Syfte: Syftet med den här studien var att undersöka om Spontaneous Eye Blink Rate (SEBR) skiljde sig åt vid läsning på utskrivet papper, surfplatta eller smartphone. Det jämfördes också huruvida fullständiga och ofullständiga blinkningar skiljde sig åt vid läsning på de olika medierna. Metod: Deltagarna (n=29) fick läsa tre olika texter på utskrivet papper, surfplatta och smartphone samtidigt som de filmades. I efterhand granskades samtliga videos två gånger för att räkna fullständiga blinkningar, ofullständiga blinkningar och totalt antal blinkningar (SEBR). Resultat: Den här studien visade att där finns en signifikant skillnad av totalt antal blinkningar vid läsning på utskrivet papper och surfplatta (p=0,03), där blinkningar/minut sjönk med 14,9% vid läsning på utskrivet papper, jämfört med surfplatta. För ofullständiga blinkningar fanns en statistiskt signifikant skillnad mellan utskrivet papper och surfplatta (p=0,02), där antalet ofullständiga blinkningar/minut ökade med 30,0% vid läsning på surfplatta, jämfört med utskrivet papper. Vid läsning på surfplatta och smartphone fanns en signifikant skillnad gällande ofullständiga blinkningar (p=0,01), där antalet ofullständiga blinkningar/minut ökade med 42% vid läsning på surfplattan, jämfört med smartphone.  Slutsats: Spontaneous Eye Blink Rate skiljer sig vid läsning på papper och surfplatta. Ofullständiga blinkningar är flest vid läsning på surfplatta. Inga signifikanta skillnader finns mellan utskrivet papper och smartphone. / Purpose: The purpose of this study was to evaluate whether Spontaneous Eye Blink Rate (SEBR) differ when reading on hard copy, tablet or smartphone. Complete and incomplete blinks were also evaluated to see if there were any differences regarding the hard copy, tablet and smartphone.  Methods: The participants read three different texts on hard copy, tablet and smartphone while they were being filmed. Afterwards, each video was analysed twice in order to count complete blinks, incomplete blinks and total blink rate (SEBR). Results: This study showed that there is a significant difference in total blink rate between reading on hard copy and tablet (p=0.03), where blinks/minute decreased by 14.9% for the hard copy condition. There was also a significant difference in incomplete blinks regarding the two devices (p=0.02), where incomplete blinks increased by 30.0% when reading on tablet. Tablet and smartphone reading also resulted in a significant difference, where incomplete blinks increased  by 42% when reading on tablet (p=0.01). Conclusion: Spontaneous Eye Blink Rate differ when reading on hard copy and tablet. Incomplete blinks increase when reading on tablet. No significant differences are found between hard copy and smartphone.

1. Clinical studies. Clinical diagnosis of dementia has been made largely on the basis of clinical findings supported by appropriate radiological and laboratory investigations. A minority of patients have treatable or reversible underlying causes for their dementing syndrome. It is important to distinguish between the two main forms of dementia Alzheimer's disease, senile dementia of Alzheimer type (AD/SDAT) and MID so that advantage can be taken of any future progress in treatments. In the clinical study significant differences between several diagnostic procedures were found between patients with AD/SDAT and MID. Blood pressure was significantly lower in the AD/SDAT group and focal neurological signs were seen in 70% of the MID patients but only in 6% of patients with AD/SDAT. Electrocardiogram was normal in all patients with AD/SDAT but pathological in 75% of the MID patients. Electroencephalogram showed generalized slow frequencies in 79% of the AD/SDAT patients and localized changes in 65% of the MID patients. Computerized tomography showed a significantly greater dilation of the ventricular system in MID patients compared to AD/SDAT patients and controls. Monoamine metabolites in the cerebrospinal fluid were lower in AD/SDAT patients and normal in MID patients. Psychopathological signs were found to be more variable and more pronounced in the AD/SDAT group compared with MID patients. 2. Etiological studies. Immunoglobulin and albumin were found changed in serum and CSF of both AD/SDAT and MID, indicating a more active immune response in MID and a less dense cerebrospinal fluid barrier in both MID and AD/SDAT. There appears to be a consumption of IgG in the central nervous system in patients with AD/SDAT. Abnormal chromosomes appearing as acentric fragments, i.e. without visible centromeres, were found in 90% of patients with AD/SDAT, 30% of patients with MID, and not at all in the control group. Increased aneuploidy was also seen both in patients with MID and AD/SDAT. Diabetes mellitus in old age and AD/SDAT do not seem to coexist. Furthermore, patients with AD/SDAT have changed carbohydrate metabolism with decreased fasting blood sugar concentrations, increased glucose tolerance and higher concentration of insulin during an oral glucose tolerance test. / <p>S. 1-47: sammanfattning, s. 49-144: 5 uppsatser</p> / digitalisering@umu.se

