| 1. |
- Andersson, Ulf, 1985-, et al.
(author)
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Clinical reasoning in the emergency medical services: an integrative review
- 2019
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In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. - : Springer Science and Business Media LLC. - 1757-7241.
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Journal article (peer-reviewed)abstract
- Abstract: Clinical reasoning is the process of gathering and understanding information conducted by clinicians in the emergency medical services (EMS) so as to make informed decisions. Research on clinical reasoning spans several disciplines, but a comprehensive view of the process is lacking. To our knowledge, no review of clinical reasoning in the EMS has been conducted.Aim: The aim was to investigate the nature, deployment, and factors influencing EMS clinicians’ clinical reasoning by means of a review.Method: Data was collected through searches in electronic databases, networking among research teams ,colleagues and friends, “grey literature,” and through ancestry searches. A total of 38 articles were deemed eligible for inclusion and were analyzed using descriptive thematic analysis. The analysis resulted in an overarching finding -namely, the importance for EMS clinicians to adjust for perceived control in unpredictable situations. Within this finding, 3 themes emerged in terms of EMS clinicians’ clinical reasoning: (1) maintaining a holistic view of the patient; (2) keeping an open mind; and (3) improving through criticism. Seven subthemes subsequently emerged from these three themes.Results: This review showed that EMS clinicians’ clinical reasoning begins with the information that they are given about a patient. Based on this information, clinicians calculate the best route to the patient and which equipment to use, and they also assess potential risks. They need to be constantly aware of what is happening on the scene and with the patient and strive to control the situation. This striving also enables EMS clinicians to work safely and effectively in relation to the patient, their relatives, other clinicians, associated organizations, and the wider community. A lack of contextually appropriate guidelines results in the need for creativity and forces EMS clinicians to use “workarounds” to solve issues beyond the scope of the guidelines available. In addition, they often lack organizational support and fear repercussions such as litigation, unemployment, or blame by their EMS or healthcare organization or by patients and relatives.Conclusion: Clinical reasoning is influenced by several factors. Further research is needed to determine which influencing factors can be addressed through interventions to minimize their impact on patient outcomes.
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| 2. |
- Andersson, Henrik, 1968-, et al.
(author)
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Simulation in Virtual World to Promote Communication
- 2018
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In: Pre-hospital care- Education and training of ambulance professionals. - Noordwijkerhout, The Netherlands.
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Conference paper (other academic/artistic)abstract
- Introduction Communication between ambulance professionals and patients is essential for understanding the patient's lifeworld (Wireklint Sundström & Dahlberg 2010). Simultaneously, communication is challenging to teach and learn within the framework of specific courses. However, simulation in virtual worlds can support the development of new skills such as communication (Combs, Sokolowski & Banks 2016). AimThe aim of this work was to design a simulation-based platform for communication training among ambulance nurse students (ANS). MethodsA qualitative action research approach was used (Coghlan & Casey 2001). Second Life® (SL) was selected since it was an existing virtual world. SL is a web-based flexible three-dimensional platform that allows customization. Interaction and communication with other virtual people can be done through avatars in real time (Hodge, Collins & Giordano 2011). Three ANS and five teachers participated, none of the participants had prior experience of SL. Observations and interviews were used as data and analysed using thematic analysis. Results The participants’ experiences generated three themes: Understanding the virtual worldIt was easy to interact and communicate with other virtual people. However, it took time to feel comfortable to navigate in SL. Technological challengesOne challenge was related to audio-visual problems e.g. not compatible headset, interfering echoes and that the image was distorted at times, which made it difficult to act and move the avatar. Another challenge was associated with the 3D modelling e.g. the capability to use of coordinates, positioning, object dimensioning and the fact that accidental deletions could not be restored. A third challenges that influenced the communication was the difficulty of visualizing clinically relevant care measures such as diagnostic examinations or drug treatment. Finally, there was a challenge to customize the avatars to look like ambulance professionals or a severely ill patient. Learning through avatars Learning through avatars requires that the participants take responsibility for delivering a convincing performance. Immersion was limited since actions do not take place from a first-person viewpoint. There is a need that the scenario is based on realistic conditions e.g. interiors, equipment, clothing, avatar appearance and behaviour. Conclusion The present system is not suitable for training of medical assessment. Teachers who are considering using virtual worlds in the training for future ambulance professionals should note that an appropriate design is crucial for how the simulation is experienced.
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| 3. |
- Axelsson, Christer, et al.
(author)
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The Early Chain of Care in Patients with Bacteraemia with the Emphasis on the Prehospital Setting
- 2016
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In: Prehospital and Disaster Medicine. - : Cambridge University Press. - 1049-023X .- 1945-1938. ; 31:3, s. 272-277
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Journal article (peer-reviewed)abstract
- There is a lack of knowledge about the early phase of severe infection. This report describes the early chain of care in bacteraemia as follows: (a) compare patients who were and were not transported by the Emergency Medical Services (EMS); (b) describe various aspects of the EMS chain; and (c) describe factors of importance for the delay to the start of intravenous antibiotics. It was hypothesized that, for patients with suspected sepsis judged by the EMS clinician, the delay until the onset of antibiotic treatment would be shorter.All patients in the Municipality of Gothenburg (Sweden) with a positive blood culture, when assessed at the Laboratory of Bacteriology in the Municipality of Gothenburg, from February 1 through April 30, 2012 took part in the survey.In all, 696 patients fulfilled the inclusion criteria. Their mean age was 76 years and 52% were men. Of all patients, 308 (44%) had been in contact with the EMS and/or the emergency department (ED). Of these 308 patients, 232 (75%) were transported by the EMS and 188 (61%) had “true pathogens” in blood cultures. Patients who were transported by the EMS were older, included more men, and suffered from more severe symptoms and signs.The EMS nurse suspected sepsis in only six percent of the cases. These patients had a delay from arrival at hospital until the start of antibiotics of one hour and 19 minutes versus three hours and 21 minutes among the remaining patients (P =.0006). The corresponding figures for cases with “true pathogens” were one hour and 19 minutes versus three hours and 15 minutes (P =.009).Among patients with bacteraemia, 75% used the EMS, and these patients were older, included more men, and suffered from more severe symptoms and signs. The EMS nurse suspected sepsis in six percent of cases. Regardless of whether or not patients with true pathogens were isolated, a suspicion of sepsis by the EMS clinician at the scene was associated with a shorter delay to the start of antibiotic treatment.
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| 4. |
- Bombarda, F., et al.
(author)
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Runaway electron beam control
- 2019
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In: Plasma Physics and Controlled Fusion. - : IOP Publishing. - 1361-6587 .- 0741-3335. ; 61:1
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Journal article (peer-reviewed)
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| 5. |
- Eriksson, Frida, 1986, et al.
