Oncologic and functional outcomes after robot-assisted radical hysterectomy for cervical cancer

Background: Cervical cancer is the fourth most common cancer in women worldwide, but the incidence has rapidly declined in developed countries after the introduction of structured screening programs. This disease is caused by persistent HPV infection commonly acquired in adolescence, thereby affecting young women. In countries with established screening programs, early detection has resulted in favorable prognosis. Surgical treatment is the main treatment for early-stage disease and radical hysterectomy (RH) cures more than 90% of those afflicted. However, this treatment is associated with considerable morbidity and impaired quality of life (QoL). In 2005, robot-assisted laparoscopic radical hysterectomy (RRH), was introduced and subsequently implemented in Sweden. The perceived benefits of minimally invasive surgery (MIS), and of RRH in particular, have not been confirmed. It is therefore imperative to assess the efficacy and safety of this surgical technique, as well as short- and long-term adverse effects, particularly since long-term survival is expected. Aims: The overall aim was to investigate the oncologic safety of RRH. Secondary aims included assessment of surgical outcomes, health care costs and impact on QoL, bladder, bowel, sexual and lymphatic function after RRH. Methods: To assess the oncologic and surgical outcomes, two population-based studies were performed (Studies I and II). Study I included 304 women who underwent RH stage IA1-IIA during 2006-2015 at Karolinska University Hospital (KUH). Surgical and oncologic outcomes, as well as the costs of RRH and open radical hysterectomy (ORH) were compared. Study II, a nationwide cohort study, assessed overall and disease-free survival after RRH and ORH in 864 women with stage IA1-IB1 disease. The functional impact of RRH was investigated in two prospective clinical studies (Studies III and IV) with one-year follow-up. In Study III, 26 women undergoing RRH filled in a questionnaire regarding psychological well‐being and sexual, bowel, bladder, and lymphatic function. In addition, postoperative ovarian function was measured by change in sex hormones. In Study IV, 27 patient-reported outcomes after RRH were assessed using two validated questionnaires concerning bladder function and its impact on QoL. Outcomes were determined objectively by urodynamics and quantification of ablated autonomic nerves. Results: In the regional study (Study I), RRH was associated with an increased risk of recurrence (HR 2.13; 95% CI, 1.06-4.26). The postoperative complication rates (37%) and costs were similar, but the hospital stay was shorter than following ORH. The nationwide study (Study II) showed no statistical difference between RRH and ORH with respect to 5-year OS (HR 1.00; 95% CI, 0.50-2.01) and DFS (HR 1.08; 95% CI, 0.66-1.78). Study III demonstrated that RRH had a minor effect on sexual function, as well as bowel function. However, bladder impairment and lymphedema remained the main dysfunctions associated with RRH for cervical cancer (Studies III and IV). No correlation between the number of autonomous nerves ablated and functional outcomes was observed. In general, postoperative urinary symptoms diminished over time, but persisted in a substantial proportion of the women and may impair QoL. Conclusions: RRH appears to be safe once surgical proficiency is achieved. Prospective trials are needed to ensure the safety of RRH for cervical cancer. RRH was associated with less perioperative morbidity, and health care costs were similar to those of ORH. RRH seems to have only minor effects on sexual function, though bladder dysfunction remains a significant sequele. The cause of functional impairment after RRH is multifactorial and cannot be explained by nerve ablation alone

Can forest fertilization be made more efficient with the help of SLU Soil moisture map?

