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Beredskapslager i kritiska försörjningskedjor : samverkansutmaningar kopplat till styrning och incitament
No full textFörsörjningsberedskap är återigen centralt för Sverige och man inser att samhällsviktiga försörjningskedjor består av såväl olika slags myndigheter som privata, ofta globala, företag. För att höja beredskap, behövs ett mer gemensamt arbete med risker och kontinuitetshantering i försörjningskedjor. Det finnas dock stora samverkansutmaningar i detta privat-offentliga gränssnitt. Artikeln beskriver ett ramverk med samverkansmekanismer för riskhantering i försörjningskedjor, och fördjupar diskussionen kring beredskapslager. Ökade säkerhetsbuffertar är en av flera riskmitigeringsstrategier, och återinförande av beredskaps-lager diskuteras allt mer. Men att bygga upp beredskapslager av rätt varor, på rätt platser, i rätt nivåer är inte trivialt och bör kompletteras med tydliga principer för vem som skall sköta dem operativt, vem som skall äga, och hur både varorna och lagringsarbetet skall finansieras
Boosting aerosol surface effects : strongly enhanced cooperative surface propensity of atmospherically relevant organic molecular ions in aqueous solution
No full textThe effects of atmospheric aerosols are key uncertainties in climate models. One reason is the complex aerosol composition which includes a relatively large fraction of organics. Another reason is the small size of aerosols, which makes surface effects and processes important. These two factors make surface-active organics relevant for atmospheric aerosols, as they can affect crucial processes, such as chemical aging and water accommodation, as well as properties such as the surface tension, which drives droplet formation. Two exemplary types of atmospherically relevant organics are carboxylic acids and alkyl amines, and often both are found together within aerosols. In the most atmospherically significant pH range, these exist as alkyl-carboxylate ions and alkyl-ammonium ions. Using liquid-jet photoelectron spectroscopy, tuned to high surface sensitivity, we measured the alkyl-carboxylate anions and the alkyl-ammonium cations of alkyl chain lengths of 1 to 6 carbon atoms, both as single-component and mixed-component aqueous solutions. This enabled us to systematically study how their surface propensity is affected by the length of the alkyl chains and how cooperative ion-ion interactions result in strongly increased surface propensity. An exponential increase in surface propensity is found for the single-species solutions, with cooperative solute-solute effects in mixed solutions of 1 : 1 molar ratio drastically increasing the number of molecules present at the solutions' surfaces up to a factor of several hundred. This cooperative surface propensity is shown to strongly affect the amounts of organics at the surface. These changes can significantly influence radiative forcing via aerosol growth, cloud condensation nuclei activity, and aerosol chemical aging. Our results demonstrate the principal feasibility of a more advanced input of molecular details for creating parameterized descriptions of aerosol surface composition needed to properly account for their impacts in climate models
Phenotyping Exertional Breathlessness Using Cardiopulmonary Cycle Exercise Testing in People With Chronic Airflow Limitation
No full textBackground: Exertional breathlessness is a cardinal symptom of people with chronic airflow limitation (CAL) and can be evaluated using cardiopulmonary exercise testing (CPET). Research Question: Does abnormally high exertional breathlessness in relationship to the rate of oxygen uptake (V′O2) and minute ventilation (V′E) indicate different underlying pathophysiologic mechanisms and clinical characteristics in people with CAL? Study Design and Methods: Analysis of people aged ≥ 40 years with CAL (FEV1 to FVC ratio after bronchodilation less than lower limit of normal) undergoing symptom-limited incremental cycle CPET in the Canadian Cohort Obstructive Lung Disease study. Using published normative references, breathlessness phenotypes at peak exercise were categorized as abnormal (Borg 0-10 scale intensity rating more than upper limit of normal) by V′O2 alone, abnormal by both V′O2 and V′E, or normal by both V′O2 and V′E. Exercise physiologic responses and clinical characteristics were compared between groups. Results: We included 325 people (44% female) with CAL (mean [SD]) FEV1, 75.4 [17.5] % predicted). Compared with the normal by both V′O2 and V′E group (n = 237 [73%]), the abnormal by V′O2 only group (n = 29 [9%]) showed lower pulmonary diffusing capacity and greater exercise ventilatory inefficiency, whereas the abnormal by both V′O2 and V′E group (n = 50 [15%]) showed even worse lung function, dynamic critical inspiratory constraints, and exertional breathlessness along with greater symptom burden in daily life, lower physical activity, and worse health status. Interpretation: Our results show that exertional breathlessness phenotyped in relationship to V′O2 and V′E using normative reference equations enables multivariable analyses of underlying symptom mechanisms and associated clinical characteristics