(author)
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Interpretative and predictive modelling of Joint European Torus collisionality scans
- 2019
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In: Plasma Physics and Controlled Fusion. - : Institute of Physics Publishing (IOPP). - 0741-3335 .- 1361-6587. ; 61:11
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Journal article (peer-reviewed)abstract
- Transport modelling of Joint European Torus (JET) dimensionless collisionality scaling experiments in various operational scenarios is presented. Interpretative simulations at a fixed radial position are combined with predictive JETTO simulations of temperatures and densities, using the TGLF transport model. The model includes electromagnetic effects and collisions as well as (E)over-right-arrow x (b)over-right-arrow shear in Miller geometry. Focus is on particle transport and the role of the neutral beam injection (NBI) particle source for the density peaking. The experimental 3-point collisionality scans include L-mode, and H-mode (D and H and higher beta D plasma) plasmas in a total of 12 discharges. Experimental results presented in (Tala et al 2017 44th EPS Conf.) indicate that for the H-mode scans, the NBI particle source plays an important role for the density peaking, whereas for the L-mode scan, the influence of the particle source is small. In general, both the interpretative and predictive transport simulations support the experimental conclusions on the role of the NBI particle source for the 12 JET discharges.
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| 6. |
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| 7. |
- Gustavsson, Carolina, et al.
(author)
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Cerebrospinal fluid levels of insulin, leptin, and agouti-related protein in relation to BMI in pregnant women
- 2016
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In: Obesity. - : Wiley. - 1930-7381. ; 24:6, s. 1299-1304
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Journal article (peer-reviewed)abstract
- ObjectiveDuring pregnancy, metabolic interactions must be adapted, though neuroendocrine mechanisms for increased food intake are poorly understood. The objective of this study was to characterize differences in insulin, leptin, and agouti-related protein (AgRP) levels in serum and cerebrospinal fluid (CSF) in pregnant women with normal weight (NW) and pregnant women with overweight (OW) or obesity (OB). Placenta as a source for increased peripheral AgRP levels during pregnancy was also investigated. MethodsWomen were recruited at admission for elective cesarean section. Insulin, AgRP, and leptin were measured in serum and CSF from 30 NW, 25 OW, and 21 OB at term. Serum during pregnancy and placenta at term were collected for further AgRP analysis. ResultsImmunohistology showed placental production of AgRP and serum AgRP levels increased throughout pregnancy. CSF AgRP, leptin, and insulin levels were higher in OW and OB than NW. Serum leptin and insulin levels were higher and AgRP lower in OB than NW. ConclusionsHigh serum AgRP levels might protect from the suppressive effects of leptin during pregnancy. Pregnant women with OB and OW might further be protected from the suppressive effect of leptin by high CSF AgRP levels. Evidence was found, for the first time, of human placental AgRP production mirrored by levels in the circulation.
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| 8. |
- Maurin Söderholm, Hanna, et al.
(author)
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Research challenges in prehospital care : the need for a simulation-based prehospital research laboratory
- 2019
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In: Advances in Simulation. - : BioMed Central. - 2059-0628 .- 2059-0628. ; 4:3, s. 1-6
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Journal article (peer-reviewed)abstract
- There is a need for improved research in the field of prehospital care. At the same time, there are many barriers in prehospital research due to the complex context, posing unique challenges for research, development, and evaluation. The present paper argues for the potential of simulation for prehospital research, e.g., through the development of an advanced simulation-based prehospital research laboratory. However, the prehospital context is different from other healthcare areas, which implies special requirements for the design of this type of laboratory, in terms of simulation width (including the entire prehospital work process) and depth (level of scenario detail). A set of features pertaining to simulation width, scenario depth, equipment, and personnel and competence are proposed. Close tailoring between these features and the prehospital research problems and context presents great potential to improve and further prehospital research.
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| 9. |
- Olander, Agnes, et al.
(author)
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Prehospital characteristics among patients with sepsis: a comparison between patients with or without adverse outcome
- 2019
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In: Bmc Emergency Medicine. - : Springer Science and Business Media LLC. - 1471-227X. ; 19:1
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Journal article (peer-reviewed)abstract
- Background The prehospital care of patients with sepsis are commonly performed by the emergency medical services. These patients may be critically ill and have high in-hospital mortality rates. Unfortunately, few patients with sepsis are identified by the emergency medical services, which can lead to delayed treatment and a worse prognosis. Therefore, early identification of patients with sepsis is important, and more information about the prehospital characteristics that can be used to identify these patients is needed. Based on this lack of information, the objectives of this study were to investigate the prehospital characteristics that are identified while patients with sepsis are being transported to the hospital by the emergency medical services, and to compare these values to those of the patients with and without adverse outcomes during their hospital stays. Methods This was a retrospective observational study. The patients' electronic health records were reviewed and selected consecutively based on the following: retrospectively diagnosed with sepsis and transported to an emergency department by the emergency medical services. Data were collected on demographics, prehospital characteristics and adverse outcomes, defined as the in-hospital mortality or treatment in the intensive care unit, and analysed by independent sample t-test and chi-square. Sensitivity, specificity and likelihood ratio, of prehospital characteristics for predicting or development of adverse outcome were analysed. Results In total, 327 patients were included. Of these, 50 patients had adverse outcomes. When comparing patients with or without an adverse outcome, decreased oxygen saturation and body temperature, increased serum glucose level and altered mental status during prehospital care were found to be associated with an adverse outcome. Conclusions The findings suggests that patients having a decreased oxygen saturation and body temperature, increased serum glucose level and altered mental status during prehospital care are at risk of a poorer patient prognosis and adverse outcome. Recognizing these prehospital characteristics may help to identify patients with sepsis early and improve their long-term outcomes. However further research is required to predict limit values of saturation and serum glucose and to validate the use of prehospital characteristics for adverse outcome in patients with sepsis.
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| 10. |
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- 2018
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In: Nuclear Fusion. - : IOP Publishing. - 1741-4326 .- 0029-5515. ; 58:9
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Journal article (peer-reviewed)
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| 11. |
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- 2018
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In: Nuclear Fusion. - : IOP Publishing. - 1741-4326 .- 0029-5515. ; 58:1
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Research review (peer-reviewed)
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| 12. |
- Adman, Per, et al.
(author)
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171 forskare: ”Vi vuxna bör också klimatprotestera”
- 2019
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In: Dagens nyheter (DN debatt). - Stockholm. - 1101-2447.
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Journal article (pop. science, debate, etc.)abstract
- DN DEBATT 26/9. Vuxna bör följa uppmaningen från ungdomarna i Fridays for future-rörelsen och protestera eftersom det politiska ledarskapet är otillräckligt. Omfattande och långvariga påtryckningar från hela samhället behövs för att få de politiskt ansvariga att utöva det ledarskap som klimatkrisen kräver, skriver 171 forskare i samhällsvetenskap och humaniora.
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| 13. |
- Ahlgren, Erika, et al.
