Policy integration for sustainable development: Agenda 2030 meets Region Skåne

In an effort to promote sustainable development work in Region Skåne, the regional government seeks to integrate Agenda 2030 into their Regional Development Strategy (RUS). This paper compares the two policies, using qualitative content analysis to problematize the prospects of policy integration. Applying theories from policy integration, policy transfer and policy diffusion, the analysis covers four dimensions of policy integration: the frame, the interactive, the substantive and the motivational dimension. Key insights from the study showcase that RUS’s international character opens it to integration: both policies share a humanistic worldview, emphasize liberal market dynamics, environmental improvement, increased sciences funding and expanded infrastructure. Simultaneously, they have differing understandings on matters of openness, governance and sustainable growth. There are also substantial challenges: Agenda 2030’s qualitative indicators for sustainable development need to be concretized into the local context of Skåne. Pressing deadlines regarding Agenda 2030’s environmental ambitions must be assessed according to Skåne’s ability to match them. Lastly, the highly competitive character of RUS should be weighed according to what is best for sustainable development on a global level. The thesis concludes that policy integration would not resolve the imbalance between the economic, social and environmental pillars of sustainable development in Region Skåne

Effects of environment factors on health and welfare in organic pig farms

Ett ekologiskt lantbruk syftar till att skapa ett uthålligt system som drivs i symbios med omgivande natur. För djuren på ett sådant lantbruk har man ambitionen att hålla hög nivå av hälsa och välfärd. Ett av de främsta målen är ökad frihet och möjlighet till naturligt beteende. Det fria levernet har både positiva och negativa konsekvenser för djurens välmående. Syftet med det här arbetet är att redovisa och diskutera hälsa och välfärd i ekologisk grishållning med ambitionen att reda ut rådande situation och utsikter för framtiden. I dagens läge verkar ekologiskt hållna grisar få sina beteendemässiga behov tillfredställda i högre grad jämfört konventionellt hållna. Bland annat ses stabilare temperament och färre problembeteenden. Parasitläget är dock sämre liksom smågrisdödligheten som ligger på en högre nivå. När det gäller skador och sjukdomar finns det aspekter som är både sämre och bättre inom ekologisk hållning jämfört konventionell. Den fria hållningen dämpar antalet beteendeberoende skador medan ledskador till följd av ökad rörelsefrihet är högre. Sjukdomar kopplade till det trängre och intensivare uppfödningssystem som konventionellt lantbruk innebär, ses det mindre av, medan sjukdomar som uppkommer till följd av ökad exponering för naturens element ökar. Min slutsats är att det ekologiska hållningssystemet är att föredra framför det konventionella, då det verkar ge djuren en högre nivå av psykiskt välbefinnande och även om risken för en del skador och sjukdomar ökar ter det sig ändå vara det system som ger högst nivå av hälsa och välfärd. Ekologiskt lantbruk är dessutom ett system under utveckling och den ytterligare välfärdspotential som finns häri för djuren verkar lovande inför framtiden.Organic farming emphasizes a sustainable system in symbiosis with surrounding nature. In such a system the ambition is to provide a high level of animal health and welfare. One of the major goals is an extended freedom to express natural behavior. This type of free housing brings positive as well as negative consequences for the animals. The aim of this report is to review health and welfare in organic pig farming to clarify the current situation and prospects for the future. Today, pigs in organic systems seem to get their natural behavior needs fulfilled to a greater extent than pigs in conventional systems. For example, they express a more stable temperament and show less behavior disturbances. However, in organic farming parasites is a bigger problem and so is piglet mortality. Concerning injuries and illness, organic housing is better in some areas and worse in others. The extended freedom provided reduces the amount of injuries due to behavior disturbances but causes more joint injuries. Illness caused by dense animal keeping and intense production as in conventional systems are less often seen, while disease due to exposure to the elements of nature increases. My conclusion is that organic housing of pigs is preferable since it seems to provide the animals with a higher level of psychological well-being. Even though the risk for some injuries and diseases are greater in such a system, it still seems to give the highest level of health and welfare. Furthermore, organic farming is under development and the potential for future animal welfare seems even more promising

Runtime and aPTT predict venous thrombosis and thromboembolism in patients on extracorporeal membrane oxygenation: a retrospective analysis

BACKGROUND: Even though bleeding and thromboembolic events are major complications of extracorporeal membrane oxygenation (ECMO), data on the incidence of venous thrombosis (VT) and thromboembolism (VTE) under ECMO are scarce. This study analyzes the incidence and predictors of VTE in patients treated with ECMO due to respiratory failure. METHODS: Retrospective analysis of patients treated on ECMO in our center from 04/2010 to 11/2015. Patients with thromboembolic events prior to admission were excluded. Diagnosis was made by imaging in survivors and postmortem examination in deceased patients. RESULTS: Out of 102 screened cases, 42 survivors and 21 autopsy cases [mean age 46.0 ± 14.4 years; 37 (58.7 %) males] fulfilling the above-mentioned criteria were included. Thirty-four patients (54.0 %) underwent ECMO therapy due to ARDS, and 29 patients (46.0 %) with chronic organ failure were bridged to lung transplantation. Despite systemic anticoagulation at a mean PTT of 50.6 ± 12.8 s, [VT/VTE 47.0 ± 12.3 s and no VT/VTE 53.63 ± 12.51 s (p = 0.037)], VT and/or VTE was observed in 29 cases (46.1 %). The rate of V. cava thrombosis was 15/29 (51.7 %). Diagnosis of pulmonary embolism prevailed in deceased patients [5/21 (23.8 %) vs. 2/42 (4.8 %) (p = 0.036)]. In a multivariable analysis, only aPTT and time on ECMO predicted VT/VTE. There was no difference in the incidence of clinically diagnosed VT in ECMO survivors and autopsy findings. CONCLUSIONS: Venous thrombosis and thromboembolism following ECMO therapy are frequent. Quality of anticoagulation and ECMO runtime predicted thromboembolic events

