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| 2. |
- Torell, Agnes, 1993, et al.
(author)
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Low CD4+T cell count is related to specific anti-nuclear antibodies, IFNα protein positivity and disease activity in systemic lupus erythematosus pregnancy.
- 2024
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In: Arthritis research & therapy. - : BioMed Central (BMC). - 1478-6362 .- 1478-6354. ; 26:1
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Journal article (peer-reviewed)abstract
- Lymphopenia, autoantibodies and activation of the type I interferon (IFN) system are common features in systemic lupus erythematosus (SLE). We speculate whether lymphocyte subset counts are affected by pregnancy and if they relate to autoantibody profiles and/or IFNα protein in SLE pregnancy.Repeated blood samples were collected during pregnancy from 80 women with SLE and 51 healthy controls (HC). Late postpartum samples were obtained from 19 of the women with SLE. Counts of CD4+and CD8+T cells, B cells and NK cells were measured by flow cytometry. Positivity for anti-nuclear antibodies (ANA) fine specificities (double-stranded DNA [dsDNA], Smith [Sm], ribonucleoprotein [RNP], chromatin, Sjögren's syndrome antigen A [SSA] and B [SSB]) and anti-phospholipid antibodies (cardiolipin [CL] and β2 glycoprotein I [β2GPI]) was assessed with multiplexed bead assay. IFNα protein concentration was quantified with Single molecule array (Simoa) immune assay. Clinical data were retrieved from medical records.Women with SLE had lower counts of all lymphocyte subsets compared to HC throughout pregnancy, but counts did not differ during pregnancy compared to postpartum. Principal component analysis revealed that low lymphocyte subset counts differentially related to autoantibody profiles, cluster one (anti-dsDNA/anti-Sm/anti-RNP/anti-Sm/RNP/anti-chromatin), cluster two (anti-SSA/anti-SSB) and cluster three (anti-CL/anti-β2GPI), IFNα protein levels and disease activity. CD4+T cell counts were lower in women positive to all ANA fine specificities in cluster one compared to those who were negative, and B cell numbers were lower in women positive for anti-dsDNA and anti-Sm compared to negative women. Moreover, CD4+T cell and B cell counts were lower in women with moderate/high compared to no/low disease activity, and CD4+T cell count was lower in IFNα protein positive relative to negative women. Finally, CD4+T cell count was unrelated to treatment.Lymphocyte subset counts are lower in SLE compared to healthy pregnancies, which seems to be a feature of the disease per se and not affected by pregnancy. Our results also indicate that low lymphocyte subset counts relate differentially to autoantibody profiles, IFNα protein levels and disease activity, which could be due to divergent disease pathways.
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| 3. |
- Torell, Agnes, 1993, et al.
(author)
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Low-density granulocytes are related to shorter pregnancy duration but not to interferon alpha protein blood levels in systemic lupus erythematosus.
- 2023
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In: Arthritis research & therapy. - : BMC. - 1478-6362 .- 1478-6354. ; 25
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Journal article (peer-reviewed)abstract
- An increased risk of pregnancy complications is seen in women with systemic lupus erythematosus (SLE), but the specific immunopathological drivers are still unclear. Hallmarks of SLE are granulocyte activation, type I interferon (IFN) overproduction, and autoantibodies. Here we examined whether low-density granulocytes (LDG) and granulocyte activation increase during pregnancy, and related the results to IFNα protein levels, autoantibody profile, and gestational age at birth.Repeated blood samples were collected during pregnancy in trimesters one, two, and three from 69 women with SLE and 27 healthy pregnant women (HC). Nineteen of the SLE women were also sampled late postpartum. LDG proportions and granulocyte activation (CD62L shedding) were measured by flow cytometry. Plasma IFNα protein concentrations were quantified by single molecule array (Simoa) immune assay. Clinical data were obtained from medical records.Women with SLE had higher LDG proportions and increased IFNα protein levels compared to HC throughout pregnancy, but neither LDG fractions nor IFNα levels differed during pregnancy compared to postpartum in SLE. Granulocyte activation status was higher in SLE relative to HC pregnancies, and it was increased during pregnancy compared to after pregnancy in SLE. Higher LDG proportions in SLE were associated with antiphospholipid positivity but not to IFNα protein levels. Finally, higher LDG proportions in trimester three correlated independently with lower gestational age at birth in SLE.Our results suggest that SLE pregnancy results in increased peripheral granulocyte priming, and that higher LDG proportions late in pregnancy are related to shorter pregnancy duration but not to IFNα blood levels in SLE.
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| 4. |
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| 5. |
- Bengtsson, Anna, 1973-, et al.