Den bristande tillgängligheten på kväve hämmar många av de boreala och tempererade skogarnas tillväxt. Att gödsla med kväve har visat sig vara en av de mest effektiva produktionshöjande åtgärderna för att öka skogens avkastning. Gödslingsaktiviteten i Sverige kom att öka som mest under 1970-talet. Därefter minskade gödslingsarealen eftersom oro för miljöeffekter så som försurning av vattendrag uppstod. Syftet med rapporten är att jämföra SCA:s nuvarande arbetssätt med SLU Markfuktighetskarta gällande om gödsling skett på rätt arealer på SCA:s innehav i Ångermanland. För att undersöka gödslingens verkan på olika marker genomförs en fältstudie. Rapporten innefattar även en litteraturstudie om gödslingens effekt på fuktiga och blöta marker ur ett produktions- och miljöperspektiv. Två nya markfuktighetskartor, en klassad och en oklassad, produceras under åren 2020 och 2021 av Sveriges Lantbruksuniversitet. Den klassade kartan är indelad i tre markfuktighetsklasser medan den oklassade kartan anger markfuktigheten på en skala från 0 till 100. Fältmätningarna gjordes med hjälp av referenslinjer i referensområden för respektive bestånd. Linjerna placerades över gränsen för två markfuktighetsklasser med lika många provytor på varje sida av gränsen. Resultatet visar att referensområdena för den torra, friska och frisk-fuktiga marken har något högre tillväxtkvot i jämförelse med referensområdena för den fuktiga och blöta marken. Majoriteten av provytorna uppfyllde alla sju baskrav för gödslingsbara bestånd. Den främsta anledningen till att en provyta ej blev godkänd berodde att andelen löv var för hög. Slutsatserna av arbetet visar att tillväxtskillnaden mellan fuktig och blöt skogsmark och torr, frisk och frisk-fuktig mark är märkbar men liten. SLU Markfuktighetskarta kan precisera gödslingen till där den ger mest effekt men kan komma att minska gödslingsarealer på beståndsnivå.The lack of available nitrogen limits the growth of many of the boreal and temperate forests. Fertilizing with nitrogen has proven to be one of the most effective production-increasing measures to increase forest yields. The fertilization activity in Sweden increased the most during the 1970s. Thereafter, the fertilization area decreased as concerns about environmental effects such as acidification of watercourses arose. The purpose of the report is to compare SCA's current working methods with the SLU Soil Moisture Map regarding whether fertilization has been made on the right areas on SCA's holding in Ångermanland. To investigate the effect of fertilization on different soils, a field study has been made. The report also includes a literature study on the effect of fertilization on moist and wet soils from a production and environmental perspective. Two new soil moisture maps, one classified and one unclassified, has been produced during the years 2020 and 2021 by the Swedish University of Agricultural Sciences. The classified map is divided into three soil moisture classes, while the unclassified map indicates soil moisture on a scale from 0 to 100. The field measurements were made using reference lines in reference areas for each area. The lines were placed between the boundary of two soil moisture classes with equal numbers of samples on each side of the boundary. The results show that the reference areas for the dry, fresh and fresh-moist soil have a slightly higher growth ratio in comparison with the reference areas for the moist and wet soil. Most of the samples met all seven basic requirements for fertilizable stands. The main reason why a sample area was not approved was that the proportion of leaves was too high. The conclusions of the work show that the growth difference between moist and wet forest soil and dry, mesic and mesic-moist soil is noticeable but small. SLU Soil moisture map can specify the fertilization to where it gives the most effect but may reduce fertilization areas at stock level

"Trade wars are good, and easy to win" : A study of Trump’s steel tariffs and international trade

For a long time, free trade has been considered the optimal trade pattern for a country to increase its welfare. This idea has however been put to the test by the ongoing steel tariff implementations by the United States. President Donald Trump has argued that foreign production and export is hurting the American steel industry. This paper will examine the effects and consequences of these tariffs from a trade theory point of view and analyze the potential risk of a trade war. Further, it will discuss whether this trade policy is an optimal way for the United States to improve its economy which will be related to data on the United States’history of trade and its membership in the World Trade Organization, WTO. The main findings of this paper are that if the country that imposes the tariffs are considered as being a large country and the tariffs are optimal, it can increase the country’s welfare. Another finding is that the negotiating of quotas instead of tariffs might have a similar effect for the implementing country depending on if they receive the quota rents, and a combination of tariffs and quotas might not diminish US role as a large country which means that the US can gain a positive welfare effect of the trade barriers. Actions like these might however be considered as violations of the WTO agreements and retaliation from other countries are likely. Furthermore, the historical data on the United States indicates that tariffs in general can have a positive effect on its GDP

