| 1. |
- Törnegren, Gull, 1955-
(författare)
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Utmaningen från andra berättelser : En studie om moraliskt omdöme, utvidgat tänkande och kritiskt reflekterande berättelser i dialogbaserad feministisk etik
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The present study has a threefold aim: First, the theoretical aim is to give a contribution to refinement of the theory of dialogue based feminist ethics, concerning the understanding of judgment and narration within such an ethics. The study also has an empirical aim, defined as to clarify what kind of knowledge, relevant to the moral judgment of an engaged outsider actor, can be received from dialogical interpretation and analysis of a limited selection of critically reflecting life stories. Third, a methodological aim is defined as to develop an approach to interpretation and analysis of reflecting life stories, which renders the storyteller visible as a reflecting moral subject, and makes the story accessible as a source of knowledge for the moral judgment of an engaged outsider actor.The thesis combines philosophical reflection and argumentation, with a narrative-hermeneutic method for interpretation of life stories, relating the two to each other in a hermeneutic process. The theoretical reflection draws on Seyla Benhabibs theory of communicative ethics. A dialogue based model for moral justification and a likewise dialogue based model for political legitimacy are at the heart of this universalistic theory, although in combination with a conception of a narratively and hermeneutically constituted context sensitive moral judgment, based on Hannah Arendt’s concept “enlarged thought”.In the reflection, this model is related to other feminist theorizing within the tradition of dialogue based feminist ethics, as found in the works of Iris M. Young, Georgia Warnke and Shari Stone-Mediatore. The empirical study draws on three critically reflecting life stories from Israeli-Palestinian women activists for a just peace. The methodology for interpretation and analysis that is worked out combines dialogical interpretation as presented in Arthur W. Frank’s socio-narratology with a method for structural analysis derived from Shari Stone-Mediatores theory of storytelling as an expression of political resistance struggle.The results show that some stories drawing on marginalized experiences have a potential to stimulate further public debate through their capacity to enable a stereoscopic seeing, elucidating a tension between ideologically structured discourse and non-linguistic experience; implying that narrative-hermeneutic competence should be considered crucial for public debate.
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| 2. |
- Brück, Emily, et al.
(författare)
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Lack of clinically relevant correlation between subjective and objective cognitive function in ICU survivors : a prospective 12-month follow-up study
- 2019
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Ingår i: Critical Care. - : Springer Science and Business Media LLC. - 1364-8535 .- 1466-609X. ; 23
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundCognitive impairment and psychological distress are common in intensive care unit (ICU) survivors. Early identification of affected individuals is important, so intervention and treatment can be utilized at an early stage. Cognitive Failures Questionnaire (CFQ) is commonly used to screen for subjective cognitive function, but it is unclear whether CFQ scores correlate to objective cognitive function in this population.MethodsBetween 2014 and 2018, 100 ICU survivors aged 18–70 years from the general ICU at the Karolinska University Hospital, Solna, were included in the study. Out of these, 58 patients completed follow-up at 3 months after ICU discharge, 51 at 6 months, and 45 at 12 months. Follow-up included objective cognitive function testing using the Cambridge Neuropsychological Test Automated Battery (CANTAB) and subjective cognitive function testing with the self-rating Cognitive Failures Questionnaire (CFQ), as well as psychological self-rating with the Post-Traumatic Stress Symptoms Scale-10 (PTSS-10) and Hospital Anxiety and Depression Scale (HADS).ResultsThe prevalence of cognitive impairment as measured by four selected CANTAB tests was 34% at 3 months after discharge, 18% at 6 months, and 16% at 12 months. There was a lack of significant correlation between CANTAB scores and CFQ scores at 3 months (r = − 0.134–0.207, p > 0.05), at 6 months (r = − 0.106–0.257, p > 0.05), and at 12 months after discharge (r = − 0.070–0.109, p > 0.05). Correlations between CFQ and PTSS-10 scores and HADS scores, respectively, were significant over the follow-up period (r = 0.372–0.710, p ≤ 0.001–0.023). In contrast, CANTAB test scores showed a weak correlation with PTSS-10 and HADS scores, respectively, at 3 months only (r = − 0.319–0.348, p = 0.008–0.015).ConclusionWe found no clinically relevant correlation between subjective and objective cognitive function in this cohort of ICU survivors, while subjective cognitive function correlated significantly with psychological symptoms throughout the follow-up period. Treatment and evaluation of ICU survivors’ recovery need to consider both subjective and objective aspects of cognitive impairment, and subjective reports must be interpreted with caution as an indicator of objective cognitive function.