(author)
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Increased knowledge makes a difference!–general practitioners’ experiences of pictorial information about subclinical atherosclerosis for primary prevention: an interview study from the VIPVIZA trial
- 2021
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In: Scandinavian Journal of Primary Health Care. - : Taylor & Francis. - 0281-3432 .- 1502-7724. ; 39:1, s. 77-84
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Journal article (peer-reviewed)abstract
- Objectives: To explore how pictorial information on subclinical atherosclerosis affects GPs’ perception of patient cardiovascular disease (CVD) risk, their communication with patients, and GPs’ attitude to the treatment of CVD risk factors.Design, setting and subjects: Fifteen individual interviews were conducted between March 2014 and December 2016, with GPs who had received pictorial information regarding their patients’ subclinical atherosclerosis. The pictorial information was also received by the patients together with written information regarding atherosclerosis and CVD risk prior to the appointment with their GP. The interviews were recorded, transcribed and analyzed using qualitative content analysis.Results: Three categories were identified in the analysis. Increased knowledge makes a difference: When patients had more in-depth knowledge regarding atherosclerosis, the consultation became more patient-centered and moved towards shared decision making. This is real, not just a number: GPs described their risk assessment and the patient’s risk perception as more accurate with pictorial information about subclinical atherosclerosis. How to deal with the result–A passive to active approach: Some GPs acted promptly on the pictorial information while others took no action.Conclusion and implications: Pictorial information regarding patients’ subclinical atherosclerosis affected GPs’ assessment of CVD risk. The communication shifted towards shared decision-making although the GPs’ attitude to the result and treatment of CVD risk factors varied. Informing patients about examination results, both in writing and pictures, prior to a consultation can facilitate shared decision making and enhance preventive measures.Trial registration: https://clinicaltrials.gov/ct2/show/NCT01849575.KEY POINTS: Providing pictorial information about carotid ultrasound results and information regarding atherosclerosis to GPs and patients affects primary prevention:Informing patients about examination results prior to a consultation can be useful in clinical practice to enhance preventive measuresGPs experienced that increased patient knowledge resulted in a more patient-centered consultation and improved shared decision-makingGPs described their risk assessment and patients’ risk perception as more accurate with pictorial information about subclinical atherosclerosis.
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| 6. |
- Bengtsson, Anna, 1973-, et al.
(author)
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Multi-view carotid ultrasound is stronger associated with cardiovascular risk factors than presence of plaque or single carotid intima media thickness measurements in subclinical atherosclerosis
- 2023
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In: The International Journal of Cardiovascular Imaging. - : Springer Nature. - 1569-5794 .- 1875-8312. ; 39:8, s. 1461-1471
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Journal article (peer-reviewed)abstract
- We aimed to explore the prevalence of atherosclerosis by using multi-view ultrasound examination of the carotid arteries and its association with clinical risk factors in a middle-aged population at low to intermediate risk of cardiovascular disease (CVD). Carotid vascular ultrasound was performed in 3532 participants in the VIPVIZA trial. Mean and maximal carotid intima media thickness (cIMT) at prespecified angles and plaque presence were examined on the left and right side. Associations between CVD risk factors and ultrasound variables were quantified by partial least squares (PLS) regression. A combined ultrasound variable was computed using weights of the first PLS component. Associations between CVD risk factors and the combined multi-view ultrasound variable, single cIMT and plaque measurements, respectively, were determined using linear regression modelling. The participants’ mean age was 55.7 years and 52.9% were women. Plaque prevalence was 51.1% in men and 39.0% in women. cIMT was higher in men than in women and in the left compared with the right carotid artery. The strongest association of CVD risk factors was observed with the combined multi-view ultrasound variable (R2 = 24%), compared with single cIMT variables (R2 = 14–18%) and plaque presence (R2 = 15%). The pattern was similar in both sexes. The association with CVD risk factors and the combined ultrasound variable was stronger in 40-year olds (R2 = 22%) compared with 50- or 60-year olds (R = 12%). CVD risk factors are stronger associated with a combined ultrasound variable than plaque presence or single cIMT measures suggesting that carotid multi-view ultrasonography better captures the focality of early atherosclerosis. Clinical Trial Registration: ClinicalTrials.gov, number NCT01849575. May 8, 2013.
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| 7. |
- Bengtsson, Anna, 1973-
(author)
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Pictorial presentation of subclinical atherosclerosis : a measure to reduce the risk for cardiovascular disease
- 2021
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Doctoral thesis (other academic/artistic)abstract
- The overall aim was improved cardiovascular disease (CVD) prevention through the VIPVIZA intervention. This includes the provision of pictorial information of subclinical atherosclerosis to participants and their general practitioners (GPs), follow-up phone call, and written information to the participant. VIPVIZA is a Prospective Randomized Open Blinded End-point (PROBE) trial nested within VIP, a CVD prevention program in primary health care in Västerbotten county, Sweden. Middle-aged individuals at low/intermediate CVD risk were enrolled to VIPVIZA and randomized 1:1 to an intervention (n=1749) or control group (n=1783 who received no pictorial or other information). Preventive measures were managed within primary health care.At baseline, clinical risk factors were measured and carotid ultrasound examination was performed. The prevalence of subclinical atherosclerotic disease was assessed as intima media thickness and presence of plaque. The association between clinical risk factors and measures of subclinical atherosclerosis was investigated. In addition to conventional risk factor-based risk evaluation, the impact of the VIPVIZA intervention on CVD risk, traditional risk factors and pharmacological treatment was evaluated after 1 and 3 years. Individual interviews were conducted with 15 GPs to explore how a pictorial representation of subclinical atherosclerosis affects physicians in their perception and communication of CVD risk. The interviews were analyzed by qualitative content analysis.The plaque prevalence was 44.7% in this population. Clinical risk factors explained more of the variation in a combined ultrasound measurement than single measurements. The results up to three years showed a VIPVIZA intervention effect, with lower and sustained CVD risk in the intervention as compared to the control group. The effect was partly mediated by differences in intake of lipid-lowering medication and partly by lifestyle behaviour. The GPs described their risk assessment and patients’ risk perception as more accurate with the VIPVIZA intervention. Informing patients about examination results prior to a consultation can facilitate shared decision-making and enhance adherence to preventive measures.The results show that the VIPVIZA intervention reduces CVD risk over three years. In the long run this has the potential to reduce the incidence of CVD events.
