardiac Failure, ISSN 1071-9164, E-ISSN 1532-8414, Vol. 15, no 7, 580-5 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Partners of heart failure (HF) patients are important in the course and management of the disease. It is unclear whether HF affects the quality of life (QoL) of partners as much as it affects the QoL of patients. METHODS AND RESULTS: The study aims to determine the influence of role (patient or partner) and gender on quality of life (QoL) and depressive symptoms in HF patients and their partners. Using a cross-sectional design, data on demographics, QoL, and depressive symptoms were collected from 393 HF patients (age, 68+/-11; 76% male) and their partners (age, 67+/-12; 24% male) using questionnaires (Medical Outcome Study 36-item General Health Survey [RAND-36], Cantril Ladder of Life, and Center for Epidemiologic Studies Depression Scale) that were send at home. At a group level HF, patients reported a significantly worse QoL and more depressive symptoms compared with their partners. When examining the influence of role and gender a significant interaction between role and gender was found. QoL in terms of general well-being of female HF partners and female HF patients did not differ (7.0 vs. 6.9), whereas male partners had a significantly higher well-being compared to male HF patients (7.6 vs. 6.8). Most of the RAND-36 domains were explained by role (either being a patient or a partner) with patients having lower scores compared with their partners. However, the RAND-36 domain mental health was mainly explained by gender, with women reporting worse mental health compared with men, independent of their role as a patient or a partner. The same trend was found for the presence of depressive symptoms. CONCLUSIONS: Females, either as patients or as partners are vulnerable in their response to HF in terms of their QoL. The QoL of male partners does not seem to be negatively affected. Supporting couples who are dealing with HF requires different interventions for male and female patients and their partners.

  • 40. Luttik, Marie Louise
    et al.
    Jaarsma, Tiny
    Lesman, Ivonne
    Sanderman, Robbert
    Hagedoorn, Mariët
    Quality of life in partners of people with congestive heart failure: gender and involvement in care.2009In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 65, no 7, 1442-51 p.Article in journal (Refereed)
    Abstract [en]

    AIM: This paper is a report of a study conducted to investigate quality of life in partners of people with congestive heart failure in comparison to individuals living with a healthy partner. BACKGROUND: Congestive heart failure is a chronic debilitating disease with severe symptoms and complex treatment. The support of partners is essential in the management of congestive heart failure. Living with a chronic illness generally affects the quality of life of patients and their partners. METHOD: Data were collected using a cross-sectional, comparative design between October 2002 and February 2005 with 303 partners of people with congestive heart failure. Reference data were collected in 304 age- and gender-matched individuals living with a healthy partner, drawn from the general population. All respondents completed questionnaires at home on quality of life and general well-being. Analysis of variance was used to analyse the data. FINDINGS: Overall, differences in quality of life between partners of people with heart failure and matched controls were small. However, substantial variation in the quality of life of partners was found by exploring the role of gender and involvement in care. Quality of life scores varied strongly for male and female partners who had to perform caregiving tasks. The performance of these caregiving tasks was negatively associated with the quality of life of female partners but not with that of male partners. CONCLUSION: Female partners especially should not be overlooked when they become involved in personal care tasks. Nurses should not be reluctant to involve male partners in caring for women with heart failure.

  • 41. Annema, Coby
    et al.
    Luttik, Marie-Louise
    Jaarsma, Tiny
    Reasons for readmission in heart failure: Perspectives of patients, caregivers, cardiologists, and heart failure nurses.2009In: Heart & Lung, ISSN 0147-9563, E-ISSN 1527-3288, Vol. 38, no 5, 427-34 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Despite efforts to improve outcomes in heart failure (HF), readmission rates remain relatively high. Reasons for readmission from different perspectives (patient, caregiver, health care providers) may help to optimize the future management of patients with HF. The aims of this study are to 1) gain insight into reasons for HF readmission from the perspective of patients, caregivers, cardiologists, and HF nurses; 2) examine similarities and differences in perspectives on the reason for an HF readmission, and 3) describe possibilities to prevent an HF readmission from different perspectives. METHODS AND RESULTS: Data on reasons for readmission were collected on 173 readmissions. Perspectives of patients, caregivers, cardiologists, and HF nurses were collected by interview and questionnaire. Worsening HF as the sole reason for readmission was reported most often; however, 36% of caregivers, 56% of patients, and 63% to 65% of health care providers indicated that other factors, such as comorbidity, nonadherence, and nonoptimal medication, were important contributing factors. In only 34% of readmissions, patients and their caregivers agreed with health care providers on the underlying reason. Respondents reported that 23% to 31% of the readmissions could probably have been prevented if adherence were higher, patients requested help earlier, and adequate multidisciplinary professional help were available. CONCLUSION: To prevent future readmissions of patients with HF, it is important to fully understand the reasons for readmission by gaining insight on the reason for readmission from different perspectives. Also, we may need another approach to prevent adverse outcomes in which other medical problems and new strategies to improve adherence have to be considered.

