| 61. |
- Linander, Ida, 1987-, et al.
(författare)
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”Det är fokus på rätt saker” : hbtq-personers upplevelser av Region Västerbottens hbtq-diplomering
- 2021
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Hbtq-diplomeringen i Region Västerbotten ämnar bidra till ett strukturerat och långsiktigt arbete med hbtq (homosexuella, bisexuella, trans- och queerpersoner), normer och jämlikhet inom regionens verksamheter. Detta arbete sker både utifrån ett patientperspektiv, ett arbetsmiljöperspektiv och ett verksamhetsperspektiv. Denna rapport fokuserar på patientperspektivet och fokuserar på upplevelser av hbtq-diplomerade sjukvårdskliniker inom Region Västerbotten. Inom ramen för studien har 12 intervjuer genomförts med hbtq-personer som har erfarenheter från någon av regionens diplomerade kliniker. Intervjuerna har analyserats med hjälp av tematisk analys. Intervjuerna representerar olika erfarenheter av regionens hbtq diplomering, men också olika åsikter och perspektiv. Vissa menar att hbtq diplomering är bra och viktigt, något alla kliniker bör genomgå medan andra har en mer avvaktade hållning och delvis problematiserar fenomenet. Men i stort framkommer positiva erfarenheter av kliniker i Västerbotten som hbtq-diplomerats. Hbtq- kompetens beskrivs ofta i relation till bemötandefrågor men det är tydligt utifrån deltagarnas erfarenheter att ett gott möte med vården inbegriper fler aspekter. Förutom vikten av att ett respektfullt bemötande som undviker normativa antaganden kom medicinsk/klinisk kunskap upp och även kunskaper om hbtq-personers livsvillkor. Deltagarna berör flera faktorer som de menar påverkar fler vårdsökande men kan få större konsekvenser för hbtq-personer, exempelvis att bo i ett stads- eller landsbygdsområde eller ha invandrarbakgrund. Brist på kontinuitet bland vårdgivare beskrivs tvinga hbtq-personer att komma ut om och om igen och brist på resurser och stressad personal upplevs göra personalen mer benägen att återgå till ett mer normativt bemötande, det vill säga utgå ifrån cis- och heteronormativa antaganden. Utifrån intervjuerna framkommer förbättringspotentialer. Ibland handlar det om enskilda vårdgivare som behöver fortbildas och ibland behövs det rutiner för att exempelvis dokumentera saker i journalen. En önskan om hbtq-kompetent gynekologisk vård återkommer och det påpekas att det saknas klinisk kunskap om exempelvis STI och risk för cervixcancer i relation till lesbiska sexuella praktiker, även på diplomerade kliniker. Det är viktigt att diplomeringen uppdateras och att alla på kliniken är utbildade, annars skapas en känsla av att diplomeringen inte spelar någon roll. På samma sätt är det viktigt att diplomeringen inte enbart blir symboler och skrivna ord, det är viktigt att klinikerna faktiskt besitter hbtq-kompetens som omsätts i adekvat vård till hbtq-personer.