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| 8. |
- Bengtsson, Anna, 1973-, et al.
(author)
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The beneficial effect over 3 years by pictorial information to patients and their physician about subclinical atherosclerosis and cardiovascular risk : results from the VIPVIZA randomized clinical trial
- 2021
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In: American Journal of Preventive Cardiology. - : Elsevier. - 2666-6677. ; 7
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Journal article (peer-reviewed)abstract
- Objective: Non-adherence to guidelines and preventive measures is a major challenge, particularly so to ob- tain long-term adherence to lifestyle changes and recommended medication. The objective was to investigate if pictorial information regarding subclinical carotid atherosclerosis provided to individuals and physicians gave sustained effects on cardiovascular risk beyond the previously reported effect after 1 year and up to 3 years. Methods: A Prospective Randomized Open Blinded End-point (PROBE) trial. Within a CVD prevention program in Västerbotten County, Sweden, 3532 healthy individuals aged 40, 50 or 60 years were enrolled and 1:1 ran- domized to intervention ( n = 1749; pictorial information with additional prevention materials to participants and physicians) or control group ( n = 1783; no pictorial information to participants and physicians). Preventive measures were managed within primary care. Participants were investigated at baseline during 2013–2016 and at follow-up after 1 and 3 years. Results: A beneficial effect on cardiovascular risk was observed at 3-year follow-up; Framingham Risk Score (FRS) was 13.38 for the intervention group and 14.08 for the control group ( p = 0.047) and SCORE was 1.69 vs. 1.82 ( p = 0.022). The effect observed at 1-year was sustained over 3 years after adjustment for sex and education and more pronounced among participants with a severe atherosclerotic picture at baseline.Conclusions: This study provides evidence of sustained beneficial effects on the adherence to prevention guidelines over 3 years of pictorial information about subclinical carotid atherosclerosis, resulting in lower cardiovascular risk regardless of sex and educational level. Direct visualization of the underlying still subclinical atherosclerotic disease, rather than just indirect information about risk factors and statistical risk of future myocardial infarction, stroke and death, is one way to tackle the problem of non-adherence to prevention of cardiovascular diseases.
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| 9. |
- Bengtsson, Karin, et al.
(author)
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Cardiac conduction disturbances in patients with ankylosing spondylitis : results from a 5-year follow-up cohort study
- 2019
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In: RMD Open. - : BMJ Publishing Group Ltd. - 2056-5933. ; 5:2
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Journal article (peer-reviewed)abstract
- Objectives: To describe electrocardiographic (ECG) development in patients with ankylosing spondylitis (AS) and identify associations between baseline characteristics and cardiac conduction disturbances (CCD) at 5-year follow-up.Methods: In a longitudinal cohort study, 172 patients (54% men, mean age (SD) of 50 (13) years at baseline) with AS underwent ECG, physical examination, questionnaires and laboratory testing at baseline and at 5-year follow-up. Descriptive statistics and univariate and age- and sex-adjusted logistic regression analyses were used. CCD included both atrioventricular and intraventricular blocks.Results: Twenty-three of the 172 patients (13.4%) had a CCD at follow-up. Eight patients had developed a new CCD and eight had normalised their ECG. In the age- and sex-adjusted analyses, CCD at baseline (OR 24.8, 95% CI 7.3 to 84.5), male sex (OR 6.4, 95% CI 2.0 to 20.8), history of anterior uveitis (OR 4.4, 95% CI 1.3 to 14.5), higher ASDAS-CRP (OR 2.3, 95% CI 1.3 to 4.0), greater waist circumference (OR 1.3, 95% CI 1.1 to 1.6, per 5 cm), and medication with antiplatelets (OR 7.0, 95% CI 1.5 to 31.8) and beta-blockers (OR 3.4, 95% CI 1.0 to 11.5) were associated with a CCD at follow-up. Higher age and longer symptom duration were highly correlated and were both associated with a CCD at follow-up.Conclusions: The presence of CCD in AS is in part dynamic and associated with both AS and non-AS characteristics. Our results suggest that patients especially prone to present with CCDs are older men with a previous CCD, longer symptom duration, higher AS disease activity, a history of anterior uveitis and medication reflecting cardiovascular disease.
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| 10. |
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| 11. |
- Bengtsson, Karin, 1980, et al.