Background High blood pressure is associated with an increased risk of cardiovascular disease and premature death. The shape of association between blood pressure and the risk of cardiovascular events is debated. Some researchers suggest that the association is linear or log-linear, whereas others suggest it is J-shaped. Randomized controlled trials of antihypertensive treatment have been successful in hypertension, but ambiguous in the high normal blood pressure range. Previous systematic reviews have not found any interaction between baseline systolic blood pressure and treatment effect, with beneficial effects at systolic blood pressure levels well below what is currently recommended. These reviews, however, use a method to standardize treatment effects and study weights according to within-trial blood pressure differences that may introduce bias. Methods We performed two systematic reviews to assess the effect of antihypertensive treatment on cardiovascular disease and mortality at different blood pressure levels. The first review was limited to people with diabetes mellitus. The second review included all patient categories except those with heart failure and acute myocardial infarction. Both reviews were designed with guidance from Cochrane Collaborations Handbook for Systematic Reviews of Interventions, and are reported according to PRISMA guidelines. We included randomized controlled trials assessing any antihypertensive agent against placebo or any blood pressure targets against each other. Results were combined in random-effects meta-analyses, stratified by baseline systolic blood pressure. Non-stratified analyses were performed for coronary heart disease trials and post-stroke trials. Interaction between blood pressure level and treatment effect was assessed with Cochran’s Q in the first review, and multivariable-adjusted metaregression in the second review. The third paper builds on data from the second paper, and assesses the effect of standardization according to within-trial blood pressure differences on the results of meta-analyses. We performed non-standardized analyses, analyses with standardized treatment effects, and analyses with standardized treatment effects and standard errors. We compared treatment effect measures and heterogeneity across different methods of standardization. We also compared treatment effect estimates between fixed-effects and random-effects meta-analyses within each method of standardization. Lastly, we assessed the association between number of events and study weights, using linear regression. Results Forty-nine trials assessed the effect of antihypertensive treatment in people with diabetes mellitus. Treatment effect on cardiovascular mortality and myocardial infarction decreased with lower baseline systolic blood pressure. Treatment reduced the risk of death and cardiovascular disease if baseline systolic blood pressure was 140 mm Hg or higher. If baseline systolic blood pressure was below 140 mm Hg, however, treatment increased the risk of cardiovascular death by 15 % (0-32 %). Fifty-one trials assessed the effect of antihypertensive treatment in primary prevention. Treatment effect on cardiovascular mortality, major cardiovascular events, and heart failure decreased with lower baseline systolic blood pressure. If baseline systolic blood pressure was 160 mm Hg or higher treatment reduced the risk of major cardiovascular events by 22 % (95 % confidence interval 13-30 %). If systolic blood pressure was 140-159 mm Hg treatment reduced the risk by 12 % (4-20 %), whereas if systolic blood pressure was below 140 mm Hg, treatment effect was neutral (4 % increase to 10 % reduction). All-cause mortality was reduced if systolic blood pressure was 140 mm Hg or higher, with neutral effect at lower levels. Twelve trials compared antihypertensive treatment against placebo in people with coronary heart disease. Mean baseline systolic blood pressure was 138 mm Hg. Treatment reduced the risk of major cardiovascular events by 10 % (3-16 %), whereas the effect on mortality was neutral (7 % increase to 11 % reduction). Standardization of treatment effects resulted in more extreme effect estimates for individual trials. This caused increased between-study heterogeneity, and different results with fixed- and random-effects model. Standardization of standard errors shifted weights from trials with many events to trials with large blood pressure differences. This caused biased overall effect estimates. Standardization of standard errors also resulted in wider confidence intervals, masking the previously increased heterogeneity. This reduced the possibility to find different treatment effects at different blood pressure levels. Conclusion The effect of antihypertensive treatment depends on blood pressure level before treatment. Treatment reduces the risk of death and cardiovascular disease if baseline systolic blood pressure is 140 mm Hg or higher. Below this level, treatment is potentially harmful in people with diabetes, has neutral effect in primary prevention, but might offer additional protection in people with coronary heart disease. Standardization should generally be avoided in meta-analyses of antihypertensive treatment. Previous meta-analyses using standardized methods should be interpreted with caution. / Hjärt-kärlsjukdomar leder till fler dödsfall och fler