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 readers’ results was good or even very good, with kappa values 0.71 – 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)

Affärsrelationer vid elektronisk handel

Detta examensarbete behandlar elektronisk handel mellan företag och vilken affärsrelation som företaget har med sina företagskunder efter införandet av elektorisk handel. Telefonintervjuer har skett med fyra olika företag som ingår i möbelbranschen. Syftet med arbete är att se om företagens förväntningar med avsikt på fem olika aspekter som utgör en god affärsrelation infriats. Denna undersökning visar att aspekterna samarbete och förtroende är de två aspekter som företagen har störst förväntningar på. De andra tre aspekterna engagemang, anpassning och kunskap om kunden har generellt företaget inga större förväntningar innan införandet av elektronisk handel. Om dessa förväntningar har infriats eller inte besvaras inte i denna undersökning på grund av olika faktorer som har spelat in

Medarbetares personlighet och deras attityd till olika typer av ledarskap

Med fokus på förändring, flexibilitet och personlig utveckling har det agila ledarskapet utvecklats och växt fram. En ledarskapsstil och arbetssätt som blir allt vanligare bland organisationer där många företag påstår sig på något sätt arbeta med agila metoder. Denna studie undersökte sambandet mellan medarbetares personlighet och attityd till olika ledarskapsstilar, med fokus på den agila. En webbaserad enkätundersökning gjordes med 129 deltagare, 83 kvinnor, 45 män och en utan kön. Enkäten innehöll personlighetstestet Big Five Inventory samt tre vinjetter kring transformativt-, transaktionellt- och agilt ledarskap. Resultatet visade att deltagare med höga värden på extraversion och öppenhet och låga värden på neuroticism tenderade ha mer positiv attityd till den agila ledarskapsstilen. Män var mer positiv inställda till transaktionellt ledarskap än kvinnor. Avslutningsvis diskuteras generaliserbarheten i resultatet utifrån de tillgänglighetsurval som studien hade samt att de resultat som redovisas kan vara till hjälp för organisationer i exempelvis rekrytering och utveckling av ledarskapskompetenser

Flexible insulation of windows

Målet med detta examensarbete är 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 väderstreck är ett exempel.   I lågenergihus är väggar, golv och tak mycket väl isolerade, de har ett mycket lågt U-värde. Fönster och dörrar, som har ett jämförelsevis högt U-värde, bryter detta klimatskal, vilket gör dem till kritiska punkter för energiläckage. Fönster ger upphov till önskade och oönskade energiflöden, till exempel dagsljus, värmeförluster, strålningsvärme och luftutbyte. I energihus är det särskilt viktigt att kunna kontrollera dessa flöden för att uppnå komfort och minimera energiförlusterna.   Arbetet resulterade i IsoSol, en utvändig jalusi som rullas upp ovan fönstret och döljs i väggkonstruktionen när den inte används. Ett flexibelt solskydd som i helt nerfällt läge mörklägger effektivt och isolerar tack vare materialval och inneslutna sidostycken. IsoSol är uppbyggd av en kombimatta sammansatt av tät väv och nålfilt. För att huset inte ska se igenbommat ut utifrån sitter horisontella ribbor i skummad polyuretan med trästruktur på den yttersta väven. Konstruktionen blir tät eftersom jalusins sidokanter sitter 10 cm in under fasaden. I över- och underkant finns gummilister som ökar tätheten. En automatisk styrning av upp och ner gång samt möjlighet till tidsprogrammering finns med hjälp av en motor från Somfy Home Motion.   IsoSol ger fönsterkonstruktionen ett U-värde på 0,31 W/m2K jämfört med 0,98 W/m2K för enbart fönstret och ett g-värde, mått på solenergitransmittansen i procent, på näst intill noll, 54 % utan IsoSol. Lösningen passar alla sorters fönster, skyddar rutan från väder 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

Safety as a dimension of social sustainability : A quantitative research about adolescents' experience of public spaces

Social hållbarhet är ett mångdimensionellt begrepp där trygghet utgör en av dimensionerna och är en viktig faktor för att skapa god livskvalité. Det offentliga rummet utgör en nyckelfaktor i en hälsosam och välfungerande stad. En god omgivande miljö är en källa till att motivera medborgare till bättre hälsa och välbefinnande. Det offentliga rummet har även en stor inverkan på trygghet, god urban planering är essentiellt för att skapa en god miljö att leva och bo i. Hög grad av trygghet skapar också förutsättningar för att nå social hållbarutveckling. Bakomliggande drivkrafter till denna studie är att det offentliga rummet är en viktig plats där alla ska vara välkomna och känna sig trygga. Det offentliga rummet skapar möjlighet för sociala relationer, kunskapsutbyte samt utgör en viktig funktion i samhället. Det offentligarummet ska värna om människan, och människan ska värna om det offentliga rummet. Därmed syftar denna studie till att undersöka ungdomars upplevelse om det offentliga rummeti relation till social hållbarhet och trygghet. Den valda arenan utgörs av det offentliga rummet i Stenungsund. Metoden som använts i studien är av en kvantitativ ansats, enkäter har delats ut till gymnasieelever i årskurs 1-3 iStenungssunds kommun. Enkäten avslutades med möjligheten för respondenterna att markera på en karta över Stenungsund de platser respondenterna känner sig trygga, otrygga samt tycker om. Resultatet av studien visar att ungdomarna i Stenungsund överlag känner sig trygga i det offentliga rummet. Dock förekommer det skillnader mellan hur tjejer och killar upplever trygghet. Killar känner sig i högre grad trygga än vad tjejer gör. Eleverna i de olika årskurserna tenderar även att uppleva trygghet på olika sätt. Markeringarna på kartan visade således på en gemensam uppfattning om vilka platser som upplevs som både 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. Sweden’s ‘youth clinic’ 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 patients’ 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 (n = 4) in one county in northern Sweden. Interviews were analyzed using grounded theory method. The results were then linked to symbolic interactionism. Main outcome measures: GPs’ perspectives about assigning meanings to patients’ presented symptoms and perception about CPPs. Results: In the encounter, GPs engaged in two simultaneous interactions, one with patients’ symptoms – and the other with CPPs. The core category Disentangling patients’ care trajectory consists of three categories, interpreted as GPs’ 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 GPs’ 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