Development and validation of a new clinical decision support tool to optimize screening for retinopathy of prematurity

Background/Aims Prematurely born infants undergo costly, stressful eye examinations to uncover the small fraction with retinopathy of prematurity (ROP) that needs treatment to prevent blindness. The aim was to develop a prediction tool (DIGIROP-Screen) with 100% sensitivity and high specificity to safely reduce screening of those infants not needing treatment. DIGIROP-Screen was compared with four other ROP models based on longitudinal weights. Methods Data, including infants born at 24–30 weeks of gestational age (GA), for DIGIROP-Screen development (DevGroup, N=6991) originate from the Swedish National Registry for ROP. Three international cohorts comprised the external validation groups (ValGroups, N=1241). Multivariable logistic regressions, over postnatal ages (PNAs) 6–14 weeks, were validated. Predictors were birth characteristics, status and age at first diagnosed ROP and essential interactions. Results ROP treatment was required in 287 (4.1%)/6991 infants in DevGroup and 49 (3.9%)/1241 in ValGroups. To allow 100% sensitivity in DevGroup, specificity at birth was 53.1% and cumulatively 60.5% at PNA 8 weeks. Applying the same cut-offs in ValGroups, specificities were similar (46.3% and 53.5%). One infant with severe malformations in ValGroups was incorrectly classified as not needing screening. For all other infants, at PNA 6–14 weeks, sensitivity was 100%. In other published models, sensitivity ranged from 88.5% to 100% and specificity ranged from 9.6% to 45.2%. Conclusions DIGIROP-Screen, a clinical decision support tool using readily available birth and ROP screening data for infants born GA 24–30 weeks, in the European and North American populations tested can safely identify infants not needing ROP screening. DIGIROP-Screen had equal or higher sensitivity and specificity compared with other models. DIGIROP-Screen should be tested in any new cohort for validation and if not validated it can be modified using the same statistical approaches applied to a specific clinical setting

Läxors vara eller inte vara? – En enkätundersökning bland lärare, elever och föräldrar.

Institution: Sociologiska institutionen, Göteborgs Universitet Författare: Camilla Bartholdsson, Magdalena Albertsson och Marie Henningsson Titel: Läxors vara eller inte vara? – En enkätundersökning bland lärare, elever och föräldrar. Handledare: Ylva Ulfsdotter Eriksson Typ av arbete: Examensarbete 10 poäng, Nya Lärarutbildningen Antal sidor: 47 sidor Tidpunkt: Höstterminen 2005 Syfte och Syftet med föreliggande arbete är att studera hur läxsituationen ser frågeställningar: ut i kommunala skolor. Vi vill få en uppfattning om vad lärare, elever och föräldrar tycker om läxor och hur de hanterar elevernas läxor. Vår förhoppning är att arbetet i förlängningen kommer att vägleda oss, som pedagoger, i vårt sätt att hantera läxor. De frågeställningar vi kunde besvara är: • Är läxorna ett användbart pedagogiskt verktyg? • Hur ser läxsituationen ut i skolorna idag? • Anser lärare, elever och föräldrar att läxor fyller en viktig funktion för elevernas kunskapsinlärning? Material och metoder: Vi har genomfört en kvantitativ studie i form av en enkätundersökning. Enkäter har lämnats ut till lärare, elever och föräldrar på sex olika kommunala skolor. Enkätfrågorna konstruerades så att vi kunde göra jämförelser mellan de olika perspektiven. Sekundärmaterialet har varit tidigare forskning samt relevanta kommentarer och uttalanden gjorda av personer med koppling till skolvärlden. Huvudresultat: Så gott som alla lärare, elever och föräldrar är överens om att läxor behövs för elevernas inlärning. Enligt eleverna och föräldrarna i vår undersökning har övervägande delen av eleverna hjälp att tillgå i hemmet då det behövs, dock är det svårt att utifrån vår enkätundersökning bedöma om elever generellt har samma möjlighet till likvärdig utbildning då hemläxor ges. Läxor är ett användbart pedagogiskt verktyg under förutsättning att de är väl genomtänkta och framförallt motiverande för eleven. Nyckelord: Läxa, likvärdig, lärare, elev och förälder

Från socialbidrag till äldreförsörjningsstöd. : En reform ur äldre invandrares perspektiv.

