Background: All patients seeking emergency care or admitted to hospital need to be assessed and often monitored over a period. Vital functions are assessed at the bedside with technical equipment and clinical judgement. A commonly performed test, the capillary refill test (CRtest), is supposed to assess circulatory function. The test is performed by pressing the examiners’ index finger onto the patient skin, often for 5 seconds, then rapidly remove the finger and watch the skin regain its original colour as it was before the blanching pressure was applied. The time it takes is called the capillary refill time (CRtime) and less than 2-3 seconds have been recommended as normal, and times longer than that as a sign of circulatory compromise. The CRtest, despite widely used, has been questioned due to its subjectivity, and uncertainty of the test’s external validity.

Objectives: The purpose of the study in Paper I was to investigate the repeatability of the CRtest, In Paper II, inter- and intra-observer reliability of the test was investigated, In Paper III, the outcome of the test in a blood loss shock model was investigated. The relationship between the changes in microcirculation to the CRtime in a blood loss shock model was investigated in Paper IV.

Methods: In Paper I, CRtests were performed on study subjects on the sternum, the forehead and the finger, in series of 2 and 5 minutes apart. Objectively quantified CRtime, (qCRtime), was obtained through polarized reflectance imaging and a software program. In Paper II, CRtests were performed on pediatric patients in an emergency department and video filmed, and qRCtimes were obtained. The video films were shown to health care staff in a pediatric clinic, and the staff was asked to assess CRtime with naked eye. In Paper III, healthy volunteers were subjected to lower body negative pressure, (LBNP), in a blood loss shock model and CRtests performed and qCRtimes obtained. In Paper IV, the qCRtimes from the healthy study subjects in the LBNP model were compared with simultaneous changes in perfusion, measured as speed resolved perfusion reflecting flow in different vessels, and tissue oxygenation was also measured.

Results: In Paper I, there were no statistical differences in qCRtime in a series of CRtests, regardless of when in the series the test was performed. In Paper II, naked eye assessment of CRtimes in children showed poor reproducibility in pediatric nurses and pediatricians, as well as in comparison to qCRtimes. In Paper III, in a blood loss shock model, qCRtimes shortened statistically significantly. In Paper IV, the shortened qCRtimes in Paper III, correlated to a decrease in perfusion and in tissue oxygenation as well as reduced flow in the smallest vessels.

Conclusion: The CRtest shows good repeatability, but the test, as it is commonly performed in clinical practice with naked eye assessment, could be questioned for its lack of reproducibility. The CRtest also shows shortening of qCRtime in a blood loss shock model, contradictory to previously believed. The shortening of qCRtime is associated with changes in perfusion. Objective methods for quantification of CRtime with biooptical imaging techniques, as in these studies with polarized reflectance imaging, is valuable in the study of the CRtest and changes in perfusion in provocations and hemodynamic stress.

Background

This thesis investigates the multifaceted experiences and outcomes associated with childhood functional constipation, a condition that significantly affects children’s health and family life. Drawing on one quantitative and three qualitative studies, the research provides an increased understanding of how children and families navigate the challenges of diagnosis, treatment, and daily life with a child suffering from functional constipation.

Aim

The overall aim was to inform a more child- and family-centred perspective to functional constipation care by exploring the experiences of parents and children, and to evaluate a clinical treatment programme.

 Methods

Study I is a retrospective cohort review of medical records with pre-post intervention measurements. Children participating in a structured bowel management programme in a secondary outpatient clinic between 2015 and 2022 were recruited. Clinical variables were compared between the recovered and the unrecovered groups to identify predisposing characteristics and predictive factors for recovery.

Studies II and III have a qualitative design, presents interviews with parents about their experiences of having a child with constipation and of giving treatment at home. The same data set of 15 parents were used for both studies. The Reflective Lifeworld Research approach originating from phenomenology was used during analysis.

Study IV, also qualitative, presents interviews with 20 children aged between 6 and 14 about their experiences of having constipation and receiving treatment. Reflexive thematic analysis was used during analysis.

Findings

The first study demonstrates significant improvements in bowel function and symptom relief among children following the intervention. Structured care helped 44% of therapy-resistant children to reach cure or self-management abilities within six months. The study underscores the value of integrating clinical protocols with family education and support.

The second study reveals how childhood constipation disrupts family routines, emotional well-being, and social interactions as treatment support requires considerable attention and strength. Parents report feelings of frustration, helplessness, and isolation, often compounded by limited support from healthcare professionals. The findings highlight the need for more empathetic child and family-centred care strategies.

The third study uncovers the emotional and practical challenges involved in managing medication routines, feelings of abuse and inadequacy, while trying to maintain adherence. The study emphasises the importance of clear communication and sustained support to empower parents in their caregiving roles because they might question their parental identity.

