<p>Even if popliteal artery aneurysm (PAA) is the most common peripheral aneurysm, no single surgeon or institution has enough patients to study this disease with appropriate scientific methods, and no population-based investigation exists. </p><p>PAA epidemiology, treatment, management, and outcome were studied in a population-based study of 571 patients (717 legs) primarily operated on for PAAs and 100 episodes of preoperative thrombolysis in Sweden between 1987 and 2002. Patients were identified in the Swedish Vascular Registry and case-records were reviewed. Information on amputation and survival was obtained for all patients, and 190 patients were re-examined with ultrasound, after mean 7.2 years (range 2-18)</p><p>Median age was 71 years; 5.8% were women. Patients with unilateral PAA had AAA in 28%, increasing to 38% when PAAs were bilateral. Crude survival was 91.4% at one and 70% at five years, significantly lower than among age and sex matched controls. The cumulative incidence for operation of PAA in Sweden was estimated to 8.3/million person year. One-year amputation-rate was 8.8 %, increasing to 11% after follow-up (7.2 years). Independent risk factors for amputation within one year were poor run-off, age, emergency procedure, and prosthetic graft. Run-off was improved by preoperative thrombolysis among 87% of legs, when acute ischemia. After surgical repair with a medial approach the risk of late expansion of the aneurysm was 33%, with a posterior approach 8% , p=0.014. Among 190 re-examined patients, 108 (57%) had at least one additional aneurysm at index-operation, increasing to 131 (68%) at re-examination, the total number of aneurysms increasing by 42% (from 244 to 346).</p><p>Conclusions: Multiple aneurysms are common among patients operated on for PAA. Preoperative thrombolysis improves run-off and decreases the amputation-rate in PAAs with acute ischemia. Vein grafts do better than prosthetic grafts, especially when a long bypass is needed. Posterior approach, when possible, reduces the risk of late expansion. A complete examination of the aorto-iliac and femoro-popliteal arteries is warranted at the time of surgery. All patients should be kept under life-long surveillance in order to detect and treat newly developed aneurysms timely. Normal arterial segments should be re-examined after three years.</p>

Thesis (Ph. D.)--Ohio State University, 1982. / Includes vita. Includes bibliographical references (leaves 124-126). Available online via OhioLINK's ETD Center.

The mechanical property of polymeric materials changes over time, especially when they are subjected to long-term loading scenarios. To predict the time-dependent viscoelastic behaviors of epoxy-based adhesive materials, it is imperative that reliable accelerated tests be developed to determine their long-term performances under different exposed environments. A neat epoxy resin system and a commercial structural adhesive system for bonding aluminum substrates are investigated. A series of moisture diffusion tests have been performed for more than three months in order to understand the influence of the absorbed moisture on creep behavior. The material properties, such as elastic modulus and glass transition temperature, are also studied under different environmental conditions. The time-temperature superposition method produces a master curve allowing the long-term creep compliance to be estimated. The physics-based Coupling model is found to fit well the long-term creep master curve. The equivalence of the temperature and moisture effect on the creep compliance of the epoxy adhesives is also addressed. Finally, a methodology for predicting the long-term creep behavior of epoxy adhesives is proposed.

This Ph.D. thesis is devoted to the development of a specific semi-analytical algorithm especially well-suited to derive the long-term evolution of near geosynchronous space debris and based on the concept of mean orbital motion. In a first approach, the semi-analytical theory is concerned with the singularity issues arising for circular and equatorial orbits as well as with the geostationary resonance modeling. In a second part, motivated by the discovery of high area-to-mass ratios space debris in high altitude Earth's orbit (mostly near the geosynchronous region), the direct radiation pressure models are revisited and completed. Within this context, the main effects of the direct solar radiation pressure for the mid- and long-term evolution of both the eccentricity and the inclination vectors are analyzed through a well-suited model. Moreover, by means of a smart extension, the passage in the Earth's shadow is taken into account in the computations of the orbits. Finally, a further insight into the intrinsic stability of such space debris is performed, by means of a recent numerical technique (MEGNO) which is based on the concept of ``variational chaos indicator'.

