| 1. |
- Bronge, Mattias, et al.
(författare)
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Identification of four novel T cell autoantigens and personal autoreactive profiles in multiple sclerosis
- 2022
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Ingår i: Science Advances. - : American Association for the Advancement of Science (AAAS). - 2375-2548. ; 8:17
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Tidskriftsartikel (refereegranskat)abstract
- Multiple sclerosis (MS) is an inflammatory disease of the central nervous system (CNS), in which pathological T cells, likely autoimmune, play a key role. Despite its central importance, the autoantigen repertoire remains largely uncharacterized. Using a novel in vitro antigen delivery method combined with the Human Protein Atlas library, we screened for T cell autoreactivity against 63 CNS-expressed proteins. We identified four previously unreported autoantigens in MS: fatty acid-binding protein 7, prokineticin-2, reticulon-3, and synaptosomal-associated protein 91, which were verified to induce interferon-gamma responses in MS in two cohorts. Autoreactive profiles were heterogeneous, and reactivity to several autoantigens was MS-selective. Autoreactive T cells were predominantly CD4(+) and human leukocyte antigen-DR restricted. Mouse immunization induced antigen-specific responses and CNS leukocyte infiltration. This represents one of the largest systematic efforts to date in the search for MS autoantigens, demonstrates the heterogeneity of autoreactive profiles, and highlights promising targets for future diagnostic tools and immunomodulatory therapies in MS.
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| 2. |
- Poulikidou, Sofia, 1984, et al.
(författare)
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Impacts on fuel producers and customers of conflicting rules for life cycle assessment
- 2022
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- The use of life cycle assessment (LCA) as a tool for estimating the environmental performance of a product or service in a holistic and systematic manner is increasing. Fuel producers may need to apply different methodological frameworks to be used in different contexts; internally for product development activities as well as externally for communication with customers or authorities. Different LCA frameworks may vary in scope, system boundaries (i.e. life cycle stages to be considered) or modelling requirements (such as data demands but also more detailed methodological features). They may also vary in terms of information they can provide in relation to the environmental performance of the product. Those variations could lead to conflicting outcomes and conclusions and may also increase complexity for the LCA practitioner leading to high competence and resource requirements. Within the research project: Impacts on fuel producers and customers of conflicting rules for LCA , the requirements of different LCA frameworks and their implications to fuel producers are investigated. Focus has been given on three specific frameworks that are identified as relevant or potentially relevant for fuel producers, namely: the recast of the EU Renewable Energy Directive (referred to here as RED II), the EU framework for Product Environmental Footprint (PEF), and the framework of Environmental Product Declaration (EPD). The aim of the project is to increase understanding on the different LCA frameworks available and identify whether the multitude of such frameworks gives conflicting recommendations for environmental improvements and fuel choices. The three LCA frameworks listed above were applied in case studies. To illustrate the potential differences that the different frameworks may lead to, a variation of production pathways and feedstocks were selected including first generation as well as advanced biofuels. Based on the results obtained it can be concluded that applying all three frameworks is not a straightforward task. The methods contain fundamental differences and are at different levels of development, maturity, and adoption. In certain situations, they can lead to diverging conclusions as a result of different quantitative outcomes for a specific production pathway, thus influencing decision making processes in different directions. Understanding those differences and underlying assumptions is important for understanding the variations in outcome. The result for a specific fuel could differ substantially depending on the framework applied and the assumptions and interpretations made when applying this framework. Certain methodological parameters were identified to have a greater impact on the results than others: • The three frameworks diverge in the methods applied for modelling waste management, which can be very important for the results when the biofuel is produced from waste. • The frameworks diverge in what approaches are allowed for modelling processes with multiple products. This can be very important for the results when the fuel is co-produced with other products. • The frameworks also diverge in how the electricity supply is modelled. This is not very important for the results in most of our case studies, because the production of these biofuels does not require a lot of electricity. The study confirms that applying a framework like EPD or PEF in addition to RED II would require significant supplementary efforts. Not only because of different rules which were often contradicting or difficult to interpret but also because of additional data and reporting requirements. The need for expertise and resources is increasing for fuel producers to be able to provide EPD and PEF compliant assessments. To enhance the development