Approximately 20% of the body’s energy consumption is ongoingly consumed by the brain, where the main part is due to the neural activity, which is only increased slightly when doing a demanding task. This ongoingly neural activity are studied with the so called resting-state fMRI, which mean that the neural activity in the brain is measured for participants with no specific task. These studies have been useful to understand the neural function and how the neural networks are constructed and cooperate. This have also been helpful in several clinical research, for example have differences been identified between bipolar disorder and major depressive disorder. Recent research has focused on temporal properties of the ongoing activity and it is well known that neural activity occurs in bursts. In this study, resting-state fMRI data and temporal graph theory is used to develop a point based method (PBM) to quantify these bursts at a nodal level. By doing this, the bursty pattern can be further investigated and the nodes showing the most bursty pattern (i.e hubs) can be identified. The method developed shows a robustness regarding several different aspects. In the method is two different variance threshold algorithms suggested. One local variance threshold (LVT) based on the individual variance of the edge time-series and one global variance threshold (GVT) based on the variance of all edges time-series, where the GVT shows the highest robustness. However, the choice of threshold needs to be adapted for the aims of the current study. Finally, this method ends up in a new measure to quantify this bursty pattern named bursty centrality. The derived temporal graph theoretical measure was correlated with traditional static graph properties used in resting state and showed a low but significant correlation. By applying this method on resting-state fMRI data for 32 young adults was it possible to identify regions of the brain that showed the most dynamic properties, these regions differed between the two thresholding algorithms

Detta kandidatexamensarbete, som genomförts på uppdrag av medicinteknisk chef på Södersjukhuset Git Eliasson, hade som mål att analysera vilken standard av ISO 9001:2015 och SS-EN ISO 13485:2016 som var lämpligast för Södersjukhusets medicintekniska verksamhet. ISO 9001:2015 och ISO 13485:2016 är internationella standarder framtagna av EU kommissionen för att hjälpa organisationer att bygga upp kvalitetsledningssystem som uppfyller de krav som ställs på dessa organisationer. För att ta reda på vad som var lämpligast för Södersjukhuset MTA så gjordes en litteraturstudie där djupgående kunskaper om ISO 9001:2015 och SS-EN ISO 13485:2016 erhölls. Vid oklarheter så kontaktades projektledare och experter för att tydliggöra regelverk. Därefter gjordes verksamhetsbesök där Södersjukhusets medicintekniska verksamhet studeras för att förstå var de befinner sig i dagsläget samt för att kunna göra en GAP-analys. Även företag som erbjuder ackreditering kontaktades. Detta för att få en inblick på kostnadsfrågan då även den var utav intresse. Den lämpligaste standarden visade sig vara ISO 13485:2016, och för att hjälpa Södersjukhusets MTA med att uppnå kraven i standarden föreslogs en del förslag såsom att bygga upp ett kvalitetsledningssystem gentemot kraven i ISO 13485. För att upprätta en sådant system skulle MTA kunna anställa en verksamhetsutvecklare, alternativt utnyttja redan anställd personal till att göra det arbetet. / This bachelor's thesis, which was carried out on behalf of the medical technical director at Södersjukhuset Git Eliasson, aimed to analyze which standard among ISO 9001:2015 and SSEN ISO 13485:2016 was most suitable for Södersjukhuset's operations. ISO 9001:2015 and ISO13485:2016 are international standards constructed by the EU Commission to help organizations build quality management systems that meet the requirements set on these organizations. To find out what was most suitable for Södersjukhuset, a literature study was conducted where in-depth knowledge of ISO 9001:2015 and SS-EN ISO 13485:2016 was obtained. In case of ambiguity and vagueness, project managers and experts were contacted to clarify regulations.Thereafter, hospital visits were made where the Södersjukhusets medical technology operations were studied to understand where they are at the present and to subsequently attain the knowledge needed to make a thorough GAP analysis. With the intention to elucidate costs that come with accreditation, companies that offer accreditation were also contacted. The most suitable standard proved to be ISO 13485:2016. The GAP analysis, and thus the methods needed to reach certification, consisted of setting up a QMS system which met the requirements in ISO 13485. Such a QMS could be set up by a business developer, or by already hired personnel with the right expertise. / Nej

