52 research outputs found
High expression of cyclin D1 is associated to high proliferation rate and increased risk of mortality in women with ER-positive but not in ER-negative breast cancers
Cyclin D1 has a central role in cell cycle control and is an important component of estrogen regulation of cell cycle progression. We have previously shown that high cyclin D expression is related to aggressive features of ER-positive but not ER-negative breast cancer. The aims of the present study were to validate this differential ER-related effect and furthermore explore the relationship between cyclin D overexpression and CCND1 gene amplification status in a node-negative breast cancer case-control study. Immunohistochemical nuclear expression of cyclin D1 (n = 364) and amplification of the gene CCND1 by fluorescent in situ hybridization (n = 255) was performed on tissue microarray sections from patients with T1-2N0M0 breast cancer. Patients given adjuvant chemotherapy were excluded. The primary event was defined as breast cancer death. Breast cancer-specific survival was analyzed in univariate and multivariable models using conditional logistic regression. Expression of cyclin D1 above the median (61.7%) in ER breast cancer was associated with an increased risk for breast cancer death (OR 3.2 95% CI 1.5-6.8) also when adjusted for tumor size and grade (OR 3.1). No significant prognostic impact of cyclin D1 expression was found among ER-negative cases. Cyclin D1 overexpression was significantly associated to high expression of the proliferation markers cyclins A (rho 0.19, p = 0.006) and B (rho 0.18, p = 0.003) in ER-positive tumors, but not in ER-negative cases. There was a significant association between CCND1 amplification and cyclin D1 expression (p = 0.003), but CCND1 amplification was not statistically significantly prognostic (HR 1.4, 95% CI 0.4-4.4). We confirmed our previous observation that high cyclin D1 expression is associated to high proliferation and a threefold higher risk of death from breast cancer in ER-positive breast cancer.Peer reviewe
A Preparatory Study for a Randomized Controlled Trial of Dietary Fiber Intake During Adult Pelvic Radiotherapy
Background: Patients undergoing pelvic radiotherapy are often advised to omit fiber-rich foods from their diet to reduce the adverse effects of treatment. Scientific evidence supporting this recommendation is lacking, and recent studies on animals and humans have suggested that there is a beneficial effect of dietary fiber for the alleviation of symptoms. Randomized controlled studies on dietary fiber intake during pelvic radiotherapy of sufficient size and duration are needed. As preparation for such a large-scale study, we evaluated the feasibility, compliance, participation rate, and logistics and report our findings here in this preparatory study. Methods: In this preparatory study of a fiber intervention trial, Swedish gynecological cancer patients scheduled for radiotherapy were recruited between January 2019 and August 2020. During the intervention, the participants filled out questionnaires and used an application. They also consumed a fiber supplement at first in powder form, later in capsules. Blood- and fecal samples were collected. The study is registered in clinicaltrials.gov (https://clinicaltrials.gov/ct2/show/NCT04534075?cond=fidura&draw=2&rank=1). Results: Among 136 approached patients, 57 started the study and the participation rate for primary outcomes was 63% (third blood sample) and 65% (third questionnaire). Barely half of the participants provided fecal samples. Providing concise and relevant information to the patients at the right time was crucial in getting them to participate and stay in the study. The most common reasons for declining participation or dropping out were the expected burden of radiotherapy or acute side effects. Tailoring the ambition level to each patient concerning the collection of data beyond the primary endpoints was an important strategy to keep the dropout rate at an acceptable level. Using capsules rather than psyllium in powder form made it much easier to document intake and to create a control group. During the course of the preparatory study, we improved the logistics and for the last 12 participants included, the participation rate was 100% for the earliest primary outcome. Conclusion: A variety of adjustments in this preparatory study resulted in an improved participation rate, which allowed us to set a final protocol and proceed with the main study
Cyclin A and cyclin E as prognostic factors in early breast cancer
