| 1. |
- Almqvist, Daniel, et al.
(author)
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Strategies for a safe interhospital transfer with an intubated patient or where readiness for intubation is needed: A critical incidents study
- 2023
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In: Intensive & Critical Care Nursing. - : Elsevier. - 0964-3397 .- 1532-4036. ; 74
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Journal article (peer-reviewed)abstract
- Introduction: The number of interhospital transports with intubated patients or where intubation readiness is required is increasing in Sweden and globally. Specialist nurses are often responsible for these transports, which involve numerous risks for critically ill patients.Aim: The aim of this study was to describe nurse anaesthetists’ and intensive care nurses’ strategies for safe interhospital transports with intubated patients or where intubation readiness is required.Method: A qualitative study was conducted using the critical incident technique. During March and April 2020, 12 semi-structured interviews were conducted with nurse anaesthetists and intensive care nurses. Data were analysed according to the critical incident technique, and a total of 197 critical incidents were identified. The analysis revealed five final strategies for safe interhospital transport.Results: Participants described the importance of ensuring clear and adequate information transfers between caregivers to obtain vital patient information that enables the nurse in charge to identify risks and problems in advance and create an action plan. Stabilising and optimising the patient's condition before departure and preparing drugs and equipment were other strategies described by the participants, as well as requesting assistance or support if questions or complications arose during transport.Conclusion: Transports with intubated patients or where intubation readiness is required are complex and require systematic patient-safety work to ensure that strategies for increasing patient safety and decreasing risks are visible to the nurses in charge, that they are applied, and that they are, indeed, effective.
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| 2. |
- Andrée, Martin, et al.
(author)
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Slutrapport för projektet Smart planering för byggande : Delprojekt 3 - BIM som informationsstöd för 3D fastighetsbildning
- 2018
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Reports (other academic/artistic)abstract
- Samhällsbyggnadsprocessen behöver utvecklas och bli smartare, öppnare och mer effektiv för ett ökat bostadsbyggande. En digitalisering av samhällsbyggnadsprocessen kan ge ett effektivare samarbete mellan kommun, fastighetsägare, byggherrar, medborgare, näringsliv och myndigheter.Vid bildande av tredimensionellt avgränsade fastigheter eller fastighetsutrymmen (3D-fastigheter) behöver gränsernas läge redovisas både verbalt och i kartor och ritningar, detsamma gäller berörda rättigheter. Det är idag ofta svårt att korrekt redovisa en 3D-volym med enbart dagens pappersritningar och även svårt att läsa en registerkarta i 2D med fastigheter och rättigheter beslutade i 3D. Beslutsunderlagen i fastighetsbildnings-processen behöver bli mer enhetliga och entydiga samt fastighetsinformationen behöver bli återanvändningsbar i hela samhällsbyggnadsprocessen.I detta projekt har vi studerat informationsbehovet i de olika tidpunkterna under fastighetsbildningsprocessen för 3D-fastigheter med fokus på vem som är ansvarig för att tillhandahålla informationsunderlag för att identifiera krav på utformning av 3D-modeller (t.ex BIM) och 3D-stöd för fastighetsbildning.Internationellt finns det ett stort intresse och många frågeställningar gällande samspelet mellan BIM och Fastighetsinformation; det är däremot ganska få fall som har identifierats där man har arbetat praktiskt med BIM i relation till redovisning av 3D-fastigheter.Projektethar även tittat på behov av visualisering och tillhandahållande av fastighetsinformation i 3D, hur informationen bör utformas för att kunna tolkas korrekt samt nyttjas vidare av andra aktörer i samhällsbyggnadsprocessen.Slutsatsen i projektetär att en framtida arbetsmodell där man i samband med myndighetsutövningen för fastighetsbildning samverkar med stöd av BIM och geografisk information i ärendehandläggningen kan ge stora effekter på både myndighetens effektivitet och i ärendeutövningen och för förståelsen av fastighetbildningsbeslutet hos samtliga intressenter i processen. För att det arbete som genomförts i denna utredning skall få genomslag i den dagliga verksamheten rekommenderar vibland annatatt de statliga och kommunala lantmäterimyndigheterna arbetar vidare med att utveckla arbetsprocessen och rekommendationerna för 3D-fastighetsbildning baserat på resultatet från detta projekt och redan i dagens modell efterfrågar att man i handläggningsprocessen kan arbeta BIM-baserat även om kommande beslutshandlingar under en övergångsperiod fortfarande kommer att vara baserade på ritningsbilagor i 2D.
