Aetiology in community-acquired pneumonia

Background: Although community-acquired pneumonia (CAP) is a common and well-known disease, its microbial aetiology is still not well characterized. During the past few years nucleic acid detection using real-time polymerase chain reaction (PCR) has been developed for detection of many bacterial and viral pathogens causing respiratory tract infections. Objectives: 1) to estimate the accuracy of the quantitative real-time PCR (RQ-PCR) method for identifying pneumococci in sputum; 2) to determine the aetiology of CAP by implementing new diagnostic PCR techniques combined with conventional methods; 3) to compare CAP patients with a pure bacterial aetiology with those with both bacterial and viral findings regarding severity of illness and length of hospital stay; 4) to study the inflammatory response, especially procalcitonin (PCT) levels, in patients with CAP and the correlation to different respiratory pathogens. Material and methods: Adults admitted to Karolinska University Hospital were studied during a 12-month period. All patients were tested with an extensive panel of conventional methods and in addition sputum samples were analysed with RQ-PCR for Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis; and nasopharyngeal specimens were analysed with real-time PCR for viruses common in the airways. Serum samples were collected within 24 hours of admission for subsequent measurement of PCT, C-reactive protein, transthyretin and interleukin-6. The pneumonia severity index (PSI) was used to assess the severity of illness. Results: In sputum samples, culture was significantly positive in 19/128 (15%), whereas a significant concentration of DNA was found with RQ-PCR in 34/127 (27%) cases (p < 0.001). Seventeen of the 34 RQ-PCR–positive sputum samples were negative by sputum culture, of which 14 were from patients treated with antibiotics prior to sampling. A microbial aetiology was found in 67% of all patients (n=124). The most frequently detected pathogens were S. pneumoniae (70 patients [38%]) and respiratory virus (53 patients [29%]). Multiple pathogens were present in 43 (35%) of those with a determined aetiology. The likelihood of getting a score corresponding to PSI classes IV or V was higher in patients with combined bacterial-viral findings than in those with a bacterial pathogen alone (odds ratio 4.98, 95% confidence interval 2.09 – 11.89; p < 0.001). The median length of hospital stay was seven days among patients with mixed infections and four days among those with a bacterial aetiology alone (p=0.018). Median serum concentrations of PCT were higher in patients with bacteraemia than in those without bacteraemia (6.11 μg/L vs. 0.34 μg/L, P=0.0002), in those with non-bacteraemic pneumococcal aetiology than in those infected with other classical bacteria (1.18 vs. 0.18, P=0.038), in patients with pneumococcal as compared to viral aetiology (2.43 vs. 0.24, P=0.017), and in patients with PSI classes 4-5 (2.07) than in those with PSI classes 1-3 (0.52, P=0.03). Conclusions: The sensitivity of sputum RQ-PCR was higher than that of sputum culture, especially after antibiotic therapy had been initiated. By supplementing traditional diagnostic methods with new PCR-based methods, a high microbial yield was achieved. Mixed bacterial-viral infections were frequent and these patients developed severe CAP more often and stayed longer in hospital than those with a bacterial aetiology alone. High PCT seems to be a good marker of invasive as well as severe disease and of pneumococcal aetiology, but for localised bacterial infections caused by other pathogens the test is less sensitive

The influence of tree age and microhabitat quality on the occurrence of crustose lichens associated with old oaks