Breast cancer is one of the most common malignancies in women. Due to early detection and the use of screening programs approximately 60% of all new cases lack lymph node involvement. Today, a substantial proportion of these women will be offered adjuvant systemic chemotherapy. However, better proliferation markers are needed to predict patient outcome and to avoid overtreatment. Cyclin A, cyclin E and Ki-67 are all markers for proliferation and involved in the regulation of the cell cycle. Overexpression has been associated with disease recurrence in several studies, but the results have not been consistent. However, none of these studies has investigated aberrant expression of cyclin E (the expression of cyclin E during phases of the cell cycle other than late G1 and early S-phase). Studies have shown that aberrant cyclin E might provide additional prognostic information compared to cyclin E alone. The aims of this thesis were 1.to investigate the prognostic value of cyclin A, cyclin E and aberrant cyclin E in early breast cancer. 2.to validate the tissue microarray (TMA) technique for cyclin A and 3.to define the most optimal cut-off values for cyclin A and Ki-67. We found that the agreement of TMA and large section results was good with kappa values 0.62-0.75 and that the reproducibility of the two readersâ results was good or even very good, with kappa values 0.71 â 0.87. The optimal cut-off value for cyclin A average was 8% and for cyclin A maximum value 11%. The corresponding values for Ki-67 were 15 and 22%. Neither cyclin E nor aberrant cyclin E was a prognostic factor in low-risk node negative breast cancer patients. Finally, we conclude that cyclin A is a prognostic factor in node negative breast cancer (univariate analysis average value OR=2.9 95% CI 1.8-4.6; maximum value OR=3.7 95% CI 2.3-5.9)
AffÀrsrelationer vid elektronisk handel
Detta examensarbete behandlar elektronisk handel mellan företag och vilken affÀrsrelation som företaget har med sina företagskunder efter införandet av elektorisk handel. Telefonintervjuer har skett med fyra olika företag som ingÄr i möbelbranschen. Syftet med arbete Àr att se om företagens förvÀntningar med avsikt pÄ fem olika aspekter som utgör en god affÀrsrelation infriats. Denna undersökning visar att aspekterna samarbete och förtroende Àr de tvÄ aspekter som företagen har störst förvÀntningar pÄ. De andra tre aspekterna engagemang, anpassning och kunskap om kunden har generellt företaget inga större förvÀntningar innan införandet av elektronisk handel. Om dessa förvÀntningar har infriats eller inte besvaras inte i denna undersökning pÄ grund av olika faktorer som har spelat in
Medarbetares personlighet och deras attityd till olika typer av ledarskap
Med fokus pÄ förÀndring, flexibilitet och personlig utveckling har det agila ledarskapet utvecklats och vÀxt fram. En ledarskapsstil och arbetssÀtt som blir allt vanligare bland organisationer dÀr mÄnga företag pÄstÄr sig pÄ nÄgot sÀtt arbeta med agila metoder. Denna studie undersökte sambandet mellan medarbetares personlighet och attityd till olika ledarskapsstilar, med fokus pÄ den agila. En webbaserad enkÀtundersökning gjordes med 129 deltagare, 83 kvinnor, 45 mÀn och en utan kön. EnkÀten innehöll personlighetstestet Big Five Inventory samt tre vinjetter kring transformativt-, transaktionellt- och agilt ledarskap. Resultatet visade att deltagare med höga vÀrden pÄ extraversion och öppenhet och lÄga vÀrden pÄ neuroticism tenderade ha mer positiv attityd till den agila ledarskapsstilen. MÀn var mer positiv instÀllda till transaktionellt ledarskap Àn kvinnor. Avslutningsvis diskuteras generaliserbarheten i resultatet utifrÄn de tillgÀnglighetsurval som studien hade samt att de resultat som redovisas kan vara till hjÀlp för organisationer i exempelvis rekrytering och utveckling av ledarskapskompetenser
Flexible insulation of windows
MÄlet med detta examensarbete Àr att ta fram en lösning som gör det möjligt att utforma fönster och bostadshus i olika stil och fortfarande kunna bygga enligt energihusprinciper. En röd stuga med vita knutar och fönster som ser likadana ut i alla vÀderstreck Àr ett exempel.  I lÄgenergihus Àr vÀggar, golv och tak mycket vÀl isolerade, de har ett mycket lÄgt U-vÀrde. Fönster och dörrar, som har ett jÀmförelsevis högt U-vÀrde, bryter detta klimatskal, vilket gör dem till kritiska punkter för energilÀckage. Fönster ger upphov till önskade och oönskade energiflöden, till exempel dagsljus, vÀrmeförluster, strÄlningsvÀrme och luftutbyte. I energihus Àr det sÀrskilt viktigt att kunna kontrollera dessa flöden för att uppnÄ komfort och minimera energiförlusterna.  Arbetet resulterade i IsoSol, en utvÀndig jalusi som rullas upp ovan fönstret och döljs i vÀggkonstruktionen nÀr den inte anvÀnds. Ett flexibelt solskydd som i helt nerfÀllt lÀge mörklÀgger effektivt och isolerar tack vare materialval och inneslutna sidostycken. IsoSol Àr uppbyggd av en kombimatta sammansatt av tÀt vÀv och nÄlfilt. För att huset inte ska se igenbommat ut utifrÄn sitter horisontella ribbor i skummad polyuretan med trÀstruktur pÄ den yttersta vÀven. Konstruktionen blir tÀt eftersom jalusins sidokanter sitter 10 cm in under fasaden. I över- och underkant finns gummilister som ökar tÀtheten. En automatisk styrning av upp och ner gÄng samt möjlighet till tidsprogrammering finns med hjÀlp av en motor frÄn Somfy Home Motion.  