Meta-analysis of the clinical performance of commercial SARS-CoV-2 nucleic acid and antibody tests up to 22 August 2020

Background: Reliable testing for SARS-CoV-2 is key for the management of the COVID-19 pandemic. Aim: We estimate diagnostic accuracy for nucleic acid and antibody tests 5 months into the COVID-19 pandemic, and compare with manufacturer-reported accuracy. Methods: We reviewed the clinical performance of SARS-CoV-2 nucleic acid and antibody tests based on 93,757 test results from 151 published studies and 20,205 new test results from 12 countries in the European Union and European Economic Area (EU/ EEA). Results: Pooling the results and considering only results with 95% confidence interval width ≤ 5%, we found four nucleic acid tests, including one pointof- care test and three antibody tests, with a clinical sensitivity ≥ 95% for at least one target population (hospitalised, mild or asymptomatic, or unknown). Nine nucleic acid tests and 25 antibody tests, 12 of them point-of-care tests, had a clinical specificity of ≥ 98%. Three antibody tests achieved both thresholds. Evidence for nucleic acid point-of-care tests remains scarce at present, and sensitivity varied substantially. Study heterogeneity was low for eight of 14 sensitivity and 68 of 84 specificity results with confidence interval width ≤ 5%, and lower for nucleic acid tests than antibody tests. Manufacturer-reported clinical performance was significantly higher than independently assessed in 11 of 32 and four of 34 cases, respectively, for sensitivity and specificity, indicating a need for improvement in this area. Conclusion: Continuous monitoring of clinical performance within more clearly defined target populations is needed.</p

Förskollärares sätt att arbeta med matematik i utomhuspedagogiken

Vi undersöker hur förskollärare arbetar med matematiken i förskolans utomhusverksamhet och hur de synliggör matematiken så att barnen lär och utvecklas. Syftet med vår studie är att få en djupare förståelse kring hur förskollärare synliggör matematiken i utomhuspedagogiken. Bakgrunden till vår studie utgår från de dåliga resultaten i matematik som visades i en undersökning av PISA, Programme for International Student Assessment som gjordes 2013. De teoretiska utgångspunkterna inspireras av de sociokulturella teoribildningarna där de tre teoretikerna Friedrich Fröbel, John Dewey och Alan Bishop varit de centrala. De teoretiska utgångspunkterna och de tre centrala teoretikerna kommer tillsammans med begrepp och tidigare forskning att hjälpa oss att stödja analysen av vår empiri. Empirin har samlats in genom 13 enkäter från förskollärare och observationer från tre förskolor. Slutsatsen av studien visar på att det krävs att man som förskollärare är medveten, närvarande och synliggör matematiken i tidig ålder. Även att man som förskollärare är medveten om vad som står i Läroplanen (Lpfö98, rev 2010). Faktorer som närvarande och medvetenhet spelar roll för vilken matematik man arbetar med och hur man synliggör den

Thoughts on the end of life in patients with oxygen-dependent chronic obstructive pulmonary disease : A qualitative interview study

Aim: The aim of the study was to deepen the current knowledge of how patients with chronic obstructive pulmonary disease and long-term oxygen treatment think about and expect end-of-life. Design: A qualitative design was used. Methods: A purposeful sample of 19 patients with oxygen-dependent chronic obstructive pulmonary disease was obtained from the Swedish National Registry on Respiratory Failure (Swedevox). Data was collected with semi-structured interviews and analysed using a hermeneutic approach. Results: The analysis revealed three themes: Living in the present without a future; difficulty talking about the uncertainty; and feeling anxious about leaving family behind. Participants indicated that healthcare professionals should invite them to mutual discussions as it was easier to reject an invitation if they could not talk right then, than to initiate a discussion themselves. Start of home oxygen or a deteriorating health status may be an important time to clinically address existential and end-of-life issues.open access</p

Thoughts on the end of life in patients with oxygen‐dependent chronic obstructive pulmonary disease: A qualitative interview study

Abstract Aim The aim of the study was to deepen the current knowledge of how patients with chronic obstructive pulmonary disease and long‐term oxygen treatment think about and expect end‐of‐life. Design A qualitative design was used. Methods A purposeful sample of 19 patients with oxygen‐dependent chronic obstructive pulmonary disease was obtained from the Swedish National Registry on Respiratory Failure (Swedevox). Data was collected with semi‐structured interviews and analysed using a hermeneutic approach. Results The analysis revealed three themes: Living in the present without a future; difficulty talking about the uncertainty; and feeling anxious about leaving family behind. Participants indicated that healthcare professionals should invite them to mutual discussions as it was easier to reject an invitation if they could not talk right then, than to initiate a discussion themselves. Start of home oxygen or a deteriorating health status may be an important time to clinically address existential and end‐of‐life issues

Pregnancy-induced changes in serum concentrations of perfluoroalkyl substances and the influence of kidney function

Background: Epidemiological associations between maternal concentrations of perfluoroalkyl substances (PFAS) and birth weight are inconsistent. There is concern that studies based on samples collected in late pregnancy may be confounded by kidney function but studies of the relation between pregnancy-induced changes in PFAS and kidney function are lacking. Our aims were to investigate changes in serum concentrations of perfluorononanoic acid (PFNA), perfluorooctanoic acid (PFOA), perfluorooctane sulfonate (PFOS) and perfluorohexane sulfonate (PFHxS) from early to late pregnancy and to explore relations to changes in glomerular filtration rate (GFR) and glomerular pore size. Methods: We conducted the study in a cohort of 73 pregnancies of normal-weight Swedish women without gestational diabetes and preeclampsia, enrolled 2009-2014. Blood was collected in median weeks 11 and 36, respectively, and analysed PFAS using liquid chromatography-tandem-mass-spectrometry. We estimated GFR based on creatinine and cystatin C and used the ratio eGFRcystatin C/eGFRcreatinine to indicate glomerular pore size. We used Wilcoxon signed-rank test to compare early and late measures and partial Spearman rank correlations to explore relations between changes in PFAS and kidney function. Results: Median concentrations of PFNA, PFOA and PFOS decreased by 15-21% but changes were uncorrelated to changes in kidney function (partial R = - 0.06-0.11). The observed increase in median PFHxS concentration of 69% was likely an artefact of systematic measurement error caused by coeluting endogenous inferences. Conclusions: Serum concentrations of PFNA, PFOA and PFOS decrease during pregnancy but the magnitudes of change are unrelated to parallel changes in eGFR and glomerular pore size, suggesting that changes in these indicators of kidney function are not important confounders in studies of PFAS and birth weight in pregnancies without gestational diabetes and preeclampsia