Questions: How do tree age, microhabitat characteristics and epiphytic competitors affect the occurrence of crustose lichens associated with old oaks? How do microhabitat characteristics and microclimate affect the cover of competitors (bryophytes and macrolichens)? How do microhabitat characteristics cor¬relate with microclimatic variables? Location: Southeast Sweden. Methods: Eight crustose lichen species were surveyed on 165 Quercus robur trees, 17-478 years old, at three study sites. The occurrence patterns of these species were examined at two spatial scales: among trees and within trees. Occurrence patterns within trees were examined in 10 cm × 10 cm plots at all four cardinal aspects at different heights from 0.5 to 4.5 m above the ground. Results: At the tree level, age-related factors were the most important predictors of species occurrence. All species were more frequent on trees > 100 years than on younger trees. At the plot level, the frequency of occurrence increased with increasing bark crevice depth. The frequencies of all study species de¬creased with increasing cover of bryophytes. Bryophytes were in turn more frequent in plots that were exposed to rainwater and showed a low evaporation rate. Patches most exposed to rainwater were directed upwards, and the lowest evaporation rates occurred on the northern side of the trunks. Conclusions: For many crustose lichens the association with old oak trees seems at least partly to depend on their preference for the deep bark crevices that only occur on old trees. Trees represent epiphyte habitat patches that differ in size due to within-tree variability in habitat quality, such as bark crevice depth and microclimate. This study shows that variability at a finer scale, within habitat patches, contribute to explain species occurrence patterns at habitat patch level

Panopticon: Inspärrandets utopi

Fängelset har sedan länge varit ett mycket aktuellt ämne och är för många en symbol för brott och straff tack vare flera skildringar i litteraturens, filmens och musikens värld. Dess organisation och administration har aldrig varit självklar och fängelset har flera gånger reformerats. Ett fascinerande fängelsesystem hette Panopticon och utvecklades i slutet av 1700-talet av den brittiske filosofen Jeremy Bentham. Denna uppsats syftar till att i ett rättsutvecklingsperspektiv ta reda på vad Panopticon var och hur det såg ut i teorin och praktiken, och vad som påverkat denna utveckling. Vidare har den franske filosofen Michel Foucault med utgångspunkt i Panopticon vidareutvecklat denna idé som att den bör genomsyra hela samhällskroppen. Därför kommer jag även utröna hur denna vidareutveckling ser ut, vad som påverkat denna utveckling och sedan jämföra dessa två filosofers tankar. Panopticon kom till under en förnuftsdriven tid då man letade efter alternativa straff till dödsstraffet och deporteringen. Panopticon är ett arkitektoniskt verk som möjliggör en konstant disciplinerande övervakning som innebar att den intagne skulle förändra sitt beteende då han visste att han var övervakad. Bentham såg även sitt Panopticon kunna användas för bl.a. skolor och verkstäder. För Foucault står makt- och disciplinanalyser i centrum; han menar att Panopticon besitter en sinneskontrollerande kraft som får själen till att bli kroppens fängelse. En jämförelse mellan dessa två filosofers tankar kan sammanfattas som att Benthams Panopticon endast gör anspråk på en del av samhället, medan Foucaults vidareutveckling gör anspråk på samhället i sin helhet. Panopticon förverkligades aldrig riktigt som det ursprungligen var tänkt. Ett flertal fängelser visar dock upp både mindre och större likheter med Panopticon varav vissa är ytterst långsökta medan andra är slående lika. En cirkulär utformning av fängelset räcker dock inte; Panopticon är en förbättringsanstalt uppbyggd på övervakning och disciplin.The history of prisons is ancient and the prison is still a current topic. Its up-to-date popularity is most likely a product of the many tales in literature, film, and music reflecting the prison and life behind bars. The organization and administration of prisons have never been set in stone, and have lived through a number of various reforms. One fascinating prison system is the one named Panopticon developed in the late 18th century by British philosopher Jeremy Bentham. The aim of this essay is to, in a perspective of legislative development, ascertain the thoughts and ideas which has influenced Panopticon. Additionally, the French philosopher Michel Foucault has further advanced the idea of Panopticon in the way that its principles should pervade and extend to the most outer shell of society. Therefore I also intend to ascertain his thoughts and influences, and then finally compare the works of these two minds. Panopticon arouse in the dawn of reason when alternative ways of punishment was sought after, especially alternatives to capital punishment and deportation. Panopticon works by a sophisticated architectural design enabling a constant disciplinary surveillance. As the inmate would be aware of the constant surveillance he would correct his behaviour. Panopticon was additionally intended by Bentham to be used as schools and workshops. In Foucault's view, analysis of power and discipline are valued high. Foucault stresses that the mind controlling powers of Panopticon makes the soul the prison of the body. A comparison of the two may be summarized as Bentham's Panopticon only claims part of society, whereas Foucault's extensive interpretation claims society in its entirety. Panopticon never saw the light of day as it was originally intended, although several prisons have claimed to be of a panoptic design. Some of these claims are a bit far-fetched, others come rather close to the original design. A circular design of a prison is however not enough; Panopticon is a sophisticated facility composed of surveillance and discipline

Whistleblowing - En komparation av gällande rätt och SOU 2014:31. Innebär lagförslaget ett tillräckligt stärkt skydd?