IsoSol ger fönsterkonstruktionen ett U-vÀrde pÄ 0,31 W/m2K jÀmfört med 0,98 W/m2K för enbart fönstret och ett g-vÀrde, mÄtt pÄ solenergitransmittansen i procent, pÄ nÀst intill noll, 54 % utan IsoSol. Lösningen passar alla sorters fönster, skyddar rutan frÄn vÀder och vind och ger ett ökat skydd mot inbrott.The objective of this project is to develop a solution that makes it possible to design windows and buildings in different styles and still be able to build according to the principles of energy-houses. A red cottage with white corners and windows that look the same in all directions is an example.  In low-energy-houses are walls, floors and roof very well insulated; they have a very low U-value. Windows and doors, that have a relatively high U-value, break this climate shell, which makes them critical points for energy leaks. Windows give rise to desired and undesired energy flows, such as daylight, heat loss, radiant heat and air exchange. In energy-houses it is particularly important to be able to control these flows to achieve comfort and minimize energy losses.  The project resulted in IsoSol, an exterior roller shutter that is rolled up above the window and hidden in the wall structure when not in use. A flexible solar control that in its closed position are an effective darker and insulator as a result of material choice and enclosed sides. IsoSol is made up of a combination carpet composed of impenetrable fabric and needle felt. In order to not make the house look closed from the outside there are horizontal bars of foamed polyurethane with wooden structure on the outer fabric. The construction is reducing the leaks because the side edges are integrated 10 centimetres underneath the facade. An automatic control of when to open and when to close and time-programming is possible by the use of a motor from Somfy Home Motion.  IsoSol gives the construction of the window a U-value of 0,31 W/m2K, compared to 0,98 W/m2K entirely the window, and a g-value, measurement of the solar transmittance, close to zero, 54 % without IsoSol. The solution suits all kinds of windows, protects the window and provides increased protection against break-ins
Legitimitet genom hÄllbarhetsredovisning : En studie om hur företag inom klÀdbranschen reparerar ochupprÀtthÄller legitimitet efter negativ publicitet i nyhetsmedia
Safety as a dimension of social sustainability : A quantitative research about adolescents' experience of public spaces
Social hÄllbarhet Àr ett mÄngdimensionellt begrepp dÀr trygghet utgör en av dimensionerna och Àr en viktig faktor för att skapa god livskvalité. Det offentliga rummet utgör en nyckelfaktor i en hÀlsosam och vÀlfungerande stad. En god omgivande miljö Àr en kÀlla till att motivera medborgare till bÀttre hÀlsa och vÀlbefinnande. Det offentliga rummet har Àven en stor inverkan pÄ trygghet, god urban planering Àr essentiellt för att skapa en god miljö att leva och bo i. Hög grad av trygghet skapar ocksÄ förutsÀttningar för att nÄ social hÄllbarutveckling. Bakomliggande drivkrafter till denna studie Àr att det offentliga rummet Àr en viktig plats dÀr alla ska vara vÀlkomna och kÀnna sig trygga. Det offentliga rummet skapar möjlighet för sociala relationer, kunskapsutbyte samt utgör en viktig funktion i samhÀllet. Det offentligarummet ska vÀrna om mÀnniskan, och mÀnniskan ska vÀrna om det offentliga rummet. DÀrmed syftar denna studie till att undersöka ungdomars upplevelse om det offentliga rummeti relation till social hÄllbarhet och trygghet. Den valda arenan utgörs av det offentliga rummet i Stenungsund. Metoden som anvÀnts i studien Àr av en kvantitativ ansats, enkÀter har delats ut till gymnasieelever i Ärskurs 1-3 iStenungssunds kommun. EnkÀten avslutades med möjligheten för respondenterna att markera pÄ en karta över Stenungsund de platser respondenterna kÀnner sig trygga, otrygga samt tycker om. Resultatet av studien visar att ungdomarna i Stenungsund överlag kÀnner sig trygga i det offentliga rummet. Dock förekommer det skillnader mellan hur tjejer och killar upplever trygghet. Killar kÀnner sig i högre grad trygga Àn vad tjejer gör. Eleverna i de olika Ärskurserna tenderar Àven att uppleva trygghet pÄ olika sÀtt. Markeringarna pÄ kartan visade sÄledes pÄ en gemensam uppfattning om vilka platser som upplevs som bÄde trygga, otrygga samt omtyckta.Social sustainability is a multidimensional concept in which safety is one of the dimensions, and is an important factor in creating a good quality of