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| 3. |
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| 4. |
- Berg, Karl, 1988, et al.
(author)
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Different Perspectives - An immersive experience using 360° video and Google Cardboard
- 2016
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In: Proceedings of SIDeR’16 – student interaction design research conference.
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Conference paper (peer-reviewed)abstract
- Becoming aware of your own or other people’s behaviour in social situations is hard, you can only see the world through your eyes, your experiences. In order to better share and understand each other we have designed a cheap but effective technology through the use of 360 degree film, binaural audio, and Google Cardboard goggles. Our focus is the school environment, while we initially dealt with bullying, we eventually shifted the issue to ambiguous social situations, to avoid the stigma of concepts such as victim and bully. Through participatory design we managed to implement a mobile application that allows a user equipped with headphones and Google Cardboard to experience the 360° film recorded. This will then be followed by a discussion with her or his peers - preferably with supervision of a professional such as a teacher, hopefully raising awareness of their attitudes and preconceived notions.
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| 5. |
- Berglund, Fanny, et al.
(author)
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An updated phylogeny of the metallo-β-lactamases.
- 2021
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In: The Journal of antimicrobial chemotherapy. - : Oxford University Press (OUP). - 1460-2091 .- 0305-7453. ; 76:1, s. 117-123
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Journal article (peer-reviewed)abstract
- Metallo-β-lactamases (MBLs) are enzymes that use zinc-dependent hydrolysis to confer resistance to almost all available β-lactam antibiotics. They are hypothesized to originate from commensal and environmental bacteria, from where some have mobilized and transferred horizontally to pathogens. The current phylogeny of MBLs, however, is biased as it is founded largely on genes encountered in pathogenic bacteria. This incompleteness is emphasized by recent findings of environmental MBLs with new forms of zinc binding sites and atypical functional profiles.To expand the phylogeny of MBLs to provide a more accurate view of their evolutionary history.We searched more than 16 terabases of genomic and metagenomic data for MBLs of the three subclasses B1, B2 and B3 using the validated fARGene method. Predicted genes, together with the previously known ones, were used to infer phylogenetic trees.We identified 2290 unique MBL genes forming 817 gene families, of which 741 were previously uncharacterized. MBLs from subclasses B1 and B3 separated into distinct monophyletic groups, in agreement with their taxonomic and functional properties. We present evidence that clinically associated MBLs were mobilized from Proteobacteria. Additionally, we identified three new variants of the zinc binding sites, indicating that the functional repertoire is broader than previously reported.Based on our results, we recommend that the nomenclature of MBLs is refined into the phylogenetic groups B1.1-B1.5 and B3.1-B3.4 that more accurately describe their molecular and functional characteristics. Our results will also facilitate the annotation of novel MBLs, reflecting their taxonomic organization and evolutionary origin.
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| 6. |
- Berglund, Fanny, et al.
