The Remote Site Doctrine in Alaska

In recent years, software development has been evolving around an Agile way of working to optimize software development processes. Simultaneously in other industries, the Leanconcept have been adopted and used to make manufacturing and production of services more efficient. Software development companies has now started to realize that in order to become competitive in software delivery they need to optimize the entire end-to-end process and not only improve the development phase. Thus, an increased interest for Lean thinking has appeared in the industry. Applying Lean successfully in a software development context is not an easy task. This since Lean is developed for and by the manufacturing industry its content is also dependent on the characteristics of this context. Thus, it is not applicable to other contexts without being adjusted. Though, literature argues that when the content of Lean is properly adjusted to nature of the relevant context it can contribute with the same benefits as in manufacturing. However, the literature lack in studies on how Lean can be successfully applied in nonmanufacturing contexts. This study aims to contribute to this knowledge gap by adjusting and applying Lean tools in software development context in order to make the end-to-end processmore time- and resource-efficient. This will be made through a case study at a software development department at a Swedish Information and Communications Technology (ICT) Company. This department develops software components that work as building blocks of the product sold to the end customer. More specifically, these components contribute with functionality that enables communications between the nodes in a network. The review of the existing body of knowledge together with an analysis of the company specific problems indicates that the most sufficient tool to apply in this case study Lean implementation is Value Stream Mapping (VSM). Hence, the study focuses on adjusting the Value Stream Mapping framework to this new context in order to visualize the entire value flow and make improvements aligned with Lean. The adjustments of VSM are underpinned by relevant findings from previous research together with an analysis of the differences between manufacturing Lean and software development Lean. The study shows that it is possible to reasonably adapt and benefit from Value Stream Mapping also in the context of an ICT Company. The outcome of the study is an overview of the current value flow at the company and suggestions on how, where and what improvements can be made. Though, all improvement suggestions evolve around the aim of improving the flow efficiency and eliminating waste by improving the communication, standardization, synchronization, resource allocation and developing proper measurements. The conclusion is that Lean is applicable in the particular software development context with some necessary adjustments made to fit the current way of working and value offering. The usage of Lean tools such as Value Stream Mapping is possible, also here adjustments are a must and the VSM shows that the current state is better in providing a base for improvements than the future state map. This since improvements in this context is not always visualized and captured in the future state map, but the future map contribute to a vision for the valuestream to aim towards. Key words: Lean, Agile, Value Stream Map, Software development, Flow, Waste, Managemen

Autoimmune diseases and hypersensitivities improve the prognosis in ER-negative breast cancer.

Breast cancer (BC) is one of the leading causes of death among women worldwide. Immunostimulatory treatment has increasingly been used as adjuvant therapy in the last few years, in patients with melanoma and other cancer forms, often with an induction of autoimmunity as a consequence of a successful treatment. We aimed at investigating if coexisting autoimmune diseases (AD) or hypersensitivities (HS) similarly to the side effects of immunostimulatory treatment resulted in a better overall survival, compared to patients without these disorders

Repeatability of radiographic assessments for feline hip dysplasia suggest consensus scores in radiology are more uncertain than commonly assumed

Variation in the diagnostic interpretation of radiographs is a well-recognised problem in human and veterinary medicine. One common solution is to create a 'consensus' score based on a majority or unanimous decision from multiple observers. While consensus approaches are generally assumed to improve diagnostic repeatability, the extent to which consensus scores are themselves repeatable has rarely been examined. Here we use repeated assessments by three radiologists of 196 hip radiographs from 98 cats within a health-screening programme to examine intra-observer, interobserver, majority-consensus and unanimous-consensus repeatability scores for feline hip dysplasia. In line with other studies, intra-observer and inter-observer repeatability was moderate (63-71%), and related to the reference assessment and time taken to reach a decision. Consensus scores did show reduced variation between assessments compared to individuals, but consensus repeatability was far from perfect. Only 75% of majority consensus scores were in agreement between assessments, and based on Bayesian multinomial modelling we estimate that unanimous consensus scores can have repeatabilities as low as 83%. These results clearly show that consensus scores in radiology can have large uncertainties, and that future studies in both human and veterinary medicine need to include consensus-uncertainty estimates if we are to properly interpret radiological diagnoses and the extent to which consensus scores improve diagnostic accuracy

