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  • Public defence: 2026-06-12 09:00 Berzeliussalen, building 463, LinköpingOrder onlineBuy this publication >>
    Abdallah, Sallam
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences.
    Epigenetic and Proteomic Regulations of Stem Cells Mediated Skin Regeneration2026Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The treatment of chronic or hard-to-heal skin wounds remains a significant challenge in healthcare, with an estimated annual cost of approximately 60 billion euros in Europe for wound management.

    Cutaneous wound healing requires coordinated activation of stem cells, epidermal cells, and extracellular signaling networks. While most wounds are resolved efficiently, impaired healing remains a major clinical challenge. Increasing evidence suggests that regenerative capacity is governed not only by cellular presence but by dynamic regulation of gene regulatory programs.

    This thesis investigates how epigenetic modulation influences regenerative behavior in adipose-derived stem cells (ASCs) and keratinocytes in a wound-healing context. By targeting histone acetylation using the histone deacetylase inhibitor, SAHA, and analyzing microRNA-mediated regulation. In parallel, proteomic analyses were performed to explore the skin proteome using the Total Protein tissue Extraction reagent (TPER) as an efficient isolation method in clinical settings.

    The findings demonstrate that SAHA modulates ASCs behavior by altering chromatin structure, DNA replication, and cell fate determination. The microRNA-based approach showed that key signaling pathways, such as those involving epidermal growth factor (EGF) and interleukin-1 alpha (IL-1α), are implicated in promoting skin cell proliferation and repair. Furthermore, skin proteomic analyses, including TPER reagent for protein isolation, may enhance clinical wound treatment.

    Together, these results advance the understanding of the interplay between gene regulation and protein function in skin healing and the development of skin regeneration future therapies.

    List of papers
    1. Modulation of biological activities in adipose derived stem cells by histone deacetylation
    Open this publication in new window or tab >>Modulation of biological activities in adipose derived stem cells by histone deacetylation
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    2025 (English)In: Scientific Reports, E-ISSN 2045-2322, Vol. 15, no 1, article id 3629Article in journal (Refereed) Published
    Abstract [en]

    Difficult-to-heal wounds management accounts for about 4% of healthcare costs, highlighting the need for innovative solutions. Extracellular signals drive cell proliferation during tissue regeneration, while epigenetic mechanisms regulate stem cell homeostasis, differentiation, and skin repair. Exploring epigenetic regulation in adipose-derived stem cells (ADSCs) holds promise for improving skin injury treatments. We investigated the effects of histone deacetylase inhibitor (SAHA) on ADSCs to better understand its cellular and molecular impacts. ADSCs were treated with SAHA for 72 h, showing no change in cell viability at the studied concentrations. However, the expression of histone deacetylase decreased at 1000 nM, while the cell proliferation marker Ki-67 increased after SAHA treatment, as confirmed by immunofluorescence. CCND1 gene expression increased, whereas protein expression of the proliferating cell nuclear antigen (PCNA) decreased. Cell cycle analysis showed an increase in G2 phase in SAHA-treated cells. Microarray analysis revealed 74 upregulated and 40 downregulated differentially expressed genes, including upregulation of P53 targets, CDKN1A and MDM2. Proteomic analysis identified 631 upregulated and 823 downregulated proteins compared to the vehicle. Pathway enrichment analysis showed cell cycle, ATP-dependent chromatin remodeling and DNA processes were among the affected pathways. This study suggests SAHA modulates ADSCs' biological processes, highlighting its potential for skin regeneration.

    Place, publisher, year, edition, pages
    NATURE PORTFOLIO, 2025
    Keywords
    Histone deacetylase inhibitor; Suberoylanilide hydroxamic acid; Adipose derived stem cells; Differentiation; Vorinostat; Epigenetic; Epigenetic modifier
    National Category
    Cell and Molecular Biology
    Identifiers
    urn:nbn:se:liu:diva-211586 (URN)10.1038/s41598-024-84652-1 (DOI)001410929000034 ()39880862 (PubMedID)
    Note

    Funding Agencies|Linkoping University; Hand and Plastic Surgery Department, Linkoeping University Hospital, Region Ostergoetland, Sweden; Centre for Advanced Medical Product, Sweden; SciLifeLab & Wallenberg Data Driven Life Science Program [KAW 2020.0239]; Swedish Cancer Society

    Available from: 2025-02-11 Created: 2025-02-11 Last updated: 2026-05-22
    2. miRNome and Proteome Profiling of Human Keratinocytes and Adipose Derived Stem Cells Proposed miRNA-Mediated Regulations of Epidermal Growth Factor and Interleukin 1-Alpha
    Open this publication in new window or tab >>miRNome and Proteome Profiling of Human Keratinocytes and Adipose Derived Stem Cells Proposed miRNA-Mediated Regulations of Epidermal Growth Factor and Interleukin 1-Alpha
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    2023 (English)In: International Journal of Molecular Sciences, ISSN 1661-6596, E-ISSN 1422-0067, Vol. 24, no 5, article id 4956Article in journal (Refereed) Published
    Abstract [en]

    Wound healing is regulated by complex crosstalk between keratinocytes and other cell types, including stem cells. In this study, a 7-day direct co-culture model of human keratinocytes and adipose-derived stem cells (ADSCs) was proposed to study the interaction between the two cell types, in order to identify regulators of ADSCs differentiation toward the epidermal lineage. As major mediators of cell communication, miRNome and proteome profiles in cell lysates of cultured human keratinocytes and ADSCs were explored through experimental and computational analyses. GeneChip(R) miRNA microarray, identified 378 differentially expressed miRNAs; of these, 114 miRNAs were upregulated and 264 miRNAs were downregulated in keratinocytes. According to miRNA target prediction databases and the Expression Atlas database, 109 skin-related genes were obtained. Pathway enrichment analysis revealed 14 pathways including vesicle-mediated transport, signaling by interleukin, and others. Proteome profiling showed a significant upregulation of the epidermal growth factor (EGF) and Interleukin 1-alpha (IL-1 alpha) compared to ADSCs. Integrated analysis through cross-matching the differentially expressed miRNA and proteins suggested two potential pathways for regulations of epidermal differentiation; the first is EGF-based through the downregulation of miR-485-5p and miR-6765-5p and/or the upregulation of miR-4459. The second is mediated by IL-1 alpha overexpression through four isomers of miR-30-5p and miR-181a-5p.

    Place, publisher, year, edition, pages
    MDPI, 2023
    Keywords
    keratinocytes; adipose-derived stem cells; direct co-culture; miRNA; proteome; epidermal growth factor; interleukin 1 alpha; stem cell differentiation
    National Category
    Medical Biotechnology (with a focus on Cell Biology (including Stem Cell Biology), Molecular Biology, Microbiology, Biochemistry or Biopharmacy)
    Identifiers
    urn:nbn:se:liu:diva-192940 (URN)10.3390/ijms24054956 (DOI)000948184700001 ()36902387 (PubMedID)
    Note

    Funding Agencies|Centre for Advanced Medical Product, Sweden; Hand and Plastic Surgery Department, Linkoeping University Hospital, Region OEstergoetland, Sweden

    Available from: 2023-04-11 Created: 2023-04-11 Last updated: 2026-05-22
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  • Public defence: 2026-06-12 10:15 Zero, hus Zenit, LinköpingOrder onlineBuy this publication >>
    Hellander, Anja
    Linköping University, Department of Electrical Engineering, Automatic Control. Linköping University, Faculty of Science & Engineering.
    Optimization-Based Planning for Task-Motion Integration and Multi-Agent Coordination2026Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Autonomous systems is a research field that has received significant attention during the last decades. An important requirement for such systems is the ability to plan before acting. This includes both higher-level task planning to determine what sequence of actions to take in order for the system to reach a goal, as well as lower-level motion planning in order to detail how to perform the actions required.

    The first part of this thesis focuses on the problem of finding plans for task and motion planning (tamp) problems that optimize a given performance measure, such as energy consumption, path length or time. A method is presented for solving a tamp problem, that can be formulated as a traveling salesman problem with dynamic obstacles and motion constraints, to resolution optimality. The proposed method uses a planner consisting of two nested graph-search planners. Several different heuristics are considered and evaluated.

    The main contribution in this part is a framework for solving a tamp problem, in the form of a rearrangement problem for a tractor-trailer system. In a first step, a method for finding a resolution-optimal solution is proposed. This method combines a task planner with motion planners, all based on heuristically guided graph search, and uses branch-and-bound techniques to improve the efficiency of the search algorithm. The efficiency is further improved by different strategies for recognizing equivalent problems. In a second step, the solution found in the first step is improved using optimal control. The proposed method takes inspiration from finite-horizon optimal control and decomposes the optimization problem into several smaller optimization problems. Compared to solving the original larger optimization problem, it is demonstrated that this can lead to reduced computation time without any significant decrease in solution quality.

