Male inguinal hernia repair with mesh. Short- and long-term results and the question of infertility.

Background: In the nineties, the patients with inguinal hernias were exposed to several newly developed repair techniques using alloplastic mesh prosthesis. Although the scientific knowledge was limited, the new techniques were rapidly introduced due to surgical enthusiasm, but also by an eagerness to reduce the recurrence rate and to shorten the time to recovery. When the first study of this thesis was initiated there were almost no randomized controlled trials comparing the short- and long-term results of open tension free repair (Lichtenstein) and totally extraperitoneal laparoscopic repair (TEP). The recurrence rates have since then been markedly reduced and the focus has moved towards studying other side effects of inguinal hernia surgery. The use of mesh in inguinal hernia surgery has been proposed to increase the incidence of male infertility due to inflammatory obstruction of the structures of the spermatic cord. Aims: To compare the Lichtenstein and the TEP operation techniques regarding short- as well as long-term results. To assess the risk of male infertility following inguinal hernia mesh repair. Methods: The first two publications were based on a prospective randomized controlled study comparing the two repair techniques, with both short- and long-term follow-up. The next two publications were derived from the Swedish Hernia Register. One was a prospective study, comparing by questionnaire, involuntary childlessness after bilateral inguinal hernia repair with or without mesh. The other was a retrospective study comparing the expected and observed incidences of diagnosed male infertility after inguinal hernia repair with or without mesh. Results: TEP resulted in less consumption of analgesics, shorter sick leave, faster recovery, longer operation time, higher hospital costs and less impaired inguinal sensibility. In the long-term both methods had a high patient satisfaction rate, almost no impact on day-to-day life and a low frequency of persistent severe chronic pain. Bilateral inguinal hernia mesh repairs in men did not increase the incidence of involuntary childlessness. Inguinal hernia mesh repairs were not associated with a clinically important increase of diagnosed male infertility. Conclusions: TEP and Lichtenstein are comparable techniques which both have overall good short- and long-term results. Inguinal hernia mesh repair is a safe method regarding male infertility

Linear decrease in VO2max and performance with increasing altitude in endurance athletes

It has been hypothesized that one reason for decreased .VO(2max) in hypoxia could be the lower maximal exercise intensity achieved in incremental, time or distance trial tests. We hypothesized that (1).VO(2max) would be decreased at altitude even when exercising at the same absolute maximal exercise intensity as at sea level and; (2) the decline in .VO(2max) in endurance-trained athletes (ETA) would be linear across the range from sea level through moderate altitudes. Eight ETA performed combined .VO(2max) and performance tests running to exhaustion at the same speed in a randomized double blind fashion at simulated altitudes of 300, 800, 1,300, 1,800, 2,300 and 2,800 m above sea level using a hypobaric chamber. Douglas bag system was used for respiratory measurements and pulse oximetry was used to estimate arterial O(2) saturation. .VO(2max) declined linearly from 66+/-1.6 ml kg(-1) min(-1) at 300 m to 55+/-1.6 ml kg(-1) min(-1) at 2,800 m corresponding to a 6.3% decrease per 1,000 m increasing altitude (range 4.6-7.5%). Time to exhaustion (performance) at a constant velocity associated with 107% of sea level .VO(2max) decreased with 14.5% (P<0.001) per 1,000 m altitude between 300 and 2,800 m. Both .VO(2max) and performance decreased from 300 to 800 m (P<0.01; P<0.05). Arterial haemoglobin oxygen saturation at test cessation (SpO(2min)) declined from 89.0+/-2.9% at 300 m to 76.5+/-4.0% at 2,800 m (P=0.001). This study report that in ETA during acute exposure to altitude both performance and .VO(2max) decline from 300 to 800 m above sea level and continued to decrease linearly to 2,800 m

How an antenna launches its input power into radiation: the pattern of the Poynting vector at and near an antenna