förlorade levnadsår än någon annan sjukdomsgrupp. Den enskilt viktigaste riskfaktorn som bidrar till hjärtkärlsjukdomar ur ett befolkningsperspektiv är högt blodtryck. Risken att drabbas av hjärt-kärlsjukdomar minskar om man behandlar högt blodtryck men till vilken nivå blodtrycket skall behandlas är kontroversiellt. Denna avhandling innefattar två systematiska översikter och meta-analyser samt ett arbete som jämför olika sätt att hantera skillnader mellan studier i meta-analyser. De systematiska översikterna sammanställer data från randomiserade kontrollerade studier av blodtryckssänkande behandling. Vår övergripande frågeställning var om effekten av behandling påverkas av blodtrycksnivån innan behandling. Mer specifikt studerades hur behandling påverkade risken att dö eller drabbas av hjärt-kärlsjukdom vid olika blodtrycksnivåer. Det första arbetet fokuserade på personer med diabetes. För dessa fann vi att blodtryckssänkande behandling minskar risken att dö eller drabbas av hjärtkärlsjukdom vid nivåer ≥ 140 mmHg. Vi fann ingen nytta, men möjligen en skadlig effekt av behandling, vid lägre blodtrycksnivåer. Det andra arbetet inkluderade studier oberoende av vilka sjukdomar deltagarna hade. Vi fann att den förebyggande effekten av blodtryckssänkande behandling berodde på blodtrycksnivån. Vid blodtryck &gt; 160 mmHg minskade risken att drabbas av hjärt-kärlsjukdomar med 22 % hos de som erhöll behandling. Om blodtrycket var 140-160 mmHg minskade risken med 12 %, men om blodtrycket var &lt; 140 mmHg sågs ingen behandlingseffekt. Hos personer med känd kranskärlssjukdom, och ett medelblodtryck på 138 mmHg, fann vi en något minskad risk för hjärt-kärlhändelser med ytterligare behandling. I det tredje arbetet fann vi att skillnader i resultat mellan olika studier inte kan antas bero endast på olika grad av blodtryckssänkning i studierna. När resultaten standardiserades, som om alla studier hade sänkt blodtrycket lika mycket, ökade nämligen skillnaderna mellan studierna. Detta resulterade i sin tur i snedvridning av resultaten från meta-analyser av standardiserade värden. Sammanfattningsvis minskar blodtryckssänkande behandling risken att dö eller drabbas av hjärt-kärlsjukdomar om blodtrycket är 140 mmHg eller högre. Vid lägre nivåer är nyttan med behandling osäker samtidigt som det finns potentiella risker. Standardisering bör inte användas rutinmässigt vid metaanalyser av blodtrycksstudier. Tidigare meta-analyser som använt denna metod bör tolkas med försiktighet.

Allt fler personer lever med eller har en nära anhörig som lever med en demenssjukdom. En demenssjukdom leder till kognitiva nedsättningar som påverkar individens kommunikation. Deltagande i social interaktion är vitalt för en god livskvalitet samt känsla av själv, värde och identitet hos personer med demenssjukdom. Interaktion där personer med demenssjukdom deltar påverkas av de kommunikationssvårigheter som följer demenssjukdomen, men också av samtalspartners syn på personen med demenssjukdom. Föreliggande studie undersöker interaktion som involverar personer med demenssjukdom med fokus på hur kunskapande manifesteras i interaktionen, hur personer med demenssjukdom positionerar sig själva och positioneras av andra som personer som kan någonting samt vilken betydelse som positionering har för personer med demenssjukdoms deltagande i social interaktion. Kunskapande har definierats som ett aktivt görande av kunskap genom mellanmänsklig interaktion. Data har utgjorts av totalt 30 timmar audio- och/eller videoinspelning av naturligt förekommande interaktion där personer med demenssjukdom deltar, från vilken 14 representativa samtalsexempel lyfts fram. Vid analys har multimodal interaktionsanalys samt positioneringsteori använts. Analysen visar att kunskap kan manifesteras hos personer med demenssjukdom genom kunskapande, en dynamisk process där kunskap förhandlas fram genom samtal. Att positioneras som samt positionera sig själv som kunnande verkar ha en positiv effekt på personer med demenssjukdoms möjlighet att ge uttryck för sin kunskap. Personer med demenssjukdom kan således vara delaktiga i kunskapandeprocesser och de sociala situationer som ligger till grund för kunskapandet. Kliniska och praktiska implikationer kring främjandet av deltagandet i social interaktion hos personer med demenssjukdom presenteras. En demenssjukdom medför förändrade förutsättningar för social interaktion men viktigt är att se till individens styrkor och bevarade förmågor samt ge individen förutsättningar för att kunna delta i samtal och ge uttryck för sin kunskap. / An increasing number of people live with dementia or have a close relative who does so. Participation in social interactions is vital for sustaining quality of life and a feeling of self, value and identity in people with dementia. Dementia causes cognitive impairments that affect the person’s ability to communicate. Interactions in which people with dementia participate are influenced by the communicative difficulties that arise as a result of the disease, but also by the conversational partner’s view of the person with dementia. The present study investigates interactions involving people with dementia, focusing on how knowledging is manifested in the interaction, how people