Publikationer från Uppsala Universitet
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Deconstructing Sepsis : Leveraging Subtypes for Personalized Diagnosis and Treatment
No full textSepsis is a life-threatening heterogenous disease triggered by a pathogenic infection. It starts with a dysregulated immune response that can result in tissue injury and organ dysfunction. Millions of patients worldwide are affected by sepsis yearly and their survival depends on timely and accurate measures. A deeper understanding of the disease’s heterogeneity could improve its management and patient survival. This can be achieved by patient stratification and subtyping, paving the way for precision medicine. This project aimed to investigate current diagnostic tests, sepsis subtyping methods, potential drug candidates, and diagnosis of invasive fungal infections. To achieve this, a literature study was performed. We found that sepsis cannot be diagnosed using a single test, as no individual method offers complete accuracy. Therefore, a combination of diagnostic tools, such as complete blood count and blood cultures are required to address their respective limitations. One promising parameter is the neutrophil-to-lymphocyte ratio. It has proven to be effective in several studies but is not yet routinely used in clinical practice. In addition, biomarkers like lactate, C-reactive protein or procalcitonin can be utilized in various stages of sepsis to support the diagnosis of the disease. Despite having these tools, significant challenges remain in the rapid and precise identification of sepsis. Invasive fungal infections are another healthcare burden. These can cause sepsis but are also an issue on their own. Diagnosis of invasive fungal infections often relies on cultures, which are slow and have low sensitivity. As an alternative, fungi-specialized diagnostic technologies have been developed, typically focusing on detecting fungal biomarkers. Much like sepsis, we found that a single test cannot be used in all situations. Currently, the standard treatment for all septic patients primarily involves antibiotics, fluid resuscitation and vasopressors. However, this one-size-fits-all approach does not account for the heterogeneity of sepsis. For more precise methods to work, a greater insight into how and what mechanisms drive sepsis, needs to be understood. Different subtyping methods focusing on the host response in sepsis are today researched and may contribute to a better understanding of how specific subtypes of sepsis can be treated. The variables that are studied include clinical variables, transcriptomic and protein signatures. From the literature study, we concluded that transcriptomic systems have provided the most promising results for more accurate treatment methods. Recent research has shifted toward precision medicine, investigating treatment strategies such as anticoagulants, corticosteroids, and immunomodulatory agents. Out findings suggest that both anticoagulants and immunomodulatory therapies as subtype specific treatments for sepsis. However, further research where more subtypes are taken into consideration is required before these approaches can be implemented in clinical practice. Continued investigation in this direction will enable a transition into individualized therapy, ultimately improving outcomes for sepsis patients
The state: Guardian or Antagonist of Human Rights? : A qualitative analysis of rights-restrictive approaches by states innational emergencies
No full textOrganized crime is a phenomenon that can create unrest in society, and in some situations, itmay be so violent, frequent and pervasive that it constitutes an emergency within a state. Intimes of emergency, the state’s duty to protect and realize the rights of its people are vital,while creating and maintaining security simultaneously becomes a priority. The way that astate goes about handling the emergency may differ, but their methods will have some sort ofimplications for human rights. This thesis examines the balancing between Sweden’s and ElSalvador’s approach to security and human rights in a time of crisis and how this balancingaffects rights-bearer’s ability to enjoy rights. By analyzing arguments by state officials, thethesis further aims to understand how the respective states legitimize security measures thatsimultaneously restrict rights and whether these arguments justify the state’s actions.The thesis finds that the respective states most often prioritize security over human rights intimes of emergency, which leads to unproportional security measures in relation to humanrights and the intended goal. Furthermore, the thesis finds that the respective states’legitimizing arguments often fail to justify the measures
Development of ankle and knee range of motion after isolated gastrocsoleus lengthening in children with cerebral palsy : a register-based longitudinal cohort study