Demography, heritability and genetic correlation of feline hip dysplasia and response to selection in a health screening programme

Feline hip dysplasia (FHD) is a debilitating condition affecting the hip joints of millions of domestic cats worldwide. Despite this, little is known about FHD except that it is relatively common in the large breed Maine Coon. We used 20 years of data from 5038 pedigree-registered Maine Coon cats in a radiographic health screening programme for FHD to determine, for the first time, its heritability, genetic correlation to body mass and response to selection. FHD prevalence was 37.4%, with no sex predilection; however, FHD severity increased with age and body mass. Heritability of the radiographic categories used to classify FHD severity was 0.36 (95%CI: 0.30-0.43). The severity of FHD symptoms was also genetically correlated with body mass (0.285), suggesting that selection for a large body type in this breed concurrently selects for FHD. Support for this was found by following generational responses to selective breeding against FHD. Not only did selective breeding successfully reduce the severity of FHD symptoms in descendants, but these cats were also smaller than their ancestors (-33g per generation). This study highlights the value of breeding programmes against FHD and cautions against breed standards that actively encourage large bodied cats

Pregnancy to postpartum transition of serum metabolites in women with gestational diabetes

Context Gestational diabetes is commonly linked to development of type 2 diabetes mellitus (T2DM). There is a need to characterize metabolic changes associated with gestational diabetes in order to find novel biomarkers for T2DM. Objective To find potential pathophysiological mechanisms and markers for progression from gestational diabetes mellitus to T2DM by studying the metabolic transition from pregnancy to postpartum. Design The metabolic transition profile from pregnancy to postpartum was characterized in 56 women by mass spectrometry-based metabolomics; 11 women had gestational diabetes mellitus, 24 had normal glucose tolerance, and 21 were normoglycaemic but at increased risk for gestational diabetes mellitus. Fasting serum samples collected during trimester 3 (gestational week 32 ± 0.6) and postpartum (10.5 ± 0.4 months) were compared in diagnosis-specific multivariate models (orthogonal partial least squares analysis). Clinical measurements (e.g., insulin, glucose, lipid levels) were compared and models of insulin sensitivity and resistance were calculated for the same time period. Results Women with gestational diabetes had significantly increased postpartum levels of the branched-chain amino acids (BCAAs) leucine, isoleucine, and valine, and their circulating lipids did not return to normal levels after pregnancy. The increase in BCAAs occurred postpartum since the BCAAs did not differ during pregnancy, as compared to normoglycemic women. Conclusions Postpartum levels of specific BCAAs, notably valine, are related to gestational diabetes during pregnancy

Lignin-first biomass fractionation using a hybrid organosolv – Steam explosion pretreatment technology improves the saccharification and fermentability of spruce biomass

For a transition to a sustainable society, fuels, chemicals, and materials should be produced from renewable resources. Lignocellulosic biomass constitutes an abundant and renewable feedstock; however, its successful application in a biorefinery requires efficient fractionation into its components; cellulose, hemicellulose and lignin. Here, we demonstrate that a newly established hybrid organosolv – steam explosion pretreatment can effectively fractionate spruce biomass to yield pretreated solids with high cellulose (72% w/w) and low lignin (delignification up to 79.4% w/w) content. The cellulose-rich pretreated solids present high saccharification yields (up to 61% w/w) making them ideal for subsequent bioconversion processes. Moreover, under high-gravity conditions (22% w/w) we obtained an ethanol titer of 61.7 g/L, the highest so far reported for spruce biomass. Finally, the obtained high-purity lignin is suitable for various advanced applications. In conclusion, hybrid organosolv pretreatment could offer a closed-loop biorefinery while simultaneously adding value to all biomass components

Utmaningar i välfärdens stuprör : Stöd till integrering för ungdomar med begränsad läs- och skrivkunnighet

