The aim of the study: to evaluate the cognitive functions of patients with early-stage Parkinson‘s disease (PD) without dementia using Cambridge Neuropsychological Test Automated Battery (CANTAB Eclipse 3.0.0), to compare the obtained results with the data of control subjects, to determine the associations of the variables of cognitive testing with biological markers and clinical non-cognitive symptoms of PD. Objectives: to examine attention, memory, visuospatial and executive functions of patients with early-stage PD without dementia using CANTAB Eclipse 3.0.0 and to compare the obtained results with the data of control subjects; to investigate the relationship between the cognitive functions of patients with early-stage PD and the severity of disease measured by UPDRS score, the echogenic properties of brainstem nigral substance (SN) examined by transcranial sonography (TCS), the striatal binding of presinaptic dopamine transporter determined by single-photon emission computed tomography (SPECT) with I¹²³-FP-CIT, sleep, fatigue, demographic factors and quality of life scores, the usage of medications for early-stage PD; to analize the diagnostic characteristics of particular computerised tests for evaluation of cognitive function in patients with early-stage PD. Methods. The study was performed at the Department of Neurology of Vilnius University Hospital Santariškių Klinikos. 115 patients diagnosed with clinically probable early-stage PD who met inclusion criteria and... [to full text] / Darbo tikslas: įvertinti ankstyva Parkinsono liga (PL) be demencijos sergančių asmenų pažinimo funkcijas naudojant Kembridžo kompiuterinės neuropsichologinio ištyrimo sistemos testų rinkinį, palyginti rezultatus su kontrolinės grupės asmenų duomenimis bei nustatyti kognityvinių rodiklių ryšius su biologiniais žymenimis ir klinikiniais nekognityviniais PL simptomais. Darbo uždaviniai: ištirti ankstyva PL sergančių asmenų dėmesio, atminties, regos erdvinę ir vykdomąsias funkcijas, naudojant kompiuterizuotų testų rinkinį CANTAB eclipse 3.0.0, ir palyginti juos su kontrolinių asmenų duomenimis; nustatyti pacientų kognityvinių funkcijų ryšį su UPLVS skale įvertintu ligos sunkumu, transkranijinės sonografijos (TKS) metodu nustatytu juodosios medžiagos (JM) echogeniškumu, presinapsinio dopamine transporterio koncentracija dryžuotame kūne, nustatyta radionuklidinės kompiuterinės tomografijos (RKT) su I¹²³-FP-CIT būdu, miego, nuovargio bei demografiniais veiksniais, gyvenimo kokybės rodikliais, PL gydyti skiriamų vaistų vartojimu; išanalizuoti kompiuterizuotais testais įvertintų kognityvinių funkcijų diagnostinę vertę sergant ankstyva PL. Metodai. Tyrimas atliktas Vilniaus universiteto ligoninės Santariškių klinikų Neurologijos centre. Atrinkta 115 pacientų, sergančių ankstyva kliniškai tikėtina PL, kurie atitiko įtraukimo kriterijus bei nebuvo neįtraukimo kriterijų, ir 42 pagal amžių, lytį, mokymosi trukmę atrinkti kontroliniai tiriamieji, kurie nesirgo PL ar kitomis... [toliau žr. visą tekstą]

Šiuo tyrimu siekta įvertinti, kaip keičiasi vaikų po sunkaus ir vidutinio sunkumo trauminio galvos smegenų sužalojimo būklė taikant kineziterapiją ankstyvuoju reabilitacijos etapu bei nustatyti veiksnius, kurie labiausiai įtakoja vaikų po traumos pažintinių funkcijų ir motorikos atsigavimą. Tyrimo uždaviniai: 1. Įvertinti vaikų po sunkaus ir vidutinio sunkumo trauminio galvos smegenų sužalojimo pažintinių funkcijų ir motorikos sutrikimus ankstyvojo reabilitacijos etapo pradžioje. 2. Įvertinti vaikų po sunkaus ir vidutinio sunkumo trauminio galvos smegenų sužalojimo pažintinių funkcijų ir motorikos kitimą ankstyvajame reabilitacijos etape taikant individualizuotą kineziterapiją. 3. Nustatyti veiksnius, turinčius įtakos vaikų po sunkaus trauminio galvos smegenų sužalojimo pažintinių funkcijų bei motorikos atsigavimui ankstyvajame reabilitacijos etape ir įvertinti jų prognozinę vertę. Atlikus tyrimą nustatyta, kad vaikams po sunkaus ir vidutinio sunkumo trauminio galvos smegenų sužalojimo ankstyvajame reabilitacijos etape stebimi motorikos (raumenų tonuso, raumenų jėgos, judesių koordinacijos) ir pažintinių funkcijų (sąmonės) sutrikimai sąlygoja šių vaikų hipokinezę bei savarankiškos veiklos sutrikimus. Individualizuota kineziterapija, taikoma vaikams po trauminio galvos smegenų sužalojimo ankstyvajame reabilitacijos etape, daugumai ligonių ženkliai pagerina jų savarankiškumą, tačiau pusei vaikų po sunkaus trauminio galvos smegenų sužalojimo ankstyvojo reabilitacijos... [toliau žr. visą tekstą] / Aim of the study – to establish the factors influencing the recovery of cognitive and motor functions during application of physical therapy in ESR among children suffering severe and moderate TBI. Objectives: 1. To evaluate the