Den prehospitala vården är en viktig del av den svenska sjukvården, vårdprocessen innefattar all vård patient får utanför sjukhus. Den prehospitala vårdens kvalitet varierar hos olika landsting beroende på deras tekniska utrustningar och arbetsmetoder. Detta arbete utreder hur Region Kronoberg (RK) och Stockholms Läns Landsting (SLL) hanterar IT- och informationssäkerhet inom den prehospitala vården, då framförallt inom ambulanssjukvården.   Arbetet har utförts via litteraturstudie kring lagar och riktlinjer som påverkar den prehospitala vården och sedan utfördes intervjuer för att finna hur RK och SLL hanterar patientjournaler.   Arbetet visar att RK och SLL har jobbat olika länge med att digitalisera den prehospitala vårdprocessen, men att de idag använder lika säkra arbetsmetoder. Anledningen till detta är att bådas lösningar grundas i användandet av det säkra nätverket Sjunet. Vidare visade det sig att RK och SLL har olika grundförutsättningar för journalåtkomst. Avslutningsvis finner detta arbete inga säkerhetsrisker i anslutningen till de digitala journalsystemen, men att användandet av mobila enheter som lagrar journal utgör en säkerhetsrisk. / Prehospital care is an important part of the Swedish health system, the care process is dedicated to any kind of emergency out-of-hospital acute medical care. The quality of prehospital care varies between different counties, depending on their technical equipment and work methods. This essay investigates how Region Kronoberg (RK) and Stockholm’s County Council (SLL) have dealt with IT- and information security questions concerning prehospital care.   The essay is conducted by collecting laws and guidelines related to IT-security. Interviews were later on conducted with intention to collect information about RK’s and SLL’s definition of accessibility and communication of patient journals   This essay shows that RK and SLL begun digitizing their prehospital care at different times, but that they are as in now able to use equally safe methods for dealing with journals. The reason behind this is that they both root their solutions in the secluded network Sjunet. It is further concluded that SLL and RK have different prerequisites for journal access. Lastly, we could conclude that the greatest security risk is not associated with the connection between hardware, but rather misplacing any hardware containing delicate information.

This project was initiated due to the need for new manners of taking care of elderly. The purpose was to determine the perception of eHealth within home care. The goal was to analyze the perception of eHealth in order to find factors which may affect the implementation of eHealth services. To distinguish the perception, surveys with health personnel within home care and the general public as well as and interviews with municipalities were performed. An extension of the Technology Acceptance Model was used in order to locate the perception to seven different categories related to eHealth. The results from the surveys were statistically analysed, and a factor analysis was executed on the surveys, in order to find groups with similar perception on eHealth. The surveys showed that the general perception of the usability and ease of use of eHealth is positive, even though one view was that the society needs to invest more money within the area. The factor analysis resulted in six different groups of perceptions for the personnel and three groups for the general public. The interviews demonstrated that a clear and common definition of eHealth is missing. Despite that, a positive perception of eHealth within the municipalities existed. A conclusion made was that with clear guidelines of how to work eHealth, a wider and faster implementation will be easier to accomplish. / Syftet med detta projekt var att undersöka inställningen till eHälsa inom äldrevården. Projektet initierades på grund av att det fanns ett behov av nya tillvägagångssätt för att ta hand om äldre människor. Målet var att analysera inställningen till eHälsa, och om möjligt, finna faktorer som kan påverka implementeringen av eHälsotjänster. För att lokalisera inställningen gjordes enkätundersökningar med personal inom hemtjänsten samt med allmänheten. Även intervjuer med kommuner utfördes. En påbyggnad av Technology Acceptance Model användes för att lokalisera upp- fattningen kring sju kategorier relaterade till eHälsa. Enkätundersökningarnas resultat analyserades statistiskt, samt så utfördes en faktoranalys för att hitta grupper som hade liknande uppfattning gällande eHälsa. Analyserna visade att den allmänna uppfattningen gällande nyttan med, och användarvänligheten av eHälsa är positiv. Majoriteten anser att samhället behöver investera mer pengar i området. Faktoranalysen resulterade i sex olika grupper av inställningar inom personalen samt tre grupper för allmänheten. Intervjuer med kommuner påvisade att en klar och tydlig definition av eHälsa saknas. Trots det, har de i stort en positiv inställning till eHälsa och dess utveckling. En slutsats är att tydligare riktlinjer rörande arbete med eHälsa skulle kunna möjliggöra en smidigare implementering.

