Ashcroft v. Iqbal: The Question of a Heightened Standard of Pleading in Qualified Immunity Cases

Background We have previously shown that Lactobacillus reuteri supplementation from pregnancy week 36 and to the infant through the first year of life decreased the prevalence of IgE-associated eczema at 2 years. The underlying immunological mechanisms are unknown, however. Objective To investigate the immunomodulatory effect of probiotic supplementation on allergen- and mitogen-induced immune responses in children until 2 years of age. Methods Blood mononuclear cells were collected at birth, 6, 12 and 24 months from 61 children (29 probiotic and 32 placebo treated) and cultured with ovalbumin, birch and cat extract and Phytohaemagglutinin (PHA). Cytokine and chemokine secretion was determined using an in-house multiplexed Luminex assay and ELISA. Real-time PCR was performed to investigate the Ebi3, Foxp3, GATA-3 and T-bet mRNA expression. Results Probiotic treatment was associated with low cat-induced Th2-like responses at 6 months (IL-5, P = 0.01, and IL-13, P = 0.009), with a similar trend for IL-5 at 12 months (P = 0.09). Cat-induced IFN-γ responses were also lower after probiotic than after placebo treatment at 24 months (P = 0.007), with similar findings for the anti-inflammatory IL-10 at birth (P = 0.001) and at 12 months (P = 0.009). At 24 months, Th2-associated CCL22 levels were lower in the probiotic than in the placebo group after birch stimulation (P = 0.02), with a similar trend after ovalbumin stimulation (P = 0.07). Lower CCL22 levels were recorded at 12 and 24 months (P = 0.03 and P = 0.01) after PHA stimulation. Conclusion and Clinical Relevance Lactobacillus reuteri supplementation decreases allergen responsiveness and may enhance immunoregulatory capacity during infancy. L. reuteri supplementation from week 36 and during the first year of life significantly decreases IgE-associated eczema and lowers allergen and mitogen responsiveness.Funding Agencies|Swedish Research Council|K2011-56X-21854-01-06|Ekhaga Foundation||Olle Engkvist Foundation||Heart and Lung foundation||Research Council for the South-East Sweden|F2000-106|Swedish Asthma and Allergy Association||Cancer and Allergy Association||BioGaia AB, Stockholm, Sweden||University Hospital of Linkoping, Sweden||</p

Boreal och subalpin skog med höga naturvärden i Sverige

Fragmentering är en av de största anledningarna till den minskande biologiska mångfalden. Till största del är det markförändringar som avverkningar och omvandling från skogslandskap till odlingslandskap som bidragit till dessa fragmenterade landskap. Utöver avverkningar och omvandlingar från skogslandskap till odlingslandskap så har bebyggelse och tätare nätverk av transportleder i kombination med ett ökat trafikflöde även det lett till en ökad fragmentering. Välfungerande nätverk av naturliga livsmiljöer är en förutsättning för människor, djur och växters välbefinnande och överlevnad. Grön infrastruktur (GI) är ett relativt nytt begrepp för dessa nätverk som har sin grund i konventionen om biologisk mångfald, CBD, och är en del i EU:s biodiversitetsstrategi. För en förbättrad grön infrastruktur krävs planering på landskapsnivå. Länsstyrelserna har tillsammans med Skogsstyrelsen, kommuner och andra skogliga aktörer tagit fram regionala handlingsplaner för arbetet med landskapsplanering och grön infrastruktur. Länsstyrelserna ansvarar för genomförandet av handlingsplanerna och tillsammans med de andra skogliga aktörerna arbetar de utifrån ett landskapsperspektiv. För att underlätta, förbättra och effektivisera planeringsarbetet med grön infrastruktur krävs mer kunskap om var i landskapet skog med höga naturvärden finns. I denna studie analyseras utfallet i en nyligen publicerad modell baserad på artificiell intelligens, som visar relativ sannolikhet för förekomst av skog med höga naturvärden, i förhållande till Metrias kartering av sannolik och potentiell kontinuitetsskog, pCF. Genom olika analyser av utfallen, som areal och andel överlappande areal, syftade studien till att bidra med kunskap om grön infrastruktur för bevarandet av biologisk mångfald och ekosystemtjänster i boreala och subalpina skogsekosystem. Analyserna genomfördes som spatiala analyser i QGIS över ett område som innefattade Norrbotten, Västerbotten, Jämtland och Västernorrlands län. Resultatet av analyserna visade att utfallet stämde förhållandevis väl överens med pCF. Det visade också att KubAI-modellen i jämförelse med pCF, har en fördel i och med att den visar relativ sannolikhet för förekomst av skog med höga naturvärden med hjälp av kontinuerliga sannolikhetsvärden, vilket gör att den kan peka ut områden med störst behov av restaurering eller områdesskydd