The fourth study presents the child’s perspectives on functional constipation with associated treatments. It presents a close and realistic narrative of procrastination of toilet visits, fear of exposure of leakage in social situations, rectal enemas as both awful and relieving, and hope, while striving for control.

Conclusions

Together these studies offer a holistic understanding of childhood functional constipation, bridging the gap between clinical outcomes and family experiences. Families deal with physical symptoms, psychological defences, fear of social judgment, and struggles with treatment. This thesis offers actionable insights for children, parents, clinicians, and researchers to improve the quality of constipation care for children and their caregivers.

In recent decades, most Western countries have experienced a religious decline, reflected in shrinking membership in religious organizations. Explanations of this decline have primarily emphasized individual-level predictors of joining or leaving religious organizations or broad macro-level processes such as modernization. Missing from this picture is the meso-level: the social context and networks in which individuals are embedded in. Attending to this level is crucial to understand not only how individuals make decisions in response to their social environment, but also how these interdependent behaviors aggregate into broader patterns of organizational growth and decline dynamics. To address this gap, this dissertation examines how joining and leaving a religious organization are shaped by the behavior of others, that is, by social influence, and how these micro-level processes generate organizational growth or decline. This is investigated in three essays, all using the Church of Sweden as the empirical case and analyzing full-population Swedish register data by combining conventional statistical approaches with machine-learning techniques and computational simulation methods. 

Essay I, co-authored with Peter Hedstrom, analyzes how exposure to leavers shapes membership dynamics in the Church of Sweden. Using Swedish full-population register data from 2002 to 2023 and a dynamic matched-sample design, the analysis shows that exposure to leavers increases the likelihood of leaving the Church of Sweden. However, this effect is moderated by how deeply socially embedded an individual is in the Church, being particularly strong among individuals with few social ties to other members. To explore how these dynamics shape collective membership trajectories, an empirically calibrated agent-based simulation model is used. The simulation results suggest that social influence has amplified the overall decline in membership of the Church of Sweden, but also that the decline would have been even steeper in the absence of religious embeddedness. The essay demonstrates how, and under what conditions, social influence shapes individual decisions to leave and what implications this has for the broader organizational decline of the Church of Sweden. 

Essay II analyzes how exposure to religious pluralism through social ties shapes parents’ decisions to baptize their children in the Church of Sweden. Using Swedish full-population register data on all parents with children born between 2002 and 2022, network-based measures of religious pluralism are constructed, and an inverse probability weighting design is used to estimate the effect of exposure to religious pluralism. The results show that exposure to religious pluralism decreases the likelihood of baptism, with particularly strong effects under religious cross-pressure (when parents differ in religious affiliation) and especially when the father has another affiliation. The essays highlight how social networks shape the intergenerational transmission of religious behavior, providing a meso-level perspective on the link between religious pluralism and religious participation. 

Essay III examines how individuals’ social ties to other church members shape their susceptibility to the Church of Sweden’s membership fee. Using full-population register data from 2001 to 2023, the analysis shows that higher fees increase the risk of leaving the Church of Sweden, but that this effect is weaker for individuals with many social ties to other church members. To explore how these micro-level dynamics shape collective membership trajectories, an empirically calibrated agent-based simulation model is used. The simulations show that while church fees contributed to membership decline, religious embeddedness dampens this effect overall while simultaneously reinforcing spatial differences in affiliation. Together, these findings demonstrate that social networks shape when and for whom costs affect religious participation, and that this micro-level heterogeneity has large consequences for the collective patterns of religious participation. 

Together, the three essays show that social influence is crucial for understanding the membership dynamics of religious organizations. In doing so, the dissertation demonstrates how micro-level interactions and their social interdependencies aggregate into the collective patterns of religious decline and secularization. 

The training of machine learning (ML) models usually requires an extensive amount of data. Nowadays, the ever-increasing number of connected user devices has benefited the development of ML algorithms by providing large sets of data that can be utilized for model training. As the society has become more aware of user privacy, using private data from user devices for training ML models becomes more restricted. Therefore, federated learning (FL) with on-device information processing has been proposed for its advantages in preserving data privacy. FL is a collaborative ML framework where multiple devices participate in training a common global model based on locally available data. Unlike the centralized ML architecture wherein the entire set of training data need to be centrally stored, in an FL system, only model parameters (or model updates) are shared between user devices and a parameter server.