and harmonization of LCA approaches this project stresses the need for product specific rules (in the form of Product Environmental Category Rules (PEFCR) and Product Category Rules (PCR)) for renewable fuels. Future versions of all three studied frameworks should be clearer on how specific methodological choices are to be applied (e.g., when it comes to allocation and multifunctional processes) as well as when it comes to model electricity supply. RED for example shall be clearer on how to define the electricity region while EPD guidelines on how to define the electricity market. Although it is not realistic to aim for a single unified LCA framework, the biofuel PCR and PEFCR can be developed with RED in mind. Some aspects of the PEF methodology can perhaps also be integrated into RED III that is currently under development. This would enhance the broader adoption of the frameworks among fuel producers. Finally, the involvement and engagement of the industry, and fuel producers themselves is very important. Industry initiatives are essential for the development of biofuel PCR and PEFCR while the general development of the three frameworks can also be influenced. In this study, we also investigated the relationship between the LCA frameworks and schemes for chain of custody certification (CoCC), in particular schemes for mass balance certifications (MBC) to investigate to what extent these schemes complement or overlap with LCA. The purpose of MBC schemes and LCA are different, in the sense that the first aim at verifying the sources and sustainability of total amounts of raw materials used by tracking them throughout the value chain, while the second at quantifying specific environmental impact. The system boundaries are similar, since both cover the entire value chain, but may be applied differently depending on the detailed frameworks applied and choices made in applying the MBC schemes. By identifying and clearly illustrating the variations among the studied frameworks the study enhances application, development, and harmonization of LCA, in a broader perspective, informs LCA practitioners but also decision makers and provides insights on how the identified challenges can be addressed.
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| 3. |
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| 4. |
- Andersson, Ingrid, et al.
(författare)
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A scoping review-Missed nursing care in community healthcare contexts and how it is measured
- 2022
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Ingår i: Nursing Open. - : John Wiley & Sons. - 2054-1058. ; 9:4, s. 1943-1966
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To examine the extent and nature of missed nursing care in elderly care in community healthcare contexts from the perspective of healthcare staff, and to identify instruments used to measure missed nursing care and the content of these instruments. Design: Scoping review. Methods: Searches were conducted in the CINAHL, PubMed, Scopus and Google Scholar databases in March 2020. The selection process followed the PRISMA flow diagram. Results: Sixteen research papers were found from nine countries. The instruments used in the studies were Basel Extent of Rationing of Nursing Care for nursing homes (BERNCA-NH), modified MISSCARE survey and study-specific instruments or items. The item content differed, as did the number of items, which was between one and 44. The studies reported values for missed nursing care, as well as described reasons for and/or the relation between missed nursing care and organization, working climate and patient outcomes.
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| 5. |
- Andersson, Ingrid, et al.
(författare)
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Prevalence, type, and reasons for missed nursing care in municipality health care in Sweden : A cross sectional study
- 2022
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Ingår i: BMC Nursing. - : BioMed Central (BMC). - 1472-6955 .- 1472-6955. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- Background With an ageing population, there is an increasing need for care, both as home care and in nursing homes. However, some needed care is not carried out for different reasons, which can affect patient safety. The aim of the study was to describe prevalence, type, and reasons for missed nursing care in home care and nursing homes, from nurses' perspective. Methods A cross sectional design with quantitative and qualitative approach. A Swedish version of Basel Extent of Rationing of Nursing Care for nursing homes and 15 study specific questions were answered by 624 registered nurses, enrolled nurses, or nurse assistants. Both descriptive and analytical, independent-samples t-test, analyses were used. Qualitative content analysis was used for the open-ended question. Results The care activity most often missed in home care was: 'set up or update care plans' (41.8%), and in nursing homes: 'scheduled group activity' (22.8%). Reasons for missed nursing care were lack of preparedness for unexpected situations, obstacles in a deficient work environment, unsatisfactory planning in the organisation, and/or shortcomings related to the individual. Conclusion Not all care activities needed are performed, due to reasons such as lack of time or organisational issues. Missed nursing care can lead to adverse events and affect patient safety. It is important to be aware of missed nursing care and the reasons for it, which gives a possibility to initiate quality improvement work to ensure patient safety.
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| 6. |
- Andersson, Ingrid, et al.