Att lära sig svenska är ett av de viktigaste målen för asylsökande ungdomar med begränsade läs- och skrivkunskaper. En effektiv språkutveckling är en förutsättning för en god integration i det svenska samhället. För att kunna stödja dessa ungdomars arbete med att utveckla sina egna resurser, krävs bland annat att lärare, coacher, handläggare, socialsekreterare och andra professioner som arbetar nära ungdomarna, arbetar tillsammans utifrån ett resursperspektiv. Genom ett sådant gemensamt arbetssätt kan de underlätta för ungdomarna att erövra handlingskapacitet och förändra sina livsvillkor. Ett sådant arbetssätt ställer nya krav på samverkan mellan kommunala förvaltningar och olika professioner, liksom på samverkan mellan praktik och forskning.I projektet Integration Unga Analfabeter arbetar forskare tillsammans med praktiker inom skola, socialtjänst och arbetsmarknadsförvaltning i Helsingborgs stad, med att åstadkomma en sådan samverkan. I projektet tar vi fasta på kompletterande teoretiska perspektiv för att ställa ungdomarna och deras resurser i centrum. Vi prövar också metoder för att få professioner att samverka och bedriva utveckling på nya sätt

Green tea powder and Lactobacillus plantarum affect gut microbiota, lipid metabolism and inflammation in high-fat fed C57BL/6J mice

BACKGROUND: Type 2 diabetes is associated with obesity, ectopic lipid accumulation and low-grade inflammation. A dysfunctional gut microbiota has been suggested to participate in the pathogenesis of the disease. Green tea is rich in polyphenols and has previously been shown to exert beneficial metabolic effects. Lactobacillus plantarum has the ability to metabolize phenolic acids. The health promoting effect of whole green tea powder as a prebiotic compound has not been thoroughly investigated previously. METHODS: C57BL/6J mice were fed a high-fat diet with or without a supplement of 4% green tea powder (GT), and offered drinking water supplemented with Lactobacillus plantarum DSM 15313 (Lp) or the combination of both (Lp + GT) for 22 weeks. Parameters related to obesity, glucose tolerance, lipid metabolism, hepatic steatosis and inflammation were examined. Small intestinal tissue and caecal content were collected for bacterial analysis. RESULTS: Mice in the Lp + GT group had significantly more Lactobacillus and higher diversity of bacteria in the intestine compared to both mice in the control and the GT group. Green tea strongly reduced the body fat content and hepatic triacylglycerol and cholesterol accumulation. The reduction was negatively correlated to the amount of Akkermansia and/or the total amount of bacteria in the small intestine. Markers of inflammation were reduced in the Lp + GT group compared to control. PLS analysis of correlations between the microbiota and the metabolic variables of the individual mice showed that relatively few components of the microbiota had high impact on the correlation model. CONCLUSIONS: Green tea powder in combination with a single strain of Lactobacillus plantarum was able to promote growth of Lactobacillus in the intestine and to attenuate high fat diet-induced inflammation. In addition, a component of the microbiota, Akkermansia, correlated negatively with several metabolic parameters known to be risk factors for the development of type 2 diabetes

The effectiveness of nurse-led interventions for cancer symptom management 2000-2018: a systematic review and meta-analysis

Background Evidence for effectiveness of nurse-led interventions for cancer-related symptoms is of variable quality. This study aimed to identify, appraise and evaluate the nature and effectiveness of nurse-led interventions on symptoms for people with cancer. Methods A systematic review and meta-analysis. Ten major databases were searched (2000 to 2018, no language restrictions). Two reviewers applied a priori selection criteria; data extraction included design, population, cancer type, and cancer-related symptoms. Interventions and providers were profiled using TIDieR reporting guidelines, and content analysis of components. Methodological quality was assessed using Cochrane risk of bias. A meta-analysis was performed using mean and standardised mean differences with 95% confidence intervals. Overall certainty was assessed using GRADE. Results From 29193 records, 149 studies (n = 107286 participants) from 22 countries were eligible. Interventions included multiple components; education and psychological approaches dominated. Pooled meta-analyses found evidence of benefit for nurse-led interventions on measures of constipation (MD −4.54, 95% CI −8.08 to −0.99; 645 participants; 6 trials; I2 = 0%; P = 0.01); nausea and vomiting (MD −1.97, 95% CI −3.61 to −0.33; 957 participants; 8 trials; I 2 = 12%; P = 0.02) and fatigue (MD −4.63, 95% CI −7.97 to −1.30; 1208 participants; 11 trials; I2 = 34%; P = 0.007). Psychological morbidity (anxiety, depression, mood) also improved. However, few trials used consistent outcome measures, interventions were poorly defined, and certainty of evidence was low or very low. Conclusion Nurse-led interventions improve specific cancer-related symptoms, including psychological morbidity. Enhanced reporting and collaboration to develop a minimum core dataset would strengthen the quality of evidence