International descriptive and interventional survey for oxycholesterol determination by gas- and liquid-chromatographic methods

Increasing numbers of laboratories develop new methods based on gas-liquid and high-performance liquid chromatography to determine serum concentrations of oxygenated cholesterol metabolites such as 7α-, 24(S)-, and 27-hydroxycholesterol. We initiated a first international descriptive oxycholesterol (OCS) survey in 2013 and a second interventional survey 2014 in order to compare levels of OCS reported by different laboratories and to define possible sources of analytical errors. In 2013 a set of two lyophilized serum pools (A and B) was sent to nine laboratories in different countries for OCS measurement utilizing their own standard stock solutions. In 2014 eleven laboratories were requested to determine OCS concentrations in lyophilized pooled sera (C and D) utilizing the same provided standard stock solutions of OCS. The participating laboratories submitted results obtained after capillary gas-liquid chromatography-mass selective detection with either epicoprostanol or deuterium labelled sterols as internal standards and high-performance liquid chromatography with mass selective detection and deuterated OCS as internal standard. Each participant received a clear overview of the results in form of Youden-Plots and basic statistical evaluation in its used unit. The coefficients of variation of the concentrations obtained by all laboratories using their individual methods were 58.5–73.3% (survey 1), 56.8–60.3% (survey 2); 36.2–35.8% (survey 1), 56.6–59.8, (survey 2); 61.1–197.7% (survey 1), 47.2–74.2% (survey 2) for 24(S)-, 27-, and 7α-hydroxycholesterol, respectively. We are surprised by the very great differences between the laboratories, even under conditions when the same standards were used. The values of OCS's must be evaluated in relation to the analytical technique used, the efficiency of the ample separation and the nature of the internal standard used. Quantification of the calibration solution and inappropriate internal standards could be identified as major causes for the high variance in the reported results from the different laboratories. A harmonisation of analytical standard methods is highly needed

The experience of nurses working within a volontary network : a qualitative study of health care for undocumented migrants

Purpose: To illuminate the experience of nurses providing healthcare to undocumented migrants in a voluntary network. Methods and sample: In a qualitative study, semi-structured interviews were conducted with RNs regarding their experience of providing healthcare to undocumented migrants within a voluntary network. The interview transcripts were analysed using the inductive method of content analysis. Findings: Three main categories emerged – structural inadequacy, ethical dilemmas and challenges, and personal impact and insights. The informants were driven by a strong ethical approach and a great sense of responsibility as human beings and as nurses. Conclusion: Engaging with the voluntary network allowed the informants to cope with their frustration and feelings of inadequacy which emerged when confronted with institutionalized injustice in the conventional healthcare system

När gruppen ökar värdet av FAMM : Så kan gruppdynamik öka prestationsförmågan i en organisation

En väl fungerande grupp kan vara oerhört attraktivt att se på men det verkligt intressanta är att förstå hur gruppen tar sig till det stadiet där de fungerar tillsammans som en enhet och presterar bra. För att tillämpa metoder att nå dit finns tillvägagångssätt som Strategic Human Resource Management (SHRM) och en allmän strävan efter att erhålla en perfekt gruppdynamik. Studien ämnade undersöka om samspelet mellan SHRM och gruppdynamik ökar produktiviteten i en organisation inom hotell- och restaurangbranschen. Studien grundades på fem vetenskapliga artiklar som granskades, analyserades och sammanfattades. Analysen av artiklarna redovisades i resultatdelen i uppsatsen. Där behandlades bland annat studier om SHRM och att sammanhållning visat sig ha en positiv effekt på grupprestation. Från resultatet fördes en diskussion om huruvida det var gynnsamt för en organisation inom hotell- och restaurangbranschen att dra nytta av lärandet om hur individer fungerar ihop för att organisationen bättre ska kunna applicera detta för att tillgodose gästens behov och önskemål. Därefter presenterades slutsatsen att samspelet mellan SHRM och gruppdynamik kan öka produktiviteten på ett hotell eller i en restaurang.B-uppsatse