    The second part of this thesis focuses on finding kinematically feasible and optimized solutions to multi-agent motion planning (mamp) problems. A method for automatic generation of optimized motion primitives such that all primitive durations are a multiple of the same sample time is proposed. This facilitates collision checking. The proposed planner consists of two steps. In the first step a feasible solution is found using a state-of-the-art mamp planner such as conflict-based search (cbs) together with a single-agent planner. The proposed single-agent planner ensures kinematic feasibility, and allows more general cost functions and larger agents than previous approaches. In the second step, a multi-phase optimal control problem is posed and the solution found in the first step is used to warm start the solver.

    For the special case where all agents are at rest initially and under the constraint of arriving at their goals simultaneously, it is shown that a feasible solution can be found by applying a standard mamp algorithm and searching backward. In particular, for certain choices of cost function and mamp algorithm it is (resolution) optimal. It is proposed to solve the optimization problem in the second step in a distributed and receding-horizon manner using the nonlinear alternating direction method of multipliers (nadmm).

     

    List of papers
    1. On a Traveling Salesman Problem with Dynamic Obstacles and Integrated Motion Planning
    Open this publication in new window or tab >>On a Traveling Salesman Problem with Dynamic Obstacles and Integrated Motion Planning
    2022 (English)In: 2022 AMERICAN CONTROL CONFERENCE (ACC), IEEE , 2022, p. 4965-4972Conference paper, Published paper (Refereed)
    Abstract [en]

    This paper presents a variant of the Traveling Salesman Problem (TSP) with nonholonomic constraints and dynamic obstacles, with optimal control applications in the mining industry. The problem is discretized and an approach for solving the discretized problem to optimality is proposed. The proposed approach solves the three subproblems (waypoint ordering, heading at each waypoint and motion planning between waypoints) simultaneously using two nested graph-search planners. The higher-level planner solves the waypoint ordering and heading subproblems while making calls to the lower-level planner that solves the motion planning subproblem using a lattice-based motion planner. For the higher-level motion planner A* search is used and two different heuristics, a minimal spanning tree heuristic and a nearest insertion heuristic, are proposed and optimality bounds are proven. The proposed planner is evaluated on numerical examples and compared to Dijkstras algorithm. Furthermore, the performance and observed suboptimality are investigated when the minimal spanning tree heuristic cost is inflated.

    Place, publisher, year, edition, pages
    IEEE, 2022
    Series
    2022 American Control Conference (ACC), ISSN 0743-1619, E-ISSN 2378-5861
    National Category
    Computational Mathematics
    Identifiers
    urn:nbn:se:liu:diva-189967 (URN)10.23919/ACC53348.2022.9867369 (DOI)000865458704089 ()9781665451963 (ISBN)9781665494809 (ISBN)
    Conference
    American Control Conference (ACC), Atlanta, GA, jun 08-10, 2022
    Note

    Funding Agencies|Wallenberg AI, Autonomous Systems and Software Program (WASP) - Knut and Alice Wallenberg Foundation

    Available from: 2022-11-16 Created: 2022-11-16 Last updated: 2026-05-12
    2. On Integrated Optimal Task and Motion Planning for a Tractor-Trailer Rearrangement Problem
    Open this publication in new window or tab >>On Integrated Optimal Task and Motion Planning for a Tractor-Trailer Rearrangement Problem
    2024 (English)In: 2023 62nd IEEE Conference on Decision and Control (CDC), IEEE, 2024, p. 6116-6123Conference paper, Published paper (Refereed)
    Abstract [en]

    In this work, a combined task and motion planner for a tractor and a set of trailers is proposed and it is shown that it is resolution complete and resolution optimal. The proposed planner consists of a task planner and a motion planner that are both based on heuristically guided graph-search. As a step towards tighter integration of task and motion planning, we use the same heuristic that is used by the motion planner in the task planner as well. We further propose to use the motion planner heuristic to give an initial underestimate of the motion costs that are used as costs during the task planning search, and increase this estimate gradually by using the motion planner to verify the cost and feasibility of actions along paths of interest. To limit the time spent in the motion planner, the use of time and cost limits to pause or prematurely abort the motion planner is proposed, which does not affect the resolution completeness or resolution optimality. The planner is evaluated on numerical examples and the results show that the proposed planner can significantly reduce the execution time compared to a baseline resolution optimal task and motion planner.

    Place, publisher, year, edition, pages
    IEEE, 2024
    Series
    Proceedings of the IEEE Conference on Decision & Control, E-ISSN 2576-2370
    Keywords
    Costs;Agricultural machinery;Planning;Task analysis
    National Category
    Computer Systems
    Identifiers
    urn:nbn:se:liu:diva-200643 (URN)10.1109/CDC49753.2023.10383959 (DOI)001166433805007 ()9798350301243 (ISBN)
    Conference
    2023 62nd IEEE Conference on Decision and Control (CDC) December 13-15, 2023. Marina Bay Sands, Singapore
    Note

    Funding: Wallenberg Artificial Intelligence, Autonomous Systems and Software Program (WASP) - Knut and Alice Wallenberg Foundation

    Available from: 2024-02-02 Created: 2024-02-02 Last updated: 2026-05-12
    3. Improved Task and Motion Planning for Rearrangement Problems using Optimal Control*
    Open this publication in new window or tab >>Improved Task and Motion Planning for Rearrangement Problems using Optimal Control*
    2024 (English)In: 2024 IEEE Intelligent Vehicles Symposium (IV), IEEE, 2024, p. 2033-2040Conference paper, Published paper (Refereed)
    Abstract [en]

    Optimal task and motion planning (TAMP) has seen an increase in interest in recent years. In this paper we propose methods for using numerical optimal control to improve upon a feasible solution to a TAMP rearrangement problem. The methods are extensions of existing improvement methods for pure motion planning. The first method poses an optimal control problem (OCP) to simultaneously improve all motions in the plan. The second method, which we denote multiple finite horizons (MFH), takes inspiration from finite horizon control and poses a sequence of finite horizon OCPs involving variables for the positions of temporary placements of movable objects as well as motions in the plan, such that after solving each problem a feasible plan is maintained and the plan cost is non-increasing after each step. The methods are evaluated on a TAMP problem for tractor-trailers in numerical experiments, and the results show that both methods improve the plan for the evaluated problems. The results also show that MFH can reduce the computation time compared to the first method, and that on one example problem it achieves plans of similar or better quality as when all the motions are optimized at the same time provided that the horizon length is sufficiently long.

    Place, publisher, year, edition, pages
    IEEE, 2024
    Keywords
    Costs, Intelligent vehicles, Optimal control, Cost function, Planning, Task analysis, Collision avoidance
    National Category
    Control Engineering
    Identifiers
    urn:nbn:se:liu:diva-206063 (URN)10.1109/iv55156.2024.10588789 (DOI)001275100902017 ()
    Conference
    35th IEEE Intelligent Vehicles Symposium (IV), 2-5 June 2024, Jeju Island, Korea
    Note

    Funding Agencies|Wallenberg AI, Autonomous Systems and Software Program (WASP) - Knut and Alice Wallenberg Foundation

    Available from: 2024-07-31 Created: 2024-07-31 Last updated: 2026-05-12Bibliographically approved
    4. On Methods for Improved Efficiency of Optimal Task and Motion Planning
    Open this publication in new window or tab >>On Methods for Improved Efficiency of Optimal Task and Motion Planning
    2024 (English)In: 2024 IEEE 63rd Conference on Decision and Control (CDC), Institute of Electrical and Electronics Engineers (IEEE), 2024, p. 1657-1663Conference paper, Published paper (Refereed)
    Abstract [en]

    Optimal task and motion planning (TAMP) has seen an increase in interest in recent years. An important performance bottleneck when solving such problems is that solving motion-planning problems for nonholonomic systems to (resolution) optimality is relatively costly, and when this has to be done a potentially large number of times, in the form of a subroutine, time quickly adds up. In this work, we significantly increase the efficiency of our previously presented optimal TAMP algorithm for rearrangement problems. The core idea that we introduce in this work is to use intermediary results from the motion planner to infer solutions to other related motion-planning problems that might be of interest to the overall TAMP problem. We also introduce the concept of equivalent states to recognize state-action pairs that require the solution of the same motion-planning problem in order to compute their associated cost. Evaluations on numerical examples considering rearrangement TAMP problems involving tractor-trailers show that the proposed strategies can significantly reduce the total computation time of the TAMP planner, as well as the number of motion-planning problems that are solved, and the number of candidate task plans that are computed.