Differences by occupation in perceived face validity and procedural justice of a common format application of hard biodata and a written job knowledge test

The concept of biodata is defined as an assessment and evaluation of demonstrated to be related to personality structure, personal adjustment, or success in social, educational, or occupational pursuits

Physiological effects of apnoeic oxygenation using high-flow nasal oxygen

In anaesthetic practice, the inability to oxygenate and ventilate patients is a much-feared complication with risk for severe hypoxia-induced adverse outcomes. By administrating oxygen in the absence of spontaneous ventilation, apnoeic oxygenation may overcome these challenges by a prolonged time with sufficient oxygenation. However, the concomitant and continuous increase in systemic carbon dioxide has limited its use. Recently, by using high-flow nasal oxygen (HFNO) during apnoea in anaesthetised patients, there seemed to be some carbon dioxide elimination, which has resulted in increased use of apnoeic oxygenation in clinical practice. From these early observations, this thesis has explored an array of aspects of apnoeic oxygenation with high-flow nasal oxygen by describing gaseous exchange, effects on lung volumes and alterations in biomarkers for organ function and oxidative stress in humans, and finally, by studying advanced haemodynamic parameters and the consequences of different oxygen flow rates in an animal model. The alterations of arterial oxygen, carbon dioxide and pH have been investigated by using apnoeic oxygenation with HFNO in subjects during general anaesthesia when laryngeal surgery of approximately 30 min duration was performed. Here, an extension of time with sufficient oxygenation was seen throughout the duration of surgery and a lower carbon dioxide rise compared to older studies of apnoeic oxygenation without high-flow oxygen. Also, an increase of arterial-end tidal carbon dioxide levels over time was noted. Thus, lung volume changes were characterised in subjects randomised to either apnoeic oxygenation with HFNO or mechanical ventilation in patients presenting for laryngeal surgery under general anaesthesia. As determined by electrical impedance tomography, no impedance differences over time or between the groups were seen perioperatively. In the same cohort, biomarkers for oxidative stress and vital organ function were explored to investigate the impact of hyperoxia and the continuously rising hypercapnia during apnoeic oxygenation with HFNO. For both groups, the oxidative stress biomarker MDA increased, and further, a discrete but non-clinically relevant increase in the CNS injury biomarker S100B was described. Finally, an experimental animal model of apnoeic oxygenation using 10 or 70 L/min of oxygen in a cross-over design with continuous central haemodynamic monitoring was used. Anaesthetised pigs were adequately oxygenated for up to 60 min of apnoea, with a carbon dioxide rise of approximately 0.5 kPa/min during both flow rates. Apnoea generated a continuously increasing, almost doubled mean pulmonary artery pressure. Also, cardiac index, heart rate, arterial blood pressure and cardiopulmonary ratio increased. Importantly, apnoea with no supplementary oxygen or flow resulted in a rapid desaturation to SpO2 < 85 % within 2.5 min. In summary, apnoeic oxygenation with HFNO enables oxygenation and partial carbon dioxide elimination, thereby extending safe apnoeic time. Perioperative lung volume changes and alterations in biomarkers for vital organ function do not differ from traditional mechanical ventilation. Experimentally, several central haemodynamic parameters were affected during extreme hypercapnia, primarily pulmonary artery pressure. Different oxygen flow rates generated an equal oxygenation and carbon dioxide rise. These findings add essential knowledge of the physiology and use of apnoeic oxygenation with HFNO

Contrast-enhanced ultrasound identifies early extrahepatic collateral contributing to residual hepatocellular tumor viability after transarterial chemoembolization.