cognitive and motor disorders at baseline (start of ESR) among children suffering severe and moderate TBI. 2. To evaluate the changes of cognitive and motor functions applying personally-adjusted physical therapy during ESR for children suffering severe and moderate TBI. 3. To establish the factors influencing the recovery of cognitive and motor functions during ESR among children suffering severe and moderate TBI and to estimate factors’ predictive validity. The children after severe and moderate traumatic brain injury have motor (muscle tone and force, movements coordination) and cognitive (consciousness) disorders during early stage of rehabilitation resulting in hypokinesis and restricted independent activity. Individually-adjusted physical therapy during early stage of rehabilitation for patients after traumatic brain injury significantly improves their independence, though by the end of early stage of rehabilitation among severe traumatic brain injury cases the disorders of balance and walking still persist. About half of those children have motor disorders (toileting, dressing lower and upper body, bathing, independent walk, and walking stairs) and cognitive disorders (communication, social interaction, and problem solving). The motor... [to full text]

Doctor of Philosophy / Department of Agronomy / S.V. Krishna Jagadish / Sorghum (Sorghum bicolor (L.) Moench) is one of the hardiest crop to abiotic stresses compared with other grain crops. However early stage chilling, terminal heat and drought stress are three most damaging abiotic stresses that have limited sorghum productivity in the US Great plains and other locations having similar environmental conditions. Three studies were conducted with an overall goal aimed at increasing grain sorghum’s resilience to harsh climatic conditions. In the first study, four promising chilling stress tolerant sorghum advanced breeding lines, a known early stage chilling tolerant Chinese landrace (Shan Qui Red - SQR) and a susceptible US elite cultivar (RTx430) as checks were assessed for chilling tolerance during emergence and early growth under field and controlled environments. Aerial phenotyping using unmanned aircraft systems (UAS) fitted with multispectral camera was used to capture reflectance-based vegetation indices (NDVI and NDRE) in field experiments. Some advanced breeding lines with superior agronomic background also recorded significantly better emergence, seedling growth and vigor compared to SQR under chilling conditions. Aerial phenotyping indices from images taken between 30 and 60 days after emergence were consistently correlated with destructive measurements under early plantings, indicating their effectiveness in differentiating chilling responses. Second study was conducted to understand physiological mechanisms inducing heat stress resilience in sorghum during flowering. A diverse set of sorghum inbreds and selected hybrids were tested under greenhouse, growth chamber facilities and field conditions. A highly conserved early-morning-flowering mechanism was observed across all the inbreds and hybrids, with the peak anthesis wherein >90% of florets completed flowering within 30 min after dawn. The conserved response was consistent even under drought stress and heat stress exposure imposed at different times of the day. Our findings report a novel heat escaping early-morning-flowering mechanism effectively employed by sorghum to minimize heat stress impact at anthesis. Another experiment with sequential increase in daytime temperature treatments suggest heat stress induced loss in pollen viability to be a key factor resulting in reduced seed-set and grain yield. The findings suggest heat stress could have a greater impact on post-pollen germination processes such as fertilization, embryo formation and development. We identified a heat tolerant genotype “Macia” which appears to be a promising donor for developing improved heat tolerant sorghum hybrids. In the third study, a bi-parental recombinant inbred lines (RILs) mapping population developed from elite post flowering drought susceptible cultivar (RTx430) and a known drought tolerant cultivar (SC35) were evaluated under wide spectrum of environments and moisture conditions. Several novel and major QTL for grain yield, panicle neck diameter, effective quantum yield of photosystem II and chlorophyll content were identified. The genomic regions and the candidate genes within these regions can potentially help in improving source and sink dynamics in sorghum under diverse environments. The findings from these studies will complement ongoing efforts in developing future sorghum with enhanced resilience to different abiotic stresses that continue to limit sorghum productivity.

