A need for the personnel at the Anaesthesiology and Intensive Care Unit at Danderyd Hospital to better understand their patients’ experiences and attitudes towards participation in their care was identified by the Clinical Innovation Fellowship program at Centre for Technology in Medicine and Health. This study aimed to provide the Anaesthesiology and Intensive Care Unit with information on patients and personnel’s experiences and attitudes towards patients’ participation; this would allow them to understand how they should focus their resources. A crosssectional and group comparing survey was performed at the Anaesthesiology and Intensive Care Unit in the spring of 2016. A total of 55 patients scheduled for surgery and 38 from the personnel at the Anaesthesiology and Intensive Care Unit participated. The results show there is high overall satisfaction among the participants of their experiences of patients’ participation. The majority of the patients wanted to be passive in decisions, no connections between personal characteristics and preferred level of participation was found. Patients who did not felt they had been able to participate enough also felt uninformed. Furthermore, physicians seemed to have better opportunities to include patients in decisions compared to the nurses. The healthcare systems should work to adapt the care for each individual patient and to provide them with information suitable for the individual in order to support patients’ participation; IT-systems could be one way of doing this. Future studies should further investigate which factors could influence patients’ participation and how healthcare services and technology could be designed in order to support patient participation. / Clinical Innovation Fellowship programmet från Centrum för teknik i medicin och hälsa identifierade ett behov hos personalen på Anestesi- och intensivvården på Danderyds sjukhus att bättre förstå vad deras patienter hade för förväntningar på sin medverkan i vården. Detta examensarbete syftar till att ge Anestesi- och intensivvården information om patienters och personals erfarenheter och förväntningar på patienters medverkan i vården för att de ska veta var de ska fokusera sina resurser. En enkätstudie har genomförts på Anestesi- och intensivvården under våren 2016. Totalt deltog 55 patienter som var inplanerade på operation samt 38 personer ur personalen på Anestesi- och intensivvården. Resultaten visar att majoriteten överlag är nöjda med sina erfarenheter gällande patienters medverkan. Majoriteten av patienterna vill ha en passiv roll i besluten, det var inte möjligt att identifiera karaktärsdrag bland de olika patientgrupperna för önskad beslutsnivå. Patienter som kände att de inte hade deltagit tillräckligt mycket kände även att de inte fått tillräckligt med information. Vidare kände läkare i större utsträckning än sjuksköterskor att de hade möjligheten att inkludera patienterna i besluten. Sjukvården borde sträva efter att anpassa vården utifrån individen och erbjuda patienter information som är bäst lämpad för dem, ett sätt att erbjuda information kan vara med hjälp av IT-system. Framtida studier borde undersöka vilka faktorer som influerar patienters medverkan samt undersöka hur tjänster och teknik inom vården bäst kan utformas för att stödja patienternas medverkan.

Patients with cerebral palsy account for great upper extremities deviationswhile walking. However, the number of studies assessing their upper bodygait kinematics are rare and no studies have been conducted interested inthe whole body kinematics during walking. In this study, we created awhole body index, the Body Profile Score made of modified existing kinematicindexes assessing the gait pattern of children with cerebral palsy. TheBody Profile Score (BPS) is an average of combination of the Gait ProfileScore (GPS), a modified Trunk Profile Score (TPS), a modified Arm PostureScore (APS) and a also new index called Head Profile Score (HPS), basedon a similar calculation. Dierent versions of the BPS were tested on threegroups: a control group, a CP group before botulinum toxin A treatmentand a CP group after botulinum toxin A treatment. The results showed apoor level of linear correlations between the dierent BPS versions and theGait Profile Score, indicating that lower body indexes such as the GPS orGait Deviation Index (GDI) and full body index such as the BPS do not renderthe same information. The BPS is the first index proposing a full bodykinematic analysis and aims at showing that such an analysis is needed ingait assessment of spastic children in order to have a realistic overview ofthe pathological walking condition.