    Place, publisher, year, edition, pages
    Institute of Electrical and Electronics Engineers (IEEE), 2024
    Keywords
    costs, algorithms, tracking, planning, WASP_publications
    National Category
    Control Engineering
    Identifiers
    urn:nbn:se:liu:diva-212270 (URN)10.1109/CDC56724.2024.10886213 (DOI)001445827201067 ()2-s2.0-86000525290 (Scopus ID)9798350316339 (ISBN)9798350316346 (ISBN)
    Conference
    2024 IEEE 63rd Conference on Decision and Control (CDC), Milan, Italy, 16-19 December 2024
    Note

    Funding Agencies|Wallenberg Artificial Intelligence, Autonomous Systems and Software Program (WASP) - Knut and Alice Wallenberg Foundation

    Available from: 2025-03-17 Created: 2025-03-17 Last updated: 2026-05-12Bibliographically approved
    5. Optimized and kinematically feasible multi-agent motion planning
    Open this publication in new window or tab >>Optimized and kinematically feasible multi-agent motion planning
    (English)Manuscript (preprint) (Other academic)
    National Category
    Robotics and automation
    Identifiers
    urn:nbn:se:liu:diva-223455 (URN)10.48550/arXiv.2605.01996 (DOI)
    Funder
    Wallenberg AI, Autonomous Systems and Software Program (WASP)
    Available from: 2026-05-03 Created: 2026-05-03 Last updated: 2026-05-12
    6. Multi-Agent Motion Planning for Simultaneous Arrival using Time-Reversed Search and Distributed Optimal Control
    Open this publication in new window or tab >>Multi-Agent Motion Planning for Simultaneous Arrival using Time-Reversed Search and Distributed Optimal Control
    (English)Manuscript (preprint) (Other academic)
    National Category
    Control Engineering
    Identifiers
    urn:nbn:se:liu:diva-223456 (URN)
    Funder
    Wallenberg AI, Autonomous Systems and Software Program (WASP)
    Available from: 2026-05-03 Created: 2026-05-03 Last updated: 2026-05-12
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  • Public defence: 2026-06-12 13:00 HasselquistsalenOrder onlineBuy this publication >>
    Paukkunen, Maija
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Implementation and costs of guideline-based biopsychosocial management of low back pain2026Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: This mixed-methods dissertation examined the implementation and costs of guideline-based biopsychosocial (BPS) management of low back pain (LBP) in Finnish occupational health primary care (OHPC). A multifaceted implementation strategy was used, combining training and booster sessions with materials, clinical champions, and outreach visits. We aimed to 1) evaluate the quality of LBP management by applying predefined criteria to physiotherapists’ documentation; 2) analyze the effects of the intervention on OHPC resource utilization and work absenteeism compared to usual care; 3) examine how capabilities, opportunities, and motivation influence the implementation of guideline-based BPS management of LBP, as perceived by occupational healthcare professionals and 4) tailor a shortened version of The Determinants of Implementation Behavior Questionnaire (DIBQ) to multiprofessional rehabilitation context and cross-culturally adapt a Finnish language version.

    Methods: The cluster-randomized trial (ISRCTN11875357) included six national OHPC providers, with 27 units randomized into intervention and control arms. In the intervention arm, physiotherapists and physicians received targeted 3-to-7-day training in guideline-based BPS management in 2017 and 2018, while the control arm continued usual care.

    Study I evaluated the quality of LBP care from physiotherapists’ first-visit documentation using predefined quality criteria applied to electronic patient records. In total, 98 records documented by 28 physiotherapists from intervention and controls arms were analyzed.

    Study II analyzed healthcare utilization and LBP-related sick leave data collected from electronic patient records over a one-year follow-up for 232 patients in the intervention arm and 80 control arm patients. Costs were estimated using linear mixed models by multiplying unit costs (in euros) by each type of OHPC resource use including visits to physicians, physiotherapists, nurses, imaging and sick leave.

    In Study III, focus group interviews (n=12) were conducted one year after the educational intervention. with physicians, physiotherapists and nurses (n=51) treating patients with LBP in occupational healthcare teams. The data were analyzed using deductive and inductive content analysis informed by the Capability, Opportunity, Motivation, Behavior (COM-B) model.

    In Study IV, the cross-cultural translation of English DIBQ to Finnish was followed by a two-round Delphi survey involving experts in multiprofessional rehabilitation including physicians, physiotherapists, occupational therapists, psychologists, nursing scientists, social scientists. Altogether, 25 experts participated in Round 1, and 21 in Round 2. Participants rated the importance of each DIBQ item for inclusion in the final scale on a 5-point Likert scale (1 = Strongly Disagree, 5 = Strongly Agree). Consensus to include an item was defined as a mean score of at least 4 by ≥75% of Delphi participants. Open-ended comments were analyzed inductively. Item- and scale-level content validities were assessed using the content validity index.

    Results: Training in guideline-based BPS management was associated with more frequent documentation of behaviors aligned with high-quality LBP care at physiotherapists’ first visit in OHPC compared to usual care.

    The multiprofessional training intervention shifted care from physician-led management toward a multiprofessional, physiotherapist-driven model without increasing total costs over 12 months (€-1908, 95% CI €-6734–2919).

    Facilitators of implementation were mainly related to increased capability and motivation. Participants reported improved confidence on their own and the teams’ capabilities on treating more challenging patients in OHPC, enhanced communication skills, a broader understanding of the multidimensional nature of LBP, and a strengthened professional role. Barriers were related to opportunities at the organizational and system levels, including limited time and resources, unclear care pathways, inconsistent team agreements, and structural constraints.

    In the cross-cultural adaptation process, consensus was reached after Round 2 on the inclusion of 21 items in the multiprofessional DIBQ (DIBQ-mp). The final version covers 11 Theoretical Domains Framework domains. Item-level content validity indices were at least 0.78, and the scale-level content validity index average was 0.93, indicating excellent content validity for multiprofessional rehabilitation context.

    Conclusion: Although the BPS training intervention improved the quality of LBP assessment and management, influenced OHPC resource allocation, and strengthened professionals’ capabilities and motivation, implementation into routine practice remained incomplete at 12-month follow-up. Complementary implementation strategies for sustained organizational support and clear care pathways should be further developed to embed BPS management in occupational health practice. The DIBQ-mp appears to be a promising tool for evaluating implementation determinants in multiprofessional guideline-based rehabilitation interventions.

    List of papers
    1. Where is the patient in the records? Evaluating physiotherapists' first visit in occupational health primary care pathway for low back pain
    Open this publication in new window or tab >>Where is the patient in the records? Evaluating physiotherapists' first visit in occupational health primary care pathway for low back pain
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    2026 (English)In: BMJ Open Quality, E-ISSN 2399-6641, Vol. 15, no 1, article id e003900Article in journal (Refereed) Published
    Abstract [en]