Introduction: The Swedish population is ageing – resulting in an increase in the number of elderly people and higher socioeconomic demands that the society needs to support them with. In Sweden, frail elderly people with for example mobility and cognitive problems, have the opportunity to attend a day care center where they can join activities and to socialize. Purpose: The purpose of this thesis was to investigate to what extent virtual reality technology could contribute to improved well-being for frail elderly at day care centers. Method: This study was conducted via a mixed method consisting of a survey and a semi-structured interview. 19 participants (15 male and 4 female) from three day care centers in Södertälje participated in this study. Results: By allowing frail elderly at day care centers to experience virtual reality, quantitative and qualitative data was collected. Both indicating that the experience of using virtual reality was positive and comfortable. 7 themes were identified through a thematic analysis demonstrating what was repeatedly mentioned by the participants. The themes were: (1) immersion & interaction, (2) usage, (3) nature movies, (4) visit places, (5) talking about things that are dear to them, (6) being limited and (7) thinking that VR could affect well-being. Conclusion: This study showed that the subjective well-being of frail elderly was arguably partially improved with virtual reality. The participants were overall positive, enjoyed the experience with a sense of immersion and awakening memories. / Introduktion: Den svenska populationen åldras - vilket resulterar i en ökning av äldre personer och högre socioekonomiska krav som samhället måste stödja dem med. I Sverige har äldre personer med till exempel rörlighet och kognitiva problem möjlighet att delta i dagverksamheter där de kan delta i aktiviteter och umgås. Syfte: Syftet med detta examensarbete var att undersöka i vilken utsträckning virtuell verklighet skulle kunna bidra till förbättrad välmående hos äldre på dagverksamheter. Metod: Detta projekt var genomfört med hjälp av en mixed method så som en enkät och en semi- strukturerad intervju. 19 äldre person (15 män och 4 kvinnor) från tre dagverksamheter i Södertälje deltog i denna studie. Resultat: Genom att låta äldre personer vid dagverksamheterna uppleva virtuell verklighet, så samlades det in kvantitativ och kvalitativ data. Där båda indikerar att det, till exempel, var en positiv och bekväm erfarenhet. 7 teman identifierades genom en tematisk analys som illustrerade vad som ofta upprepades av deltagarna. Teman var: (1) immission & interaktion, (2) användning (3) naturfilmer, (4) besöka platser, (5) pratar om saker som ligger dem kärt om hjärtat, (6) att vara begränsad och (7) tror att VR kan påverka välmående. Slutsats: Denna studie visade att det subjektiva välmåendet hos äldre delvist var förbättrad med virtuell verklighet. Deltagarna var generellt positiva, njöt av upplevelsen av immersion samt minnen som väcktes.

Idiopathic clubfoot causes severe deformity of the foot and lower leg. Due to the complex anatomy and small size of the foot, the condition is difficult to define and describe. This study focused on 3D modeling of different foot positions associated with clubfoot relapse, and investigation of muscle parameters. The 3D modeling was performed in the AnyBody Modeling System to retrieve information about muscle length. Musculoskeletal modeling could provide further understanding of the condition and contribute to assessment and treatment evaluation. Five children that received clubfoot treatment as infants, and five typically developing children, serving as a control group, participated in the study. Despite treatment with the Ponseti method, Achilles tenotomy and use of an abduction orthosis, all participants of the clubfoot group showed signs of relapse. In total, seven affected legs were studied. Data from gait analyses of all participants were compiled and interpreted in the AnyBody Modeling System. The Plug-in-Gait Model for lower extremities and the Oxford Foot Model were used as marker protocol for the study. Studied lower leg muscles were Gastrocnemius Lateralis, Gastrocnemius Medialis, Soleus Lateralis and Soleus Medialis. Muscle length, defined as length of contractile element, for each leg and participant were evaluated using the AnyBody model template LowerExtremity. Compared to the control group, the models of the clubfoot group presented shorter mean muscle lengths of all investigated muscles. / Idiopatisk klumpfot orsakar allvarlig deformation av fot och underben. På grund av fotens anatomi och ringa storlek kan tillståndet vara svårt att beskriva och definiera. Denna studie innefattade 3Dmodellering av olika fotpositioner orakade av recidivklumpfot, för att undersöka muskelegenskaper. AnyBody Modeling System användes för att generera 3D-modeller och ta fram information om muskellängd. Muskuloskeletal modellering skulle kunna öka förståelsen för sjukdomen och bidra till förbättringar av initial bedömning och utvärdering av behandling. Fem barn som behandlades för klumpfot efter födseln deltog i studien. Även fem typiskt utvecklade barn medverkade och fungerade som en kontrollgrupp. Trots behandling med Ponseti-metoden, hälseneförlängning och användning av abduktionsortos, uppvisade samtliga barn i klumpfotsgruppen tecken på återfall. Totalt studerades sju ben med recidivklumpfot. Data från gånganalyser av deltagarna sammanställdes och analyserades i AnyBody Modeling System. Plug-in-Gait Model för nedre extremiteter och Oxford Foot Model användes som markörprotokoll. Under studien analyserades underbensmusklerna Gastrocnemius Lateralis, Gastrocnemius Medialis, Soleus Lateralis och Soleus Medialis. Muskellängd (längd av kontraktilelement) för varje patient och ben beräknades med hjälp av modellmallen LowerExtremity i AnyBody Modeling System. Jämfört med kontrollgruppen visade klumpfotsgruppen kortare medelmuskellängder för samtliga av de analyserade musklerna.