The mainstay of treatment for unresectable hepatocellular carcinoma is locoregional therapy including percutaneous ablation and transarterial chemo- and radioembolization. While monitoring for tumor response after transarterial chemoembolization is crucial, current imaging strategies are suboptimal. The standard of care is contrast-enhanced magnetic resonance imaging or computed tomography imaging performed at least 4 to 6 weeks after therapy. We present a case in which contrast-enhanced ultrasound identified a specific extra-hepatic collateral from the gastroduodenal artery supplying residual viable tumor and assisting with directed transarterial management

Förändrad markanvändning vid biodrivmedelsproduktion

Increasing the use of biofuels is an important part of achieving the EU’s target of 10 percent renewable energy in the transport sector. However, the competition between biofuels and food production is an ongoing concern. Also, several studies have indicated a significantly higher climate impact than was earlier estimated, due to emissions from land use. In Sweden, both the use and production of biofuels from crops have increased substantially during the last decade. The purpose of this project is first to present an overview of the Swedish land use in all sectors. Secondly, the purpose is to analyse the influence of Swedish biofuels on land use changes, both inside and outside of Sweden. The study covers the period 2000 – 2012 and was performed through gathering, processing and analysing of statistical data. The arable land in Sweden has decreased by about 100 000 hectares during the studied period. In 2012, the domestic raw material needed about 50 000 hectares for bioethanol and 8 000 hectares for biodiesel. Together, these amounts correspond to a share of two percent of the arable land in Sweden. The domestic land use in the biofuel sector varies due to the produced amount of biofuel, the share of imported raw material and yearly variations in yield. The Swedish bioethanol production used only domestic land at first. However, according to the calculations in this study, the share of foreign land needed in Swedish bioethanol production has increased and reached almost 60 000 hectares in 2012. Areas directly required for biodiesel production have mostly consisted of foreign land ever since the opening of Swedish biodiesel factories. It could not be concluded with certainty whether or not biofuel production from crops has prevented the decline of arable land. Instead, the study indicated that biofuels have affected Sweden's total requirement of foreign areas abroad for rapeseed and wheat. Therefore, if cultivation of feedstock for biofuels is to prevent the ongoing abandonment of farmland, both producers and politicians must decide on the future role of biofuels in Swedish agriculture. The increased use of land outside of Sweden for Sweden’s biofuel production leads to a decrease in control of land use changes, and there may be a risk for indirect land use changes. This study indicates that the Swedish biodiesel production implies larger risk of iLUC than the Swedish ethanol production. The reason is the deficit of vegetable oil in Europe. An increased demand for rapeseed oil in the biofuel sector may lead to increased import of palm oil. To reach further conclusions in a future study with similar methodology the author recommends to: - Use a lower geographical level of aggregation of data on land use and cultivation of raw materials for biofuels. - Study a larger geographic area than Sweden such as Europe or the EU. - Specifically study the import of vegetable oil to Europe and its connection with increased biodiesel production. A question of interest is whether the increased consumption of European rapeseed for biodiesel has caused increased imports of palm oil or decreased imports of soymeal.En ökad andel biodrivmedel är en del i att nå EU:s mål om 10 procent förnybar energi i transportsektorn. Frågan om huruvida biodrivmedel konkurrerar med livsmedelsproduktion är en ständigt aktuell diskussion. Ett flertal studier har dessutom indikerat att klimatpåverkan från biodrivmedel är betydligt större än vad man tidigare antagit på grund av utsläpp från markanvändning. Både den inhemska produktionen av biodrivmedel från åkergrödor och användningen av biodrivmedel har ökat kraftigt det senaste decenniet i Sverige. Syftet med detta projekt är dels att genomföra en kartläggning över Sveriges markanvändning över alla sektorer, och dels att analysera hur svenskproducerade biodrivmedel påverkat markanvändningen, både inom och utanför Sveriges gräns. Studien omfattar åren 2000 till 2012 och genomfördes genom att statistik insamlades, bearbetades och analyserades. Arealen åkermark i Sverige har minskat med cirka 100 000 hektar under den studerade perioden. År 2012 användes cirka 50 000 hektar för odling av etanolråvara och 8 000 hektar för odling av biodieselråvara i Sverige. Detta motsvarade tillsammans cirka två procent av Sveriges åkermark. Arealer som används i Sverige inom biodrivmedelssektorn förändras från år till år på grund av variation i producerad mängd biodrivmedel, andel importerad råvara samt hektarskördars årsvariationer. För etanolproduktion i svenska fabriker var arealanspråken enbart inhemska till en början men under perioden har de utländska arealanspråken ökat. Svensk biodieselproduktion har till största del gjort anspråk på utländska marker. Inga säkra slutsatser har kunnat dras om huruvida biodrivmedelsproduktion från åkergrödor bidragit till att outnyttjade jordbruksarealer tagits i anspråk. Däremot har indikerats att biodrivmedelstillverkning i svenska fabriker har ökat Sveriges totala arealanspråk utomlands för raps och spannmål. För att odling av råvara för biodrivmedel i större utsträckning ska ske i Sverige, och bidra till att hindra den pågående nedläggningen av jordbruksmark, måste aktiva beslut av producenter och politiker tas. Att arealer utanför Sveriges gräns utnyttjas för vår biodrivmedelsproduktion innebär att kontrollen över markanvändningsförändringar minskar och det går inte att bortse från att det kan finnas risk för iLUC. I denna studie anses risken för iLUC större för den svenska biodieselproduktionen än för etanolproduktionen. Detta eftersom det råder ett underskott på vegetabilisk olja i Europa vilket kan innebära att den ökade efterfrågan leder till ökad import av exempelvis palmolja. För att kunna dra mer långtgående slutsatser vid en framtida studie med liknande metodik rekommenderas att: - Utgå från en lägre geografisk aggregeringsnivå för data över markanvändning och odling av råvaror för biodrivmedel - Studera ett större geografiskt område än Sverige såsom Europa eller EU - Specifikt studera import av vegetabilisk olja till Europa och dess samband med utökad biodieselproduktion. En intressant frågeställning är till exempel om den ökade åtgången av europeisk raps för biodiesel har orsakat ökade importer av palmolja eller minskat importen av sojafoder

