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DAPAgliflozin for renal protection in heart transplant recipients. Rationale and design of the randomized controlled DAPARHT trial
No full textBackground and aims: Heart transplantation is the preferred treatment for selected patients with end stage heart failure. Kidney function often declines after heart transplantation. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) slow the decline in eGFR in different populations. However, the effect of SGLT2i on kidney function in heart transplant recipients is unknown. Methods: The Dapagliflozin for Renal protection in Heart Transplant recipients (DAPARHT) trial is an investigator initiated, double blind, randomized, placebo-controlled trial designed to assess dapagliflozin's effect on kidney function in heart transplant recipients. Adults heart transplanted at least one year prior to randomization are eligible. Exclusion criteria include an estimated glomerular filtration rate (eGFR) <25 mL/min/1.73 m2, diabetes type I, and contraindication to study medication. Four hundred and thirty patients will be randomized 1:1 to receive 12 months blinded treatment with dapagliflozin 10 mg o.d. or placebo, followed by 24-months open-label treatment. The primary endpoint is the chronic slope of the eGFR from two weeks to 12 months after starting randomized treatment. The open-label phase evaluates dapagliflozin's long-term effects on kidney function, clinical outcomes, safety, and tolerability. Enrolment began in June 2022. As of December 18, 2024, 300 patients were enrolled. The mean baseline creatinine was 104 ± 28 µmol/L with corresponding eGFR of 66 ± 22 mL/min/1.73 m2. Estimated last patient visit is in September, 2028. Conclusion: The DAPARHT trial will test whether dapagliflozin improves eGFR slope compared to placebo during one year of follow-up, providing the first randomized evidence of the efficacy of SGLT2i in heart transplant recipients. Trial Registration: Dapagliflozin for Renal protection in Heart Transplant recipients (DAPARHT), NCT05321706, clinicaltrials.gov
Fetal exposure to a mixture of endocrine-disrupting chemicals and biomarkers of male fecundity : A population-based cohort study
No full textBackground: Fetal exposure to endocrine-disrupting chemicals (EDCs) has been associated with reduced male fecundity, but with few studies considering chemical mixtures. Objectives: We assessed the association between fetal exposure to a mixture of EDCs and biomarkers of male fecundity in young adulthood. Materials and methods: The study population comprised 841 young adult males enrolled in the Fetal Programming of Semen Quality cohort, established as a male offspring sub-cohort within the Danish National Birth Cohort. Maternal blood samples were analyzed for concentrations of per- and polyfluoroalkyl substances (PFAS), phthalate metabolites, and triclosan. We used quantile g-computation to estimate the change in semen characteristics, testicular volume, and reproductive hormone levels with 95% confidence intervals (CI) per one-quartile increase in all chemicals within three chemical mixtures; an overall chemical mixture, a PFAS mixture, and a non-persistent chemical mixture. Results: Fetal exposure to a one-quartile increase in the overall chemical mixture was associated with 4.0 million/mL lower sperm concentration (95% CI: −9.1, 1.1), 16.1 million lower total sperm count (95% CI: −33.8, 1.6), 0.5 mL smaller testicular volume (95% CI: −1.2, 0.3), 5% higher proportion of non-progressive and immotile spermatozoa (95% CI: 0.99, 1.11), and 7% higher concentration of FSH (95% CI: 0.99, 1.16), but with limited precision. Effect sizes were greatest in magnitude for sperm concentration and total sperm count. We observed somewhat similar associations for the PFAS mixture and no associations for the non-persistent chemical mixture. Discussion: Results suggest that fetal exposure to an overall mixture of EDCs may be adversely associated with several biomarkers of male fecundity, but findings are also compatible with null associations. These associations, if true, appeared to be driven by PFAS, but misclassification due to a single measurement of the phthalate metabolites and triclosan may have attenuated the results
Islamic Aid and Gulf States in Contemporary Crises
No full textProvides a conceptual framework for the analysis of Gulf States’ foreign aid Describes the Islamic values of humanitarianism and the Islamic social welfare instruments used for humanitarian financing, including zakat, sadaqa and waqf Introduces new empirical evidence on the aid structures and project implementation of Qatar and the UAE in Syria Explores an innovative conceptual framework on Gulf States’ foreign aid analysis, which is applicable beyond the case studies Analyses the aid interventions of Qatar and the UAE in Syria and for the Syrian refugee issue in the period 2015-2023The central argument of this book is based on the existence of non-universal but coexisting values that inspire humanitarianism, and the confrontation between values and practices in humanitarian aid implementation. The Gulf States, like any other donor states, are guided by the structural norms of the aid system and the politicisation of aid itself. However, originating from a different political and cultural background, including different Islamic understandings, they bring with them distinct practices and approaches within the system that can no longer be ignored.Altea Pericoli brings together an analysis of Islamic norms and foreign aid interventions by the Gulf States through the study of various levels of aid implementation and policies, and examines their behaviour in a specific case study: the Syrian humanitarian response from 2015 to 2023. The analysis explores the top-down decision-making process of aid allocation by Qatar, the UAE and non-state regional actors, as well as the humanitarian negotiations and aid distribution conducted by Gulf charities and local organisations in Syria after 2015
Personligt ansvar i en patientsäkerhetskultur : Avvägningar i rätten, rättslig förutsebarhet och drabbades behov
