Bakgrund: När sjukvården till stor del förlitar sig på medicinsk teknik och läkemedelsbehandling är det lätt att omvårdnadsåtgärder som syftar till att förebygga och lindra lidande inte ges tillräckligt utrymme. Intensivvårdsdelirium är ett förhållandevis outforskat område inom barnintensivvården. Idag finns inga riskskattningsinstrument översatta till svenska.   Syfte: Syftet var att studera barns beteenden när de vårdades på en barnintensivvårdsavdelning. Dessutom undersöktes om dessa beteenden kunde användas för att besvara frågor från ett engelskspråkigt riskskattningsinstrument för delirium.   Metod: Studien utfördes som en fokuserad etnografisk observationsstudie där sju patienter på en barnintensivvårdsavdelning observerades under tre timmar vardera. Utifrån observationernas fältanteckningar gjordes en innehållsanalys med fokus på manifest innehåll. I ett andra steg utfördes en deduktiv analys där kategorierna från fältanteckningarna jämfördes mot frågor från riskskattningsinstrumentet för delirium.   Resultat: Innehållsanalysen av fältanteckningarna resulterade i åtta kategorier som representerade barnens beteende under observationerna: reagerar på vårdhandling, förmedlar fysiska behov, förmedlar smärta, svarar på fråga, sysselsätter sig själv, stimuleras av underhållning, uppmärksammar omgivningen och väcks av stimuli. Den deduktiva innehållsanalysen visade att fyra av de åtta frågorna från riskskattningsinstrumentet kunde besvaras med hjälp av kategorierna.   Slutsats: Urvalet bestod av en homogen subgrupp där inga beteenden med tydlig koppling till risk för delirium kunde observeras. Miljörelaterade riskfaktorer för delirium i form av frekventa vårdhandlingar, höga ljud och störd sömn förekom. Trots att denna grupp patienter inte visade tecken på delirium kan förebyggande av dessa störningar leda till minskat vårdlidande. Barnintensivvården kan ytterligare minska vårdlidande genom att öka föräldrarnas möjligheter att vara hos sitt sjuka barn dygnet runt. / Background: Nursing and preventive measures may be overlooked when health care in large relies on medical technology and medical treatment. Intensive care delirium is a relatively unexplored area in pediatric intensive care. There are currently no risk assessment tools translated to Swedish.   Aim: The objective was to study children's behaviour when they were cared for in a pediatric intensive care unit. In addition, it was questioned whether these behaviours where able to answer questions originating from an English language risk assessment tool for delirium.   Method: Using focused ethnographic observation seven patients were observed during three hours each. Content analysis was performed on the field notes from the observations with focus on manifest content. As a second step, a deductive analysis compared the categories with questions from the risk assessment tool for delirium.   Findings: The content analysis of field notes resulted in eight categories which represented the children’s behavior during the observations: reacting to care, expressing physical needs, expressing pain, answering question, occupying oneself, stimulated by entertainment, observing the surroundings and awakened by stimulus. The deductive analysis showed that four of the eight questions from the risk assessment tool could be answered with the categories.   Conclusion: The selection consisted of a homogenous subgroup where no obvious behaviors related to risk of delirium was observed. Environmental risk factors for delirium such as frequent care related interventions, loud noise and disturbed sleep where observed. Despite that, prevention of these disturbances could reduce health care related suffering even though this group of patients did not show signs of delirium. Pediatric intensive care units can further reduce healthcare related suffering by enabling families to be present with their sick child during all hours of the day and night.

There is a moment in Edward Yang’s acclaimed film Yi Yi (2000) in which a young boy in a conversation with his father observes that he cannot see what his father sees and that his father cannot see what he sees, prompting two questions: “How can I know what you see?” and “Can we only know half of the truth?” Unable to provide adequate answers, his father instead offers his son a camera. Later in the film, the same boy presents his uncle with a picture he took of the back of his head. When asked why, the boy responds by saying, “You cannot see it yourself, so I’m helping you.” These two scenes in Yang’s film illustrate the spirit of the questions that guide the aesthetic approach I have taken in my own documentary project. My thesis is composed of two parts: a video project and a research paper, the former of which is a documentary entitled Yi. Named after its primary subject, the film explores the intersections of transnational migrancy and cultural identity through a series of interviews that are intercut with scenes of everyday life that are shot in an observational style. The research paper that follows will situate the project within a specific historical, conceptual, and aesthetic context, before delineating how the cinematic composition of my documentary engages with this framework.

