| 1. |
- Selldén, Tilia, 1996, et al.
(författare)
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Radiographic airway abnormalities in untreated early rheumatoid arthritis are associated with peripheral neutrophil activation
- 2023
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Ingår i: Arthritis Research & Therapy. - : Springer Science and Business Media LLC. - 1478-6362. ; 25:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: The role of the lung for the initiation and progression of rheumatoid arthritis (RA) is still unclear. Up to 10% of RA patients develop interstitial lung disease which remains a clinical challenge. Understanding early disease mechanisms is of great importance. The objective of this study was to determine whether there is an association between peripheral neutrophil phenotypes and presence of pulmonary abnormalities (PA) on chest high-resolution computed tomography (HRCT) in untreated early RA (ueRA).MethodsClinical data and blood were collected, and HRCT performed at diagnosis on 30 consecutive anti-citrullinated protein antibody (ACPA) and/or rheumatoid factor (RF) positive ueRA patients. HRCTs were evaluated for the presence of RA-associated parenchymal, airway and/or pleural abnormalities. Expression of phenotype markers on neutrophils were determined by flow cytometry. Levels of calprotectin, ACPA and RF were measured using immunoassays.ResultsThe frequency of having any PA was 60%. Airway abnormalities were present in 50%, parenchymal nodules in 43% and interstitial lung abnormalities (ILA) in 10%. Unsupervised multivariate data analysis showed clustering of any PA with neutrophil activation, parameters of inflammation and RF titres. In univariate analysis, the patients with PA displayed significantly increased CD11b and decreased CD62L expression on neutrophils (1.2-fold, p = 0.014; 0.8-fold, p = 0.012) indicating activation and significantly increased RF IgM titre and CRP (5.7-fold, p = 0.0025; 2.3-fold, p = 0.0035) as compared to no PA. Titres of RF, but not ACPA, correlated with expression of the neutrophil activation marker CD11b. A stratified analysis demonstrated that airway involvement was the PA subtype with the strongest association with neutrophil activation.ConclusionWe report a strong association between radiographic airway findings and activation of circulating neutrophils in early RA supporting a role of innate immunity and the lung at disease onset. Our results also indicate different contributions of RF and ACPA in the RA pathogenesis.
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| 2. |
- Engholm, Albin, 1991-, et al.
(författare)
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The emerging technological innovation system of driverless trucks
- 2020
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Ingår i: Transportation Research Procedia. - : Elsevier BV. - 2352-1465. ; , s. 145-149
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Konferensbidrag (refereegranskat)abstract
- Driving automation technology is attractive for the road freight transport sector since driverless trucks (DL-trucks) may drastically reduce driver costs, increase truck utilization and improve road safety. Although DL-trucks may bring significant impacts to the transport system, research on the future diffusion and impacts of DL-trucks is scarce compared to passenger transport. In this paper the sociotechnical innovation system developing, diffusing and utilizing DL-trucks in Sweden is analyzed based on the technological innovation systems (TIS) framework. The analysis is based on 20 expert interviews with a total of 23 representatives from 16 actors in the DL-truck TIS in Sweden. The TIS analysis shows that there are significant uncertainties in the timeline, operational capabilities, infrastructure requirements and regulative landscape for a widespread DL-truck deployment. There is a general view among the interviewees that DL-trucks is an important opportunity for Swedish industry and the economy. From a transport system perspective, DL-trucks are expected to bring sustainability benefits but it remains uncertain whether these benefits will be realized and what the negative side effects might be. The development of DL-trucks is heavily influenced by incumbent firms in the truck manufacturing industry but new actors from the telecom sector, energy sector and emerging truck technology companies are entering the area and shaping the development. The current relatively rigid institutions for truck manufacturing and road freight transport will require significant alignment to adapt to DL-truck operations in areas such as laws and regulations, business models and operational practices. The value chain of road freight transport may be disrupted as some of the current key actors, for instance traditional road carriers, could become less relevant in future DL-truck value chains. A critical uncertainty is how and by which actors the setting of requirements, deployment and financing of digital infrastructure for DL-trucks will be done.
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| 3. |
- Milton, Anna, et al.
