Cystatin C influences the autoimmune but not inflammatory response to cartilage type II collagen leading to chronic arthritis development

Introduction: Collagen-induced arthritis (CIA) is a mouse model for rheumatoid arthritis (RA) and is induced after immunization with type II collagen (CII). CIA, like RA, is an autoimmune disease leading to destruction of cartilage and joints, and both the priming and inflammatory phases have been suggested to be dependent on proteases. In particular, the cysteine proteases have been proposed to be detrimental to the arthritic process and even immunomodulatory. A natural inhibitor of cysteine proteases is cystatin C. Methods: Cystatin C-deficient, sufficient and heterozygous mice were tested for onset, incidence and severity of CIA. The effect of cystatin C-deficiency was further dissected by testing the inflammatory effector phase of CIA; that is, collagen antibody-induced arthritis model and priming phase, that is, T cell response both in vivo and in vitro. In addition, in order to determine the importance of T cells and antigen-presenting cells (APCs), these cell populations were separated and in vitro T cell responses determined in a mixed co-culture system. Finally, flow cytometry was used in order to further characterize cell populations in cystatin C-deficient mice. Results: Here, we show that mice lacking cystatin C, develop arthritis at a higher incidence and an earlier onset than wild-type controls. Interestingly, when the inflammatory phase of CIA was examined independently from immune priming then cystatin C-deficiency did not enhance the arthritis profile. However, in line with the enhanced CIA, there was an increased T cell and B cell response as delayed-type hypersensitivity reaction and anti-CII antibody titers were elevated in the cystatin C-deficient mice after immunization. In addition, the ex vivo naive APCs from cystatin C-deficient mice had a greater capacity to stimulate T cells. Interestingly, dendritic cells had a more activated phenotype in naive cystatin C-deficient mice. Conclusions: The lack of cystatin C enhances CIA and primarily affects in vivo priming of the immune system. Although the mechanism of this is still unknown, we show evidence for a more activated APC compartment, which would elevate the autoimmune response towards CII, thus resulting in an enhanced development of chronic arthritis

Valuing Supporting Soil Ecosystem Services in Agriculture: A Natural Capital Approach

Soil biodiversity through its delivery of ecosystem functions and attendant supporting ecosystem services—benefits soil organisms generate for farmers—underpins agricultural production. Yet lack of practical methods to value the long-term effects of current farming practices results, inevitably, in short-sighted management decisions. We present a method for valuing changes in supporting soil ecosystem services and associated soil natural capital—the value of the stock of soil organisms—in agriculture, based on resultant changes in future farm income streams. We assume that a relative change in soil organic C (SOC) concentration is correlated with changes in soil biodiversity and the generation of supporting ecosystem services. To quantify the effects of changes in supporting services on agricultural productivity, we fitted production functions to data from long-term field experiments in Europe and the United States. The different agricultural treatments at each site resulted in significant changes in SOC concentrations with time. Declines in associated services are shown to reduce both maximum yield and fertilizer-use efficiency in the future. The average depreciation of soil natural capital, for a 1% relative reduction in SOC concentration, was 144 € ha⁻¹ (SD 47 € ha⁻¹) when discounting future values to their current value at 3%; the variation was explained by site-specific factors and the current SOC concentration. Moreover, the results show that soil ecosystem services cannot be fully replaced by purchased inputs; they are imperfect substitutes. We anticipate that our results will both encourage and make it possible to include the value of soil natural capital in decisions.Keywords: soil organic carbon, economic valuation, ecological intensification, sustainable agriculture, land us

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Att lära av den Andra? : Transformativt lärande i svenska gymnasieelevers berättelser om en utbildningsresa till Kenya

Learning from “The Other”? Transformative learning in Swedish high school students’ narratives from an educational trip to Kenya. The study explores transformative learning in a group of Swedish high school students’ shared narratives about an educational trip to Kenya. The understanding of transformative learning is inspired by a discourse analytical approach, which emphasizes the use of discursive frameworks and repertoires for making sense of experiences. The analysis shows that the participants express a desire to learn from ‘the Other’, which is associated with a critical examination of their own ways of thinking. Moreover, the image of ‘the other’ is complex. On the one hand, it is constructed as a generalized image of the exotic other and reproduces notions of ‘the noble savage’. On the other hand, the image of ‘the other’ is also framed by a liberal discourse of individualism and tolerance. Finally, the narratives also entail constructions of similarity, which indicates a more radical renegotiation of previous discursive frames and blurs the borders between us and them.Ingår i projektet: Resa för att lära? – globalisering, internationella fältresor och transformativt lärande. Finansierat genom forskningsbidrag från Lärarutbildningen vid Södertörns högskola.</p