(author)
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Association between Plasma Homocysteine Levels and Neuronal Injury in HIV Infection
- 2016
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In: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 11:7
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Journal article (peer-reviewed)abstract
- Objective To investigate the role of homocysteine in neuronal injury in HIV infection. Methods Using a cross-sectional design and archived samples, we compared concentrations of plasma homocysteine and cerebrospinal fluid (CSF) neurofilament light protein (NFL), a sensitive marker of neuronal injury, in 83 HIV-1-infected subjects without antiretroviral treatment. We also analyzed plasma vitamin B12, serum folate, CSF, and plasma HIV RNA, the immune activation marker neopterin in CSF and serum, and albumin ratio as a marker of blood-brain barrier integrity. Twenty-two subjects provided a second sample median of 12.5 months after antiretroviral treatment initiation. Results A significant correlation was found between plasma homocysteine and CSF NFL concentrations in untreated individuals (r = 0.52, p < 0.0001). As expected, there was a significant inverse correlation between homocysteine and B12 (r = -0.41, p < 0.001) and folate (r = -0.40, p = < 0.001) levels. In a multiple linear regression analysis homocysteine stood out as an independent predictor of CSF NFL in HIV-1-infected individuals. The correlation of plasma homocysteine and CSF NFL was also present in the group receiving antiretroviral therapy (r = 0.51, p = 0.016). Conclusion A correlation between plasma homocysteine and axonal injury, as measured by CSF NFL, was found in both untreated and treated HIV. While this study is not able to prove a causal link, homocysteine and functional B12/folate deficiency appear to play a role in neural injury in HIV-infected individuals.
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| 14. |
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| 15. |
- Andersson, Anneli, 1992-, et al.
(author)
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Genetic overlap between ADHD and externalizing, internalizing and neurodevelopmental disorder symptoms : a systematic review and meta-analysis
- 2018
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In: Behavior Genetics. - : Springer. - 0001-8244 .- 1573-3297. ; 48:6, s. 455-456
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Journal article (other academic/artistic)abstract
- Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder (Wilens, Biederman & Spencer 2002) and affects approximately 5% of children (Polanczyk, de Lima, Horta, Biederman & Rohde 2007). About half of those diagnosed in childhood continue to have the diagnosis and symptoms in adulthood (Kessler et al. 2006). The co-occurrence of ADHD with other psychiatric disorder symptoms (Burt et al. 2001; Cole et al. 2009; Polderman et al. 2014) has been suggested to be partly explained by a shared genetic vulnerability (Polderman et al. 2014). However, the strength of the genetic overlap is currently unclear. Also, no study has examined whether the genetic correlations differs between age groups (childhood versus adulthood), by rater (self-report, other informant, combined (parent-teacher, parent-twin, teacher-twin)), or by type of psychiatric disorder symptoms (externalizing, internalizing, neu-rodevelopmental). To address this gap, we conducted a systematic literature search to identify relevant twin studies, in PubMed, PsycINFO, and EMBASE. A total of 31 articles were identified and included in the present study. The pooled estimates showed that the comorbidity between ADHD and diverse psychiatric disorder symptoms were explained by shared genetic effectsrg= 0.50 (0.43–0.56). A similar shared genetic overlap between ADHD and psychiatric disorder symptoms was observed in both childhood rg= 0.51(0.42–0.61) and adulthood rg= 0.47 (0.40–0.53). Similar results werealso found for self-reports rg= 0.49 (0.42–0.55), other informants rg= 0.50 (0.40–0.60), and combined raters rg= 0.51 (0.30–0.69). Further, the strength of the genetic correlations of ADHD with the externalizing rg= 0.49 (0.39–0.59), internalizing rg= 0.55 (0.40–0.68) and neurodevelopmental rg= 0.47 (0.40–0.53) spectrums were similar in magnitude. These findings emphasize the presence of a shared genetic liability between ADHD and externalizing, internalizing and neurodevelopmental disorder symptoms, independent of age and rater.ReferencesBurt, S. A., Krueger, R. F., McGue, M., Iacono, W. G. (2001).Sources of covariation among attention-deficit/hyperactivity disorder,oppositional defiant disorder, and conduct disorder: the importance ofshared environment.Journal of Abnormal Psychology, 4, 516–525.Cole, J., Ball, H. A., Martin, N. C., Scourfield, J., McGuffin, P.(2009). Genetic overlap between measures of hyperactivity/inatten-tion and mood in children and adolescents.J Am Acad Child AdolescPsychiatry48, 1094–1101.Kessler, R. C., Adler, L., Barkley, R., Biederman, J., Conners, C.K., Demler, O., Faraone, S. V., Greenhill, L. L., Howes, M. J., Secnik,K., Spencer, T., Ustun, T. B., Walters, E. E., Zaslavsky, A. M. (2006).The prevalence and correlates of adult ADHD in the United States:results from the National Comorbidity Survey Replication.Am JPsychiatry, 163, 716–723.Polanczyk, G., de Lima, M. S., Horta, B. L., Biederman, J., Rohde,L. A. (2007). The worldwide prevalence of ADHD: a systematicreview and metaregression analysis.Am J Psychiatry, 164, 942-8.Polderman, T. J., Hoekstra, R. A., Posthuma, D., Larsson, H.(2014). The co-occurrence of autistic and ADHD dimensions inadults: an etiological study in 17,770 twins.Transl Psychiatry2014;4: e435.Wilens, T. E., Biederman, J., Spencer, T. J. (2002). Attentiondeficit/hyperactivity disorder across the lifespan.Annual Review Med53:113–131.
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| 16. |
- Andersson, Henrik, 1968-, et al.
(author)
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Acute coronary syndrome in relation to the occurrence of associated symptoms : A quantitative study in prehospital emergency care.
- 2017
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In: International Emergency Nursing. - : Elsevier BV. - 1755-599X .- 1878-013X. ; 33, s. 43-47
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Journal article (peer-reviewed)abstract
- INTRODUCTION: Acute chest pain is a common symptom among prehospital emergency care patients. Therefore, it is crucial that ambulance nurses (ANs) have the ability to identify symptoms and assess patients suffering from acute coronary syndrome (ACS). The aim of this study is to explore the occurrence of dyspnoea and nausea and/or vomiting in the prehospital phase of a suspected ACS and the associations with patients' outcome.METHODS: This study has a quantitative design based on data from hospital records and from a previous interventional study (randomised controlled trial) including five Emergency Medical Service (EMS) systems in western Sweden in the years 2008-2010.RESULTS: In all, 1836 patients were included in the interventional study. Dyspnoea was reported in 38% and nausea and/or vomiting in 26% of patients. The risk of death within one year increased with the presence of dyspnoea. The presence of nausea and/or vomiting increased the likelihood of a final diagnosis of acute myocardial infarction (AMI).CONCLUSION: This study shows that dyspnoea, nausea and/or vomiting increase the risk of death and serious diagnosis among ACS patients. This means that dyspnoea, nausea and/or vomiting should influence the ANs' assessment and that special education in cardiovascular nursing is required.
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| 17. |
- Andersson, Henrik, 1968-, et al.