Monitoring Progression of Ductal Carcinoma In Situ Using Photoacoustics and Contrast-Enhanced Ultrasound.

Breast cancer is the leading form of cancer in women, accounting for approximately 41,400 deaths in 2018. While a variety of risk factors have been identified, physical exercise has been linked to reducing both the risk and aggressiveness of breast cancer. Within breast cancer, ductal carcinoma in situ (DCIS) is a common finding. However, less than 25% of DCIS tumors actually progress into invasive breast cancer, resulting in overtreatment. This overtreatment is due to a lack of predictive precursors to assess aggressiveness and development of DCIS. We hypothesize that tissue oxygenation and perfusion measured by photoacoustic and contrast-enhanced ultrasound imaging, respectively, can predict DCIS aggressiveness. To test this, 20 FVB/NJ and 20 SV40Tag mice that genetically develop DCIS-like breast cancers were divided evenly into exercise and control groups and imaged over the course of 6 weeks. Tissue oxygenation was a predictive precursor to invasive breast cancer for FVB/NJ mice (P = 0.015) in the early stages of tumor development. Meanwhile, perfusion results were inconclusive (P \u3e 0.2) as a marker for disease progression. Moreover, voluntary physical exercise resulted in lower weekly tumor growth and significantly improved median survival (P = 0.014)

Evaluation of Hepatocellular Carcinoma Transarterial Chemoembolization using Quantitative Analysis of 2D and 3D Real-time Contrast Enhanced Ultrasound.