In the age of information people want to get hold of as much information as possible, which is probably why whistleblowing has become such a hot topic. Whistleblowers constitute an important body of control in society which historically has revealed information and scandals of great public interest. The aim of this essay is two-folded. First off the aim is to in a perspective of legislative development examine the rights and obligations of employees who use their freedom of expression and blow the whistle. Secondly, in regards of a recent legislative proposal, I will examine and critically analyze the legislative proposal of government white paper SOU 2014:31. This essay will then compare the rights and obligations of whistleblowers to the legislative proposal in order to determine whether the legislative proposal actually means an improved protection of whistleblowers, and if so, whether the protection is sufficient. The study shows that employees hold relatively far-stretched rights to use their freedom of expression and to blow the whistle. These rights are however more extensive for employees working in the public sector as such employees are able to claim the freedom of expression in the relationship of employment. The legislative proposal of SOU 2014:31 holds a prohibition of victimization targeted against the employer sanctioned with compensation for damages. The proposal have been criticized for ambiguity, for not including workers supplied by employment agencies or other workforce and for suggesting that total deviations may be approved through collective agreements. By comparison of the current rights and obligations and the legislative proposal the study shows that the proposal actually means an improved protection of whistleblowers, though not sufficient. In a concluding analysis codification combined with legislation of revised improved protection of whistleblowers incorporating all personnel is discussed as a possible solution. In such an improved protection deviations in disadvantage for the employee should not be possible and must offer sufficient protection to jeopardize the reputation, employment and career of the whistleblower.I dagens informationssamhälle vill medborgarna kunna ta del av så mycket information som möjligt, varför visselblåsning har blivit ett mycket uppmärksammat ämne. Visselblåsare utgör ett viktigt kontrollmoment i samhället som historiskt sett avslöjat uppgifter och skandaler av stort allmänintresse. Denna framställning syftar i en första del till att i ett rättsutvecklingsperspektiv redogöra för de rättigheter och skyldigheter arbetstagare som vill utnyttja sin yttrandefrihet samt slå larm om missförhållanden har att iaktta. Med anledning av ett nytt lagförslag syftar framställningen i en andra del till att redogöra för och kritiskt analysera lagförslaget i SOU 2014:31. Framställningen kommer sedan i ett komparativt perspektiv jämföra gällande rätt för visselblåsare med lagförslaget i SOU 2014:31 för att ta reda på huruvida lagförslaget innebär ett stärkt skydd, och isåfall, om det innebär ett tillräckligt stärkt skydd. Utredningen ger för handen att arbetstagare har relativt långtgående rättigheter att utnyttja sin yttrandefrihet och slå larm om missförhållanden. Dessa rättigheter är emellertid mer långtgående för arbetstagare inom den offentliga sektorn då denna personkategori kan åberopa den grundlagsstadgade yttrandefriheten i anställningsförhållandet. Lagförslaget i SOU 2014:31 innebär ett skadeståndssanktionerat repressalieförbud riktat mot arbetsgivaren. Lagförslaget har kritiserats bl.a. p.g.a. otydlighet, att inte inhyrd arbetskraft och uppdragstagare omfattas samt p.g.a. att avvikelser från lagen helt föreslås få göras genom kollektivavtal. Vid en komparation av gällande rätt och lagförslaget ger utredningen för handen att lagförslaget innebär ett stärkt skydd, dock inte ett tillräckligt stärkt skydd. I en avslutande analys diskuteras huruvida en lösning skulle kunna vara en kodifiering av gällande rätt i kombination med lagstiftning om ett reviderat stärkt skydd som innefattar samtliga personkategorier vid en arbetsplats. Ett sådant stärkt skydd bör vidare vara tvingande till arbetstagarens förmån och innebära tillräckligt starkt skydd för att visselblåsaren ska riskera sitt anseende, sin anställning och sin karriär