(author)
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Nurses competencies in Home health care : An interview study
- 2017
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In: BMC Nursing. - : Springer. - 1472-6955. ; 16:65
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Journal article (peer-reviewed)abstract
- Background: Nurses working in Home health care (HHC) are facing major challenges when more advanced care and treatment are performing in the patient’s home. The aim of this study was to explore how nurses experiencing their competencies in HHC. Methods: This study has a qualitative and explorative design. Ten nurses were interviewed and data were analysed by content analysis.Results: The themes “Being a capable nurse”, “Being a useful nurse” and “Being a subordinate and dependent nurse” were identified. Nurses want to be capable to take care of patients, develop their competencies and perform their duties in the way that are requested. They also want to be useful in their work and providing good and safe HHC. Finally, nurses want to improve the care in HHC with their competencies. Simultaneously, they are subordinate and dependent in the relation with their manager and manager’s interest to encourage nurses’ competence development.Conclusions: Nurses in HHC are responsible for many seriously ill patients and they want to contribute to a good and safe patient care. To maintain patient safety, reduce the risk for burnout and staff turnover as well as to contribute to a sustainable development of the work, strategies for transfer competencies between nurses and efforts for competence development are needed.
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| 18. |
- Andersson, Henrik, 1968-, et al.
(author)
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The early chain of care in bacteraemia patients: Early suspicion, treatment and survival in prehospital emergency care
- 2018
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In: American Journal of Emergency Medicine. - : Elsevier BV. - 0735-6757 .- 1532-8171. ; 36:12, s. 2211-2218
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Journal article (peer-reviewed)abstract
- Introduction: Bacteraemia is a first stage for patients risking conditions such as septic shock. The primary aim of this study is to describe factors in the early chain of care in bacteraemia, factors associated with increased chance of survival during the subsequent 28 days after admission to hospital. Furthermore, the long-term outcome was assessed. Methods: This study has a quantitative design based on data from Emergency Medical Services (EMS) and hospital records. Results: In all, 961 patients were included in the study. Of these patients, 13.5% died during the first 28 days. The EMS was more frequently used by non-survivors. Among patients who used the EMS, the suspicion of sepsis already on scene was more frequent in survivors. Similarly, EMS personnel noted the ESS code "fever, infection" more frequently for survivors upon arriving on scene. The delay time from call to the EMS and admission to hospital until start of antibiotics was similar in survivors and non-survivors. The five-year mortality rate was 50.8%. Five-year mortality was 62.6% among those who used the EMS and 29.5% among those who did not (p < 0.0001). Conclusion: This study shows that among patients with bacteraemia who used the EMS, an early suspicion of sepsis or fever/infection was associated with improved early survival whereas the delay time from call to the EMS and admission to hospital until start of treatment with antibiotics was not. 50.8% of all patients were dead after five years. (C) 2018 Elsevier Inc. All rights reserved.
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| 19. |
- Andersson Hagiwara, Magnus, et al.
(author)
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Measuring participants’ immersion in healthcare simulation : the development of an instrument
- 2016
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In: Advances in Simulation. - : BioMed Central. - 2059-0628. ; 2016:1
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Journal article (peer-reviewed)abstract
- BackgroundImmersion is important for simulation-based education; however, questionnaire-based instruments to measure immersion have some limitations. The aim of the present work is to develop a new instrument to measure immersion among participants in healthcare simulation scenarios.MethodsThe instrument was developed in four phases: trigger identification, content validity scores, inter-rater reliability analysis and comparison with an existing immersion measure instrument. A modified Delphi process was used to develop the instrument and to establish validity and reliability. The expert panel consisted of 10 researchers. All the researchers in the team had previous experience of simulation in the health and/or fire and rescue services as researchers and/or educators and simulation designers. To identify triggers, the panel members independently screened video recordings from simulation scenarios. Here, a trigger is an event in a simulation that is considered a sign of reduced or enhanced immersion among simulation participants.ResultsThe result consists of the Immersion Score Rating Instrument (ISRI). It contains 10 triggers, of which seven indicate reduced and three enhanced immersion. When using ISRI, a rater identifies trigger occurrences and assigns them strength between 1 and 3. The content validity analysis shows that all the 10 triggers meet an acceptable content validity index for items (I-CVI) standard. The inter-rater reliability (IRR) among raters was assessed using a two-way mixed, consistency, average-measures intra-class correlation (ICC). The ICC for the difference between weighted positive and negative triggers was 0.92, which indicates that the raters are in agreement. Comparison with results from an immersion questionnaire mirrors the ISRI results.ConclusionsIn conclusion, we present a novel and non-intrusive instrument for identifying and rating the level of immersion among participants in healthcare simulation scenarios.
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| 20. |
- Backlund, Per, 1964-, et al.
(author)
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Breaking Out of the Bubble Putting Simulation Into Context to Increase Immersion and Performance
- 2018
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In: Journal Simulation & Gaming. - : Sage Publications. - 1046-8781 .- 1552-826X. ; 49:6, s. 642-660
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Journal article (peer-reviewed)abstract
- Objective. Simulation based training with full-size mannequins is a prominent means of training within the healthcare sector. Prehospital missions include all parts of the healthcare process which take place before a patient is handed over to the receiving hospital. This implies that the context for prehospital care is varied and potentially challenging or dangerous in several ways. In this article we present a study which explores immersion and performance by emergency medical services (EMS) professionals in in a training situation which takes the specifics of prehospital interventions into account.Methods. The study was carried out as a field experiment at an ambulance unit. The experiment was designed to compare the differences between two types of medical scenarios: basic and contextualized. We analyzed the levels of immersion throughout the scenarios and then team performance was evaluated by independent experts. Both analyses were made by observing video recordings from multiple camera angles with a custom made analysis tool.Results. Our results show that the contextualization of a medical scenario increases both immersion as measured by the Immersion Score Rating Instrument (ISRI) and team performance as measured by the Global Rating Scale (GRS). The overall ISRI score was higher in the contextualized condition as compared to the basic condition, with an average team wise difference of 2.94 (sd = 1.45). This difference is significant using a paired, two-tailed t-test (p<.001). The GRS score was higher for overall clinical performance in the contextualized scenario with an average team wise difference of 0.83 (sd = 0.83, p=.005).Conclusions. Full-size mannequin simulation based training for EMS professionals may be enhanced by contextualizing the medical scenarios. The main benefits are that the contextualized scenarios better take prehospital medical challenges into account and allow participants to perform better.
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| 21. |
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| 22. |
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| 23. |
- Citrin, J., et al.
