98 research outputs found
Improving chemotherapy in advanced urothelial cancer : real-world data studies and prospective clinical trials
Advanced urothelial cancer (UC) is an aggressive disease with high morbidity and mortality. The primary aim of this thesis was to improve chemotherapy with respect to treatment efficacy, safety, and health-related quality of life (HRQoL) in advanced UC. The recently introduced chemotherapeutical drug vinflunine was investigated as monotherapy and in novel treatment combinations for metastatic UC (mUC). Further, two different neoadjuvant chemotherapy regimens were evaluated in muscle-invasive bladder cancer (MIBC).
Platinum-based combination chemotherapy have been standard treatment in mUC patients since the late 1980s. Vinflunine, approved in 2009, show a small but important improvement in survival when given as second line treatment. In Paper I, patients treated with vinflunine were evaluated in a retrospective real-world data study. The results confirmed that vinflunine is an active drug in an unselected cohort of routine patients. Further, patients with poor performance status had short survival and a high frequency of adverse events.
With the aim of further improving the efficacy of second-line treatment of mUC, vinflunine was combined with sorafenib in the dose-finding phase I trial VINSOR (Paper II). A recommended phase II dose could be identified. The adverse events generally agreed with those previously reported for vinflunine and sorafenib as monotherapy. The novel combination generated clinically meaningful disease stabilisation and tumour responses.
There is an unmet medical need for new treatment options for cisplatin-ineligible patients in first-line mUC, which was addressed in the randomised phase II trial VINGEM (Paper III) that compared the experimental combination of vinflunine and gemcitabine (VG) and standard treatment with gemcitabine and carboplatin. Compared to standard treatment, VG did not improve the primary endpoint progression-free survival. However, patients treated with VG did show a notably high overall response rate that was similar to the best data reported for any systemic therapy for mUC. The toxicity profile for VG was generally manageable, although high rates of neutropenia and febrile neutropenia were observed. No significant differences in HRQoL were found between the two treatment arms.
For patients with MIBC, neoadjuvant cisplatin-combination chemotherapy prior to cystectomy improves overall survival, but the optimal regimen is still unknown. A more cisplatin-dose- intense 3-week schedule was compared with a 4-week schedule of gemcitabine and cisplatin (GC) as neoadjuvant treatment in a retrospective study (Paper IV). Compared to the 4-week schedule, the 3-week schedule led to a significantly higher degree of pathological complete response, although this was associated with more frequent neutropenia. Despite the differences in downstaging, no differences in survival were observed between the two schedules.
In summary, vinflunine is an active drug for second-line treatment of mUC patients in a real- world setting. The novel combination of vinflunine and sorafenib can be safely combined in second-line treatment. In cisplatin-ineligible patients, compared to standard first-line treatment, the experimental combination of VG shows a higher response rate but does not prolong survival. In patients with MIBC, a more cisplatin-dose-intense 3-week schedule achieves significantly more complete responses compared to a 4-week schedule of GC as neoadjuvant chemotherapy prior to cystectomy
Quality of fermented dairy products beyond best before date
Date labelling is one factor influencing food waste in consumer households and evaluation of optimum shelf life is a tool food industry can use to contribute to di-minished food waste. This explorative pilot study aimed to investigate how quality of sour milk and yogurt changed beyond best before date. Sour milk and yogurt were stored in 8°C and 15°C for a total of 34 and 56 days, respectively. Instrumen-tal measurements of pH, water holding capacity (WHC) and rheological behaviour were performed along with microbiological and sensory analysis. Lowest pH was observed at best before date and WHC was stable through storage. The solid-like properties of sour milk were temperature dependent and decreased during storage. The solid-like properties of yogurt increased during storage. Viability of Strepto-coccus spp. was more apparent in yogurt while other species of lactic acid bacteria were dominant in sour milk. Storage temperature appeared to be more influential on microbiological viability in yogurt. Yogurt