Meeting global temperature targets-the role of bioenergy with carbon capture and storage

In order to meet stringent temperature targets, active removal of CO2 from the atmosphere may be required in the long run. Such negative emissions can be materialized when well-performing bioenergy systems are combined with carbon capture and storage (BECCS). Here, we develop an integrated global energy system and climate model to evaluate the role of BECCS in reaching ambitious temperature targets. We present emission, concentration and temperature pathways towards 1.5 and 2 degrees C targets. Our model results demonstrate that BECCS makes it feasible to reach temperature targets that are otherwise out of reach, provided that a temporary overshoot of the target is accepted. Additionally, stringent temperature targets can be met at considerably lower cost if BECCS is available. However, the economic benefit of BECCS nearly vanishes if an overshoot of the temperature target is not allowed. Finally, the least-cost emission pathway over the next 50 years towards a 1.5 degrees C overshoot target with BECCS is almost identical to a pathway leading to a 2 degrees C ceiling target

Evaluation of fire resistant glass in facade

The objective of this report was to investigate different types of glass when exposed to heat radiation from a typical fire in a dangerous goods carrier. The purpose was to evaluate if tempered glass could be used in facades instead of the more expensive fire resistant glass. Experiments were made in a cone calorimeter where different thicknesses of laminated, tempered and fire resistant glass were exposed to four different levels of radiation, 15 kW/m2, 25 kW/m2, 30 kW/m2 and 50 kW/m2. Transmitted radiation through the glass was recorded during the experiments to be able to analyze the different levels of blockage of radiation. Tempered glass with thicknesses between 4 and 12 mm could stand high levels of radiation without breaking and reduced the radiation with 33-46 % depending on which level it was exposed to. Fire glass reduced the radiation with 87-96 %. The conclusion of the work was that, according to small scale tests, tempered glass with a C-shaped edge could be an alternative when building close to roads where dangerous goods is to be transported. Recommendations for further research are to evaluate if the results are applicable on glass of large scale type

Transnationell kooperation

Farmers Cooperative has in recent years developed from national markets to cross-border, international, collaborations. One example is the merger between the Swedish dairy company Arla and Danish MD Foods, where the companies collectively are sought to reduce transaction costs and thus improve efficiency. The Swedish market for commodities (fertilizers and pesticides) in agriculture has for many years been dominated by a few large players, with little opportunity for grain associations and local grain companies to offer their customers a varied range of commodities with a competitive pricing. To change this state, a majority of Swedish and Danish grain associations and local grain companies have established a trans-national cooperation. Through the establishment of the organization DLA Agro, they offer their customers a good variety of products with competitive prices. This study investigates thus according to the theory of cooperative models to what extent and how the DLA Agro helps to create benefits for the Swedish member companies. Crucial to this analysis is to DLA Agro's special organizational features can be expected to have significant bearing on the transaction and agency costs, which member companies are experiencing. Organizational features means that it is a federal organization and that it is trans-national cooperation, which has consequences for the financing, governance and operations. The method for conducting the survey consists of qualitative interview techniques with detailed interviews of every Swedish association and companies connected to the DLA Agro. The interviews indicate that members largely feel that the DLA Agro has a good relationship with the Swedish member group. The fact that the member group is relatively small in number and largely homogeneous with regard to the benefits members want out of it helps to contribute to the cooperation. Also that DLA Agro has a limited business portfolio with few products makes it easier for the cooperation to focus on reducing transaction costs. An important factor explaining the success of the cooperation is that it does not store any collective capital within the DLA Agro. This facilitates control of the DLA Agro, as potential conflict of interest on what the collective capital is to be invested in reduces. The fact that DLA Agro has inscribed in the statutes that members must sign a declaration of loyalty and the obligation to purchase ensures DLA Agro that the members will purchase every year. By doing so the risk of getting passive members with too divergent business interests reduces. The survey also shows that future conflicts may arise. This is because a number of respondents would like the opportunity to trade in seeds. This could cause problems because a number of the members in the Swedish member group are also grain producers

