Publikationer från Uppsala Universitet
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Risk factors and short-term respiratory outcomes associated with unplanned extubations during neonatal intensive care
No full textBackground: Unplanned extubation (UE) represents an unwanted adverse event in neonatal intensive care. Although skin-to-skin care (SSC) in intubated infants receiving mechanical ventilation (MV) is challenging, its impact on the incidence of UEs has not been reported. Purpose: To determine the incidence, infant characteristics, and short-term respiratory outcomes of UEs in a unit applying SSC as standard of care also during MV. Methods: Single-center retrospective cohort study including all infants receiving MV in a Swedish tertiary care center during 2021-2023. UE incidence was calculated per 100 days of MV related to time spent in conventional care (CC) and SSC, using automated chart review of electronic medical records. Pre-defined short-term respiratory outcomes were mode of respiratory support, ventilator settings and fraction of inspired oxygen (FiO(2)), at 30-120 min post-UE. Results: The UE incidence was 3.9 per 100 days of MV (3.0 in CC vs. 10.4 in SSC; p < 0.001). The UE incidence during SSC decreased from 14.5 in 2021, to 7.7 in 2023 (p = 0.07), whereas it remained the same during CC. After UE, 72% infants were reintubated within 120 min, and showed an increased mean FiO(2) (0.37 vs. 0.43; p = 0.01). Conclusions: The number of UEs were high during SSC but decreased during the study period. Reintubation was not required in >25% of all UEs, regardless of type of care. Following UE, an increased need for supplemental oxygen was observed. Safe SSC in mechanically ventilated infants requires experienced staff and increased staff and parental risk awareness
Initial experience with robotic-assisted resection for suspected or confirmed gallbladder cancer : - comparison with open technique in a single centre retrospective observational cohort study
No full textBackground and aim: Robotic-assisted surgery has become increasingly common and is now the gold standard for many procedures. In hepato-pancreato-biliary surgery, it has shown promise but remains insufficiently studied. This study reports our initial experience with robotic-assisted radical cholecystectomy for suspected or confirmed gallbladder cancer. The primary objective was to compare hospital length-of-stay - used as a proxy for functional recovery - between robotic-assisted and open surgery. The secondary objective was to assess surgical quality by comparing the number of retrieved lymph nodes. Methods: All patients with suspected or confirmed gallbladder cancer accepted for radical cholecystectomy at Karolinska University Hospital between January 2019 and December 2022 were reviewed. Ninety-five patients were identified; 22 were excluded. Of the remaining 73, 23 underwent robotic-assisted surgery and 50 underwent open surgery. Results: Robotic-assisted surgery was associated with shorter hospital stays: a median of four days compared to seven days for open surgery (p < 0.001). The number of retrieved lymph nodes was low in both groups but lower in the robotic group (median 1 vs. 3, p = 0.013). No difference regarding severe complications, readmissions or positive margin resections was found. Conclusion: In this single-centre retrospective observational study, robotic-assisted radical cholecystectomy was associated with faster recovery compared to open surgery. To confirm these findings, a multi-centre randomized clinical trial has been initiated (ClinicalTrials.gov NCT06246448)
Toward a Systematics for the Lowest Excited States of Heteroaromatics Enabled via Cyclic π-Conjugated Carbenes and Heteroelement Analogues
No full textThe photochemistry of heteroaromatic compounds depends on the character of their lowest electronically excited states, which are of either n,π* or π,π* type. For species with 4n + 2 π-electrons, the latter type of states can be antiaromatic to various extents according to Baird’s rule and, thus, highly reactive. The n,π* type of states, on the other hand, will have an odd number of π-electrons leading to an unclear character, spanning from aromatic to antiaromatic. Six-membered ring (6-MR) heteroaromatics with in-plane lone-pair orbitals (nσ, herein n) have either n,π* or π,π* states as their lowest vertically excited states, but regular five-membered ring (5-MR) heteroaromatics with one or two