Blood-based biomarkers for detecting Alzheimer's disease pathology in cognitively impaired individuals within specialized care settings : A systematic review and meta-analysis
No full textBACKGROUND: This systematic review and meta-analysis aimed to assess the diagnostic test accuracy of blood-based biomarkers (BBMs) for detecting Alzheimer's disease (AD) pathology in cognitively impaired individuals in specialized care settings. The overarching goal is to inform the development of a clinical practice guideline, led by the Alzheimer's Association, for use in clinical practice. METHODS: A systematic search of MEDLINE, Embase, and Cochrane Library was conducted from January 2019 to November 2024. Studies evaluating the diagnostic test accuracy of plasma phosphorylated tau (p-tau) and amyloid beta (Aβ) tests (p-tau217, %p-tau217, p-tau181, p-tau231, and Aβ42/Aβ40) compared to reference standard tests (cerebrospinal fluid [CSF] AD biomarkers, amyloid positron emission tomography [PET], or neuropathology) in individuals with cognitive impairment (mild cognitive impairment or dementia) in specialized care settings were included. Pooled diagnostic test accuracy measures were calculated, including sensitivity, specificity, and likelihood ratios. Across a range of pre-test probabilities, we evaluated how much a positive or a negative test result would lead to a change in the probability of having amyloid positivity (post-test probability). All analyses were conducted for each test within each biomarker. The Quality Assessment of Diagnostic Accuracy Studies 2 tool was used to evaluate the risk of bias, and the certainty of the evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation approach. RESULTS: Across 49 observational studies meeting eligibility criteria, 31 different BBM tests were examined. When evaluated using a single cut-point, the diagnostic test accuracy varied considerably across tests: the pooled sensitivity ranged from 49.3% (95% confidence interval [CI]: 41.2–57.4) to 91.4% (95% CI: 86.6–94.6), and the pooled specificity ranged from 61.5% (95% CI: 45.6–75.3) to 96.7% (95% CI: 87.8–99.2). Differences in post-test probability based on a range of pre-test probabilities varied greatly across tests. Furthermore, the certainty of evidence across tests ranged from moderate to very low. Most included studies were judged to be at high risk of bias, particularly in domains related to patient selection, index test conduct, and reference standard. CONCLUSION: This systematic review provides a comprehensive synthesis of the current evidence on the diagnostic accuracy of BBMs for detecting AD pathology in cognitively impaired individuals in specialized care settings. The findings serve as a foundation for an accompanying clinical practice guideline that provides evidence-based recommendations for BBM use in the clinical diagnostic pathway. Given continuous developments in this rapidly evolving field, ongoing evaluation will be critical to ensure the synthesized evidence and clinical guidelines remain up to date and maintain clinical relevance. Highlights: This is the first comprehensive systematic review and meta-analysis to evaluate the diagnostic accuracy of blood-based biomarker (BBM) tests specifically in individuals with objective cognitive impairment seen in specialized care settings. Across 49 studies, BBM test performance varied widely. Pooled sensitivity ranged from 49.3% to 91.4% and specificity from 61.5% to 96.7%, depending on the analyte and assay platform. This review followed the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy, the Grading of Recommendations, Assessment, Development, and Evaluation approach to assess the certainty of evidence. This review served as the evidence base for the Alzheimer's Association's new clinical practice guidelines on BBMs, providing structured, evidence-based guidance for implementing BBMs in the diagnostic workup of suspected Alzheimer's disease. The review underscores that BBM test performance is assay- and platform specific and advises clinicians and laboratory directors to interpret results in the context of the specific test used and integrate the results with a comprehensive clinical assessment
Betydelsen av beprövad erfarenhet inför formella beslut i socialtjänsten – en kollaborativ arbetsprocess