    Background Clinical guidelines recommend a biopsychosocial approach to low back pain (LBP) management, with physiotherapists playing a key role in occupational health primary care (OHPC). However, little is known about how their clinical behaviours at the first visit align with guideline-oriented biopsychosocial principles. Therefore, we evaluated LBP management quality in OHPC by applying predefined criteria to physiotherapists' documentation. Methods Based on a cluster-randomised implementation study data (ISRCTN11875357) we analysed 98 electronic patient records (EPRs) documented by 28 physiotherapists across diverse OHPC units. The intervention arm had received 3-7 days of biopsychosocial training. A stratified random sample of EPRs from individuals with LBP was reviewed using a structured researcher's evaluation tool. Each item was scored dichotomously (yes/no) and evaluated against predefined quality criteria with stepwise thresholds for different work disability risk groups. Results Step I, multidimensional biopsychosocial assessment of LBP, was documented in fewer than half of the records (36.5% in the intervention vs 16.7% in the control arm, p=0.081). The biological dimension was well documented in both arms (100% vs 95.8%, p=0.245), while psychological (58.1% vs 25%, p=0.009) and social (54.1% vs 29.2%, p=0.038) dimensions were more frequently documented in the intervention arm. Step II quality criteria (low-risk patients) were met in 58.1% of intervention versus 4.2% of control records (p<0.001), and step III (medium-risk) in 55.4% versus 4.2% (p<0.001). No EPRs met step IV (high-risk) quality criteria. The intervention arm more often documented psychosocial assessments, risk stratification, behavioural strategies and advice to stay active. Person-centredness (ie, goals, values, resources, expectations) was rarely documented (36.5% vs 0%, p<0.001).Results Step I, multidimensional biopsychosocial assessment of LBP, was documented in fewer than half of the records (36.5% in the intervention vs 16.7% in the control arm, p=0.081). The biological dimension was well documented in both arms (100% vs 95.8%, p=0.245), while psychological (58.1% vs 25%, p=0.009) and social (54.1% vs 29.2%, p=0.038) dimensions were more frequently documented in the intervention arm. Step II quality criteria (low-risk patients) were met in 58.1% of intervention versus 4.2% of control records (p<0.001), and step III (medium-risk) in 55.4% versus 4.2% (p<0.001). No EPRs met step IV (high-risk) quality criteria. The intervention arm more often documented psychosocial assessments, risk stratification, behavioural strategies and advice to stay active. Person-centredness (ie, goals, values, resources, expectations) was rarely documented (36.5% vs 0%, p<0.001).Results Step I, multidimensional biopsychosocial assessment of LBP, was documented in fewer than half of the records (36.5% in the intervention vs 16.7% in the control arm, p=0.081). The biological dimension was well documented in both arms (100% vs 95.8%, p=0.245), while psychological (58.1% vs 25%, p=0.009) and social (54.1% vs 29.2%, p=0.038) dimensions were more frequently documented in the intervention arm. Step II quality criteria (low-risk patients) were met in 58.1% of intervention versus 4.2% of control records (p<0.001), and step III (medium-risk) in 55.4% versus 4.2% (p<0.001). No EPRs met step IV (high-risk) quality criteria. The intervention arm more often documented psychosocial assessments, risk stratification, behavioural strategies and advice to stay active. Person-centredness (ie, goals, values, resources, expectations) was rarely documented (36.5% vs 0%, p<0.001). Conclusion Training in guideline-oriented biopsychosocial approach was associated with more frequent documentation of behaviours aligned with high-quality LBP management. However, overall quality varied, and person-centred aspects remained underreported. Complementary implementation strategies are required to ensure consistent delivery and documentation of biopsychosocial clinical practice in OHPC.

    Place, publisher, year, edition, pages
    BMJ, 2026
    Keywords
    Health services research; Patient-centred care; Quality improvement; Implementation science; Occupational Health
    National Category
    General Medicine
    Identifiers
    urn:nbn:se:liu:diva-221851 (URN)10.1136/bmjoq-2025-003900 (DOI)001702754300001 ()41748266 (PubMedID)2-s2.0-105031759077 (Scopus ID)
    Note

    Funding: Finnish Cultural Foundation; Avohoidon Tutkimssti; Finnish Work Environment Fund; Finnish Association on the Study of Pain; Juhani Aho Foundation for Medical Research

    Available from: 2026-03-12 Created: 2026-03-12 Last updated: 2026-05-20
    2. Cost analysis comparing guideline-oriented biopsychosocial management to usual care for low-back pain: a cluster-randomized trial in occupational health primary care
    Open this publication in new window or tab >>Cost analysis comparing guideline-oriented biopsychosocial management to usual care for low-back pain: a cluster-randomized trial in occupational health primary care
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    2025 (English)In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 51, no 3, p. 201-213Article in journal (Refereed) Published
    Abstract [en]

    Objectives This study aimed to investigate the effect of a brief training intervention for occupational health services (OHS) professionals on multiprofessional resource utilization and the costs of biopsychosocial management of patients with low-back pain (LBP) compared to usual care among all participants and those in work disability-based risk groups. Methods OHS utilization and back-related sick leave data were collected from electronic patient records over one-year follow-up comparing 232 patients in the intervention arm and 80 control-arm patients, stratified for risk of work disability based on the Orebro Musculoskeletal Pain Screening Questionnaire. We estimated costs using linear mixed models by multiplying unit costs (in euros) by each type of OHS resource use (visits to physicians, physiotherapists, nurses, use of imaging) and the number of sick leaves. Estimated mean cost differences with confidence intervals (CI) were reported using bootstrapping to deal with skewed cost data. Results The median number of visits to physicians and physiotherapists in the intervention versus control arms was 1 [interquartile range (IQR) 0-3] and 2 (IQR 1-4) versus 2 (IQR 1-3) and 1 (IQR 0-2), respectively. The intervention arm accrued lower physician costs (<euro>-43, 95% CI <euro>-82--3, P=0.034) and higher physiotherapist costs (<euro>55, 95% CI <euro>26-84, P<0.001) compared to the control arm. There was no statistically significant difference in average total costs between the arms (<euro>-1908, 95% CI <euro>-6734-2919). In the low- and medium-risk groups of work disability, physiotherapist costs were higher in the intervention than control arm, but no statistically significant differences were observed between the arms in the total resource utilization or sickness absence costs. Conclusions Brief biopsychosocial training may support shifting OHS resources towards multiprofessional physiotherapist-driven care, instead of solely physician-driven care, for management of patients with LBP in differing risk groups of work disability with no substantial differences in total costs.

    Place, publisher, year, edition, pages
    Helsingfors: Nordic Association of Occupational Safety and Health (NOROSH), 2025
    Keywords
    health services research, implementation research, occupational health service, pain, resource, return to work, risk stratification, screening, workability, Orebro Musculoskeletal Pain Screening Questionnaire, Orebro Musculoskeletal Pain Screening Questionnaire, implementation research, occupational health service, pain, resource, return to work, risk stratification, screening, workability, Orebro Musculoskeletal Pain Screening Questionnaire
    National Category
    Rehabilitation Medicine
    Identifiers
    urn:nbn:se:liu:diva-211756 (URN)10.5271/sjweh.4212 (DOI)001428791200001 ()39970070 (PubMedID)39970070 (Scopus ID)
    Note

    Funding Agencies|Finnish Work Environment Fund; Finnish Cultural Foundation; Finnish Association on the Study of Pain

    Available from: 2025-02-19 Created: 2025-02-19 Last updated: 2026-05-29
    3. Capabilities, opportunities and motivations in implementing guideline-oriented biopsychosocial low back pain management: perceptions of occupational healthcare professionals after an educational intervention
    Open this publication in new window or tab >>Capabilities, opportunities and motivations in implementing guideline-oriented biopsychosocial low back pain management: perceptions of occupational healthcare professionals after an educational intervention
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    2025 (English)In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 25, no 1, article id 1153Article in journal (Refereed) Published
    Abstract [en]

    BackgroundWe explored Finnish occupational healthcare professionals' (HCP) perceptions of biopsychosocial (BPS) low back pain (LBP) management after an educational intervention.MethodsWe conducted twelve group interviews of 51 physicians, physiotherapists and nurses from intervention units in a cluster randomized controlled trial (ISRCTN11875357). We used deductive and inductive content analysis to examine the data, and the Capability-Opportunity-Motivation-Behaviour (COM-B) model to identify the facilitators of and barriers to changes in three target behaviours: (A) forming a common BPS-based understanding with patients, (B) systematically using risk stratification tools, and (C) multidisciplinary collaboration in individualized care planning.ResultsFacilitators and barriers were categorized into the following COM-B domains. Most of the facilitators were in the Capability and Motivation domains: increased confidence regarding managing treatment decisions, improved therapeutic alliance and renewed professional identity. Significant system-level barriers were mostly in the Opportunity domain: time constraints, limited resources and unclear treatment pathways. The HCPs reported improved individual skills and awareness after the training, but varying organizational policies and lacking incentives hindered the adoption of BPS methods in multidisciplinary teams. Initial resistance to change decreased as positive patient outcomes emerged. The perceived benefits were increased multidisciplinary collaboration and a shift toward holistic pain management. Those who embraced BPS management reported greater professional satisfaction and confidence when handling LBP patients.ConclusionsTo effectively implement BPS management in occupational health services, organizational and system-level barriers must be addressed and HCPs' skills and motivation enhanced. For sustained support through policy initiatives and reinforced multidisciplinary collaboration, future strategies should integrate BPS practices into routine workflows.Trial registrationThe trial was retrospectively registered on 13.05.2019 ISRCTN11875357.