Tanto as incubadoras como as aceleradoras são organizações especializadas no suporte de empreendimentos em fases iniciais, em especial, aqueles intensivos em inovação conhecidos como startups. Apesar da grande disseminação dessas organizações, há poucas informações na literatura que evidenciem as suas diferenças e as contribuições na jornada do empreendedorismo inovador. Assim, o objetivo principal deste estudo é comparar a diferença entre as propostas de valor das aceleradoras e das incubadoras a partir da percepção das startups que tenham sido tanto incubadas como aceleradas. Entre os objetivos específicos temos: discutir possíveis relações entre as aceleradoras e as incubadoras de negócios; apresentar a evolução das incubadoras e os fatores que induziram o surgimento das aceleradoras, descrevendo os diferentes arquétipos e as implicações que essas organizações têm no ecossistema de empreendedorismo; apresentar o cenário nacional do fenômeno de aceleração e de incubação. O levantamento de dados contará com duas etapas: análise documental de fontes de dados secundárias e estudos de caso com uso de técnica de entrevista e questionário semiestruturado. A análise documental foi feita a partir de banco de dados de artigos científicos, dados oficiais de governos, fundações, revistas e páginas web especializadas e editais de chamamento das próprias organizações. A análise documental fornecerá o retrato de como as incubadoras e as aceleradoras se promovem no ecossistema como organizações importantes no apoio às startups. Em seguida, através de abordagem exploratória descritiva e qualitativa, foram realizadas entrevistas com roteiros semiestruturados com fundadores de startups que foram incubadas e aceleradas, para compreender o valor que cada um desses processos forneceu ao desenvolvimento dessas empresas. Concluiu-se que existe uma dissonância entre o valor percebido pelas startups e o que as incubadoras e as aceleradoras promovem. Também foi possível identificar que a busca por recursos pelas startups tende a não seguir um processo linear, capturando as melhores oportunidades que estejam disponíveis no momento. Por fim, esta pesquisa é um passo exploratório para trazer novas evidências do fenômeno das startups e dos diferentes instrumentos que as constroem. Sugerem-se encaminhamentos que possam preencher lacunas na literatura a respeito dos fenômenos citados, indicando a necessidade de estudos futuros que adensem o conhecimento desse fenômeno. / Both incubators and acelerators are specialized organizations to support early-stage ventures, especially innovation-intensive ones known as startups. Despite the great spread of these organizations, there is a few information in the literature that show their differences and contributions in the journey of innovative entrepreneurship. The main objective of this study is comparing the difference between value porposition of accelerators and incubators from the perception of startups that have been both incubated and accelerated. The specific objectives are: to discuss possible relationships between accelerators and incubators; to present the evolution of the incubators and the factors that led to the emergence of the accelerators, describing the different accelerators archetypes and the implications in entrepreneurship ecosystem; to present the national scenario of acceleration and incubation. The data collection stage had two stages: documentary analysis of secondary data sources; and the case study using interview technique through semi-structured questionnaire. The documentary analysis was made from a database of scientific articles, official data from governments, foundations, journals and specialized web pages and incubators and accelerators calls for proposals. Documentary analysis provided a picture of how incubators and accelerators are promoted to the ecosystem and startups. Then, through a descriptive and qualitative exploratory approach, interviews were conducted with semistructured scripts with founders of startups that were incubated and accelerated to understand the value that each of these processes provided to the development of these companies. It was concluded that there is a dissonance between what the incubators and the accelerators promote and the value perceived by the startups, they are not being able to identify enough characteristics that distinguish them. The reason for it is the diversity of the needs and demands of the startups, different models of accelerators and incubators are formulated that, in many cases, overlap in the benefits offered. It was also possible to identify that the search for resources by startups, whether radical or disruptive startups, does not follow a linear process, capturing the best opportunities available in the ecosystem through a minimally tactical and selective approach. In order to contribute to the understanding of the growing formation of organizations supporting startups, such as incubators and accelerators, and considering the findings of this research, a tool was suggested to define the types of these organizations, loosely termed \"startup guiders\". This tool analyzes three basic dimensions: business model, value proposition and stage of intervention in the development of early-stages ventures. Finally, this research is an exploratory step in bringing new evidence of the phenomenon of startups and of the different instruments that construct them. It is suggested that there be gaps in the literature regarding the mentioned phenomena, indicating the need for future studies that increase the knowledge of this phenomenon.