(författare)
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Caregiver burden and emotional wellbeing in informal caregivers to ICU survivors-A prospective cohort study
- 2022
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Ingår i: Acta Anaesthesiologica Scandinavica. - : John Wiley & Sons. - 0001-5172 .- 1399-6576. ; 66:1, s. 94-102
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Tidskriftsartikel (refereegranskat)abstract
- Background: Informal caregivers to intensive care unit (ICU) survivors may develop post-intensive care syndrome family (PICS-F), including depression, anxiety and post-traumatic stress (PTS). Our primary aim was to investigate associations between caregiver burden in informal caregivers cohabiting with ICU survivors and patients' physical and psychological outcomes.Methods: A prospective, multicentre cohort study in four ICUs in Sweden. Adults cohabiting with ICU patients included in a previous study were eligible for inclusion. Three months post-ICU, informal caregivers received questionnaires assessing caregiver burden, health-related quality of life (HRQL) and symptoms of depression, anxiety and PTS. In parallel, patients reported their three-month physical and psychological status via validated questionnaires. The primary outcome of this study was to compare caregiver burden in informal caregivers to patients with and without adverse physical and psychological outcomes 3 months post-ICU. Secondary outcomes were correlations between caregiver burden and informal caregivers' mental HRQL.Results: Among 62 included informal caregivers, 55 (89%) responded to the follow-up questionnaires. Caregiver burden was higher among informal caregivers to patients with an adverse outcome, compared to informal caregivers to patients without an adverse outcome, caregiver burden scale score mean (+/- standard deviation) 52 (11) and 41 (13) respectively (p = 0.003). There was strong negative correlation between caregiver burden and informal caregivers' mental HRQL (r(s) -0.74, p < 0.001).Conclusion: Informal caregivers to ICU survivors with adverse physical or psychological outcome experience a higher caregiver burden. A higher caregiver burden correlates with worse caregiver mental HRQL. ICU follow-up programs should consider screening and follow-up of informal caregivers for mental health problems.
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| 4. |
- Milton, Anna, et al.
(författare)
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ICU discharge screening for prediction of new-onset physical disability - a multinational cohort study
- 2020
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley-Blackwell Publishing Inc.. - 0001-5172 .- 1399-6576. ; 64:6, s. 789-797
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Methods to identify patients at risk for incomplete physical recovery after intensive care unit (ICU) stay are lacking. Our aim was to develop a method for prediction of new-onset physical disability at ICU discharge.METHODS: Multinational prospective cohort study in ten general ICUs in Sweden, Denmark and the Netherlands. Adult patients with an ICU stay ≥12 hours were eligible for inclusion. Sixteen candidate predictors were analyzed with logistic regression for associations with the primary outcome; new-onset physical disability three months post-ICU, defined as a ≥10 score reduction in the Barthel Index compared to baseline.RESULTS: Of 572 included patients, follow-up data are available on 78% of patients alive at follow-up. The incidence of new-onset physical disability was 19%. Univariable and multivariable modeling rendered one sole predictor for the outcome: physical status at ICU discharge, assessed with the five first items of the Chelsea Critical Care Physical Assessment Tool (CPAx) (odds ratio 0.87, 95% confidence interval (CI) 0.81 to 0.93), a higher score indicating a lower risk, with an area under the receiver operating characteristics curve of 0.68 (95% CI 0.61 to 0.76). Negative predictive value for a low-risk group (CPAx score >18) was 0.88, positive predictive value for a high-risk group (CPAx score ≤18) was 0.32.CONCLUSION: The ICU discharge assessment described in this study had a moderate AUC but may be useful to rule out patients unlikely to need physical interventions post-ICU. For high-risk patients, research to determine post-ICU risk factors for an incomplete rehabilitation is mandated.
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| 5. |
- Bergenheim, Anna, et al.
(författare)
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Stress levels predict substantial improvement in pain intensity after 10 to 12years in women with fibromyalgia and chronic widespread pain: a cohort study.
- 2019
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Ingår i: BMC rheumatology. - : Springer Science and Business Media LLC. - 2520-1026. ; 3
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Tidskriftsartikel (refereegranskat)abstract
- Previous studies of prognosis for women with Fibromyalgia (FM) or chronic widespread pain (CWP) show contradictory results. However, some women appear to improve in pain and other core symptoms over time. There is limited knowledge about predictors of substantial improvement in pain intensity over a longer period of time. The primary objective of this study was to investigate the natural course of pain intensity and distribution of pain over 10 to 12years in a cohort of 166 women with FM or CWP. Secondarily we wanted to investigate predictors of substantial improvement (≥50%) in pain intensity after 10 to 12years.The study is a longitudinal prospective cohort study. 166 women with FM or CWP were followed up after 10 to 12years. 126 women (76%) participated in the follow-up and completed a battery of questionnaires concerning pain intensity, pain distribution and other physical and mental aspects of health. Differences in symptoms within the cohort over 10 to 12years and predictors of substantial improvement (≥50%) in pain intensity were calculated.Pain had improved at the 10 to 12year follow-up (p<0.001) with a mean change of -9.2mm (SD 23.3, 95% CI: -13.3; -5.0) for pain intensity and-2.0 sites (SD 4.2, 95% CI: -2.7; -1.2) for pain distribution. Nine percent of the 126 women showed an individual moderate improvement in pain intensity while 16% showed a substantial improvement at the follow-up as compared to baseline. Lower symptoms of stress and higher pain intensity at baseline predicted higher probability of reporting at least 50% less pain intensity after 10 to 12years as compared to baseline.A majority of women with FM and CWP appear to have a positive course of pain over time, which should be communicated to these patients in health care. Reducing stress levels might contribute to better chances of improvement over time.Clinicaltrials.gov NCT02872129, registered 06/30/2016.