    Place, publisher, year, edition, pages
    BMC, 2025
    Keywords
    Implementation; Occupational health services; Musculoskeletal; Qualitative; Primary care; Multiprofessional
    National Category
    Health Care Service and Management, Health Policy and Services and Health Economy
    Identifiers
    urn:nbn:se:liu:diva-217966 (URN)10.1186/s12913-025-13267-7 (DOI)001565224600003 ()40883739 (PubMedID)2-s2.0-105014870503 (Scopus ID)
    Note

    Funding Agencies|Linkping University

    Available from: 2025-09-25 Created: 2025-09-25 Last updated: 2026-05-20
    4. Measuring the determinants of implementation behavior in multiprofessional rehabilitation
    Open this publication in new window or tab >>Measuring the determinants of implementation behavior in multiprofessional rehabilitation
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    2023 (English)In: European Journal of Physical and Rehabilitation Medicine, ISSN 1973-9087, E-ISSN 1973-9095, Vol. 59, no 4, p. 488-501Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND: The Determinants of Implementation Behavior Questionnaire (DIBQ) measures facilitators or barriers of healthcare professionals implementation behaviors based on the current implementation research on practice and policy. The DIBQ covers 18 domains of the Theoretical Domains Framework and consists of 93 items. A previously tailored version (DIBQ-t) covering 10 domains and 28 items focuses on implementing best-practice low back pain care. AIM: To tailor a shortened version of DIBQ to multiprofessional rehabilitation context with cross-cultural adaptation to Finnish language. DESIGN: A two-round Delphi study. SETTING: National-level online survey. POPULATION: Purposively recruited experts in multiprofessional rehabilitation (N.=25). METHODS: Cross-cultural translation of DIBQ to Finnish was followed by a two-round Delphi survey involving diverse experts in rehabilitation (physicians, physiotherapists, occupational therapists, psychologists, nursing scientists, social scientists). In total, 25 experts in Round 1, and 21 in Round 2 evaluated the importance of DIBQ items in changing professionals implementation behavior by rating on a 5-point Likert Scale (1 = Strongly Disagree, 5 = Strongly Agree) of including each item in the final scale. Consensus to include an item was defined as a mean score of &gt;= 4 by &gt;= 75% of Delphi participants. Open comments were analyzed using inductive content analysis. Items with agreement of &lt;= 74% were either directly excluded or reconsidered and modified depending on qualitative judgements, amended with experts suggestions. After completing an analogous second-round, a comparison with DIBQ-t was performed. Lastly, the relevance of each item was indexed using content validity index on item-level (I-CVI) and scale-level (S-CVI/Ave). RESULTS: After Round 1, 17 items were included and 48 excluded by consensus whereas 28 items were reconsidered, and 20 items added for Round 2. The open comments were categorized as: 1) "modifying"; 2) "supportive"; and 3) "critical". After Round 2, consensus was reached regarding all items, to include 21 items. After comparison with DIBQ-t, the final multiprofessional DIBQ (DIBQ-mp) covers 11 TDF domains and 21 items with I-CVIs of &gt;= 0.78 and S-CVI/Ave of 0.93. CONCLUSIONS: A Delphi study condensed a DIBQ-mp with excellent content validity for multiprofessional rehabilitation context. CLINICAL REHABILITATION IMPACT: A potential tool for evaluating determinants in implementing evidence-based multiprofessional rehabilitation interventions.

    Place, publisher, year, edition, pages
    EDIZIONI MINERVA MEDICA, 2023
    Keywords
    Rehabilitation; Implementation science; Delphi Technique; Surveys and questionnaires
    National Category
    Clinical Medicine
    Identifiers
    urn:nbn:se:liu:diva-199143 (URN)10.23736/S1973-9087.23.07857-7 (DOI)001087047000006 ()37486174 (PubMedID)
    Available from: 2023-11-14 Created: 2023-11-14 Last updated: 2026-05-20
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  • Public defence: 2026-08-19 09:15 Ada Lovelace, LinköpingOrder onlineBuy this publication >>
    Khan, Suleman
    Linköping University, Department of Computer and Information Science, Cybersecurity. Linköping University, Faculty of Science & Engineering.
    Secure Mobility and Authentication Protocols in Heterogeneous Aviation Data Networks2026Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Civil aviation is undergoing a transition towards digital, IP-based air–ground communication systems in order to accommodate increasing air traffic density, improve operational efficiency, and maintain safety-critical services. Within this evolution, technologies such as Controller–Pilot Data Link Communications (CPDLC), the L-band Digital Aeronautical Communications System (LDACS), and the Future Communication Infrastructure (FCI) have become key to enabling continuous data exchange between aircraft and ground systems. Despite their operational benefits, however, these systems do not yet provide security protection in a unified and consistently deployed manner across communication establishment, operational message exchange, and mobility or handover phases. In particular, guarantees related to mutual authentication, key establishment, integrity, confidentiality, and secure mobility management are not uniformly maintained across current air–ground communication environments. As a result, aviation communication systems remain exposed to replay, impersonation, message injection, man-in-the-middle (MITM), session hijacking, and denial-of-service (DoS) attacks, especially during mobility events and handover transitions, thereby posing significant risks to operational safety.

    Motivated by these challenges, we develop lightweight, aviation-compatible, and formally verifiable security frameworks in this thesis to secure communication and handover across CPDLC, LDACS, and heterogeneous FCI environments. For CPDLC, the thesis introduces lightweight security mechanisms that provide mutual authentication, session key establishment, and secure handover by using Elliptic Curve Cryptography (ECC), Elliptic Curve Diffie–Hellman (ECDH), Schnorr signatures, and symmetric protection. For LDACS, the thesis strengthens security through lightweight authentication together with post-quantum-resilient key establishment and handover mechanisms. In this framework, Physically Unclonable Functions (PUFs) enable lightweight hardware-bound authentication, while the Bit-Flipping Key Encapsulation (BIKE) mechanism supports post-quantum-secure key establishment. This design reduces reliance on conventional public key infrastructure and supports secure key continuity across intra- and inter-domain scenarios. At the network level, the thesis further introduces a Host Identity Protocol (HIP)-based framework for the FCI to enable secure multi-homing and seamless mobility across heterogeneous links, including LDACS, the Aeronautical Mobile Airport Communications System (AeroMACS), and Satellite Communications (SATCOM).

    To ensure that the proposed mechanisms provide rigorous security guarantees suitable for safety-critical aviation environments, the thesis complements framework design with formal security assurance. Symbolic analysis using Tamarin Prover and ProVerif is employed to establish essential properties, including authentication, key secrecy, forward secrecy, and secure handover, under strong adversary models. Overall, this thesis advances the security and robustness of both legacy and nextgeneration aviation communication systems across operational communication and mobility scenarios.

    List of papers
    1. AKAASH: A realizable authentication, key agreement, and secure handover approach for controller-pilot data link communications
    Open this publication in new window or tab >>AKAASH: A realizable authentication, key agreement, and secure handover approach for controller-pilot data link communications
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    2023 (English)In: International Journal of Critical Infrastructure Protection, ISSN 1874-5482, E-ISSN 2212-2087, Vol. 42, article id 100619Article in journal (Refereed) Published
    Abstract [en]

    Controller-Pilot Data Link Communications (CPDLC) are rapidly replacing voice-based Air Traffic Control (ATC) communications worldwide. Being digital, CPDLC is highly resilient and bandwidth efficient, which makes it the best choice for traffic-congested airports. Although CPDLC initially seems to be a perfect solution for modern-day ATC operations, it suffers from serious security issues. For instance, eavesdropping, spoofing, man-in-the-middle, message replay, impersonation attacks, etc. Cyber attacks on the aviation communication network could be hazardous, leading to fatal aircraft incidents and causing damage to individuals, service providers, and the aviation industry. Therefore, we propose a new security model called AKAASH, enabling several paramount security services, such as efficient and robust mutual authentication, key establishment, and a secure handover approach for the CPDLC-enabled aviation communication network. We implement the approach on hardware to examine the practicality of the proposed approach and verify its computational and communication efficiency and efficacy. We investigate the robustness of AKAASH through formal (proverif) and informal security analysis. The analysis reveals that the AKAASH adheres to the CPDLC standards and can easily integrate into the CPDLC framework.