The slope of the ultraviolet continuum emissions from a galaxy between 1250 and 2600 Å provides insights about several facets of the galaxy. Mainly, it is well-correlated with the amount of dust. This work presents a search for objects whose UV-continuum slopes are excessively steep, as well as suggestions for follow-up. The method used is looking through existing data sets, and proposing follow-up of the outliers in the distribution of slopes. Close to fifteen objects with slopes beyond what is easily explained by theory are presented. Since these lie beyond the realm of current theories, confirmations of these may hint at more extreme stellar populations than those currently known. This may include excessively metal-poor stars such as population III stars, or stellar populations where the initial mass function (IMF) for some reason may be biased towards massive stars. Steeper slopes are in general indicative of a lack of dust and an abundance of hot, blue stars; this is due to the reddening caused by dust, and emissions from cooler stars being peaked at longer wavelengths.

La population de galaxies poussiéreuses ayant un fort taux de formation stellaire (Dusty Star Forming Galaxies, DSFGs) joue un rôle très important dans l’histoire de l’univers, avec des taux de formation d’étoiles allant de quelques centaines à quelques milliers de masses solaires par an. Les sondages infrarouges, comme ceux entrepris à l’aide du satellite Herschel, nous offrent l’opportunité de recenser de manière approfondie ces DSFGs jusqu’à de grands décalages spectraux. Cependant, jusqu’à présent seul un petit nombre de DSFG détecté par Herschel ont été confirmés pour être à des décalages spectraux supérieurs à 4. Les modèles de formation et d’évolution des galaxies stipulent généralement que la population de DSFG à z > 4 sont les progéniteurs des galaxies elliptiques, observées dans les amas les plus massifs de l’univers local. L’abondance des DSFGs à z > 4 se révèle donc être décisive pour contraindre ces modèles ainsi que pour vérifier notre compréhension globale de l’univers lointain. Le premier objectif de mon travail de recherche est d’identifier les candidates galaxies à z > 4 détectées sur des champs les plus larges possibles observés par Herschel et l’instrument SPIRE et d’examiner les propriétés statistiques de celles-ci. A cette fin, j’ai créé un nouvel algorithme de sélection dans le but d’augmenter substantiellement le nombre de candidates et de comprendre leur nature. / Over the last few decades, great progress has been made in our understanding of the star formation history of the Universe. With the discovery of distant, dusty star-forming galaxies (DSFGs) it has become apparent that observing at rest-frame UV and optical wavelengths is insufficient as a large fraction of the star formation is dust obscured. Thanks to the extensive observational studies carried out during the last two decades, we learn that DSFGs have a redshift peak at z ∼ 2, matching the cosmic time where galaxies have formed most of their young, massive stars. However, it remains extremely challenging to use the Herschel space observatory for identifying a tail extending towards much higher redshifts (z > 4). As a result, until recently only a small number of infrared-selected DSFGs at z > 4 were known, most of them strongly gravitationally lensed. One of the main goals of this Thesis is to assemble candidate z > 4 galaxies detected in a large area survey observed by Herschel-SPIRE and to examine the statistical properties and environments of these systems.

The present investigation examined observational learning during equivalence-based instruction using the PEAK Equivalence curriculum, across five children with disabilities. A multiple baseline across skills was used to evaluate observational learning across the participants, including directly observed relations, as well as derived symmetrical and transitive relations. Each skill contained 5 stimulus classes, where a subset of relations for a single class was trained for each participant. The remaining 4 class subsets were observed by each of the participants. For the derived relations, participants never observed peers contact reinforcement for correct responding nor did they themselves contact reinforcement for correct responding. After multiple sessions, results indicated increases in both observed directly trained relations, as well as emergent derived relations. Over the course of the sessions, the participants average correct answers increased from an average of 12% during baseline to100% at the end of the training phase and during a follow-up test probe. The results have implications for equivalence-based ABA instruction in schools and other settings where group-based instruction is common in application with individuals with disabilities.

