Publikationer från Umeå universitet
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Rural–urban disparities in in-home care journeys in sparsely populated areas : a case from northern Sweden
No full textThis paper investigates rural–urban disparities in the experiences of in-home care services for older adults in a sparsely populated municipality (Storuman) in Northern Sweden. Such municipalities are characterised by long-term population loss and ageing, an increasing concentration of residents and services in municipal centres and resultant rural ‘resource deserts’. Disparities are measured through four ‘endpoint’ measures—exits to residential care, resource use, longevity and survival in the in-home care system. Data were drawn from the municipality’s care service contract database (2014–2020). Users living in the municipal centre had lower resource use and used direct care less frequently than those in smaller and more distant settlements. Those living near a grocery store were more likely than others to survive long term in the in-home care system. The research reveals a potential to reduce exits to residential care, to make more effective use of direct care and shopping services and to limit disruptive transfers of care, particularly between municipal and regional health services. Overall, there was limited evidence of rural–urban disparities in in-home care outcomes, but particular attention should be paid to transactional proximity of different parts of the care system and proactive rather than reactive care planning. The paper contributes to debates about quality measures for in-home care and the impacts of micro-urbanisation on the lives of people living in sparsely populated areas
Balloon-expandable versus self-expanding valves in bicuspid aortic stenosis : insights from the SWEDEHEART registry
No full textBackground: Transcatheter aortic valve replacement (TAVR) is increasingly used in patients with bicuspid aortic valve (BAV) stenosis, but there is limited comparative data on balloon-expandable (BEV) versus self-expanding valves (SEV) in this population. Aim: To compare clinical and hemodynamic outcomes between BEVs and SEVs in patients with BAV stenosis. Methods: This observational cohort included all patients who underwent TAVR in Sweden between 2016 and 2022. Exclusion criteria included procedures for pure aortic insufficiency and valve-in-valve interventions. The analysis focused on Evolut, Sapien, Acurate, and Portico/Navitor valve families. A doubly robust approach was applied combining inverse probability of treatment weighting and multivariable regression. Sensitivity analyses were also conducted. Results: Of 577 patients, 274 (47.5%) received a BEV. The majority in the SEV group received an Evolut valve (62%). The mean EUROSCORE II-predicted mortality risk was 4.1% for BEV and 3.6% for SEV. BEVs were used more in patients with reduced ejection fraction (EF ≤ 40%) and larger aortic annuli. There were no significant differences between groups in periprocedural mortality, all-cause mortality at a median follow-up of 675 days, or device success. However, SEVs had higher technical success (aOR: 2.21, p = 0.006), lower postprocedural gradients (adjusted coefficient: −3.72, p < 0.001), and reduced risk of prosthesis-patient mismatch (aOR: 0.10, p = 0.02). SEVs, though, had a higher incidence of paravalvular leakage (aOR: 7.5, p < 0.01). Conclusion: Both BEVs and SEVs were feasible with similar clinical outcomes in BAV stenosis. SEVs had better hemodynamic outcomes but more paravalvular leakage. Randomized trials are needed to determine the optimal valve choice
Acute loss of tactile input leads to general compensatory changes in eye–hand coordination during object manipulation
No full textCurrent models of motor control emphasize the critical role of sensory feedback, as demonstrated by movement coordination deficits following sensory impairment. When both vision and touch are available for object-oriented manual behaviors, they serve distinct roles; vision guides the execution of planned movements, while touch provides more direct feedback on hand–object interactions. The impact of losing somatosensory feedback on eye–hand coordination during dexterous object manipulation tasks has not been thoroughly studied. Conceivably, vision is recruited to compensate for the feedback lost when touch is abolished based on the dexterity demands of the behavior. To investigate this, we tested healthy participants of either sex on a manual dexterity task requiring the movement of small metal pegs, both before and after the administration of digital anesthesia, which selectively abolished cutaneous sensations in the fingertips while preserving motor function. We recorded participants’ gaze and hand positions. Despite loss of cutaneous feedback, participants successfully completed the pegboard task. However, they exhibited significantly longer trial times and altered force profiles. Notably, acute somatosensory loss triggered a rapid shift in visual behavior, characterized by a tighter coupling between gaze and hand positions across all task actions, even those not directly involving object manipulation. These changes, which occurred with anesthesia of the dominant and nondominant hands, were not evident with sham (saline) injections. Our findings underscore the contributions of sensory feedback to force control in service of dexterous object manipulation and reveal the nonselective nature of compensatory gaze–hand coordination processes
Coloring, list coloring, and fractional coloring in intersections of matroids
