Chronic back pain is costly and potentially disabling, with low response to medical procedures. Poor physical and mental health demonstrate correlation with chronic back pain. The current study investigated the value of using health-related locus of control and pain-related self-efficacy to predict physical and mental health outcomes following multidisciplinary intervention for chronic back pain. Form C of the Multidimensional Health Locus of Control scales and the Chronic Pain Self Efficacy scale were administered to 28 males and 33 females ages 28 to 72 completing chronic back pain rehabilitation. Locus of control, self-efficacy, and physical and mental health demonstrated treatment-related changes, with notable improvements in physical and mental health. Regression analyses examined the value of pre-treatment health locus of control and pain-related self-efficacy as predictors of physical and mental health one month following treatment. Higher internal and lower doctor health locus of control, and higher self-efficacy at baseline predicted higher lift scores one month after treatment. Higher baseline self-efficacy also predicted better physical functioning and lower disability at one month. Pain-related self-efficacy and health locus of control may be valuable predictors of treatment benefit for chronic back pain patients. Limitations included low sample size.

The Sevier River Basin situated in south central Utah is characterized by its semiarid climate, snowmelt-driven runoff, and high dependency on agricultural economy. High evapotranspiration and low precipitation make agricultural production challenging, but naturally stored water in the snowpack in the mountains alleviates water stresses during high water demand seasons. The snowmelt-driven river flow along the main channel is highly exploited for irrigation for farms near the Sevier River. Reservoir operations and river diversions result in heavily regulated flows from the upper to the lower basins. The return flows of over-irrigated water in the upper basin increase salinity of surface water. Long-term applications of salinity water in agriculture eventually produce high soil salinity in the agricultural areas near Delta in the lower basin, which deteriorated farmers’ crop productivity. Farmers cropping near Delta struggle with both water and salinity stresses. Indeed, crop prices and yields are always their concerns. For them, efficient water management can be achieved with consideration of hydrologic, agronomic, and economic aspects of water resources. The overall goal of this research was to develop a decision supporting framework for efficient water and land allocations that considered hydrologic processes, crop response to water in salinity-affected farms, and farmers’ profit and financial risk. This research introduces a methodology for predicting water availability in a given cropping year from the snowpack in the mountains, and agronomic simulations with satellite images follow for quantifying crop response to water. The hydrologic predictions and the agronomic simulations are finally incorporated into an economic analysis that provides efficient water and land allocations with multiple crop selections. In a rural river basin, data limitation is a common concern for water resources engineers; thus simple but robust methodologies are proposed for hydrologic prediction. In the same context, satellite images are used for the estimation of crop yields in individual farms near Delta with no prior crop experimental plots. Historical records of crop prices are used for the economic analysis. The methodologies developed in this research provide a comprehensive decision analysis framework for efficient water management where water is scare and available from snowmelt only, the economy depends on agriculture only, and salinity is present in both soil and water due to long-term irrigation. The case study is for the agricultural area near Delta in the Sevier River Basin, but its applicability is not limited and is flexibly applicable to other agricultural regions.

Intervention assistance (IA) programs have been developed as a mechanism for avoiding costly special education referrals and for supporting teachers in their instruction of students with varying needs within the general education classroom (Safran and Safran, 1996). Although IA programs are designed to be consultative, multidisciplinary approaches to assisting teachers, some studies report that teachers conduct the majority of classroom-based interventions for a given student on their own prior to referring students to an IA team (Wilson, Hagen, Gutkin, and Oats, 1998). It is important to determine what interventions or strategies teachers commonly consider and what factors are associated with breadth and depth of intervention knowledge. The purpose of the present study was to replicate a portion of the research of Wilson et al. (1998), which assessed general education teachers knowledge of classroom-based interventions. The present study also extended the work of Wilson et al. by using an exploratory descriptive/nonexperimental design to examine the degree to which teachers individual professional characteristics, as well as the IA practices of the schools in which they work, were related to their knowledge of interventions. Twenty-nine general education teachers in Hillsborough County, FL responded to a vignette describing a typical classroom-based problem in a structured-interview format. Participants responses were then counted and coded for (a) how specifically interventions were described, and (b) what types of interventions the teachers used (e.g., instructional, behavioral, etc.). Teachers also completed a brief demographic questionnaire, which included items about the IA programs at their schools, as well as their individual referral history over the last two years, and the degree to which they had been trained in classroom-based interventions. Results were similar to Wilson et al. with regard to number of intervention ideas, but teachers were more specific than in previous investigations. Descriptive data regarding teachers' characteristics as problem-solvers and their perceptions of IA at their school are offered, but few noteworthy relationships were identified between these variables and structured interview outcomes. Nevertheless, the present study offers a glimpse into the intervention practices of general education teachers. Implications for both school psychology practice and research are offered.