life. The public space is a key factor in a healthy and well-functioning city. A good environment is a source for motivating citizens to better health and wellness. Public space also has a great impact on safety, good urban planning is essential to create a good environment to live in. High level of safety also creates the conditions for achieving socially sustainable development. The driving forces behind this study is that the public space is an important place where everybody will be welcomed and feel safe. The public space creates the opportunity for social relations, exchange of knowledge and constitute an important function in society. The publicspace should protect and promote the citizen, and the citizen must take care and show respect for the public space. Thus, this study aims to investigate young people's experience of publicspace in relation to social sustainability and safety. The method used in the study is a quantitative approach, questionnaires have been distributed to high school students in Stenungssund. The survey ended with the possibility for respondents to mark on a map of Stenungsund the places they feel secure, insecure and like. The results of the study show that young people in Stenungsund generally feel safe in public spaces. However, there are differences between how girls and boys experience safety. Boys feel increasingly confident than girls do. Students in different grades also tend to experience safety differently. The markings on the map thus showed a common understanding of what places are experienced as both secure, insecure and liked
"There is no reward penny for going out and picking up youths" : issues in the design of accessible youth healthcare services in rural northern Sweden
Objective: There is a continuing challenge to ensure equitable access to youth healthcare services in small rural communities. Swedenâs âyouth clinicâ system is an attempt to provide comprehensive youth health services from a single centre, but many small rural communities have not adopted the youth clinic model. This study uses one case study to examine what the issues might be in establishing a youth clinic in a small rural community. The objective of this paper is to examine the issues around youth healthcare access in one municipality without a youth clinic, and to explore whether and how a youth clinic model might contribute to access in this municipality. Results: Three categories emerged from the analysis; (i) rural closeness; both good and bad, (ii) youth are not in the centre of the healthcare organization, and (iii) adapting youth clinics to a rural setting. While limited to one case example, the study provides valuable insights into youth health service planning in particular types of rural communities. This paper identified structural barriers to developing youth-specific services, and some alternative approaches that might be more suitable to smaller communities
GPs' perspectives of the patient encounter : in the context of standardized cancer patient pathways
Objective: We aim to explore how GPs assign meanings and act upon patientsâ symptoms in primary care encounters in the context of standardized cancer patient pathways (CPPs). Design, setting and subjects: Thirteen individual interviews were conducted with GPs, at primary healthcare centers (nâ=â4) in one county in northern Sweden. Interviews were analyzed using grounded theory method. The results were then linked to symbolic interactionism. Main outcome measures: GPsâ perspectives about assigning meanings to patientsâ presented symptoms and perception about CPPs. Results: In the encounter, GPs engaged in two simultaneous interactions, one with patientsâ symptoms â and the other with CPPs. The core category Disentangling patientsâ care trajectory consists of three categories, interpreted as GPsâ strategies developed to assign meaning to symptoms. These strategies are carried out not in a straightforward manner but rather in a conflicting way, illuminating the complexity of GPsâ daily work. Conclusions: Interacting with patients is vital for assigning meaning to presented symptoms. However, nowadays GPs are not only required to interact with patients, they are also required to interact with CPPs. These standardized routines might create pressure and demands on GPs, especially for those experiencing a lack of information about CPPs. Beside of carrying out the challenging patient/person-centered dialogues and interpreting presented symptoms, GPs also need to link the interpreted symptoms to CPPs. Therefore, it is essential that GPs are given opportunities at their workplaces to continuously be informed and be supported in order to practice CPPs and thereby optimize trajectories for patients undergoing cancer diagnostics
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