När gruppen ökar värdet av FAMM : Så kan gruppdynamik öka prestationsförmågan i en organisation

En väl fungerande grupp kan vara oerhört attraktivt att se på men det verkligt intressanta är att förstå hur gruppen tar sig till det stadiet där de fungerar tillsammans som en enhet och presterar bra. För att tillämpa metoder att nå dit finns tillvägagångssätt som Strategic Human Resource Management (SHRM) och en allmän strävan efter att erhålla en perfekt gruppdynamik. Studien ämnade undersöka om samspelet mellan SHRM och gruppdynamik ökar produktiviteten i en organisation inom hotell- och restaurangbranschen. Studien grundades på fem vetenskapliga artiklar som granskades, analyserades och sammanfattades. Analysen av artiklarna redovisades i resultatdelen i uppsatsen. Där behandlades bland annat studier om SHRM och att sammanhållning visat sig ha en positiv effekt på grupprestation. Från resultatet fördes en diskussion om huruvida det var gynnsamt för en organisation inom hotell- och restaurangbranschen att dra nytta av lärandet om hur individer fungerar ihop för att organisationen bättre ska kunna applicera detta för att tillgodose gästens behov och önskemål. Därefter presenterades slutsatsen att samspelet mellan SHRM och gruppdynamik kan öka produktiviteten på ett hotell eller i en restaurang.B-uppsatse

Bilirubin Levels in Neonates ≥ 35 Weeks of Gestation Receiving Delayed Cord Clamping for an Extended Time - an Observational Study

OBJECTIVE: To describe bilirubin levels in neonates ≥ 35+0 gestational weeks, receiving delayed cord clamping (CC), in relation to the updated Bhutani nomogram.STUDY DESIGN: This was a retrospective, observational study based on data from medical records and local data sheets. Singleton neonates, born vaginally at a gestational age (GA) ≥ 35+0, and with a registered time to CC and at least one registered bilirubin, were included. We excluded neonates with positive direct antiglobulin test (DAT) or hemolytic disorders. Adjusted analyses were performed using analysis of variance, and linear or logistic regression.RESULTS: We analyzed 558 neonates, mean GA (SD) 39.9 (1.3) weeks. CC was performed at a median (interquartile range (IQR)) time of 6 (5-8) minutes. The dataset contained 1330 bilirubin measurements. Median (IQR) age at bilirubin measurement was 37 (22-54) hours. Bilirubin percentiles in neonates with CC time ≥ 2 min were similar, or lower, compared with the Bhutani nomogram between 12 and 72 hours, but with higher 95 th percentile at later hours of age. Phototherapy was initiated in 13 (2.3 %) of the neonates. We found no association between time to CC and hyperbilirubinemia (β = -0.05, p=0.07). Need for phototherapy was marginally higher in neonates with shorter time to CC. CONCLUSION: Bilirubin levels were not correlated to time to CC. Our findings indicate that CC beyond 2 minutes can be performed without additional monitoring for jaundice

Androgen Deprivation Therapy and the Risk for Inguinal Hernia : An Observational Nested Case Control Study

It has been suggested that hypogonadism increases the risk for inguinal hernia (IH). The aim of this study was to investigate any association between androgen deprivation therapy (ADT) for prostate cancer and increased risk for IH. The study population in this population-based nested case-control study was based on data from the Prostate Cancer Database Sweden. The cohort included all men with prostate cancer who had not received curative treatment. Men who had been diagnosed or had undergone IH repair (n = 1,324) were cases and controls, where not diagnosed, nor operated on for IH, matched only on birth year (n = 13,240). Conditional multivariate logistic regression models were used to assess any temporal association between ADT and IH, adjusting for marital status, education level, prostate cancer risk category, Charlson Comorbidity Index, ADT, time since prostate cancer diagnosis, and primary prostate cancer treatment. Odds ratio (OR) for diagnosis/repair of IH 0 to 1 year from start of ADT was 0.5 (95% confidence interval [CI] = [0.38, 0.68]); between 1 and 3 years after, the OR was 0.35 (95% CI = [0.26, 0.47]); between 3 and 5 years after, the OR was 0.39 (95% CI = [0.26, 0.56]); between 5 and 7 years after, the OR was 0.6 (95% CI = [0.41, 0.97]); and >9 years after, the OR was 3.68 (95% CI = [2.45, 5.53]). The marked increase in OR for IH after 9 years of ADT supports the hypothesis that low testosterone levels increase the risk for IH. The low risk for IH during the first 8 years on ADT is likely caused by selection of men with advanced cancer unlikely to be diagnosed or treated for IH