We focus on FL deployed at the wireless edge, namely, information exchanges in FL are over wireless networks. There are two major challenges for the considered FL setup: stringent communication resources, and non-independent-and-identically distributed (non-i.i.d.) data. Since the information exchange between different entities takes place over wireless networks, the resource limitation therein affects how many devices can participate in the training and how much information can be reliably communicated in each round of the FL process. One common approach to reduce communication load is partial device participation, allowing only a subset of devices to transmit model updates in every round. The design of scheduling policies is critical for ensuring efficient collaborative training under limited communication resources. On the other hand, data heterogeneity introduces objective bias to the course of model evolution. This differentiates FL from the standard distributed ML frameworks where training data are homogeneously distributed. Federated Averaging (FedAvg) is one of the most representative and baseline FL algorithms, with an iterative process of model broadcasting, on-device training, and model aggregation. One well known issue of FedAvg is the straggler effect. Specifically, in every iteration, the model aggregation process takes place only when all the devices have finished local training. As a result, the duration of one iteration is limited by the slowest device.

To resolve the straggler issue commonly observed in synchronous FL methods, a paradigm shift to asynchronous FL has been explored in the literature; that is, local devices perform local training and updating in an asynchronous manner without system-wide model synchronization. However, the existing asynchronous FL methods incur frequent information exchange and large model variation. To address these issues, in Paper A, we propose a new asynchronous FL framework with periodic aggregation and develop channel-aware data-importance-based device scheduling policies, which are theoretically motivated by the convergence analysis of the proposed FL design. In addition, an age-aware aggregation weight design is proposed to deal with the model update asynchrony among scheduled devices. The effectiveness of the proposed scheme is empirically verified in terms of alleviating the straggler effect and achieving better learning performance compared to the state-of-the-art methods.

In Paper B, we consider Federated Edge Learning (FEEL), where in addition to the heterogeneity in data and wireless channel conditions, heterogeneous computing capability and energy availability are also additional factors that are taken into account in the algorithm design. Under such premises, we aim to develop a dynamic scheduling and resource management design via jointly optimizing system efficiency and learning performance. Besides, instead of assuming that all the local data are available at the beginning of the entire training process, a more practical scenario where the training data are generated randomly over time is considered. To develop a dynamic scheduling and resource allocation algorithm, we formulate a stochastic network optimization problem with a long-term objective and constraints and solve it using the Lyapunov drift-plus-penalty framework. The proposed algorithm makes adaptive decisions on device scheduling, computational capacity adjustment, and allocation of bandwidth and transmit power in every iteration. We provide the convergence analysis for the considered setting with heterogeneous data and time-varying objective functions. The effectiveness of our scheme is verified through simulation results, demonstrating improved learning performance and energy efficiency as compared to baseline schemes.

Finally, most previous research on communication efficiency in FL has focused on the uplink (UL) transmission (from devices to server), whereas the downlink (DL) (from server to devices) has been relatively less investigated. In standard FL, the server broadcasts the global model to the devices in every iteration. Applying differential coding to the global model dissemination can save communication resources. However, devices may occasionally miss differential updates due to wireless link failures and thus fail to reconstruct the model. Consequently, they will continue local training based on an outdated model, or remain idle, until the next full-model broadcast is available. To address this issue, in Paper C we propose a mixed-timescale differential coding (MTDC) scheme that performs differential coding hierarchically at two different levels. With MTDC, between two full-model broadcasts, a device can reconstruct the latest model if missing an update. We provide a convergence analysis, which motivates the design of an age-aware version of the MTDC, and a device scheduling policy for improving communication efficiency. In simulation results, the proposed MTDC schemes deliver superior learning performance compared to baseline methods with similar communication resource budgets and in the presence of device decoding failures.

Parkinson's Disease (PD) is among the most prevalent neurodegenerative diseases, primarily recognized for its motor symptoms. However, PD also encompasses debilitating non-motor symptoms (NMS), such as olfactory dysfunction and memory decline, both strongly associated with cognitive deficit. As the disease progresses, combined with long-term oral levodopa therapy, patients experience frequent and unpredictable motor fluctuations, marking the so called "complication phase". At this phase, device-aided Parkinson therapy (DAPT), which provides continuous dopaminergic stimulation, can effectively restore motor control. Despite its efficacy, some patients exhibit increased apathy and cognitive decline following DAPT, highlighting the need for new markers of cognitive decline in PD before DAPT selection.

The objectives of this thesis are: (1) to explore dynamic functional connectivity (dFC) underlying olfaction and memory processes, with a particular emphasis on episodic odor memory, and (2) to map hippocampal dFC patterns during task-based and resting-state conditions and assess their implications for olfactory function and declarative memory in individuals with PD, awaiting evaluation for DAPT.

