Lighting Recommendations in Operating Theatres

“The eyes lead the body.” A good visual environment is important for performance and wellbeing. Unsatisfactory visual conditions often induce a strained posture, more or less unconsciously, in an effort to improve vision. The requirements for the visual environment in an operating theatre are high. Surgeons or assistants who are having visual problems can induce treatment hazards. The purpose of this study was to evaluate the visual environment in operating theatres, and also examine if the surgeon’s visual acuity at near work can be improved with better glasses. Thirty percent of the surgeons had eyestrain, and those with eyestrain had three times as much musculoskeletal strain. The measurements of the illuminance and luminance show a low uniformity level on the operating table; the operating lamps give an average of 100.000 lux, while the surrounding area values are much lower. The most important recommendation for lighting intervention in the operating theatre is a more uniform illuminance on the operating table

Urgent lung allocation system in the Scandiatransplant countries

BACKGROUND: Throughout the world, the scarcity of donor organs makes optimal allocation systems necessary. In the Scandiatransplant countries, organs for lung transplantation are allocated nationally. To ensure shorter wait time for critically ill patients, the Scandiatransplant urgent lung allocation system (ScULAS) was introduced in 2009, giving supranational priority to patients considered urgent. There were no pre-defined criteria for listing a patient as urgent, but each center was granted only 3 urgent calls per year. This study aims to explore the characteristics and outcome of patients listed as urgent, assess changes associated with the implementation of ScULAS, and describe how the system was utilized by the member centers. METHODS: All patients listed for lung transplantation at the 5 Scandiatransplant centers 5 years before and after implementation of ScULAS were included. RESULTS: After implementation, 8.3% of all listed patients received urgent status, of whom 81% were transplanted within 4 weeks. Patients listed as urgent were younger, more commonly had suppurative lung disease, and were more often on life support compared with patients without urgent status. For patients listed as urgent, post-transplant graft survival was inferior at 30 and 90 days. Although there were no pre-defined criteria for urgent listing, the system was not utilized at its maximum. CONCLUSIONS: ScULAS rapidly allocated organs to patients considered urgent. These patients were younger and more often had suppurative lung disease. Patients with urgent status had inferior short-term outcome, plausibly due to the higher proportion on life support before transplantation. (C) 2018 International Society for Heart and Lung Transplantation. All rights reserved.Peer reviewe

Proteomics identifies neddylation as a potential therapy target in small intestinal neuroendocrine tumors.

Patients with small intestinal neuroendocrine tumors (SI-NETs) frequently develop spread disease; however, the underlying molecular mechanisms of disease progression are not known and effective preventive treatment strategies are lacking. Here, protein expression profiling was performed by HiRIEF-LC-MS in 14 primary SI-NETs from patients with and without liver metastases detected at the time of surgery and initial treatment. Among differentially expressed proteins, overexpression of the ubiquitin-like protein NEDD8 was identified in samples from patients with liver metastasis. Further, NEDD8 correlation analysis indicated co-expression with RBX1, a key component in cullin-RING ubiquitin ligases (CRLs). In vitro inhibition of neddylation with the therapeutic agent pevonedistat (MLN4924) resulted in a dramatic decrease of proliferation in SI-NET cell lines. Subsequent mass spectrometry-based proteomics analysis of pevonedistat effects and effects of the proteasome inhibitor bortezomib revealed stabilization of multiple targets of CRLs including p27, an established tumor suppressor in SI-NET. Silencing of NEDD8 and RBX1 using siRNA resulted in a stabilization of p27, suggesting that the cellular levels of NEDD8 and RBX1 affect CRL activity. Inhibition of CRL activity, by either NEDD8/RBX1 silencing or pevonedistat treatment of cells resulted in induction of apoptosis that could be partially rescued by siRNA-based silencing of p27. Differential expression of both p27 and NEDD8 was confirmed in a second cohort of SI-NET using immunohistochemistry. Collectively, these findings suggest a role for CRLs and the ubiquitin proteasome system in suppression of p27 in SI-NET, and inhibition of neddylation as a putative therapeutic strategy in SI-NET

Characterization of Impaired Glucose Tolerance - Insulin Sensitivity, Islet Function and Metabolic Risk Factors