(author)
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Comprehensive screening of genomic and metagenomic data reveals a large diversity of tetracycline resistance genes
- 2020
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In: Microbial genomics. - : Microbiology Society. - 2057-5858. ; 6:11
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Journal article (peer-reviewed)abstract
- Tetracyclines are broad-spectrum antibiotics used to prevent or treat a variety of bacterial infections. Resistance is often mediated through mobile resistance genes, which encode one of the three main mechanisms: active efflux, ribosomal target protection or enzymatic degradation. In the last few decades, a large number of new tetracycline-resistance genes have been discovered in clinical settings. These genes are hypothesized to originate from environmental and commensal bacteria, but the diversity of tetracycline-resistance determinants that have not yet been mobilized into pathogens is unknown. In this study, we aimed to characterize the potential tetracycline resistome by screening genomic and metagenomic data for novel resistance genes. By using probabilistic models, we predicted 1254 unique putative tetracycline resistance genes, representing 195 gene families (<70% amino acid sequence identity), whereof 164 families had not been described previously. Out of 17 predicted genes selected for experimental verification, 7 induced a resistance phenotype in an Escherichia coli host. Several of the predicted genes were located on mobile genetic elements or in regions that indicated mobility, suggesting that they easily can be shared between bacteria. Furthermore, phylogenetic analysis indicated several events of horizontal gene transfer between bacterial phyla. Our results also suggested that acquired efflux pumps originate from proteobacterial species, while ribosomal protection genes have been mobilized from Firmicutes and Actinobacteria. This study significantly expands the knowledge of known and putatively novel tetracycline resistance genes, their mobility and evolutionary history. The study also provides insights into the unknown resistome and genes that may be encountered in clinical settings in the future.
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| 7. |
- Berglund, Fanny, et al.
(author)
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Evidence for wastewaters as environments where mobile antibiotic resistance genes emerge
- 2023
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In: Communications Biology. - : Springer Science and Business Media LLC. - 2399-3642. ; 6
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Journal article (peer-reviewed)abstract
- The emergence and spread of mobile antibiotic resistance genes (ARGs) in pathogens have become a serious threat to global health. Still little is known about where ARGs gain mobility in the first place. Here, we aimed to collect evidence indicating where suchinitial mobilizationevents of clinically relevant ARGs may have occurred. We found that the majority of previously identified origin species did not carry the mobilizing elements that likely enabled intracellular mobility of the ARGs, suggesting a necessary interplay between different bacteria. Analyses of a broad range of metagenomes revealed that wastewaters and wastewater-impacted environments had by far the highest abundance of both origin species and corresponding mobilizing elements. Most origin species were only occasionally detected in other environments. Co-occurrence of origin species and corresponding mobilizing elements were rare in human microbiota. Our results identify wastewaters and wastewater-impacted environments as plausible arenas for the initial mobilization of resistance genes.
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| 8. |
- Berglund, Fanny, 1988, et al.
(author)
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Identification and reconstruction of novel antibiotic resistance genes from metagenomes
- 2019
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In: Microbiome. - : Springer Science and Business Media LLC. - 2049-2618. ; 7:1
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Journal article (peer-reviewed)abstract
- BackgroundEnvironmental and commensal bacteria maintain a diverse and largely unknown collection of antibiotic resistance genes (ARGs) that, over time, may be mobilized and transferred to pathogens. Metagenomics enables cultivation-independent characterization of bacterial communities but the resulting data is noisy and highly fragmented, severely hampering the identification of previously undescribed ARGs. We have therefore developed fARGene, a method for identification and reconstruction of ARGs directly from shotgun metagenomic data.ResultsfARGene uses optimized gene models and can therefore with high accuracy identify previously uncharacterized resistance genes, even if their sequence similarity to known ARGs is low. By performing the analysis directly on the metagenomic fragments, fARGene also circumvents the need for a high-quality assembly. To demonstrate the applicability of fARGene, we reconstructed -lactamases from five billion metagenomic reads, resulting in 221 ARGs, of which 58 were previously not reported. Based on 38 ARGs reconstructed by fARGene, experimental verification showed that 81% provided a resistance phenotype in Escherichia coli. Compared to other methods for detecting ARGs in metagenomic data, fARGene has superior sensitivity and the ability to reconstruct previously unknown genes directly from the sequence reads.ConclusionsWe conclude that fARGene provides an efficient and reliable way to explore the unknown resistome in bacterial communities. The method is applicable to any type of ARGs and is freely available via GitHub under the MIT license.