Machine learning methods provide an opportunity to improve the classification of skin lesions and the early diagnosis of melanoma by providing decision support for general practitioners. So far most studies have been looking at the creation of features that best indicate melanoma. Representation learning methods such as neural networks have outperformed hand-crafted features in many areas. This work aims to evaluate the performance of convolutional neural networks in relation to earlier machine learning algorithms and expert diagnosis. In this work, convolutional neural networks were trained on datasets of dermoscopy images using weights initialized from a random distribution, a network trained on the ImageNet dataset and a network trained on Dermnet, a skin disease atlas.  The ensemble sum prediction of the networks achieved an accuracy of 89.3% with a sensitivity of 77.1% and a specificity of 93.0% when based on the weights learned from the ImageNet dataset and the Dermnet skin disease atlas and trained on non-polarized light dermoscopy images.  The results from the different networks trained on little or no prior data confirms the idea that certain features are transferable between different data. Similar classification accuracies to that of the highest scoring network are achieved by expert dermatologists and slightly higher results are achieved by referenced hand-crafted classifiers.  The trained networks are found to be comparable to practicing dermatologists and state-of-the-art machine learning methods in binary classification accuracy, benign – melanoma, with only little pre-processing and tuning.

Proteases are crucial to many biological processes and have become an important field of biomedical and biotechnological research. Engineering of proteases towards therapeutic applications has been limited due to the lack of high-throughput methods for characterization and selection. We have developed a novel high-throughput method for quantitative assessment of proteolytic activity in the cytoplasm of Escherichia coli bacterial cells. The method is based on coexpression of a protease of interest and a reporter complex consisting of an aggregation-prone protein fused to a fluorescent reporter. Cleavage of a substrate sequence situated between the two reporter complex proteins results in increased whole-cell fluorescence proportional to proteolytic activity, which can be monitored using flow cytometry. We have demonstrated that the method can distinguish efficiencies with which Tobacco Etch Virus (TEV) protease processes different substrates. We believe that this is the first method in the field of protease engineering that enables simultaneous measurement of proteolytic activity and protease expression levels and can therefore be applied for substrate profiling, as well as screening and selection of libraries of engineered proteases.

Nowadays, sleep disorders e.g. sleep apnea —the cessation of airflow at the nose and mouth lasting at least 10 second— are a broadly problem around the world. Direct and indirect costs associated to sleep problems are outsize and the quality of patient life is deteriorated because of it. In addition, Sleep is a fundamental part of everyday life, the lack of it or the poor quality of sleep may lead into the development of important diseases. Sleep studies are usually carried out by specialists by means of polysomnography. Polysomnography is a type of sleep study which is consisting of EEG, EOG, EMG, ECG, respiratory signals and/or many other biosignals which together can be used to determine the state of patient’s sleep and any other issue. Nowadays, visual inspection of these signals forms the “gold standard” in sleep clinics. The cost of monitoring a person overnight, the scarcity of beds available and the uncertainty of whether the results are representative of a normal nights’ sleep means that a move to home diagnostics is likely to be advantageous. Therefore, a necessity for home recorders systems capable of perform this kind of analysis has come out. A state machine based automatic scorer is developed and evaluated in Matlab by using 12 recordings of apnoeic patients from sleep heart health study (SHHS) database. By the analysis of EEG, EOG, EMG, Oxygen saturation (Sao2) and respiratory movements signals, the implemented algorithm is trained and evaluated to detect the five stages of subject’s sleep (Wake, N1, N2, N3, or REM) as well as apnoeic episodes according to guidelines from American Academy of Sleep Medicine (AASM). In the final evaluation of algorithms, the automatic scorer achieved 74±5.27% accuracy for all five stages and Cohen’s kappa of 0.5 for the overall set of 12 patients, being the accuracy better for healthier subjects and reaching in this case 78±4.05%. The analysis of the sleep apnea concluded with a sensitivity of 47.08%, a specificity of 83.38%, and an accuracy of 78.1%. Differences in the performance among patients according to their apnea/hypopnea index were significant.   Key Words: Polysomnography, AASM, Sleep apnea/hypopnea.