The effect of autistic traits on response to and side-effects of pharmacological ADHD treatment in children with ADHD : results from a prospective clinical cohort

BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is a common childhood behavioral condition that globally affects an average of around 5% of children and is associated with several adverse life outcomes. Comorbidity with autism spectrum disorder (ASD) is highly prevalent. Pharmacological treatment for ADHD symptoms has been shown to be effective. However, the prevailing perception is that children with ADHD and concomitant ASD symptoms report poorer efficacy and more side effects. This has been supported by studies on this population, but prospective studies directly comparing children with ADHD and different levels of ASD symptoms are lacking. We aimed to assess if children with ADHD and concomitant ASD symptoms differ regarding effects and side-effects of pharmacological ADHD treatment compared to children with ADHD without ASD traits. This is to our knowledge the second study to directly compare the effect of ADHD medication between ADHD patients with different levels of ASD symptoms. METHODS: In a non-randomized, observational, prospective cohort study, 323 patients aged 6 to 17 years who were diagnosed with ADHD and starting pharmacological treatment were divided into two groups: one with high level of ASD symptoms (ASD group, N=71) and one with low level of ASD symptoms (non-ASD group, N = 252). Treatment outcome was measured as ADHD symptoms, and evaluated using the Swanson, Nolan and Pelham Teacher and Parent ADHD rating scale-version IV (SNAP-IV). Side-effects were evaluated using the Pediatric Side Effects Checklist (P-SEC), at 3 months follow-up. RESULTS: From baseline to 3 months, there was no significant difference in neither treatment effect nor number of clinically significant adverse events experienced between the ASD group and the non-ASD group. CONCLUSIONS: Our results did not implicate that ADHD patients with concomitant ASD symptoms have decreased treatment effect of ADHD medication than patients with ADHD without concomitant ASD symptoms. Neither did the results support that ADHD patients with ASD symptoms experienced significantly more side-effects than ADHD patients without ASD symptoms. Although, we did not analyze different medications separately, this is in line with the only previous study directly comparing methylphenidate treatment in children with or without ASD

Sulphatation does not appear to be a protective mechanism to prevent oxysterol accumulation in humans and mice.

24S- and 27-hydroxycholesterol (24OHC and 27OHC) are potent regulators of different biochemical systems in vitro and are the major circulating oxysterols. A small fraction of these oxysterols has been reported to be sulphated but there are no detailed studies. We considered the possibility that sulphatation is a protective mechanism preventing accumulation of free oxysterols. Using an accurate assay we found the sulphated fraction of 24OHC and 27OHC in circulation of adults to be less than 15% of total. In two patients with a mutation in CYP7B1 and markedly increased levels of 27OHC the sulphated fraction was 8% and 10% respectively. Infants with severe neonatal cholestasis had however markedly increased sulphate fraction of the above oxysterols. In untreated mice the degree of sulphatation of 24OHC and 27OHC in serum varied between 0 and 16%. Similar degree of sulphatation was found in two mouse models with markedly increased levels of 27OHC and 24OHC respectively. Bile duct ligated mice had higher levels of oxysterols than sham-operated controls but the sulphate fraction was not increased. We conclude that a primary increase in the levels of the oxysterols due to increased synthesis or reduced metabolism in adults and mice does not induce increased sulphatation