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| 62. |
- Magnusson, Anders, 1957-
(författare)
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Evaluation of surgically assisted rapid maxillary expansion and orthodontic treatment : Effects on dental, skeletal and nasal structures and rhinological findings
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Surgically Assisted Rapid Maxillary Expansion (SARME) is frequently used to treat skeletal maxillary transverse deficiency (MTD) in skeletally mature and non-growing individuals. Despite previous research in the field, questions remain with respect to the long-term stability of SARME and its effects on hard and soft tissue.The overall aim of the present doctoral work was to achieve a greater understanding of SARME, using modern image technology and a multidisciplinary approach, with special reference to effects on the hard and soft tissues and respiration. A more specific aim was to evaluate the long-term stability in a retrospective sample of patients treated with SARME and orthodontic treatment and to compare the results with a matched, untreated control group. The studies in this doctoral project are thus based on two different samples and study designs.The first sample, Study I (Paper I), is a retrospective, consecutive, long-term follow-up material of study models from 31 patients (17 males and 14 females) treated with SARME and orthodontic treatment between 1991 and 2000. The mean pre-treatment age was 25.9 years (SD 9.6) with a mean follow-up time of 6.4 years (SD 3.3). Direct measurements on study models were made with a digital sliding caliper at reference points on molars and canines. To evaluate treatment outcome and long-term stability, the results were compared with study models from an untreated control group, matched for age, gender and follow-up time.The second sample, Study II (Papers II-IV), is a prospective consecutive, longitudinal material of 40 patients scheduled to undergo SARME and orthodontic treatment between 2006 and 2009.In Paper II, one patient was excluded because of a planned adenoidectomy. The final sample comprised 39 patients (16 males and 23 females). The mean age at treatment start was 19.9 years (range 15.9 – 43.9). Acoustic rhinometry, rhinomanometry and a questionnaire were used to assess the degree of nasal obstruction at three time-points; pre-treatment, three months after expansion and after completed treatment (mean 18 months).In Papers III–IV, three patients declined to participate and two had to be excluded because their CT-records were incomplete. The final sample comprised 35 patients (14 males and 21 females). The mean age at treatment start was 19.7 years (range 16.1 – 43.9). Helical CT-images were taken pre-treatment and eighteen months’ post-expansion. 3D models were registered and superimposed at the anterior cranial base. The automated voxel-based image registration method allows precise, accurate measurements in all areas of the maxilla. In Papers II–IV, the treatment groups constituted their own control groups.The main findings in the retrospective, long-term follow-up study were that SARME and orthodontic treatment normalized the transverse discrepancy and was stable for a mean of 6 years post-treatment. Pterygoid detachment did not entirely eliminate the side effect of buccal tipping of the posterior molars. Relapse is time-related and is most pronounced during the first 3 years after treatment. Thus the retention period should be extended and should be considered for this period. The main rhinological findings in the prospective longitudinal study were that SARME had a shortterm, favourable effect on nasal respiration, but the effect did not persist in the long-term. However, subjects with pre-treatment nasal obstruction reported a lasting sensation of improved nasal function.SARME and orthodontic treatment had a significant but non-uniform skeletal treatment effect, with significantly greater expansion posteriorly than anteriorly. The expansion was parallel anteriorly but not posteriorly. The lateral tipping of the posterior segment was significant, despite careful surgical separation. No correlation was found between tipping and the patient's age. Furthermore, SARME and orthodontic treatment significantly affected all dimensions of the external features of the nose. The most obvious changes were at the most lateral alar-bases. The difference in lateral displacement profoundly influenced the perception of a more rounded nose. There were no predictive correlations between the changes. Patients with narrow and constrained nostrils can benefit from these changes with respect to the subjective experience of nasal obstruction. It is questionable whether an alar-cinch suture will prevent widening at the alar-base.The 3D superimposition applied in Study II is a reliable method, circumventing projection and measurement errors. In conclusion, SARME and orthodontic treatment normalize the transverse deficiency, with long-term stability. SARME has a favourable effect on the subjective perception of nasal respiration. SARME significantly affects dental, skeletal and nasal structures.
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| 63. |
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| 64. |
- Manjate, Alice, 1971-, et al.