By using independent component analysis and k-means clustering as main methodological approaches in this thesis, data analysis relied minimally on theoretical assumptions and was predominantly explorative and data-driven. Study I identified an overlapping neural network encompassing regions of the olfactory cortex engaged during passive smelling, odor encoding and odor recognition memory (ORM). A distinct ORM-related network involving the hippocampus exhibited delayed reactivity. Moreover, successful recognition of previously encoded odors was associated with neuronal suppression. Study II revealed that four hippocampal networks were sequentially activated during ORM. One network, incorporating regions of the dorsal attention network, showed shorter and less frequent activations, along with reduced asymmetric hippocampal activity (AHA), a pattern linked to impaired successful ORM in PD. Study III uncovered two resting-state hippocampal networks that distinguish individuals with PD from healthy controls. The first network, involving occipitoparietal regions and the cerebellum, exhibited shorter activations, whereas the second network, including regions of the central executive network, showed less frequent activations in PD. Individuals with PD who demonstrated reduced AHA within these networks, exhibited a general trend toward deficit in semantic odor memory and auditory-verbal memory.

Taken together, ORM not only engages primary olfactory regions but also recruits higher-order cognitive areas such as the hippocampus. Individuals with PD exhibit shorter and less frequent activations of specific hippocampal networks, along with reduced AHA, both during episodic olfactory memory task and at rest. These hippocampal dFC patterns are associated with deficits in declarative odor memory and auditory-verbal memory, suggesting their potential as markers of cognitive decline in PD, particularly prior to the selection of DAPT. Nevertheless, longitudinal studies with larger, more diverse, and well-characterized cohorts are essential before these markers can be translated into clinical practice.

Background

In a mass casualty incident (MCI), sudden patient surges can overburden the health system and cause material and human resource limitations, as well as challenges in adapting systems and structures to the changed needs. This leads to an increased risk of avoidable patient morbidity and mortality. Low-resource countries bear the brunt of the global trauma and disaster burden, and, although not formally assessed, are more likely to be more frequently exposed to MCIs. The ability to adequately manage a sudden patient influx is called “surge capacity”, and can be measured using the 4S-Framework, which assesses the dimensions staff, stuff, systems, and space. However, current MCI research primarily originates from high-resource settings, with uncertain generalizability to low-resource settings.

Objectives

This thesis aimed to increase the understanding of MCI epidemiology in Rwanda, including at the incident level (event type, location, and timing) and at the patient level (injury patterns, patient outcomes, treatment provided) (studies I and IV). Secondly, this thesis aimed to assess the surge capacity to manage mass casualty incidents in Rwanda (studies II, III, and IV), and to develop a knowledge base for future surge capacity strengthening efforts.

Materials and Methods

This thesis employed multiple study designs and analysis methods. Study I was a pilot study for a new data collection method (the media review), based on a scoping review methodology using a database of news items. Study II was a qualitative study with semi-structured interviews with trauma care responders, which were analyzed using qualitative content analysis. Study III was a cross-sectional survey study of surge capacity perceptions with clinical department leaders at Rwanda’s leading trauma hospitals. Study IV was a retrospective study of routine prehospital data from emergency medical services (EMS). Studies I, III, and IV utilized descriptive statistics and parametric and non-parametric hypothesis tests for group comparisons. Study III additionally utilized analysis of one-way variance to assess intra-class correlation between respondents from the same hospital, and study IV utilized mixed-model analysis based on logistic and linear regression to evaluate the role of confounders in EMS MCI dispatch.

Main results

Studying MCIs and surge capacity in Rwanda is challenged by the lack of appropriate registers, the sudden onset of events, and resource limitations. In Rwanda, the media review demonstrated extensive reporting on the number of injured victims, on-site deaths, and the geographic location of the MCI, indicating that this method can be used as a complementary method to assess epidemiological patterns in MCIs in the absence of trauma registers.

Rwanda has a high MCI exposure, with road-traffic accidents being the most frequent, but natural hazards appear to be on the rise. The majority of mass casualty incidents are small to moderately sized. MCIs are managed at all levels of the health system.

Perceived surge capacity to manage low- to moderately sized mass casualty incidents is high in Rwanda. Trauma care responders attribute this to the wealth of real-life experience in MCI management and having a supportive team. The successful resolution of dilemmas during MCIs can lead to positive effects such as self-confidence, teambuilding, and personal or professional growth. Surge capacity is higher in tertiary “level 1” hospitals, located in urban areas. There are specific challenges in the Rwandan context, primarily resource and staff shortages, as well as limited EMS coverage in rural areas, that limit the generalizability of surge capacity paradigms from high-income countries.