Personalised medicine describes the practice of tailoring medical care to the individual characteristics of each patient. Fundamental to this practice is the identification of markers associated with differential treatment response. Such markers can be identified through the assessment of treatment effect modification using statistical methods. Randomised controlled trials provide the optimal setting for evaluating differential response to treatment. Due to restrictions regarding sample size, study length and ethics, observational studies are more appropriate in many circumstances, particularly for the identification of markers associated with adverse side-effects and long term response to treatments. However, the analysis of observational data raises some additional challenges. The overall aim of this thesis was to develop statistical methodology for the analysis of observational data, specifically primary care databases, to identify and evaluate markers associated with differential treatment response. Three aspects of the assessment of treatment effect modification in an observational setting were addressed. The first aspect related to the assessment of treatment effect modification on the additive measurement scale which corresponds to a comparison of absolute treatment effects across patient subgroups. Various ways in which this can be assessed in an observational setting were reviewed and a novel measure, the ratio of absolute effects, which can be calculated from certain multiplicative regression models, was proposed. The second aspect regarded the confounding adjustment and it was investigated how the presence of interactions between the moderator and confounders on both treatment receipt and outcome can bias estimates of treatment effect modification if unaccounted for using Monte Carlo simulations. It was determined that the presence of bias differed across different confounding adjustment methods and, in the majority of settings, the bias was reduced when the interactions between the moderator and confounders were accounted for in the confounding adjustment model. Thirdly, it has been proposed that patient data in observational studies be organised into and analysed as series of nested nonrandomised trials. This thesis extended this study design to evaluate predictive markers of differential treatment response and explored the benefits of this methodology for this purpose. It was suggested how absolute treatment effect estimates can be estimated and compared across patient subgroups in this setting. A dataset comprising primary care medical records of adults with rheumatoid arthritis was used throughout this thesis. Interest lay in the identification of characteristics predictive of the onset of type II diabetes associated with steroid (glucocorticoid) therapy. The analysis in this thesis suggested older age may be associated with a higher risk of steroid-associated type II diabetes, but this warrants further investigation. Overall, this thesis demonstrates how observational studies can be analysed such that accurate and meaningful conclusions are made within personalised medicine research.