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| 6. |
- Berggren, Karin, et al.
(författare)
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Healthcare workers' experiences of patient safety in the intensive care unit during the COVID-19 pandemic : A multicentre qualitative study
- 2023
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Ingår i: Journal of Clinical Nursing. - : John Wiley & Sons. - 0962-1067 .- 1365-2702. ; 32:19-20, s. 7372-7381
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Tidskriftsartikel (refereegranskat)abstract
- AimTo describe healthcare workers' experiences of preconditions and patient safety risks in intensive care units during the COVID-19 pandemic. BackgroundHealthcare workers' ability to adapt to changing conditions is crucial to promote patient safety. During the COVID-19 pandemic, healthcare workers' capacity to maintain safe care was challenged and a more in-depth understanding on frontline experiences of patient safety is needed. DesignA qualitative descriptive design. MethodsIndividual interviews were conducted with 29 healthcare workers (nurses, physicians, nurse assistants and physiotherapists) from three Swedish hospitals directly involved in intensive care of COVID-19 patients. Data were analysed with inductive content analysis. Reporting followed the COREQ checklist. ResultsThree categories were identified. Hazardous changes in working conditions describes patient safety challenges associated with the extreme workload with high stress level. Imperative adaptations induced by changed preconditions for patient safety which include descriptions of safety risks following adaptations related to temporary intensive care facilities, handling shortage of medical equipment and deviations from routines. Safety risks triggered by reorganisation of care describe how the diluted skill-mix and team disruptions exposed patients to safety risks, and that safety performance mostly relied on individual healthcare worker's responsibility. ConclusionsThe study suggests that healthcare workers experienced an increase in patient safety risks during the COVID-19 pandemic mainly because the extremely high workload, imperative adaptations, and reorganisation of care regarding skill-mix and teamwork. Patient safety performance relied on the individuals' adaptability and responsibility rather than on system-based safety. Relevance to Clinical PracticeThis study provides insights on how healthcare workers' experiences can be used as a source of information for recognition of patient safety risks. To improve detection of safety risks during future crises, guidelines on how to approach safety from a system perspective must include healthcare workers' perceptions on safety risks. Patient and Public ContributionNone in the conceptualisation or design of the study.
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| 7. |
- Bruno, Linnéa, 1975-, et al.
(författare)
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Heroes and others : tensions and challenges in implementing Mentors in Violence Prevention in Swedish schools
- 2020
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Ingår i: Journal of Gender-Based Violence. - 2398-6808 .- 2398-6816. ; 4:2, s. 141-155
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Tidskriftsartikel (refereegranskat)abstract
- This article explores the challenges that were detected in the first evaluation of the violence prevention programme Mentors in Violence Prevention at senior levels of compulsory schools and upper-secondary schools in Sweden. In particular, we analyse how the gender-transformative dimension and the bystander perspective aspect of the programme played out in the classroom. What are the implications of implementing a gender-transformative violence prevention programme such as Mentors in Violence Prevention when it is carried out by teachers in the school setting? The empirical basis for this study includes classroom observations during all seven Mentors in Violence Prevention sessions in two schools, and group interviews with a total of 14 teachers and 26 pupils (aged 13‐19) from five schools. Our findings suggest that most teachers did not appear to be comfortable with either the Mentors in Violence Prevention programme’s pedagogical model or its theoretical approach. Consequently, they occasionally worked in manners contrary to the programme’s intentions. However, observations and interviews demonstrated that a learning process about gender-based violence had been initiated. It may be necessary to make further adjustments if Mentors in Violence Prevention is to be used in schools in Sweden, particularly if teachers are to be the programme leaders.
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| 8. |
- Danielski, Itai, 1973-, et al.
(författare)
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Air source heat pumps and their role in the Swedish energy system
- 2012
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Ingår i: Support your future today; Turning environmental problems into business opportunities.
