The prognostic impact of the tumour stroma fraction: A machine learning-based analysis in 16 human solid tumour types

Background: The development of a reactive tumour stroma is a hallmark of tumour progression and pronounced tumour stroma is generally considered to be associated with clinical aggressiveness. The variability between tumour types regarding stroma fraction, and its prognosis associations, have not been systematically analysed.Methods: Using an objective machine-learning method we quantified the tumour stroma in 16 solid cancer types from 2732 patients, representing retrospective tissue collections of surgically resected primary tumours. Image analysis performed tissue segmentation into stromal and epithelial compartment based on pan-cytokeratin staining and autofluorescence patterns.Findings: The stroma fraction was highly variable within and across the tumour types, with kidney cancer showing the lowest and pancreato-biliary type periampullary cancer showing the highest stroma proportion (median 19% and 73% respectively). Adjusted Cox regression models revealed both positive (pancreato-biliary type periampullary cancer and oestrogen negative breast cancer, HR(95%CI)=0.56(0.34-0.92) and HR (95%CI)=0.41(0.17-0.98) respectively) and negative (intestinal type periampullary cancer, HR(95%CI)=3.59 (1.49-8.62)) associations of the tumour stroma fraction with survival.Interpretation: Our study provides an objective quantification of the tumour stroma fraction across major types of solid cancer. Findings strongly argue against the commonly promoted view of a general associations between high stroma abundance and poor prognosis. The results also suggest that full exploitation of the prognostic potential of tumour stroma requires analyses that go beyond determination of stroma abundance.</p

En lärobok för alla? : En kartläggning av mångtydiga ord i läroböcker i matematik utifrån ett flerspråkighetsperspektiv.

Mellan flerspråkiga elever och elever med svenska som modersmål har en stor skillnad i resultat kunnat ses i årskurs nio, både gällande nationella prov och slutbetyg. Vidare har det visats att de flerspråkiga eleverna möter många språkliga utmaningar i skolan, bland annat i de läroböcker som används. En aspekt i läroböckerna som visats innebära en potentiell svårighet för dessa elever är mångtydiga ord. Eftersom få studier av ordanvändning har gjorts i läroböcker för de lägre årskurserna granskas därför i denna studie två läroböcker framtagna för årskurs tre utifrån huruvida mångtydiga ord förekommer i dem och i sådana fall på vilket sätt de används. I studien framkommer att mångtydiga ord används i en mycket stor utsträckning på ett flertal olika sätt i läroböckerna. Användningen och förekomsten av de mångtydiga orden ser relativt lika ut mellan de båda läroböckerna men vissa skillnader i vilka ord som förekommer och den frekvens olika ord förekommer i kan ändå ses. Användningen av mångtydiga ord i läroböckerna anses i studien vara så pass omfattande att den potentiellt skulle kunna ge problem i förståelsen för de flerspråkiga eleverna

Ord i nationella prov : En jämförande studie av ordanvändningen hos första- och andraspråkselever samt dess potentiella konsekvenser för lärandet.