(author)
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Incidence of extra-articular manifestations in ankylosing spondylitis, psoriatic arthritis and undifferentiated spondyloarthritis : Results from a national register-based cohort study
- 2021
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In: Rheumatology (United Kingdom). - : Oxford University Press (OUP). - 1462-0324 .- 1462-0332. ; 60:6, s. 2725-2734
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Journal article (peer-reviewed)abstract
- Objectives: To estimate the incidence and strength of association of extra-articular manifestations [EAMs, here: anterior uveitis (AU), IBD and psoriasis] in patients with AS, undifferentiated SpA (uSpA) and PsA, compared with controls. Methods: Three mutually exclusive cohorts of patients aged 18-69 years with AS (n = 8517), uSpA (n = 10 245) and PsA (n = 22 667) were identified in the Swedish National Patient Register 2001-2015. Age-, sex- and geography-matched controls were identified from the Swedish Population Register. Follow-up began 1 January 2006, or six months after the first SpA diagnosis, whichever occurred later, and ended at the first date of the EAM under study, death, emigration, 70 years of age, and 31 December 2016. Incidence rates (IRs) and incidence rate ratios were calculated for each EAM, and stratified by sex and age. Results: Incidence rate ratios for incident AU, IBD and psoriasis were significantly increased in AS (20.2, 6.2, 2.5), uSpA (13.6, 5.7, 3.8) and PsA (2.5, 2.3, n.a) vs controls. Men with AS and uSpA had significantly higher IRs per 1000 person-years at risk for incident AU than women with AS (IR 15.8 vs 11.2) and uSpA (IR 10.1 vs 6.0), whereas no such sex difference was demonstrated in PsA or for the other EAMs. Conclusions: AU, followed by IBD and psoriasis, is the EAM most strongly associated with AS and uSpA. Among the SpA subtypes, AS and uSpA display a largely similar pattern of EAMs, whereas PsA has a considerably weaker association with AU and IBD.
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| 12. |
- Bengtsson, Karin, 1980, et al.
(author)
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Occurrence and relative risks for non-vertebral fractures in patients with ankylosing spondylitis compared with the general population: a register-based study from Sweden
- 2023
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In: Rmd Open. - : BMJ. - 2056-5933. ; 9:1
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Journal article (peer-reviewed)abstract
- ObjectivesTo estimate the incidence of non-vertebral fractures in ankylosing spondylitis (AS) compared with the general population.MethodsNationwide register-based cohort study including patients with AS (n=11 611, 65% men, mean age 48 years), and matched general population controls (n=58 050). Five prespecified fracture outcomes: (1) non-vertebral; (2) fracture of the proximal humerus, distal forearm or hip; (3) proximal humerus; (4) distal forearm and (5) hip) were identified through register linkages with follow-up 2007-2016. We used Poisson regression to calculate incidence rates (IRs), number of fractures per 1000 person-years at risk and IR ratios (IRRs), overall and by sex and age. IRRs were adjusted for history of any prior fracture.ResultsIRs (men/women) for non-vertebral fracture in AS were 11.9 (95% CI 11.0 to 12.9)/14.5 (95% CI 13.1 to 16.1) and in controls 10.0 (95% CI 9.7 to 10.4)/11.8 (95% CI 11.1 to 12.4), IRR (men/women) 1.2 (95% CI 1.1 to 1.3)/1.2 (95% CI 1.1 to 1.4). IRs (men/women) for fractures of the humerus, forearm or hip in AS were 4.0 (95% CI 3.5 to 4.6)/6.3 (95% CI 5.4 to 7.3) and in controls 2.7 (95% CI 2.5 to 2.9)/5.5 (95% CI 5.1 to 6.0), IRR (men/women) 1.5 (95% CI 1.3 to 1.7)/1.1 (95% CI 0.9 to 1.3). IRRs were statistically significantly elevated in men with AS versus controls for forearm fracture (1.4 (95% CI 1.1 to 1.7)) and hip fracture (1.8 (95% CI 1.4 to 2.3)), whereas not in women with AS where the IRRs were 1.1 (95% CI 0.9 to 1.4) and 1.0 (95% CI 0.6 to 1.4). For humerus fracture, IRRs were 1.4 (95% CI 0.99 to 1.9) in men with AS versus controls and 1.1 (95% CI 0.8 to 1.6) in women.ConclusionsBoth men and women with AS have a slightly higher risk of non-vertebral fractures than the general population. A statistically significantly higher risk of fractures of the proximal humerus, distal forearm or hip was found in men with AS in comparison to general population, where the relative risk was especially pronounced for hip fracture.
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| 13. |
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| 14. |
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| 15. |
- Berggren, Christian, et al.
(author)
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Exploring Knowledge Integration and Innovation
- 2011
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In: Knowledge integration and innovation. - Oxford : Oxford University Press. - 9780199693924 - 9780191730580 ; , s. 228-245
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Book chapter (other academic/artistic)abstract
- Technology-based firms continue to compete primarily on innovation, and are continuously required to present new solutions to an exacting market. As technological complexity and specialization intensifies, firms increasingly need to integrate and co-ordinate knowledge by means of project groups, diversified organizations, inter-organizational partnerships, and strategic alliances. Innovation processes have progressively become interdisciplinary, collaborative, inter-organizational, and international, and a firm's ability to synthesize knowledge across disciplines, organizations, and geographical locations has a major influence on its viability and success.This book demonstrates how knowledge integration is crucial in facilitating innovation within modern firms. It provides original, detailed empirical studies of prerequisites, mechanisms, and outcomes of knowledge integration processes on several organizational levels, from key individuals, projects, and internal organizations, to collaboration between firms. It stresses the need to understand knowledge integration as a multi-level phenomenon, which requires a broad repertoire of organizational and technical means. It further clarifies the need for strong internal capabilities for exploiting external knowledge, reveals how costs of knowledge integration affect outcomes and strategic decisions, and discusses the managerial implications of fostering knowledge integration, providing practical guidance and support for managers of knowledge integration in
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| 16. |
- Flisbäck, Marita, 1973, et al.