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| 9. |
- Berglund, Fanny, 1988, et al.
(author)
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Identification of 76 novel B1 metallo-beta-lactamases through large-scale screening of genomic and metagenomic data
- 2017
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In: Microbiome. - : Springer Science and Business Media LLC. - 2049-2618. ; 5:1, s. 134-134
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Journal article (peer-reviewed)abstract
- Background: Metallo-beta-lactamases are bacterial enzymes that provide resistance to carbapenems, the most potent class of antibiotics. These enzymes are commonly encoded on mobile genetic elements, which, together with their broad substrate spectrum and lack of clinically useful inhibitors, make them a particularly problematic class of antibiotic resistance determinants. We hypothesized that there is a large and unexplored reservoir of unknown metallo-beta-lactamases, some of which may spread to pathogens, thereby threatening public health. The aim of this study was to identify novel metallo-beta-lactamases of class B1, the most clinically important subclass of these enzymes. Results: Based on a new computational method using an optimized hidden Markov model, we analyzed over 10,000 bacterial genomes and plasmids together with more than 5 terabases of metagenomic data to identify novel metallo-beta-lactamase genes. In total, 76 novel genes were predicted, forming 59 previously undescribed metallo-beta-lactamase gene families. The ability to hydrolyze imipenem in an Escherichia coli host was experimentally confirmed for 18 of the 21 tested genes. Two of the novel B1 metallo-beta-lactamase genes contained atypical zinc-binding motifs in their active sites, which were previously undescribed for metallo-beta-lactamases. Phylogenetic analysis showed that B1 metallo-beta-lactamases could be divided into five major groups based on their evolutionary origin. Our results also show that, except for one, all of the previously characterized mobile B1 beta-lactamases are likely to have originated from chromosomal genes present in Shewanella spp. and other Proteobacterial species. Conclusions: This study more than doubles the number of known B1 metallo-beta-lactamases. The findings have further elucidated the diversity and evolutionary history of this important class of antibiotic resistance genes and prepare us for some of the challenges that may be faced in clinics in the future.
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| 10. |
- Berglund, Fanny, et al.
(author)
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The resistome and microbiome of wastewater treatment plant workers - The AWARE study.
- 2023
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In: Environment international. - 0160-4120 .- 1873-6750. ; 180
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Journal article (peer-reviewed)abstract
- Urban wastewater treatment plants harbor a large collection of antibiotic resistant enteric bacteria. It is therefore reasonable to hypothesize that workers at such plants would possess a more diverse set of resistant enteric bacteria, compared to the general population. To address this hypothesis, we have compared the fecal microbiome and resistome of 87 workers at wastewater treatment plants (WWTPs) from Romania and the Netherlands to those of 87 control individuals, using shotgun metagenomics. Controlling for potential confounders, neither the total antibiotic resistance gene (ARG) abundance, nor the overall bacterial composition were significantly different between the two groups. If anything, the ARG richness was slightly lower in WWTP workers, and in a stratified analysis the total ARG abundance was significantly lower in Dutch workers compared to Dutch control participants. We identified country of residence, together with recent antibiotic intake in the Dutch population, as the largest contributing factors to the total abundance of ARGs. A striking side-finding was that sex was associated with carriage of disinfectant resistance genes, with women in both Romania and the Netherlands having significantly higher abundance compared to men. A follow up investigation including an additional 313 publicly available samples from healthy individuals from three additional countries showed that the difference was significant for three genes conferring resistance to chemicals commonly used in cosmetics and cleaning products. We therefore hypothesize that the use of cosmetics and, possibly, cleaning products leads to higher abundance of disinfectant resistance genes in the microbiome of the users. Altogether, this study shows that working at a WWTP does not lead to a higher abundance or diversity of ARGs and no large shifts in the overall gut microbial composition in comparison to participants not working at a WWTP. Instead, other factors such as country of residence, recent antibiotic intake and sex seem to play a larger role.
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