In 2003 the Swedish parliament decided to incorporate maintenance support for the elderly within the framework of the state social insurance system. Maintenance support for the elderly entails that individuals who, due to too short a period of residence in Sweden, do not qualify themselves for a full guarantee pension and thus have the right to receive benefits after completion of an income test. A large proportion of these people previously received individually incometested social benefits. Maintenance support for the elderly and how it is perceived by the elderly is the focus of the study. The overall aim of the study is to gain knowledge about what it means for immigrants who moved in later life to be the subject of a transfer from a selective benefit system to one where more general principles apply. More specifically the aim concerns what it means for their possibilities for gaining access to social rights and what it means for their relationship with the Swedish welfare state. The study’s empirical material consists of two parts. The first part contains register data from the social services register of the National Board of Health and Social Welfare and the social insurance register of the Swedish Social Insurance Board. The second consists of interviews with eleven foreign-born elderly persons who previously received social benefits and now receive maintenance support for the elderly. The analysis of the register data indicates that one-fifth of the target group actually includes people born in Sweden while the rest are immigrants arriving in Sweden in later life. For most of those in this latter group the maintenance support is their only source of financial support while it is a supplement for the Swedish-born elderly recipients. The results show that of those, who previously received social benefits and where the maintenance support is their only source of financial support, about onefifth received a smaller amount of benefit after the reform. The interview study indicates the existence of a gap between what the respondents express as needs of more individual considerations both in terms of the contact with the administrating authority and the maintenance support’s monetary content and how the elderly perceive that these needs are provided for. In order to try to understand this gap the result was analysed by using a number of major theoretical concepts such as universalism, stigma and shame, and social citizenship, public identity and recognition. The conclusions of the study is that a comprehension of the gap can be found in the standardised design and administration of the maintenance support and in the socio-economic context that immigrants coming to Sweden in later life find themselves in

Be yourself but not too much : En studie om förändringen av sociala-medier och hur detta påverkar individens presentation av Identitet online och offline

Studiens syfte är att få en bättre förståelse av hur utvecklingen i sociala-medier – dels en ökande del av digital interaktion i förhållande till samvaro ansikte mot ansikte och dels en förflyttning av interaktion från text till bilder – inverkar på individers presentation av sin identitet. Uppsatsen syftar också till att undersöka hur individer upplever skillnaden mellan olika plattformar och vad utveckling betyder för interaktionen mellan individer. Detta gjordes genom kvalitativa semistrukturerade intervjuer samt en innehållsanalys av informanternas online-profiler på Instagram. För att diskutera fenomenet ur ett socialpsykologiskt perspektiv, används teorierna rörande interaktion genom Goffman, Baudrillards teori kring individernas varseblivning av realitet samt Giddens teori gällande modernitet och självidentifiering.                      Resultatet av studien visar att sociala-medier är en stor del av individernas liv och förändringen av detta upplevs tydligt. Individerna är medvetna om att det finns en skillnad mellan online och offline realitet, dock inverkar online-realiteten på individernas liv och självuppfattning med en omfattande påtryckning. Interaktionen upplevs mer passiv och indirekt, vilket gör att individerna känner sig ensamma även då de har många vänner/följare online. Trenden mot perfektion på sociala-medier och samhällets press på individen skapar ett måste att vara online och hålla sig uppdaterad. Dessutom är sociala-medier en realitet där individer upplever en lättnad från offline-realiteten, då de kan välja vem dem vill interagera med och slipper det som känns obekvämt i offline-realiteten. I stort sätt uppfattas sociala-medier och förändringen från text till bild som något positivt, eftersom individerna känner sig mindre angripbara och tryggare inom den enklare bildbaserade applikationen Instagram

Temporal and spatial changes in benthic invertebrate trophic networks along a taxonomic richness gradient