This thesis describes the bene ts and disadvantages of using synthetic Magnetic Resonance Imaging (MRI) instead of conventional MRI. The thesis is based on a clinical study performed at Orebro University Hospital were 11 patients diagnosed with Multiple Sclerosis (MS) went through a brain examination with both methods. The examination time was measured and compared between the two methods, and the quality of the images was analysed by two radiologists. The study shows that the examination time can be reduced using the synthetic method instead of the conventional. The image quality is however not as good with the synthetic method which opens a discussion whether the time reduction is worth the loss of image quality. However, the conclusions are that the method can be useful for patients diagnosed with MS who are examined yearly and especially useful as a complement to the conventional sequence to gain as much information as possible that can be compared between the patients yearly exams. To completely replace other conventional examination types, the method has to be further evaluated and equipped with functions that are present in the conventional sequences, such as correction for motion artefacts. / Denna rapport beskriver de fördelar och nackdelar som finns med att använda syntetisk magnetresonanstomografi (MRI) istället för konventionell MRI. Rapporten är baserad på en klinisk studie som har genomförts vid Universitetssjukhuset i Örebro där 11 patienter diagnostiserade med Multipel Skleros (MS) genomförde en undersökning av hjärnan med båda metoderna. Undersökningstiden mättes och jämfördes metoderna emellan, och bildkvaliteten analyserades av två radiologer. Den kliniska studien visar att undersökningstiden kan förkortas när den syntetiska metoden används i jämförelse med den konventionella. Bildkvaliteten för de konventionella bilderna anses vara av högre kvalitet i denna studie vilket öppnar en diskussion gällande huruvida det är värt att förlora en viss bildkvalitet mot förkortat undersökningstid. Slutsatsen är att metoden är användbar för patienter diagnostiserade med MS som undersöks årligen, och speciellt användbar som ett komplement till de konventionella sekvenserna för att generera så mycket information som möjligt. Denna information är sedan användbar vid jämförelse av bilderna från patienternas återkommande undersökningar. För att helt ersätta de konventionella sekvenserna krävs vidare utvärderings av den syntetiska metoden samt att den kompletteras med er funktioner, exempelvis för att korrigera för rörelseartefakter.

Heart Rate Variability (HRV) is a medical term describing the heart’s natural varying time difference between heartbeats (called NN-intervals). A higher HRV i.e. a larger variability between NN-intervals is connected to healthiness, and lower HRV to unhealthy states. Biofeedback (BF) is a method that can detect and send physiological signals back to the user on a screen. Every individual has a resonant frequency, and when breathing at this frequency, the interplay between blood pressure and respiration causes HRV to increase momentarily. HRV biofeedback aims at increasing HRV, by measuring heart rhythm and respiration to guide the user in resonant breathing. This thesis had the objective to investigate the effectiveness of one 20 minutes long biofeedback session with resonant frequency breathing. The hypothesis was that the time frame would be longer than two hours. It was carried out with 12 healthy volunteers, who participated in a biofeedback session with an Android application, and afterwards 5 minutes long ECG measurements were made every half hour for two hours. A control session was held with the same participants to give the trial more scientific strength. The result showed that a 20 min resonant breathing biofeedback session can elevate Standard Deviation of NN intervals (SDNN) significantly (p < 0.05), 2 hours after the biofeedback session. The conclusion was that the hypothesis cannot be rejected, but the result is too weak to strengthen it much. Further research is needed to draw more conclusions about the time frame of HRV elevations in healthy people.