Semiconductor detectors are attracting interest for use in photon-counting spectral computed tomography. In order to obtain a high spatial resolution, it is of interest to find the photon interaction position. In this work we investigate if machine learning can be used to obtain a sub-pixel spatial resolution in a photon-counting silicon strip detector with pixels of 10 µm. Simulated charge distributions from events in one, three, and seven positions in each of three pixels were investigated using the MATLAB® Classification Learner application to determine the correct interaction position. Different machine learning models were trained and tested in order to maximize performance. With pulses originating from one and seven positions within each pixel, the model was able to find the originating pixel with an accuracy of 100% and 88.9% respectively. Further, the correct position within a pixel was found with an accuracy of 54.0% and 29.4% using three and seven positions per pixel respectively. These results show the possibility of improving the spatial resolution with machine learning. / Halvledardetektorer är av stigande intresse inom forskning för användning i fotonräknande datortomografi med spektral upplösning. För att erhålla en hög spatiell upplösning är det av intresse att hitta fotonens ursprungliga interaktionsposition. I detta arbete undersöks om maskininlärning kan användas för att erhålla en spatiell upplösning på subpixelnivå i en fotonräknande kiselstrippdetektor med 10 µm pixlar. Laddningsfördelningen från simulerade interaktioner i en, tre, och sju positioner inom var och en av tre pixlar undersöktes med hjälp av applikationen Classification Learner i MATLAB® för att bestämma den korrekta interaktionspositionen. Olika maskininlärningsmodeller tränades och testades för att maximera prestandan. När pulser från en och sju positioner inom pixeln användes, kunde modellen hitta den korrekta pixeln med en noggrannhet på 100% respektive 88.9%. Vidare kunde den korrekta positionen inom en pixel bestämmas med en noggrannhet på 54.0% och 29.4% när tre respektive sju positioner inom varje pixel användes. Resultaten visar att det skulle vara möjligt att förbättra den spatiella upplösningen med hjälp av maskininlärning.

Brain tumors pose a big challenge in the field of neuro-oncology. Gliomas are the largest subgroup. Magnetic resonance imaging is a non-invasive tool for detecting and characterizing these tumors. Mathematical models, such as the reaction-diffusion equation, can be used for understanding the intricate behavior of gliomas. This thesis aims to improve the understanding and prediction of tumor growth by modifying and evaluating a reaction-diffusion mathematical model and incorporating magnetic resonance (MR) images, namely intensity from T1-weighted and T2-weighted images, and apparent diffusion coefficient values. Image data from five patients was used. The finite difference method was used to approximate the solution, and brain segmentation is performed using the software package FSL. The Jaccard index is used to compare the simulation results with the ground truth, being the segmented tumor area. A spatially varying proliferation rate is introduced and histology images are used to construct an initial condition for the reaction-diffusion mathematical model. The results show improvement in performance based on the Jaccard index, with the highest values achieved when using a diffusion matrix given as an affine function of intensity in T1-weighted images. Incorporating a spatially varying proliferation rate reduces the number of iterations required to reach the maximum Jaccard index compared to a constant proliferation rate, but this does not influence the simulation time. The introduction of the p-Laplace operator, particularly with a value of p = 1.8 instead of the usual Laplace operator (where p = 2), leads to a higher Jaccard index, indicating an improvement in the model’s performance. The best Jaccard index achieved was 0.4909 with p = 1.8 compared to the basic model (JI = 0.4382 with p = 2). An initial tumor cell density is constructed using histology images. In conclusion, insights are provided into improving tumor growth modeling by incorporating MR images, the p-Laplace operator, a spatially varying proliferation rate and possibility of constructing the initial conditions for tumor cell density based on histology images.