Species interactions underlie most ecosystem functions and are important for understanding ecosystem changes. Representing one type of species interaction, trophic networks were constructed from biodiversity monitoring data and known trophic links to assess how ecosystems have changed over time. The Baltic Sea is subject to many anthropogenic pressures, and low species diversity makes it an ideal candidate for determining how pressures change food webs. In this study, we used benthic monitoring data for 20 years (1980-1989 and 2010-2019) from the Swedish coast of the Baltic Sea and Skagerrak to investigate changes in benthic invertebrate trophic interactions. We constructed food webs and calculated fundamental food web metrics evaluating network horizontal and vertical diversity, as well as stability that were compared over space and time. Our results show that the west coast of Sweden (Skagerrak) suffered a reduction in benthic invertebrate biodiversity by 32% between the 1980s and 2010s, and that the number of links, generality of predators, and vulnerability of prey have been significantly reduced. The other basins (Bothnian Sea, Baltic Proper, and Bornholm Basin) do not show any significant changes in species richness or consistent significant trends in any food web metrics investigated, demonstrating resilience at a lower species diversity. The decreased complexity of the Skagerrak food webs indicates vulnerability to further perturbations and pressures should be limited as much as possible to ensure continued ecosystem functions

Violaxanthin accessibility and temperature dependency for de-epoxidation in spinach thylakoid membranes

Using DTT and iodoacetamide as a novel irreversible method to inhibit endogenous violaxanthin de-epoxidase, we found that violaxanthin could be converted into zeaxanthin from both sides of the thylakoid membrane provided that purified violaxanthin de-epoxidase was added. The maximum conversion was the same from both sides of the membrane. Temperature was found to have a strong influence both on the rate and degree of maximal violaxanthin to zeaxanthin conversion. Thus only 50% conversion of violaxanthin was detected at 4 degreesC, whereas at 25 degreesC and 37 degreesC the degree of conversion was 70% and 80%, respectively. These results were obtained with isolated thylakoids from non-cold acclimated leafs. Pigment analysis of sub-thylakoid membrane domains showed that violaxanthin was evenly distributed between stroma lamellae and grana partitions. This was in contrast to chlorophyll a and beta-carotene which were enriched in stroma lamellae fractions while chlorophyll b, lutein and neoxanthin were enriched in the grana membranes. In combination with added violaxanthin de-epoxidase we found almost the same degree of conversion of violaxanthin to zeaxanthin (73-78%) for different domains of the thylakoid membrane. We conclude that violaxanthin de-epoxidase converts violaxanthin in the lipid matrix and not at the proteins, that violaxanthin does not prefer one particular membrane region or one particular chlorophyll protein complex, and that the xanthophyll cycle pigments are oriented in a vertical manner in order to be accessible from both sides of the membrane when located in the lipid matrix

Normalization of puberty and adult height in girls with Turner syndrome : results of the Swedish Growth Hormone trials initiating transition into adulthood