No full textThis thesis clarifies and highlights how selected parts of Swedish law in the field of health care relate to different ways of understanding events that have caused or could have caused patient injury: a systems perspective and an individual perspective, respectively. It thus examines how the law and its application relate to conflicts between supporting openness and learning based on a systems perspective, and professional accountability based on an individual perspective. The approach expressed by the law and its application is evaluated on the basis of legal predictability as a principle of the rule of law. In addition, the thesis highlights what the law’s approach to these perspectives, and the considerations made, imply for the ability to meet the needs of persons affected by adverse events in healthcare.The study was conducted using a deconstructive and revealing legal dogmatic method, as well as through an empirical study of healthcare providers' reports of incidents that caused or could have caused serious patient injury, and the Swedish Health and Social Care Inspectorate's handling of these cases.The thesis concludes that Swedish law gives the impression of wanting to achieve a “just culture” a culture in which boundaries are drawn between errors that are acceptable and those that are not. However, the answers provided by the law on how these boundaries should be drawn are characterised by considerable uncertainty. This lack of clarity stems from the fact that the provisions leave considerable room for subjective interpretation, but also from the fact that the legal answers in some cases send directly contradictory signals. The empirical study shows that healthcare providers have generally embraced the prospective preventive main purpose of investigating more serious incidents. At the same time, healthcare providers may apply different considerations depending on whether they adopt a systems or an individual perspective in their investigations, and it is not clear when or why one perspective is favoured over the other.The ambition to promote high patient safety based on a systems perspective has led to a gradual and significant limitation of access to justice for patients and their relatives. Patients and relatives affected by adverse events are today largely dependent on the goodwill and capacity of healthcare providers to meet their needs. In particular, the possibility for patients and relatives to hold individuals personally accountable – and thereby obtain a sense of redress – has been limited
Phytoplankton community dynamics in a changing world : Ecological drivers of Microcystis and Naiadinium polonicum dominance
No full textLakes provide critical ecosystem services and are therefore particularly sensitive to disruptions such as harmful algal blooms (HABs). Cyanobacteria are the most common HAB-forming species in lakes, and their prevalence is expected to increase with climate change. However, during a 2018 heatwave in southern Sweden, Lake Vombsjön experienced an unexpected shift from its usual cyanobacterial dominance to a bloom of the dinoflagellate Naiadinium polonicum. This event provided a rare opportunity to examine how ecological drivers shape the population dynamics of cyanobacteria and dinoflagellates, two groups predicted to do well under future climate change scenarios due to shared functional traits, though freshwater dinoflagellates remain comparatively understudied. In particular, this thesis focuses on Microcystis, a toxin-producing cyanobacterium of global importance, and N. polonicum, a bloom-forming dinoflagellate whose autoecology is largely unresolved. Across the first three papers, I examined field biomass dynamics, recruitment and growth responses to temperature, and allelopathic interactions between Microcystis and N. polonicum. In Lake Vombsjön, N. polonicum biomass was associated with higher temperatures, elevated soluble reactive phosphorus concentrations, water column stratification, and anoxic conditions near the sediment surface. While higher temperatures in 2018 did not directly enhance N. polonicum growth, temperature-dependent recruitment from sediments likely allowed it to establish earlier than Microcystis, whose recruitment was temperature independent. These findings point to seasonal timing as a key determinant of species dominance. Co-culture experiments revealed no evidence that N. polonicum inhibited Microcystis, whereas Microcystis was able to suppress N. polonicum growth at ecologically relevant densities. In my fourth paper, I focused on Microcystis and identified abiotic and biotic factors favoring toxigenic strains in natural populations. Toxigenic strains were associated with elevated nitrogen concentrations, consistent with the high nitrogen demands of microcystins, while microcystin concentrations were most strongly linked to phosphorus availability and overall Microcystis biomass, supporting dual nutrient reduction strategies to mitigate toxic blooms. Together, these results highlight two broader implications. First, freshwater dinoflagellates remain underrepresented in phytoplankton ecology despite evidence that they may become more prominent under future climate conditions, potentially impacting cyanobacteria bloom dynamics. Second, benthic life stages, particularly recruitment from sediments, must be incorporated into future research on cyanobacterial HABs. As climate change drives phenological shifts and alters pelagic conditions, understanding benthic-pelagic links will be essential for predicting and managing HAB events
User participation in co-design–requirements for accessible online collaboration : an exploratory study
No full textThe aim of this study was to describe prerequisites for online collaboration for user participation in co-design of online digital services as perceived by people with impairments and to develop requirements for how online collaboration should be designed to be accessible for all participants. An exploratory study was conducted in parallel to activities in two co-design projects. Researchers, accessibility experts, designers and 31 members of disability organisations participated. All participants had lived experience of impairments. Data was co-analysed by all participants using a qualitative thematic analysis with an inductive approach. Sixty-three requirements for accessible online collaboration were identified pertaining to four themes: digital tools and accessibility; preparation of an online collaboration activity; performing and participating in an online collaboration activity; and documenting and evaluating an online collaboration activity. Conclusion: the co-design process can be strengthened by transition to online collaboration, owing to the possibility of having more frequent interaction, economising the participants’ energy and the design process being more transparent. Using accessible online tools, careful planning, and meeting preparation, and establishing a trustful and convivial atmosphere during each activity, are the cornerstones for accessible online collaboration. People with impairment can participate in online collaboration if the activities meet accessibility requirements
Sensory Archaeology in the Digital Age: Exploring Ancient Spaces through Computational Methods
No full textJa eller nej till ”fictiv eganderätt”? : Historien om en knepig donation
No full textRegogörelse för när Lunds universitet 1844 erbjöds egendomen Häckeberga som donation, men på villkor som gjorde att regeringen beslöt att avböja gåvan