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| 3. |
- Cedborg, Anna I. Hardemark, et al.
(författare)
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Co-ordination of spontaneous swallowing with respiratory airflow and diaphragmatic and abdominal muscle activity in healthy adult humans
- 2009
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Ingår i: Experimental Physiology. - : Wiley. - 1469-445X .- 0958-0670. ; 94:4, s. 459-468
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Tidskriftsartikel (refereegranskat)abstract
- Co-ordination of breathing and swallowing is essential for normal pharyngeal function and to protect the airway. To allow for safe passage of a bolus through the pharynx, respiration is interrupted (swallowing apnoea); however, the control of airflow and diaphragmatic activity during swallowing and swallowing apnoea are not fully understood. Here, we validated a new airflow discriminator for detection of respiratory airflow and used it together with diaphragmatic and abdominal electromyography (EMG), spirometry and pharyngeal and oesophageal manometry. Co-ordination of breathing and spontaneous swallowing was examined in six healthy volunteers at rest, during hypercapnia and when breathing at 30 breaths min(-1). The airflow discriminator proved highly reliable and enabled us to determine timing of respiratory airflow unambiguously in relation to pharyngeal and diaphragmatic activity. During swallowing apnoea, the passive expiration of the diaphragm was interrupted by static activity, i.e. an 'active breath holding', which preserved respiratory volume for expiration after swallowing. Abdominal EMG increased throughout pre- and post-swallowing expiration, more so during hyper- than normocapnia, possibly to assist expiratory airflow. In these six volunteers, swallowing was always preceded by expiration, and 93 and 85% of swallows were also followed by expiration in normo- and hypercapnia, respectively, indicating that, in man, swallowing during the expiratory phase of breathing may be even more predominant than previously believed. This co-ordinated pattern of breathing and swallowing potentially reduces the risk for aspiration. Insights from these measurements in healthy volunteers and the airflow discriminator will be used for future studies on airway protection and effects of disease, drugs and ageing.
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| 5. |
- Cedborg, Anna I Hårdemark, et al.
(författare)
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Pharyngeal Function and Breathing Pattern during Partial Neuromuscular Block in the Elderly: Effects on Airway Protection.
- 2014
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Ingår i: Anesthesiology. - 1528-1175. ; 120:2, s. 312-325
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Tidskriftsartikel (refereegranskat)abstract
- Intact pharyngeal function and coordination of breathing and swallowing are essential for airway protection and to avoid respiratory complications. Postoperative pulmonary complications caused by residual effects of neuromuscular-blocking agents occur more frequently in the elderly. Moreover, elderly have altered pharyngeal function which is associated with increased risk of aspiration. The purpose of this study was to evaluate effects of partial neuromuscular block on pharyngeal function, coordination of breathing and swallowing, and airway protection in individuals older than 65 yr.
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| 6. |
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| 7. |
- Eriksson, Lars I, et al.
(författare)
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Functional assessment of the pharynx at rest and during swallowing in partially paralyzed humans: simultaneous videomanometry and mechanomyography of awake human volunteers
- 1997
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Ingår i: Anesthesiology. - : Ovid Technologies (Wolters Kluwer Health). - 1528-1175 .- 0003-3022. ; 87:5, s. 1035-1043
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Functional characteristics of the pharynx and upper esophagus, including aspiration episodes, were investigated in 14 awake volunteers during various levels of partial neuromuscular block. Pharyngeal function was evaluated using videoradiography and computerized pharyngeal manometry during contrast bolus swallowing. METHODS: Measurements of pharyngeal constrictor muscle function (contraction amplitude, duration, and slope), upper esophageal sphincter muscle resting tone, muscle coordination, bolus transit time, and aspiration under fluoroscopic control (laryngeal or tracheal penetration) were made before (control measurements) and during a vecuronium-induced partial neuromuscular paralysis, at fixed intervals of mechanical adductor pollicis muscle train-of-four (TOF) fade; that is, at TOF ratios of 0.60, 0.70, 0.80, and after recovery to a TOF ratio > 0.90. RESULTS: Six volunteers aspirated (laryngeal penetration) at a TOF ratio < 0.90. None of them aspirated at a TOF ratio > 0.90 or during control recording. Pharyngeal constrictor muscle function was not affected at any level of paralysis. The upper esophageal sphincter resting tone was significantly reduced at TOF ratios of 0.60, 0.70, and 0.80 (P < 0.05). This was associated with reduced muscle coordination and shortened bolus transit time at a TOF ratio of 0.60. CONCLUSIONS: Vecuronium-induced partial paralysis cause pharyngeal dysfunction and increased risk for aspiration at mechanical adductor pollicis TOF ratios < 0.90. Pharyngeal function is not normalized until an adductor pollicis TOF ratio of > 0.90 is reached. The upper esophageal sphincter muscle is more sensitive to vecuronium than is the pharyngeal constrictor muscle.
