Congenital adrenal hyperplasia is a very rare cause of adrenal incidentalomas in Sweden

BackgroundUndiagnosed congenital adrenal hyperplasia (CAH) can cause adrenal incidentalomas, but the frequency is unclear.ObjectivesThis study aimed to investigate the prevalence of CAH in a population with adrenal incidentalomas and report the clinical characterization.Material and methodsThis was a prospective study performed at a regional hospital from 2016 to 2021. Patients with adrenal incidentalomas were investigated with an adrenocorticotropic hormone (ACTH)-stimulation test in addition to hormonal workup. Serum cortisol and 17-hydroxyprogesterone (17OHP) were analyzed. Individuals with a basal or stimulated 17OHP ≥30 nmol/L were classified as suspicious non-classic CAH, and a CYP21A2-gene analysis was performed in these subjects.ResultsIn total, 320 individuals with adrenal incidentalomas were referred to the center, and of these individuals, an ACTH-stimulation test was performed in 222 (median age, 67 (24–87) years; 58.6% women; and 11.7% with bilateral lesions). None of the individuals presented a basal 17OHP ≥30 nmol/L, but there were 8 (3.6%) who did after ACTH stimulation. Four of these subjects (50%) presented bilateral lesions, and the tumor size was larger compared to that of the individuals with a stimulated 17OHP <30 nmol/L (median, 38 (19–66) vs. 19 (11–85) mm, p=0.001). A CYP21A2 variation (p.Val282Leu) was detected in one of the eight subjects with a stimulated 17OHP ≥30 nmol/L, i.e., the patient was a heterozygotic carrier. None of the eight subjects presented with cortisol insufficiency or clinical signs of hyperandrogenism.ConclusionsThe prevalence of non-classic CAH in an adrenal incidentaloma cohort was 3.6% based on stimulated 17OHP and 0% based on gene analysis. CAH should be considered in AI management in selected cases and confirmed by genetic analysis

Tutkimusetiikka ja hyvien tutkimuskäytäntöjen edistäminen Tampereen yliopistossa. Hankeraportti.

Tampereen yliopistossa v. 2005 toteutetun tutkimusetiikka ja hyvien tutkimuskäytäntöjen edistäminen Tampereen yliopistossa -hankkeen loppuraportissa keskitytään tarkastelemaan tutkimusetiikkaa ja hyviä tutkimuskäytäntöjä jatkokoulutuksen osalta. Raportin keskiössä ovat jatkokoulutuksen ohjaajien näkemykset, joita on kerätty haastattelemalla 12 jatkokoulutuksen ohjaajaa. Raportissa kuvataan tutkimusetiikkaa ilmiönä ja tuodaan esille keskustelun monitasoisuus, jota valottavat haastatteluissa esille tuodut tutkimusetiikan teemat. Keskeisinä teemoina ovat tutkimuksen vaikuttavuus, ohjauskysymykset sekä tutkijoiden keskinäinen suhde. Raportissa pohditaan myös sitä, miten tutkimusetiikkaa ja hyviä tutkimuskäytäntöjä voitaisiin oppia ja opettaa

Från Grundton till b2 : Ett jazzmetodiskt Forskningsprojekt : Avhandling för graden PhD i populärmusik

Denna avhandling presenterar ett forskningsprojekt som fokuserat på ökad kunskap om improvisationsmetodik och improvisatorisk utveckling. Målet med projektet var att prova och dokumentera en ledande jazzimprovisatörs undervisningsmetodik. Elbasisten Gary Willis från bandet Tribal Tech fyllde rollen som lärare i projektet. I tillägg ville jag fördjupa mig i jazzimprovisation och utveckla mina solistiska improvisationsfärdigheter. Då vidareutveckling stod i centrum använde jag aktionsforskning som metod. Vidareutveckling är en primär målsättning i sådan forskning. För att demonstrera detta gjorde jag inspelningen Past:Present (2013) som startpunkt för forskningen. Den största och viktigaste perioden var sedan när jag studerade för Gary Willis i två år. Efter denna period gjorde jag inspelningen Present:Future (2015) som fungerar som en dokumentation av mina färdigheter som improvisatör efter att studierna med Willis var avslutade. Willis kommenterade de två inspelningarna och dessa kommentarer ligger till grund för mina observationer och reflektioner över aktionsforskningen. Med utgångspunkt i denna metod presenteras forskningens resultat.publishedVersio