Varför litteraturhistoria? : En studie om lärares motiverande arbete kring litteraturhistoria

Syftet med denna studie är att undersöka hur lärare arbetar med litteraturhistoria för att motivera eleverna och få dem att läsa de texter de planerat samt hur de väljer den litteratur de vill behandla i sin undervisning inom litteraturhistoria. Empirin samlades genom semistrukturerade intervjuer med fem lärare i svenska. Informanternas svar visar att de: väljer olika litteratur, arbetar på olika sätt och har olika strategier för att motivera eleverna. Litteraturvalen baseras på eget intresse för verken vilket informanterna även menar krävs för att skapa intresse hos eleverna och arbetet sker med olika upplägg beroende på lärare och klass. Antalet epoker som tas upp och hur man gör detta med att ha allt kopplat till litteraturhistorien eller att ha den som ett specifikt moment är olika exempel på hur upplägget varierar hos informanterna. Dock menar samtliga att ett lärarintresse för litteraturhistoria eller de verk man väljer är viktigt.

Do changes in macroeconomic variables affect stock market volatility? : -A GARCH-S approach in examining the volatility of the Swedish stock market

The behaviour of stock markets is characterized by volatility, that is the rate at which stock prices moves up and down within a short period of time. The importance of understanding the nature of volatility is that excessive volatility may prevent the smooth functioning of financial markets and adversely affect the performance of the economy. Economic theory and previous studies have suggested that the volatility of stock prices are affected by fluctuations in macroeconomic factors due to the ability of these factors to determine stock prices. The inclusion of macroeconomic variables in the modelling of the volatility of stock prices has therefore been investigated to further explain the volatility of stock prices. The purpose of this thesis is to examine whether changes in macroeconomic variables have an effect on the volatility of the Swedish stock market. Using GARCH-S models, this study was able to find that changes in the exchange rate, the price of oil and prices of international financial markets had significant effects on the volatility of the Swedish stock market, proxied by the OMX Stockholm 30 Index. However, the study was not able to find any significant effects of changes in the interest rate, the inflation or the money supply on the volatility of the OMX Stockholm 30 Index. These findings suggest that changes in macroeconomic variables may help to understand the nature of volatility

Do changes in macroeconomic variables affect stock market volatility? : -A GARCH-S approach in examining the volatility of the Swedish stock market

The behaviour of stock markets is characterized by volatility, that is the rate at which stock prices moves up and down within a short period of time. The importance of understanding the nature of volatility is that excessive volatility may prevent the smooth functioning of financial markets and adversely affect the performance of the economy. Economic theory and previous studies have suggested that the volatility of stock prices are affected by fluctuations in macroeconomic factors due to the ability of these factors to determine stock prices. The inclusion of macroeconomic variables in the modelling of the volatility of stock prices has therefore been investigated to further explain the volatility of stock prices. The purpose of this thesis is to examine whether changes in macroeconomic variables have an effect on the volatility of the Swedish stock market. Using GARCH-S models, this study was able to find that changes in the exchange rate, the price of oil and prices of international financial markets had significant effects on the volatility of the Swedish stock market, proxied by the OMX Stockholm 30 Index. However, the study was not able to find any significant effects of changes in the interest rate, the inflation or the money supply on the volatility of the OMX Stockholm 30 Index. These findings suggest that changes in macroeconomic variables may help to understand the nature of volatility

Bronze Age individuals and their health : An osteological analysis of three stone cists from Nyplings, Lokrume parish, Gotland