No full textIt is known that in matroids the difference between the chromatic number and the fractional chromatic number is smaller than 1, and that the list chromatic number is equal to the chromatic number. We investigate the gap within these pairs of parameters for hypergraphs that are the intersection of a given number k of matroids. We prove that in such hypergraphs the list chromatic number is at most k times the chromatic number and at most 2k-1 times the maximum chromatic number among the k matroids. We study the relationship between three polytopes associated with k-sets of matroids, and connect them to bounds on the fractional chromatic number of the intersection of the members of the k-set. This also connects to bounds on the matroidal matching and covering number of the intersection of the members of the k-set. The tools used are in part topological
Ideological tensions in identity construction of Chinese medical teachers and students in EMI
No full textEnglish-medium instruction (EMI) has been promoted in China’s mainland for over two decades, and its developmental landscape is complex. This article explores ideological tensions and how these tensions are created in the discourse of Chinese medical teachers and students in EMI courses. Drawing on the concept of tension-filled English, this article employs critical discursive psychology (CDP) to analyse ideological tensions in identity construction that emerged in semi-structured interviews with teachers and students about their imagined EMI courses. The analysis identifies two main ideological tensions between monolingual and bilingual approaches to EMI and between standard and practical orientations to English. By observing the interplay among different language ideologies in identity making, this study provides a valuable angle to understand the challenge-ridden experience of EMI teachers and students according to their own contextual needs and disciplinary practices. The findings suggest the importance of EMI stakeholders reflecting on how teaching and learning practices can enable learners (and teachers) to reflexively understand the role of English (and other languages) and leverage their bilingual repertoires for medical careers
Occupational physical activity and stroke mortality in male Swedish construction workers between 1971 and 2015
No full textBackground: Contrary to leisure-time physical activity, high levels of occupational physical activity (OPA) have been linked to cardiovascular disease and mortality. Many occupations in the construction industry are known to have high levels of OPA.Aims This study investigated OPA and stroke mortality risk among 299 382 Swedish male construction workers. Methods: OPA was derived from job titles and categorized as low, medium or high, and stroke mortality was ascertained via the Swedish National Cause of Death Register. The average follow-up was 24 years resulting in a total of 6.9 million person-years, during which 4606 participants died from stroke. Relative risks were estimated with robust Poisson regressions and adjusted for age, calendar year, body mass index and smoking. Results: The relative risk for overall stroke mortality was higher in the medium and high OPA groups compared to the low OPA group [1.15 (1.04, 1.27) and 1.13 (1.04, 1.23), respectively], with no clear dose-response association. Age-stratified analyses showed that higher OPA increased stroke mortality risk in participants between 70 and 89 years. Participants with high versus low OPA had a higher risk of ischaemic stroke mortality [1.15 (1.01, 1.31)]. Conclusions: Construction workers with high OPA have a slight increase in overall stroke mortality, mainly after retirement. Contrary to leisure-time physical activity, high levels of occupational physical activity have been linked to an increased risk of cardiovascular disease and mortality. Construction workers in this study with medium and high occupational physical activity had higher stroke mortality than those with low occupational physical activity. However, there was no difference in stroke mortality between those with high and medium occupational physical activity
Cloud behavior prediction for solar power applications : a bibliometric analysis, categorized literature review, and future research directions
No full textAccurate Cloud Behavior Prediction (CBP), also referred to as forecasting in this context, is essential for Solar Power Prediction (SPP), as well as for weather forecasting, climate analysis, and satellite imaging. However, the nonlinear and dynamic nature of clouds, combined with other limitations, presents significant challenges to advancing CBP. Recent developments, particularly the integration of Machine Learning (ML), Numerical Weather Prediction (NWP), and other innovative approaches, show strong potential for improving CBP and, in turn, enhancing SPP and related applications. This review presents a bibliometric analysis of 467 publications from 1970 to 2024, retrieved from the Scopus database using CBP-related keywords. It identifies trends, influential studies, major subject areas, leading authors, contributing countries, and key publishers. The study further categorizes the essential steps in CBP and provides a detailed review of the most relevant literature on cloud cover, cloud motion (including vector-based methods), and cloud image prediction. Additionally, it examines critical factors affecting model performance and introduces a framework for evaluating predictive methods based on input types, methodologies, prediction horizons, results, and evaluation metrics. Several key challenges are highlighted, including the nonlinearity of cloud behavior, limited data availability, image quality issues, and model accuracy. In response, actionable recommendations are offered, such as expanding data sources, applying hybrid imaging and modeling approaches, managing uncertainty, improving postprocessing techniques, and incorporating cloud content estimation. Given the relatively limited research in this field, this study serves as a valuable benchmark for researchers, engineers, and policymakers engaged in real-time SPP and other cloud-dependent domains