High plant species diversity depends on a landscape that provides enough habitual space, functional connectivity and heterogeneity. Habitat destruction and land use change is recognized as the biggest threat to biodiversity of today. The Swedish landscape has not only undergone dramatic changes in land-use the last 60 years, it also contains some of the last fragments in Europe of the highly valuable hay-meadows. Many of the Swedish hay-meadows are considered to hold high ecological values and are protected by Natura 2000 regulations. Yet there are no systematic conservation strategies for the hay-meadows and most of the work is done by volunteers. This study aims to further investigate how the surrounding landscape affects the total plant species richness on Swedish hay-meadows. A local scale GIS-analysis on landscapes surrounding 21 hay-meadows across two time steps was carried out. The historical land-use was compared with the present landscapes and with species data from the same areas. Results show that the forest cover has grown almost 12% in 60 years. There is a negative correlation between forest and the plant species richness of both time steps. The total area of arable fields has dropped 19%, although no statistical correlation with the plant species richness of either time step was found. The ex-arable fields of 1950 however, did show a negative impact, both alone and together with open pasture. Open pasture has decreased 17%, although no statistical correlation was found between this land-cover category and plant species richness. The overall results indicate that the historical land-use on the local scale is of greater importance on the current plant species richness than present land-use. This should be considered within landscape planning and when designing conservation strategies. / En hög plantdiversitet är beroende av ett landskap som erbjuder tillräckligt stora habitat, funktionell konnektivitet och heterogenitet. Habitatförlust och förändrad markanvändning utgör det största hotet mot biodiversitet idag. Det svenska landskapet har inte bara förändrats dramatiskt de senaste 60 åren, det innehåller också några av Europas sista fragment av de mycket värdefulla slåtterängarna. Många av de svenska slåtterängarna är upptagna i Natura 2000-områden. Trots detta finns inga systematiska bevarandestrategier för dessa slåtterängar och arbetet hänger mestadels på volontärer. Den här studien ämnar bidra till en ökad förståelse för hur omgivande landskap påverkar plantdiversiteten på svenska slåtterängar. GIS-analyser av lokala landskap som omger 21 svenska slåtterängar har utförts. Nedslag vid två tidpunkter har gjorts; år 1950 och 2015. Genom digitalisering av kartor från 1950-talet har arean av marktyper kunnat beräknas och sedan jämföras med dagens markanvändning och artdata i samma områden. Resultaten visar att den totala skogsarealen har ökat med 12% sedan 1950-talet och det finns negativa samband mellan både den historiska och den nutida skogsarealen och artrikedomen på ängarna. Arean av åkermark har minskat med 19% i de undersökta områdena, men inga samband med artrikedomen kunde finnas. Däremot visade det sig att den före detta åkermark som fanns på 1950-talet påverkar dagens artrikedomen negativ, både som ensam oberoende variabel och tillsammans med öppen mark. Öppen mark har minskat med mellan 17% och 24%, men inga samband mellan denna landskapskategori och plantdiversiteten fanns. De sammanställda resultaten indikerar att den historiska markanvändningen på lokal skala har större påverkan på dagens plantdiversitet än den nutida markanvändningen. Detta bör tas i beaktande vid utformande av bevarandestrategier och vid fysisk planering.