    Place, publisher, year, edition, pages
    ELSEVIER, 2023
    Keywords
    Authentication, CPDLC, Critical infrastructure, Safety, Security
    National Category
    Communication Systems Computer Systems Other Electrical Engineering, Electronic Engineering, Information Engineering
    Identifiers
    urn:nbn:se:liu:diva-196595 (URN)10.1016/j.ijcip.2023.100619 (DOI)001040791200001 ()2-s2.0-85164225597 (Scopus ID)
    Projects
    This work was supported by Trafikverket, Sweden and Luftfartsverket, Sweden under Automation Program II. This work was also partially supported by the Wallenberg AI, Autonomous Systems and Software Program (WASP), Sweden .
    Funder
    Swedish Transport AdministrationWallenberg AI, Autonomous Systems and Software Program (WASP)
    Note

    Funding: Trafikverket, Sweden; Luftfartsverket, Sweden under Automation Program II; Wallenberg AI, Autonomous Systems and Software Program (WASP), Sweden

    Available from: 2023-08-15 Created: 2023-08-15 Last updated: 2026-05-12
    2. A Secure Framework For Controller Pilot Data Link Communications in Aviation Network
    Open this publication in new window or tab >>A Secure Framework For Controller Pilot Data Link Communications in Aviation Network
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    2024 (English)In: 2024 AIAA DATC/IEEE 43rd Digital Avionics Systems Conference (DASC), Institute of Electrical and Electronics Engineers (IEEE), 2024Conference paper, Published paper (Refereed)
    Abstract [en]

    Controller Pilot Data Link Communications (CPDLC) enhances air traffic communication by replacing traditional voice transmissions with digital messages over Very High Frequency (VHF) radio systems. This transition improves communication resilience by providing clear, text-based instructions that reduce misunderstandings and increase bandwidth efficiency by enabling more data to be transmitted simultaneously. It benefits congested airspace by reducing radio frequency congestion and minimizing communication errors. However, due to the plain-text nature of its messages, CPDLC faces significant security challenges, making it vulnerable to cyber-attacks such as eavesdropping, modification, injection, and man-in-the-middle (MITM) attacks. This vulnerability allows motivated attackers to intercept CPDLC messages using inexpensive devices like Software-Defined Radio (SDR), HACKRF-one, and an antenna. Such breaches can lead to fatal safety incidents, severely impacting passengers and the aviation industry. To address this, we proposed a robust security framework for securing CPDLC communication by implementing critical measures, including mutual authentication, secure key establishment, and handover. The proposed framework has been tested on hardware to verify its effectiveness in practical scenarios, ensuring it aligns with existing CPDLC standards and integrates seamlessly into current systems without impacting operational efficiency. Our findings indicate that the proposed security framework enhances CPDLC's defenses against potential cyber threats while maintaining system performance, making it feasible to protect global air traffic communications.

    Place, publisher, year, edition, pages
    Institute of Electrical and Electronics Engineers (IEEE), 2024
    Series
    IEEE/AIAA Digital Avionics Systems Conference, ISSN 2155-7195, E-ISSN 2155-7209
    Keywords
    Aviation, CPDLC, Handover, Security, VHF
    National Category
    Communication Systems
    Identifiers
    urn:nbn:se:liu:diva-209995 (URN)10.1109/DASC62030.2024.10749527 (DOI)001453360400202 ()2-s2.0-85211215823 (Scopus ID)9798350349610 (ISBN)9798350349627 (ISBN)
    Conference
    AIAA DATC/IEEE 43rd Digital Avionics Systems Conference (DASC), 29 Sept-3 Oct 2024, San Diego, CA, USA
    Funder
    EU, Horizon Europe, 101114635
    Note

    Funding Agencies|SESAR Joint Undertaking [101114635]

    Available from: 2024-11-22 Created: 2024-11-22 Last updated: 2026-05-12Bibliographically approved
    3. Enhancing Cybersecurity for LDACS: a Secure and Lightweight Mutual Authentication and Key Agreement Protocol
    Open this publication in new window or tab >>Enhancing Cybersecurity for LDACS: a Secure and Lightweight Mutual Authentication and Key Agreement Protocol
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    2023 (English)In: 2023 IEEE/AIAA 42ND DIGITAL AVIONICS SYSTEMS CONFERENCE, DASC, IEEE , 2023Conference paper, Published paper (Refereed)
    Abstract [en]

    The aviation industry faces significant challenges due to rising global air travel demand. Frequency saturation in Air Traffic Management (ATM) leads to communication problems, necessitating the enhancement of traditional systems. The Single European Sky ATM Research (SESAR) initiative, backed by the European Commission, aims to digitize ATM, with the L-band Digital Aeronautical Communications System (LDACS) as a key component. LDACS aims to improve communication, enhance surveillance, and optimize airspace usage for safer, more efficient ATM. Although LDACS is protected against most cyberattacks, a critical security objective, anonymity, is currently overlooked. To strengthen LDACS's security, robust authentication mechanisms, Post-Quantum security, and measures to ensure aircraft anonymity are crucial. Therefore, we propose a comprehensive security framework to enhance LDACS's cybersecurity, focusing on mutual authentication and key agreement. The protocol uses Physical Unclonable Function (PUF) for robust mutual authentication and Bit-flipping Key Encapsulation (BIKE) for secure session key establishment utilizing Post-Quantum Cryptography (PQC). This framework ensures anonymity and secure communication between aircraft and ground stations while minimizing message exchange, latency, and data overhead. An informal security analysis confirms our proposed framework's potential to augment the efficiency and security of ATM operations.

    Place, publisher, year, edition, pages
    IEEE, 2023
    Series
    IEEE-AIAA Digital Avionics Systems Conference, ISSN 2155-7195, E-ISSN 2155-7209
    Keywords
    Aviation Cybersecurity; BIKE; LDACS; PUF; Mutual Authentication and Key Exchange (MAKE)
    National Category
    Communication Systems
    Identifiers
    urn:nbn:se:liu:diva-200533 (URN)10.1109/DASC58513.2023.10311307 (DOI)001103267600200 ()9798350333572 (ISBN)9798350333589 (ISBN)
    Conference
    IEEE/AIAA 42nd Digital Avionics Systems Conference (DASC), Barcelona, SPAIN, oct 01-05, 2023
    Note

    Funding Agencies|Trafikverket and Luftfartsverket under Automation Program II; Autonomous Systems and Software Program (WASP)

    Available from: 2024-01-30 Created: 2024-01-30 Last updated: 2026-05-12
    4. Post Quantum Secure Handover Mechanism for Next Generation Aviation Communication Networks
    Open this publication in new window or tab >>Post Quantum Secure Handover Mechanism for Next Generation Aviation Communication Networks
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    2024 (English)In: IEEE Transactions on Green Communications and Networking, E-ISSN 2473-2400, Vol. 8, no 3, p. 939-955Article in journal (Refereed) Published
    Abstract [en]

    The L-band Digital Aeronautical Communications System (LDACS) is a key advancement for next-generation aviation networks, enhancing Communication, Navigation, and Surveillance (CNS) capabilities. It operates with VHF Datalink mode 2 (VDLm2) and features a seamless handover mechanism to maintain uninterrupted communication between aircraft and ground stations (GSs), improving safety and efficiency in air traffic management (ATM). However, LDACS’ handover process encounters significant security risks due to inadequate authentication and key agreement between aircraft and ground station controllers (GSCs) during handovers. This vulnerability threatens communications’ confidentiality, integrity, and authenticity, posing risks to flight safety and sensitive data. Therefore, developing and implementing a robust security framework to protect aviation communications is essential. In response, we have proposed a security solution specifically designed to protect LDACS handovers. Our solution uses a mutual authentication and key agreement mechanism tailored for LDACS handovers, ensuring robust security for all types of handovers, including Intra GSC - Intra Aeronautical Telecommunication Network (ATN), Inter GSC - Intra ATN, and Inter GSC - Inter ATN. Our approach utilizes post-quantum cryptography to protect aviation communication systems against potential post-quantum threats, such as unauthorized access to flight data, interception of communication, and spoofing of aircraft identity. Furthermore, our proposed solution has undergone a thorough informal security analysis to ensure its effectiveness in addressing handover challenges and offering robust protection against various threats. It seamlessly integrates with the LDACS framework, delivering low Bit Error Rate (BER) and latency levels, making it a highly reliable approach in practice.

