| 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. |
- 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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| 6. |
- 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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| 7. |
- Joelsson, Tove
(författare)
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High strength paper from high yield pulps by means of hot-pressing
- 2020
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- AbstractHigh Yield Pulp (HYP), i.e. TMP, SGW or CTMP, is normally used in printing papers (News, SC and LWC) or in a middle layer on cardboard i.e. in products that either have high demands on printability and runnability in fast printing presses or contribute to high bulk in cardboards in order to minimize pulp consumption at a certain sheet stiffness. Tensile strength as a function of density is significantly higher for HYP compared to chemical pulps such as sulphate and sulphite pulps. However, chemical pulp is mainly used in packaging materials that require very high tensile strength, while at the same time allowing the density of the paper to be high. By utilizing the softening properties of high-yielding lignin-rich fibres by hot-pressing technology, it is possible to significantly increase sheet density and thereby strength closer to the level of chemical pulps. Furthermore, due to the presence of high levels of lignin, it was shown that considerably higher wet strength can be achieved compared to chemical pulp without the addition of strengthening agents. The study focuses on the softening of stiff and lignin-rich fibres in papers based on HYP with sufficiently high moisture contents, when hot-pressing at temperature levels significantly above the softening temperature (Tg) of lignin Hot-pressing increases the density of the sheet which increases the contact surface between the fibres in the paper structure. The high pressing temperature can be said to induce a viscous flow of lignin, which also increases the potential for fibre-fibre bonding. It is conceivable that covalent bonds are obtained via condensation reactions and partly that interdiffusion between the lignin in the fibre walls can be obtained as they come close enough to each other during the hot-pressing. The research also shows that hot-pressing greatly improves properties in the form of dry and wet strength as well as hydrophobicity for HYP and for lignin-rich kraft paper. The first part of the study shows the effect of hot-pressing on strength properties of paper sheets based on CTMP, HT-CTMP, TMP, NSSC, SCPal and NBSK. The second part includes a study on how and to what extent different amounts of residual lignin in the pulp contribute to the dry and wet strength of the sheets of paper during hot-pressing as a function of increasing temperature. To demonstrate this, pilot scale cooking of unbleached pulp to various lignin levels was carried out. In all experiments in parts one and two, laboratory sheets with a surface weight of 150 g/m2 and a dry content of 50% were made with a Rapid Köthen (RK) sheet former, after which the sheets were hot-pressed in a cylinder press at temperatures up to 200°C, constant high pressure of about 7 MPa, nip pressure dwell time of 1.5 sec and production speed 1 m/min. The third part includes a study on the optimization of variables in a new design of a dynamic cylinder press for hot-pressing technology. This design is based on previous research at Mid Sweden University combined with key knowledge of steel band technology within IPCO AB. The new pilot machine is based on heating of a steel belt with infrared heat (IR) up to 300°C, a maximum line load of 15 kN/m in two press nips and a dwell time of 23-240 ms in the nip depending on the production speed which is up to 5 m/min. The experiments in part three were based on RK paper sheets with 100 g/m2 and approximately 63% dry content made by HT-CTMP. The results confirm that hot-pressed HYP-based paper sheets enable permanent densification by softening lignin, which provides a very high dry tensile strength and a remarkable improvement in wet tensile strength compared to bleached kraft pulp without the need for wet strength agents. A tensile index of 75 kNm/kg, compression strength index (SCT) of 45 kNm/kg and wet tensile strength index of 16 kNm/kg were obtained, which can be compared with the corresponding values for bleached kraft pulp based paper sheets of 85 kNm/kg, 35 kNm/kg and 5 kNm/kg respectively, all with the same density after hot-pressing at 200°C. The NSSC reached the highest tensile strength index of 92 kNm/kg. The study with the unbleached kraft pulps showed that the lignin content had a significant effect on both the dry and wet tensile strength indices. The pulps showed a linear relationship between wet strength and lignin content. The increase in lignin content from 0% to 12% improved the dry tensile index by 20% and SCT by 35% and gave a very significant increase in the wet strength index from 3 to 23 kNm/kg after hot-pressing. All lignin-rich paper samples exhibit good wet stability for at least 24 hours and an improved surface hydrophobicity by increasing the pressing temperature and lignin content.Optimization of the new steel belt based press machine showed that high nip pressure and two press nips had a great effect on density and strength. Whereas high temperature, well above Tg of lignin, and long pressing time were more important to achieve high wet strength. The highest wet strength index value, 27 kNm/kg, was reached when the pressing temperature was 290°C, the nip pressure about 8 MPa, the pressing time in the press nip 40 ms and the dwell time in contact with the steel belt 23.5 sec. It was also noted that no delamination occurred in these tests.In order to obtain both high dry and wet strength, it is important to have high lignin content, high temperature, high nip pressure and sufficiently long pressing time
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| 8. |
- Joelsson, Tove, et al.