Bronsåldern är en period med många praktfulla fynd, långhus, storhögar och kremationsgravar. Nu under senare år har flera hällkistor med skelettgravar 14C daterats till bronsåldern, vilket öppnar upp för ny forskning inom tidsperioden när det gäller bland annat hälsoaspekter. Med hjälp av en kvalitativ humanosteologisk studie av två gravanläggningar i Nyplings 1:8, Lokrume socken på Gotland syftar uppsatsen till att påbörja forskningen inom bronsålderns folkhälsa samt motivera till fortsatta framtida forskning inom området. Totalt analyserades 2 598 benfragment med en totalvikt på 6 586 gram. Ett flertal osteologiska metoder användes för ålders- och könsbedömningar samt kvantifiering. Gravarna innehöll tolv individer där två beräknas vara barn och resterande i vuxen ålder. Endast tre individer har kunnat könsbedömmas varav en är av manligt kön och två av kvinnligt kön. Individerna har inte kunnat kroppslängds beräknas i brist på mätbara ben. Analysen av individerna i gravanläggningarna visade att flertalet skeletala förändringar drabbade individerna däribland ledförändringar, fraktur, skärskada och aktivitetsspår. En del av skeletten har uppvisat överlevnad av trauma, vilket är en indikation på en god grundhälsa. Men då majoriteten av individerna inte påvisar skeletala sjukdomar och dött vid en ung ålder har de enligt den osteologiska paradoxen överlag en dålig grundhälsa. De förändringar som har påträffats visar att individerna utsatts för en del smärta, obehag, stelhet och belastning under deras liv. Men trots allt har individerna levt ett relativt långt liv med bättre hälsa än andra individer både från Gotland och Skåne under Bronsåldern.The Bronze Age is a period with many magnificent finds, naves, large mounds and cremation graves. Now in recent years, several stone cists with skeletal graves have been 14C dated to the Bronze Age, which opens up new research within the time period regarding, among other things, health aspects. With the help of a qualitative human osteological study of two burial sites in Nyplings 1:8, Lokrume parish on Gotland, the essay aims to begin research in Bronze Age public health and to motivate future research in the area. A total of 2 598 bone fragments with a total weight of 6 586 grams were analyzed. A number of osteological methods were used for age and gender assessments and quantification. The graves contained twelve individuals, two of whom are estimated to be children and the rest adults. Only three individuals have been able to be gender assessed, of which one is male and two are female. The individuals’ length was not possible to calculate due to lack of bones measurable bones. The analysis of the individuals in the burials showed that multiple skeletal changes affected the individuals such as joint changes, fracture, cut damage and traces of activity. Some of the skeletons have shown survival of trauma, which is an indication of good basic health. But since the majority of individuals do not show any skeletal diseases and died at a young age, according to the osteological paradox, they generally had poor basic health. The skeletal changes that have been found show that the individuals were exposed to some pain, discomfort, stiffness, and strain during their lives. But despite everything, the individuals lived a relatively long life with better health than other individuals both from Gotland and Skåne during the Bronze Age

Vad bestämmer den reala jämviktsväxelkursen? : En kointegrationsanalys av den reala växelkursen mellan kronan och euron och dess bestämningsfaktorer

Den traditionella utgångspunkten i analyser och beräkningar av den reala jämviktsväxelkursen mellan olika valutor är att den följer teorin om köpkraftsparitet. Studier har dock visat att teorin om köpkraftsparitet inte håller och att den reala jämviktsväxelkursen istället bestäms av olika bestämningsfaktorer. Denna upptäckt har lett till att alternativa tillvägagångssätt tagits fram för att analysera och beräkna den reala jämviktsväxelkursen vilka bygger på ett långsiktigt samband mellan den reala växelkursen och dessa bestämningsfaktorer. Syftet med denna uppsats är att utifrån detta undersöka vad som bestämmer den reala jämviktsväxelkursen mellan den svenska kronan och euron. Genom Johansens kointegrationstest kunde denna studie visa på ett långsiktigt samband mellan den bilaterala reala växelkursen mellan den svenska kronan och euron och bestämningsfaktorerna; produktivitetsskillnader mellan internationellt handelsbara varor samt internationellt icke-handelsbara varor i Sverige relativt till i euroområdet, Sveriges nettoutlandsställning, Sveriges grad av öppenhet relativt euroområdet, skillnaden i BNP per capita mellan Sverige och euroområdet samt skillnaden i realräntan mellan de två. Samtliga bestämningsfaktorer, förutom skillnaden i BNP per capita, uppvisade dessutom de effekter på den reala växelkursen som var förväntade utifrån ekonomisk teori