In formal assessment, surge capacity is limited in all 4S-domains metrics, including low levels of disaster plan uptake and limited awareness of existing plans. Formal surge capacity routines are also limited in the pre-hospital setting. Yet, Rwandan trauma care workers and emergency medical services utilize surge capacity strategies, including patient distribution to multiple facilities, on-site patient EMS treatment to reduce hospital referrals, and patient co-transportation. However, MCIs in rural areas are less likely to be managed by formal EMS. Viewed in the light of limited in-hospital surge capacity in rural areas, rural patients are likely at higher risk of poor outcomes in mass casualty incidents in Rwanda.

Conclusions

Despite limited formal disaster planning and routines, Rwanda appears to have developed a strong surge capacity to manage small- to moderately sized mass casualty incidents organically. However, there are limitations to surge capacity and areas for improvement in all 4S-domains, including staff, stuff, systems, and space, especially in rural areas. Trauma systems and emergency medical services need further development to ensure adequate surge capacity.

This thesis examines the shift towards temporary protection for refugees in Sweden since 2016 and its implications for access to permanent residency and family reunification. Situated at the intersection of welfare law and critical border studies, the thesis conceptualises this shift and its implications in terms of ‘temporary legality’: a prevailing condition of asylum marked by legal conditionality and protracted deportability. Drawing on research on borders, racialisation, and neoliberal welfare reforms, it analyses how spatial, temporal, and racial dimensions converge in shaping this condition.

The thesis examines residence-permit requirements tied to housing and education to show how such requirements function as internal borders that are negotiated across and within municipalities, revealing how migration law is enacted through welfare institutions. Methodologically, it adopts a socio-legal lens to trace migration law beyond the Migration Agency and the courts into welfare sites, foregrounding the municipality as a bordering space. The analysis draws on 31 interviews with welfare practitioners, local politicians, and civil society actors, complemented by policy documents, court cases, and press material.

The analysis shows clearly that temporary legality produces a fluctuating space between legality and illegality, delegated to welfare practitioners to regulate. In such a space, municipal discretion, enacted through local policies and everyday practices, contests, cushions, or exacerbates migration law, generating locally differentiated status trajectories for individuals in need of protection. It is within such a condition, the thesis argues, that residence-permit requirements operate as internal borders, producing uneven and racialised access to welfare rights, family reunification, and permanent status. That is, by governing asylum through temporary legality, the Swedish state creates protracted forms of uncertainty and differentiates and dismantles the right to asylum.

This thesis analyzes the design and effects of carbon pricing in the national and international freight transport sector, with a particular focus on maritime shipping. It brings together four papers that examine both short- and long-term behavioural responses and welfare effects of carbon pricing. The responses studied include reductions in sailing speed, changes in freight demand, investments in research and development (R&D) and learning-by-doing to reduce abatement costs through technological development, abatement of carbon emissions (e.g. alternative fuels), modal shifts, and adjustments in shipment sizes. The thesis also investigates the role of international cooperation and the incentives created by unilateral carbon pricing and carbon-intensity limits on marine fuels.

The first paper investigates short-run responses in the shipping sector and shows that ships reduce their sailing speed when fuel costs increase, indicating that carbon pricing can lower emissions even in the short run. The second paper studies carbon pricing in international shipping under the constraint that participating countries should be better off with the policy than without it. The results suggest that bilateral agreements can reduce emissions when countries differ in their willingness to pay, though their effectiveness is limited in static settings with high abatement costs. The third paper extends this analysis by considering the dynamic effects of unilateral carbon pricing. It shows that such policies can foster investments in research and development, thereby lowering future abatement costs and increasing the likelihood that other regions will adopt complementary policies.

The fourth paper broadens the perspective beyond shipping sector. Using a calibrated mode- and route-choice model for domestic freight transport in Sweden, it examines the welfare-optimal internalization of external costs from carbon emissions, air pollution, accidents, noise, and infrastructure. Internalizing external costs increases shipment sizes and shifts freight from waterborne and road transport to rail. However, the effects are modest, implying that the potential for large-scale modal shift from road to rail or waterborne transport is limited.

In summary, the thesis shows that reducing carbon emissions in the shipping sector is challenging for two main reasons: abatement is very costly, and reductions in freight volumes entail welfare losses. Moreover, shipping is an inherently international sector, where efficient carbon pricing would need to be globally coordinated, but this is hampered by large differences in the willingness to price carbon emissions across countries.

Overcoming these difficulties, the thesis underlines the importance of accounting for both short- and long-term behavioral responses, the role of international cooperation, and the dynamic incentives created by unilateral policies. The thesis is relevant for policymakers seeking to align maritime and freight transport policy with broader climate and welfare objectives.