Truely optimal solutions to system design can only be obtained if the entire system is considered. In this research we consider design of commercial aircraft, but we expand the system to include a family of planes. A multidisciplinary design optimization framework is developed in which multiple aircraft, each with different missions, can be optimized simultaneously. Results are presented for a two-member family whose individual missions differ significantly. We show that both missions can be satisfied with common designs, and that by optimizing both planes simultaneously rather than following the traditional baseline plus derivative approach, the common solution is vastly improved. The new framework is also used to gain insight to the effect of design variable scaling on the optimization algorithm. / Singapore-MIT Alliance (SMA)

This thesis describes a systematical study, including multidisciplinary modeling, simulation, control, and optimization, of a fuel cell - gas turbine hybrid power system that aims to increase the system efficiency and decrease the energy costs by combining two power sources. The fuel cell-gas turbine hybrid power systems can utilize exhaust fuel and waste heat from fuel cells in the gas turbines to increase system efficiency. This research considers a hybrid power system consisting of an internally reforming solid oxide fuel cell and a gas turbine. In the hybrid power system, the anode exhaust, which contains the remainder of the fuel, is mixed with the cathode exhaust as well as an additional supply of fuel and compressed air and then burned in a catalytic oxidizer. The hot oxidizer exhaust is expanded through the turbine section, driving an electric generator. After leaving the gas turbine, the oxidizer exhaust passes through a heat recovery unit in which it preheats the compressed air that is to be supplied to the fuel cell and the oxidizer. This research concentrates on multidisciplinary modeling and simulation of the fuel cell-gas turbine hybrid power system. Different control strategies for the power sharing between the subsystems are investigated. Also, the power electronics interfaces and controls for the hybrid power system are discussed. Two different power sharing strategies are studied and compared. Simulation results are presented and analyzed. Transient response of the hybrid energy system is studied through time-domain simulation. In addition, in this effort, Particle Swarm Optimization (PSO) is used to optimize the power sharing for the hybrid power system to increase the efficiency and decrease the fuel consumption.

This qualitative study addressed an intersection in which the application of the medical model to educational disabilities and its implications for educational labeling of students interacted with the professional enculturation of clinical social workers. Employed as clinicians in programs administered in a large south eastern school district in the United States, five social workers served elementary students labeled Emotionally/Behaviorally Disabled (EBD) through federally authorized provisions for special education related services. This study used grounded theory methods to discover and analyze the social workers' underlying assumptions, values, and patterns of practice with regard to ethical and guild issues, roles and responsibilities, and bases of knowledge. The study found that participants interpreted and applied a knowledge base grounded in the normative aspects of social work. Their preparation made it possible to compete for licensure (LCSW) and assume roles as professional helpers but did not provide all the tools they needed to carry out their work as clinicians with students in EBD programs. Secondly, it found that ambiguities regarding ethics, guild issues, and roles emerged with regard to acting as helping professionals in an integrated professional setting. Each practitioner exercised certain latitude to respond as needed to challenges which varied from site to site. Finally, the findings reflected how the clinicians have situated themselves in the face of the demands of documentation procedures and of participation in meetings endemic to special education.

In der neurologischen Rehabilitation werden in zunehmendem Maße tracheotomierte Patienten mit schweren Dysphagien behandelt. Daher sollte den hierzu bisher entwickelten Interventionsverfahren eine evidenzbasierte Grundlage gegeben werden. In der vorliegenden Arbeit wird ein multidisziplinärer Behandlungsansatz zur Trachealkanülenentwöhung und Dekanülierung vorgestellt, der auf der Grundlage der relevanten Forschungsliteratur und klinischen Beobachtungen entwickelt wurde. Des Weiteren wird erstmals eine systematische Evaluation eines multidisziplinären Trachealkanülenmangements vorgenommen und es werden explorative Daten zum Rehabilitationsverlauf dargestellt. In einem retrospektiven Vergleich wurden hierzu die Dekanülierungs- und Komplikationsraten sowie die Dauer der Trachealkanülenentwöhnung zweier Patientengruppen gegenübergestellt, die vor bzw. nach Einführung des beschriebenen multidisziplinären Trachealkanülenmanagements