    Place, publisher, year, edition, pages
    Institute of Electrical and Electronics Engineers (IEEE), 2024
    Keywords
    Aviation Network, Aviation Security, BIKE, FCI, LDACS
    National Category
    Electrical Engineering, Electronic Engineering, Information Engineering Communication Systems
    Identifiers
    urn:nbn:se:liu:diva-206859 (URN)10.1109/tgcn.2024.3417298 (DOI)001302503300012 ()
    Funder
    Wallenberg AI, Autonomous Systems and Software Program (WASP)Swedish Transport AdministrationEU, Horizon Europe, 101114635
    Note

    Funding Agencies|Trafikverket, Sweden; Luftfartsverket, Sweden; Wallenberg AI, Autonomous Systems and Software Program (WASP), Sweden; SESAR Joint Undertaking - European Union's [101114635]

    Available from: 2024-08-24 Created: 2024-08-24 Last updated: 2026-05-12
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  • Public defence: 2026-08-25 13:00 K3, Kåkenhus, NorrköpingOrder onlineBuy this publication >>
    Klar, Robert
    Linköping University, Department of Science and Technology, Communications and Transport Systems. Linköping University, Faculty of Science & Engineering.
    Digital Twins and Explainable AI for Decision Support in Port and Maritime Operations2026Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Ports are actively pursuing greater operational efficiency to handle the increasing global flow of goods, while simultaneously improving the energy efficiency of their operations to comply with new environmental regulations. As a result, innovation-leading ports have begun to recognize the potential of digital twins to monitor, coordinate, and optimize port processes, enabling energy savings and reductions in both costs and CO2 emissions. Although digital twins have gained significant momentum in other domains, such as smart manufacturing and aerospace, their adoption in ports remains challenging. This can be explained by the multi-stakeholder nature of ports and the high complexity of their interconnected processes, requiring decision-making across organizational boundaries.

    Grounded in the port context, this thesis examines what constitutes a digital twin, proposes a framework to assess the maturity of existing port digital twins, and develops modeling and explainable AI-enabled decision support components for port and maritime operations. These components span seaside, quay, yard, and gate processes and can serve as building blocks of future port digital twin implementations. The thesis consists of six papers:

    Paper 1 provides an in-depth literature review of digital twins across multiple domains and transfers insights from these to the port domain. The paper outlines how digital twins can enhance operational efficiency and support energy savings in ports. It also identifies the characteristics and design requirements that a port-specific digital twin must fulfill. Based on these findings, the paper proposes a tailored definition of a digital twin for the port domain.

    Paper 2 discusses how digital twins’ maturity can be assessed within six maturity levels and presents milestones for their implementation. Notably, Interoperability is identified as the highest maturity level,as the numerous stakeholders and their respective digital twins must work together to reach a coordinated system of systems performance. Using this assessment demonstrates that only a few innovation-leading ports have developed sophisticated digital twinning solutions so far.

    Paper 3 focuses on container retrieval, balancing two competing objectives: minimizing yard crane moves and adhering to tight truck scheduling. This reflects the conflicting perspectives of different stakeholders in the port context. The provided optimization model and heuristic algorithm demonstrate that addressing both problems simultaneously may result in reduced efficiency of the individual objectives. However, from a systems perspective, this approach leads to higher overall port efficiency.

    Paper 4 examines quay cranes at the system level by developing an explainable AI framework to predict whether a quay crane will experience a breakdown during vessel operations. Using monitoring data, operational data, and weather observations, the study identifies how operational intensity, hoist-related warning patterns, and environmental conditions jointly influence the likelihood of a breakdown. This system-level predictive capability enhances situational awareness and enables early identification of disruptions.

    Paper 5 builds on Paper 4 by focusing on the prediction of individual critical error events. Rather than assessing the overall likelihood of a breakdown, the model identifies which error type is likely to occur next and estimates its timing. Using eXtreme Gradient Boosting with lagged error sequences, operational data, and weather conditions, the study offers component-level insights that complement the systemlevel prediction in Paper 4 and support more targeted maintenance interventions.

    Paper 6 expands the perspective beyond ports by analyzing fuel consumption in inland ferry operations using GPS-derived trip legs and journeys enriched with environmental data. Combining unsupervised clustering to uncover operational patterns with supervised learning and SHAP-based explainability, the study identifies operational speed as the dominant driver of fuel consumption and links consumption patterns to individual captains’ driving behavior. This contributes to maritime decision-making by enabling targeted interventions such as eco-driving strategies.

    Together, these six papers contribute a conceptual grounding of port digital twins, provide a tool for their assessment, and provide modeling components to aid in port and maritime decision-making.

    List of papers
    1. Digital Twins for Ports: Derived From Smart City and Supply Chain Twinning Experience
    Open this publication in new window or tab >>Digital Twins for Ports: Derived From Smart City and Supply Chain Twinning Experience
    2023 (English)In: IEEE Access, E-ISSN 2169-3536, Vol. 11, p. 71777-71799Article in journal (Refereed) Published
    Abstract [en]

    Ports are striving for innovative technological solutions to cope with the ever-increasing growth of transport, while at the same time improving their environmental footprint. An emerging technology that has the potential to substantially increase the efficiency of the multifaceted and interconnected port processes is the digital twin. Although digital twins have been successfully integrated in many industries, there is still a lack of cross-domain understanding of what constitutes a digital twin. Furthermore, the implementation of the digital twin in complex systems such as the port is still in its infancy. This paper attempts to fill this research gap by conducting an extensive cross-domain literature review of what constitutes a digital twin, keeping in mind the extent to which the respective findings can be applied to the port. It turns out that the digital twin of the port is most comparable to complex systems such as smart cities and supply chains, both in terms of its functional relevance as well as in terms of its requirements and characteristics. The conducted literature review, considering the different port processes and port characteristics, results in the identification of three core requirements of a digital port twin, which are described in detail. These include situational awareness, comprehensive data analytics capabilities for intelligent decision making, and the provision of an interface to promote multi-stakeholder governance and collaboration. Finally, specific operational scenarios are proposed on how the ports digital twin can contribute to energy savings by improving the use of port resources, facilities and operations.

    Place, publisher, year, edition, pages
    IEEE-INST ELECTRICAL ELECTRONICS ENGINEERS INC, 2023
    Keywords
    Digital twin; IoT; smart city; smart port; supply chain
    National Category
    Computer Systems
    Identifiers
    urn:nbn:se:liu:diva-196955 (URN)10.1109/ACCESS.2023.3295495 (DOI)001035836900001 ()
    Available from: 2023-08-29 Created: 2023-08-29 Last updated: 2026-06-02
    2. Digital Twins' Maturity: The Need for Interoperability
    Open this publication in new window or tab >>Digital Twins' Maturity: The Need for Interoperability
    2024 (English)In: IEEE Systems Journal, ISSN 1932-8184, E-ISSN 1937-9234, Vol. 18, no 1, p. 713-724Article in journal (Refereed) Published
    Abstract [en]

    Digital twins have gained tremendous momentum since their conceptualization over 20 years ago, as more and more domains discover their value in driving efficiencies and reducing costs, while enabling technologies continue to advance. Originally aimed at product optimization and intelligent manufacturing, the range of applications for digital twins now spans entire complex, often highly interconnected systems such as ports, cities, and supply chains. Despite the increasing demand for sophisticated digital twinning solutions across all domains and scopes, their development is often still constrained by differing definitions, different understandings of their functional scope and design, and a lack of concrete methodology toward implementing a comprehensive digital twinning solution. Although there are already papers that evaluate the capabilities of existing digital twinning solutions on the basis of maturity levels, these usually consider the object to be twinned in isolation and are often domain-specific. With this article we address exactly this gap discussing how interoperability of digital twins can break physical boundaries of an isolated system, enabling system of systems joint optimization. We therefore consider interoperable digital twins to be the most mature twinning platforms, thus, we discuss in detail six digital twin maturity levels, departing from the interrelated contexts of ports, cities, and supply chains. Examples drawn from these domains demonstrate the need for interoperability toward optimizing processes and systems in realistic contexts, rather than in assumed isolation.

    Place, publisher, year, edition, pages
    IEEE-INST ELECTRICAL ELECTRONICS ENGINEERS INC, 2024
    Keywords
    Digital twin (DT) maturity; interoperability; smart cities; ports; supply chains
    National Category
    Computer Systems
    Identifiers
    urn:nbn:se:liu:diva-200262 (URN)10.1109/JSYST.2023.3340422 (DOI)001129770400001 ()
    Note

    Funding Agencies|Trafikverket Sweden as part of the Triple F (MODIG-TEK)

    Available from: 2024-01-19 Created: 2024-01-19 Last updated: 2026-06-02Bibliographically approved
    3. Container Relocation and Retrieval Tradeoffs Minimizing Schedule Deviations and Relocations
    Open this publication in new window or tab >>Container Relocation and Retrieval Tradeoffs Minimizing Schedule Deviations and Relocations
    2024 (English)In: IEEE Open Journal of Intelligent Transportation Systems, E-ISSN 2687-7813, Vol. 5, p. 360-379Article in journal (Refereed) Published
    Abstract [en]

    Ports are striving to improve operational efficiency in the context of constantly growing volumes of trade. In this context, port terminal storage yard operation is key, since complexity and poor coordination lead to containers stacked without consideration of retrieval schedules, resulting in time- and energy-consuming reshuffling operations. This problem, known as the block relocation (and retrieval) problem (BRP), has recently gained considerable attention. Indeed, there are promising solutions to the BRP. However, the literature views the problem in isolation, optimizing one operational parameter for one of the many port stakeholders. This often leads to efficiency losses since port processes involve different stakeholders and port parts. In this work, we explicitly focus on scheduling trucks for pick-up for hinterland distribution. Appointments are often postponed in order to minimize reshuffling operations, leading to losses for the transport forwarders and decreasing the competitiveness of the port. We discuss the trade-off between minimizing container reshuffling operations while maintaining scheduled time windows for container retrieval. We describe the multi-objective optimization problem as a weighted sum of the two objectives. Given the complexity of the problem, we also present a greedy heuristic. Our results indicate that the number of schedule deviations can be reduced without significantly affecting the number of relocations compared to solutions that consider only the latter. Ideally, a weighting of 0.4 and 0.6 should be applied, reflecting schedule deviations and relocations, respectively, to achieve the highest joint optimization potential. This demonstrates that in complex environments, such as ports, with multiple interacting stakeholders and processes, coordination of solutions yields significant benefits.