Aims: The initial aim of this thesis was to understand the relationship between non-psychotropic medication and risk of suicidality. This was achieved by conducting a systematic review, which, among other conclusions, identified the need for improved estimation of risk of suicide and attempted suicide associated with antiepileptic drugs (AEDs). This stimulated this programme of research which sought to estimate the risk of suicide and other causes of unnatural death in people with epilepsy, the role of AEDs in fatal poisonings, the risk of self-harm in people with epilepsy and factors associated with self-harm amongst those people with epilepsy. Methods: Cohorts of individuals with prevalent epilepsy were identified separately in two population-based linked-primary care datasets: the Clinical Practice Research Datalink (CPRD) in England and the Secure Anonymised Information Linkage (SAIL) in Wales. Individuals were matched on age, gender and general practice to up to 20 people without epilepsy. The risks of cause-specific types of unnatural death (e.g. suicide, accident) were estimated using stratified Cox proportional hazards models, adjusted for level of deprivation. From each of the prevalent epilepsy cohorts, individuals with incident epilepsy, no history of self-harm and who were new users of the AEDs; carbamazepine, lamotrigine or valproate, were identified. The risk of first self-harm event associated with each AED compared to valproate was estimated using Inverse Probability of Treatment Weighting propensity score analysis. Estimates from each dataset were combined in a random effects meta-analysis. In the CPRD, the risk of self-harm in the incident epilepsy cohort versus a comparison cohort was estimated using a stratified Cox proportional hazards model. From this cohort, a nested case-control study was constructed. Individuals with a first self-harm event (cases) were matched to up to 20 people with no history of self-harm (controls). Conditional logistic regression was used to estimate the risk of self-harm associated with various factors including history of mental illness diagnoses, referrals and AED utilisation. Results: There were 44,678 and 14,051 people in the prevalent epilepsy cohorts and 891,429 and 279,365 in the comparison cohorts, in the CPRD and the SAIL respectively. Increased risks of suicide (HR 2.15, 95%CI 1.51-3.08) and accidental death (HR 2.97, 95%CI 2.54-3.48) were observed for people with epilepsy versus the comparison cohort, from the deprivation-adjusted meta-analysed estimates. Overall, AEDs were involved in 9.7% (95%CI 3.6%-19.9%) of the 62 poisoning deaths in people with epilepsy. There were 5,107 new users of carbamazepine, lamotrigine or valproate with incident epilepsy in the CPRD and 2,654 in the SAIL. No increased risk of self-harm was evident for carbamazepine (HR 1.53, 95%CI 0.89-2.64) or lamotrigine (HR 1.35, 95%CI 0.79-2.29), compared to valproate, from the meta-analysed estimates. In the CPRD, there were 11,690 individuals with incident epilepsy and 215,569 in the comparison cohort. The deprivation-adjusted hazard ratios for first self-harm event were 5.31 (95%CI 4.08-6.89) in the year following diagnosis and 3.31 (95%CI 2.85-3.84) in subsequent years. The nested-case control study derived from this incident epilepsy cohort included 273 cases of first self-harm and 3,790 controls. An increased risk of self-harm was associated with history of a mental illness diagnosis (OR 4.08, 95% CI 3.06-5.42) or referral to specialist psychiatric services (OR 3.41, 95% CI 2.63-4.43), compared to none; or being prescribed no AEDs (OR 1.47, 95% CI 1.01-2.12) or two AEDs (OR 1.84, 95% CI 1.33-2.55) in the 90 days prior to index date, compared to a single AED. Augmentation of AED treatment carried an elevated risk (OR 2.12, 95% CI 1.38-3.26) whereas there was no evidence to indicate that switching from one AED to another altered risk (OR 0.69, 95% CI 0.21-2.23). Conclusions: Compared to those without the condition, people with epilepsy are at an elevated risk of unnatural death, including suicide and accidental death, and nonfatal self-harm. The risk of self-harm is particularly elevated in the year following diagnosis of epilepsy but persists beyond this. Factors associated with increased risk of self-harm within the epilepsy population include prior mental illness and referral to psychiatric services. There was no evidence of difference in the risk of self-harm associated with carbamazepine or lamotrigine compared to valproate, but further replication of this result would be beneficial. However, treatment with multiple AEDs and augmentation of AED treatment increase the risk of self-harm within this population. These may be markers of uncontrolled epilepsy.

This thesis explores the intersection of observational filmmaking with auto-ethnographic writing, a combination not used very often but with great potential for visual anthropologists. I examine how my research and filmmaking over a ten-year period have been shaped both by my cancer experience as well as by my Japanese background. Using the metaphor "journey", I approach my own traumatic cancer experience and turn it into a field of study. My journey begins from the moment of my first cancer diagnosis and treatment in the US, moving through my second diagnosis in Norway, and leading up to my most recent fieldwork with a cancer support community in Japan. My auto-ethnographic journey illustrates how I altered my own relationship to my cancer, moving through critical encounters that transformed me from a silent sufferer to an attentive listener. These experiences have also influenced my metaphorical thinking about "dying well" to "living well" with cancer. My personal journey is closely linked to my professional one, and also affects my approaches to filmmaking. By meeting the anthropologist Paul Stoller, who has also lived in the world of cancer, I learned the importance of coming to terms with one's own cancer mask. This mask can easily evoke a sense of being trapped in a "continuous liminality" (Stoller 2005), a transitional state between health and sickness, hopefulness and hopelessness, past and future, life and death. How am I able, as a researcher and filmmaker, to go on with my life in this in-between state and attend to the lives of others through this cancer mask? In my recent fieldwork, I decided to enter the world of the cancer patients' shadow and met with the families of patients and bereaved families in a support group in Japan. I learned that they too wore a mask, though I struggled to establish friendships with them as my cancer status versus their caregiver status distanced us somewhat. I overcame this challenge by using the technique of collaborative filmmaking to seek mutual fellowship with them, and trying to create a shared space in-between, ma in Japanese, where we could meet and feel with each other (kyokan empathy). For that purpose, and combined with the technique of feedback screening, I used a mobile phone as a filming device to free up my face and to make me available as a listener for the filmed persons. The fieldwork resulted in the film 'To the Last Drop' (2016). By combining the methods of auto-ethnographic writing and observational filmmaking, my personal account served to broaden my understanding of the experiences of those afflicted by cancer in Japan. Together, these methods expand on the space between, where suffering becomes visible and silence becomes audible, in a culturally sensitive way.

