Publikationer från Linköpings universitet
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Glucagon-Like Peptide 1 Receptor Agonist Is Associated With Improved Survival in Overweight Heart Failure Patients
No full textBACKGROUND Glucagon-like peptide 1 receptor agonists (GLP-1RAs) have shown improved symptomatic relieving and functional capacity in patients with heart failure (HF) with preserved ejection fraction and obesity. OBJECTIVES The purpose of this study was to evaluate the effect of GLP-1RA on outcome in patients with HF. METHODS A retrospective analysis was performed based on the Swedish HF Registry since 2007 among patients with a body mass index (BMI) >25 kg/m(2) to assess whether GLP-1RA treatment was associated with reduced mortality in patients with HF. RESULTS In the overall cohort, 34,247 patients were not treated with GLP-1RA, and 808 patients were. In patients treated with GLP-1RA, 96.3% had diabetes mellitus. Treatment with GLP-1RA showed a statistically significant association with reduced all-cause (adjusted HR [aHR]: 0.75 [95% CI: 0.60-0.94]; P = 0.013) and cardiovascular (CV) mortality (aHR: 0.52 [95% CI: 0.35-0.77]; P = 0.0010) compared with those not receiving GLP-1RA within 2 years after index registration. In a 1:1 propensity score matched cohort, there was no significant association between GLP-1RA and all-cause mortality (aHR: 0.79 [95% CI: 0.59-1.06]; P = 0.11), but there was with CV mortality (aHR: 0.53 [95% CI: 0.32-0.87]; P = 0.012). GLP-1RA-associated risk reduction in CV death was more pronounced in patients with a BMI >30 kg/m(2) and appears to be greater in individuals with an ejection fraction <= 40% compared with >40%. CONCLUSIONS This nationwide real-world study shows that patients with HF who received GLP-1RA have a significant reduction in CV mortality, which is particularly pronounced in overweight and obese patients with reduced ejection fraction. (c) 2025 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY license (http://creativecommons.org/ licenses/by/4.0/)
Assessment of Elbow Trauma and Antibiotic Prophylaxis of Prosthetic Elbow Replacement
No full textThe primary role of the elbow is to enable hand positioning in space and also to allow efficient load transmission. Most often when the elbow is injured, the person falls on an outstretched hand and sustains a fracture and/or dislocation of the elbow depending on the resulting force vector. Most elbow fractures are associated with a soft-tissue injury of varying severity. The treatment of these injuries is usually based on a radiographic fracture classification. The treatment of the soft-tissue component in elbow injuries is likely to be of the greatest importance, as post-traumatic instability and post-traumatic stiffness are common and often difficult to treat. The extent of these complications could probably be reduced if both the primary, surgical treatment and the postoperative rehabilitation were optimised. There has been an increasing interest in using Patient-reported outcomes (PROMs) and they are becoming a key tool in research, decision-making and clinical care. The Oxford Elbow Score (OES) is the only elbow-specific rating system for which measurement properties have been assessed with high-quality methodology. There is a lack of well-validated PROMs in Swedish for elbow conditions and for elbow trauma (paper I). The interpretation of differences in scores of PROMs between groups is aided by the Minimal Important Difference (MID) and Smallest Detectable Change (SDC). MID can be defined as the smallest measured change in a score that the patient perceives as important. MIDs have not been estimated for the OES in a trauma population (paper II). Proximal radius fracture is a common fracture in the elbow and can cause disturbances in elbow movement, stability, and loss of rotational ability in the forearm. There are several studies that have shown that associated injuries are common. Little has been written to describe the relationship of radial head fractures to associated ligament injuries in the elbow (paper III). In severe trauma to the elbow, arthroplasty is becoming increasingly frequent, though it is a relatively rare procedure. Periprosthetic Joint Infection (PJI) in elbow arthroplasty is a serious complication, with great suffering for the patients and large costs for the healthcare. There is a lack of evidence as to the best antibiotic prophylaxis in elbow arthroplasty (paper IV). The primary purpose of this thesis is to increase understanding of elbow trauma, improve assessment systems, improve antibiotic prophylaxis for elbow replacement, and thereby improve the care of patients suffering fractures and ligament injuries of the elbow
Impact of physical activity on the incidence of psychiatric conditions during childhood: a longitudinal Swedish birth cohort study