(author)
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Exploring blind spots of retirement: Individuals’ meaning-making from an existential sociology perspective
- 2014
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In: The 27th Conference of the Nordic Sociological Association, Exploring Blind Spots, Lund, Sweden, August 14–16 2014. ; , s. 1-21
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Conference paper (other academic/artistic)abstract
- The aim of this paper is to develop a theoretical framework for the exploration of ‘blind spots of retirement’ as part of the research project ‘Towards a new everyday: Individuals’ meaning-making at the entry of retirement from a social inequality perspective’. Retirement is regarded as a socially marked point in the life course of individuals that signalizes societal norms on when it is appropriate to withdraw from employment. However, these norms do not always coincide with peoples’ needs and values. Some have to withdraw earlier due to illness; others both want and are able to work for several additional years. Even if the paths of withdrawal are heterogeneous, retirement is a main transitional phase in peoples’ lives as they depart from everyday labour activities and its associated communities, identities and meaning-making processes. Thus, we introduce a new sociological framework for the study of retirement by combining important insights from areas as existential sociology, sociology of work and the welfare state, cultural sociology and social stratification. This theoretical framework deals with the prominent values, norms and beliefs in the institutions of retirement and employment, with meaning-making and social identity formation, and with the issue of social inequality. We present a holistic perspective serving a methodological approach of what retirement as a transitional phase means for individuals – existentially, socially and materially. Thus, we will be able to explore blind spots in how people create meaning, as well as consider and establish new routines, identities and social belongings. We highlight into what extent existential issues, new forms of meaning-making and identities are related to social inequality and shaped by the strong work ethic in Western societies.
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| 17. |
- Flowers, Sarah A., et al.
(author)
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Decrease of core 2 O-glycans on synovial lubricin in osteoarthritis reduces galectin-3 mediated crosslinking
- 2020
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In: Journal of Biological Chemistry. - 0021-9258 .- 1083-351X. ; 295:47, s. 16023-16036
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Journal article (peer-reviewed)abstract
- The synovial fluid glycoprotein lubricin (also known as proteoglycan 4) is a mucin-type O-linked glycosylated biological lubricant implicated to be involved in osteoarthritis (OA) development. Lubricin's ability to reduce friction is related to its glycosylation consisting of sialylated and unsialylated Tn-antigens and core 1 and core 2 structures. The glycans on lubricin have also been suggested to be involved in crosslinking and stabilization of the lubricating superficial layer of cartilage by mediating interaction between lubricin and galectin-3. However, with the spectrum of glycans being found on lubricin, the glycan candidates involved in this interaction were unknown. Here, we confirm that the core 2 O-linked glycans mediate this lubricin-galectin-3 interaction, shown by surface plasmon resonance data indicating that recombinant lubricin (rhPRG4) devoid of core 2 structures did not bind to recombinant galectin-3. Conversely, transfection of Chinese hamster ovary cells with the core 2 GlcNAc transferase acting on a mucin-type O-glycoprotein displayed increased galectin-3 binding. Both the level of galectin-3 and the galectin-3 interactions with synovial lubricin were found to be decreased in late-stage OA patients, coinciding with an increase in unsialylated core 1 O-glycans (T-antigens) and Tn-antigens. These data suggest a defect in crosslinking of surface-active molecules in OA and provide novel insights into OA molecular pathology.
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| 18. |
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| 19. |
- Kadefors, Anna, Professor, 1962-, et al.