No full textVilken roll spelar beprövad erfarenhet i socialtjänstens beslutsfattande? I det här kapitlet undersöks hur socialsekreterare inom områdena barn och unga samt vuxna med beroendeproblematik använder och delar kunskap i en komplex vardag präglad av krav på rättssäkerhet, evidens och effektivitet. Genom fokusgruppsintervjuer synliggörs det kollegiala lärandets betydelse och hur erfarenhetsbaserad kunskap formas, förmedlas och får genomslag inför formella beslut. Kapitlet belyser också hur struktur och reflektion kan bidra till att hantera osäkerhet i det sociala arbetets praktiska verklighet
Everyday Geopolitics of Uzbek Migrants in Russia and Their Left-behind Families in Uzbekistan
No full textDifferent plasma biomarker patterns associated with coronary atherosclerosis in low- versus high-risk individuals – an observational cross-sectional study
No full textBackground and aims: Targeted omics techniques can be used to identify systemic blood biomarkers associated with coronary artery disease (CAD) and cardiovascular disease (CVD) events. Our aim was to study associations between plasma protein, metabolite biomarkers and subclinical CAD in a low and a high CVD risk population. Methods: The Swedish CArdioPulmonary bioImage Study (SCAPIS) was used for inclusion of a study group without a history of atherosclerotic CVD stratified by cardiovascular risk; one low-risk group with a Systematic COronary Risk Evaluation 2 (SCORE2) of less than 5 % and one high-risk group with a SCORE2 above 7.5 %. In a cross-sectional study design, random forest and ordinal logistic regression models were used to analyse the relative importance of 409 proteins and metabolites for associations with the degree of coronary computed tomography angiography-detected subclinical coronary atherosclerosis, measured as coronary artery calcium score (CACS) and number of segments with coronary atherosclerosis (SIS) in the two groups. Results: In the low-risk group (n = 2063), branched-chain amino acids were associated with both CACS and SIS, while increased high-density lipoprotein (HDL) metabolites, with the exception of phospholipids, were associated with a lower CACS and SIS. In the high-risk group (n = 576), proteins involved in inflammatory processes showed negative associations with coronary atherosclerosis, while HDL metabolites did not show any protective effect. Renin and MMP12 were associated with subclinical CAD in both groups. Conclusions: Different plasma biomarker patterns associated with subclinical CAD (CACS and SIS) were identified in individuals with a low and a high CVD risk, which could be used to better understand protective and risk factors for CAD in primary prevention
Metabolic Health and Heterogenous Outcomes of Prenatal Interventions : A Secondary Analysis of a Randomized Clinical Trial
No full textImportance: Prenatal intensive behavioral therapy (IBT) interventions that promote adequate gestational weight gain (GWG) have had variable and mostly modest effects on clinically relevant maternal and infant outcomes. It is unknown whether different maternal obesity metabolic phenotypes underlie the heterogeneity in response. Objective: To examine GWG, adverse perinatal outcomes, substrate changes, and differential changes in each in a prenatal IBT intervention conducted among pregnant individuals with 2 identified obesity phenotypes. Design, Setting, and Participants: The Lifestyle Interventions for Expectant Moms (LIFE-Moms) trial was a consortium of 7 independent but collaborative multicenter randomized clinical trials that took place between November 1, 2012, and December 31, 2017, and evaluated a prenatal IBT intervention on GWG and perinatal outcomes among women with overweight and obesity. Statistical analysis for the present preplanned secondary analysis was conducted from March 29, 2023, to June 4, 2025. Participants (n = 1150) had a confirmed viable singleton pregnancy and no previous diagnosis of cardiometabolic diseases. This analysis was limited to those with obesity. Participants were classified into 2 groups: obesity with no additional qualifying cardiometabolic disease risk factors (metabolically healthy obesity [MHO]) or obesity with 2 qualifying risk factors (metabolically unhealthy obesity [MUO]) in early pregnancy. Intervention: A behavioral lifestyle intervention incorporating diet and physical activity was delivered to increase adherence to the National Academy of Medicine GWG guidelines. Main Outcomes and Measures: GWG (total and adherence to guidelines), adverse perinatal outcomes, substrate changes, and infant body composition. Analysis was conducted on an intent-to-treat basis. Results: The mean (SD) age of the 640 participants was 30.2 (5.6) years, and the participants presented in early pregnancy with a mean (SD) body mass index of 35.2 (4.1). Participants in the MUO (n = 172) and MHO (n = 228) groups did not differ in response to treatment in weight outcomes, adverse perinatal outcomes, or substrate changes, with the exception that patients in the intervention group experienced smaller mean (SE) triglyceride increases more in the MUO group than in the MHO group (90.3% [7.4%] vs 81.8% [8.3%]; P =.02). After adjustment for maternal baseline demographics and treatment group, individuals with MUO had lower GWG (0.30 [0.23] kg/wk) compared with individuals with MHO (0.41 [0.27] kg/wk; P <.001), a 36.7% difference, and had a lower proportion exceed weight gain guidelines (57.0% [98 of 172] vs 68.0% [155 of 228]; P =.03). Participants with MUO had a higher incidence of gestational diabetes (23.8% [41 of 172] vs 9.8% [22 of 228]; P =.001) and had infants with a higher proportion of adiposity (mean [SD], 12.5% [3.9%] vs 11.7% [3.7%] fat; P =.05) compared with participants with MHO. Conclusions and Relevance: In this preplanned secondary analysis of a randomized clinical trial of an IBT on GWG among pregnant individuals, those with MUO experienced less GWG, had a higher incidence of gestational diabetes, and had infants with a higher proportion of adiposity compared with those who MHO. Data supported that the maternal obesity metabolic phenotype has a greater clinical effect on adverse maternal and infant clinical outcomes compared with GWG alone and did not contribute to a differential response to a lifestyle intervention. Future interventions should identify methods to better optimize the maternal metabolic milieu as early in pregnancy as possible to reduce the intergenerational transmission of metabolic disease. Trial Registration: ClinicalTrials.gov Identifiers: NCT01545934, NCT01616147, NCT01771133, NCT01631747, NCT01768793, NCT01610752, NCT01812694
Digital och interaktiv palliativ mottagning
No full textBakgrundDetta projekt utgår dels från vår ALLAN-studie kring tidig palliativ vård, och dels från tidigare erfarenhet av digital vårdinnovation.Den digitala vårdtjänsten 1177.se erbjuder flexibel kontakt med patienter, vilket kan vara ett alternativ till fysiska hembesök. Samtidigt ifrågasätts om svårt sjuka och äldre patienter kan använda och acceptera digital vård, samt om detta påverkar den interpersonella relationen mellan vårdpersonal och patienten, och därmed den personcentrerade vården, negativt. Internationella pilotstudier visar dock att digital palliativ vård är väl accepterat, kostnadseffektiv och förbättrar både symtomkontroll och patientnöjdhet¹. Dessutom har digital självrapportering visat förbättrad symtomkontroll vid onkologisk behandling² och kan stödja patienters coping³,4Vår vision - Att identifiera patienter med palliativa vårdbehov tidigare- Att patienter och närstående ska få tillgång till palliativ vård tidigare i vårdförloppet vid obotliga eller kroniska sjukdomar- Att integration och samarbete mellan sjukhusvård och palliativ vård ska upplevas som en naturlig del av vårdprocessenDigitala mottagningsbesök- Kontakt med patienten och närstående digitaltPatientinformation och egenvårdsfilmer - All information till patient och närstående tillgänglig eller skickas digitaltDigitala symtomskattningar (p-NVP)- Nyutvecklat digitalt formulär Digital gemenskap och kunskap via interaktiva gruppmöten- Synkrona gruppmöten via 1177- Månadsvisa möten med anmälan via 1177Vår digitala vårdprocess- Bedömning av inkommen remiss- Bedömning efter samtal med patienten- Symtomskattningsinstrument skickas till patienten- Patienten rapporterar in sina aktuella läkemedel digitalt- Initialt fysiskt hembesök till patienten- Därefter en individuell uppföljningsplanFördelar med en digitala vårdformen- Fler patienter och närstående får tillgång till palliativ vård tidigare i vårdförloppet- Digital asynkron symtomskattning ökar patientsäkerheten- Flexibelt och enkelt att delta och svara när det passar patienten och närstående- Vård anpassad efter unika behov och prioriteringar- Oberoende av geografisk närhet till ett palliativt vårdteam.Referenser: Worster, B. and K. Swartz, Telemedicine and Palliative Care: an Increasing Role in Supportive Oncology. Curr Oncol Rep, 2017. 19(6): p. 37.Cho, Y., et al., Acceptance and Use of Home-Based Electronic Symptom Self-Reporting Systems in Patients With Cancer: Systematic Review. J Med Internet Res, 2021. 23(3): p. e24638.Poort, H., et al., Feasibility and Acceptability of a Mobile Phone App Intervention for Coping With Cancer as a Young Adult: Pilot Trial and Thematic Analysis. J Med Internet Res, 2021. 23(6): p. e25069.Greer, J.A., et al., Role of Patient Coping Strategies in Understanding the Effects of Early Palliative Care on Quality of Life and Mood. Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2018. 36(1): p. 53-60