Varför litteraturhistoria? : En studie om lärares motiverande arbete kring litteraturhistoria

Syftet med denna studie är att undersöka hur lärare arbetar med litteraturhistoria för att motivera eleverna och få dem att läsa de texter de planerat samt hur de väljer den litteratur de vill behandla i sin undervisning inom litteraturhistoria. Empirin samlades genom semistrukturerade intervjuer med fem lärare i svenska. Informanternas svar visar att de: väljer olika litteratur, arbetar på olika sätt och har olika strategier för att motivera eleverna. Litteraturvalen baseras på eget intresse för verken vilket informanterna även menar krävs för att skapa intresse hos eleverna och arbetet sker med olika upplägg beroende på lärare och klass. Antalet epoker som tas upp och hur man gör detta med att ha allt kopplat till litteraturhistorien eller att ha den som ett specifikt moment är olika exempel på hur upplägget varierar hos informanterna. Dock menar samtliga att ett lärarintresse för litteraturhistoria eller de verk man väljer är viktigt.

Should I, or should I not complain? : A quantitative study of the consumer's intention to complain in the online fashion industry

Frågeställning: Vilken påverkan har attityd, subjektiv norm och eWoM på konsumentens klagomålsintention? Syfte: Syftet med denna studie är att studera klagomålsintention ur ett konsumentperspektiv. Studien ämnar undersöka vilken påverkan attityd, subjektiv norm och eWoM har på konsumenten klagomålsintention. Undersökningen utgår från en kvantitativ forskningsstrategi av deduktivt anslag.  Metod: Denna studie baseras på en kvantitativ forskningsmetod där primärdata har samlats in via en digital enkätundersökning med frågor utformade från tidigare forskning. Kvantitativa primärdata samlades in med ett resultat av 314 respondenter där 17 respondenter blev bortfall, vilket gav 297 medverkande respondenter. En teorimodell skapade tillsammans med tillhörande hypoteser. Resultatet av studien undersöktes via en korrelations- och multivariat regressionsanalys i IBM SPSS-Statistics. Slutsats: Resultatet visade att attityd-tidigare erfarenhet, attityd-inställning att klaga samt subjektiv norm har en påverkan på klagomålsintentionen. Attityd-inställning till att klaga och subjektiv norm hade störst  påverkan med en mycket säker signifikans på klagomålsintentionen. Studiens resultat visade därmed att attityd-inställning till att klaga hade en större påverkan på klagomålsintentionen än attityd-tidigare erfarenhet. EWoM visade ingen direkt påverkan klagomålsintenitonen. Däremot kan vi konstatera att eWoM visade sig ha en relation till de oberoende variablerna attityd-inställning att klaga samt subjektiv norm. Vilket indikerar att det krävs fortsatt forskning inom detta ämne. Research questions: Which effect do attitude, subjective norm, and eWoM have on the consumer's complaint intention?          Purpose: The purpose of this study is to examine complaint intention from a consumer perspective. The study examines the impact of attitude, subjective norm, and eWoM on the consumer's complaint intention. The study is based on a quantitative research strategy of    deductive funding.               Method: This study is based on a quantitative research strategy where primary data has been collected via a digital survey with questions designed from previous research. Quantitative primary data were collected with a result of 314 respondents where 17 respondents were excluded, which gave 297 participating respondents. A theoretical model was created together with associated hypotheses. The results of the study were examined via a correlation and multivariate regression analysis in IBM SPSS-Statistics.    Conclusion: The results showed that attitude previous experience, attitude to complaining, and subjective norm have an influence on the intention to complain. Attitude to complaining and subjective norm had the greatest impact with a very certain significance on the intention to complain. The results of the study thus showed that attitude to complaining had a greater impact on the intention to complain than attitude to previous experience. EWoM showed no direct impact on the complaint intention. However, we can state that eWoM was found to have a relationship to the independent variables' attitude to complain as well as subjective norm. This indicates that further research is required in this subject.