(author)
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Tractable flux-driven temperature, density, and rotation profile evolution with the quasilinear gyrokinetic transport model QuaLiKiz
- 2017
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In: Plasma Physics and Controlled Fusion. - : IOP Publishing. - 1361-6587 .- 0741-3335. ; 59:12
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Journal article (peer-reviewed)abstract
- Quasilinear turbulent transport models are a successful tool for prediction of core tokamak plasma profiles in many regimes. Their success hinges on the reproduction of local nonlinear gyrokinetic fluxes. We focus on significant progress in the quasilinear gyrokinetic transport model QuaLiKiz (Bourdelle et al 2016 Plasma Phys. Control. Fusion 58 014036), which employs an approximated solution of the mode structures to significantly speed up computation time compared to full linear gyrokinetic solvers. Optimisation of the dispersion relation solution algorithm within integrated modelling applications leads to flux calculations x 10(6-7) faster than local nonlinear simulations. This allows tractable simulation of flux-driven dynamic profile evolution including all transport channels: ion and electron heat, main particles, impurities, and momentum. Furthermore, QuaLiKiz now includes the impact of rotation and temperature anisotropy induced poloidal asymmetry on heavy impurity transport, important for W-transport applications. Application within the JETTO integrated modelling code results in 1 s of JET plasma simulation within 10 h using 10 CPUs. Simultaneous predictions of core density, temperature, and toroidal rotation profiles for both JET hybrid and baseline experiments are
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| 24. |
- Dellgren, Göran, 1961, et al.
(author)
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Continuous improvement in outcome after heart transplantation - Long-term follow-up after three decades of experience.
- 2017
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In: International journal of cardiology. - : Elsevier BV. - 1874-1754 .- 0167-5273. ; 231, s. 188-194
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Research review (peer-reviewed)abstract
- Heart transplantation (HTx) has become the standard treatment for patients with end-stage heart disease. We report on the long-term outcome after HTx at our centre and investigate trends in outcome over time.During the period, between 1984 and 2014, a total of 610 HTx procedures were performed in 595 patients (median 48years; IQR 31-57years; range 24days-71years; mean 43years; 75% male) in our institution. Long-term outcome was investigated in the whole cohort, among children (n=76), bridged with mechanical circulatory support (MCS, n=131), re-transplanted (n=17), and concomitant kidney transplantation (n=12).Long-term survival was at 1, 5, 10, 15 and 20years: 86% (95CI 0.83-0.89); 77% (95CI 0.73-0.80); 63% (95CI 0.59-0.68); 48% (95CI 0.43-0.54) and 30% (95CI 0.25-0.36), respectively. The median survival for the whole cohort was 14.1years. Patients transplanted during the most recent time period (2010-2014) had a better survival compared to previous eras, with a 1- and 3-year survival of 94% (95CI 0.89-0.97) and 93% (95CI 0.88-0.96), respectively (p<0.001). However, when survival was analysed for long-term MCS (n=80) versus short term MCS (n=35), there was a significantly poorer survival for the short-term MCS group (p=0.001). Independent predictors of long-term mortality included recipient age (p=0.041); previous smoking (p=0.034); ischemic heart disease (p=0.002); and preoperative ventilator therapy (p=0.004).We have shown that continuous improvement in outcome after HTx still occurs. In the last time era, direct transplantation from short-term MCS was abandoned, which may have inflicted outcome during the last time era.
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| 25. |
- Engholm, Magnus, et al.
(author)
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A bio-compatible fiber optic pH sensor based on a thin core interferometric technique
- 2019
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In: Photonics. - : MDPI AG. - 2304-6732. ; 6:1
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Journal article (peer-reviewed)abstract
- There is an increasing demand for compact, reliable and versatile sensor concepts for pH-level monitoring within several industrial, chemical as well as bio-medical applications. Many pH sensors concepts have been proposed, however, there is still a need for improved sensor solutions with respect to reliability, durability and miniaturization but also for multiparameter sensing. Here we present a conceptual verification, which includes theoretical simulations as well as experimental evaluation of a fiber optic pH-sensor based on a bio-compatible pH sensitive material not previously used in this context. The fiber optic sensor is based on a Mach-Zehnder interferometric technique, where the pH sensitive material is coated on a short, typically 20-25 mm thin core fiber spliced between two standard single mode fibers. The working principle of the sensor is simulated by using COMSOL Multiphysics. The simulations are used as a guideline for the construction of the sensors that have been experimentally evaluated in different liquids with pH ranging from 1.95 to 11.89. The results are promising, showing the potential for the development of bio-compatible fiber optic pH sensor with short response time, high sensitivity and broad measurement range. The developed sensor concept can find future use in many medical- or bio-chemical applications as well as in environmental monitoring of large areas. Challenges encountered during the sensor development due to variation in the design parameters are discussed. © 2019 by the authors.
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| 26. |
- Engström, Henrik, 1968-, et al.
(author)
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The impact of contextualization on immersion in healthcare simulation
- 2016
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In: Advances in Simulation. - : BioMed Central. - 2059-0628. ; 1
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Journal article (peer-reviewed)abstract
- BackgroundThe aim of this paper is to explore how contextualization of a healthcare simulation scenarios impacts immersion, by using a novel objective instrument, the Immersion Score Rating Instrument. This instrument consists of 10 triggers that indicate reduced or enhanced immersion among participants in a simulation scenario. Triggers refer to events such as jumps in time or space (sign of reduced immersion) and natural interaction with the manikin (sign of enhanced immersion) and can be used to calculate an immersion score.MethodsAn experiment using a randomized controlled crossover design was conducted to compare immersion between two simulation training conditions for prehospital care: one basic and one contextualized. The Immersion Score Rating Instrument was used to compare the total immersion score for the whole scenario, the immersion score for individual mission phases, and to analyze differences in trigger occurrences. A paired t test was used to test for significance.ResultsThe comparison shows that the overall immersion score for the simulation was higher in the contextualized condition. The average immersion score was 2.17 (sd = 1.67) in the contextualized condition and −0.77 (sd = 2.01) in the basic condition (p < .001). The immersion score was significantly higher in the contextualized condition in five out of six mission phases. Events that might be disruptive for the simulation participants’ immersion, such as interventions of the instructor and illogical jumps in time or space, are present to a higher degree in the basic scenario condition; while events that signal enhanced immersion, such as natural interaction with the manikin, are more frequently observed in the contextualized condition.ConclusionsThe results suggest that contextualization of simulation training with respect to increased equipment and environmental fidelity as well as functional task alignment might affect immersion positively and thus contribute to an improved training experience.
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| 27. |
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| 28. |
- Eriksson, Frida, 1986, et al.
(author)
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Impact of fast ions on density peaking in JET : fluid and gyrokinetic modeling
- 2019
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In: Plasma Physics and Controlled Fusion. - : Institute of Physics Publishing (IOPP). - 0741-3335 .- 1361-6587. ; 61:7
-
Journal article (peer-reviewed)abstract
- The effect of fast ions on turbulent particle transport, driven by ion temperature gradient (ITG)/trapped electron mode turbulence, is studied. Two neutral beam injection (NBI) heated JET discharges in different regimes are analyzed at the radial position rho(t) = 0.6, one of them an L-mode and the other one an H-mode discharge. Results obtained from the computationally efficient fluid model EDWM and the gyro-fluid model TGLF are compared to linear and nonlinear gyrokinetic GENE simulations as well as the experimentally obtained density peaking. In these models, the fast ions are treated as a dynamic species with a Maxwellian background distribution. The dependence of the zero particle flux density gradient (peaking factor) on fast ion density, temperature and corresponding gradients, is investigated. The simulations show that the inclusion of a fast ion species has a stabilizing influence on the ITG mode and reduces the peaking of the main ion and electron density profiles in the absence of sources. The models mostly reproduce the experimentally obtained density peaking for the L-mode discharge whereas the H-mode density peaking is significantly underpredicted, indicating the importance of the NBI particle source for the H-mode density profile.