Development and grade dialogues are recurring meetings, central for both educational governing and students’ perceptions of themselves and their abilities. This thesis examines development and grade dialogues with students who receive grades in Years 4–6. The aim is to contribute to knowledge about the actions of students, teachers and parents in these meetings and their implications for students and school. The focus is on how these dialogues shape students within a performativity-driven school system. The research questions address how narratives are formed, how students are positioned, how national assessment policies and local conditions interact, and how notions of students are constructed in relation to broader educational goals. The thesis uses an interaction-oriented narrative approach combined with perspectives on positioning, policy enactment and performativity. The data consists of audio recordings of development and grade dialogues in five schools, analysed through positioning analysis. The included articles show how participants (I) construct narratives about students’ paths, (II) negotiate expectations about students’ verbal participation and (III) construct grades as an emotional concern. The findings are discussed using the concepts of individualisation and temporality, illustrating how the students’ responsibility and progress are negotiated, understood and valued over time. The thesis also introduces the concepts of student performativity and assessment narratives. Student performativity refers to expectations for students to present themselves as responsible and strategic in line with school objectives. Assessment narratives demonstrate how participants, in interaction with assessment policies, form stories about students and their performance. The thesis demonstrates that development and grade dialogues function as mechanisms that can stabilise, challenge or negotiate assessment narratives, shaping how students understand themselves and their abilities in school. 

This thesis investigates the interplay between calculative practices and eco-innovation, examining both how calculative practices adapt to emerging eco-innovations and how they, in turn, enable or constrain their development. Eco-innovation involves creating solutions that deliver value while reducing environmental impacts across their lifecycle, thereby challenging conventional understandings of value creation and assessment. Developing such innovations requires the reshaping of calculative practices so that new forms of value, cost, and impact can be defined, measured, and made visible. By selecting, quantifying, and valuing particular dimensions of eco-innovation, calculative practices do more than represent these innovations—they actively participate in shaping them. Drawing on performativity theory, this thesis analyses the active role of calculative practices in constituting eco-innovation.

The thesis is based on four papers: a literature review, two papers drawing on action case studies, and one based on an interview study. The findings suggest that calculative practices adapt to eco-innovation by integrating the shifts in value creation it introduces. This implies embracing a value-based approach, accounting for solution-level cost impacts, adopting life-cycle costing from suppliers’ and customers’ perspectives, accounting for hidden costs that make sustainable value visible, and incorporating environmental costs and externalities. The results further suggest that calculative practices for managing eco-innovation adapt by taking an outside-in approach, including the use of target costing to reduce uncertainties and enhance customer value creation. While adapting calculative practices is necessary for making eco-innovation outcomes visible, their performative influence relies on existing conditions. The thesis develops a dual process indicating that the performative effects of calculative practices depend on the dynamics between supporting and hindering conditions. When supporting conditions prevail, calculative practices enable eco-innovation. These include collaboration with stakeholders, availability of guidelines, education, strategic commitment, and regulatory pressure. However, when hindering conditions dominate, calculative practices constrain eco-innovation. Such conditions include short-term logic, uncertainties about long-term value, and measurement challenges. The thesis contributes to management accounting and innovation management by explaining how calculative practices perform to make eco-innovation visible and offers a framework illustrating mechanisms through which calculative practices enable or constrain eco-innovation.

Despite decades of scientific consensus on anthropogenic climate change, global mitigation efforts remain insufficient to curb its escalating impacts on nature and human societies. Effective climate change mitigation requires engagement across multiple levels – from policy and technological innovation, to large-scale shifts in individual behavior. Research over the past decade suggests that one reason individual behavior change has had limited impact is that people often choose actions with low objective mitigation potential. While many individuals engage in pro-environmental actions, these are often low-impact behaviors (low CO₂ reduction), whereas high-impact behaviors (high CO₂ reduction) remain largely unchanged.

This thesis operationalizes the limited adoption of high-mitigation behaviors as a manifestation of “impact neglect” – a phenomenon shaped by both low carbon numeracy (i.e., limited knowledge about the relative mitigation potential of different actions), as well as psychological and structural barriers associated with high-impact behavioral shifts. This research identified mental imagery as an underexplored intervention within the field of behavioral science for climate change mitigation. Drawing on evidence from research in memory, athletic performance, and clinical interventions, this research proposed that mental imagery may address both facets of impact neglect: by enhancing the learning and retention of objective mitigation potential (i.e., improving carbon numeracy), and by lowering psychological barriers, thereby increasing motivation to engage in high-impact pro-environmental behaviors.

The first two papers in this thesis tested the effect of simulated mental imagery on psychological determinants for climate change behaviors. Support was found for a causal relationship between mental imagery of climate change-related risk events (i.e., wildfire), affective valence, and global perceived risk of climate change. Furthermore, combining mental imagery with information about mitigation potential, in a feedback format, lead to a significantly larger increase in pro-environmental intention, when compared to only receiving the information feedback. However, mental imagery increased the impact belief (i.e., perceived mitigation potential) globally, thus not necessarily increasing carbon numeracy, whereas feedback by itself led to more correct impact beliefs.

