Survey research was conducted to explore Speech-Language Pathologists’ (SLPs) perceptions and experiences collaborating with Registered Dietitians (RDs) in the pediatric population. 107 SLPs in different settingsparticipated. Findings indicate SLPs were not exposed to RDs or the role of nutrition in their didactic and clinical training. Rather this exposure occurred once they were in the field practicing as an SLP. A clear need was identified regarding graduate and continued education on collaboration between SLPs and RDs.

Sepsis is a severe life-threatening critical illness that damages multiple physiological systems. After hospital discharge, more than 70% of severe sepsis survivors report profound weakness which significantly impacts quality of life. Such weakness gives rise to new limitations of daily living, which ultimately leads to loss of independence in many patients. Despite wide recognition of this serious issue by clinicians and researchers alike, the mechanisms contributing to chronic skeletal muscle dysfunction after sepsis are not well understood. Lack of progress in this field is largely due to the absence of an appropriate animal model; current models are either too mild to induce muscle weakness or too severe and cause death within a few days. As such, this dissertation work first focused on establishing a clinically-relevant animal model of sepsis which yields surviving mice with chronic skeletal muscle weakness (Aim 1). This aim involved refining the cecal slurry injection model of polymicrobial sepsis in young adult animals, as well as optimizing the timing, duration, and dose of multiple therapeutic agents. The resulting resuscitation protocol was adapted for use in late-middle-aged animals, and muscle strength was evaluated using an ex vivo system which confirmed significant muscle weakness in sepsis survivors, long after sepsis was resolved. Next, using this novel model, we sought to characterize sepsis-induced long-term muscle dysfunction at the molecular level (Aim 2). The first set of experiments under this aim was designed to identify the primary global mechanism(s) (i.e. atrophy, polyneuropathy, and/or myopathy) responsible for muscle weakness in sepsis survivors. Analysis of the force-frequency curves and specific force measurements led to the conclusion that myopathy is the primary cause. Electron micrograph observation, functional assays, and protein analysis then showed that sepsis survivors’ skeletal muscles are characterized by profound mitochondrial abnormalities and oxidative damage. Collectively, these studies demonstrate that long-term muscle weakness is apparent in sepsis-surviving animals, and the functional decline is associated with unresolved mitochondrial damage and dysfunction. This work suggests that medical treatments beyond targeting muscle wasting alone could allow sepsis survivors to regain function and return to productive lives.

Cells regularly take on various types of force in the body. They have structures that are able to mediate, transfer and respond to the forces. A mutation in force regulating proteins such as lamin in the nucleus or the KASH domain which connects the nucleus to the cytoskeleton of the cell can cause catastrophic events to occur. The aims of this study were to better understand the response of the nucleus when structural proteins are mutated or are not present while under force. Progeria, a rare disease where an additional farnesyl group is attached to lamin was used in this study. Different types of forces were used to represent similar conditions in the body. Confinement of endothelial cell width showed an increase of surface defects. When restricting proteins such as actin was removed the nucleus appeared to rupture. This was shown to occur at a higher rate in the progeria groups. Endothelial cells under shear force showed high amount of nuclear rupture in progeria expressing group. prolonged exposure showed more rupture which eventually cased cell death and cells to come off the surface. Progeria expressing smooth muscle cells under cyclic stretch also showed similar results as endothelial cells. The amount and rate of deformation of the nucleus when the cytoskeleton is connected and not was looked at. When the connected the rate of deformation was higher. The high rate of nuclear defects and rupture while under force in progeria expressing cells shows that the nuclei have different structural properties and are weaker. It’s also been shown that the LINC complex contributes to nuclear deformation when stretching.

Bakgrund: Evidens styrker att teamrehabilitering är en lämplig rehabiliteringsform för patienter med reumatiska sjukdomar. Gruppträning har i tidigare studier visat goda resultat för personer med reumatisk sjukdom. Dock är forskning om den subjektiva upplevelsen av gruppträningen bristfällig. Syfte: Syftet med studien är att ur ett socialkognitivt perspektiv undersöka vilka upplevelser och erfarenheter deltagare med reumatisk sjukdom fått av den gruppträning som ingår i teamrehabiliteringen. Metod: Studien har en kvalitativ design med induktiv ansats. Semistrukturerade intervjuer utfördes. Fem deltagare inkluderades och det insamlade materialet analyserades genom en kvalitativ innehållsanalys. Resultat: Det framkom att deltagarna hade en positiv uppfattning om teamrehabiliteringen och att de tog med sig många erfarenheter därifrån. Samhörigheten i gruppen framhölls särskilt av deltagarna. Resultatet visar också att deltagarna fick ökad förståelse om träningens effekt i relation till välmående och smärthantering. Slutsats: Gruppträning skapar en samhörighet som skapar förutsättningar för en ökad förståelse för sin situation. Erfarenheten att leva med en reumatisk sjukdom kan sammanföra personer och bidrar till att ett erfarenhets- och kunskapsutbyte sker. Många av upplevelserna och erfarenheterna som framkom kunde kopplas till begrepp inom den socialkognitiva teorin. Större och kvantitativa studier inom ämnet gör det möjligt överföra studiens resultat till en större population. / Background: Evidence proving the team rehabilitation is an appropriate rehabilitation for patients with rheumatic diseases. Group training has previously shown good result for people with rheumatic disease. Research on the subjective experience of group training is deficient. Objective: The purpose of this study is that from a social cognitive perspective investigate the perceptions and experiences of participants with rheumatic disease received by the group exercise as part of the rehabilitation. Method: The study has a qualitative design with inductive approach. Semi-structured interviews were conducted. Five participants were included and the collected material was analyzed by qualitative content analysis. Result: It was revealed that the participants had a positive perception of the team rehabilitation and they brought with them many experiences from there. The connection within the group was particularly emphasized by the participants. The result also shows that the participants had increased understanding of the benefits of exercise in relation to well-being and pain management. Conclusion: The experience of living with a rheumatic disease can bring together people and contributes to the experience and knowledge exchange takes place. Many of the experiences and the experiences that emerged could be linked to concepts in the social cognitive theory.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2001. / Härtill 5 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2002. / Härtill 5 uppsatser.

Diss. (sammanfattning) Alnarp : Sveriges lantbruksuniv. / Härtill 6 uppsatser.

Diss. (sammanfattning) Uppsala : Univ., 2004. / Härtill 4 uppsatser.

Diss. Luleå : Luleå tekniska universitet, 2007.