Mucus detachment by host metalloprotease meprin \beta requires shedding of its inactive pro-form, which is abrogated by the pathogenic protease RgpB

The host metalloprotease meprin β is required for mucin 2 (MUC2) cleavage, which drives intestinal mucus detachment and prevents bacterial overgrowth. To gain access to the cleavage site in MUC2, meprin β must be proteolytically shed from epithelial cells. Hence, regulation of meprin β shedding and activation is important for physiological and pathophysiological conditions. Here, we demonstrate that meprin β activation and shedding are mutually exclusive events. Employing ex vivo small intestinal organoid and cell culture experiments, we found that ADAM-mediated shedding is restricted to the inactive pro-form of meprin β and is completely inhibited upon its conversion to the active form at the cell surface. This strict regulation of meprin β activity can be overridden by pathogens, as demonstrated for the bacterial protease Arg-gingipain (RgpB). This secreted cysteine protease potently converts membrane-bound meprin β into its active form, impairing meprin β shedding and its function as a mucus-detaching protease

A literature review of the regional implementation of the central Swedish government's health care reforms on choice and privatization.

The introduction in 2010 of the Freedom of Choice Act represents one of the most far-reaching reforms of the Swedish health system. While it is mandatory for the regional counties to introduce choice plans for primary care it is voluntary for ambulatory specialist services. The voluntary nature of the regulations for the latter types of care generates a potential gap between the central government's reform attempts and the regional implementation of the plans. We review the regional implementation of this reform with respect to specialist services from a political economy perspective. Data on the scope of implementation show that counties of the same political ideology as the central government have introduced the most choice plans for specialist care. In particular, counties ruled by right-wing majorities have introduced the Choice Act to a considerably larger extent than left-wing counties. This creates a highly uneven situation across the various parts of the country, possibly at odds with the basic premises of the country's health law of equal access to care. The introduction of choice plans forms part of a decidedly contentious set of issues that are high on the political agenda of Sweden. The nature and impacts of these reforms are also a concern to the general public and the broader industry. Considerably more rigorous analyses will be needed to assess the impact on key policy parameters such as overall system efficiency and equitable access to services as a result of these changes to the health care markets

Evaluating the effect of digital primary care on antibiotic prescription : Evidence using Swedish register data

Background: The growing use of digital primary care consultations has led to concerns about resource use, equity and quality. One of these is how it affects antibiotic prescription. Differences in ease of access for patients and available diagnostic information for the prescribing physicians are reasons to believe prescription rates may be affected. Objectives: We estimated differences in antibiotic prescription between traditional office-based and digital contacts, if these differences varied between groups of diagnoses depending on the availability of information for the prescribing physician, and if differences were associated with socio-demographic patient characteristics. Methods: Using individual level register data for a sample of patients diagnosed with an infection over a two-year period, we estimated differences in prescription between the two types of contacts and applied propensity score techniques to mitigate possible problems with treatment selection bias. Results: The share of antibiotic prescription was 28 (95% CI 27–30, p < 0.001) to 33 (95% CI 29–36, p < 0.001) percentage points lower among digital contacts as compared to office-based contacts. For urinary tract infections, the differences in prescription rates between the two contact types were smaller (34 to 41 percentage points difference) than for throat and skin infections (50 to 60 percentage points difference). For women, rural, older, and people born outside Sweden, digital contacts were associated with higher prescription rates. Conclusions: Antibiotic prescription rates were significantly lower for digital contacts compared with office-based contacts. The findings suggest that digital primary care may be an effective alternative to in-person visits without undue consequences for antibiotic prescription levels, although to varying degree depending on diagnosis

Digitalization of Health Care : Findings from Key Informant Interviews in Sweden on Technical, Regulatory, and Patient Safety Aspects