Lastly, this research examined spontaneous mental representations of climate change – including both mental images and verbal thoughts – and tested how these representations were related to psychological determinants of climate action and policy support. Using structural topic modeling, certain types of spontaneous representations were identified as systematically associated with pro-environmental outcomes. Representations that were more emotionally charged, negatively valenced, and emphasized long-term consequences were linked to a pro-environmental profile. In contrast, representations that were vaguer, more detached, and reflected prototypical or media-reproduced content were associated with lower levels of pro-environmental engagement.

Drawing on literature from mental imagery and pro-environmental behavior, together with the empirical findings from the three studies in this thesis, the Imagery–Behavior Feedback Model was created – a conceptual framework outlining paths through which mental imagery may influence behavior. The findings presented here provide initial support for several paths of the model: first, that spontaneous mental representations were meaningfully related to pro-environmentalism; and second, that simulated mental imagery could evoke experiences that lead to updated psychological determinants of action.

Furthermore, the empirical evidence suggests several underlying mechanisms through which mental imagery may reduce impact neglect: (1) increasing the availability of relevant information, (2) enhancing perceived behavioral control, (3) strengthening the perceived value of acting, and (4) supporting risk-related deliberation. Future research should endeavor to test these mechanisms and the feasibility of the Imagery–Behavior Feedback Model.

Background

Surgery may be the only chance for curative treatment of liver tumors and ensuring long-term survival. The extent of major liver resection is limited by the volume of liver parenchyma remaining after surgery. When the remaining liver volume is too small, the patient is at risk of posthepatectomy liver failure, which is a highly feared complication after extensive hepatic resection. In attempts to avoid posthepatectomy liver failure, hypertrophy of the future liver remnant can be induced before surgery. The aim of this thesis is to provide new and/or greater insights, along with possible benefits, problems and limitations, of the materials, methods, and measurements used for portal vein embolization and associated techniques for inducing liver hypertrophy.

Methods/materials

The studies reported in Papers I, III and IV were conducted as retrospective, multicenter cohort studies, and the outcomes after portal vein embolization were analyzed. Paper II presents a long-term follow-up survival analysis from a randomized controlled trial.

Results

Paper I: Compared with microparticles, the use of N-butyl-cyanoacrylate as an embolizing material results in a greater degree of hypertrophy and a higher resection rate, as well as lower radiation exposure, a shorter fluoroscopy time, and less contrast used, within the context of portal vein embolization.

Paper II: With a median follow-up time of almost eight years, no significant differences in long-term survival were detected between patients who underwent two-stage hepatectomy and patients who underwent associating liver partition and portal vein ligation for staged hepatectomy. In a multivariable analysis, the factors influencing long-term survival were extrahepatic disease, an increasing size of the largest liver metastasis, liver tumor-free status at the first follow-up, and a primary rectal tumor.

Paper III: Compared with portal vein embolization characterized by normal P-bilirubin levels, hyperbilirubinemia at the time of portal vein embolization did not result in decreased liver hypertrophy, as measured by absolute and relative growth, degree of hypertrophy, or kinetic growth rate. N-butyl-cyanoacrylate and elevated P-bilirubin levels were associated with increased liver hypertrophy.

Paper IV: Hypertrophy of the future liver remnant, as measured by absolute and relative growth, degree of hypertrophy, or kinetic growth rate, did not significantly differ between groups categorized by the timing of tumor clearance from the future liver remnant in relation to portal vein embolization.

Conclusions

The use of N-butyl-cyanoacrylate as an embolizing material is superior to the use of microparticles within the context of portal vein embolization.

Portal vein embolization is safe and exhibits a high success rate.

Two-stage hepatectomy and associating liver partition and portal vein ligation for staged hepatectomy yield similar long-term oncological outcomes in patients with advanced colorectal liver metastasis.

Hyperbilirubinemia at the time of portal vein embolization does not impair induced liver hypertrophy.

Similar results of liver hypertrophy are observed after portal vein embolization, regardless of whether the future liver remnant is cleared before the portal vein embolization procedure.

Cellulose stands at a strategic crossroads in the pursuit of a more sustainable materials economy. Whether as a chemical feedstock, a structural component, or a precursor for advanced derivatives and high-performance devices, this pivotal biopolymer continues to drive scientific and technological innovation, even after nearly two centuries of study.

Inspired by this rich scientific legacy, the present thesis aspires to provide new insights into cellulose understanding and valorization. At its core lies a unifying theme: addressing at our level the chemical challenges of cellulose transformation and functionalization, which serves as the red thread throughout this work.