  • 42. Broers, C J M
    et al.
    Sinclair, N
    van der Ploeg, T J
    Jaarsma, T
    van Veldhuisen, D J
    Umans, V A W M
    The post-infarction nurse practitioner project: A prospective study comparing nurse intervention with conventional care in a non-high-risk myocardial infarction population.2009In: Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation, ISSN 1568-5888, Vol. 17, no 2, 61-7 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To confirm the feasibility of nurse practitioner interventionin non-high-risk patients with recent myocardial infarction (MI). DESIGN: Observational study. SETTING: Acute coronary care unit in a teaching hospital. METHODS: We performed an open-label feasibility study to identify non-high-risk MI patients and evaluate the outcome of a new nurse practitioner intervention programme. The initial pilot phase served to identify the non-high-risk population. In the subsequent confirmation phase, 500 consecutive non-high-risk post-MI patients with preserved LV function without heart failure were included to receive nurse practitioner management. The nurse practitioner intervention started on transfer from the coronary care unit to the cardiology ward and continued thereafter for up to 30 days. MAIN OUTCOME MEASURES: Time to first event analysis of death from all causes or repeat myocardial infarction. RESULTS: 500 Patients without signs of heart failure or depressed LV function were identified as nonhigh- risk and eligible for inclusion in the nurse practitioner intervention programme. In the implementation phase, none of the patients died and 0.9% developed a repeat myocardial infarction after 30 days of follow-up. Compared with the pilot phase, patients in the implementation phase spent fewer days in hospital (mean 11.1 versus 6.2 days; p<0.001). CONCLUSION: It is feasible to identify non-high-risk post-MI patients, who can be managed adequately by a nurse practitioner. Embedding experienced nurse practitioners within critical care pathways may result in significant decreases in length of hospital stay. (Neth Heart J 2009;17:61-7.Neth Heart J 2009;17:61-7.).

  • 43. Jaarsma, Tiny
    et al.
    Lesman, Ivonne
    van Veldhuisen, Dirk J
    Psychology and cardiology: do not forget the heart failure patient.2008In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 29, no 9, 1208; author reply 1208-9 p.Article in journal (Refereed)
  • 44. Jaarsma, T
    et al.
    van der Wal, M H L
    Lesman-Leegte, I
    Luttik, M L
    Hogenhuis, J
    Veeger, N J
    Sanderman, R
    Hoes, A W
    van Gilst, W H
    Lok, D J A
    Dunselman, P H J M
    Tijssen, J G P
    Hillege, H L
    van Veldhuisen, D J
    [Value of basic and intensive management of patients with heart failure; results of a randomised controlled clinical trial]2008In: Nederlandsch tijdschrift voor geneeskunde, ISSN 0028-2162, Vol. 152, no 37, 2016-21 p.Article in journal (Refereed)
    Abstract [nl]