Vilket spår tar du? : En studie om hur rumsliga element kan förbättra förståelsen kring avdelningars placering i ett möbelvaruhus

Denna rapport presenterar en studie i hur ett nytt kundvägledningssystem kan utformas för att underlätta navigationen på ett möbelvaruhus. Arbetet genomfördes i samarbete med IKEA Örebro där syftet var att varuhuset skulle få en tydligare kundvägledning, för att på så sätt förbättra kundernas förståelse kring avdelningarnas placering. I nuläget brister kundvägledningen i språk, färg, navigation och tillgänglighet, vilket kan leda till att kunderna känner sig förvirrade. För att hitta en bättre lösning till ett gestaltningsförslag applicerades olika metoder. Dessa metoder bestod av intervjuer, observation och en rumsligs analys där både användarnas behov och det befintliga rummet studerats. Med stöd från litteraturen och resultaten ifrån de empiriska studierna utvecklades ett gestaltningsförslag som presenteras i denna rapport. Gestaltningsförslaget presenteras i form av text och tillhörande bilder som tagits fram utifrån 3D programmet SketchUp. Genom nya lösningar ska detta gestaltningsförslag öka förutsättningarna till ett mer navigerbart kundvägledningssystem på IKEA.This thesis work presents a study about how a new customer guidance system can be designed to facilitate navigation in a furniture store. The thesis work was carried out at IKEA Örebro were the goal was to help the department store with a clearer customer guidance system and by this improve the customers aknowledgement about the placement of the sections. The guidance system can be improved in both language, shape, color and accessibility, that today leads to confusion among the customers. To find the optimal design proposal different methods were applied. This methods consisted in interviews, observation, and a spatial analysis were both needs of the users and the existing room were studied. With the support from the literature and the results of the empirics a design proposal was created which is presented in this thesis work. The design proposal is presented in both text and pictures from the 3D program SketchUp. Through new solutions the design proposal should improve the conditions for a more navigable customer guidance systems at IKEA