No full textBackground and purpose: Outcome after gastrocsoleus lengthening in cerebral palsy (CP) is reported to be influenced by type of lengthening, age, CP subtype, and preoperative range of motion (ROM). We examined the development of ankle and knee ROM after 3 types of isolated gastrocsoleus lengthening. Methods: This is a register-based longitudinal cohort study based on data from the Swedish Cerebral Palsy follow Up Program, of children born 2000–2011 who underwent isolated gastrocsoleus lengthening. ROM development was analyzed using mixed-effects modeling. Event limits were defined as ankle ROM ≤ 0° or ≥ 20° and knee extension deficit ≤ –10° and described in Kaplan–Meier curves and Cox regression analyses. The study protocol was published at clinicaltrials.gov. Results: 184 children were included. The mean differences in ankle ROM 10 years postoperatively between open tendo Achilles lengthening (OTAL) and percutaneous tendo Achilles lengthening (PTAL) was –2.3° (95% confidence interval [CI] –7.4 to 2.7), and between gastrocnemius lengthening (GCL) and PTAL –4.4° (CI –10.4 to 1.5). The adjusted hazard ratio (aHR), adjusted for baseline ROM, Gross Motor Function Classification System level, and CP subtype, comparing ankle event rates between OTAL and PTAL was 2.5 (CI 1.1–5.7). GCL was also associated with a higher event rate compared with PTAL, aHR 2.0 (CI 0.85–4.6). The adjusted mean difference in knee ROM at 10 years between OTAL and PTAL was 5.1° (CI 0.4–9.8), and between GCL and PTAL 1.9° (CI –3.6 to 7.6). Comparing event rates for the knee yielded uncertain results. Conclusion: PTAL appears at least as effective as OTAL and GCL for favorable ankle and knee ROM development in children with CP
A Völva or Seiðmaðr in Finland? : Cultural Creolization as a Problem for Interpretations
No full textThis chapter focuses on the elite boat burial from Pukkilain Isokyrö, Finland (ad 700), one of the last elaborate burials during the Merovingian period in southern Ostrobothnia. This is a Scandinavian-type burial which is situated in a cemetery context (cremation cemetery under level ground) that is often associated with Finnic language areas but in a region where the closest genetic matches are not too distant to the modern Sami. Based on diverse grave-goods we interpret the buried as a local middleman in the fur trade between Scandinavia and eastern cultures. A key concept is cultural creolization. Culture is here approached in terms of socially accessed signs with their conventions of use and combination.From this perspective, language is one type of sign system among others. Creolization developed in linguistics as a concept to account for the emergence of languages called ‘creoles’. ‘Creole’ initially referred to ahybrid language (and also people) that emerged in the process of European expansion and in environmentsof colonialism. In more recent times, ‘creole’ as alinguistic phenomenon has been distinguished from specific historical political-economic circumstances in which emblematic examples arose. This concept has been extended from language to the full spectrum of cultural phenomena. Creolization has sometimes been used as a vague synonym for hybridization, but is here described more specifically as the hybridization of a sign system or systems that move between groups in an asymmetrical relationship resulting in a new, distinct,synthetic and socially shared sign system or systems. This case study illustrates the utility of the concept as a tool in research while simultaneously illustrating the problems of simple correlations of emblematic objects with ethnic or cultural identities
Exploring the Patients' Perspective on Digital Tools for Psychosocial Assessment in Dentistry
No full textBackground: Psychosocial screening is a valuable part of the assessment of patients with orofacial pain, as psychosocial factors will affect prognosis and treatment outcomes. Paper-based questionnaires are predominately used to assess the degree of psychosocial comorbidity; however, digital alternatives for screening questionnaires may be more cost-effective and resource-saving if patients are receptive to using them. Objective: To evaluate how patients perceive digital psychosocial screening in dentistry. Method: Using a qualitative approach, individual semi-structured interviews were conducted with a purposive sample of adult patients with orofacial pain (n = 16) recruited from specialist dental clinics in Ume & aring; and G & auml;vle, Sweden. The interviews were transcribed verbatim and then analysed using Qualitative Content Analysis. Before the interviews, patients first completed the paper-based questionnaires and then the digital version. Results: The analysis of patients' experiences resulted in an overarching theme: Patients appreciate a holistic approach, thus valuing psychosocial screening, and they particularly favour screening in a digital format. From this theme, two categories emerged: 1. Perceptions about health shape patients' expectations of dental care, and with deeper understanding of the value of psychosocial assessment, patients appreciate a holistic approach that includes psychosocial factors. 2. Digital screening is perceived by patients as a reliable, meaningful and environmentally sustainable method. Conclusions: In general, the patients appreciated a holistic approach in dentistry and understood the value of psychosocial screening as part of this. From the patients' perspective, digital psychosocial screening was both acceptable and beneficial. The findings support the introduction of digital psychosocial screening into daily dental practice