Exploring the world together : The colonial continuity of family adventure travel

The article examines notions of family holidays in the marketing of family adventure travel, a small but growing segment of the alternative tourism sector in Sweden. In family adventure travel, the family vacation is oriented toward exotic destinations in the Global South. The analysis is conducted through a multimodal discourse analysis of web-based marketing material from seven Swedish travel agencies. It shows that the travel style of family adventure travel is constructed through a novel discourse, filled with overlapping meanings of family life, authenticity, and adventure. The article offers a unique approach to family tourism research by theorizing family adventure travel from a post-colonial perspective. It demonstrates how family adventure travel entails a colonial continuity, where notions of exploring and discovering the world become reproduced and re-negotiated in the context of family tourism. In the marketing of family adventure travel, the family vacation is reimagined as a journey of discovery

Service user's voice during a public competition procurement

Studiens syfte är att fånga brukarperspektivet och dess upplevda konsekvenser av en ofrivillig förändring i befintliga boendemiljön, på grund av en offentlig konkurrensupphandling. Studien är genomförd med kvalitativ metod och insamlandet av empirin gjorde jag genom semistrukturerade intervjuer.  Intervjupersonerna tillika brukarna i studien har en lindrig intellektuell funktionsnedsättning.   Den tidigare forskningen och teoretiska utgångspunkt för studien är brukarperspektiv, förändring, social identitet och Antonovskys (2009) teorier om känsla av sammanhang, KASAM.   Intervjupersonerna i studien beskriver processen som en lång och kaotisk tid med hög psykisk press, vilket går att jämföra med en traumatisk kris. De upplever sig inte vara delaktiga i förändringen utan beskriver sig stå utanför handlingens centrum. De beskriver att de inte fått tillräckligt med anpassad information om vad den kommande förändringen innebär och saknar förmåga att tolka den abstrakta ofrivilliga förändringen. Intervjupersonerna uppfattar att besluten är tagna utan deras delaktighet och att de står utan påverkansmöjligheter. Samtliga beskriver att de fått fysiska besvär av olika slag på grund av upphandlingsprocessen. De uttrycker en låg grad av begriplighet, hanterbarhet och meningsfullhet i händelserna. Intervjupersonerna menar att beslutet att byta utförare känns oförklarligt och beskriver den kommande verksamhetsövergången som meningslös och de önskar att den inte ska bli verklighet. Intervjupersonerna upplevde att personalen utgjorde en viktig del av deras i övrigt glesa sociala nätverk. Intervjupersonerna beskriver att personalen varit obeslutsamma kring om de ska arbeta kvar eller inte. Intervjupersonerna förstår inte varför personal väljer att sluta och tolkar besluten som att det beror på dem själva och upplever sig bli bortvalda av personalen. Studien visar på behov av att utveckla arbetsmetoder som fångar brukarnas frågeställningar och funderingar för att bättre kunna förbereda dem på en kommande förändring av den här digniteten. Studien visar att intervjupersonerna hamnar i en komplex och mycket utsatt marginaliserande situation vid en verksamhetsövergång efter en offentlig konkurrensupphandling.The aim of the study is to capture the perceived consequences of an involuntary change after a public competitive procurement of an existing group-home with special services, from a care taker/service user’s perspective. The study was conducted with qualitative method, and the collection of empirical evidence was through interviews. Respondents and users in the study have a mild intellectual disabilities.   The previous research and the theoretical starting point that the study had been in is; service user perspective, change models, social identity and Antonovsky's (2009) theories of SOC, sense of coherence.   The service users in the study describes a chaotic time with mental pressure during the change process, which can be comparable with traumatic crisis. They experienced fear and felt that the change was difficult to understand. The users describe a lack of knowledge of the upcoming changes. They felt they were unable to interpret and organize the communicative information that they had received. They identified that decisions were taken over their heads and had the feeling that they were without influence during the whole process. All respondents described different physical symptoms as consequents of the procurement. The service users express a low degree of comprehensibility, manageability and meaningfulness in the whole process and experience fear and the decisions seems inexplicable and nonsensical. They describe the future business transition as a burden and an unfortunate circumstance they wish to get undone. They feel themselves not to be involved in the upcoming change, and describes that they are outside the center of act and therefor choose to focus on the staffs decision whether they will stay or quit their posts. They blame themselves when members of the staff decide to quit and they feel themselves to be eliminated by the staff.   The social context of the users turned out to contain sparse networks and property staff emerged as a significant and important part of their lives. The study demonstrates the need to develop working methods that capture the user’s questions and concerns in order to better prepare them for upcoming changes. The study shows that users end up in a complex and very exposed situation and are marginalized in the process of a public competitive procurement