To do so, the first part of this doctoral project explored the synthesis of fully bio-based ionic liquids derived from betaine, specifically designed to exhibit chemical affinity for cellulose. In combination with co-solvents such as dimethyl sulfoxide (DMSO) or acetic acid, one variant was found to facilitate the chemical modification of cellulose, with a range of biorelevant anhydrides.

Building on the methodologies developed using model substrates, these chemical tools were then translated into material design, fostering concepts at the interface between chemical control, tunability, and material engineering. For example, strong and transparent plastic-like materials were obtained via chemically enabled self-densification of delignified wood templates upon simple air-drying. Another example involves the valorization of anhydride-functionalized wood fibers to initiators via radical transfer during classical free radical polymerization under aqueous conditions, resulting in ultra-charged fibers. Beyond the synthetic concept, such materials hold valuable potential for applications in water remediation for example.

Altogether, this thesis aims to bridge as close as possible cellulose green chemistry with material design. By providing efficient and relevant workflows, we hope to contribute and help promote cellulose and cellulosic materials as the pillar of a more sustainable future.

In this thesis, local politicians’ regulation of social work practice’s legal authority to make decisions about distributing welfare is investigated, with a particular focus on elder care. Although social workers are central actors in needs assessment and service allocation, they can only exercise legal authority to make decisions if it has been delegated to them by local politicians. In a highly decentralised welfare state such as Sweden, where municipalities are legally responsible for welfare distribution but differ widely in terms of economic, demographic, and geographic conditions, it is essential to understand the local and political contexts of welfare distribution.

This thesis is positioned at the intersection of social work and political science through the analysis of how local “hard policies” – local political policy documents that determine the scope of legal decision-making authority (DMA) – shape the legal premises for social work practice to distribute elder care. By using principal-agent theory, the interdependent relationship between politicians and social workers is made visible. Local political hard policies are understood as tools for control designed to minimise risks when politicians (principals) delegate authority to social workers (agents). Moreover, the concept of accountability is employed to explain external demands on politicians, their need for control over elder-care distribution, and their need to hold civil servants accountable for welfare distribution.

The thesis is based on four studies. The first maps the extent of social workers’ legal DMA across municipalities. The second examines contrasting types of local political policies as examples of strategies for regulating social workers’ legal discretion. The third investigates the relationship between local conditions – economic, demographic, geographic, and political – and restrictiveness in delegating DMA. The fourth analyses the implications of delegating legal DMA for accountability, depending on whether it is transferred to managers or front line social workers or retained by politicians.

The findings demonstrate that local variation in the design of hard policies determining legal DMA can significantly influence whether and how social workers can legally distribute elder care. In some municipalities, social workers possess wide-ranging legal discretion, while in others their authority is extensively restricted. These differences can be linked to local conditions and politics.

Methodologically, the thesis contributes with a macro level, nationwide mapping and comparative analysis of policy documents on delegation, combined with statistical analyses of factors explaining such variations. Theoretically, it advances social work theory by applying the principal–agent framework and highlighting the distinction between soft (optional) and hard (mandatory) policies. This adds to and enhances the legal dimension of discretion and conceptualises hard policies as core instruments of political control in decentralised welfare. Empirically, it provides systematic evidence of municipal variation in the design of legal DMA and discusses the potential implications for equality in access to services, the rule of law, accountability, and the role of educated social workers in relation to local democracy.

Ultimately, the results reveal that the way delegation is structured have implications for the legal and professional discretion of social workers, as well as potential implications for transparency and accountability – vital for democratic values. Ultimately, the thesis highlights the relation between social work and local politics, while pointing toward a contradicting structure with a complex relationship between local politicians and the public administration.  

This dissertation examines the entanglements of religion, modernity, and women’s emancipation in Sweden at the turn of the twentieth century. Through close readings of works by Lydia Wahlström, Ellen Key, and Anna Söderblom, written between 1896 and 1920, it examines how their accounts of women’s history articulate distinct attempts to preserve a divine and transhistorical truth about women’s significance within a modern framework.

Adopting a post-secular perspective, the study challenges the dominant secularisation narrative in previous research, showing how religious categories and temporal conceptions actively shaped female intellectuals’ understandings of history, the future, and liberation. Through a close reading of the three authors’ key concepts for linking historical time to eternity – personality (personlighet), force (kraft), and vocation (kall) – the study demonstrates how the authors’ debates around these concepts reveal differing strategies for reconciling eternal truths within historical time in the plural frameworks of modern and Christian time regimes.

The dissertation argues that women’s emancipation and Christianity’s future were conceived as interdependent by the three authors and that the early Swedish women’s movement was deeply rooted in a religious framework whose theological dimensions are essential to understanding the intellectual and historical significance of the early women’s movement.