I Sverige ökar flerspråkigheten i skolan och allt fler elever har svenska som andraspråk. I de nationella proven presterar förstaspråkseleverna generellt bättre än andraspråkspråkseleverna, vilket gör att orsaken till detta därför blir intressant att undersöka. En studie av skillnaden i resultat mellan elevgrupperna kan av denna anledning eventuellt synliggöra det stöd andraspråkseleverna behöver för att prestera bättre. Ordförrådet har tidigare visat sig vara en viktig faktor för elevers möjligheter att lyckas i skolan och därför valdes just denna aspekt ut för att undersökas i den här studien. Tidigare studier som undersökt liknande ämnen har mestadels riktats mot äldre elever och därför fokuserar denna studie istället på elever i de yngre åldrarna, närmare bestämt elever i årskurs tre. För att få tillgång till ett stort urval av texter användes elevtexter från de nationella proven i analysen där ett så representativt urval som möjligt gjordes sett till kön, geografisk placering och uppnåelse av kravnivåerna. Hälften av de analyserade texterna var vidare skrivna av elever vilka följer studiegången svenska som andraspråk och hälften av elever med studiegången svenska. Analysen genomfördes sedan utifrån aspekterna ordvariation, mångtydiga ord, sammansatta ord och verb, vilka tidigare visat sig användas på ett utmärkande sätt av elever med svenska som andraspråk. Även vilka ord som var låg- respektive högfrekventa i de olika elevgruppernas texter undersöktes. De resultat som framkom av denna analys ställdes sedan i relation till en sociokulturell teori om språk och lärande. Detta för att synliggöra eventuella konsekvenser av studiens resultat för elevernas lärande. Resultaten i studien visade på betydande skillnader mellan första- och andraspråkselevernas ordanvändning i alla undersökta aspekter, vilket skulle kunna medföra att eleverna har olika förutsättningar i deras fortsatta lärande. Det blir därför relevant att den kommande undervisningen är språkfokuserad för att ge andraspråkseleverna möjligheten att nå skolframgång i lika stor utsträckning som förstaspråkseleverna.

Hemma bra men borta bäst? : en studie om utlandstjänsgöring med betoning på hemkomst och tillvaratagande av kompetens

Utlandstjänstgöring kan för många vara en spännande del i yrkeskarriären. En mission i utlandet innebär möten med andra kulturer, främmande språk, insikt i främmande länders organisationer och ger framförallt en möjlighet till personlig utveckling. Tjänstgöringen utomlands ger ofta mersmak, väljer man att åka iväg en första gång så följer gärna fler missioner. Polismannen samlar på sig, utöver den personliga utvecklingen, en stor kompetens genom de erfarenheter en utlandstjänstgöring ger. Med hjälp av denna rapport vill vi belysa problematiken kring tillvaratagandet av kompetensen efter hemkomst från myndighetens sida samt visa på hur den enskilda uppfattar tillvaratagandet. För att få fram resultatet har vi valt att genomföra ett antal intervjuer med representant från polismyndigheten samt poliser som har erfarenhet av utlandstjänstgöring. Efter hemkomst finns en större motivation till arbetet och personen vill i många fall se en möjlighet till karriärutveckling. För att karriärutveckling ska ske måste denne och myndigheten kunna mötas för en dialog där de tillsammans kan diskutera kring vilken kompetens som förvärvats och hur denna kan nyttjas av myndigheten på bästa sätt. Som en lösning på problemet vill vi att myndigheten ska se deras medarbetare som varit på utlandstjänstgöring som den resurs de faktiskt är

Midwives’ experiences of professional learning when practicing collegial midwifery assistance during the active second stage of labour: data from the oneplus trial

Abstract Background Learning is a lifelong process and the workplace is an essential arena for professional learning. Workplace learning is particularly relevant for midwives as essential knowledge and skills are gained through clinical work. A clinical practice known as ‘Collegial Midwifery Assistance’ (CMA), which involves two midwives being present during the active second stage of labour, was found to reduce severe perineal trauma by 30% in the Oneplus trial. Research regarding learning associated with CMA, however, is lacking. The aim was to investigate learning experiences of primary and second midwives with varying levels of work experience when practicing CMA, and to further explore possible factors that influence their learning. Methods The study uses an observational design to analyse data from the Oneplus trial. Descriptive statistics and proportions were calculated with 95% confidence intervals. Stratified univariable and multivariable logistic regression analysis were performed. Results A total of 1430 births performed with CMA were included in the study. Less experienced primary midwives reported professional learning to a higher degree ( 20 years, 22%). A similar but less pronounced pattern was seen for the second midwives. Duration of the intervention ≥ 15 min improved learning across groups, especially for the least experienced primary midwives. The colleague’s level of experience was found to be of importance for primary midwives with less than five years’ work experience, whereas for second midwives it was also important in their mid to late career. Reciprocal feedback had more impact on learning for the primary midwife than the second midwife. Conclusions The study provides evidence that CMA has the potential to contribute with professional learning both for primary and second midwives, for all levels of work experience. We found that factors such as the colleague’s work experience, the duration of CMA and reciprocal feedback influenced learning, but the importance of these factors were different for the primary and second midwife and varied depending on the level of work experience. The findings may have implications for future implementation of CMA and can be used to guide the practice