(författare)
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Laboratory-based evaluation of the 4th-generation AlereTM HIV Combo rapid point-of-care test
- 2024
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 19:2
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Mozambique is a high-prevalence country for HIV and early detection of new HIV infections is crucial for control of the epidemic. We aimed to evaluate the accuracy of the 4th-generation rapid diagnostic test (RDT) AlereTM HIV Combo in detecting acute and seroconverted HIV-infection, among sexually-active women attending three clinical health centers in Maputo, Mozambique.METHODS: Women aged 14-55 years (n = 920) seeking care at the Mavalane Health Area, Maputo (February 2018-January 2019) were included, and blood specimens sampled. Sociodemographic and sexual behavior data were collected. Point-of-care HIV testing was performed using Alere DetermineTM HIV-1/2 and Uni-GoldTM HIV-1/2. All samples were also tested using Enzygnost® HIV Integral 4 and Innotest® HIV Antigen mAb in laboratory. The 4th-generation RDT AlereTM HIV Combo was evaluated on serum samples in the laboratory. Finally, Innotest® HIV Antigen mAb, Enzygnost® HIV Integral 4 (Ag/Ab), and HIV RNA quantification acted as gold standard assays in the evaluation of AlereTM HIV Combo test for HIV antigen detection (in clinical samples and in three HIV-1 seroconversion panels).RESULTS: The antibody component of the 4th generation AlereTM HIV Combo RDT demonstrated a sensitivity and specificity of 100% examining clinical samples. However, the test did not detect HIV p24 antigen in any clinical samples, while Innotest® HIV Antigen mAb, verified by Enzygnost® HIV Integral 4 (Ag/Ab) and/or HIV RNA quantification, detected HIV antigen in six clinical samples. Furthermore, the AlereTM HIV Combo RDT had a low sensitivity in the detection of HIV p24 antigen in seroconversion panels. The HIV prevalence among the examined women was 17.8%.CONCLUSIONS: The 4th-generation RDT AlereTM HIV Combo showed similar sensitivity to the 3rd-generation RDTs to detect seroconverted HIV-infections. However, the sensitivity for detection of HIV p24 antigen and diagnosing acute HIV infections, before seroconversion, was low. There is an urgent need to develop and evaluate simple and affordable POC tests with high sensitivity and specificity for diagnosing individuals with acute HIV infection in resource-limited settings with high HIV prevalence.
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| 65. |
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| 66. |
- Montelius, Mikael, 1979, et al.
(författare)
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Identification of Potential MR-Derived Biomarkers for Tumor Tissue Response to 177Lu-Octreotate Therapy in an Animal Model of Small Intestine Neuroendocrine Tumor.
- 2018
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Ingår i: Translational oncology. - : Elsevier BV. - 1936-5233. ; 11:2, s. 193-204
-
Tidskriftsartikel (refereegranskat)abstract
- Magnetic resonance (MR) methods enable noninvasive, regional tumor therapy response assessment, but associations between MR parameters, underlying biology, and therapeutic effects must be investigated. The aim of this study was to investigate response assessment efficacy and biological associations of MR parameters in a neuroendocrine tumor (NET) model subjected to radionuclide treatment. Twenty-one mice with NETs received 177Lu-octreotate at day 0. MR experiments (day -1, 1, 3, 8, and 13) included T2-weighted, dynamic contrast-enhanced (DCE) and diffusion-weighted imaging (DWI) and relaxation measurements (T1/T2*). Tumor tissue was analyzed using proteomics. MR-derived parameters were evaluated for each examination day and for different radial distances from the tumor center. Response assessment efficacy and biological associations were evaluated using feature selection and protein expression correlations, respectively. Reduced tumor growth rate or shrinkage was observed until day 8, followed by reestablished growth in most tumors. The most important MR parameter for response prediction was DCE-MRI-derived pretreatment signal enhancement ratio (SER) at 40% to 60% radial distance, where it correlated significantly also with centrally sampled protein CCD89 (association: DNA damage and repair, proliferation, cell cycle arrest). The second most important was changed diffusion (D) between day -1 and day 3, at 60% to 80% radial distance, where it correlated significantly also with peripherally sampled protein CATA (association: oxidative stress, proliferation, cell cycle arrest, apoptotic cell death). Important information regarding tumor biology in response to radionuclide therapy is reflected in several MR parameters, SER and D in particular. The spatial and temporal information provided by MR methods increases the sensitivity for tumor therapy response.
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| 67. |
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| 68. |
- Montelius, Mikael, 1979, et al.
(författare)
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Multiparametric MR for non-invasive evaluation of tumour tissue histological characteristics after radionuclide therapy.
