| 1. |
- Hadimeri, Henrik, et al.
(författare)
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A fixed protocol for outpatient clinic routines in the care of patients with severe renal failure
- 2013
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Ingår i: Renal failure. - : Informa Healthcare. - 0886-022X .- 1525-6049. ; 35:6, s. 845-854
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Tidskriftsartikel (refereegranskat)abstract
- Background: The primary aim of this study was to assess whether a fixed protocol, using a specially trained team, for intermediate follow-up to fulfillment of guideline targets is non-inferior to conventional follow-up in the care of uraemic patients. A secondary aim was to investigate possible impact on patient outcome.Methods: The cohort comprised 424 patients from seven centers. Inclusion criteria were either serum creatinine exceeding 200 mu mol/l or calculated clearance below 30 ml/min, representing CKD 4 or 5a. Six centers followed a standardized protocol (group 1). One center provided controls (group 2). The study design was prospective and interventional. The variables measured were blood hemoglobin, bicarbonate, calcium, phosphate, intact parathyroid hormone, albumin, renal function variables, blood pressure and RAAS blockade. The number of patients achieving the set goals was analyzed as a time trend to determine if the intervention resulted in an improvement.Results: At baseline, group 1 had significantly lower GFR and higher serum creatinine, calcium, phosphate, calcium x phosphate product and bicarbonate, lower mean arterial pressure (MAP), systolic blood pressures and less use of RAAS. During the intervention, group 1 improved in the direction of guidelines for blood hemoglobin, albumin, bicarbonate and MAP. Outcome of secondary endpoints gave a risk of death of 30% in both groups, while the risk of renal replacement therapy was higher in group 1.Conclusions: However, the time to renal replacement therapy was significantly shorter in the intervention group, indicating that other variables than guideline achievements are important for the patient.
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| 2. |
- Hedberg, Maria E., et al.
(författare)
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Prevotella jejuni sp. nov., isolated from the small intestine of a child with celiac disease.
- 2013
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Ingår i: International journal of systematic and evolutionary microbiology. - : Microbiology Society. - 1466-5034 .- 1466-5026. ; 63:11, s. 4218-4223
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Tidskriftsartikel (refereegranskat)abstract
- Five obligately anaerobic, Gram-negative, saccharolytic and proteolytic, non-spore-forming bacilli (CD3:27, CD3:28T, CD3:33, CD3:32 and CD3:34) are described. All five strains were isolated from the small intestine of a female child with celiac disease. The cells of the five strains were observed to be short rods or coccoid cells with longer filamentous forms seen sporadically. The organisms produced acetic acid and succinic acid as major metabolic end products. Phylogenetic analysis, based on comparative 16S rRNA gene sequence analysis revealed close relationships between CD3:27, CD3:28T and CD3:33 on one hand, between CD3:32 and P. histicola CCUG 55407T and between CD3:34 and P. melaninogenica CCUG 4944BT on the other. The strains CD3:27, CD3:28T and CD3:33 were clearly different from any other species within the genus Prevotella and most closely related to but distinct from P. melaninogenica. Based on 16S rRNA gene, RNA polymerase β-subunit gene and 60-kDa chaperonin protein subunit gene sequencing, phenotypic, chemical and biochemical properties strains CD3:27, CD3:28T and CD3:33 have been determined to represent a novel species within the genus Prevotella, named Prevotella jejuni sp. nov. Strain CD3:28T (CCUG 60371T = DSM 26989T) is the type strain of the proposed new species. All five strains were able to form homologous aggregates, in which tube-like structures were connecting individual bacteria cells. The five strains were able to bind to human intestinal carcinoma cell lines at 37 °C.
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| 3. |
- Souihi, Nabil, et al.
(författare)
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A Quality by Design approach to investigate the effect of mannitol and dicalcium phosphate qualities on roll compaction
- 2013
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Ingår i: International Journal of Pharmaceutics. - : Elsevier. - 0378-5173 .- 1873-3476. ; 447:1-2, s. 47-61
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Tidskriftsartikel (refereegranskat)abstract
- Roll compaction is a continuous process for solid dosage form manufacturing increasingly popular within pharmaceutical industry. Although roll compaction has become an established technique for dry granulation, the influence of material properties is still not fully understood. In this study, a quality by design (QbD) approach was utilized, not only to understand the influence of different qualities of mannitol and dicalcium phosphate (DCP), but also to predict critical quality attributes of the drug product based solely on the material properties of that filler. By describing each filler quality in terms of several representative physical properties, orthogonal projections to latent structures (OPLS) was used to understand and predict how those properties affected drug product intermediates as well as critical quality attributes of the final drug product. These models were then validated by predicting product attributes for filler qualities not used in the model construction. The results of this study confirmed that the tensile strength reduction, known to affect plastic materials when roll compacted, is not prominent when using brittle materials. Some qualities of these fillers actually demonstrated improved compactability following roll compaction. While direct compression qualities are frequently used for roll compacted drug products because of their excellent flowability and good compaction properties, this study revealed that granules from these qualities were more poor flowing than the corresponding powder blends, which was not seen for granules from traditional qualities. The QbD approach used in this study could be extended beyond fillers. Thus any new compound/ingredient would first be characterized and then suitable formulation characteristics could be determined in silico, without running any additional experiments.
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| 4. |
- Svensson, Anna Maria
(författare)
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Rektors ledarskap : styrningssammanhang och stil
- 2010
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The role of the principal in Sweden has undergone significant changes over the past two decades. Task and responsibility has been decentralized from the national level to o the local school board affecting principals´ everyday life. At the same time a new inspection system for all schools has been introduced. These changes puts focus on how principals implement and report political decisions within established guidelines. For many principals it is a balancing act to achieve the national goals within a local context. All the above include for the principal important work with evaluations of quality in different processes in the school, especially those related to teacher performance and children’s grades and results. In the mid 1990’s a debate about the lack of evaluations and school improvement in Swedish schools started, and as a result the Government decided in 1997 that every school should write a quality assessments and that the school board should write a summery for the whole school district. Many schools had problems in the beginning with the working processes around quality assessments, and many schools view this national law only as a top-down control decision from the Government and were not able to see the school improvement part of the law. The aim of this study is to describe how principals take responsibility for the quality assessment regulation and to analyze how they act and lead their schools in relation to quality assessments. In this study, results are presented from survey data, done with 131 principals who attended the National Principal Training Program at Umeå University. A theoretical model which discusses four leadership styles is used as a theoretical background. This model has an organizational frame. After making an argument for the importance of each of these styles for understanding principals work with quality assessments, two strands are examined. First, leadership styles are described from a principal perspective and factor analysis is used to investigate if these styles can illustrate principals´ work with quality assessments. Second, important factors explaining different ways in which principals tackle the work with quality assessments is highlighted. These factors are affected by different laws and regulations and even some time local political decisions and policies which here is understood as structure and culture, and personal background, for example the principals´ age, sex, education and experience. Based on the empirical results, my theoretical conclusion is that the four leadership styles used are relevant for understanding how principals work with quality assessments. The study also shows that structure and culture are important factors when it comes to explaining how principals´ work with quality assessments. Personal background, however, are not shown as important in this study.
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