    Place, publisher, year, edition, pages
    IEEE-INST ELECTRICAL ELECTRONICS ENGINEERS INC, 2024
    Keywords
    Containers; Seaports; Stacking; Logic gates; Stakeholders; Schedules; Container relocation problem; ports; optimization; digital twins; schedule deviations; schedule deviations
    National Category
    Computational Mathematics
    Identifiers
    urn:nbn:se:liu:diva-206956 (URN)10.1109/OJITS.2024.3413197 (DOI)001276383900002 ()
    Note

    Funding Agencies|Trafikverket Sweden as part of the Triple F (MODIG-TEK) Project [2019.2.2.16]

    Available from: 2024-08-27 Created: 2024-08-27 Last updated: 2026-06-02
    4. Understanding and predicting quay crane breakdowns using explainable AI
    Open this publication in new window or tab >>Understanding and predicting quay crane breakdowns using explainable AI
    2026 (English)In: MARITIME TRANSPORT RESEARCH, ISSN 2666-822X, Vol. 10, article id 100152Article in journal (Refereed) Published
    Abstract [en]

    Quay cranes (QCs) play a vital role in ship-to-shore operations, enabling the seamless transfer of cargo between sea and land. However, increasing trade volumes require faster and more costeffective container handling, exerting significant pressure on QCs and leading to greater wear on critical components such as wires, hoists, and rope clamps. While operations research has explored maintenance scheduling to improve terminal performance, comparatively little work has examined how machine learning can exploit the growing volume of QC monitoring and operational data to predict breakdowns before they occur. This study contributes to this area by integrating terminal operations data, QC monitoring logs, and meteorological observations into a unified analytical framework. We employ explainable artificial intelligence (XAI), using both global and local SHapley Additive exPlanations (SHAP) to identify the operational and environmental factors most strongly associated with QC failures and to illustrate concrete, instance-level examples of how specific conditions contribute towards breakdowns. In parallel, we develop a robust machine learning pipeline built around nested cross-validation to assess the predictive capability of multiple classifiers for forecasting QC breakdowns. Our XAI analysis reveals that breakdown risk is closely linked to QC working time, the distribution of moves across simultaneously operating QCs, hoist overload and trolley alignment warnings, and adverse weather conditions. Among the evaluated models, LightGBM achieved the highest predictive accuracy, reaching up to 83% in identifying breakdown-prone scenarios. These findings demonstrate the feasibility and value of data-driven predictive maintenance for QCs, providing insights that support safer, more reliable, and more efficient terminal operations.

    Place, publisher, year, edition, pages
    ELSEVIER, 2026
    Keywords
    Quay cranes; Container terminal operations; Breakdown prediction; Predictive maintenance; Machine learning; Explainable artificial intelligence (XAI); Port performance
    National Category
    Other Civil Engineering
    Identifiers
    urn:nbn:se:liu:diva-224236 (URN)10.1016/j.martra.2026.100152 (DOI)001768973200001 ()2-s2.0-105038341249 (Scopus ID)
    Note

    Funding Agencies|Trafikverket Sweden [2019.2.2.16]

    Available from: 2026-05-26 Created: 2026-05-26 Last updated: 2026-06-02
    5. Predicting Error Types and Timing in Quay Crane Operations with eXtreme Gradient Boosting
    Open this publication in new window or tab >>Predicting Error Types and Timing in Quay Crane Operations with eXtreme Gradient Boosting
    2026 (English)In: Proceedings of the 20th Annual IEEE International Systems Conference, 2026Conference paper, Published paper (Refereed)
    Abstract [en]

    Efficient port operations depend on the disruption free operation of quay cranes (QCs), which transfer containers between vessels and internal trucks. As global container through put rises, QCs face increased pressure, resulting in accelerated wear and tear. This can lead to QC downtime, which could interrupt the entire chain of port operations. Therefore, timely identification and prediction of critical errors is essential to enable timely maintenance to lower the risk of downtime. This study utilizes two years of QC monitoring data, enriched with weather conditions and terminal operational context, alongside twenty critical error events identified by the terminal operator. The goal is to predict the occurrence and timing of these critical errors through a three-stage machine learning model. The first stage predicts the type of the next critical event based on historical error patterns, warnings, and contextual data. The second stage estimates a time window in which the event will occur. The third stage refines timing predictions when more than one hour remains. The first two stages are formulated as multiclass classification problems, and the third as a regression task. All stages utilize eXtreme Gradient Boosting (XGBoost). SHapley Additive exPlanations (SHAP) are used to identify influential features. Results show that the model predicts the next critical error type with 83% accuracy and its immediacy with 71% accuracy. However, approximating the timing of events anticipated to occur beyond one hour remains challenging. These findings support proactive maintenance planning and operational adjustments, helping port operators mitigate disruptions and enhance QC reliability.

    Keywords
    eXtreme Gradient Boosting (XGBoost), Machine Learning, Predictive Maintenance, Quay Cranes, Resilient Port Operations
    National Category
    Transport Systems and Logistics
    Identifiers
    urn:nbn:se:liu:diva-223585 (URN)
    Conference
    20th Annual IEEE International Systems Conference (SYSCON 2026), Halifax, Canada, April 6-9, 2026.
    Funder
    Swedish Transport Administration
    Note

    Research funding provided by The Swedish Transport Administration through the Triple F project MODIG-TEK (2019.2.2.16). 

    Available from: 2026-05-05 Created: 2026-05-05 Last updated: 2026-06-02
    6. Fuel efficiency in ferry services: GPS-based clustering and explainable AI
    Open this publication in new window or tab >>Fuel efficiency in ferry services: GPS-based clustering and explainable AI
    2026 (English)In: Transportation Research Part D: Transport and Environment, ISSN 1361-9209, E-ISSN 1879-2340, Vol. 157, article id 105403Article in journal (Refereed) Published
    Abstract [en]

    Enhancing fuel efficiency in ferry operations is essential for reducing emissions and advancing maritime sustainability. This study presents a data-driven framework that uses second-level GPS data enriched with operational and environmental variables to identify and explain fuel consumption patterns. Vessel movements are segmented into trip legs and journeys, and operational metrics such as speed, wind exposure, and fuel use are computed. A hybrid machine learning approach combines unsupervised clustering to detect recurring operational patterns with gradient boosting models and explainable methods to quantify feature impacts. The framework achieves strong performance, with a cluster classification accuracy of 94 percent and a coefficient of determination of 0.97 for fuel prediction. Results indicate that operational speed is the dominant driver of fuel consumption, while analysis of captain assignments reveals the influence of human factors. The proposed framework provides actionable insights for speed management and operational optimization, enabling cost-effective emission reductions in ferry services.

    Place, publisher, year, edition, pages
    PERGAMON-ELSEVIER SCIENCE LTD, 2026
    Keywords
    Fuel efficiency; Ferry operations; Maritime sustainability; Explainable artificial intelligence; Extreme gradient boosting; Hierarchical density-based clustering
    National Category
    Transport Systems and Logistics
    Identifiers
    urn:nbn:se:liu:diva-224247 (URN)10.1016/j.trd.2026.105403 (DOI)001765014200001 ()2-s2.0-105037879285 (Scopus ID)
    Note

    Funding Agencies|Interreg Central Baltic Programme [CB0300186]; European Union [CB0300186]; Trafikverket Sweden, Triple F (MODIG-TEK) [2019.2.2.16]

    Available from: 2026-05-26 Created: 2026-05-26 Last updated: 2026-06-02
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