Over the past few decades, digital technologies for health care have been introduced to improve effectiveness, reduce costs, and enhance access [1]. The case for digital health care increased dramatically during the COVID-19 pandemic [2,3]. However, less is known about some of the broader conditions under which these technologies would be able to contribute to improving health care [4]. To inform policy development from a national perspective, we conducted key informant interviews around 3 domains of digitalization: (1) infrastructure and skills, (2) regulatory considerations, and (3) patient safety and quality of care (see, for example, Desveaux et al [4])

Impact of the Covid-19 pandemic on primary care utilization : evidence from Sweden using national register data

OBJECTIVE: To analyze changes in primary care utilization as a result of the Covid-19 pandemic. Swedish national register data from 2019 to 2020 on utilization of services were used to compare overall utilization levels and across types of contacts and patient groups. A specific objective was to assess the extent to which remote types of patient consultations were able to compensate for any observed fall in on-site visits. Data were stratified by sex and age to investigate any demographic pattern.RESULTS: Findings show significant reductions in overall utilization of services as the pandemic occurred in the first quarter of 2020. On-site visits fell during the first wave of the pandemic and rebounded thereafter. Patients over 65 years of age appear to have reduced utilization to a larger extent compared with younger groups. Simultaneously, remote contacts increased from around 12% before the pandemic to 17% of the total number of consultations. However, the net effect of changes in service utilization suggests an overall reduction of around 12 percent in the number of primary care consultations as a result of the pandemic. No differences between men and women were observed. Further research will continue to monitor changes in primary care utilization as the pandemic continues

Utilization of digital primary care in Sweden : Descriptive analysis of claims data on demographics, socioeconomics, and diagnoses

Objective: As digital technologies for health continue to develop, the ability to provide primary care services to patients with new symptoms will grow. In Sweden, two providers of digital primary care have expanded rapidly over the past years giving rise to a heated debate with clear policy implications. The purpose of the study is to present a descriptive review of digital primary care as currently under development in Sweden. Methods: Descriptive analysis of national coverage data on the utilization of digital care by sex, age, place of residence, socioeconomic status, and most common diagnoses. The data are compared with samples of corresponding data on traditional, office-based primary care, out-of-hours care, and on non-emergency telephone consultations to obtain a comparative analysis of digital care. Results: Digital primary care in Sweden has increased rapidly over the past two years. Currently, more than 30,000 digital consultations are made per month, equivalent to around two percent of all physician-led primary care. Digital care differs in some ways to that of traditional care as users are generally younger and seek for different conditions compared with office-based primary care. Digital care is also similar to traditional care as utilization is higher in metropolitan areas compared with rural areas. Similar to general health care use, there is a negative correlation between use of digital care and socioeconomic status. User profiles by age and sex of digital care are also similar to those of out-of-hours care and non-emergency telephone medical consultations. Conclusions: By providing a detailed description of the development of digital primary care the study contributes to a growing understanding of the contributions that digital technologies can make to health care. Based on current trends digital primary care is likely to continue to increase in frequency over the coming years. As technologies develop and the public becomes more familiar to interacting with medical providers over the Internet also the scope of digital care is likely to expand. As the provision of digital primary care expands across Europe and beyond, policy makers will need to develop regulating capacities to ensure its safe, effective and equitable integration into existing health systems

Real-time Multiplayer Game on IoT-backend

This report presents a project carried out for the company Cybercom by eight students from Linköping University. The aim of the project has been to develop a real-time multiplayer game using an existing system for communication between different devices. The game has been developed as a web app that contains multiple game modes. The specific development methodology that has been used throughout the project is presented in this report. This methodology has been iterative, agile and followed a simplified version of the Scrum framework. The end result of the project is a well functioning product that directly creates value for the customer, but also allows for further development.I denna rapport presenteras ett projekt för företaget Cybercom utfört av åtta studenter från Linköpings universitet. Projektet har gått ut på att utveckla ett realtidsspel som använder sig av ett existerande system för kommunikation mellan enheter. Spelet har utvecklats som en webbapplikation och innehåller flera olika spellägen. I det genomförda projektet har en modifierad, nedskalad variant av arbetsmetodiken Scrum följts och denna presenteras i rapporten. Utvecklingen har därmed varit iterativ och agil. Resultatet av projektet är en väl fungerande produkt som direkt skapar värde för kunden, men även tillåter smidig vidareutveckling