Philosophiae Doctor - PhD / PURPOSE: High risk human papillomavirus (HR-HPV) is well established as a causative agent of squamous cell carcinoma (SCC) of the orophaynx. HR-HPV has also been reported in periocular cancers and precancers, but controversy exists about its overall incidence and clinicopathologic profile. The purpose of this study is to evaluate the role of HR-HPV infection in periocular cancers and precancers, using multiple methods of detection. DESIGN: Retrospective observational case series with laboratory investigations. METHODS: Sequential surgical samples of 87 carcinomas (invasive SCC, SCC in situ and sebaceous carcinoma) from three different periocular sites (conjunctiva, lacrimal sac and the eyelid) diagnosed over a 15-year period (2000-2015) were selected for evaluation. Unstained paraffin sections of 87 cases of periocular carcinomas were analyzed with immunohistochemistry (IHC) for p16 as a screening test. p16 positive conjunctival- and lacrimal sac SCC were further evaluated for HR-HPV using DNA in situ hybridization (DNA ISH), and a subset was also analyzed by DNA Polymerase Chain Reaction (DNA PCR). p16 positive periocular sebaceous carcinomas (SC) were analyzed with PCR, and a subset of 18cases was further studied with a novel method of mRNA ISH, an advanced technique with an enhanced sensitivity and specificity. Relevant patient clinical information was obtained from review of the electronic medical records.

Statins are cholesterol-lowering medications with immunologic properties. To assess the role of statins on incident immune-mediated conditions, a modified case-cohort study was performed using administrative databases from the Midwest Veterans Administration (VA) region. A comparison sub-cohort was formed by randomly sampling 10,000 subjects with medical and pharmacy benefits during fiscal year (FY) 2002. Cases were identified by inpatient or outpatient medical claims using International Classification of Disease, Ninth Revision (ICD-9) codes between FY 2003-2004. All subjects needed at least one year of medical claims and at least one pharmacy claim. The incident cases (n=28,642) included non-mutually exclusive groups of immune-mediated (n=2,327), infectious (n=8,221), and non-immunologic (n=10,730) diagnoses. Demographic and medical variables were obtained from FY 2001-2004, and pharmacologic data from FY 2002-2004. Cox proportional hazards regression modeling was used to estimate hazard ratios for the current statin use (within the last 180 days) and former statin use, compared to non-users, including time-dependant variables for demographic factors, comorbidity as measured by Elixhauser and Chronic Disease Score variables, medications, and visit rates after initiating statins. Current statin use was associated with decreased diagnoses rates of psoriasis; rheumatoid arthritis; inflammatory bowel diseases, including ulcerative colitis and Crohn disease; diffuse connective tissue diseases, including systemic lupus erythematosus; ankylosing spondylitis; bacterial pneumonia; urinary tract infection; cellulitis; sepsis; candidiasis; osteomyelitis; and tuberculosis. Former statin use was also associated with increased rates of polymyalgia rheumatica, sepsis, and osteomyelitis. Statin use was not associated with other spondylitis, multiple sclerosis, thyroiditis, sarcoidosis, temporal arteritis, influenza, shingles, histoplasmosis, or pyelonephritis. Although current statin use appeared protective for some study conditions, selection bias, misclassification, healthy user effects, adherence bias, confounding by indication, and surveillance bias were considered as possible explanations of the study findings.