In this paper I first address the question of whether the seat of the power radiated by an antenna made of conducting members is distributed over the ``arms'' of the antenna according to -J . E, where J is the specified current density and E is the electric field produced by that source. Poynting's theorem permits only a global identification of the total input power, usually from a localized generator, with the total power radiated to infinity, not a local correspondence of -J . E dv with some specific radiated power, r^2 S . n dO. I then describe a model antenna consisting of two perfectly conducting hemispheres of radius a separated by a small equatorial gap across which occurs the driving oscillatory electric field. The fields and surface current are determined by solution of the boundary value problem. In contrast to the first approach (not a boundary value problem), the tangential electric field vanishes on the metallic surface. There is no radial Poynting vector normal to the surface. Numerical examples are shown to illustrate how the energy flows from the input region of the gap and is guided near the antenna by its ``arms'' until it is launched at larger r/a into the radiation pattern determined by the value of ka.Comment: 24pages, 8 figures, submitted for publicatio

”Jag är ledsen men du får tyvärr hjälpa dig själv” : personer med Emotionellt instabil personlighetsstörning upplevelser av bemötande i vården

Background: Mental illness is one of our major public health problem and has for a long time increased both internationally and in Sweden (Socialstyrelsen, 2015). A need for knowledge of how to treat these patients adequately is needed for all professional nurses, not just in psychiatry. According to a report from Socialstyrelsen (2010), the mentally ill receive inferior care than others and the need for increased knowledge about the treatment of these patients, their behaviors and care needs is great among professional nurses (Socialstyrelsen, 2015). A large proportion of the patients who seek help in emergency departments and somatic care after they have self-harmed or tried to take their own life are people suffering from emotionally unstable personality disorder (Lamph, 2011). Aim: To highlight obstacle and success factors for a healthy caring relation between a nurse and a person with emotionally unstable personality disorder. Method: A general literature review in which 10 articles were studied to see the connection of attitudes in health care towards people with emotionally unstable personality disorder. Results: People with EIPS is facing negative attitudes when seeking care and they experience difficulties in caring relationship with the nurses. It is a complex situation where both the diagnosis itself and the nurses' lack of knowledge about the diagnosis and how the treatment of these patients should be, that together create this problem. However, there are factors that can help in developing a good health care relationship. Conclusions: Based on the results we can see that if you treat people with emotionally unstable personality disorder with respect, as adults, give them time, listening to them and see them, a care relationship can occur that is both person-centered, equitable and caring.Bakgrund: Psykisk ohälsa är idag ett av våra största folkhälsoproblem och har under en lång period ökat både internationellt och inom Sverige (Socialstyrelsen, 2015). Enligt en rapport från Socialstyrelsen (2010) får psykiskt sjuka sämre vård än andra och behovet av ökad kunskap om bemötande av dessa patienter, deras beteenden och omvårdnadsbehov hos sjuksköterskor är stort (Socialstyrelsen, 2015). Många vårdsökande inom både akutsjukvård och somatisk vård som behöver vård efter att de självskadat eller försökt ta sitt liv, lider av Emotionellt instabil personlighetsstörning (EIPS) (Lamph, 2011). Syfte: Belysa hinder och framgångsfaktorer för en lyckad vårdrelation mellan sjuksköterska och personer med Emotionellt Instabil Personlighetsstörning (EIPS). Metod: En allmän litteraturstudie där 10 artiklar studerades föratt se samband av bemötande och attityder inom vården emot personer med Emotionellt instabil personlighetsstörning (EIPS). Resultat: Personer med EIPS bemöts av negativa attityder när de söker vård och de upplever svårigheter i vårdrelationen med sjuksköterskor. Det är en komplex situation där både diagnosen i sig och sjuksköterskornas okunskap om diagnosen och hur bemötandet av dessa patienter bör vara som tillsammans skapar denna problematik. Dock finns det faktorer som kan främja att en god vårdrelation kan utvecklas. Diskussion: Utifrån resultatet kan vi se att om man behandlar människor med EIPS med respekt, som vuxna, ge dem tid, lyssnar på och ser dem kan en vårdrelation uppstå som både är personcentrerad, jämlik och vårdande

Reference-dependent preferences in the case of Allsvenskan: Outcome uncertainty and live-game attendance