Spin-lattice couplings in 3d ferromagnets : Analysis from first principles
No full textMagnetoelasticity plays a crucial role in numerous magnetic phenomena, including magnetocalorics, magnon excitation via acoustic waves, and ultrafast demagnetization, or the Einstein-de Haas effect. Despite a long-standing discussion on anisotropy-mediated magnetoelastic interactions of relativistic origin, the exchangemediated magnetoelastic parameters within an atomistic framework have only recently begun to be investigated. As a result, many of their behaviors and values for real materials remain poorly understood. Therefore, by using a proposed simple modification of the embedded cluster approach that reduces the computational complexity, we critically analyze the properties of exchange-mediated spin-lattice coupling parameters for elemental 3d ferromagnets (bcc Fe, fcc Ni, and fcc Co), comparing methods used for their extraction and relating their realistic values to symmetry considerations and orbitally decomposed contributions. Additionally, we investigate the effects of noncollinearity (spin temperature) and applied pressure on these parameters. For Fe, we find that singlesite rotations, associated with spin temperatures around 100 K, induce significant modifications, particularly in Dzyaloshinskii-Moriya-type couplings; in contrast, such interactions in Co and Ni remain almost configuration independent. Moreover, we demonstrate a notable change in the exchange-mediated magnetoelastic constants for Fe under isotropic contraction. Finally, the conversion between atomistic, quantum-mechanically derived parameters and the phenomenological magnetoelastic theory is discussed, which can be a useful tool towards larger and more realistic dynamics simulations involving coupled subsystems
Search for boosted low-mass resonances decaying into hadrons produced in association with a photon in pp collisions at √\u88\u9as=13 TeV with the ATLAS detector
No full textMany extensions of the Standard Model, including those with dark matter particles, propose new mediator particles that decay into hadrons. This paper presents a search for such low mass narrow resonances decaying into hadrons using 140 fb(-1) of proton-proton collision data recorded with the ATLAS detector at a centre-of-mass energy of 13 TeV. The resonances are searched for in the invariant mass spectrum of large-radius jets with two-pronged substructure that are recoiling against an energetic photon from initial state radiation, which is used as a trigger to circumvent limitations on the maximum data recording rate. This technique enables the search for boosted hadronically decaying resonances in the mass range 20-100 GeV hitherto unprobed by the ATLAS Collaboration. The observed data are found to agree with Standard Model predictions and 95% confidence level upper limits are set on the coupling of a hypothetical new spin-1 Z ' resonance with Standard Model quarks as a function of the assumed Z '-boson mass in the range between 20 and 200 GeV.For complete list of authors see http://dx.doi.org/10.1007/JHEP01(2025)099</p
Predictive value of burnout complaints and depressive symptoms for medically certified sickness absence among physicians in Sweden : a 1 year follow-up observational study
No full textObjective This study aimed to explore the predictive value of severe burnout complaints, symptom dimension of burnout and depressive symptoms for subsequent all-cause medically certified sickness absence (ACMCSA) during the pandemic among physicians in Sweden. Design A 1 year follow-up panel cohort observational study—the Longitudinal Occupational Health Survey for HealthCare in Sweden. At baseline (February–May 2021), a representative sample of 6699 physicians was drawn from the Swedish occupational register and invited to participate in the study. At follow-up (March–May 2022), the full sample (excluding those who died, retired, stopped working as a physician or migrated, n=94) was invited to answer the survey. Setting Swedish primary and specialist healthcare. Participants At baseline, the response rate was 41.3% (n=2761) of which 1575 also answered at follow-up. Primary and secondary outcome measures ACMCSA data came from the Swedish Social Insurance Agency. The Burnout Assessment Tool (BAT-23) was used to measure burnout, including a burnout total score and scores for the four symptom dimensions