(författare)
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Registered nurse´s perception of staffing in community care – contributing to a sustainable health care workforce
- 2022
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Konferensbidrag (refereegranskat)abstract
- Background: Population ageing will lead to increased need for care, both as home care and in nursing homes. The time spent in hospital are shorten, so more and more advanced care takes place as community care. To meet this challenges, it will be important to ensure a sustainable health care workforce in which registered nurses (RNs) have a key role. Staffing in community care is related to patient safety and care quality.Aim of the study: To describe registered nurse´s perceptions of staffing in community care.Methods: A number of 56 RNs (age 26 to 65, median age 47) working in community care answered a questionnaire including questions about staffing. Data were collected in 2019/2020. Descriptive statistical- and qualitative content analyses were used. Results: The majority of the RNs (71%) perceived the planned staffing in community care as acceptable or good. Although, when looking back on the previous week, around half of the RNs (55%) perceived it to be lower that needed. The RNs holds perceptions of staffing in a continuum from positive to negative. The RNs perceptions of staffing are expressed in five sub-themes; “it´s working, it´s all fine,” “the willingness to do good”, “being in a vicious circle”, “having a feeling of resignation”, and “challenging for a vulnerable organization”.Conclusions and implications: RNs perceptions on staffing in community care are important in contributing to a sustainable and resilient workforce, they are like the organisation´s band-aid. There is a need to optimise and increase nurse staffing in community care.
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| 7. |
- Andersson, Ingrid, et al.
(författare)
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Validation of the Basel Extent of Rationing of Nursing Care for Nursing Homes and Home Care, a Swedish version
- 2023
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Ingår i: Nursing Open. - : John Wiley & Sons. - 2054-1058. ; 10:7, s. 4504-4514
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Tidskriftsartikel (refereegranskat)abstract
- AimThe aim of the study was to translate, adapt and validate the instrument Basel Extent of Rationing of Nursing Care for Nursing Homes and Home Care for use in the Swedish community health care context. DesignA cross-sectional study. Data were collected from October 2019 to January 2020, and the questionnaire was sent to Registered Nurses, Enrolled Nurses and assistant nurses. MethodsThe study was performed in four phases: (1) translation, (2) adaptation of the Basel Extent of Rationing of Nursing Care for Nursing Homes and Home Care to the Swedish context, (3) content validity testing, and (4) evaluation of psychometric properties. The collected data resulted in 611 responses. Explorative factor analysis was performed to explore the interrelationship, and Cronbach's alpha was used to evaluate the internal consistency. ResultsExplorative factor analysis presented six factors/subscales: (1) fundamental care, (2) timely needed-based care, (3) dignity and support, (4) ensuring respectful treatment, (5) social activities, and (6) documentation, planning and reporting. The Cronbach's alpha for the components showed values between 0.7 and 0.9. ConclusionThe analyses indicate an instrument to be usable for Enrolled Nurses and nurse assistants in community health care. Additional tests, can contribute to refining the content of the items and further test reliability and validity of the instrument. No patient or public contributionAs this is a study of translation and validation of the instrument Basel Extent of Rationing of Nursing Care for Nursing Homes and Home Care.
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| 8. |
- Andersson, Ingrid
(författare)
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Vård som inte blivit utförd : Uppfattningar från vårdpersonal och enhetschefer inom kommunal vård och omsorg för äldre
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Övergripande syfte – Att undersöka samt öka och fördjupa kunskapen om vård som inte blivit utförd, inom kommunal vård och omsorg för äldre, utifrån vårdpersonals och enhetschefers uppfattningar och erfarenheter.Metod – Forskningsområdet vård som inte blivit utförd inom kommunal vård och omsorg för äldre kartlades med en scoping review, 16 artiklar inkluderades (I). Kvantitativ och kvalitativ metod användes för att samla in och analysera data (II-IV). Det genomfördes en tvärsnittsstudie med 624 sjuksköterskor, undersköterskor och vårdbiträden som besvarade ett frågeformulär med flervalsfrågor och en öppen fråga. Instrumentet Basel Extent of Rationing of Nursing Care for Nursing Homes (BERNCA-NH) samt studiespecifika frågor, för svensk kommunal kontext om vård som inte blivit utförd användes. Beskrivande och analytisk statistik användes samt kvalitativ innehållsanalys (II). En översättning, anpassning och validering av BERNCA-NH gjordes med explorativ faktoranalys (III). En intervjustudie genomfördes med 24 enhetschefer inom kommunal vård och omsorg för äldre, där deras uppfattningar av vård som inte blivit utförd efterfrågades. Analysen utfördes med fenomenografisk ansats (IV).Resultat – Det förekommer att vård inte blivit utförd inom kommunal vård och omsorg för äldre, orsakat av tidsbrist eller på grund av organisatoriska förhållanden (I, II). Instrumentet BERNCA-NH/HC, SWE indikerade en god reliabilitet och validitet, men ytterligare tester behövs (III). Enhetschefer som är medvetna om förekomsten av att vård inte alltid blir utförd, försöker följa upp händelserna för att förebygga att det ska hända igen. Vård som inte blivit utförd kan innebära negativa konsekvenser för både vårdpersonal och de äldre (IV).Konklusion – Det är av vikt att få kännedom om vård som inte blivit utförd samt att det går att mäta. Utifrån det kan orsaker diskuteras och förbättringsarbete ske. Vård som inte blivit utförd är relaterat till patientsäkerhet och behöver lyftas upp på agendan.