This thesis studies how different preferences for uncertainty affects live game attendance in the Swedish premier football league Allsvenskan. A framework proposed by previous literature concerning this relationship is highlighted. In the presence of reference dependency, two types of preferences is of interest. On one hand, there is the Uncertainty of Outcome Hypothesis (UOH), stating that uncertainty drives attendance. On the other, there are loss averse preferences, predicting higher attendance on games where the outcome is certain. To examine what preferences holds for Allsvenskan, a panel data regression is used to investigate the relationship between the level of uncertainty and attendance. The probability of a home team win, derived from the odds, is used as a proxy for the uncertainty present in the game. Our panel includes data on twelve teams that have participated in Allsvenskan during the seasons 2014-2016. The dataset is created by combining game-by-game statistics from the official webpage of Allsvenskan, with odds data compiled from 20+ bookmakers. Additionally, other sources are used to obtain data on control variables which rounds out the set. Ultimately we find the UOH to be present in the aggregate spectator of Allsvenskan. Also, Attendance is found to peak at a point where the probability to win is 61,5%

Quality validation of PCB-mounted sensors to prevent counterfeit components

Counterfeiting of electronic components is a growing problem, leading to lost revenue for companies as well as unreliable products delivered to customers. There is no general way for small hardware companies to deal with the problem. Addressing counterfeiting is usually not a high priority for these companies, though it is still imperative for them to deliver products with guaranteed functionality. This thesis, written at Minut AB in collaboration with Lund University, concerns the problem of counterfeit components in the tech industry. The approach is to test components during product manufacturing. A test system validating the components' performance is developed to guarantee the quality and functionality of the final product. The results show that the developed test system is capable of finding components with deviating performance. A malfunctioning counterfeit component can be discovered by the test system, though, counterfeiting is a complex problem difficult to assess at individual component level. Introduction of test and production statistics can point to failing component batches. These statistics opens for further investigation in the search for counterfeit components.Prevent counterfeit electronics Abstract Today's tech industry is struggling with a growing problem, counterfeiting of components. In the semiconductor industry, an estimated $3 billion worth of components are counterfeit worldwide. But lost revenue is not all. Counterfeit components may compromise the performance and safety of electronics. If a component is not what it claims to be, this can result in unreliable and dangerous systems. Introduction The problem with counterfeit components is known in the tech industry, but the solution is not obvious. Finding counterfeit components is a difficult task. They appear in many different shapes and ways. Old components sold as new, components relabeled to a higher grade, or components scrapped from the original manufacturer are just some examples. Today, big corporations and semiconductor manufacturers works with authentication and standardizations to fight the problem. That means extra work which takes time and requires money, money that not every company can spend. Especially these days where a multitude of small hardware companies are making their way into the market. They don't have the resources to motivate additional development of anti-counterfeit techniques. And it does not exist any predefined methods or standards of how to handle the problem. With the increasing number of hardware start-ups in the industry comes a growing number of smaller factories and component distributors. This results in larger and more complex supply chains which means a greater risk of counterfeit. While it is hard to motivate implementation of additional anti-counterfeit methods for a new company, it is still desired to deliver working products without malfunctioning or counterfeit components. Minut is one of those hardware start-ups making a connected home monitoring product called Point. They want to ensure that every shipped unit works as supposed and contains no counterfeit components. How to handle the problem Simply, by testing. Point uses a variety of sensors to sense the ambient environment. By developing a custom test system that validates the performance and quality of all sensors on every produced Point, it is possible to tell if the unit works and is ready to be shipped to customer. All tests will be designed to validate that the output of the sensors conforms to their specifications. If a sensor performs within specified accuracy, it is assumed to be working and not to be counterfeit. Also the power consumption of every Point is measured to assure that none of the components consumes more current than expected. The combination of all these tests ensures the functionality of every unit. Result The test system makes it possible to validate the performance of all the critical components on Point. Test results from the system shows that malfunctioning components can be distinguished during production. This assures that no defect units leaves the factory and hence fulfills one purpose of the test system. The other purpose is to find counterfeit components. This is a more complex task. The work points out that it is hard to binary determine if a component is counterfeit or not. However, by the use of data logging and statistics, the solution is one step closer. By storing the results from all the tested units, Minut can gather statistics over the quality of every single component. If the statistics shows high failure rate or poor performance within specific component batches, it could be counterfeit components. with these statistics it is possible for a company to put pressure on the supply chain and component manufacturer. The work shows that is it possible for small hardware companies to test and quality validate their products. The test system built also introduces simple ways to keep statistics of the testing and production. With every produced unit tested, the risk of delivering a product containing a counterfeit or malfunctioning component is reduced. With more companies testing their products, it is more difficult for counterfeit components to reach consumers and the overall safety of delivered products is increased