    OBJECTIVE: To determine the efficacy of 2 nurse-directed programmes of different intensity for the counselling and follow-up of patients hospitalised for heart failure, compared with standard care by a cardiologist. DESIGN: Multicentre randomised clinical trial (www.trialregister.nl: NCT 98675639). METHOD: A total of 1023 patients were randomized after hospitalisation for heart failure to 1 of 3 treatment strategies: standard care provided by a cardiologist, follow-up care from a cardiologist with basic counselling and support by a nurse specialising in heart failure, or follow-up care from a cardiologist with intensive counselling and support by a nurse specialising in heart failure. Primary end points were the time to rehospitalisation due to heart failure or death and the number of days lost to rehospitalisation or death during the 18-month study period. Data were analysed on an intent-to-treat basis. RESULTS: Mean patient age was 71 years, 38% were women, 50% had mild heart failure and 50% had severe heart failure. During the study, 411 patients (40%) were rehospitalised due to heart failure or died from any cause: 42% in the control group, and 41% and 38% in the basic and intensive support groups, respectively (differences not significant). The time to rehospitalisation or death was similar in the 3 groups: hazard ratios for the basic and intensive support groups versus the control group were 0.96 (95% CI: 0.76-1.21; p = 0.73) and 0.93 (95% CI: 0.73-1.17; p = 0.53), respectively. The number of days lost to rehospitalisation or death was 39,960 in the control group; this number was 15% less in the intervention groups, but the difference was not significant. However, there was a trend toward lower mortality in the intervention groups. In all 3 groups, more visits occurred than planned, which may have had a considerable effect on care, notably in the control group. CONCLUSION: The results of this study indicated that the provision of additional counselling and support by a nurse specialising in heart failure as an adjuvant to intensive follow-up care provided by a cardiologist does not always lead to a reduction in rehospitalisation frequency.

  • 45. Lesman-Leegte, Ivonne
    et al.
    Jaarsma, Tiny
    Coyne, James C
    Hillege, Hans L
    Van Veldhuisen, Dirk J
    Sanderman, Robbert
    Quality of life and depressive symptoms in the elderly: a comparison between patients with heart failure and age- and gender-matched community controls.2009In: Journal of Cardiac Failure, ISSN 1071-9164, E-ISSN 1532-8414, Vol. 15, no 1, 17-23 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Comparisons of heart failure (HF) patients with an unselected healthy sample in terms of quality of life (QoL) and depressive symptoms might prove misleading. We compared QoL and depressive symptoms of a HF population with an age- and gender-matched sample of community dwelling elderly. METHODS AND RESULTS: Data were collected from 781 HF patients (36% female; age 72 +/- 9; New York Heart Association II-IV) and 781 age- and gender-matched community-dwelling elderly. Participants completed the Medical Outcome Study 36-item General Health Survey, the Cantril's Ladder of life, and the Center for Epidemiological Studies-Depression scale (CES-D). Analysis of variance techniques with Welch F test and chi-square tests were used to describe differences in QoL and depressive symptoms between different groups. For both men and women with HF, QoL was reduced and depressive symptoms were elevated when compared with their elderly counterparts (CES-D >or=16: 39% vs. 21%, P < .001). HF patients had more chronic conditions-specifically diabetes and asthma/chronic obstructive pulmonary disease. Impaired QoL and depressive symptoms were most prevalent among HF patients with comorbidities. Prevalence was also higher in HF patients in the absence of these conditions. CONCLUSIONS: HF has a large impact on QoL and depressive symptoms, especially in women with HF. Differences persist, even in the absence of common comorbidities. Results demonstrate the need for studies of representative HF patients with direct comparisons to age- and gender-matched controls.

  • 46. Annema, Coby
    et al.
    Luttik, Marie Louise
    Jaarsma, Tiny
    Do patients with heart failure need a case manager?2009In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 24, no 2, 127-31 p.Article in journal (Refereed)
    Abstract [en]

    The management of patients with heart failure (HF) is complex and often benefits from a patient-tailored approach. Since the early 1990s, HF disease management programs have been developed and implemented to improve outcomes of patients with HF. The body of evidence of the effectiveness of these programs is still growing, but meta-analyses of disease management program studies show various results on outcomes. This raises questions regarding the optimal organizational structure and components of a most cost-effective HF management program. Case management has been described as a solution to improve outcomes in complex patients and as a possible link to effective disease management. This raises the question of what case management can add to the disease management of patients with HF and which patients might benefit. The aim of this article is to discuss the potential contribution of case management in the disease management of patients with HF.