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| 29. |
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| 30. |
- Gisslén, Magnus, 1962, et al.
(author)
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CSF concentrations of soluble TREM2 as a marker of microglial activation in HIV-1 infection
- 2019
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In: Neurology-Neuroimmunology & Neuroinflammation. - : Ovid Technologies (Wolters Kluwer Health). - 2332-7812. ; 6:1
-
Journal article (peer-reviewed)abstract
- Objective To explore changes in CSF sTREM2 concentrations in the evolving course of HIV-1 infection. In this retrospective cross-sectional study, we measured concentrations of the macrophage/ microglial activation marker sTREM2 in CSF samples from 121 HIV-1-infected adults and 11 HIV-negative controls and examined their correlations with other CSF and blood biomarkers of infection, inflammation, and neuronal injury. CSF sTREM2 increased with systemic and CNS HIV-1 disease severity, with the highest levels found in patients with HIV-associated dementia (HAD). In untreated HIV-1-infected patients without an HAD diagnosis, levels of CSF sTREM2 increased with decreasing CD4(+) T-cell counts. CSF concentrations of both sTREM2 and the neuronal injury marker neurofilament light protein (NFL) were significantly associated with age. CSF sTREM2 levels were also independently correlated with CSF NFL. Notably, this association was also observed in HIV-negative controls with normal CSF NFL. HIV-infected patients on suppressive antiretroviral treatment had CSF sTREM2 levels comparable to healthy controls. Elevations in CSF sTREM2 levels, an indicator of macrophage/microglial activation, are a common feature of untreated HIV-1 infection that increases with CD4(+) T-cell loss and reaches highest levels in HAD. The strong and independent association between CSF sTREM2 and CSF NFL suggests a linkage between microglial activation and neuronal injury in HIV-1 infection. CSF sTREM2 has the potential of being a useful biomarker of innate CNS immune activation in different stages of untreated and treated HIV-1 infection.
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| 31. |
- Hall, Ulrika Andersson, et al.
(author)
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Central and Peripheral Leptin and Agouti-Related Protein during and after Pregnancy in Relation to Weight Change.
- 2018
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In: Clinical endocrinology. - : Wiley. - 1365-2265 .- 0300-0664. ; 88:2, s. 263-271
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Journal article (peer-reviewed)abstract
- To study changes of neuropeptides and adipokines in cerebrospinal fluid (CSF) and serum from pregnancy to post-pregnancy in relation to weight changes, fat mass and glucose metabolism.With high postpartum weight retention being a risk factor in future pregnancies and of life-long obesity we evaluated neuropeptide and adipokine changes in women who either gained weight or were weight stable.Women were followed for 5±1 years after pregnancy and divided into two groups, Weight-Stable and Weight-Gain, by weight change from start of pregnancy.Twenty-five women (BMI 27±5kg/m2 ) recruited at admission for elective caesarean section.CSF and serum levels of agouti-related protein (AgRP), leptin, and insulin, and serum levels of adiponectin and soluble leptin receptor were measured during and after pregnancy. These measurements were further related to fat mass and insulin sensitivity (HOMA-IR).S-AgRP levels during pregnancy were lower in the Weight-Stable group and a 1 unit increase in s-AgRP was associated with 24% higher odds of pertaining to the Weight-Gain group. After pregnancy, s-AgRP increased in the Weight-Stable group but decreased in the Weight-Gain group. Decreased transport of leptin into CSF during pregnancy was reversed by an increased CSF:serum leptin ratio after pregnancy. In women who returned to their pre-pregnancy weight, serum adiponectin increased after pregnancy and correlated negatively with HOMA-IR.S-AgRP concentration in late pregnancy may be one factor predicting weight change after pregnancy, and circulating AgRP may be physiologically important in the long-term regulation of body weight. This article is protected by copyright. All rights reserved.
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| 32. |
- Hammarling, Krister, 1968-, et al.
(author)
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Broad-range hydrogel-based pH sensor with capacitive readout manufactured on a flexible substrate
- 2018
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In: Chemosensors. - Basel, Switzerland : MDPI AG. - 2227-9040. ; 6:3
-
Journal article (peer-reviewed)abstract
- Environmental monitoring of land, water and air, is an area receiving greater attention because of human health and safety concerns. Monitoring the type of pollution and concentration levels is vital, so that appropriate contingency plans can be determined. To effectively monitor the environment, there is a need for new sensors and sensor systems that suits these type of measurements. However, the diversity of sensors suitable for low, battery powered- and large area sensor systems are limited. We have manufactured and characterized a flexible pH sensor using laser processing and blade coating techniques that is able to measure pH between 2.94 and 11.80. The sensor consists of an interdigital capacitance with a pH sensitive hydrogel coating. Thin sensors can reach 95% of their final value value within 3 min, and are stable after 4 min. Good repeatability was achieved in regard to cycling of the sensor with different pH and multiple measurements from dry state. We have also studied the relation between an interdigital capacitance penetration depth and hydrogels expansion. We believe that our passive sensor is suitable to be used in low power and large area sensor networks.
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| 33. |
- Hammarling, Krister, 1968-
(author)
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Hydrogel-based pH-sensors : Development and characterisation of optical and electrical pH sensors based on stimuli-responsive hydrogels
- 2019
-
Doctoral thesis (other academic/artistic)abstract
- The ability to measure the chemical parameter pH is of high importance in many areas. With new government regulations and evolving markets, there is a strong motivation for improving such measurements and conducting research on new types of pH sensors and sensor materials. Stimuli-responsive hydrogels (a group of polymers) have attracted a lot of attention in recent decades, due to their ability to be customized to suit many applications. One specific area where they have attracted attention is pH sensor technology.Two stimuli-responsive hydrogels are used in this thesis. One is a non-toxic hydrogel, 1,4-acryl-terminated oligo(beta-amino esters) (1,4-AOBAE). Although it was previously used in drug- and DNA- delivery systems, it has not (to my knowledge) been used in a sensor configuration, and thus it is interesting to study. The second hydrogel, 1,3-acryl-terminated oligo(beta-amino esters) (1,3-AOBAE), is an improved variant of the first one. This improved hydrogel was synthesized because the original hydrogel crystallizes at room temperature, which meant that it was not optimal for various coating techniques. This hydrogel was characterized and verified for pH responsivity in two sensor configurations: electrical and optical. Designing a hydrogel for a specific application can be a complex procedure due to the many synthesizing parameters. For example, increasing a hydrogel's mechanical strength by introducing a higher degree of cross linking, leads to a smaller mesh size, which in turn leads to a lower diffusion rate and less solution absorption. The two hydrogels examined in this thesis respond to pH changes by absorbing or desorbing water; this change in the hydrogel's water content also changes its effective refractive index and permittivity. These changes can be measured using optical or electrical sensor systems. Three types of sensor systems were used in this thesis to verify the hydrogel's pH response and to ensure that they are suitable for use in thin-film techniques on various substrates (e.g. glass and plastic). The experimental results prove that these hydrogels are suitable for use in both electrical and optical sensor configurations. For electrical systems, a pH range of approximately 3-12 was achieved, and for optical, the range was approximately 2-12. These ranges can likely be improved, as the sensor film delaminated from the substrate at low pHs due to adhesion problems and as measurements above 12 were not conducted.The findings of this thesis could, after more research, have strong implications for the development of improved pH-sensor configurations, especially for medical and healthcare applications and in environmental monitoring.