(author)
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Samverkan Hög inom väg- och järnvägsunderhåll : Uppföljning av tidiga skeden i tre pilotkontrakt
- 2023
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Reports (other academic/artistic)abstract
- BakgrundAffärsformerna för drifts- och underhållskontrakt har varit föremål för diskussion av flera olika anledningar de senaste åren. Dels har entreprenörerna påtalat att osäkerheten i uppdragens innehåll är för stor för att de traditionella mängdkontrakten, upphandlade på lägsta pris, ska fungera bra. Man menar att sådana kontrakt medför stora risker för företagen och även påverkar arbetsmiljön och förutsättningarna att rekrytera personal till branschen negativt. Entreprenörerna har därför efterlyst kontrakt med mindre risk och bättre samverkan. En annan aspekt är att Trafikverkets egna kontraktsanalyser och Riksrevisionens granskningar har pekat på att taktiserad prissättning (obalanserad budgivning) i traditionella driftkontrakt medför att Trafikverket har bristande kunskap om kostnadsbilden och även kan leda till ineffektiv användning av statliga resurser.Trafikverket har sedan några år börjat testa samverkansinriktade upphandlingsstrategier (Samverkan Hög) i större investeringsprojekt inom verksamhetsområdena Stora projekt och Investering. Utifrån dessa erfarenheter och kritiken mot de traditionella kontrakten beslöt Trafikverket att även utveckla en kontraktsmodell för Samverkan Hög för baskontrakt för väg- och järnvägsunderhåll. Den nya kontraktsmodellen innebär att entreprenören upphandlas i ett tidigt skede, baserat på kvalitetsparametrar samt entreprenörarvodet. Kontraktet delas in i två faser, där Fas 1 utgörs av en process där entreprenören och beställaren gemensamt tar fram genomförandeplan, produktionskalkyl, detaljerad tidplan och riktkostnad. I Fas 2, som är en option, ingår sedan etablering (Fas 2a) och utförande av basunderhåll (Fas 2b). Våren 2020 upphandlade Trafikverket tre pilotkontrakt med kontraktsmodellen Samverkan Hög inom drift och underhåll: två vägkontrakt och ett järnvägskontrakt.Under hösten 2021 initierades ett nytt forskningsprojekt i samarbete mellan Trafikverket och forskare knutna till det nationella forskarnätverket ProcSIBE ((Procurement for Sustainable Innovation in the Built Environment[1]) för att följa upp och utvärdera kontraktsmodellen Samverkan Hög inom basunderhåll för väg och järnväg. Hela forskningsprojektet omfattar tre delstudier av anbudsskedet, Fas 1 samt Fas 2. Den här rapporten behandlar Fas 1 i de tre pilotkontrakten. De två vägkontrakten har följts upp genom intervjuer med Trafikverket och entreprenörerna. Forskningsprojektet kommer att fortsätta med att följa upp utvecklingen under Fas 2 och även jämföra med två traditionellt upphandlade kontrakt. Järnvägskontraktet avbröts efter Fas 1 och uppföljningen av detta baseras på medverkan i tre workshops som organiserades av Trafikverket efter avbrottet.ResultatIntervjuerna visar på ett stort stöd bland de intervjuade, även på järnvägssidan, för att arbeta mer samverkansinriktat. De fördelar som framhålls har att göra med ökad resurseffektivitet och innovation, bättre arbetsmiljö som ökar branschens attraktivitet, samt att lägre risk gör det lättare för nya aktörer att etablera sig på marknaden. Sammanfattningsvis visar erfarenheterna på en betydande potential i den modell som har testats, men det är också tydligt att det behövs ytterligare utveckling och justeringar, liksom kompetensutveckling och ett mer långsiktigt utvecklingsarbete.Några centrala resultat och rekommendationer sammanfattas nedan[2]:· För att lyckas i ett samverkanskontrakt är det avgörande att ledande personer på båda sidor är erfarna i sina roller, tror på samverkan, har skaffat sig en förståelse av både kontrakt och etablerade principer för samverkan, och inte underskattar uppgiftens komplexitet. Båda kontraktsparterna behöver därför ha funktioner som kan förbereda personalen, följa upp samverkan och flytta personer som inte fungerar. Detta är en organisatorisk kompetens som även kan bedömas vid utvärdering av anbud.· För Trafikverket har insynen i entreprenörernas kostnadskalkyler inneburit en ökad förståelse av hur förfrågningsunderlagen för driftkontrakt ska vara konstruerade för att vara lätta för entreprenörerna att prissätta och minska onödiga riskpåslag. Man har också kunnat konstatera att Trafikverkets egenkalkyler stämmer relativt bra. Arbetet med att ta fram självkostnader för olika poster tog dock betydligt mer tid och kraft än vad man hade förväntat sig. Utifrån den kunskap man nu har fått skulle Trafikverket och entreprenörsidan kunna gå vidare och gemensamt identifiera principer för prissättning och områden där det kan vara bättre att använda schabloner. Kostnadsindexering, viten och bonusar behöver också ses över på basis av de erfarenheter som gjorts i pilotkontrakten.· Det finns goda möjligheter för utveckling och innovation i Samverkan Högkontrakten. En viktig lärdom är att förutsättningarna för att driva utvecklingsarbete i driftkontrakt snarast är bättre i Fas 2, då hela organisationen och alla underentreprenörer är på plats. Detta är en skillnad mot investeringsprojekt, där Fas 1 uppfattas vara mest central. Medarbetarna på projektnivån upplever dock att Trafikverkets ambitioner har varit otydliga, framför allt när det gäller vilken frihet pilotkontrakten haft att utmana regelverken. Inför Fas 2 och kommande kontrakt behöver Trafikverket förtydliga vilka frihetsgrader som finns, samt aktivt stödja nytänkande även under Fas 2.· De flesta av de intervjuade ser betydande fördelar med samverkan med Samverkan Hög och menar att kommande projekt kan ha stor nytta av de lärdomar som gjorts. Trafikverksrepresentanterna upplever dock att det interna stödet för pilotkontrakten har minskat över tid och att syftet att driva utveckling har ersatts av ett ensidigt fokus på kostnadsutvecklingen på kort sikt. Man ser ingen tydlig plan för hur erfarenheterna ska föras vidare och upplever att rutiner och funktioner för att stödja sådant lärande till stor del saknas.· För att investera i ny kunskap och anpassa sina strategier behöver entreprenörerna se en tydlig riktning, men även de intervjuade entreprenörrepresentanterna uppfattar Trafikverkets långsiktiga målsättningar för Samverkan Hög och andra samverkansmodeller inom driftverksamheten som oklara. Flera intervjuade från både Trafikverket och entreprenörerna lyfter risken att förlora tid och missa chansen att vara på erfarenheterna från de tre kontrakten.· En slutsats är att Trafikverket bör överväga att snarast starta ytterligare några pilotkontrakt där konceptet utvecklas baserat på lärdomarna från pilotkontrakten. Det är också viktigt att ta fram en plan för fortsättningen baserat på de resultat som kommer fram. ProcSIBEs tidigare studier har visat att Trafikverket har svårt att uppnå tillräcklig uthållighet och systematik det förändringsarbete man driver kopplat till kontraktsmodeller. För att stärka kan Trafikverket kommunicera strategier och planer brett samt involvera andra beställare, branschrepresentanter och forskning i utveckling och uppföljning. Detta skulle öka trycket på Trafikverket att hålla fast vid intentioner och överenskommelser, bygga förtroende samt tillföra fler kunskaper och perspektiv. [1] ProcSIBE (på svenska: Upphandling för ett hållbart och innovativt samhällsbyggande) har under flera år studerat och utvärderat ett flertal modeller som Trafikverket har tillämpat för upphandling av olika typer av uppdrag. Se www.procsibe.se för mer information och rapporter från tidigare studier. [2] Fler slutsatser och rekommendationer återfinns i kapitel 8 i rapporten.