‘I miss the physical presence of the students’ : Swedish teachers’ experiences of online teaching and learning during the COVID-19 pandemic

Peer reviewedPublisher PD

Vented gas explosions

Explosion venting technology is widely accepted as the effective constructional protection measures against gas and dust explosions.The key problem in venting is the appropriate design of the vent area necessary for an effective release of the material i.e. the pressure developed during explosion did not cause any damage to the plant protected.Current gas explosion vent design standards in the USA (NFPA68, 2002) and European (2007) rely on the vent correlation first published by Bartknecht in 1993 (Siwek, 1996).N FPA 68 also recommends the correlation of Swift (Swift,1983)at low overpressures. For a vent to give no increase in overpressure other than that due to the pressure difference created by the mass flow of unburnt gases through the vent, the vent mass flow rate is assumed to be equal to the maximum mass burning rate of the flame and this consideration should be used as the design mass flow through the vent. Two different methods ( Method I and Method 2) have been proposed based on the Sμ and Sμ (E-1) to describe the maximum mass burning rate given as, mb = ASμpμ=CdeA(2pPμred)o.5 mb =ASgPm =AgSμ(E-I)P μ=Cde4,(2pu Pred)0,5 (2) The equation given in (2) is slightly different from (1) as is about 6.5 times the mass flow of the first method as it takes the effect of (E-1) where E is the expansion ratio. A critical review were carried out for the applicability, validity and limitation on the venting correlations adopted in NFPA 68 and European Standard with 470 literature experimental data, covering a wide range of values for vessel volume and geometries, bursting vent pressure, Pv L/D ratio, maximum reduced pressure, Pred and ignition location. The fuels involved are methane, propane, hydrogen, town gas, ethylene, acetone/air mixtures with the most hazardous near-stoichiornetric fuel-air concentration. Besides, Molkov's equation (Molkov, 2001) which is regarded as alternative venting design offered in NFPA 68 and Bradley and Mitcheson's equation for safe venting design were also analysed on the experimental data for their validity and limitation as well as the proposed methods. From the results, it is clear that Bartknecht's equation gave a satisfactory result with experimental data for K <-5 and Swift's equation (Swift, 1983) can be extended to wider range for Pred> 200 mbar, providing the parameter PV is added into the equation. Method 2 gave a good agreement to most of the experimental data as it followed assumptions applied for correlations given by Bradley and Mitcheson for safe venting design (Bradley and Mitcheson, 1978a,B radley and Mitcheson, 1978b). It is also proven that the vent coefficient, K is confident to be used in quantifying the vessel's geometry for cubic vessel and the use of As/Av term is more favourable for non-cubic vessels. To justify the validity and applicability of the proposed methods, series of simply vented experiments were carried out, involving two different cylindrical volumes i.e. 0.2 and 0.0065 M3. It is found that self acceleration plays important role in bigger vessel in determining the final Pmax inside the vessel. Method 2 gave closer prediction on Pmax in respect with other studied correlations. The investigation of vented gas explosion is explored further with the relief pipe been connected to the vessel at different fuel/air equivalence ratios, ignition position and Pv. The results demonstrate that the magnitude of Pmax was increased corresponding to the increase of Pv- From the experiments,it is found that peak pressure with strong acoustic behaviour is observed related to increase in Pv and in some cases,significant detonation spike was also observed particularly in high burning velocity mixtures. It is found that substantial amount of unburnt gases left inside the vessel after the vent burst is the leading factor in increase of Pmax for high burning velocity mixtures at centrally ignited. The associate gas velocities ahead of the flame create high unburnt gas flows conditions at entry to the vent and this give rise to high back pressures which lead to the severity in final Pmax inside the vessel. It was observed that end ignition leads to a higher explosion severity than central ignition in most cases, implying that central ignition is not a worst-case scenario in gas vented explosions as reported previously.EThOS - Electronic Theses Online ServiceGBUnited Kingdo