Postoperative heart failure (PHF) remains a major determinant of the outcome after cardiac surgery. However, characteristics of and risk factors for PHF after valve surgery have received little attention. Post-ischaemic disturbances of myocardial metabolism that may contribute to PHF and are amenable to metabolic treatment have been identified early after coronary surgery (CABG). Knowledge derived from these studies may not be applicable to other patient groups. We therefore studied myocardial energy metabolism in 20 elective patients undergoing aortic valve replacement (AVR) for isolated aortic stenosis (AS). The metabolic studies indicated that myocardial oxidative metabolism had not fully recovered when the procedure was completed. Free fatty acids were the only major substrates taken up by the heart. Signs of preoperative and postoperative metabolic adaptation with substantial uptake of glutamate, previously demonstrated in patients with coronary artery disease, were found. Postoperative infusion of glutamate, (2 mL/kg body weight and hour of 0.125 M solution) based on assessment of myocardial glutamate requirements in CABG patients, resulted in a two-fold increase in myocardial glutamate uptake and a seven-fold increase in AV differences across the leg. This was associated with a significant myocardial uptake of lactate and metabolic changes in the leg suggesting mitigation of net amino acid loss and peripheral tissue lipolysis. Characteristics of and risk factors for PHF were evaluated in 398 patients undergoing isolated AVR for AS from 1 January 1995 to 31 December 2000. These were compared with 398 patients, matched for age and sex, undergoing on-pump isolated CABG. Forty-five AVR and 47 CABG patients fulfilled criteria for PHF and these were studied in detail. PHF usually presented at weaning from cardiopulmonary bypass. After CABG it was closely associated with preoperative ischaemic events and intraoperatively acquired myocardial infarction. Potential causes and eliciting events of PHF after AVR for AS were obvious only in one-third of the patients. Risk factors for PHF after AVR for AS indicated either pre-existing myocardial dysfunction, increased right or left ventricular after-load, or intraoperatively acquired myocardial injury. PHF was associated with high early mortality after CABG, whereas the consequences of PHF after AVR for AS became evident only with time, resulting in a 42% five-year mortality. Although PHF had a different temporal impact on late mortality after CABG and AVR for AS, it emerged as the statistically most significant risk factor for mortality occurring within 5 years from surgery both after AVR for AS and after CABG. Potential implications of our findings include needs for greater focus on preoperative surveillance of patients with AS for optimal timing of surgery, mitigation of intraoperatively acquired myocardial injury and tailoring of treatment for PHF. Furthermore, the findings have implications for long-term follow up of AS patients after surgery.

The increased demand from citizens for efficient service delivery from public sector organizations has implications for the information that underpins those services. Robust and effective information management is required. Information is looked upon as a resource that can give organizations a competitive edge if it is well leveraged. To address the need for more services and for more efficient service delivery, the Swedish government has promoted e-government initiatives and the two municipalities that are the subjects of this research have responded by engaging in e-service development and provision. e-Government has at its core the use of information and communication technology (ICT).  The municipalities have embarked on the analysis and automation of their business processes and hence the use of information systems.  Web-based technologies have created a two-way communication flow which has generated complex information for the municipalities to address. This development calls for stronger information and records management regimes. Enterprise Content Management is a new information management construct proposed to help organizations to deal with all their information resources. It promotes enterprise-wide information management. There is, however, little knowledge and understanding of ECM in the Swedish public sector. Further, how e-government developments have affected the management of information is an issue that has not been explored. Traditionally Swedish public authorities have employed records management to address the challenges of managing information. Records management has been used for the effective and systematic capture of records and the maintenance of their reliability and authenticity. While information helps with the daily running of business activities, records carry the evidentiary value of the interactions between the citizens and the municipalities. This research critically examines the interface between Enterprise Content Management (ECM) and records management as information/records management approaches. This has meant examining what the similarities and the differences between the two approaches are.  The research instrumentally used the lens of the Records Continuum Model (RCM), which promotes the management of the entire records’ continuum, a proactive approach, combines the management of archives and records and supports the pluralisation of the captured records. The research further highlights the information management challenges that the municipalities are facing as they engage in e-government developments.    Keywords: Enterprise Content Management, Records Management, E-government, Long-term Preservation, Business Process Management, Enterprise Architecture. / Centre for Digital Information Management

The present research intended to examine the relationship between childhood stable peer status and adjustment in midadolescence for both genders, and adjustment in early and middle adulthood for women. One-year stably peer rejected, popular, and average boys and girls were identified by an age 10 and age 11 sociometric classification procedure using positive nominations and rank-ordering. These groups were examined in midadolescence. Findings indicated that stable peer rejection in childhood was associated with negative school adjustment and problems in peer relations in adolescence for both genders, and that many rejected boys were school dropouts. However, rejected children did not associate with deviant peers or show more antisocial behavior than their counterparts. For the adulthood follow-up, cluster analysis using LICUR was applied on rank-ordering data from age 10 and age 13 in order to identify 3-year stably rejected, popular, and average groups of girls. A methodological comparison with a standard sociometric method showed that the applied cluster analysis seems to be a useful additional tool in the arsenal of sociometric classification methods. Furthermore, one seems to arrive at larger stable peer status groups with this method than with other sociometric classification methods. The longitudinal follow-up into adulthood showed that rejected girls were at increased risk for criminal offending and alcohol abuse in young adulthood. Childhood aggressive behavior explained the significant association between peer rejection and criminality. There were no significant differences between the stable peer status clusters in the midadulthood adjustment areas of social relations, health, occupation, and subjective well-being, except that popular girls had achieved more successful vocational careers (which in its turn was explained by their higher academic achievement in childhood). Constraints and implications for future research were discussed.