maintained its microbiological quality beyond best before date but the observed fungal growth in sour milk, beginning at best before date, needs to be further investigated. The sensory evaluation showed that both products were associated with creaminess at best before date and associ-ated with the attribute thin thereafter. Sour milk was associated with musty after best before date, which might relate to fungal growth. Further research is required to determine if the observed changes in sensory attributes have a significant influ-ence on consumer acceptability.Datummärkning är en faktor som påverkar mängden matsvinn som uppstår i konsu-mentled. Att utvärdera livsmedels optimala hållbarhet är ett verktyg livsmedelsindu-strin kan använda för att bidra till minskat matsvinn. Denna pilotstudie syftade till att undersöka hur kvaliteten på filmjölk och yoghurt förändrades efter bäst före-datum. Filmjölk och yoghurt lagrades i 8°C och 15°C under totalt 34, respektive 56, dagar. Instrumentella mätningar av pH, vattenhållande kapacitet och reologiska egenskaper utfördes tillsammans med mikrobiologisk och sensorisk analys. Det lägsta pH-värdet uppmättes på bäst före datum och den vattenhållande kapaciteten var stabil under lagringstiden. Fastheten i filmjölk var temperaturberoende och minskade under lag-ring. Fastheten i yoghurt ökade under lagring. Streptococcus spp. dominerade i yog-hurt medan andra arter av mjölksyrabakterier var dominerande i filmjölk. I yoghurt tenderade lagringstemperatur att i högre grad påverka det totala antalet mjölksyra-bakterier. Yoghurt upprätthöll mikrobiologisk kvalitet efter bäst före datum men för filmjölk behöver den observerade svamptillväxten, som uppkom vid bäst före datum, undersökas ytterligare. Den sensoriska analysen visade att båda produkterna var as-socierade med krämighet vid bäst före-datum och därefter associerades med attributet tunn. Filmjölk associerades med attributet unken efter bäst före datum, vilket möjli-gen kan relatera till svamptillväxten. Ytterligare forskning krävs för att avgöra om de observerade förändringarna i sensoriska attribut har en betydande påverkan på kon-sumentacceptans
VoiTas-kouluttautumisen näkyvyys hoitotyössä : Kotkan kotihoidon työntekijöiden näkökulmasta
VoiTas on Ikäinstituutin kehittämä iäkkäiden voima- ja tasapainoharjoittelun koulutuskokonaisuus. Tämän opinnäytetyön tarkoituksena oli selvittää, miten VoiTas-koulutuksen keskeiset sisällöt toteutuvat Kotkan alueellisessa kotihoidossa käytännön hoitotyössä ja kirjaamisessa. Tarkasteltavia pääsisältöjä olivat voima- ja tasapainoharjoittelu, toimintakykyä edistävä työote ja fyysisen toimintakyvyn arviointi.
Tutkimus toteutettiin kvalitatiivisena teemahaastattelututkimuksena. Aineisto kerättiin kotihoidon henkilöstöltä yksilöhaastatteluina. Tutkimusaineiston analysoinnissa käytettiin deduktiivista sisällönanalyysiä. Työn teoriaosuudessa käsiteltiin tutkimuksen kohteena olevia koulutuksen pääsisältöjä, kotihoidon palveluita yleisellä tasolla ja Kotkan alueellista kotihoitoa.
Voima- ja tasapainoharjoittelu on tärkeä osa asiakkaiden kokonaisvaltaista hoitotyötä, mutta se ei haastateltavien mukaan toteudu kaikilta osin VoiTas-koulutuksen periaatteiden mukaisesti. Haastateltavat näkevät toimintakyvyn edistämisen tavoiteltavana toimintamallina, mutta sen toteutuminen on vaihtelevaa. Asiakkaiden fyysistä toimintakykyä arvioidaan yhdistellen VoiTas-koulutuksen oppien mukaisesti useampia eri menetelmiä. Haastateltavat pitävät hoito- ja palvelusuunnitelmien sekä liikuntasuunnitelmien laadintaa tärkeänä osana vastuuhoitajan työtä, mutta niiden tavoitteellisuus ja toteutumisen seuranta ovat puutteellisia. Päivittäinen kirjaaminen ei ole haastateltavien mukaan Kotkan kotihoidossa arvioivaa ja sitä on asiakkaan voimavarojen esille tuomiseksi kehitettävä.
VoiTas-koulutuksen keskeiset sisällöt korostuvat haastateltavien päivittäisessä työskentelyssä, mutta niitä ei liitetä aktiivisesti varsinaiseen koulutukseen. Periaatteita siis noudatetaan, mutta koulutuksen sisältöihin verraten puutteellisesti. Tämä tutkimus nosti esille toteuttamisen ongelmakohtia, joihin puuttumalla voidaan hoitotyön toimintamalleja kehittää paremmin VoiTas-koulutusta vastaaviksi.VoiTas (strength and balance training for the elderly) is a collection of training programs developed by the Age Institute. The objective of this thesis was to find out how the main content of the VoiTas-training program is executed in practice and in the documentation of nursing in Kotka home care. The main content areas of the training program studied were strength and balance training, development of performance and evaluation of physical performance.