(författare)
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High strength paper from high yield pulps by means of hot-pressing
- 2020
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Ingår i: Nordic Pulp & Paper Research Journal. - : De Gruyter Open Ltd. - 0283-2631 .- 2000-0669. ; 35:2, s. 195-204
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Tidskriftsartikel (refereegranskat)abstract
- The hypothesis is that it should be possible to modify papermaking conditions in line with the softening properties of high yield pulp fibres and achieve similar strength properties to conventional chemical pulp based paper. We therefore investigated the rheological and physical properties of high yield pulp based papers during hot-pressing. Our results confirm that increased temperature combined with sufficient pressure enables permanent densification by softening of lignin, producing very high tensile strength. This treatment also significantly improved the wet tensile strength in comparison to bleached kraft pulp without using wet strength agents. The high yield pulps used here were spruce based thermomechanical pulp, chemi-thermomechanical pulp, and high temperature chemi-thermomechanical pulp, and birch-aspen based neutral sulphite semi chemical pulp, with spruce-pine based bleached kraft pulp as reference. Rapid Köhten sheets of 150 g/m 2 150\hspace{0.1667em}\text{g}/{\text{m}^{2}} and 50 % dryness were hot-pressed in a cylinder-press at 20-200 °C, 7 MPa, and 1 m/min. The mechanical properties showed great improvements in these high yield pulp papers, with tensile index increased to 75 kNm/kg and compression strength index to 45 kNm/kg; levels close to and better than bleached kraft. Wet strength increased to 16 Nm/g compared to 5 Nm/g for bleached kraft.
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| 9. |
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| 10. |
- Joelsson, Tove, et al.
(författare)
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Improving paper wet strength via increased lignin content and hot-pressing temperature
- 2020
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Ingår i: TAPPI Journal. - 0734-1415. ; 19:10, s. 487-499
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Tidskriftsartikel (refereegranskat)abstract
- It is known that the strength properties of wood-based paper materials can be enhanced via hot-pressing techniques. Today, there is a desire not only for a change from fossil-based packaging materials to new sustainable bio-based materials, but also for more effective and eco-friendly solutions for improving the dry and wet strength of paper and board. Against this background, hot pressing of paper made from high yield pulp (HYP), rich in lignin, becomes highly interesting. This study investigated the influence of pressing temperature and native lignin content on the properties of paper produced by means of hot pressing. Kraft pulps of varied lignin content (kappa numbers: 25, 50, 80) were produced at pilot scale from the same batch by varying the cooking time. We then studied the effect of lignin content by evaluating the physical properties of Rapid When sheets after hot pressing in the temperature range of 20 degrees C-200 degrees C with a constant nip pressure of 7 MPa. The pilot-scale cooked pulps were compared with reference samples of mill-produced northern bleached softwood kraft (NBSK) pulp and mill-produced chemithermomechanical pulp (CTMP). Generally, the results demonstrated that lignin content had a significant effect on both dry and wet tensile index. All of the pilot cooked pulps with increased lignin content had a higher tensile index than the reference NBSK pulp. To obtain high tensile index, both dry and wet, the pressing temperature should be set high, preferably at least 200 degrees C; that is, well above the glass transition temperature (Tg) for lignin. Moreover, the lignin content should preferably also be high. All kraft pulps investigated in this study showed a linear relationship between wet strength and lignin content.
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