Occupational exposure alters innate and adaptive immune responses

The farming environment is contaminated with high levels of organic dust. Especially pig barn facilities are highly polluted with airborne inhalable organic dust containing high amounts of molecular patterns from bacteria and fungi known to activate cells of the innate immunity through pattern recognition receptors (PRRs). Some hours of exposure in pig barn environment leads to an intensive upper and lower airway inflammation with systemic influences in previously unexposed healthy subjects. In farmers, daily exposed in the pig barn environment, the immune response becomes attenuated. The effect of the attenuated response is not apparent but respiratory symptoms are very common among farmers, a group with higher prevalence of respiratory chronic inflammatory disorders such as asthma-like syndrome, chronic bronchitis and chronic obstructive pulmonary disease (COPD) than the population in general. Working with laboratory animals is associated with high exposure to allergens but involves also exposure to molecular patterns such as lipopolysaccaride (LPS). Respiratory symptoms, allergic sensitisation against laboratory animals and development of occupational asthma are common health problem among personnel in biomedical research and industry. In paper I the aim was to study influence of regular exposure to organic dust on expression of pattern recognition receptors (PRRs) on blood neutrophils and monocytes and the cytokine profile interleukin (IL)-2, IL-4, IL-13 and interferon (IFN)-γ of blood T-cells before and after exposure in pig barn environment and a bronchial LPS challenge. The study included one group of pig farmers, one group of smokers, who are regularly exposed to organic material and like farmers have an increased prevalence of chronic respiratory diseases, and in one group of non-farming non-smoking healthy subjects. Blood from farmers and healthy controls were also stimulated ex vivo with pro-inflammatory stimuli. Before exposure farmers and smokers had increased concentration of blood neutrophils compared to controls. Farmers also showed decreased expression of TLR2 on blood monocytes compared to controls. After in vivo and ex vivo exposure, the expression of TLR2 and release of IL-6 were attenuated in farmers compared to controls. Further, farmers and smokers had increased proportion of IL-4 and IL-13 producing T-helper cells (Th) compared to controls before exposure. After in vivo exposures the proportion of IL-4 and IL-13 producing Th cells increased in controls but not in farmers and smokers. This attenuation in PRR expression in farmers is probably due to repeated exposure to microbial components and might be involved in the attenuated response to pig barn exposure previously observed in pig farmers. Increased proportion of Th2 cells is also probably due to regular exposure to microbial components and may be involved in development of respiratory symptoms and airway disorders (i.e. chronic bronchitis) that are frequently occurring in these groups. In paper II the aim was to investigate expression of PRRs, lymphocyte activating markers, T-cell cytokine profile and serum levels of soluble CD14 (sCD14) and sST2 in laboratory animal (LA) workers who experience respiratory symptoms while working with laboratory animals (LAs), one group with and one group without allergic sensitization to LA. Two control groups not exposed in LA facilities were included, one group with birch pollen allergy (run during season) and one group of non-atopic subjects. Laboratory animal workers, especially those without LA atopy, showed increased expression of CD14 on blood monocytes compared to the control groups. Further was the level of sST2 in serum elevated in birch pollen atopics and in the group of LA workers who experienced respiratory symptoms but without LA atopy. Increased expression of CD14 may be a marker for LPS exposure which seems to be associated with respiratory symptoms. Increased levels of sST2 in serum might be due to LPS exposure and may prevent allergic sensitization to laboratory animals. However, it might also be caused by exposure to allergens and being an early marker for allergic sensitization. In paper III the aim was to elucidate the influence of regular exposure in pig barn facilities on expression of PRR, adhesion proteins on blood and sputum neutrophils, levels of soluble PRRs in blood and sputum and serum levels of sST2 before and after exposure in a pig barn and a bronchial LPS challenge. A further aim was to study release of pro-inflammatory cytokines after ex vivo stimulations of blood with PRR ligands in presence or absence of anti-ST2. Farmers had decreased expression of adhesion moleculer (CD62L and CD162) on blood neutrophils and CD14 on sputum neutrophils compared to controls. Farmers also had lower levels of sTLR2 and sCD14 in sputum compared to controls. Before exposure there was no difference in sST2 levels in serum but after in vivo exposures sST2 levels in serum increased only in the controls. Attenuated release of sST2 in serum is probably due to development of tolerance among pig farmers. Decreased expression of adhesion molecules might be involved in the reduction in cell recruitment after exposure in pig barn environment previously observed in farmers. In paper IV the aim was to further investigate the influence of regular exposure to organic material on the cytokine profile of Tcells. Proportion and concentration of blood Th cells and cytotoxic T-cells (Tc) producing IL-2, IL-4, IL-13, IFN-γ were investigated in pig farmers, smokers and non-farming, non-smoking healthy subjects. Farmers and smokers had increased proportion and concentration of Th cells producing IL-4 and IL-13 compared to controls. Smokers also had increased proportion and concentration of IL-4 and IL-13 producing Tc cells and concentration of Tc cells producing IL-2 compared to controls and farmers. Farming environment seems to favor a Th2 profile, however, not to the same extent as does smoking. This increase in IL-4/IL-13 producing cells likely stimulate goblet cell metaplasia and might therefore be involved in development of chronic bronchitis, a frequently occurring condition in these groups. In conclusion, occupational exposure in pig barn and in laboratory animal facilities alters expression of receptors and cytokines important for the inflammatory response. This alteration may be of importance in the development of chronic inflammatory airway disorders that are known to be common both in smokers and in farmers

Vilket spår tar du? : En studie om hur rumsliga element kan förbättra förståelsen kring avdelningars placering i ett möbelvaruhus

Denna rapport presenterar en studie i hur ett nytt kundvägledningssystem kan utformas för att underlätta navigationen på ett möbelvaruhus. Arbetet genomfördes i samarbete med IKEA Örebro där syftet var att varuhuset skulle få en tydligare kundvägledning, för att på så sätt förbättra kundernas förståelse kring avdelningarnas placering. I nuläget brister kundvägledningen i språk, färg, navigation och tillgänglighet, vilket kan leda till att kunderna känner sig förvirrade. För att hitta en bättre lösning till ett gestaltningsförslag applicerades olika metoder. Dessa metoder bestod av intervjuer, observation och en rumsligs analys där både användarnas behov och det befintliga rummet studerats. Med stöd från litteraturen och resultaten ifrån de empiriska studierna utvecklades ett gestaltningsförslag som presenteras i denna rapport. Gestaltningsförslaget presenteras i form av text och tillhörande bilder som tagits fram utifrån 3D programmet SketchUp. Genom nya lösningar ska detta gestaltningsförslag öka förutsättningarna till ett mer navigerbart kundvägledningssystem på IKEA.This thesis work presents a study about how a new customer guidance system can be designed to facilitate navigation in a furniture store. The thesis work was carried out at IKEA Örebro were the goal was to help the department store with a clearer customer guidance system and by this improve the customers aknowledgement about the placement of the sections. The guidance system can be improved in both language, shape, color and accessibility, that today leads to confusion among the customers. To find the optimal design proposal different methods were applied. This methods consisted in interviews, observation, and a spatial analysis were both needs of the users and the existing room were studied. With the support from the literature and the results of the empirics a design proposal was created which is presented in this thesis work. The design proposal is presented in both text and pictures from the 3D program SketchUp. Through new solutions the design proposal should improve the conditions for a more navigable customer guidance systems at IKEA