The study was executed by using qualitative research methods. The research material was collected with individual interviews directed to the personnel working in Kotka home care. The interviews were semi-structured and based on a theme frame. The material was analyzed by using deductive content analysis. The theoretical part of this thesis covers the studied main content of the training program, home care services in general and Kotka regional home care.
Strength and balance training is a very important part of comprehensive nursing but according to the interviewees it does not actualize completely by the principles of VoiTas-training program. The interviewees see development of performance as a priority but its actualization is variable. Physical performance of home care clients is evaluated according to the principles of VoiTas-training program by combining different methods. Creating the care and service plans and exercise plans is seen as an important part of work of a primary nurse but they are not goal orientated and the following of their actualization is insufficient. According to the interviewees the daily documentation of nursing is not evaluative and must be improved in order to reveal clients’ resources.
The main principles of VoiTas-training program are emphasized in daily work of the interviewees but they are not connected to the actual program. The principles are executed but insufficiently when compared to the actual content. By intervening in the identified problems the procedures of care work can be improved to match the VoiTas-training program more precisely
Abiotiska faktorers inverkan på laxens (Salmo salar) dagliga lekvandring i två älvar i norra Sverige
Atlantic salmon (Salmo salar) depends on two major migrations to fulfil their life cycle, from their birth place in rivers to sea, and back upstream the river again to spawn. Salmon stocks have been heavily reduced during the last century due to human activities such as hydropower and timber floating. Construction of fish ladders and restoration of rivers are recent management actions taken aiming at improving the remaining salmon stocks. Salmon are monitored during their migrations to get information on the stock status. This study focused on how environmental factors correlated with adult salmon upstream spawning migration data from two rivers in northern Sweden, Västerbotten County, Umeälven and Byskeälven. Salmon data from both rivers were obtained from fish counters placed in fish ladders. The fish ladder in river Umeälven was equipped with two VAKI fish counters, and salmon data from 2010-2013 was used. Salmon data from 2009-2013 from river Byskeälven were used, the fish ladder was equipped with a PORO fish counter 2009-2012, and a VAKI fish counter 2013. There were three questions that led the study; (I) which environmental variables can explain the daily variations in salmon upstream migration? (II) Are there any major differences between the factors influencing salmon spawning migration in an exploited river compared to an unexploited river? (III) Can an environmental factor be of greater or less importance for salmon upstream migration during the first and the last half of the season? Stepwise linear regressions were used to create models to find how the environmental factors correlated with salmon upstream migration. Both rivers had a seasonal migration pattern with most of the salmon migrating early in the season. Water flow had most influence on the salmon upstream migration in the studied rivers. There was a difference in which environmental factors had most influence on salmon migration between the first and second 50 % of migrating salmon in river Byskeälven. Adjusted Julian day number explained most of the migration in the best model for the migration first half of the season. Water temperature, water flow, and adjusted Julian day number explained the migration in the second half of the season
"Can you hear me, Hanoi?" Compensatory mechanisms employed in synchronous net-based English language learning
This paper reports the intelligibility difficulties experienced by students of English for academic purposes
at a university in Sweden while taking part in synchronous net-based seminars. Connectivity limitations,
microphone and headphone problems, background noise and other factors in combination with limited
skill in the perception of English speech make it difficult for these students to process speech directed to
them. In addition, the speech the students are trying to process may be produced by nonnative speakers of
English, either fellow students or teachers. A comparison of simultaneous communication in several of
the modes available in the virtual seminar environment showed that students make use of a number of
strategies to partly compensate for their failure to optimally perceive and produce speech
Cereal dietary fibres as prebiotics : metabolite production and health effects of arabinoxylan and β-glucan fermentation
The human gut is colonized by an enormous amount of microorganisms, the so called
microbiota. The microbiota degrades dietary components in the colon and utilize
them as substrates in their metabolism. Dietary fibres are the most important energy
source for the microbiota. Some dietary fibres are classified as prebiotics, as they
have the ability to alter the composition and activity of the microbiota and promote
health benefits.
Cereals are the major source of dietary fibres in Scandinavia. Among the cereals rye (Secale cereale) and oat (Avena sativa) are most frequently consumed as whole grains. The aim of this literature study was to review the current knowledge about the
prebiotic properties of arabinoxylan and β-Glucan, the major dietary fibres in rye and
oats.