Real-time Multiplayer Game on IoT-backend

This report presents a project carried out for the company Cybercom by eight students from Linköping University. The aim of the project has been to develop a real-time multiplayer game using an existing system for communication between different devices. The game has been developed as a web app that contains multiple game modes. The specific development methodology that has been used throughout the project is presented in this report. This methodology has been iterative, agile and followed a simplified version of the Scrum framework. The end result of the project is a well functioning product that directly creates value for the customer, but also allows for further development.I denna rapport presenteras ett projekt för företaget Cybercom utfört av åtta studenter från Linköpings universitet. Projektet har gått ut på att utveckla ett realtidsspel som använder sig av ett existerande system för kommunikation mellan enheter. Spelet har utvecklats som en webbapplikation och innehåller flera olika spellägen. I det genomförda projektet har en modifierad, nedskalad variant av arbetsmetodiken Scrum följts och denna presenteras i rapporten. Utvecklingen har därmed varit iterativ och agil. Resultatet av projektet är en väl fungerande produkt som direkt skapar värde för kunden, men även tillåter smidig vidareutveckling

Real-time Multiplayer Game on IoT-backend

This report presents a project carried out for the company Cybercom by eight students from Linköping University. The aim of the project has been to develop a real-time multiplayer game using an existing system for communication between different devices. The game has been developed as a web app that contains multiple game modes. The specific development methodology that has been used throughout the project is presented in this report. This methodology has been iterative, agile and followed a simplified version of the Scrum framework. The end result of the project is a well functioning product that directly creates value for the customer, but also allows for further development.I denna rapport presenteras ett projekt för företaget Cybercom utfört av åtta studenter från Linköpings universitet. Projektet har gått ut på att utveckla ett realtidsspel som använder sig av ett existerande system för kommunikation mellan enheter. Spelet har utvecklats som en webbapplikation och innehåller flera olika spellägen. I det genomförda projektet har en modifierad, nedskalad variant av arbetsmetodiken Scrum följts och denna presenteras i rapporten. Utvecklingen har därmed varit iterativ och agil. Resultatet av projektet är en väl fungerande produkt som direkt skapar värde för kunden, men även tillåter smidig vidareutveckling

Pediatric aseptic lower leg fracture nonunion

PURPOSE Lower leg nonunion in pediatric patients is a rarity. Therefore, eight European pediatric trauma units retrospectively analyzed all patients younger than 18 years suffering lower leg fractures resulting in aseptic nonunion. METHODS Thirteen children and adolescents less than 18 years old (2 girls and 11 boys) diagnosed with aseptic nonunion of the tibia and/or fibula were evaluated. In all patients, epidemiological data, mechanism of injury, fracture configuration, and the initial treatment concept were assessed, and the entire medical case documentation was observed. Furthermore, potential causes of nonunion development were evaluated. RESULTS The mean age of patients was 12.3 years with the youngest patient being seven and the oldest being 17 years old. Open fractures were found in six out of thirteen patients (46%). Nonunion was hypertrophic in ten and oligotrophic in three patients. Mean range of time to nonunion occurrence was 7.3 ± 4.6 months. Nonunion healing resulting in complete metal removal was found in 12 out of 13 patients (92%), only in one case of a misinterpreted CPT type II osseous consolidation could not be found during the observation period. Mean range of time between surgical nonunion revision and osseous healing was 7.3 months as well. CONCLUSION If treatment principles of the growing skeleton are followed consistently, aseptic nonunion of the lower leg remains a rare complication in children and adolescents. Factors influencing the risk of fracture nonunion development include patient's age, extended soft tissue damage, relevant bone loss, and inadequate initial treatment