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| 34. |
- Hammarling, Krister, 1968-, et al.
(author)
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Synthesis, Curing Behavior and Swell Tests of pH-Responsive Coatings from Acryl-Terminated Oligo(beta-Amino Esters)
- 2018
-
In: CHEMOSENSORS. - : MDPI AG. - 2227-9040. ; 6:1
-
Journal article (peer-reviewed)abstract
- The ability of acryl-terminated oligo(beta-amino esters) (AOBAE) to be coated on fibers and printed electronics without solvents and to be cross-linked to a pH-responsive coatings, makes AOBAE-based coatings a potential type of pH-sensor coating. However, there are currently no reports of AOBAEs used as a pH-responsive coating material in sensor applications. Here we present an investigation of the synthesis, curing behavior and swell tests of AOBAEs. AOBAEs were synthesized from reacting an excess of asymmetric diacrylates with piperazine without the use of any solvents. They were then cross-linked to an insoluble network by UV-curing. Nuclear magnetic resonance (NMR) and Fourier transform infrared (FTIR) spectroscopy were used to characterize the AOBAEs. NMR was used to clarify the irregular structure of the AOBAE. FTIR was used to monitor the effects of UV-curing dose and air exposure on monomer conversion during curing. An interferometric technique was used to monitor the swelling behavior of the coating in response to pH variations. Swell experiments showed that the AOBAE also responded to pH variations after polymerization. Therefore, AOBAE is an interesting class of material with potential use as a pH responsive coating in optical-and printed electronics pH-sensors applications.
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| 35. |
- Holmberg, Mats, 1976-, et al.
(author)
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Association between the reported intensity of an acute symptom at first prehospital assessment and the subsequent outcome : a study on patients with acute chest pain and presumed acute coronary syndrome
- 2018
-
In: BMC Cardiovascular Disorders. - : Springer. - 1471-2261 .- 1471-2261. ; 18, s. 1-10
-
Journal article (peer-reviewed)abstract
- Background: To decrease the morbidity burden of cardiovascular disease and to avoid the development of potentially preventable complications, early assessment and treatment of acute coronary syndrome (ACS) are important. The aim of this study has therefore been to explore the possible association between patients' estimated intensity of chest pain when first seen by the ambulance crew in suspected ACS, and the subsequent outcome before and after arrival in hospital. Methods: Data was collected both prospectively and retrospectively. The inclusion criteria were chest pain raising suspicion of ACS and a reported intensity of pain 4 on the visual analogue scale. Results: All in all, 1603 patients were included in the study. Increased intensity of chest pain was related to: 1) more heart-related complications before hospital admission; 2) a higher proportion of heart failure, anxiety and chest pain after hospital admission; 3) a higher proportion of acute myocardial infarction and 4) a prolonged hospitalisation. However, there was no significant association with mortality neither in 30 days nor in three years. Adjustment for possible confounders including age, a history of smoking and heart failure showed similar results. Conclusion: The estimated intensity of chest pain reported by the patients on admission by the ambulance team was associated with the risk of complications prior to hospital admission, heart failure, anxiety and chest pain after hospital admission, the final diagnosis and the number of days in hospital.
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| 36. |
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| 37. |
- Jaldell, Henrik, 1968-, et al.
(author)
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Are national injury prevention and research efforts matching the distribution of injuries across sectors?
- 2015
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In: Injury Prevention. - : BMJ Publishing Group Ltd. - 1353-8047 .- 1475-5785. ; 21:e1, s. e113-e115
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Journal article (peer-reviewed)abstract
- In 2011, 88% of all unintentional injury fatalities occurred in home and leisure environments in Sweden, while transportation fatalities accounted for 10% and work/school injuries for 2%. The corresponding proportions among non-fatal injuries were 75, 12 and 13%, respectively. However, 83% of the national governmental expenditure on unintentional injury prevention in 2011 was allocated to transportation safety, 7% to home and leisure, and 10% to the work sector including schools. Likewise, around 85% of the governmental research budget aimed for unintentional injury research was allocated to the transportation sector, 9% to home and leisure environments, and 6% to the work and school sector. Our results reveal a striking lack of correspondence between problem profile and governmental countermeasures.
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| 38. |
- Jaldell, Henrik, 1968-, et al.
(author)
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Restvärdesverksamhetens nytta – en förstudie
- 2018
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Reports (pop. science, debate, etc.)abstract
- I denna förstudie undersöks förutsättningarna för en möjlig kommande studie kring restvärdesverksamhetens nytta. Verksamheten har kartlagts, definierats och avgränsats på ett sätt som är tänkt att möjliggöra en vetenskaplig operationalisering. Tidigare forskning tycks saknas vilket gör att studier på området startar från en mycket grund nivå.Ett spektrum av nyttoposter har identifierats. Dessa tillkommer försäkringsbolagen, men även den skadedrabbade ”kunden” (enskilda, företag eller samhället) samt räddningstjänsten och samhället i övrigt. I rapporten redovisas i vilken grad dessa nyttoposter bedöms möjliga att uppskatta i monetära termer, respektive kan värderas på annat sätt.Tillgång till relevanta data är en nyckelfråga för ett fortsatt genomförande av en huvudstudie. Tekniska och juridiska hinder kring dataåtkomst fördröjde delar av förstudien, samtidigt som det finns ett värde i att dessa identifierats och delvis överbryggats inom förstudiens ram inför beslut om en huvudstudie.Förstudien bedöms sammantaget uppfylla behovet av att lägga en grund för fortsatt forskning kring restvärdesverksamhetens nytta. Fyra delstudier föreslås som en fortsättning på arbetet med att belysa olika nyttoposter, såväl kvantitativt som kvalitativt.
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| 39. |
- Joffrin, E., et al.