with dementia position themselves and are positioned by others as people with knowledge, and what effects this positioning has on the participation of people with dementia in social interactions. Knowledging is defined as the active making of knowledge through interpersonal interactions. The data consists of 30 hours of audio and video recordings of naturally occurring conversations in which people with dementia participate, from which 14 representative conversational examples were highlighted. Multimodal interaction analysis and positioning theory were used in the analysis. The analysis revealed that knowledge can be manifested in people with dementia through knowledging, a dynamic process in which knowledge is negotiated through conversation. Being positioned as knowing by others, as well as positioning oneself as knowing, seems to have a positive effect on the ability to express knowledge in people with dementia. People with dementia can therefore be involved in knowledging processes and the social situations that form the basis of knowledging. Some potential clinical and practical implications of promoting the participation of people with dementia in social interactions are suggested. Dementia changes the conditions for social interaction, but it is important to highlight each individual’s strengths and retained abilities and provide them with the conditions for participating in interactions and expressing their knowledge.

ABSTRACT   Background Removal of mandibular third molars can be associated with postoperative complications. Coronectomy with partial removal of the crown, is described as an alternative surgical method when risks for post-operative complications are substantial.  Aim  The aim of this study was to evaluate risk factors for post-operative complications after coronectomy.   Materials and Methods Fifty-six patients (26 men/30 women, median age 51 years) were operated with coronectomy of mandibular third molars. Risk factors were identified from medical records and radiographic examinations. Post-operative complications lasting over 14 days were registered.   Results  Fifty percent of the patients had a post-operative complication with significant higher risk for complications for patients over 51 years (p = 0.016). The most common complications were pain from surgical site and local infection. Three patients were registered with affected sensory function. Root migration was registered in 16 patients. Gender, comorbidity, medication, tobacco use, cause of referral (bacterial/other causes) or angulation of the third molar did not affect the risk for complications. Conclusion  The results indicate that coronectomy is an appropriate surgical technique when the risks for postoperative complications are significant, although a high level of short-term complications has been observed.

Plack i arteria carotis kan ha olika utseende beroende på innehåll och morfologi. Det kan vara lågekogena eller högekogena plack. De lågekogena placken är mest problematiska eftersom de består av lipider och inflammationsceller som ger en mjuk konsistens och kan spricka och ledda till embolisering med stroke och kardiovaskulära incidenter som följd. För mätning av plack-ekogenicitet används i forskningssyfte ett GSM-värde, grey scale median som mäts med en ultraljudapparat med GSM-inställning. Ju lägre GSM-värde desto mer lågekogen är placken. Syftet med denna studie är att jämföra två GSM-värde för samma plack, den ena mätt med ultraljudstandardinställning och den andra mätt med GSM-inställningen för att avgöra om det blir en bra överensstämmelse mellan värdena. Om så är fallet innebär detta att plack-ekogenicitet kan avgöras i framtiden med mätning av GSM-värde med en ultraljudsapparat med standardinställning i forskningssyfte. Resultatet visade att det fanns en god överensstämmelse mellan en stor del av GSM-värdena, men det fanns en del värde där det blev en signifikant skillnad som gjorde att studien inte var tillräcklig övertygande för förväntade utfallet. / Plaque in the carotid artery can have different appearances depending on the content and morphology. It can be echolucent or more-echogenic plaques. The echolucent plaques are most problematic because they consist of lipids and inflammatory cells that give a soft consistency and can crack and lead to embolization with stroke and cardiovascular incidents as a result. For measuring plaque echogenicity for research purposes, a GSM value, gray scale median is used and is measured with an ultrasound device with a GSM setting. The lower the GSM value, the lower echolucent is the plaque. The purpose of this study is to compare two GSM values for the same plaque, one measured with the ultrasonic standard setting and the other measured with the GSM setting to determine if there is a good agreement between the values. If this is the case, this means that plaque echogenicity can be determined in the future by measuring GSM value with an ultrasound device with a standard setting for research purpose. The results showed that there was a good agreement between a large part of the GSM values, but there were some values where there was a significant difference which made the study not sufficiently convincing for the expected outcome.