Self-compassion and professional quality of life among midwives and nurse assistants : A cross-sectional study

INTRODUCTION: Self-compassion and satisfaction derived from helping others is part of healthcare providers' professional quality of life. The aim of this study was to explore and psychometrically test two instruments measuring self-compassion and professional quality of life among midwives and nurse assistants. METHODS: This was a cross-sectional study with midwives and nurse assistants working with intrapartum care at five different labor wards in Sweden. The Self-Compassion Scale (SCS) and the modified Professional Quality of Life Measurement (ProQOL) were validated and correlation analyses were calculated between the different subscales. Descriptive statistics, t-test, were calculated to analyze associations between the subscales of the SCS, the ProQOL and the background variables. RESULTS: Midwives were more self-critical than nurse assistants, and the midwives who were negative towards the new clinical practice scored higher for compassion fatigue. The principal component analysis showed a two-factor solution for both the SCS and the modified ProQOL. The two SCS subscales were named 'self-criticism' (α=0.85) and 'self-kindness' (α=0.87). The two ProQOL subscales were named 'compassion satisfaction' (α=0.83) and 'compassion fatigue' (α=0.78). A negative correlation was found between self-kindness and compassion fatigue subscales, between compassion satisfaction and compassion fatigue, and between self-kindness and self-criticism. CONCLUSIONS: The SCS and modified ProQOL are considered as valid questionnaires for use in a Swedish maternity setting and a correlation between the scales was found. Midwives are more self-critical than nurse assistants. Understanding and identifying compassion fatigue among midwives is important to managers responsible for quality improvement and practice changes

Severe perineal trauma among women undergoing vaginal birth after cesarean delivery : A population-based cohort study

Background: To examine risk of severe perineal trauma among nulliparous women and those undergoing vaginal birth after cesarean delivery (VBAC). Methods: This is a population-based cohort study of all births to women with their two first consecutive singleton pregnancies in Stockholm-Gotland Sweden between 2008 and 2014. Risk of severe perineal trauma was compared between nulliparous women and those undergoing VBAC with severe perineal trauma being the main outcome measure. Associations between indication and timing of primary cesarean delivery and risk of severe perineal trauma in subsequent vaginal birth were analyzed using Poisson regression analysis. Results: The rate of severe perineal trauma among nulliparous women and those undergoing VBAC was 7.0% and 12.3%, respectively. Compared with nulliparous women, those undergoing VBAC were significantly older, had a shorter stature, and gave birth in a non-upright position to heavier infants with larger head circumferences. The rate of instrumental vaginal delivery among nulliparous women and those undergoing VBAC was 19.3% and 20.2%, respectively (P = 0.331). An increased risk of severe perineal trauma remained after adjustments among those undergoing VBAC (adjusted risk ratio 1.42, 95% CI 1.23-1.63). Level of risk was not associated with indication (dystocia or signs of fetal distress) of primary cesarean delivery, nor how far the woman had progressed in labor (fully dilated versus planned cesarean delivery) before delivering by cesarean. Conclusions: Compared with nulliparous women, those undergoing VBAC are at increased risk of severe perineal trauma, irrespective of indication and timing of primary cesarean delivery

Labor unit culture and attitudes toward supporting vaginal birth-The Swedish version of the labor culture survey (S-LCS)-Psychometric properties