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| 8. |
- Krivospitskaya, Olesya, 1983-, et al.
(författare)
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A CYP26B1 polymorphism enhances retinoic acid catabolism and may aggravate atherosclerosis
- 2012
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Ingår i: Molecular Medicine. - New York, USA : The Feinstein Institute for Medical Research. - 1076-1551 .- 1528-3658. ; 18:1, s. 712-718
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Tidskriftsartikel (refereegranskat)abstract
- All-trans retinoic acid, controlled by CYP26 enzymes, potentially has beneficial effects in atherosclerosis treatment. This study investigates CYP26B1 in atherosclerosis and effects of a genetic polymorphism in CYP26B1 on retinoid catabolism. We found that CYP26B1 mRNA was induced by retinoic acid in human atherosclerotic arteries and CYP26B1 and the macrophage marker CD68 co-localized in human atherosclerotic lesions. In mice, Cyp26B1 mRNA was higher in atherosclerotic than normal arteries. Databases were queried for non-synonymous CYP26B1 SNPs and rs2241057 selected for further studies. Constructs of the CYP26B1 variants were created and used for production of purified proteins and transfection of macrophage-like cells. The minor variant catabolized retinoic acid with significantly higher efficiency, indicating that rs2241057 is functional and suggesting reduced retinoid availability in tissues with the minor variant. rs2241057 was investigated in a Stockholm Coronary Atherosclerosis Risk Factor (SCARF) subgroup. The minor allele was associated with slightly larger lesions as determined by angiography. In summary, this study identifies the first CYP26B1 polymorphism that alters CYP26B1 capacity to metabolize retinoic acid. CYP26B1 was expressed in macrophage-rich areas of human atherosclerotic lesions, induced by retinoic acid and increased in murine atherosclerosis. Taken together, the results indicate that CYP26B1 capacity is genetically regulated and suggest that local CYP26B1 activity may influence atherosclerosis.
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| 9. |
- Sundman, Eva
(författare)
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Pharyngeal function, airway protection and anesthetic agents
- 2002
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Anesthesia related complications occur most frequently in the immediate postoperative period. The three most common conditions associated with such events are ventilatory failure, airway obstruction and aspiration. The pharynx is essential for respiration and protection of the upper airway. We hypothesized that residual concentrations of anesthetic agents (neuromuscular blocking agents (NMBA), propofol and inhaled anesthetics) impair pharyngeal function and airway protection. Using simultaneous solid-state videomanometry we studied the effects of anesthetic agents on pharyngeal function and airway protection in awake human volunteers. Partial neuromuscular block was induced by a continuous infusion of vecuronium or atracurium to train-of-four (TOF) ratios of 0.60 - 0.80, followed by spontaneous recovery. A four- to five-fold increase in the incidence of pharyngeal dysfunction with impaired airway protection and bolus penetrating to the laryngeal inlet was revealed during partial neuromuscular block. The mechanisms behind the pharyngeal dysfunction were delayed initiation of swallowing, impaired pharyngeal muscle function and impaired coordination. The upper esophageal sphincter (UES) was sensitive to partial neuromuscular block with a reduced resting tone even after recovery to a TOF ratio of > 0.90 while the inferior pharyngeal constrictor muscle was more resistant. Pharyngeal function was also evaluated in volunteers randomized to receive propofol, isoflurane or sevoflurane in subhypnotic concentrations corresponding to 0.50 an 0.25 Cp50asleep (predicted blood propofol concentration for the transition between sleep and consciousness) or 0.50 and 0.25 MACawake (alveolar concentration for the transition between sleep and consciousness). The volunteers estimated their degree of sedation on a visual analogue scale (VAS). The three agents caused a six- to nine-fold increase in the incidence of pharyngeal dysfunction, the