No full textBackground Emerging evidence supports the importance of physical activity (PA) and behaviours that build resilience to prevent childhood psychiatric disorders. Objective To investigate associations between parent-reported PA, time spent outdoors and participation in organised sports and later incidence of psychiatric conditions in children. Methods A birth cohort of 17 055 Swedish children was followed up until age 18 years. Data on parent-reported PA, time outdoors and participation in organised sports were collected for children at ages 5, 8 and 11. Diagnoses of psychiatric conditions were obtained from a national registry. Longitudinal interactions were analysed with two-way analysis of variance, and hazard ratios for incidence until 18 years were calculated with Cox proportional hazard models, adjusting for mothers' education and use of psychotropics, children's adverse life events and sex. Results PA declined from 4.2 to 2.5 hours per day between 5 and 11 years of age. PA at 11 years was negatively associated with the incidence of any psychiatric conditions among all participants (HR=0.88, 95% CI 0.79 to 0.98) until 18 years. PA at 11 years showed a trend for reducing depression among girls (HR=0.82, 95% CI 0.67 to 1.00) and boys (HR=0.71, 95% CI 0.47 to 1.06) and protected against anxiety (HR=0.61, 95% CI 0.42 to 0.90) and addiction (HR=0.65, 95% CI 0.45 to 0.95) for boys, but not for girls (anxiety: HR=0.96, 95% CI 0.81 to 1.13, addiction: HR=1.04, 95% CI 0.68 to 1.58). Time outdoors showed no protective associations, while participation in organised sports showed significant protective effects on anxiety and addiction for both boys and girls, and on depression for boys. Conclusions This study provides evidence that PA and participation in organised sports may have sex-specific protective effects against several childhood psychiatric conditions
The open work and the closing reading : Navigating openness and ambiguity in literature discussions
No full textThe tension between openness and ambiguity in literature and readers’ expectation of coherence and consistency (i.e., their ‘desire for closure’) may present a pedagogical dilemma in literature classrooms. While prior research has identified an educational potential of using open works to de-automatize students’ thinking, encourage tolerance for ambiguity, and shape literary awareness, empirically-based knowledge of such classroom practice is scarce. The present study examined the interaction between structured openness of literary texts and readers’ ‘desire for closure’ in the context of literature discussions in lower secondary school. Drawing on videotaped whole-class discussions about narratively complex short stories in an ongoing intervention to support quality of literature discussions, we identified six different closing mechanisms used by either the teacher or the students: 1) Forcing a one-sided interpretation; 2) Inferring new context, not given by the text, to embed already preferred interpretations; 3) Magnifying peripheral details to support interpretations; 4) Staying on the surface – concentrating on the empirically verifiable and determinate; 5) Skipping between inquiries instead of developing lines of thought; and 6) Encouraging readers to connect fictive elements to their own lives. Based on the analysis, we discuss how interactional closure of literary openness in the classroom context relates to principal educational ideals of promoting clarity, comprehension, and coherence.Funding Agencies|Swedish Institute for Educational Research [2021-00043]</p
"We'll be here until it all collapses" : An Ethnography of Persistence and Hope Among Solidarity Actors in the Calais Borderscape
No full textAcross Europe and beyond, solidarity actors remain heavily engaged in the border struggle against the undignified treatment of people on the move. Border struggles are known to be hostile and exhausting, and repression against solidarity actors is rising; however, little is known about how solidarity actors persist in such challenging contexts. The northern French border in Calais has been described as a testing ground for Europe's border externalisation policies. Understanding resistance and persistence in Calais, therefore, offers insights for both scholars and activists at other borders. This thesis aims to examine how the repression of solidarity affects solidarity actors in Calais, focusing on their sustaining resistant practices and the roles of power and emotion in these practices. It also explores how repression shapes solidarity relations with people on the move. The thesis is based on one month of ethnographic observation and eleven interviews in Calais. Observation notes and interview transcripts were analysed using reflexive thematic analysis, theoretically informed by 'borderscapes as method', Foucault's 'productive power' and 'resistance', and Ahmed's theories of 'emotion' and 'solidarity'. This thesis shows that, when facing repression, solidarity actors adopt protective relationships with people on the move, leading to dilemmas between their ideals and practices. Furthermore, experiences of repression politicise and fuel the drive to resist. The emerging resistant practices are marked by adaptability, including flexibility, creativity, using legal know-how, self-censorship, and counter-surveillance, which are not only guided by emotional attachments, such as anger and hope, but also by dynamic, relational, and productive power relations that generate new solidarity identities and practices. Future research could benefit from focusing further on the generative potential of struggles and specifically including intersectional and marginalised perspectives in the analysis.