Quantitative 2D and 3D contrast-enhanced ultrasound (CEUS) was assessed to evaluate early transarterial chemoembolization (TACE) treatment response. Seventeen patients scheduled for TACE for the treatment of hepatocellular carcinoma participated in the study. 2D and 3D CEUS were performed for each patient at three time points: Prior to TACE, 1-2 weeks post TACE, and 1 month post TACE. Peak-intensities of the tumor and surrounding liver tissue were calculated from 2D and 3D data before and after TACE and used to evaluate tumor treatment response. Residual tumor percentages were calculated from 2D and 3D CEUS acquired 1-2 weeks and 1 month post TACE and compared with results from MRI 1 month post TACE. Nine subjects had complete response while 8 had incomplete response. Peak-intensities of the tumor from 3D CEUS prior to TACE were similar between the complete and incomplete treatment groups (p = 0.70), while 1-2 weeks (p \u3c 0.01) and 1 month post treatment (p \u3c 0.01) were significantly lower in the complete treatment group than in the incomplete treatment group. For 2D CEUS, only the peak-intensity values of the tumor from 1 month post TACE were significantly different (p \u3c 0.01). The correlation coefficients between 2D and 3D residual tumor estimates 1-2 weeks post TACE and the estimates from MRI were 0.73 and 0.94, respectively, while those from 2D and 3D CEUS 1 month post TACE were 0.66 and 0.91, respectively. Quantitative analysis on 2D and 3D CEUS shows potential to differentiate patients with complete versus incomplete response to TACE as early as 1-2 weeks post treatment

Modelo preliminar do geóide na província de SanJuan: Estudo de caso nos Andes

A high-resolution and high-precision detailed gravimetric geoid has been computed for San Juan province in Argentina, ranging from 27º S to 34º S in latitude and 72º'W to 65º W in longitude. The gravimetric geoid was calculated using the RTM method, a multiband spherical Stokes Fast Fourier Transformation, and the remove-restore technique for the spherical harmonic reference field and the terrain. As an external evaluation, the gravimetric quasigeoid/geoid was compared to the geoid heights obtained from 90 GPS/levelling points available for the province. Finally, a GPS-tailored local geoid, which fits the GPS observations, was computed. Keywords: Gravimetric Geoid; RTM Method; High Precision Geoid.Um geóide gravimétrico, com alta resolução e alta precisão, foi calculado para a província de San Juan na Argentina, delimitado pelos paralelos 27º S to 34º S e pelos meridianos 72º'W to 65º W. O geóide gravimétrico foi calculado usando o método RTM associado com uma transformação rápida de Fourier de múltiplas bandas sobre a função esférica de Stokes, com aplicação da técnica remove-restore para o modelo de referência do campo da gravidade e de elevação do terreno, ambos expressos em harmônicos esféricos. Como avaliação externa, o quase-geóide/geóide foi comparado com o geóide obtido de 90 pontos de nivelamento disponíveis na província e que foram ocupados também com GPS. Finalmente, foi calculado um geóide local adaptado via GPS, o qual se ajusta com as observações GPS. Palavras-chave: Geóide gravimétrico; Método RTM; Geóide de alta precisão

From chaos to a new normal—the COVID-19 pandemic as experienced by municipal health and social care providers in Sweden: A qualitative study

When the COVID-19 pandemic began to spread around the world, Swedish municipalities were unprepared. Different guidelines on how to act in relation to the disease varied and protective equipment was lacking. This study aims to describe the experiences of health and social care providers of working at municipality level during the COVID-19 pandemic. A total of 12 assistant nurses, 13 registered nurses, and three physicians were interviewed, individually or in groups, between fall 2020 and spring 2021. The interviews were semi-structured and were analyzed using thematic analysis, utilizing a design following the COREQ-checklist. Three main themes were identified as follows: ‘Initial chaotic situation and uncertainty regarding how to deal with the pandemic’; ‘Continuous changes in organization and work routines’, and ‘Management of the pandemic has become the new normal’. Though health and social care workers eventually managed to embed dealing with COVID-19 as a routine feature of their daily work, municipalities must prepare for future crises