im REHAB Basel, Schweiz, behandelt wurden. Der rehabilitative Verlauf der multidisziplinär behandelten Gruppe wurde mittels der Messinstrumente FIM (Functional Independence Measure) und EFA (Early Functional Abilities) untersucht. Der Vergleich der Dekanülierungs- und Komplikationsraten ergab eine vergleichbare Effektivität der beiden Behandlungsansätze. Darüber hinaus zeigte sich eine signifikante Verkürzung der Kanülenentwöhnungsphase bei Anwendung des multidisziplinären Vorgehens, so dass dieses als effizenter zu beurteilen ist. Die Verlaufsanalyse der multidisziplinär behandelten Patienten ergab erst nach der Dekanülierung einen signifikanten Zuwachs der funktionellen Selbständigkeit in Alltagsaktivitäten. Bei der Mehrzahl der Patienten konnte ein vollständiger oraler Kostaufbau nach der Dekanülierung erreicht werden. / In neurological rehabilitation there is a growing need for information about treatment of tracheotomized dysphagic individuals and treatment methods have to be evaluated objectively. This dissertation presents a multidisciplinary approach for the treatment of tracheotomized dysphagic patients that was developed based on research findings and clinical experiences. Furthermore it presents a first approach to a systematic evaluation of a multidisciplinary treatment protocol and explorative data about the rehabilitative progress in this patient group. In a retrospective analysis mean cannulation times and the success rate of decannulation from patients were compared before and after introduction of the multidisciplinary procedure in a rehabilitation centre, REHAB Basel, Switzerland. Furthermore, the rehabilitation progress was analyzed by means of the assessment tools ‘Functional Independence Measure (FIM)’ and ‘Early Functional Abilities (EFA)’. Decannulation rates and success of decannulation were comparable in both groups of patients. With regard to mean cannulation times, however, a significant reduction was found in the group who underwent multidisciplinary treatment. This indicates a higher efficiency of the multidisciplinary approach, whereas, with regard to effectiveness, the two approaches seem to be comparable. After decannulation the patients of the multidisciplinary group showed clear functional improvements in performing activities of daily living. Most of these patients were able to return to full oral nutrition after decannulation. The multidisciplinary approach was found to be more efficient than the former intradisciplinary protocol as it led to a safe but faster decannulation of tracheotomized dysphagic patients. The explorative data concerning rehabilitation progress in these patients supports the importance of the development of evidence-based treatment protocols that lead to a fast and safe decannulation. This can be considered the basis for further significant improvement of the functional independence of the tracheotomized dysphagic patient.

Aircrafttrajectory optimization is traditionally used forminimizing fuel consumption or time when going from one flightstate to another. This thesis presents a possible approach toincorporate tactical constraints in aircraft trajectoryoptimization. The stealth technology of today focuses on making thetactics already in use more effective. Since tactics andstealth are closely interrelated, new and better results may beobtained if both aspects are considered simultaneously. Simplyreducing the radar cross section area in some directionswithout considering tactical aspects may result in little, ifany, improvement. Flight tests have been performed in cooperation withEricsson Microwave Systems and the Swedish Air Force FlightAcademy. The aircraft used was the subsonic jet trainer Saab105, designated SK60 by the Swedish Air Force. The results showa decrease of 40% in the time interval between the instant theaircraft was first detected until it could pass above the radarstation. This corresponds to a reduced radar cross section(RCS) in the direction from the aircraft to the radar of almost90%, if classical RCS reduction techniques would have beenapplied. If a modern aircraft with stealth properties would be used,the proposed methodology is believed to increase the possibleimprovements further. This is because the variation of themagnitude of RCS in different directions is greater for a shapeoptimized aircraft, which is the property exploited by thedeveloped method. The methods presented are indeed an approach utilizing theideas of the network centric warfare (NCW) concept. Themethodology presented depends on accurate information about theadversary, while also providing up-to-date information to theother users in the information network. The thesis focuses on aircraft but the methods are generaland may be adapted for missiles, shipsor land vehicles. Theproposed methods are also economically viable since they areuseful for existing platforms without costly modifications. Themethods presented are not limited to radar threats only. Thereasons for using radar in this thesis are the availablenon-classified data and that radar is known to pose a majorthreat against aircraft.