majority of dysfunctional swallows leading to penetration of bolus to the larynx. There was a correlation between pharyngeal dysfunction and VAS degree of sedation. The effect on the pharyngeal contraction pattern was most prominent in the propofol group. Hypothesizing that a difference in nicotinic acetylcholine receptor (nAChR) density would explain the different responses to NMBA in the pharynx, the nAChR density was determined bybungarotoxin binding in muscle samples from the human cricopharyngeal muscle, the main component of the UES, and the pharyngeal constrictor muscle. We were, however, unable to detect a difference in nAChR density between the cricopharyngeal and pharyngeal constrictor muscle. The muscle fiber size and fiber type composition in the human cricopharyngeal muscle were compared with that of the pharyngeal constrictor muscle. The muscle fiber cross sectional area was generally smaller in the cricopharyngeal than the pharyngeal constrictor muscle while the muscle fiber type composition did not differ between the two muscles. In conclusion, anesthetic agents cause pharyngeal dysfunction and impaired airway protection in concentrations present during recovery. Residual neuromuscular block with TOF ratios < 0.90 should be considered incomplete neuromuscular recovery. Morphological differences between pharyngeal muscles have been demonstrated but it is unlikely that these findings alone explain the different responses to neuromuscular blocking agents.
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| 10. |
- Sundman, Eva, et al.
(författare)
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Pharyngeal function and airway protection during subhypnotic concentrations of propofol, isoflurane, and sevoflurane: volunteers examined by pharyngeal videoradiography and simultaneous manometry
- 2001
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Ingår i: Anesthesiology. - : Ovid Technologies (Wolters Kluwer Health). - 1528-1175 .- 0003-3022. ; 95:5, s. 1125-1132
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Anesthetic agents alter pharyngeal function with risk of impaired airway protection and aspiration. This study was performed to evaluate pharyngeal function during subhypnotic concentrations of propofol, isoflurane, and sevoflurane and to compare the drugs for possible differences in this respect. METHODS: Forty-five healthy volunteers were randomized to receive propofol, isoflurane, or sevoflurane. During series of liquid contrast bolus swallowing, fluoroscopy and simultaneous solid state videomanometry was used to study the incidence of pharyngeal dysfunction, the initiation of swallowing, and the bolus transit time. Pressure changes were recorded at the back of the tongue, the pharyngeal constrictor muscles, and the upper esophageal sphincter. After control recordings, the anesthetic was delivered, and measurements were made at 0.50 and 0.25 predicted blood propotol concentration (Cp50(asleep)) for propofol and 0.50 and 0.25 minimum alveolar concentration (MAC)(awake) for the inhalational agents. Final recordings were made 20 min after the end of anesthetic delivery. RESULTS: All anesthetics caused an increased incidence of pharyngeal dysfunction with laryngeal bolus penetration. Propofol increased the incidence from 8 to 58%, isoflurane from 4 to 36%, and sevoflurane from 6 to 35%. Propofol in 0.50 and 0.25 Cp50(asleep) had the most extensive effect on the pharyngeal contraction patterns (P < 0.05). The upper esophageal sphincter resting tone was markedly reduced from 83 +/- 36 to 39 +/- 19 mmHg by propofol (P < 0.001), which differed from isoflurane (P = 0.03). Sevoflurane also reduced the upper esophageal sphincter resting tone from 65 +/- 16 to 45 +/- 18 mmHg at 0.50 MAC(awake)(P = 0.008). All agents caused a reduced upper esophageal sphincter peak contraction amplitude (P < 0.05), and the reduction was greatest in the propofol group (P = 0.002). CONCLUSION: Subhypnotic concentrations of propofol, isoflurane, and sevoflurane cause an increased incidence of pharyngeal dysfunction with penetration of bolus to the larynx. The effect on the pharyngeal contraction pattern was most pronounced in the propofol group, with markedly reduced contraction forces.
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