(author)
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Overview of the JET preparation for deuterium-tritium operation with the ITER like-wall
- 2019
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In: Nuclear Fusion. - : IOP Publishing. - 1741-4326 .- 0029-5515. ; 59:11
-
Research review (peer-reviewed)abstract
- For the past several years, the JET scientific programme (Pamela et al 2007 Fusion Eng. Des. 82 590) has been engaged in a multi-campaign effort, including experiments in D, H and T, leading up to 2020 and the first experiments with 50%/50% D-T mixtures since 1997 and the first ever D-T plasmas with the ITER mix of plasma-facing component materials. For this purpose, a concerted physics and technology programme was launched with a view to prepare the D-T campaign (DTE2). This paper addresses the key elements developed by the JET programme directly contributing to the D-T preparation. This intense preparation includes the review of the physics basis for the D-T operational scenarios, including the fusion power predictions through first principle and integrated modelling, and the impact of isotopes in the operation and physics of D-T plasmas (thermal and particle transport, high confinement mode (H-mode) access, Be and W erosion, fuel recovery, etc). This effort also requires improving several aspects of plasma operation for DTE2, such as real time control schemes, heat load control, disruption avoidance and a mitigation system (including the installation of a new shattered pellet injector), novel ion cyclotron resonance heating schemes (such as the three-ions scheme), new diagnostics (neutron camera and spectrometer, active Alfven eigenmode antennas, neutral gauges, radiation hard imaging systems...) and the calibration of the JET neutron diagnostics at 14 MeV for accurate fusion power measurement. The active preparation of JET for the 2020 D-T campaign provides an incomparable source of information and a basis for the future D-T operation of ITER, and it is also foreseen that a large number of key physics issues will be addressed in support of burning plasmas.
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| 40. |
- Johansson, Ellen, et al.
(author)
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Revising the embryonic origin of thyroid C cells in mice and humans
- 2015
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In: Development (Cambridge, England). - : The Company of Biologists. - 1477-9129 .- 0950-1991. ; 142:20, s. 3519-3528
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Journal article (peer-reviewed)abstract
- Current understanding infers a neural crest origin of thyroid C cells, the major source of calcitonin in mammals and ancestors to neuroendocrine thyroid tumors. The concept is primarily based on investigations in quail-chick chimeras involving fate-mapping of neural crest cells to the ultimobranchial glands that regulate Ca(2+) homeostasis in birds, reptiles, amphibians and fishes, but whether mammalian C cell development implicates a homologous ontogenetic trajectory has not been experimentally verified. With lineage tracing we now provide direct evidence that Sox17+ anterior endoderm is the only source of differentiated C cells and their progenitors in mice. In similarity with many gut endoderm derivatives embryonic C cells were found to co-express pioneer factors forkhead box (Fox) a1 and Foxa2 before neuroendocrine differentiation takes place. In the ultimobranchial body epithelium emerging from pharyngeal pouch endoderm in early organogenesis differential Foxa1/Foxa2 expression distinguished two spatially separated pools of C cell precursors with different growth properties. A similar expression pattern was recapitulated in medullary thyroid carcinoma cells in vivo consistent with a growth-promoting role of Foxa1. Contrasting embryonic precursor cells, C cell-derived tumor cells invading the stromal compartment down-regulated Foxa2 foregoing epithelial-mesenchymal transition designated by loss of E-cadherin; both Foxa2 and E-cadherin were re-expressed at metastatic sites. These findings revise mammalian C cell ontogeny, expand the neuroendocrine repertoire of endoderm, and redefine the boundaries of neural crest diversification. The data further underpin distinct functions of Foxa1 and Foxa2 in both embryonic and tumor development.
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| 41. |
- Johansson, Henrik J., et al.
(author)
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Extracellular nanovesicles released from the commensal yeast Malassezia sympodialis are enriched in allergens and interact with cells in human skin
- 2018
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In: Scientific Reports. - : NATURE PUBLISHING GROUP. - 2045-2322. ; 8
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Journal article (peer-reviewed)abstract
- Malassezia sympodialis is a dominant commensal fungi in the human skin mycobiome but is also associated with common skin disorders including atopic eczema (AE). M. sympodialis releases extracellular vesicles, designated MalaEx, which are carriers of small RNAs and allergens, and they can induce inflammatory cytokine responses. Here we explored how MalaEx are involved in hostmicrobe interactions by comparing protein content of MalaEx with that of the parental yeast cells, and by investigating interactions of MalaEx with cells in the skin. Cryo-electron tomography revealed a heterogeneous population of MalaEx. iTRAQ based quantitative proteomics identified in total 2439 proteins in all replicates of which 110 were enriched in MalaEx compared to the yeast cells. Among the MalaEx enriched proteins were two of the M. sympodialis allergens, Mala s 1 and s 7. Functional experiments indicated an active binding and internalization of MalaEx into human keratinocytes and monocytes, and MalaEx were found in close proximity of the nuclei using super-resolution fluorescence 3D-SIM imaging. Our results provides new insights into host-microbe interactions, supporting that MalaEx may have a role in the sensitization and maintenance of inflammation in AE by containing enriched amounts of allergens and with their ability to interact with skin cells.
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| 42. |
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| 43. |
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| 44. |
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| 45. |
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| 46. |
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| 47. |
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| 48. |
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| 49. |
- Olander, Agnes, et al.
(author)
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Identify the septic patient in the prehospital care
- 2017
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In: Abstractbook. ; , s. 63-63
-
Conference paper (peer-reviewed)abstract
- AIMThe aim was to determine the sensitivity of the new symptom based index test Altered Signs and Symptoms Emerge Sudden in Sepsis (ASSESS) in order to identify sepsis and compare it with four established index tests in the prehospital care.METHODThis is a quantitative study were the researchers collected data from medical records, and tested whether a new symptom based index test ASSESS was significantly better to identify sepsis compared to Rapid Emergency Triage and Treatment System (RETTS-ESS 47), BAS 90-30-90, Quick Sequential [Sepsis-related] (qSOFA) and The prehospital severe sepsis screening tool (PSSST). According to the Standards for Reporting of Diagnostic Accuracy (STARD-concept), a retrospective diagnostic accuracy and cohort study was conducted. The participants were 380 consecutive adult patients (age >18 years) who activated the Prehospital care-system and were transported to Skaraborgs County Hospital in west of Sweden , and subsequently discharged with an ICD-10-code consistent with sepsis, during a three-month period between January through April, 2012.RESULTSOf 380 patients 180 (47%) were female and 200 (53%) were male and with a mean age of 74±15 years. The ASSESS had a higher sensitivity to all four established index tests. Of the included symptoms in ASSESS the most common were sudden fever (63,9%), sudden breathing difficulties (60%), sudden muscle weakness (23,9%) and sudden gastrointestinal symptoms (20,2%).CONCLUSIONASSESS showed a higher sensitivity compared to the other four index test, which could in turn enable an earlier identification of sepsis patients in the prehospital care. Symptom presentation is included in the ASSESS index test as compared to the other four index tests which focus in major on vital signs alone. An inclusion of symptom presentation in a prehospital screening tool may thus increase the identification of sepsis. However, evidence on clinical benefit of the ASSESS index test need to be prospectively validated.
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| 50. |
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