Objective. The overall aim of this thesis was to evaluate the biopsychosocial consequences after stroke and test the validity of the ICF Core Sets for Stroke during one year post-stroke. Material and Methods. Studies I, II and III were based on data from a prospective cohort study with 120 stroke survivors who were recruited at admission to stroke units in western Sweden and were followed-up at six weeks, three months and one year after stroke event. Repeated assessments were done through face-to-face interviews consisting of a battery of questions based on the Stroke ICF Core Set (59 categories of Body Functions, 59 of Activities and Participation and 37 of Environmental Factors) and several questionnaires (EuroQol-5D (EQ-5D), Stroke Impact Scale (SIS), Medical Outcome Study Short Form 36 (SF-36), Self administered Comorbidity Questionnaire (SCQ), information on health care and social services utilization and spouse support). Study IV was based on data from the multi-center cross-sectional validation study of the Stroke ICF Core Set with 757 stroke survivors from China, Germany, Italy and Sweden. Results. Study I: A total of 28 of 59 ICF categories of Body Functions and a total of 41 of 59 categories of Activities and Participation were significant problems for stroke survivors at six weeks and three months. These categories showed a good discriminative ability to distinguish between independent (≤ 2 on modified Ranking Scale (mRS)) and dependent (> 2 on mRS) stroke survivors. Study II: Most stroke survivors felt satisfied with their stroke care and rehabilitation during three months post-stroke. Frequently perceived environmental facilitators could be documented with eleven of 37 ICF categories of Environmental Factors. Only physical geography, such as hills, was a common perceived barrier. Study III: Independent factors of health-related quality of life (HRQoL) varied over time. Almost all variance in HRQoL was explained by categories within Body Functions and within Activities and Participation during the first three months, while at one year only half of the variance could be explained by categories within either Body Functions or Environmental Factors. Problems with personal and energy functions, as well as limited recreational activities, were recurringly associated with poorer HRQoL. Study IV: It was possible to integrate ICF categories of Body Functions and Structures, Activities and Participation into a cross-cultural measurement with good reliability providing summary scores of the overall functioning of stroke survivors. However, the five-point ICF qualifier scale was not consistently applicable. Conclusions. The results of the present thesis showed that the ICF,particularly the ICF Core Set for Stroke, was a valid and practical tool for documenting the multi-faceted biopsychosocial problems and consequences after stroke structured with one common terminology throughout the long chain of care and rehabilitation. The opportunity to integrate ICF categories of Body Functions and Structures, Activities and Participation into a measurement provides new possibilities for monitoring, following-up and comparing overall functioning after stroke. / Syfte. Avhandlingen i sin helhet syftade till att fastställa de mångfaldiga biopsykosociala konsekvenserna under ett års tid efter stroke med hjälp av ICF och att testa validiteten av det nyetablerade Stroke ICF Core Set med avsikt att mäta funktionstillstånd efter stroke. Material och metod. I studie I, II och III ingår data från en ett års prospektiv kohortstudie med 120 personer med stroke som vårdades på strokeenheter i Västsverige och somföljdes upp efter sex veckor, tre månader och efter ett år. Datainsamlingen genomfördes med intervjuer som bestod av ett batteri av frågor grundat påStroke ICF Core Set, EuroQol-5D (EQ-5D), Stroke Impact Scale (SIS), Medical Outcome Study Short Form 36 (SF-36), Self-administered Comorbidity Questionnaire (SCQ), och information om insatser från hälso- och sjukvård, socialtjänst och familj. I studie I analyserades de 59 ICFkategorierna gällande Kroppsfunktioner och de 59 kategorier gällande Aktivitet och Delaktighet deskriptivt vid sex veckor och tre månader efter stroke. Därutöver prövades core sets förmåga att skilja mellan personer som var antingen beroende eller oberoende av hjälp efter stroke. Hur deltagarna uppfattade omgivningsfaktorernas betydelse analyserades deskriptivt utifrån de 37 ICF kategorierna från Omgivningsfaktorer i studie II vid sex veckoroch tre månader liksom skillnaderna mellan deltagarna som var hemma redan vid sex veckor och deltagarna som kom hem senare men inom tre månader. I studie III identifierades faktorerna av generell hälso-relaterad livskvalitet (EQ-5D visuell analog skala) med hänsyn till den biopsykosociala mångfaldigheten