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| 20. |
- Löfqvist, Lars, 1973-
(author)
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Innovation and Design Processes in Small Established Companies
- 2009
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Licentiate thesis (other academic/artistic)abstract
- This thesis examines innovation and design processes in small established companies. There is a great interest in this area yet paradoxically the area is under-researched, since most innovation research is done on large companies. The research questions are: How do small established companies carry out their innovation and design processes? and How does the context and novelty of the process and product affect the same processes?The thesis is built on three research papers that used the research method of multiple case studies of different small established companies. The innovation and design processes found were highly context dependent and were facilitated by committed resources, a creative climate, vision, low family involvement, delegated power and authority, and linkages to external actors such as customers and users. Both experimental cyclical and linear structured design processes were found. The choice of structure is explained by the relative product and process novelty experienced by those developing the product innovation. Linear design processes worked within a low relative novelty situation and cyclical design processes worked no matter the relative novelty. The innovation and design processes found were informal, with a low usage of formal systematic design methods, except in the case of design processes for software. The use of formal systematic methods in small companies seems not always to be efficient, because many of the problems the methods are designed to solve are not present. Customers and users were found to play a large and important role in the innovation and design processes found and gave continuous feedback during the design processes. Innovation processes were found to be intertwined, yielding synergy effects, but it was common that resources were taken from the innovation processes for acute problems that threatened the cash flow. In sum, small established companies have the natural prerequisites to take advantage of lead-user inventions and cyclical design processes. Scarce resources were found to be the main factor hindering innovation, but the examined companies practiced several approaches to increase their resources or use existing scarce resources more efficiently in their innovation and design processes. Examples of these approaches include adopting lead-user inventions and reducing formality in the innovation and design processes.
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| 21. |
- Mohammad, Majd, et al.
(author)
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Staphylococcus aureus lipoproteins promote abscess formation in mice, shielding bacteria from immune killing.
- 2021
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In: Communications biology. - : Springer Science and Business Media LLC. - 2399-3642. ; 4:1
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Journal article (peer-reviewed)abstract
- Despite being a major bacterial factor in alerting the human immune system, the role of Staphylococcus aureus (S. aureus) lipoproteins (Lpp) in skin infections remains largely unknown. Here, we demonstrated that subcutaneous injection of S. aureus Lpp led to infiltration of neutrophils and monocytes/macrophages and induced skin lesions in mice. Lipid-moiety of S. aureus Lpp and host TLR2 was responsible for such effect. Lpp-deficient S. aureus strains exhibited smaller lesion size and reduced bacterial loads than their parental strains; the altered phenotype in bacterial loads was TLR2-independent. Lpp expression in skin infections contributed to imbalanced local hemostasis toward hypercoagulable state. Depletion of leukocytes or fibrinogen abrogated the effects induced by Lpp in terms of skin lesions and bacterial burden. Our data suggest that S. aureus Lpp induce skin inflammation and promote abscess formation that protects bacteria from innate immune killing. This suggests an intriguing bacterial immune evasion mechanism.
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| 22. |
- Nyman, Emma, et al.