N, O, and/or S atoms never have n,π* states as these states. However, this is different for cyclic π-conjugated (potentially aromatic) 5-MR carbenes that have the n orbitals at the divalent C atom. Also, 3-MR species have n,π* states as their lowest vertically excited states. Herein, we reveal which factors determine which type of vertical excited state is the lowest in energy for various heteroaromatics. The important factors are (i) the electronegativity of the heteroatom(s), (ii) the valence angle at the heteroatom impacting the lone-pair orbital energy, (iii) the number of π-orbitals and π-electrons, (iv) the degree of (anti)aromatic character of the n,π* state, (v) the electronegativity of atoms adjacent to the heteroatom, and (vi) the spatial extent of the n orbital affecting the intraorbital electron repulsion. Our findings point toward the development of a rational systematics for prediction of which heteroaromatics have n,π* as the first vertical excited states and which ones have π,π* states as these
Challenges with shifting, regardless of disengagement : attention mechanisms and eye movements in Williams syndrome
No full textBackground: People with Williams syndrome (WS) face challenges in various areas of cognitive processing, including attention. Previous studies suggest that these challenges are particularly pronounced when disengagement of attention from a previously attended stimulus is required, as compared to shifting attention without the need to disengage. Difficulties with attention could in turn be implicated in several of the behavioral characteristics of WS. Here, disengagement and shifting of visual attention, together with pupil dilation, were independently assessed in one of the largest eye-tracking studies of WS to date. Methods: We investigated shifting, disengagement, and the effects of auditory alerting cues on pupil dilation in WS individuals ( n = 45 , age range=9-58 years), non-WS individuals with intellectual disability (ID) ( n = 36 age range=6-59 years), and typically developed (TD) infants ( n = 32 , age range=6-7 months), children and adults ( n = 31 age range=9-60 years), using a modified gap-overlap task. Data were analyzed using linear mixed-effect models (LMMs). Results: Individuals with WS were less likely to shift their attention to upcoming targets than TD individuals (all ages), but more likely than the ID group to do so. When they did shift attention, participants with WS and ID were slower to initiate a gaze shift than TD participants regardless of whether disengagement was needed. In the WS group, failure to shift attention was strongly predicted by higher arousal (pupil dilation), which was induced by auditory alerting cues. Conclusions: Contrasting with previous theories of attention in WS, we found no evidence for a specific challenge in disengaging attention. Instead, our results point to a more general challenge in shifting attention. Reduced attention shifting in WS may be partly explained by atypical arousal regulation. These results contribute to our understanding of the WS phenotype
Can programming support mathematics learning? : An analysis of Swedish lower secondary textbooks
No full textIn the wake of the present inclusion of programming in mathematics education, which is a feature of curricular revisions in many countries, we have analysed newly inserted programming activities in mathematics textbooks. The aim was to investigate how such activities relate to and potentially affect students' opportunities to learn mathematics. Data consist of Swedish textbooks for grades 7-9 (ages 13-15) intended for mathematics classes, where all units labelled as or including programming activities were analysed. Concerning the relation between mathematics and programming, our results show that in the intricate balance between teaching mathematics on the one hand and teaching programming on the other hand, the textbooks seem to lean towards the latter, thus not greatly contributing with mathematical learning opportunities. We see a dominance of mathematics as a context for programming, rather than programming as a tool for learning mathematics. The lack of exploration and rare occurrence of novel mathematics in the programming activities implies a weak relationship between mathematics and programming
From Protection to Rights. How the New Social Services Act (2025) Strengthens Children’s Participation and Influence in Child Protection Investigations.