Breast cancer is the most common cancer among women in Sweden and globally. Socio-demographic, genetic and productive factors together with some endogenous and exogenous hormones and lifestyle are some of the risk factors that can cause this type of cancer. There is no cure for metastatic breast cancer but the treatment goal is to control the disease and prolong the survival. Treatment options in metastatic breast cancer are exactly like the ones in primary breast cancer. Targeted cancer therapy is a treatment that targets either one or some specific characters of the cancer. Serine-threonine kinases called CDK4/6 inhibitors like Ibrance with chemical name palbociclib, Kisqali with chemical name ribociclib and Verzenios with chemical name abemaciclib are used for target therapy against metastatic breast cancer. CDK4/6 inhibitors in combination with aromatase inhibitors, estrogen receptor down regulators or selective receptor modulators are also used to address the treatment resistant metastatic breast cancers. The aim of this thesis is to investigate the role and the effect of CDK4/6 inhibitors in the treatment of metastatic breast cancer. Six randomized controlled trial studies were selected from the PubMed data base. Results from the trial analysis showed equal effects and relative same adverse event profiles between those three mentioned CDK4/6 inhibitors. The primary endpoint, progression free survival and secondary endpoints including overall survival, clinical benefit rate, overall response rate and safety were investigated in these studies. The duration of progression free survival (PFS) and overall response rate (ORR) was longer and improved in most studies however improvement in overall survival (OS) was not achieved. More research studies are needed to determine optimal treatment for patients with metastatic breast cancer who are medicated by CDK4/6 inhibitors. / Bröstcancer är den vanligaste cancerformen bland kvinnor i Sverige och globalt. Sociodemografiska, genetiska och reproduktiva faktorer samt vissa endogena och exogena hormoner och livsstil är några riskfaktorer som kan orsaka denna typ av cancer. Metastatisk bröstcancer innebär att cancer har spridit sig bland andra organ i kroppen bland annat ben, hjärna, lever och lungor. Det finns inget botemedel mot metastatisk bröstcancer men målet är att kontrollera sjukdomen och förlänga överlevnaden och behandlingsalternativ för detta är exakt som den i den primära bröstcancern. Målspecifik cancerterapi är en behandling som riktar sig mot någon specifik karaktär hos cancercellerna. En klass av läkemedel består av en stor familj av serintreoninkinaser som kallas CDK4/6-hämmare: Ibrance (palbocilcib), Kisqali (ribocilcib) och Verzenios (abemaciclib) används mot metastaserad bröstcancer. Syftet med det här examensarbetet var att undersöka rollen samt effekten av CDK4/6 hämmare vid behandling av metastatisk bröstcancer. Sex randomiserade kliniska studier erhölls från artikelsökningar i databasen PubMed. Resultat från artikelanalyser visade likvärdiga effekter samt relativt samma biverkningsprofil mellan de tre ovannämnda CDK4/6 inhibitorerna. Den primära utfallsvariabeln var progressionsfri överlevnad och de sekundära utfallsvariablerna inkluderade total överlevnad, klinisk nytta, den totala svarsfrekvensen och säkerhet undersöktes i dessa studier. Varaktigheten av progressionsfri överlevnad (PFS) samt den totala svarsfrekvensen (ORR) var längre och förbättrades i nästan alla studier medan den totala överlevnaden (OS) kunde inte fastställas då inte tillräckligt med data kunde samlas in. Ytterligare undersökningar behövs för att förstå den fulla mekanismen bakom resistensutveckling samt utöka strategier för att minska negativa biverkningar av CDK4/6 hämmare vid behandling av patienter vid metastatisk bröstcancer.