Artificial Intelligence in Digital Pathology : with a Focus on Breast Cancer
No full textBreast cancer is the most common cancer among women in Sweden, and pathology is central to diagnosis and treatment planning. Advances in digital pathology, using high-resolution whole-slide images, (WSI), have enabled the use of AI-based (artificial intelligence) image analysis tools that improves diagnostic efficiency and reproducibility. However, responsible implementation requires careful attention to clinical accountability, data governance and human oversight. This thesis presents a multimodal evaluation framework and contributes to technical and medical insights to the field. In the first study a research database was constructed to support generalizable AI development, compromising six annotated imaging collections, comprising 754 WSIs and 24,043 pathology annotations, 110 radiology cases and 397 lesion annotations. One study evaluated a human-in-the-loop (HITL) workflow, when pathologist assess cellproliferation as expressed by Ki-67 from an AI result. Even though AI showed reduced cell-level performance on local data, (F1 score 0.68 compared to 0.83), status agreement for visual estimation of Ki-67 performed significantly worse (Cohen’s κ 0.62) than digital image analysis (κ 0.84) and HITL (κ 0.76). HITL reduced variability of the Ki-67 error and mitigated key limitations such as tumour heterogeneity, misidentification, and staining variability, while highlighting risks from user handling errors. Subsequent studies introduced Feature Enhancing Zoom (FEZ), a visualization technique that amplifies stain patterns at low magnification. In a study with eight pathologists, FEZ improved task efficiency by 15% without compromising accuracy. A usability study with 16 pathologists confirmed high ratings, especially for stains requiring small object identification. Finally, a methodology was evaluated to mitigate domain restraints during clinical implementation of a pretrained AI model for detecting metastases in lymph nodes. A locally curated dataset of 396 cases (4,462 WSIs) was used, with slides labelled by surgical procedure and lesion presence. Results showed that surgical procedure affects model performance, and retraining significantly improved generalization and thus reducing false positive predictions. In summary, this thesis demonstrates how AI and digital pathology can be integrated into clinical workflows to enhance diagnostic precision.Funding: This work has been supported by grants from ALF and RFoU through Region Östergötland, as well as funding from the Swedish Breast Cancer Association, Vinnova, and Visual Sweden.</p
Renovation or demolition? Management insights into addressing aging school and preschool buildings in Sweden
No full textThis article examines the choice between renovation and demolition and new building construction approaches for addressing aging school and preschool buildings in Sweden. This study aims to identify common reasons for implementing measures and to analyze the effectiveness and limitations of renovation to address these problems. This study identifies essential factors relevant to the management of these buildings that contribute to the benefits from a management perspective and assesses the extent to which these benefits are realized through renovation. Data were collected through qualitative interviews and questionnaires with municipal managers overseeing school and preschool buildings. The findings show that renovation is the most common approach, however, limitations exist in increasing capacity, achieving economies of scale, and fully improving poor indoor environments caused by structural issues. The results also showed that smaller municipalities struggle with a lack of economic resources to address problems in school and preschool buildings. Despite the higher costs per square meter, demolition and new construction are sometimes viewed as cost-effective alternatives, contributing to many of the identified benefits from a management perspective. This study provides valuable insights into the decision-making process between renovation and new construction, balancing building functionality with management needs.Funding Agencies|Svenska Forskningsrdet Formas https://doi.org/10.13039/501100001862; Swedish Research Council Formas</p