No full textMaskulinum och femininum går igen : Genus och sexus hos djurbetecknande substantiv från 1800-talet och framåt
No full textDet gamla tregenussystemet med maskulinum och femininum i stället för utrum jämte neutrum har beskrivits som försvunnet ur standardsvenskt skriftspråk sedan förra sekelskiftet. Visst förekommer än i dag maskulina och feminina pronomen, men dessa sägs numera uttrycka sexus snarare än genus, med undantag för några få lexikaliserade rester som klockan – hon. Det finns emellertid anledning att ifrågasätta om så verkligen är fallet bland de icke-neutrala djurbetecknande substantiven. Dessa har uteslutits i tidigare undersökningar av och uttalanden om substantivens genusbehandling därför att man – på lösa grunder – har antagit att de pronominaliseras i enlighet med sexus eller någon annan semantik. Ändå har flera andra före mig iakttagit att gamla maskuliner påtagligt oftare omtalas med maskulina pronomen och femininer med feminina än tvärtom. Detta är svårt att förklara med hänvisning till sexus, som snarare torde ge upphov till en någorlunda jämn fördelning av pronomen. Syftet med denna uppsats är därför att bidra till förståelsen dels av genussystem och hur ett sådant kan förändras, dels av förhållandet mellan genus och sexus genom en undersökning av pronomenbruket i fråga om tolv djurbetecknande substantiv. Materialet till denna består av tidningstext och skönlitteratur från 1800- till 2000-tal – två genrer som sägs i hög grad prägla vad som under denna period uppfattas som standardsvenskt skriftspråk – och finns digitaliserat och sökbart tack vare Språkbankens korpusverktyg Korp. Resultatet av undersökningen visar först och främst att det blir stadigt vanligare med utrala pronomen om djur. Särskilt stort är utrums genomslag vid avsaknad av sammanfall mellan sexus och genus och om substantiv som utgör korrelat till objektspronomen. I 1800-talsmaterialet tycks också obestämd form på substantivet särskilt gynna utrum. Vidare ger resultatet även vid handen att det, som förmodat, är påtagligt vanligare med maskulina pronomen om gamla maskulina djurbeteckningar och med feminina om gamla feminina än vice versa. Detta är giltigt under hela den undersökta perioden, även om trenden mattas av med tiden. I ljuset av detta resultat argumenterar jag därför i den avslutande diskussionen för en uppdatering av beskrivningen av det svenska genussystemet. Tvågenussystemet har, av allt att döma, absolut inte varit allenarådande sedan förra sekelskiftet, utan det svenska genussystemet bör kanske snarare beskrivas som ett slags fyrgenussystem där maskulinum och femininum kan dyka upp som ett sidogenus till utrum, än i dag.
Exploring the Role of Medication Information on Patient Participation in the Psychiatric Care of Patients with Substance Use
No full textLow-fibre diet is associated with high-risk coronary plaque features
No full textAims Diet is a determinant of cardiovascular diseases (CVD) with coronary disease as predominant cause of pre-mature death. To analyse how diet was associated with coronary atherosclerosis, including plaque features. Methods and results The cross-sectional population-based study using data from the Swedish CArdioPulmonary BioImage Study (SCAPIS) included 24 079 adults aged 50–64 years, recruited in 2013 to 2018 who were free of clinical cardiovascular disease. The recruitment and comprehensive examinations were conducted at six locations in Sweden. A dietary index (DI) based on a previously published anti-inflammatory DI including high proportion of plant-based foods, and low in red or processed meat and sugar-sweetened beverages was constructed. The reference group was within lowest DI tertile. Coronary atherosclerosis assessed by coronary computed tomography angiography, including any-, significant-, and adverse or high-risk coronary plaque, which is non-calcified with a significant stenosis ≥50%. Lowest, compared to highest DI tertile was associated with younger age, more often men (62.2% vs. 32.9%), higher high-sensitive C-reactive protein, more cardiometabolic risk and smokers, higher alcohol-, and higher energy-intake. In the highest and lowest tertile, coronary plaques were present in 36.3% and 44.3%, respectively, stenosis ≥ 50% in 3.7% and 6.0%. Non-calcified coronary plaques with stenosis ≥50% were present in 0.9% and 1.5% in highest and lowest tertiles. In multivariable analyses, the lowest tertile of DI was associated with high-risk plaque features after adjusting for age, sex, smoking, with waist circumference, triglycerides (TGs), and hypertension as possible mediators. Conclusion A low-fibre diet with high red meat content was associated with high-risk plaques features, increased coronary calcification and significant stenosis. Waist circumference, TGs, and hypertension emerged as potential mediators of these associations, underscoring the role of metabolic and hemodynamic factors in the dietary impact on coronary atherosclerosis. Our findings strengthen the importance of cardioprotective dietary recommendations