Modification and re-validation of the ethyl acetate-based multi-residue method for pesticides in produce

The ethyl acetate-based multi-residue method for determination of pesticide residues in produce has been modified for gas chromatographic (GC) analysis by implementation of dispersive solid-phase extraction (using primary–secondary amine and graphitized carbon black) and large-volume (20 μL) injection. The same extract, before clean-up and after a change of solvent, was also analyzed by liquid chromatography with tandem mass spectrometry (LC–MS–MS). All aspects related to sample preparation were re-assessed with regard to ease and speed of the analysis. The principle of the extraction procedure (solvent, salt) was not changed, to avoid the possibility invalidating data acquired over past decades. The modifications were made with techniques currently commonly applied in routine laboratories, GC–MS and LC–MS–MS, in mind. The modified method enables processing (from homogenization until final extracts for both GC and LC) of 30 samples per eight hours per person. Limits of quantification (LOQs) of 0.01 mg kg−1 were achieved with both GC–MS (full-scan acquisition, 10 mg matrix equivalent injected) and LC–MS–MS (2 mg injected) for most of the pesticides. Validation data for 341 pesticides and degradation products are presented. A compilation of analytical quality-control data for pesticides routinely analyzed by GC–MS (135 compounds) and LC–MS–MS (136 compounds) in over 100 different matrices, obtained over a period of 15 months, are also presented and discussed. At the 0.05 mg kg−1 level acceptable recoveries were obtained for 93% (GC–MS) and 92% (LC–MS–MS) of pesticide–matrix combinations

Patients’ expectations of coming home with Very Early Supported Discharge and home rehabilitation after stroke - an interview study

BACKGROUND: An Early Supported Discharge (ESD) and rehabilitation from a coordinated team in the home environment is recommended in several high-income countries for patients with mild to moderate symptoms after stroke. Returning home from the hospital takes place very early in Sweden today (12 days post stroke), thus the term Very Early Supported Discharge (VESD) is used in the current study. The aim of this study was to describe patients’ expectations of coming home very early after stroke with support and rehabilitations at home. METHOD: This is an interview study nested within a randomized controlled trial; Gothenburg Very Early Supported Discharge (GOTVED), comparing VESD containing a home rehabilitation intervention from a coordinated team to conventional care after stroke. Ten participants (median age 69) with mild to moderate stroke symptoms (NHISS 0 to 8 points) were recruited from the intervention group in GOTVED. Interviews were conducted 0–5 days before discharge and the material was analyzed with qualitative content analysis. RESULTS: Four main categories containing 11 subcategories were found. The VESD team was expected to provide “Support towards independency”, by helping the participants to manage and feel safe at home as well as to regain earlier abilities. The very early discharge gave rise to expectations of coming home to “A new and unknown situation”, causing worries not to manage at home and to leave the safe environment at the ward. A fear to suffer a recurrent stroke when being out of reach of immediate professional help was also pronounced. In contrast to these feelings of insecurity and fear, “Returning to one’s own setting” described the participants longing home, where they would become autonomous and capable people again. They expected this to facilitate recovery and rehabilitation. “A new everyday life” waited for the participants at home and this was expected to be challenging. Different strategies to deal with these challenges were described. CONCLUSIONS: The participants described mixed expectations such as insecurity and fear, and on the other hand, longing to come home. Moreover, they had a high degree of confidence in the expected support of the VESD team. The health professionals at the hospital may build on this trust to reduce the patients’ insecurity for coming home. In addition, it may be beneficial to explore the patients’ expectations thoroughly in front of discharge, as certain feelings and thoughts could complicate or support the home coming process. Thus, a greater attention on such expectations may facilitate the patient’s transition from hospital to home after stroke

Stroke in women — from evidence to inequalities

Stroke is the second largest cause of disability-adjusted life-years lost worldwide. The prevalence of stroke in women is predicted to rise rapidly, owing to the increasing average age of the global female population. Vascular risk factors differ between women and men in terms of prevalence, and evidence increasingly supports the clinical importance of sex differences in stroke. The influence of some risk factors for stroke — including diabetes mellitus and atrial fibrillation — are stronger in women, and hypertensive disorders of pregnancy also affect the risk of stroke decades after pregnancy. However, in an era of evidence-based medicine, women are notably under-represented in clinical trials — despite governmental actions highlighting the need to include both men and women in clinical trials — resulting in a reduced generalizability of study results to women. The aim of this Review is to highlight new insights into specificities of stroke in women, to plan future research priorities, and to influence public health policies to decrease the worldwide burden of stroke in women

University admission based on tests and interviews : Implementation and assessment

Admission to higher education has far-reaching implications and an impact not only on individuals, but also on society. In most developed countries, admission to university studies remains a key issue in higher education: the admissions system determines who will have access to higher education and raises the issue of equal opportunity, in terms of e.g. age, gender, and social class. Traditionally, admission to university studies in Sweden has been centralised, but in recent decades, universities have been permitted to reserve a specified number of undergraduate places for individual admission of selected students. Such a system was introduced to the dental course at the Dental School, Karolinska Institutet, in 1993. The main objective is to seek out, from a pool of applicants with good academic standards, highly motivated students with the potential to become good dentists. The overall aim of the thesis was to assess the relationship between individual student selection adopted at the Dental School and subsequent student achievement, including professional competence. It also presents an overall impression of the selection procedures, as perceived by successful applicants and by members of the selection committee. The specific aims of the thesis were to assess the outcome of an individualised admissions system for dental undergraduates in terms of. student drop-out rates, academic performance during the preclinical years and professional competence of dental students in their final undergraduate year. Students admitted through traditional modes served as a control group. The results are based on data from the first three rounds of admission using the system. During the first years of the undergraduate course, the results of three major integrated examinations, designed to disclose both comprehension and academic ability were analysed to give an early indication of students' potential to become 'good dentists'. The individually selected students achieved better results than those accepted through traditional modes. After three intakes, there have been few or no dropouts among the individually selected students. With respect to professional competence, faculty members who were clinical supervisors in the comprehensive care clinic and knew the students well assessed all the final-year students from the same three rounds of admission. The assessors were uninformed of the means by which the students had originally been admitted to the undergraduate course. Assessment by means of a specially designed protocol comprised seven different criteria and one overall - global - rating. Students originally admitted by individual selection seem to be more professionally competent than students admitted by traditional means. With respect to the relationship between student selection procedures and academic achievement, both interviewed students and the admissions committee are of the same opinion: that the individualised admissions procedure has a positive influence on students' academic achievement and professional competence. The students feel specially selected for their potential to become good dentists and the committee members agree that this awareness lead the students to aspire to higher achievements. It is concluded that motivation and commitment are important determinants of student achievement and that these criteria are more readily disclosed through tests and interview than through traditional modes such as matriculation grades and aptitude tests