of exhaustion, mental distance, emotional impairment and cognitive impairment. Depressive symptoms were assessed using the Symptom Checklist-core depression (SCL-CD6). Associations between baseline burnout and depressive symptoms and subsequent ACMCSA were estimated with logistic regression analyses. Results ACMCSA was found in 9% of the participating physicians. In the sample, 4.7% had severe burnout complaints, and 3.7% had depressive symptoms. Burnout (OR=2.57; 95% CI=1.27 to 5.23) and the burnout symptom dimensions emotional impairment (OR=1.80; 95% CI=1.03 to 3.15) and cognitive impairment (OR=2.52; 95% CI=1.12 to 5.50) were associated with a higher likelihood of subsequent ACMCSA. Depressive symptoms were not associated with ACMCSA when adjusted for severe burnout complaints and other covariates. Conclusion This study demonstrates the distinction between burnout and depressive symptoms, particularly in predicting future ACMCSA. Early intervention targeting exhaustion and burnout may mitigate symptom development and reduce the risk of ACMCSA
Evidence-based methods for relieving pain in infants before and during medically related painful procedures
No full textBakgrund: Inom sjukvården utsätts patienter, och inte minst spädbarn, för smärtsamma procedurer. Det kan vara svårt att bedöma och upptäcka smärta hos spädbarn, vilket leder till att adekvata smärtlindringsmetoder inte alltid används i den utsträckning som de bör. Metoder för smärtlindring kan vara antingen farmakologiska eller icke farmakologiska. Syfte: Syftet var att sammanställa och beskriva evidensbaserade metoder som verkar lindrande på smärtreaktioner hos spädbarn i samband med smärtsamma procedurer inom sjukvården. Metod: En systematisk litteraturöversikt genomfördes genom systematiska sökningar av aktuell forskning i databaserna PubMed och CINAHL. Sökord utformades med svensk MeSH och med hjälp av Universitetsbiblioteket. Dessa utgjorde sedan sökningarna, där studier granskades utifrån inklusions-och exklusionskriterier. Analys utfördes där teman skapades. Kvalitetsgranskning gjordes med hjälp av relevanta granskningsmallar. Resultat: Totalt inkluderades 13 studier. Resultatet presenterades utifrån teman som baseras på de särskilda metoderna som identifierades. De teman som skapades var; Amning och orala glukoslösningar lindrar smärtreaktionen hos spädbarn, Föräldrars delaktighets betydelse för smärtreaktionen hos deras spädbarn samt Hudförberedande metoders inverkan på procedursmärta hos spädbarn. Flera metoder visade sig vara effektiva för att minska smärta hos spädbarn i samband med sjukvårdsrelaterade procedurer. Dessa var framför allt icke-farmakologiska och involverade i stor utsträckning föräldrarnas deltagande och engagemang. Detta medför att de är enkla att använda i praktiken då de flesta metoder kräver få, eller inga, avancerade resurser. Slutsats: Amning, orala glukoslösningar, föräldrakontakt/föräldrainteraktion och hudförberedande metoder, så som Buzzy-Bee och värme, verkar smärtstillande och/eller lugnande på spädbarn i samband med smärtsamma sjukvårdsrelaterade procedurer. Introduction: Patients, especially infants, are often exposed to painful procedures when they visit healthcare facilities. Assessing and detecting pain in children can be challenging, which means that adequate pain relief methods are not always used as extensively as they should be. Pain relief and distraction methods can be either pharmacological or non-pharmacological. Aim: To compile and describe evidence-based methods to use for alleviating pain reactions for infants during painful procedures in healthcare. Method: A systematic literature review was conducted on the current research through systematic searches in the databases PubMed and CINAHL. Keywords were designed using Swedish MeSH and with the assistance of the University Library. These keywords formed the basis of the searches, where studies were reviewed based on inclusion and exclusion criteria. An analysis was performed where themes were created. Quality assessment was carried out using relevant assessment templates. Results: A total of 13 studies were included. The results were presented based on themes derived from the specific methods identified. The themes created were: Breastfeeding and oral glucose solutions alleviate pain reactions in infants, The importance of parental involvement for the pain reactions of their infants and The impact of skin preparation methods on procedural pain in infants. Several methods were found to be effective in reducing pain in infants during healthcare-related procedures. These were primarily non-pharmacological and largely involved parental participation and engagement. This means they are easy to use in practice as they require few, or no, advanced resources. Conclusion: Breastfeeding, oral glucose solutions, parental contact/interaction, and skin preparation methods, such as Buzzy-Bee and heat, have analgesic effects on infants during painful medical procedures.