This master‘s thesis is a journey of generating a prototype evaluation tool for Sparbanken Rekarne, the aim was to contribute to the emerging field as an innovation and design and specifically pre-project management. The major stakeholder was Sparbanken Rekarne AB, they needed an innovation model and the research question formulated was: What are the perspectives and the process of an early stage tool for evaluating innovation project ideas? ‘The approach was gathering theoretical knowledge in the development of the evaluation tool using a systematic literature review. The theoretical knowledge building was done by carrying out a systematic literature review to inspect different credible evaluation tool to use. Focusing specifically on pre-project evaluation tools, a knowledge gap (Gap spotting) was soon discovered after reviewing some pre-project evaluation tools. Firstly needed to see what pre-project evaluation tools are available. One stood out with stages and that ended being the main inspiration for the early-stage evaluation tool. Still basing the tool on theoretical knowledge, the solution was to hybridizing existing pre-project evaluation tools and tools already developed. Merging interactive research with Agile principals was how the information was gathered and how the project was planned. The data gathered was dissected and used in developing the evaluation tool. Purpose of the pre-project evaluation tool is to bring clarity for Sparbanken Rekarne in making decisions about choosing pre-projects to invest in. This master‘s thesis gives a detailed description of how to implement the Early-stage evaluation tool (Chapter 4) from a Sparbanken Rekarne developer‘s perspective. Results, a contribution to innovation and design, specifically pre-project management. The early-stage evaluation tool can maturate idea‘s into concept pre-project that are measured. Involvement with all stakeholder makes sure the pre-projects entering the project planning phase has a market.

No description available.

Managing innovations is a well studied success factor for companies and organizations. This research focuses on the recently established Lean Startup Methodology (LSM) and the obstacles of implementing it in early- and later-stage business-to-business (B2B) Software as as Service (SaaS) startups. The scarcity of academic research around this framework, in contrast to its popularity, motivated the researchers’ aim to provide a better understanding on how it could be adapted to better fit the needs of these companies.Following an interpretivist paradigm, this qualitative research uses a literature review and semi-structured interviews for its purposes. Interviews were conducted with six individuals at four different early- and late-stage startups. The focus was on understanding the realities of working with innovation management and the different approaches at early and later stage startups. Startups face an abundance of ideas regarding what to do next, a hypothesis confirmed with this study. It is the researchers’ belief that the LSM does not provide sufficient tools for organizations to make an idea selection decision without committing too many resources initially. Lastly, the importance of product ownership for an effective innovation management process was validated.In conclusion, we present the need for an updated Lean Startup Methodology with a dedicated selection step to validate an idea early in the process. This contributes to the theory of innovation management and its practical implementation. The identified gap in academic research around frameworks tailored towards these types of organizations provides a good starting point for future research.