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| 9. |
- Andreou, Dimitrios, et al.
(författare)
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Cardiac left ventricular ejection fraction in men and women with schizophrenia on long-term antipsychotic treatment
- 2020
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Ingår i: Schizophrenia Research. - : Elsevier BV. - 0920-9964 .- 1573-2509. ; 218, s. 226-232
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Tidskriftsartikel (refereegranskat)abstract
- Patients with schizophrenia exhibit a higher cardiovascular mortality compared to the general population which has been attributed to life-style factors, genetic susceptibility and antipsychotic medication. Recent echocardiographic studies have pointed to an association between clozapine treatment and reduced left ventricular ejection fraction (LVEF), a measure that has been inversely associated with adverse outcomes including all-cause mortality. Cardiovascular magnetic resonance (CMR) is considered the reference method for LVEF measurement. The aim of the present study was to investigate the LVEF in patients with schizophrenia on long-term treatment with antipsychotics and healthy controls. Twenty-nine adult patients with schizophrenia on long-term medication with antipsychotics and 27 age-, sex- and body mass index-matched healthy controls (mean ages 44 and 45 years, respectively) were recruited from outpatient psychiatric clinics in Uppsala, Sweden. The participants were interviewed and underwent physical examination, biochemical analyses, electrocardiogram and CMR. Men with schizophrenia on long-term antipsychotic treatment showed significantly lower LVEF than controls (p = 0.0076), whereas no such difference was evident among women (p = 0.44). Specifically, clozapine-treated male patients had 10.6% lower LVEF than male controls (p = 0.0064), whereas the LVEF was 5.5% below that of controls among male patients treated with non-clozapine antipsychotics (p = 0.047). Among medicated men with schizophrenia, we found significantly lower LVEF compared to healthy individuals, suggesting the need of routine cardiac monitoring in this patient group. This is the first study showing a significant negative association between treatment with non-clozapine antipsychotics and LVEF.
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| 10. |
- Bayani, Jane, et al.
(författare)
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Evaluation of multiple transcriptomic gene risk signatures in male breast cancer
- 2021
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Ingår i: npj Breast Cancer. - : Springer Science and Business Media LLC. - 2374-4677. ; 7:1
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Tidskriftsartikel (refereegranskat)abstract
- Male breast cancer (BCa) is a rare disease accounting for less than 1% of all breast cancers and 1% of all cancers in males. The clinical management is largely extrapolated from female BCa. Several multigene assays are increasingly used to guide clinical treatment decisions in female BCa, however, there are limited data on the utility of these tests in male BCa. Here we present the gene expression results of 381 M0, ER+ve, HER2-ve male BCa patients enrolled in the Part 1 (retrospective analysis) of the International Male Breast Cancer Program. Using a custom NanoString™ panel comprised of the genes from the commercial risk tests Prosigna®, OncotypeDX®, and MammaPrint®, risk scores and intrinsic subtyping data were generated to recapitulate the commercial tests as described by us previously. We also examined the prognostic value of other risk scores such as the Genomic Grade Index (GGI), IHC4-mRNA and our prognostic 95-gene signature. In this sample set of male BCa, we demonstrated prognostic utility on univariate analysis. Across all signatures, patients whose samples were identified as low-risk experienced better outcomes than intermediate-risk, with those classed as high risk experiencing the poorest outcomes. As seen with female BCa, the concordance between tests was poor, with C-index values ranging from 40.3% to 78.2% and Kappa values ranging from 0.17 to 0.58. To our knowledge, this is the largest study of male breast cancers assayed to generate risk scores of the current commercial and academic risk tests demonstrating comparable clinical utility to female BCa.
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