Robust valuation and optimal harvesting of forestry resources in the presence of catastrophe risk and parameter uncertainty
No full textWe determine forest lease value and optimal harvesting strategies under model parameter uncertainty within stochastic bio-economic models that account for catastrophe risk. Catastrophic events are modeled as a Poisson point process, with a two-factor stochastic convenience yield model capturing the lumber spot price dynamics. Using lumber futures and US wildfire data, we estimate model parameters through Kalman filtering and maximum likelihood estimation and specify the model parameter uncertainty set as the 95% confidence region. We numerically determine the forest lease value under catastrophe risk and parameter uncertainty using reflected backward stochastic differential equations (RBSDEs) and establish conservative and optimistic bounds for lease values and optimal stopping boundaries for harvesting. Numerical experiments further explore how parameter uncertainty, catastrophe intensity, and carbon sequestration impact the lease valuation and harvesting decision. In particular, we explore the costs arising from this form of uncertainty in the form of a reduction of the lease value. These are implicit costs which can be attributed to climate risk, and are likely to become more significant as forestry resources play a larger role in the energy transition. We conclude that in the presence of parameter uncertainty, it is better to lean toward a conservative strategy reflecting, to some extent, the worst case than being overly optimistic. Moreover, our results suggest that convenience yield plays a substantial role in determining optimal harvesting strategies within the two-factor model adopted in this study
High IL-10 mRNA levels in regional lymph nodes of colon cancer patients indicate poor prognosis
No full textIntroduction: The prognostic value of determining mRNA levels of two markers for regulatory T cells, IL-10 and FoxP3, in lymph nodes (LNs) and primary tumors of colon cancer (CC) patients receiving curative surgery was investigated. Methods: mRNA levels were determined by real-time qRT-PCR in 370 LNs from 120 CC patients representing all four TNM stages, 66 primary tumors, 30 normal colon tissue samples and appropriate cell lines. Protein expression was analyzed by immunohistochemistry. Patients were followed for 12 years. Results: High levels of IL-10 mRNA in LNs were associated with poor prognosis with shorter mean survival time of 10 and 32 months (p = 0.001 and p = 0.004) at 5- and 12-year follow-up with hazard ratios of 12.4 and 6.3, respectively. No association between IL-10 level and prognosis was seen in the primary tumor. High levels of FoxP3 mRNA were associated with good prognosis, both in LNs and primary tumor. The difference in survival time was, however, small. Analysis of IL-10 mRNA in combination with LGR6 or CXCL17 mRNA in LNs generated patients with different risk of recurrence – low-, high- and very high risk. Immunohistochemistry identified IL-10 and FoxP3 positive cells located at the outer rim of tumor aggregates. Conclusion: Level determinations of IL-10 mRNA in LNs are useful for prediction of outcome for CC patients after curative surgery. Low levels indicate that the patients do not require further treatment, while IL-10 in combination with LGR6 or CXCL17 can be used to identify patients at very high risk of recurrence
Impact of bovine lactoferrin supplementation and reduced iron in formula on infant oral microbiome : a randomized controlled trial
No full textIntroduction: Infant formulas with reduced iron levels and lactoferrin (Lf) supplementation might mimic the beneficial effects of breast milk on the oral microbiome. This study aimed to investigate the impact of a bovine Lf-supplemented and iron-reduced formula on the oral microbiota in infants at 4, 6 and 12 months. Methods: In a double-blind controlled trial, 6-week-old formula-fed infants were randomized to receive either a formula with reduced iron levels (2 mg/L) and Lf supplementation (1 g/L) (n = 72), the same formula without Lf (n = 72), or a standard formula (8 mg iron/L) (n = 36). A breast-fed reference group (n = 72) was also included. The oral microbiota was analyzed at 4 (n = 244), 6 (n = 216) and 12 (n = 229) months of age using the Oxford Nanopore Technology of the 16S rRNA gene annotation (eHOMD database). Results: Neither the within- or between-group diversities nor overall microbiota pattern assessment revealed any statistically significant differences in microbiota composition between the formula groups. However, single species were significantly associated with specific formula-fed groups. At 6 months, breast-fed infants exhibited significantly lower species richness and distinct microbiota composition compared to the formula-fed groups. Conclusions: The effects of reduced iron levels and lactoferrin supplementation of infant formula on the oral microbiome were inconclusive