Even if popliteal artery aneurysm (PAA) is the most common peripheral aneurysm, no single surgeon or institution has enough patients to study this disease with appropriate scientific methods, and no population-based investigation exists. PAA epidemiology, treatment, management, and outcome were studied in a population-based study of 571 patients (717 legs) primarily operated on for PAAs and 100 episodes of preoperative thrombolysis in Sweden between 1987 and 2002. Patients were identified in the Swedish Vascular Registry and case-records were reviewed. Information on amputation and survival was obtained for all patients, and 190 patients were re-examined with ultrasound, after mean 7.2 years (range 2-18) Median age was 71 years; 5.8% were women. Patients with unilateral PAA had AAA in 28%, increasing to 38% when PAAs were bilateral. Crude survival was 91.4% at one and 70% at five years, significantly lower than among age and sex matched controls. The cumulative incidence for operation of PAA in Sweden was estimated to 8.3/million person year. One-year amputation-rate was 8.8 %, increasing to 11% after follow-up (7.2 years). Independent risk factors for amputation within one year were poor run-off, age, emergency procedure, and prosthetic graft. Run-off was improved by preoperative thrombolysis among 87% of legs, when acute ischemia. After surgical repair with a medial approach the risk of late expansion of the aneurysm was 33%, with a posterior approach 8% , p=0.014. Among 190 re-examined patients, 108 (57%) had at least one additional aneurysm at index-operation, increasing to 131 (68%) at re-examination, the total number of aneurysms increasing by 42% (from 244 to 346). Conclusions: Multiple aneurysms are common among patients operated on for PAA. Preoperative thrombolysis improves run-off and decreases the amputation-rate in PAAs with acute ischemia. Vein grafts do better than prosthetic grafts, especially when a long bypass is needed. Posterior approach, when possible, reduces the risk of late expansion. A complete examination of the aorto-iliac and femoro-popliteal arteries is warranted at the time of surgery. All patients should be kept under life-long surveillance in order to detect and treat newly developed aneurysms timely. Normal arterial segments should be re-examined after three years.

The European Union has lead to higher collaboration between the European countries, more exchange of information and a tendency to centralize more political decisions. There is also a tendency to try to create legislations that are more similar in each nation.   This paper aims at giving an idea about the challenges that the nations might meet when working towards higher archival collaboration within the European Union. The report by the European Commission “Report on archives in the enlarged European Union - Increased archival collaboration in Europe: action plan” from 2005 states that there is a need for higher European collaboration within the field of archives. The goal is to create a gateway for the citizens to have easy access to archival information from the different member states.   There are some obstacles for this to easily work. To start with the member nations have different cultural traditions and legislations when it comes to freedom of information. It has also got to do with technical issues such as which computer systems, file types and structures et c that are allowed.   This paper takes its starting point in the field of digital deliveries to the national archives of Sweden and The United Kingdom. A comparison has been made to show the difference of how these countries proceed with their archival work to give an idea about how these differences can affect the wish for higher collaboration within the European Union.

Flera studier har pekat på viktiga faktorer för att hälsa och återgång till yrkeslivet ska vara möjliga men hur detta i praktiken ska ske och vilka rehabiliteringsåtgärder som är mest effektiva är otillräckligt belagt. Studien har genom intervjuer med sju kvinnor med stressrelaterade störningar granskat hur en tillfriskningsprocess kan upplevas och vad som upplevs som meningsfull hjälp i samband med den. Deras tillfriskning har inneburit en kamp och ett starkt personligt engagemang. Beslutsamhet och målinriktning var förutsättningar för att få ta del av rehabiliteringsåtgärder. Kvinnorna i studien har upplevt ett stort personligt ansvarstagande för sin tillfriskning men de har också betonat vikten av bekräftelse från en förstående omgivning. En stor besvikelse har uttryckts gentemot Försäkringskassan och i vissa fall arbetsgivare för bristande förståelse, stöd och hjälp. Genom bland annat kampandan har kvinnorna utvecklat sin självkännedom och sin livssituation. / Several studies have identified factors associated with the promotion of health and return to work. But knowledge is insufficient of how this is practically done and which rehabilitation methods are most effective. This study aimed to shed light on women’s experiences of their rehabilitation process and also experiences of meaningful support associated with the process. Interviews were done with seven women with stress-related disorders whose recovery involved great efforts and a great deal of personal responsibility. The respondents’ determination was a condition for receiving the needed rehabilitation measures. They also emphasized the importance of social support and an empathetic attitude from others. Respondents expressed disappointment with the way The Swedish Social Insurance Agency and employers have handled and treated them. Through the struggles women in this study have endured, they’ve achieved personal growth and the awareness needed to change their situation of life.