Lärplattform i skolan - Införandet av den virtuella lärplattformen Fronter i en svensk kommun

Avsikten med denna uppsats har varit att undersöka om det går att urskilja några särskilda mönster i hur införandet av lärplattformen Fronter fungerar i olika undersökta skolor i en svensk kommun. Fokus lades på skolledarnas eget användande av lärplattformen som ett dagligt verktyg i sin verksamhet samt om det fanns några andra möjliga samband mellan grad av användande på skolorna och datortätheten eller elevernas ålder. För att ta reda på detta behövde jag få veta hur skolledarna använde sig av systemet samt hur väl systemet användes på olika undersökta skolor i kommunen. Undersökningsgruppen har varit några utvalda skolledare i den undersökta kommunen. Jag har bedrivit en tredelad undersökning. En strukturerad och standardiserad intervju med utvalda skolledare som berörde skolledarnas eget användande av systemet, skolans datortäthet med mera. Statistik över de olika skolornas användande av systemet är den andra metoden. Statistiken hjälpte mig att se om det fanns några kopplingar mellan skolans användandegrad och skolledarens användandegrad. Den tredje metoden var halvstrukturerad intervju med två utvalda skolledare. En skolledare på en skola där införandet av Fronter har gått sämre och en skolledare på en skola där införandet har gått bättre. Sammantaget gav dessa tre metoder större reliabilitet och tyngd åt mitt svar på frågeställningarna. Arbetets slutsats är att, på de undersökta skolorna, spelar skolledarnas eget användande i kombination med deras engagemang och tydliga ledning, säkerligen tillsammans med många andra faktorer, större roll för ett lyckat införande än vad exempelvis datortätheten gör. Allt handlar inte om skolledaren. Men initialt sett kan hon eller han vara den som bildar en samarbetsgrupp, påbörjar framtagandet av handlingsplan, utser administratörer eller bara nämner möjligheten på en skolkonferens och att användandegraden på skolan sedan ökar som ringar på vattnet. En tid efter införandet kommer enligt min uppfattning det stora eldprovet – om lärare och elever ser en verklig nytta med att använda systemet.The purpose of this extended essay has been to examine if any patterns are identified when it comes to how successfull the introduction of the VLE Fronter is in different schools in a Swedish municipality. Focus is on the principals’ own activity and usage of Fronter. I have come to the conclusion that the most successful schools are the schools where the principals themselves use the system and the way they lead and encourage their teachers

Advanced radiological imaging in patients treated with Extracorporeal Memebrane Oxygenation

Extracorporeal membrane oxygenation (ECMO) is the use of a modified heart-lung machine to support life during severe acute cardiac and/or respiratory failure. Patients on ECMO are at high risk for complications due to the severe underlying disease and to the ECMO procedure itself. The clinical evaluation of patients on ECMO may be unreliable and the diagnostic value of portable bedside imaging is limited. Advanced radiographic methods like CT are rarely used during ongoing ECMO and MRI has previously never been tested. There is also lack of knowledge of the long term respiratory function in survivors of severe acute respiratory distress syndrome (ARDS) and ECMO. The frequency, indications, findings and effect on treatment of CT performed in patients during ECMO therapy, at the ECMO department Karolinska University Hospital, were retrospectively reviewed. Paper I: It was found that CT had been performed in nearly half of the treated patients, most often due to suspected complications. In 57% of 104 CT occasions clinically significant findings were revealed. There were no complications to the CT examinations. Paper II: In 25% of 118 performed thoraco-abdominal CT scans clinically important complications, dominated by hemothorax, massive pleural fluid, pericardial tamponade and abdominal hemorrhages, were revealed. The majority resulted in surgery or percutaneous drainage during ECMO, with high survival rates. Accordingly, the role of chest and abdominal CT during ECMO is to identify patients with complications where urgent invasive therapy is essential, when bedside imaging has been inconclusive. Paper III: In 37% of 123 pediatric and adult patients on ECMO, intracranial hemorrhage or infarction was revealed with CT during the treatment. Large hemorrhages or pronounced general edema were reasons to discontinue the ECMO treatment, neurosurgical intervention was motivated in a few patients and in patients with lesions with expected fair prognosis, ECMO was continued with high survival. Thus, the main value of cranial CT is in differentiating patients who have no CNS complications or complications with good prognosis from those with poor prognosis where the treatment should be withdrawn. Paper IV: Twenty-one adult long term survivors of severe ARDS and ECMO were studied in a follow-up program including CT of the lungs, pulmonary function tests and a dedicated questionnaire for evaluation of respiratory problems. It was found that lung parenchymal changes suggestive of fibrosis, pulmonary function abnormalities and subjective respiratory symptoms can be found more then one year after ECMO-treated severe ARDS. However, the impairments are most often mild and the majority has good physical and social functioning. Paper V: In an experimental study, the ECMO system was tested for magnetic resonance imaging (MRI) compatibility, using a pig model. The study showed that MRI can safely be performed in living subjects. on ECMO with high quality images. In the future this may have an impact, especially on early diagnosis and treatment of cerebral complications in patients on ECMO