A prebiotic substrate is selective and confer health benefits. The result shows that
arabinoxylan and β-Glucan fermentation display prebiotic properties. Both confer
health benefits by indirectly stimulating beneficial metabolite production of the shortchain
fatty acids acetate, propionate and butyrate. The literature shows that arabinoxylan
particularly promotes butyrate production, while β-Glucan promotes propionate
production and in some conditions butyrate as well.
Butyrate has been shown to improve intestinal integrity, prevent inflammation
and exhibit an anti-carcinogenic effect. Propionate inhibits cholesterol synthesis.
However, health effects of dietary fibres can depend on the individual responsiveness
to a substrate, the so-called enterotype. In general, a diet with various dietary fibres
has been connected to health benefits, partly because it prevents production of detrimental
metabolites that is formed in the absence of fermentable carbohydrates.
Future studies will have to further confirm the prebiotic properties of arabinoxylan
and β-Glucan in vivo with human subjects. If such studies would present enough
scientific support for authority health claims, it may be a way to increase the consumption
of dietary fibres in the population and contribute to improving public
health.Människans mag-tarmkanal är koloniserad av ett enormt antal mikroorganismer, den
så kallade mikrobiotan. I tjocktarmen bryter mikrobiotan ner komponenter i maten
och använder dem som substrat i sin metabolism. Kostfibrer är mikrobiotans viktigaste
energikälla. Vissa kostfibrer klassas som prebiotika, eftersom de har förmågan
att påverka kompositionen och aktiviteten hos mikrobiotan och ge positiva hälsoeffekter.
Cerealier är den största kostfiberkällan i Skandinavien, och av dem är det råg
(Secale cereale) och havre (Avena sativa) som oftast konsumeras som fullkorn. Syftet
med denna litteraturstudie var attsammanställa den nuvarande kunskapen om de
prebiotiska egenskaperna hos kostfibrerna arabinoxylan och β-Glukan, som finns i
högst mängd i råg och havre.
Prebiotiska substrat är selektiva och ger hälsofördelar. Resultatet visar att fermenteringen
av arabinoxylan och β-Glukan har prebiotiska egenskaper. Båda ger hälsofördelar
genom att indirekt stimulera gynnsam metabolitproduktion av de kortkedjiga
fettsyrorna acetat, propionat och butyrat. Litteraturen visar att arabinoxylan särskilt
gynnar butyratproduktion, medan β-Glukan gynnar propionatproduktion och under
visa förhållanden även butyrat.
Butyrat har visats förbättra tarmbarriärens integritet, motverka inflammation och ha en anti-carcinogen effekt. Propionat inhiberar kolesterolsyntes. Men hälsoeffekter
av kostfibrer kan även bero på individens mottaglighet för ett substrat, den så kallade
nterotypen. Generellt har en varierad kost med många olika kostfibrer kopplats till
bättre hälsa, vilket delvis beror på en minskning av skadliga metaboliter som kan
produceras i tjocktarmen när det är brist på fermenterbara kolhydrater.
Framtida studier bör vidare bekräfta den prebiotiska effekten av arabinoxylan och
β-Glukan in vivo. Om sådana studier skulle visa på tillräckligt vetenskapligt stöd för
att utfärda hälsopåståenden, kan det vara ett sätt att öka kostfiberkonsumtionen I populationen
och bidra till att förbättra folkhälsan
Skillnader i migrationsframgång mellan vild och odlad laxsmolt (Salmo salar L.)