Introduktion: Röntgenmottagningen på Universitetssjukhuset i Örebro (USÖ) undersökertraumapatienter med sliding gantry datortomografi (SGDT). I ett SGDT-system står bordet fastpå plats och det är istället gantryt som rör sig över patienten under bildtagningen. Detta öppnarupp för möjligheten till ett nytt arbetssätt vilket kan påverka både röntgensjuksköterskor ochpatienten. Syfte: Syftet med studien är att undersöka hur SGDT påverkar röntgensjuksköterskans arbete vidtrauma och akutverksamhet. Underlättar SGDT arbetsflödet för röntgensjuksköterskor? I sådanafall hur? Metod: Studien utfördes som en kvalitativ studie med semistrukturerade intervjuer. Tioröntgensjuksköterskor deltog i studien. För att koda material och skapa tema gjordes en kvalitativinnehållsanalys. Resultat: Fördelar med SGDT är att arbetsflödet blivit smidigare eftersom det finns en tydligareroll i traumarummet, det är bättre organiserat, samarbetet med traumateamet har blivit bättre ochröntgensjuksköterskorna återgår fortare till normala akutflödet. Nackdelen med SGDT är att detinte är anpassad till ett vanligt akutflöde på USÖ. Slutsats: SGDT underlättar arbetsflödet för röntgensjuksköterskan vid en traumasituation med ettförbättrat samarbete, kommunikation och organisering. Dock är SGDT inte optimal för detvanliga akuta flödet. / Introduction: The department of radiology at Örebro University Hospital (USÖ) examinestrauma patients with sliding gantry computed tomography (SGDT). A SGDT system incorporatesa stationary examination table with a gantry that passes over the patient during scanning. Thisnovel method has the potential to affect both the radiographer as well as patient care. Aim: The aim of the study is to ascertain how SGDT affects the work of radiographers in traumaand emergency care. Does a SGDT facilitate an improved workflow for radiographers? If so,how? Method: The study used a qualitative design with semi-structured interviews. Ten radiographersfrom USÖ participated in the study. A qualitative content analysis was performed to create codesand themes from the collected materials. Results: The foremost benefit of SGDT is that the radiographers’ workflow improved. This isdue to a clearer role in the trauma suite, improved organisation, better interprofessionalcooperation with the trauma team and the ability to return more quickly to regular acuteexaminations. A drawback with SGDT is that it is suboptimal for normal acute examinations. Conclusion: SGDT facilitates a better workflow for radiographers in trauma examinationsbecause of improved coordination, communication and organisation, with few drawbacks.

A standard Neurofeedback approach to mitigate the working memory decline in some fragile groups (elderly, subjects affected by stroke or Alzheimer's disease) can be suboptimal for some patients. The goal of this research is to investigate which visual stimulus (among colour, geometrical shape, direction, and symbol) is the most suited for each of the six healthy participants and which brain areas are the most discriminative, during the maintenance of a presented stimulus in a retro-cue-based working memory experiment. In order to identify the most discriminative stimulus, the single-trial classification accuracies of some Support Vector Machines, trained on the theta, alpha and beta electroencephalography power bands, have been compared; while, in order to identify the most involved brain regions, three machine learning feature reduction techniques have been explored: the first based on a massive univariate analysis, the second based on multivariate filtering and wrapping, and the last one based on Frequency-based Common Spatial Pattern. The results have shown that the univariate approach, more than the others, managed to clearly identify for each participant at least one preferential type of stimulus and a brain region of discriminative electrodes during the maintenance of the stimulus. These promising results can be interpreted as a further step to optimize the Neurofeedback working memory enhancement through a personalised approach.

The Member States of EU27 need to accelerate the integration of energy efficient technology solutions to reach the 20% energy efficiency target set for 2020. At current pace, projections indicate that only half of expected primary energy reductions will be reached. To meet the energy demands of growing populations and a vibrant economy, while simultaneously reducing primary energy supplies, the European continent faces a new kind of challenge never previously encountered. The identification and application of feasible, competitive, and comprehensive solutions to this problem are of highest priority if the remaining gap is to be closed in time. How is this multi-dimensional and complex dilemma to be dissolved? In this work, expanded use of district heating technology is conceived as a possible solution to substantially reduce future primary energy demands in Europe. By extended recovery and utilisation of vast volumes of currently disregarded excess heat from energy and industry sector fuel transformation processes, district heating systems and combined generation of heat and power can improve the general efficiency of the European energy balance. To investigate the possible range of this solution, this thesis introduces a set of methodologies, theoretical concepts, and model tools, by which a plausible future excess heat utilisation potential, by means of district heat deliveries to residential and service sectors, is estimated. At current conditions and compared to current levels, this potential correspond to a threefold expansion possibility for directly feasible district heating systems in European urban areas and a fourfold increase of European excess heat utilisation.