- 2019
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Ingår i: NMR in biomedicine. - : Wiley. - 1099-1492 .- 0952-3480. ; 31:3
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Tidskriftsartikel (refereegranskat)abstract
- Early non-invasive tumour therapy response assessment requires methods sensitive to biological and physiological tumour characteristics. The aim of this study was to find and evaluate magnetic resonance imaging (MRI) derived tumour tissue parameters that correlate with histological parameters and that reflect effects of radionuclide therapy. Mice bearing a subcutaneous human small-intestine neuroendocrine tumour were i.v. injected with 177 Lu-octreotate. MRI was performed (7 T Bruker Biospec) on different post-therapy intervals (1 and 13 days) using T2-weighted imaging, mapping of T2* and T1 relaxation time constants, as well as diffusion and dynamic contrast enhancement (DCE-MRI) techniques. After MRI, animals were killed and tumours excised. Four differently stained histological sections of the most central imaged tumour plane were digitized, and segmentation techniques were used to produce maps reflecting fibrotic and vascular density, apoptosis, and proliferation. Histological maps were aligned with MRI-derived parametric maps using landmark-based registration. Correlations and predictive power were evaluated using linear mixed-effects models and cross-validation, respectively. Several MR parameters showed statistically significant correlations with histological parameters. In particular, three DCE-MRI-derived parameters reflecting capillary function additionally showed high predictive power regarding apoptosis (2/3) and proliferation (1/3). T1 could be used to predict vascular density, and perfusion fraction derived from diffusion MRI could predict fibrotic density, although with lower predictive power. This work demonstrates the potential to use multiparametric MRI to retrieve important information on the tumour microenvironment after radiotherapy. The non-invasiveness of the method also allows longitudinal tumour tissue characterization. Further investigation is warranted to evaluate the parameters highlighted in this study longitudinally, in larger studies, and with additional histological methods.
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| 69. |
- Montelius, Mikael, 1979, et al.
(författare)
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Multiparametric MRI with spatiotemporal evaluation reveals potential therapy response biomarkers for 177Lu-octreotate therapy of mice with human neuroendocrine tumor
- 2017
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Ingår i: ISMRM 25th Annual Meeting. 22-27 April 2017, Honolulu, Hawaii, USA.
-
Konferensbidrag (refereegranskat)abstract
- Tissue parameters derived from multiparametric MRI were evaluated as potential imaging biomarkers for therapy response assessment in mice with human neuroendocrine tumor treated with 177Lu-octreotate. Animals were imaged before and repeatedly after 177Lu-octreotate treatment, using T2w, IVIM-DWI, DCE-MRI, T1- and T2*-mapping techniques. MR-parameters were evaluated regionally and longitudinally, and quantitative proteomics was used to evaluate underlying biological response in central and peripheral tumor separately. Several MR-parameters showed strong correlation with tumor response, as verified by MRI-based tumor volume measurements, but also with proteins associated with radiobiological effects on tumor tissue. Spatial and temporal evaluation increased sensitivity of the methods.
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| 70. |
- Nilsson, Christer, et al.
(författare)
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A Comparison of Species Richness and Traits of Riparian Plants between a Main River Channel and Its Tributaries
- 1994
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Ingår i: Journal of Ecology. - : JSTOR. - 0022-0477 .- 1365-2745. ; 82:2, s. 281-295
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Tidskriftsartikel (refereegranskat)abstract
- Summary1 We examined differences in species richness and frequencies of vascular plants in the riverbank vegetation between the main channel of the Vindel River system and seven of its tributaries which spanned the same biogeographic range.2 Species richness per site was higher in the main channel than in the tributaries, both as a whole and for many species groups. The proportions of woody plants (phanerophytes and chamaephytes), geophytes, and natural species were higher in the tributaries, while the proportions of hemicryptophytes, ruderals, and short-floating species (i.e. species unable to float > 1 day) were higher in the main channel. Both types of river had species that were more than twice as frequent there than in the other category.3 The main channel had a high species richness at intermediate altitudes whereas the tributaries had least species at intermediate altitudes. Except for the highest altitudes, the tributaries also had a generally lower mean species richness than the main channel.4 Stepwise multiple regression analyses using 15 predictor variables explained stat- istically up to 85% of the floristic variation in the river system. Mean annual discharge and number of substrates explained most of the variation in five equations each, while peat cover explained most of the variation in four equations, and altitude and silt cover in one equation each. Mean annual discharge, peat cover and silt cover differed between the main channel and the tributaries and could therefore be responsible for the observed difference.
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