(author)
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Reduced progression of carotid intima media thickness by personalised pictorial presentation of subclinical atherosclerosis in VIPVIZA : A randomised controlled trial
- 2023
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In: Clinical Physiology and Functional Imaging. - : John Wiley & Sons. - 1475-0961 .- 1475-097X. ; 43:4, s. 232-241
-
Journal article (peer-reviewed)abstract
- Objectives: Reduced progression of atherosclerosis can decrease the risk of cardiovascular disease (CVD). This study aimed at evaluating the effect of a pictorial intervention showing atherosclerotic severity on the progression of carotid atherosclerosis.Methods: A prospective randomised open-label blinded end-point trial with participants aged 40–60 years enroled from a routine CVD prevention programme. The intervention group (n: 1575) and their treating physicians received an image based presentation of subclinical atherosclerotic severity measured by carotid ultrasound. The control group (n: 1579) did not receive any information about ultrasound results. Carotid ultrasound at baseline and at 3-year follow-up contained plaque detection and measurements of carotid intima media thickness (cIMT). The left, right and bilateral-mean-cIMT, plaque prevalence and total plaque area (TPA) at 3-year follow-up were compared between groups. Significance level was set to p = 0.01 to adjust for multiple comparisons.Results: The intervention group revealed reduced cIMT progression in the left-mean-cIMT of −0.011 mm (p = 0.001) compared with the control group. The intervention effect on cIMT progression was most prominent in individuals with increased cIMT and plaque prevalence at baseline (−0.021 mm, p = 0.005). There were no differences in progression between groups for the right-and bilateral-mean-cIMT (−0.005 mm, p = 0.223 and −0.005 mm, p = 0.036, respectively), nor any differences between groups for plaque prevalence or TPA (odds ratio 0.88, p = 0.09 and 0.89, p = 0.21, respectively).Conclusion: Pictorial presentation of subclinical atherosclerotic severity sent to both the individual and their treating physician resulted in significantly reduced left cIMT progression. Pictorial presentation has the potential to increase adherence in CVD prevention.
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| 23. |
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| 24. |
- Olsson, Daniel S, 1983, et al.
(author)
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Life expectancy in patients with pituitary adenoma receiving growth hormone replacement.
- 2017
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In: European journal of endocrinology. - 1479-683X. ; 176:1, s. 67-75
-
Journal article (peer-reviewed)abstract
- Hypopituitarism has been associated with increased mortality. The excess mortality may be due to untreated growth hormone (GH) deficiency but also due to various underlying disorders. We therefore analysed mortality in patients with only one underlying disorder, non-functioning pituitary adenoma (NFPA), with and without GH replacement therapy (GHRT).Patients with NFPA in the western region of Sweden, 1997-2011, were identified through the National Patient Registry and cross-referenced with several National Health Registries. All patient records were reviewed. Standardised mortality ratios (SMRs) with 95% confidence intervals (CIs) were calculated using the general population as reference. Cox-regression models were performed to identify predictors of mortality.A total of 426 NFPA patients with 4599 patient-years were included, of whom 207 had used GHRT and 219 had not received GHRT. Median (range) follow-up in patients with and without GHRT was 12.2 (0-25) and 8.2 (0-27) years, respectively. Other pituitary hormone deficiencies were more frequent in the GHRT group than those in the non-GHRT group. SMR was 0.65 (95% CI, 0.44-0.94; P=0.018) for the GHRT group and 1.16 (0.94-1.42; P=0.17) for the non-GHRT group. Direct comparison between the groups showed reduced mortality among those who were GH replaced (P=0.0063). The SMR for malignant tumours was reduced in the GHRT-group (0.29; 0.08-0.73; P=0.004) but not in untreated patients.Selection bias explaining some of the results cannot be excluded. However, NFPA patients with GHRT had reduced overall mortality compared with the general population, and death due to malignancy was not increased. This suggests that long-term GHRT is safe in adult patients selected for treatment.
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| 25. |
- Sjöström, Lars, et al.
(author)
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Effects of bariatric surgery on cancer incidence in obese patients in Sweden (Swedish Obese Subjects Study): a prospective, controlled intervention trial.
- 2009
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In: The lancet oncology. - 1474-5488. ; 10:7, s. 653-62
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Journal article (peer-reviewed)abstract
- BACKGROUND: Obesity is a risk factor for cancer. Intentional weight loss in the obese might protect against malignancy, but evidence is limited. To our knowledge, the Swedish Obese Subjects (SOS) study is the first intervention trial in the obese population to provide prospective, controlled cancer-incidence data. METHODS: The SOS study started in 1987 and involved 2010 obese patients (body-mass index [BMI] >or=34 kg/m(2) in men, and >or=38 kg/m(2) in women) who underwent bariatric surgery and 2037 contemporaneously matched obese controls, who received conventional treatment. While the main endpoint of SOS was overall mortality, the main outcome of this exploratory report was cancer incidence until Dec 31, 2005. Cancer follow-up rate was 99.9% and the median follow-up time was 10.9 years (range 0-18.1 years). FINDINGS: Bariatric surgery resulted in a sustained mean weight reduction of 19.9 kg (SD 15.6 kg) over 10 years, whereas the mean weight change in controls was a gain of 1.3 kg (SD 13.7 kg). The number of first-time cancers after inclusion was lower in the surgery group (n=117) than in the control group (n=169; HR 0.67, 95% CI 0.53-0.85, p=0.0009). The sex-treatment interaction p value was 0.054. In women, the number of first-time cancers after inclusion was lower in the surgery group (n=79) than in the control group (n=130; HR 0.58, 0.44-0.77; p=0.0001), whereas there was no effect of surgery in men (38 in the surgery group vs 39 in the control group; HR 0.97, 0.62-1.52; p=0.90). Similar results were obtained after exclusion of all cancer cases during the first 3 years of the intervention. INTERPRETATION: Bariatric surgery was associated with reduced cancer incidence in obese women but not in obese men. FUNDING: Swedish Research Council, Swedish Foundation for Strategic Research, Swedish Federal Government under the LUA/ALF agreement, Hoffmann La Roche, Cederoths, AstraZeneca, Sanofi-Aventis, Ethicon Endosurgery.
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