Laxen är en anadrom fiskart som reproducerar sig i sötvatten men lever huvuddelen av sitt vuxna liv i saltvatten. På grund av vattenkraftens dammbyggen hindras laxen att göra dessa habitatbyten och reproduktionen drabbas. För att kompensera för minskade laxstammar sätter vattenkraftbolagen varje år ut miljontals odlad laxsmolt i vattendrag som mynnar ut i östersjön. I Umeälven släpps 80000 laxsmolt ut årligen. Tidigare rapporter visar att överlevnaden hos dessa är lägre än hos vild smolt. I den här rapporten försöker vi ta reda på om det finns en skillnad i migrationsframgång mellan vild och odlad smolt i Umeälven och vad konditionsfaktorn har för betydelse för den odlade smoltens migrationsframgång. Vi har använt oss av tre grupper med fiskar, två odlade och en vild grupp. Dessa skiljer sig från varandra gällande storlek och konditionsfaktor. Vi har också genom akustiska sändare i samma individer mätt hur fort de migrerat och hur långt de har kommit. Överlevnaden varierade, vild smolt hade 39 % den odlade gruppen med lägre medelvikt hade 48 % och den odlade gruppen med högre medelvikt hade 16 % överlevnad till Holmsund. Migrationshastigheten varierade mellan sträckor i älven men inte mellan grupper av fisk. Tendenser fanns i alla grupper att smolten föredrog att migrera nattetid, tydligast var det bland de vilda smolten på den senare sträckan. Vi tycker att man i framtida kompensationsodlingar ska satsa på mindre smolt med lägre konditionsfaktor för att efterlikna vild smolt och därmed förhoppningsvis öka överlevnaden till havet.The Atlantic salmon (Salmo salar L.) is an anadromous fish. It reproduces in freshwater streams but spends the major parts of its mature life in seawater. Due to hydropower dams the salmon is prevented from making these habitat changes and reproduction is compromised. Hydropower companies stock millions of salmon smolt in the Baltic Sea annually to compensate for decreasing salmon populations. In the Ume River 80000 hatchery reared salmon smolts are stocked every year. Previous reports show that the survival of these smolts is lower than the survival of wild smolts. In this report, we try to find out if there is a difference in migration success between wild and reared smolts in the Ume River and how conditionfactor affect the migration success. We have used three groups of fishes, two hatchery reared groups and a wild group. These differ from one another regarding size and condition factor. Acoustic transmitters measured how fast they migrated and how far they came. The rate of survival was 39 % for the wild smolt, 16 % for the hatchery reared group with high condition factor and 48 % for the hatchery reared group with low condition factor. Migration rate differed significant between stretches of the river, but not among groups of fish. We also discovered that there was a tendency for all groups to migrate at night, especially among the wild smolts in the later stretch of the river. We think that future hatcheries should aim for smaller smolts with lower condition factor to mimic wild smolts and thus hopefully increase migration success
Responsible sourcing and transparency in the home textile industry : the case of cotton
CSR, Corporate Social Responsibility, has become increasingly important in a globalised world where the responsibilities of companies and governments are somewhat blurry. The textile industry is an industry where long supply chains and raw material production in developing countries are factors adding to the complexity and difficulties of solving ethical issues. Cotton production faces many environmental, social and financial challenges in the value chain. Therefore this case study takes a closer look at five Nordic home textile companies, Ikea, Hemtex, S Group, Moko and Finlayson, and how these companies choose their cotton related CSR tools and communicate their work on this area. These companies are of various sizes and therefore the resources for CSR work are also different, as well as the perceived values for working with CSR. The results show that there are a variety of approaches to CSR in the companies’ value chain but each company is taking steps towards CSR. However, the supplier relationships, in the case companies, are more often based on compliance with a Code of Conduct or similar rather than a commitment approach. Additionally, some of the “tools” identified were multi-stakeholder initiatives, eco-labels and innovations. In the end, this study reflects that the solutions are mostly instrumental so there would be room for more collaboration in taking steps towards significant change in the industry.CSR är ett begrepp som blir alltmer aktuellt i och med en globaliserad värld där multi-nationella företag gör affärer med utvecklingsländer. Det finns ofta varierande etiska utmaningar som företagen stöter på i utvecklingsländerna och företagen får ofta agera i rollen som myndigheter och regering. Tekstil industrin är ett av de exempel på industrier som stöter på dessa problem redan i början av värde-kedjan i och med produktionen av råmaterial.
Dethär arbetet har därför tagit en närmare titt på hur tekstil företag kommunicerar sitt CSR arbete med bomull. Eftersom nästan ingenting har skrivits om hemtekstiler tidigare har denna studie fokuserat på hemtekstil företag. Fem företag, Ikea, Hemtex, S Group, Moko och Finlayson, i Norden (Sverige och Finland) har varit föremål för denna fallstudie. Intervjuer har gjorts med experter i området inom varje företag och har därefter analyserats efter följande teman; strategisk ledning, upphandling och kommunikation.
Resultaten visar på att alla fem företag jobbar med CSR, men att de använder olika tillvägagångsätt. Det kunde finnas ett mervärde i mera sammarbete mellan företagen. Alla företag är också rätt blygsamma med att marknadsföre sin strävan till etisk upphandling av bomull. Det kunde ytterligare finnas ett mervärde i att upplysa och informera kunder om deras ansträngingar och därmed stärka sina varumärken och efterfrågan på sina produkter
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