  • 47. De Smedt, Ruth H E
    et al.
    Jaarsma, Tiny
    van den Broek, Stan A J
    Haaijer-Ruskamp, Flora M
    Decompensation of chronic heart failure associated with pregabalin in a 73-year-old patient with postherpetic neuralgia: a case report.2008In: British Journal of Clinical Pharmacology, ISSN 0306-5251, E-ISSN 1365-2125, Vol. 66, no 2, 327-8 p.Article in journal (Refereed)
  • 48. Jaarsma, Tiny
    et al.
    van Veldhuisen, Dirk J
    When, how and where should we "coach" patients with heart failure: the COACH results in perspective.2008In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 10, no 4, 331-3 p.Article in journal (Refereed)
  • 49. De Smedt, R H E
    et al.
    Denig, P
    Haaijer-Ruskamp, F M
    Jaarsma, T
    Perceived medication adverse effects and coping strategies reported by chronic heart failure patients.2009In: International journal of clinical practice (Esher), ISSN 1368-5031, E-ISSN 1742-1241, Vol. 63, no 2, 233-42 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Data on medication adverse effects (AEs) in chronic heart failure (CHF) are primarily based on results from clinical trials. Little is known about AEs perceived by CHF patients in daily practice and how patients deal with these subjective AEs. AIMS: To describe the scope and nature of perceived AEs of CHF patients, their coping strategies and the relationship of perceived AEs to medication, patient characteristics and quality of life. METHODS: This cross-sectional observational study included a sample of 680 patients previously hospitalised for CHF. Perceived AEs and coping strategies were collected by interviews based on a structured questionnaire. Medication and clinical information were collected by chart review. RESULTS: Of the 670 CHF patients completing the questionnaire, 17% reported at least one AE. In total, 186 AEs were reported of which 15% could not be linked to any medication. Nausea (4%), dizziness (4%), itches (3%) and rash (3%) were the most prevalent. The drug associated with the highest AE rate was pravastatin (27%). On average, more than five different drugs could be related to the AEs headache, dizziness and nausea. Patients reporting AEs had a lower general health perception, younger age and were more often using antiarrhythmic drugs. Of patients experiencing AEs, 69% conferred with their doctor, 24% reported having done nothing in reaction and 2% discontinued their medication without discussing it with the doctor. CONCLUSION: Adverse effects are frequently perceived by CHF patients, but they are difficult to recognise and manage in daily practice.

  • 50. Hogenhuis, Jochem
    et al.
    Jaarsma, Tiny
    Voors, Adriaan A
    Hillege, Hans L
    Lesman, Ivonne
    van Veldhuisen, Dirk J
    Correlates of B-type natriuretic peptide and 6-min walk in heart failure patients.2006In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 108, no 1, 63-7 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: B-type natriuretic peptide (BNP) and 6-min walk test (6MWT) are both related to the severity and prognosis in chronic heart failure (CHF), but may reflect different aspects of CHF. We related BNP and 6MWT to left ventricular ejection fraction (LVEF), New York Heart Association functional class (NYHA), and two indices of quality of life (physical subscales): the Minnesota Living with Heart Failure Questionnaire (MLwHFQph) and the RAND-36ph. METHODS: Plasma BNP and 6MWT were measured at discharge in 229 patients who had been admitted for CHF. LVEF and NYHA were determined, and patients completed the MLwHFQ and RAND-36 questionnaires. RESULTS: BNP was weakly correlated to LVEF (r=-0.29, P<0.01) and NYHA (r=0.20, P<0.01), but not to MLwHFQph and RAND-36ph. On the other hand, 6MWT is related to MLwHFQph (r=-0.23, P<0.01), RAND-36ph (r=0.52, P<0.01), and NYHA (r=-0.46, P<0.01), but not to LVEF (r=-0.15, P=0.05). There is also no correlation between BNP and 6MWT (r=-0.01, P=0.87). CONCLUSIONS: The present data show that BNP and 6MWT represent different aspects of the clinical syndrome of CHF. The outcomes of this study suggest that BNP plasma levels are more related to cardiac function, while 6MWT reflects functional capacity and quality of life.

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