Denna studie undersöker området för gröna fastigheter och hållbarhet, vilket idag ligger i tiden för de flesta fastighetsbolag. Nya krav och regler ihop med en större medvetenhet hos aktörer och intressenter gör att fastighetsbolag idag jobbar mer och mer med gröna investeringar. Inte minst då i gröna fastigheter, vilket är något som ökat markant de senaste åren. Syftet med denna studie är att undersöka vad ett nystartat bolag prioriterar vid förvärv av gröna fastigheter, det vill säga en miljöcertifierad fastighet. Vilka faktorer är det man som aktör värderar och hur prioriterar man dessa gentemot varandra? För att besvara studiens syfte kommer tre olika forskningsfrågor att behandlas i studien. En forskningsfråga kommer att behandlas via en litteraturundersökning och titta på vilka faktorer det är som lyfts fram som viktiga i litteraturen när det gäller förvärv av gröna fastigheter. Sedan kommer en forskningsfråga bestå av beräkningar där huvudsakliga syftet är att bekräfta det litteraturen säger om premier för gröna fastigheter. Den sista forskningsfrågan kommer att undersöka eventuella faktorer ett nystartat fastighetsbolag prioriterar vid förvärv av gröna fastigheter till sin portfölj, samt hur dessa värderas mot varandra. Denna fråga kommer att besvaras via en fallstudie bestående av ett nystartat fastighetsbolag och kommer utgöra en betydande del av studien. Resultaten i studien pekar på att det finns en premie för gröna fastigheter likt det som den internationella litteraturen indikerar. Vidare så resulterade studien i att påvisa att det som främst prioriteras hos ett nystartat bolag vid förvärv av gröna fastigheter är de olika ekonomiska incitamenten ihop med att man som företag skapar sig en konkurrensfördel på marknaden. Denna studie bidrar till den nuvarande litteraturen om gröna fastigheter genom att vara den första studien i Sverige som tar sikte på hur ett nystartat bolag värderar olika faktorer och hur det kan gynna liknande företag att välja gröna fastigheter som sin nisch. / This study examines the research area of green real estate and sustainability, which today is something that is topical for almost every real estate company. New requirements and rules together with a greater awareness amongst actors and stakeholders means that real estate companies today work more with different forms of green investments. Not to say the least by investing in green properties, which is something that has increased significantly in recent years. The purpose of this study is to investigate what a newly started real estate company prioritizes when acquiring green properties, in other words an environmentally certified property. What factors do an actor such as a real estate company value and how do the actor prioritize these amongst each other? To answer the purpose of this study, three different research questions will be addressed in the study. One of the research questions will be answered by a literature review where the aim is to look at which factors are highlighted as important in the literature when it comes to the acquisition of green properties. Another research question will consist of calculations where the main aim is to confirm what the literature says about premiums for green properties. The last research question will examine what factors a newly started real estate company prioritizes when acquiring green properties for its portfolio, and how these are valued against each other. This question will be answered by a case study consisting of a newly started real estate company and will be a significant proportion of the study. The results of the study indicate that there is a premium for green properties similar to what the international literature indicates. Furthermore, the study results indicate that the main priority for a newly started company when acquiring green properties are the various economic incentives followed by the opportunity to create a competitive advantage on the market. This study contributes to the current literature on green properties by being the first study in Sweden that aims at how a newly started company values different factors when investing in green real estate and how similar companies can benefit from choosing green properties as its niche.

Idag ställs höga krav på gott inomhusklimat och tillfredsställande termisk komfort. Tack vare flera tekniska innovationer går det att möta dessa behov, men detta medför att installationssystemen i dagens flerbostadshus tar allt mer plats. Samtidigt som tekniken får ta mer och mer plats har utvecklingen på projekteringssidan gått i en helt annan riktning. Arkitekten har istället kommit att bli en av de många konsulter som specialiserar sig på sin del av projektet (Östnäs, 1984). Att dessa utvecklingar skett åt olika håll skapar ett kunskapsgap mellan teknikkonsulter och arkitekter i dagens byggprojekt. 