This thesis presents a three-year prospective study on metabolic characteristics of impaired glucose tolerance (IGT) and the regulation of insulin sensitivity versus islet function in relation to changes in glucose tolerance. 108 non-diabetic women aged 57-58 years were randomly selected from a population of women born in 1935 with a high prevalence of IGT. At baseline and follow-up, glucose tolerance was determined with an oral glucose tolerance test, insulin sensitivity was measured using a euglycemic, hyperinsulinemic clamp, and islet function was measured after arginine injection at fasting, 14 and >25 mmol/L glucose levels. Androgen activity was measured as the ratio of testosterone to sex hormone-binding globulin, and muscle fiber size and distribution as well as capillary density were determined from a muscle biopsy. At the baseline examination in 1993-94, 71 women had normal glucose tolerance (NGT) and 37 had IGT. The women with IGT were characterized by hyperinsulinemia, insulin resistance, hypertension and dyslipidemia. Androgen activity was increased in IGT compared to NGT. The percentage of type I, IIa and IIx muscle fibers was not altered, while the size of the type IIa and IIx muscle fibers was increased in IGT. In women with NGT, insulin sensitivity and insulin secretion were inversely related in a hyperbolic manner, indicating that insulin secretion is upregulated to match the degree of insulin resistance in order to maintain normal glucose tolerance. The islet compensation index (CI) was calculated as the insulin sensitivity times insulin secretion to enable quantification of the relation between these parameters. In IGT the CI was reduced compared to NGT. Thus, in the IGT group the insulin secretion was decreased in relation to insulin sensitivity, suggesting deficient adaptation of islet function to insulin resistance. A multifaceted islet dysfunction was evident in women with IGT, who manifested a reduced glucose potentiation of insulin secretion and a decreased glucose inhibition of glucagon secretion. Furthermore, the relative proinsulin secretion was increased in the IGT compared to the NGT group. 86 women participated in the three-year follow-up study in 1996-97. We found that the yearly progression from IGT to diabetes was 1.1%, from NGT to diabetes 0.6% and from NGT to IGT 7%. Subjects who developed IGT (n=13) or diabetes (n=2) during the study had increased baseline levels of 2h glucose and triglycerides. Moreover, changes in insulin sensitivity during the study were inversely related to alterations in insulin secretion in the individual subjects. The follow-up glucose tolerance was independently predicted by a low islet compensation index, increased glucagon secretion and a high 2h glucose at baseline. We conclude that islet adaptation to the individual degree of insulin sensitivity is of paramount importance for glucose tolerance, and that increased glucagon secretion is a novel risk factor for developing glucose intolerance

Rektorers uppfattningar av vad en skola på vetenskaplig grund och beprövad erfarenhet innebär

Den här studien utforskar genom fenomenografins arbetssätt, vad det innebär för rektorer att undervisningen vilar på vetenskaplig grund och beprövad erfarenhet samt hur rektorerna arbetar för detta på sin skola. Skollagen från 2010 har i första paragrafen inskrivet att utbildningen ska vila på vetenskaplig grund och beprövad erfarenhet.  Genom intervjuer har rektorer i gymnasieskolan svarat på vad skollagens nya skrivning innebär för dem. Rektorerna har svarat på vad det innebär för dem att undervisningen på deras skola ska vila på vetenskaplig grund och beprövad erfarenhet och hur de arbetar för att detta ska komma till stånd. En differentierad bild ges av gymnasieskolornas olika förutsättningar att anta denna utmaning. Rektorerna visar på svårigheter med att ge alla elever samma förutsättningar, då bland annat ämne och programtillhörighet ger olika möjligheter. Rektorerna ger också en bild av att förlita sig på lärarnas utbildning och kompetensutveckling.This study explores by the phenomenographic way of working, what it means for principals´ that education is scientific ground and evidence based and how the principals´ work to achieve this at their schools. The school law from 2010 has in its first paragraph inscribed that education should be scientific ground and evidence based. Principals´ at upper secondary schools have through interviews answered questions on what the new school law writing means to them. The principals´ have given replies on what it means for them that education at their schools is scientific ground and evidence based and how they work for this to become a standard.  A differentiated picture is given by the upper secondary schools different conditions to accept this challenge. The principals´ point out difficulties in giving all the students the same possibilities, when subject and belonging to a certain program give students different possibilities. The principals´ rely on the teachers´ education and skills development

Quantification of insulin secretion in relation to insulin sensitivity in nondiabetic postmenopausal women.

To evaluate mechanisms underlying the close association between insulin secretion and insulin sensitivity, insulin sensitivity was evaluated by the euglycemic-hyperinsulinemic clamp technique (M/I(clamp)) and insulin secretion was determined from the 75-g oral glucose tolerance test (OGTT) and from the glucose-dependent arginine-stimulation test in 81 nondiabetic postmenopausal women, all aged 61 years. M/I(clamp) was normally distributed with mean plus minus SD of 69.9 plus minus 30.5 nmol glucose center dot kg(-1) center dot min(-1)/pmol insulin center dot l(-1). It was found that the several different measures of insulin secretion from the OGTT and the glucose-dependent arginine-stimulation test were all inversely related to M/I(clamp). However, measures determining the direct insulin responses were more markedly potentiated by low M/I(clamp) than were measures determining glucose potentiation of insulin secretion. Moreover, the product of M/I(clamp) times measures of insulin secretion (disposition index [DI]) was inversely related to the 2-h glucose value. Finally, surrogate insulin sensitivity measures quantified from OGTT and the glucose-dependent arginine-stimulation test only weakly correlated to M/I(clamp) (R(2) approximate 0.25). Thus, 1) insulin secretion is adaptively increased when insulin sensitivity is low in nondiabetic postmenopausal women; 2) beta-cell exocytotic ability shows more efficient adaptation than beta-cell glucose recognition to low insulin sensitivity; 3) impaired beta-cell adaptation (i.e., low DI) is associated with higher 2-h glucose values during OGTT, although other regulatory mechanisms also exist; and 4) indirect surrogate measures of insulin sensitivity only weakly correlate to insulin sensitivity as determined by the euglycemic-hyperinsulinemic clamp