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Konferensbidrag (refereegranskat)abstract
- Newly produced air source heat pumps can provide heat energy from outdoor air at temperature as low as -20°C. As a result they could be utilized during most days of the year even in the cold Nordic climates. The drawback of air source heat pumps is the reduction in efficiency as the outdoor air become colder, resulting in lower heat supply in times when it is most needed. Despite its inverse relationship between efficiency and outdoor temperature, air source heat pumps were installed in 57000 detached houses in Sweden during 2010 alone, which is 3% of the total detached houses stock. That makes air source heat pumps the most sold heating technology for detached houses in Sweden during 2010, 1.6 times more than the number of installations of ground source heat pump and 3 times more than the number of connections of detached houses to district heating during the same year. Similar trends can be found in other Nordic countries.This study compares the use of an air source heat pump with other existing commercial technologies in detached houses and analyzes the impacts on primary energy use, on final energy use, on electricity production and on costs benefits for house owners. It was found that converting existing electric heated Swedish detaches houses to district heating with biomass based CHP or bed-rock heat pump could reduce the use of resources, which could benefit Sweden as a society. Converting electric heated Swedish detaches houses to district heating or pellets stove could reduce power demand and level out the power demand load curve. That would benefit utilities of power supply as it could secure power supply. However cost effectiveness in one of most important drivers for house owners of detached houses to choose energy efficiency measures. For that reason house owners may most likely benefit by the installation of air-source heat pumps.
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| 9. |
- Danielski, Itai, 1973-
(författare)
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Energy performance of residential buildings : projecting, monitoring and evaluating
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Energy security and climate change mitigation have been discussed in Sweden since the oil crisis in the 1970s. Sweden has since then increased its share of renewable energy resources to reach the highest level among the EU member states, but is still among the countries with the highest primary energy use per capita. Not least because of that, increasing energy efficiency is important and it is part of the Swedish long term environmental objectives. Large potential for improving energy efficiency can be found in the building sector, mainly in the existing building stock but also in new constructions.Buildings hold high costs for construction, service and maintenance. Still, their energy efficiency and thermal performance are rarely validated after construction or renovation. As energy efficiency become an important aspects in building design there is a need for accurate tools for assessing the energy performance both before and after building construction. In this thesis criteria for energy efficiency in new residential buildings are studied. Several building design aspects are discussed with regards to final energy efficiency, energy supply-demand interactions and social aspects. The results of this thesis are based on energy modelling, energy measurements and one questionnaire survey. Several existing residential buildings were used as case studies.The results show that pre-occupancy calculations of specific final energy demand in residential buildings is too rough an indicator to explicitly steer towards lower final energy use in the building sector. Even post occupancy monitoring of specific final energy demand does not always provide a representative image of the energy efficiency of buildings and may result with large variation among buildings with similar thermal efficiency. A post occupancy method of assessing thermal efficiency of building fabrics using thermography is presented. The thermal efficiency of buildings can be increased by design with low shape factor. The shape factor was found to have a significant effect on the final energy demand of buildings and on the use of primary energy. In Nordic climates, atria in multi-storey apartment buildings is a design that have a potential to increase both energy efficiency (by lower shape factor) and enhance social interactions among the occupants.
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| 10. |
- Danielski, Itai, et al.
(författare)
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Heated atrium in multi-storey apartment buildings, a design with potential to enhance energy efficiency and to facilitate social interactions
- 2016
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Ingår i: Building and Environment. - : Elsevier. - 0360-1323 .- 1873-684X. ; 106, s. 352-364
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Tidskriftsartikel (refereegranskat)abstract
- The design concept of conditioned atria gains increasing popularity in commercial and service buildings all over the world, but is still not a common building design in the residential sector. This study investigates the potential of such design in residential buildings in Nordic climates as means to enhance both energy efficiency as well as social interaction among residents. Energy modelling was used to compare energy efficiency among designs of residential buildings with and without atrium and to identify important design parameters. Social interaction was analysed, based on a survey evaluating the perception of residents living in an existing multi-storey apartment building designed with a heated atrium in the north of Sweden.The results show that heated atrium in Nordic climates have a potential to reduce the total final energy demand while at the same time increase the conditioned space of the building. To positively impact energy efficiency, the atrium should fulfil three requirements: (i) it should be designed to reduce the shape factor for the whole building; (ii) it should have the minimum glazed area that comply with the building requirements concerning natural light and visual comfort; and (iii) adjustable solar shading should be installed in the atrium’s façades to avoid unwanted overheating. The survey results indicate that the additional space created by the atrium has a potential to facilitate and promote social interaction among residents and to increases a sense of neighbourliness and belongingness, which are often discussed as important parameters in relation to social sustainability.
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