BACKGROUND: In order to evaluate interventions aimed at reducing cesarean births, care practitioners' attitudes are important to measure. The Labor Culture Survey (LCS) is a scale that measures individual and unit attitudes towards supporting vaginal birth. As no equivalent scale exists in Sweden, the aim was to translate, adapt, and validate the LCS and to investigate whether there were differences in attitudes toward supporting vaginal birth between maternity care practitioners. METHODS: A cross-sectional study including midwives, physicians, and nurse assistants working with intrapartum care in five labor wards in Sweden. The original LCS was translated into Swedish, and six context-specific items were developed for the Swedish setting (SLCS). The translation was tested for face validity. Psychometric analysis was conducted using exploratory factor analysis with principal component analysis, parallel analysis, and principal axis factoring. Reliability was estimated using Cronbach's alpha. One-way ANOVA and Tukey HSD were calculated to analyze differences in attitudes between professions on the subscales of the S-LCS. RESULTS: A total of 539 midwives, physicians, and nurse assistants participated. The final S-LCS showed a five-factor solution with the following subscales: Best Practices to reduce cesarean overuse, Unpredictability of vaginal birth, Unit Microculture, Maternal Agency, and Organizational Oversight. Chronbach alpha values varied from 0.60 to 0.83. Midwives were more supportive towards vaginal birth and less fearful of potential consequences of vaginal birth compared with physicians. CONCLUSIONS: The S-LCS demonstrated satisfactory psychometric properties for use in Swedish maternity care. Further work to improve the scale should include additional items reflecting the subscale Maternal Agency

Impact of collegial midwifery assistance during second stage of labour on women’s experience: a follow-up from the Swedish Oneplus randomised controlled trial

Objective To compare experiences of the second stage of labour in women randomised to assistance by one or by two midwives to reduce severe perineal trauma (SPT).Design Analysis of a secondary outcome within the Swedish Oneplus multicentre randomised trial.Setting Five obstetric units in Sweden between December 2018 and March 2020.Participants Inclusion criteria in the Oneplus trial were women opting for their first vaginal birth from gestational week 37+0 with a singleton pregnancy and a live fetus in the vertex presentation. Further inclusion criteria were language proficiency in Swedish, English, Arabic or Farsi. Exclusion criteria were multiple pregnancies, intrauterine fetal demise and planned caesarean section. Of the 3059 women who had a spontaneous vaginal birth, 2831 women had consented to participate in the follow-up questionnaire.Interventions Women were randomly assigned (1:1) to assistance by two midwives (intervention group) or one midwife (standard care) when reaching the second stage of labour.Outcome measures Data were analysed by intention to treat. Comparisons between intervention and standard care regarding experiences of the second stage of labour were evaluated with items rated on Likert scales. The Student’s t-test was used to calculate mean differences with 95% CIs.Results In total 2221 (78.5%) women responded to the questionnaire. There were no statistically significant differences regarding women’s experiences of being in control, feelings of vulnerability or pain. Women randomised to be assisted by two midwives agreed to a lesser extent that they could handle the situation during the second stage (mean 3.18 vs 3.26, 95% CI 0.01 to 0.15). Conducted subgroup analyses revealed that this result originated from one of the study sites.Conclusions The intervention’s lack of impact on the experience of the second stage is of importance considering the reduction in SPT when being assisted by two midwives.Trial registration number NCT03770962

Women's experiences of the second stage of labour

Background: The second stage of labour is generally considered as an intensive part of labour. Despite this, knowledge about women's experiences of the second stage of labour is scant. Aim: To explore experiences of the second stage of labour in women with spontaneous vaginal birth. Methods: This is a qualitative study where twenty-one women with a spontaneous birth at term, were interviewed four to ten weeks after birth. Data were analysed using qualitative thematic analysis based on descriptive phenomenology. The participating women had experienced a vaginal birth; some for the first time, having previously given birth by caesarean section and some with a previous vaginal birth. Findings: Three themes emerged: “An experience of upheaval” which represents the women's experiences of intensity, power and pain during the second stage of labour. “The importance of trusting relationships” signifies the meaning of women's relationships during the second stage of labour. “Becoming a mother” which is characterised by feelings of accomplishment and the experience of the final moments of birth. Conclusion: During the second stage of labour women experienced overwhelming sensations which made evident the importance of trusting relationships with those involved in the birth. The women were in a transformative state between pregnancy and motherhood where experiences of being involved and being provided with information and guidance were all considered crucial. Continuous support should be offered to women during the second stage of labour