av hälsan och huruvida faktorerna ändrades under ett år efter stroke. Till detta användes korrelation- och regressionsanalys och de 155 ICF kategorier gällande Kroppsfunktioner, Aktivitet och Delaktighet samt Omgivningsfaktorer. Den pyskometriska analysen i studie IV baserades på datamaterial från WHO:s internationella multicentertvärsnittsstudie för validering av Stroke ICF Core Sets där 757 personer med stroke från Kina, Tyskland, Italien och Sverige ingår. Möjligheten att integrera 15 ICF kategorier från Brief ICF Core Set for Stroke (6 kroppsfunktioner, 2 strukturer, 7 aktiviteter och delaktighet) med dess 5-stegsbedömningsskala (från 0 till 4, inget, lätt, måttligt, stort och totalt problem) undersöktes både nationsspecifikt men också tvärkulturellt med Raschanalys. Resultat. Studie I. Signifikanta problem kunde dokumenteras med 28 ICF kategorierfrån komponenten Kroppsfunktion och med 41 ICF kategorier frånkomponenten Aktivitet och Delaktighet. Det fanns inga skillnader mellan 6veckor och 3 månader. Kategorierna hade en god förmåga att skilja mellan personer som var antingen oberoende eller beroende av hjälp efter stroke. Personer som var beroende av hjälp hade kontinuerlig mera problem inom området som gällde framförallt förflyttning, personlig vård och urinering men även kommunikation. Studie II. Deltagarna uppfattade elva omgivningsfaktorer som underlättande vid sex veckor och vid tre månader (framförallt familj, vänner och hälso- ochsjukvårdspersonal men också hjälpmedel, medicin och hälso- och sjukvårdsservice) och endast en faktor (fysisk geografi, dvs. backe, grusvägar, etc.) som hindrande. Vid tre månader uppfattades de sistnämnda faktorerna vanligare som hindrande än vid sex veckor. Vården på strokeenheten upplevdes något bättre jämfört med den senare tillkomna servicen från primär- och kommunvård. Studie III. Medan kroppsfunktioner och aktiviteter och delaktighet kunde förklara nästan all varians av självupplevd hälsa under de första tre månaderna (R2=0.80 - 0.93), så kunde bara hälften av variationen förklaras antingen med kroppsfunktioner eller med omgivningsfaktorer (R2=0.51). Problem med fritidsaktiviteter, personlighet, mental uttröttbarhet ochgångförmåga var återkommande problem som var relaterat till sämre självupplevd hälsa under året efter insjuknandet. Studie IV. Efter justeringar som innebar en minskning av bedömningsskalan till mellan två till tre svarsalternativ för vissa kategorier och en borttagning av några kategorier som inte passade in i Raschmodellen visade de resterande ICF kategorierna en bra täckning av personernas funktionstillstånd efter stroke och en god reliabilitet för att mäta funktionstillstånd. I den tvärkulturella analysen fanns det fyra kategorier sominte hade samma betydelse i de olika länderna. Därför utformades nationsspecifika kategorier. Det slutliga tvärkulturella instrumentet omfattar 20 ICF kategorier. Därmed blir det möjligt att integrera olika ICF kategorier till ett instrument och summera bedömningsvärden av de olika kategorierna till ett helhetsvärde för funktionstillstånd som underlättar uppföljning av och jämförelse mellan personer med stroke men även jämförelse mellan olika nationer. Slutsats. Studierna visar att ICF, och särskilt det specifika Stroke ICF Core Set, är ett valid och praktiskt verktyg för att strukturerat kunna dokumentera de mångfaldiga problemen och konsekvenserna efter stroke enhetlig genom hela förloppet av vårdkedjan. Strokesjukvården i Sverige upplevs som välfungerande men en god förbättringspotential finns framförallt i senare skede när primär- och kommunvård ta över ansvaret för personernas vård och rehabilitering. För dokumentation av funktionstillstånd av den typiska äldre patienten med stroke kan de 166 ICF kategorierna reduceras till 92. Faktorer som påverkar hälsorelaterad livskvalitet varierar under tiden efter insjuknandet där kroppsfunktioner och aktiviteter och delaktighet är starkt relaterade under de första tre månaderna. Vid ett år efter insjuknandet har omgivningens betydelse ökat för hälsorelaterad livskvalitet. Tidig hänsyn inte bara till gångförmåga men också till problem med personlighet och temperament, mental uttröttbarhet och återgång till fritidsaktiviteter borde kunna förbättra personernas livskvalitet efter stroke. Att konstruera ett tvärkulturellt instrument i syfte att mäta funktionstillstånd efter stroke genom integrering av ICF kategorier som omfattar kroppsfunktioner, strukturer, och aktiviteter och delaktighet är möjligt. Därmed öppnas nya potentialer för att kunna följa upp och jämföra funktionstillstånd efter stroke inte enbart på individ- och nationell nivå men även på populations- och internationell nivå. Den 5-stegs bedömningsskala (ICF qualifier) är dock inte psykometrisk användbart och fortsatt forskning behövs.