Robotic-assisted surgery is a rapid growing field, facing challenging tasks and demands from surgeons, in particular in minimally invasive and microsurgery. However many of the present robotic systems are not well integrated in the surgical workflow, too big or too expensive. Micron is an innovative fully handheld active micromanipulator that helps surgeons to improve position accuracy and precision in microsurgery by cancelling the normal hand tremor. This thesis proposes an improvement and development of Micron, considering as target the stapedotomy procedure, microsurgery performed at the middle ear that aims to restore the hearing impairments. Two tools, a handle and a brace were designed and prototyped and the control was adapted; at the end the entire system was assessed through some experiments. Promising results were obtained in terms of tremor cancellation but further research is needed in order to reach clear advantages.

A human body can carry out many physiological complex processes which can be mechanical, electrical or bio-chemical. Each mechanical activity generates a signal that describes the characteristics of the particular action in the form of pressure or temperature. Any irregularity in the process changes the usual functioning thus affecting the performance of the system. Several techniques were introduced to evaluate these muscular signals in order to get a deeper understanding of the medical abnormalities. Displacement sensors, laser optics, electrodes, accelerometers and microphones are some of the widely used devices in measuring the electrical and mechanical activities produced in the muscles. The aim of this thesis project was to find and implement a simple non-contact optical method to measure and monitor the displacements caused on the surface of the skin due to muscular movements. In this study, a device was developed using photo electric sensors that can record surface changes caused on the skin due to the movements forearm muscles.

Mandometermetoden hjälper personer med ätstörningar genom att med träning lära dem ätapå ”rätt” sätt med en produkt som kallas Mandometer®. Detta sker genom att användarna viadisplayen på Mandometers® handdator får återkoppling på om de äter för fort eller förlångsamt under måltiden. Mando Group AB, företaget som utvecklat Mandometermetoden,har även tagit fram ett datorprogram som fungerar som en simulering av en måltid medMandometer®. Syftet med det här arbetet var att undersöka om träning med denna simuleringskulle kunna ge samma effekt som träning med Mandometer®. Genom att låta en gruppfriska testpersoner träna med simuleringen under tre veckor erhölls ett resultat som tydligtvisade att testpersonerna ändrat sitt ätbeteende i önskad riktning. Resultatet visar att det finnsen möjlighet att i framtiden lägga till träning med simuleringen som en del avMandometermetoden förutsatt att utökade tester samt utveckling av programmet förstgenomförs.För att förbättra Mandometer® ytterligare har dessutom en ny version tagits fram därhanddatorn ersatts med en mobil och dess funktioner med en applikation. Applikationensfunktionalitet och användarvänlighet testades bland annat med metoden cognitivewalkthrough vilken visade att applikationen generellt höll en hög standard. Med någrajusteringar på sidorna där användarvänligheten var låg bör applikationen kunna ersättaden nuvarande versionen av Mandometer® i framtiden. / The Mandometer® Method helps people with eating disorders by teaching them how to eat ina ”correct” way by training with a product called Mandometer®. The users learn the correcteating behavior by receiving feedback from the display on the Mandometer® handheldcomputer on whether they eat too fast or too slow during the meal. Mando Group AB, thecompany which has developed the Mandometer® Method, has also created a computerprogram that works as a simulation of a meal with the Mandometer®. The purpose of thisstudy was to examine if training with the simulation could give the same effect as trainingwith Mandometer®. By letting a group of healthy testpersons practice with the simulationduring three weeks a result was given which clearly showed that the eating behavior of thetest persons had changed in the desired direction. The result indicates that there is a possibilityto add the simulation to the Mandometer® Method in the future. However, more testing anddeveloping of the program is first required.To improve Mandometer® further, a new version of the product has been developed wherethe handheld computer has been replaced by a cellphone and its functions by anapplication. The functionality and usability of the application was tested with the methodcognitive walkthrough, which showed that most of the pages of the application maintaineda high standard. With some adjustment of the pages where the usability was low, theapplication should be able to replace the old version of Mandometer® in the future.