Kardiotokografi (CTG) används idag under graviditet och förlossning för att övervaka fostrets hjärtfrekvens i förhållande till livmoderns värkar. Kurvan som erhålls av CTG-apparaten utvärderas av barnmorskan eller läkaren för patologiska mönster. Om CTG-kurvan är för avvikande kan det finnas misstanke om att fostret inte får tillräckligt med syre i livmodern. Dessa avvikelser är dock inte alltid ett tecken på att fostret inte mår bra vilket försvårar tolkningen av kurvorna för personalen. I detta arbete skapades en CTG-kurva utifrån en EKG-registrering gjort på ett lamm för att undersöka om metoden ger en tydlig CTG-kurva. Sedan analyserades kurvan för eventuella patologiska mönster. Resultatet blev en CTG-kurva med avvikelser. De patologiska mönster relaterade till variablerna basal hjärtfrekvens, acceleration och deceleration som förekom i hjärtfrekvenskurvan kunde återges i en graf med tillfredsställande kvalitet. / Cardiotocography (CTG) is used today during pregnancy and labour to monitor the fetal heartbeat in relation to uterine contractions. The graph obtained by the CTG machine is evaluated by the midwife or doctor for pathological patterns. If the CTG graph is too abnormal, there may be a suspicion that the fetus is not getting enough oxygen in the uterus. However, these abnormalities are not always a sign that the fetus is not feeling well, which makes the interpretation of CTG graphs difficult for the medical personnel. In this paper, a CTG graph was created based on an ECG recording taken on a lamb in order to investigate whether this method gives a clear CTG graph. The graph was then analyzed for any pathological patterns. The result was a CTG graph with deviations. The pathological patterns relating to the variables baseline heart rate, acceleration and deceleration that appeared in the heart rate curve could be represented in a graph with satisfactory quality.

To date, there are no existing models for evaluating foreign markets, adapted to mobile health (mHealth) consumer medical device (CMD) start-ups seeking to launch their products or services in new countries. This calls for the development of a suitable international market selection (IMS) model that captures the complexity of and opportunities for mHealth. mHealth is a sub-segment of electronic health (eHealth), which furthermore is part of the wider phenomenon of digital health. mHealth covers medical and public health practice supported by mobile devices. This paper proposes a multidimensional IMS model comprising both macro and micro level factors. Our specialized approach integrates tools and theories by a number of researchers and is showcased in the assessment of the European Union (EU) for the mHealth CMD company AdhereBox. AdhereBox is a Swedish start-up that has developed a CMD consisting of a “smart” pillbox and a complementary mobile software application. We propose a number of dimensions that should be evaluated when assessing the potential  of the different EU health care markets in regards to mHealth CMD start-ups. Our suggested approach includes factors which are categorized into two groups of parameters: (i) stakeholders (which comprises consumers, providers, payers, distributors and collaborators) and (ii) barriers & enablers (consisting of incentives, reimbursement models, technological infrastructure, regulations and existing solutions). In summary, our study identifies critical factors that mHealth CMD start-ups should consider when evaluating foreign markets in an IMS. By applying our IMS model on AdhereBox, we illustrate how our model can be used, its parameters assessed and the interdependencies between these analyzed in order to arrive at a set of recommendations for further market analysis and conclusions on country attractiveness. As such, we believe that our research could provide valuable insights and guidelines for firms within mHealth seeking to expand their business within the EU, as well as for governmental organizations that want to better leverage and stimulate the potentials of a flourishing domestic mHealth ecosystem.