54% av respondenterna i denna studie, uppger att kunskapsgapet mellan A och VVS är så stort att det skapar problem i projekteringen och 35% av respondenterna anger att det ofta bidrar negativt till slutresultatet i form av nödlösningar. Detta examensarbete syftar till att undersöka om samordningen mellan arkitekt och VVS-projektör kan förbättras genom att överbrygga installationskunskap. Studien begränsas till att omfatta enbart samordning mellan Arkitekt och VVS-projektör och avgränsas alltså mot övriga projektörer i ett byggprojekt. Undersökningen fokuserar på samordning i tidigt skede av projekteringen, programskede. Hypotesen är att det generellt finns ett behov av ökad installationssamordning i projekteringen, denna testades genom en kvantitativ undersökning i form av en webbenkät. Totalt deltog 99 personer i undersökningen. Med hjälp av statistisk analys i form av hypotestest påvisades att det generellt finns ett behov av ökad samordning, hypotesen gick att bevisa. Utöver det identifierades, med hjälp av hypotestest I, att det behövs en förändring i vilka projektörer som ingår i projektet i programskede. De oftast förekommande samordningsproblemen identifierades genom kvalitativa djupintervjuer med elva verksamma projektörer och två branschexperter. Här framgick att de problem som förkommer i störst utsträckning är storlekar på fläktrum och placeringar av schakt. De problem som medför störst konsekvenser var vertikala utrymmen. Orsaken till uppkomsten av problem menar många är bristande kunskap eller erfarenhet från arkitektens sida. Arkitekter i sin tur uppger att det beror på ändringar i sena skeden från beställarens eller vvs-projektörens håll. Majoriteten hävdar att om vvs-projektören kom in i ett tidigare skede så skulle problemen minska. Därefter utvecklades, under en workshop med 5 deltagande projektörer ett förslag till hjälpmedel. Kontentan från den workshopen var att om vvs-projektören kommer in i projektet i tidigt skede, programskede, så kan rätt förutsättningar sättas tidigt. Förslag om kreativa startmöten uppkom bland annat. Deltagarna var även överens om att det bästa sättet att förmedla installationskunskap är att utbilda, detta dels genom tvärfackliga projekt under arkitektutbildningen, dels genom kurser eller platsbesök för de praktiserande arkitekterna. Ur samtlig insamlad data formades ett hjälpmedel för att möta de identifierade behoven. Detta hjälpmedel blev en checklista för hur möten och konsultation mellan A och VVS ska ske i programskede. Checklistan tydliggör ansvar och förväntningar för båda parter. Detta hjälpmedel testades sedan experimentellt i ett gestaltningsförslag. Gestaltningsförslaget är ett flerbostadshus på fastigheten Kv. Notstället 5 & 6 i Eskilstuna kommun. I programhandlingen, som utgör resultatet av experimentet, presenteras även lösningar för installationssystem. Hjälpmedlets förmåga att möta de identifierade behoven utvärderades med slutsatsen att behoven tillgodoses men att ett kompletterande verktyg för ökad installationskunskap kan behövas. Hjälpmedlet anses inte bekosta projektet på arkitektoniska kvaliteter i så stor mån utan skapat mervärde genom nya innovationer samt att överraskningar undveks. Som forskningsämne har detta projekt väckt stort intresse i branschen. Insikter från denna studie är att tvärfacklig kommunikation och kunskapsöverföring mellan disciplinen generellt är ett intressant ämne att studera. De samlade resultaten från denna studie pekar på att en förändring i arbetsrätt under tidigare skeden i projekteringen är något som bör ske. Detta för att effektivisera projekteringen och säkerställa god kvalitet i slutprodukten, våra flerbostadshus. / Sweden has high statutory standards for inside climate and thermic comfort in buildings. Because of technical advances these requirements can be met, but at a cost. Increasingly effective HVAC and plumbing systems are linked to a larger volume claim for units, pipes and ducts. As the systems grow the design aspect moves in a contrary direction. A direction where the role of the architect has changed to become a consulting part (Östnäs 1984). These diverging developments has triggered a knowledge gap between technical engineers and architects. 54% of respondents on this study claim that this gap causes problems, and 35% claim that it often contributes negatively to the end result in the form of having to resort to last minute solutions. This master thesis aims to investigate if the coordination between architects and HVAC & plumbing engineers can be improved by bridging the knowledge gap. The study is limited to only encompass the coordination between these two groups and leaves out remaining disciplines and parties. The focus of this study is directed to the early stages in the building design process. The hypothesis suggests that there exists a need for further coordination regarding installations design. This has been tested through a quantitative survey consisting of a web form with a total of 99 respondents. This data was then statistically analyzed in the form of hypothesis testing, which concluded there exists a general need for improved coordination. Furthermore, hypothesis test I showed that there is also need for a change regarding which disciplines should be involved in early stages of projects. The most common coordination problems were identified by a quantitative study consisting of interviews with eleven projectors and two branch experts. The two most coveted aspects were the volumetric size of room containing ventilation machinery and the placing of vertical shafts. Where vertical spaces caused greatest consequences. The reason for these problems, according to many, being an acute lack of interdisciplinary knowledge or experience from the architect. On the other hand, architects claim this is due to changes being made in latter stages of projects by other disciplines or the client. The majority claim that a solution is to bring in the HVAC & plumbing engineer