Short-billed Dowitcher (Limnodromus griseus hendersoni) nesting habitat preferences and climate change implications in Churchill, Manitoba, Canada
No full textClimate change poses a threat to subarctic ecosystems, and subarctic breeding shorebirds are already experiencing loss of breeding habitat due to the changing landscape. In this study, we aimed to identify the nesting habitat preferences of the Short-billed Dowitcher Limnodromus griseus hendersoni, a declining shorebird that breeds in the subarctic tundra of Canada, at one of their nesting sites near Churchill, Manitoba. We use Maxent, a presence-only species distribution model, to identify its nesting habitat preferences and visualize the potential distribution of suitable nesting habitat around Churchill. Presence locations were acquired by intensive nest surveys from 2021 to 2023. Terrain data, acquired via remote sensing, were used as environmental predictors. Nest sites were mostly predicted by vegetation structure, particularly high vegetation productivity related with wet-sedge meadows. Suitable nesting habitat is predicted to be 3357 ha in the area around Churchill, but encroachment by shrub or trees would severely decrease habitat suitability. Modelling was based on a relatively small number of observations because Short-billed Dowitcher nests are both uncommon on the landscape and highly cryptic. Nonetheless, this study provides valuable insights into the breeding biology of an understudied shorebird species at one of their few monitored breeding sites.Funding Agencies|Smithsonian Institute; Environment and Climate Change Canada; Northern Scientific Training Program (NSTP); Churchill Northern Studies Centre Northern Research Fund (NRF); Natural Sciences and Engineering Research Council of Canada (NSERC) Canada Graduate Scholarship-Master's program (CGS M); Ontario Graduate Scholarship; NSERC</p
Early Sterile Keratolysis Complication With Decellularized Porcine Corneal Inlay Implant: A Case Report and Cautionary Tale
No full textPurpose:To describe an early sterile keratolysis associated with a decellularized porcine corneal inlay implant for keratoconus.Methods:This is a case report of a 23-year-old man with keratoconus who underwent lenticular intrastromal keratoplasty in his OD. Within 4 weeks, the patient presented with anterior sterile keratolysis and partial inlay extrusion, leading to surgical inlay removal.Results:After inlay removal, despite aggressive topical treatment including steroid drops, antibiotic ointment, and bandage contact lenses, the patient developed severe anterior scarring and corneal flattening, resulting in decreased visual acuity. Over a period of 4 months, the cornea underwent long-term remodeling, with vision improving to a best-corrected distance visual acuity of 0.1 logarithm of the minimum angle of resolution.Conclusions:The removal of the porcine corneal inlay because of severe keratolysis highlights the potential risks of this procedure. In addition, the spontaneous improvement in visual acuity over 4 months emphasizes the need for adequate healing time before further surgeries, such as keratoplasty
The Load-Bearing System from the Perspective of Sustainable Building
No full textThe building sector has a great potential to achieve goals for sustainable development by promoting environmental quality, economic effectiveness, and social improvement. One aspect that can possibly be considered in this context is the design of the building structure. The purpose of this case study is to investigate how the choice of a load-bearing system of building can affect the amount of concrete and steel reinforcement used in the foundation and its impact on the economy and environment. An alternative structural system of an existing building is proposed. The load-bearing frame walls and spread concrete foundations under walls are replaced by load-bearing timber columns that are placed on separate concrete footing pads. The results show that the amount of concrete and steel in the proposed system have considerably been decreased compared to the reference building. Consequently, this results in minimizing the construction costs as well as the resulting emissions of carbon dioxide into the environment. This case study reviews practical engineering design aspects that can be used by structural and construction engineers to help achieve sustainability goals of the built environment