Herd-level risk factors associated with cow mortality in Swedish dairy herds

An increase in on-farm mortality (euthanasia and death) in dairy herds has been reported in several countries in the last decade. This does not only imply possible problems with animal welfare, but it also causes economic losses to the farmer. The objective of this study was to evaluate time trends in on-farm dairy cow mortality in Sweden and identify potential herd-level risk factors. Data was retrieved on all Swedish dairy herds enrolled in the milk recording scheme between 2002 and 2010. Herds with a herd size of 40 dead or euthanized cows per 100 cow-years were excluded. Two different models were used: 1 multiple year analysis which included 6,898 herds during the period 2002 to 2010 and 1 single year analysis including 4,252 herds for the year 2010, where other variables that were not present during the entire multiple year study were analyzed. The outcome variable was the number of euthanized and dead cows per year and season. A negative binomial regression model, adjusted for clustering within herd, was applied to both models. Fixed effects in the multiple year analysis were breed, calving interval, herd size, milk yield, region, season, pasture period, and year. Fixed effects in the single year analysis were breed, calving interval, conventional vs. organic farming, herd size, housing system, milk yield, region, and season. The multiple year analysis demonstrated that MR gradually increased from 5.1 to 6.6 events per 100 cow-years during the study period. Swedish MR are consequently on par with, or even greater than, MR among dairy herds in other comparable countries. Higher mortality was associated with larger herd size, longer calving intervals, and herds that had Swedish Holstein as the predominant breed. Lower mortality was observed in herds with a higher herd average milk yield, during the fall and winter, and in organically managed herds. There were regional differences in mortality. An interaction between herd size and season was found in both models. Also, an interaction between housing system and milk yield was found in the single year analysis. This first assessment of on-farm mortality in Swedish dairy herds confirmed that the MR has increased over the last few years. The study also identified some herd-level risk factors

Detection of compound mode of action by computational integration of whole-genome measurements and genetic perturbations

BACKGROUND: A key problem of drug development is to decide which compounds to evaluate further in expensive clinical trials (Phase I- III). This decision is primarily based on the primary targets and mechanisms of action of the chemical compounds under consideration. Whole-genome expression measurements have shown to be useful for this process but current approaches suffer from requiring either a large number of mutant experiments or a detailed understanding of the regulatory networks. RESULTS: We have designed an algorithm, CutTree that when applied to whole-genome expression datasets identifies the primary affected genes (PAGs) of a chemical compound by separating them from downstream, indirectly affected genes. Unlike previous methods requiring whole-genome deletion libraries or a complete map of gene network architecture, CutTree identifies PAGs from a limited set of experimental perturbations without requiring any prior information about the underlying pathways. The principle for CutTree is to iteratively filter out PAGs from other recurrently active genes (RAGs) that are not PAGs. The in silico validation predicted that CutTree should be able to identify 3–4 out of 5 known PAGs (~70%). In accordance, when we applied CutTree to whole-genome expression profiles from 17 genetic perturbations in the presence of galactose in Yeast, CutTree identified four out of five known primary galactose targets (80%). Using an exhaustive search strategy to detect these PAGs would not have been feasible (>10(12 )combinations). CONCLUSION: In combination with genetic perturbation techniques like short interfering RNA (siRNA) followed by whole-genome expression measurements, CutTree sets the stage for compound target identification in less well-characterized but more disease-relevant mammalian cell systems