in an earlier stage. Following this a workshop including five professionals was carried out to draft up a solution. It established that if the HVAC & plumbing engineer is brought in at an earlier stage it allows for the right conditions to be set. Suggestions regarding creative start up meetings were introduced. Participants agreed that the best way to mediate knowledge about installations is to educate through both interdisciplinary projects at universities, and also through courses or site visits for architects. To meet the identified needs a solution was constructed from collected data. This solution took the form of a checklist to help guide how meetings between the architect and HVAC & plumbing engineer should be carried out in early stages. The checklist clarifies responsibility and expectations for both parts. This solution was then tested through a simulated design project. The project consists of an apartment building property for Notstället 5 & 6 in Eskilstuna municipality. A solution for the installations is presented. The checklists ability to meet the identified needs were concluded to suffice but an additional tool for bridging the knowledge gap further would be beneficial. The use of this solution did not cause any significant negative consequences on the architectural qualities, but created value by discovering new innovative solutions, in addition to preventing unplanned surprises from arising. As a research topic this project has sparked interest in the branch. Insights from this study concludes that interdisciplinary communication and knowledge transfer between disciplines in general is an interesting topic to study.

Breast cancer is the most common cancer among women in the United States with over 60% of cases diagnosed as early stage disease. For those women without prohibiting clinical or cosmetic concerns, a choice between breast-conserving surgery and mastectomy can be made. Either choice confers equivalent survival. The decision-making process also involves consideration of recurrence risk as well as management of the unaffected, contralateral breast for both future surveillance and risk reduction. In recent years, increasing rates of mastectomy with contralateral prophylactic mastectomy have been reported among women with unilateral, early stage breast cancer. If eligible for a choice among surgical options, a woman’s decision becomes one of personal preference. The decision-making process is complex and involves consideration of potential benefits and harms with each option. The purpose of this dissertation was to: 1) analyze the psychometric properties of the Anxiety Subscale of the Depression Anxiety Stress Scale, 2) critically review Decisional Conflict Scales and 3) prospectively identify demographic, clinical, cognitive and affective factors influencing a woman’s decision to choose either breast conserving surgery or mastectomy with contralateral prophylactic mastectomy and to identify self-reported sources of information in the surgical decision-making process. Three manuscripts make up the dissertation. A secondary data analysis was conducted to test the psychometric properties of the Anxiety Subscale of the Depression Anxiety Stress Scale (DASS). The results of this analysis supported the reliability and validity of the DASS anxiety subscale. A critical review of decisional conflict measures for use with early stage breast cancer patients making surgical treatment decisions was conducted. The results of this review supported the use of Decisional Conflict Scales from a clinical and research perspective. Existing Decisional Conflict Scales show moderate to acceptable reliability. The first two manuscripts provided background and support for the use of scales included in the research study described in the third manuscript. This study was a prospective, exploratory, cross-sectional, mixed-methods study describing factors influencing preference for surgical choice among women with early stage breast cancer. A sample of 78 participants enrolled in the study, 47 who chose breast conserving surgery and 31 who chose mastectomy with contralateral prophylactic mastectomy. Differences were tested between the groups. Women who chose mastectomy with contralateral prophylactic mastectomy were younger, more likely to work full or part-time, had larger tumors and participated in preoperative genetic counselling. Women who chose breast conserving surgery were more likely to have participated in preoperative breast magnetic resonance imaging. Overall, women choosing either surgery were not experiencing severe levels of distress, depression, anxiety or stress although there were individual variations. Women choosing mastectomy with contralateral prophylactic mastectomy were more anxious and had more frequent intrusive thoughts about the diagnosis. They also had less decisional conflict as compared to women choosing breast conserving surgery. Information sources were similar but the most influential information source differed among the two groups. In both groups, intention for surgical choice was matched by the final decision. There are many factors influencing surgical choice among women with early stage breast cancer. Previous work has focused on clinical, demographic and diagnostic processes influencing the decision. With this study, evidence regarding the influence of cognitive and affective factors is described.