Objective: To study the impact of GH dose and age at GH start in girls with Turner syndrome (TS), aiming for normal height and age at pubertal onset (PO) and at adult height (AH). However, age at diagnosis will limit treatment possibilities. Methods: National multicenter investigator-initiated studies (TNR 87-052-01 and TNR 88-072) in girls with TS, age 3–16 years at GH start during year 1987–1998, with AH in 2003–2011. Of the 144 prepubertal girls with TS, 132 girls were followed to AH (intention to treat), while 43 girls reduced dose or stopped treatment prematurely, making n=89 for Per Protocol population. Age at GH start was 3–9 years (young; n=79) or 9–16 years (old; n=53). Treatment given were recombinant human (rh)GH (Genotropin® Kabi Peptide Hormones, Sweden) 33 or 67 µg/kg/day, oral ethinyl-estradiol (2/3) or transdermal 17β-estradiol (1/3), and, after age 11 years, mostly oxandrolone. Gain in heightSDS, AHSDS, and age at PO and at AH were evaluated. Results: At GH start, heightSDS was −2.8 (versus non-TS girls) for all subgroups and mean age for young was 5.7 years and that of old was 11.6 years. There was a clear dose–response in both young and old TS girls; the mean difference was (95%CI) 0.66 (−0.91 to −0.26) and 0.57 (−1.0 to −0.13), respectively. The prepubertal gainSDS (1.3–2.1) was partly lost during puberty (−0.4 to −2.1). Age/heightSDS at PO ranged from 13 years/−0.42 for GH67young to 15.2 years/−1.47 for GH33old. At AH, GH67old group became tallest (17.2 years; 159.9 cm; −1.27 SDS; total gainSDS, 1.55) compared to GH67young group being least delayed (16.1 years; 157.1 cm; −1.73 SDS; total, 1.08). The shortest was the GH33young group (17.3 years; 153.7 cm: −2.28 SDS; total gainSDS, 0.53), and the most delayed was the GH33old group, (18.5 years; 156.5 cm; −1.82 SDS; total gainSDS, 0.98). Conclusion: For both young and old TS girls, there was a GH-dose growth response, and for the young, there was less delayed age at PO and at AH. All four groups reached an AH within normal range, despite partly losing the prepubertal gain during puberty. Depending on age at diagnosis, low age at start with higher GH dose resulted in greater prepubertal height gain, permitting estrogen to start earlier at normal age and attaining normal AH at normal age, favoring physiological treatment and possibly also bone health, hearing, uterine growth and fertility, psychosocial wellbeing during adolescence, and the transition to adulthood

Continued benefit of coronary stenting versus balloon angioplasty: five-year clinical follow-up of Benestent-I trial.

OBJECTIVES: This study sought to establish whether the early favorable results in the Benestent-I randomized trial comparing elective Palmaz-Schatz stent implantation with balloon angioplasty in 516 patients with stable angina pectoris are maintained at 5 years. BACKGROUND: The size of the required sample was based on a 40% reduction in clinical events in the stent group. Seven months and one-year follow-up in this trial showed a decreased incidence of restenosis and clinical events in patients randomized to stent implantation. METHODS: Data at five years were collected by outpatient visit, via telephone and via the referring cardiologist. Three patients in the stent group and one in the percutaneous transluminal coronary angioplasty (PTCA) group were lost to follow-up at five years. Major clinical events, anginal status and use of cardiac medication were recorded according to the intention to treat principle. RESULTS: No significant differences were found in anginal status and use of cardiac medication between the two groups. In the PTCA group, 27.3% of patients underwent target lesion revascularization (TLR) versus 17.2% of patients in the stent group (p = 0.008). No significant differences in mortality (5.9% vs. 3.1%), cerebrovascular accident (0.8% vs. 1.2%), myocardial infarction (9.4% vs. 6.3%) or coronary bypass surgery (11.7% vs. 9.8%) were found between the stent and PTCA groups, respectively. At five years, the event-free survival rate (59.8% vs. 65.6%; p = 0.20) between the stent and PTCA groups no longer achieved statistical significance. CONCLUSIONS: The original 10% absolute difference in TLR in favor of the stent group has remained unchanged at five years, emphasizing the long-term stability of the stented target site

Toward “Green” Hybrid Materials: Core–Shell Particles with Enhanced Impact Energy Absorbing Ability

Restrained properties of “green” degradable products drive the creation of materials with innovative structures and retained eco-attributes. Herein, we introduce the creation of impact modifiers in the form of core–shell (CS) particles toward the creation of “green” composite materials. Particles with CS structure constituted of PLA stereocomplex (PLASC) and a rubbery phase of poly­(ε-caprolactone-<i>co</i>-d,l-lactide) (P­[CL-<i>co</i>-LA]) were successfully achieved by spray droplet atomization. A synergistic association of the soft P­[CL-<i>co</i>-LA] and hard PLASC domains in the core–shell structure induced unique thermo-mechanical effects on the PLA-based composites. The core–shell particles enhanced the crystallization of PLA matrices by acting as nucleating agents. The core–shell particles functioned efficiently as impact modifiers with minimal effect on the composites stiffness and strength. These findings provide a new platform for scalable design of polymeric-based structures to be used in the creation of advanced degradable materials