Framtagande av dynamiskt VSM-verktyg : Ett utvecklingsarbete hos ABB Robotics

ABSTRACT Introduction and purpose Development of a VSM tool has been done by performing experimental field work at ABB Robotics, a company that mass produces industrial robots and associated accessories. The tool development, the primary part of the project, mainly puts focus on production aspects. Furthermore, it has been centered on plant layouts of the product layout kind (production line). The purpose of the development is to create a tailored VSM tool that auto generates a foundation for value stream maps based on calculations and possibly simple simulation. The purpose is broken down into two questions where concrete problems can be illustrated: A) How should the VSM tool plainly signal capacity vs. demand, time balances in production and the ratio between value and non-value adding aspects as well as intuitively promote knowledge and in a simple and fast manner be applicable to different kinds of production lines? B) Which constraints are placed on the potential of the VSM tool due to the current situation of the company, how does this contradict the main principles of VSM and how can the company work to maximize the tool´s potential in the future? Methodology and knowledge The development which is characterized by continuous counseling and feedback with the internal mentor is mainly based on laboratory work in Excel. In addition, the work has also involved the making of a user guide as well as an adjustable function for indicating production effects with colors. An evaluation of the tool and the user guide has also been made, which mainly is supported by a test run with the internal mentor and the nature of the methodology. The knowledge that the development uses as its footing mainly involves process- and value stream maps from the company, discussions with company personnel, self-performed laboratory work and theory from Rother and Shooks book “Lära sig se” (2005) and Drew. A. Locher´s book “Value Stream Mapping for Lean Development” (2008). Results The VSM tool manages, in a relevant way, to factor in all aspects that can be interpreted using a typical value stream map. In addition it also provides the following: balances between workstations and production lines, suggestions for amount of WIP between these, simple simulation of WIP between these, disturbance aspects, three total times; manufacturing lead time, inventory time and value adding time as well as a graphic illustration over production courses. The results are considered to fulfill the purpose of the project. Conclusion and future meaning The development results in a hybrid solution of sorts, a tool that exists somewhere in-between the typical draw-by-hand VSM work and simulation software. Its advantage is that it combines VSM theory with intuitive, swift and practical usage, which goes well in hand with today´s fluctuating conditions where time pressure of different kinds are present. The drawback is that the concept as a whole requires complementing in the form of Lean knowledge and gemba observations. Furthermore, there are implications associated with some types of parallel production and editing of the tool, which is to be addressed before implementation. In order to fully utilize the tool, the company also has to examine production times and make a minor adjustment to the process of collecting disturbance data. Three suggestions for the future are given; to study availability, transport aspects and the measuring of production times

Tutkimusetiikka ja hyvien tutkimuskäytäntöjen edistäminen Tampereen yliopistossa. Hankeraportti.

Tampereen yliopistossa v. 2005 toteutetun tutkimusetiikka ja hyvien tutkimuskäytäntöjen edistäminen Tampereen yliopistossa -hankkeen loppuraportissa keskitytään tarkastelemaan tutkimusetiikkaa ja hyviä tutkimuskäytäntöjä jatkokoulutuksen osalta. Raportin keskiössä ovat jatkokoulutuksen ohjaajien näkemykset, joita on kerätty haastattelemalla 12 jatkokoulutuksen ohjaajaa. Raportissa kuvataan tutkimusetiikkaa ilmiönä ja tuodaan esille keskustelun monitasoisuus, jota valottavat haastatteluissa esille tuodut tutkimusetiikan teemat. Keskeisinä teemoina ovat tutkimuksen vaikuttavuus, ohjauskysymykset sekä tutkijoiden keskinäinen suhde. Raportissa pohditaan myös sitä, miten tutkimusetiikkaa ja hyviä tutkimuskäytäntöjä voitaisiin oppia ja opettaa