Sex and gender aspects on intensive care : access, intensity and outcome

There is an underlying assumption in society that critically ill patients are admitted to an intensive care unit (ICU) based on their illness severity coupled with their comorbidities, and that other variables are irrelevant. It is therefore troublesome to not fully understand the sexdiscrepancy in the ICU-population; the gender distribution in intensive care units is consistently found to be around 60% men and 40% women. We sought to elucidate the reasons for this discrepancy by constructing five different studies, covering the entire chain from admittance to the ICU until 90 days post intensive care. The overall aim for this thesis is to investigate if there are differences in allocation of intensive care resources depending on whether the patient is a man or a woman. The first two studies aimed at investigating gender differences in the afferent arm, i.e., the access to the ICU. This was done using surveys with fictive patient cases, where the respondent was to decide whether the patient in each case described was in need of ICU care or not. We concluded that in a blinded survey we could not see any differences in admittance to the ICU depending on whether the patient was a man or a woman. Study III is a retrospective cohort study with 8,598 adult patients admitted between 2006 and 2016 to the ICU at Karolinska University Hospital in Stockholm, Sweden. This study explored differences in the efferent arm, i.e., sex- and gender-based differences in discharge from the ICU and mortality after intensive care. We found that women had a higher probability of being discharged from the ICU. There were no differences in 30- or 90-day mortality. In Study IV we used the same cohort as in study III. In this retrospective cohort study, we explored care provided within the ICU, specifically different ICU-typical items, for example mechanical ventilation, vasoactive and inotropic treatment. We concluded that differences in the level of intensive care provided to men and women exist. Given equal severity of illness, men receive more intensive care. Finally, in study V, we investigated differences between men and women regarding care provided in the ICU as well as long-term outcome for all ICU-treated patients with COVID- 19 during the spring of 2020 in Sweden. Male sex was significantly associated with mortality. Additionally, age, COPD/asthma, immune deficiency, malignancy, SAPS 3 and admission month were associated with mortality. In this nationwide study of ICU patients with COVID- 19 we concluded that men were at higher risk of poor long-term outcome compared to women

The Mulberry School : reflection on a designprocess

The quality of a design can improve essentially through a participatory designprocess. Initially, The Mulberry School project was supposed to be finished in two months but the involvement of artist Scott G Burnham extended the work and brought a new dimension into the project. In the beginning, Scott and I both worked on the project unaware of each other. I was appointed by the architect to design the external areas of the school and based on a site survey and analysis of the factors infl uencing the site I created a design proposal with the concept form and function. At the same time Scott performed a series of workshops initiated by the school. The purpose and goal was to include the students in the redevelopment of the school and to produce a design based on the thoughts and wishes of the students. As Scott and I, by chance became aware of each others existence, an integrated designprocess began. Since Scott, as an artist specialises in forming relationships between people and their shared environments the workshops became a qualitative sociological study in youth's relationship to the environment. Because of the artistic character of the study and the qualitative, not quantitative approach, I found it interesting to study literature that has been written on the subject. The literature studies confi rmed the outcome of the workshops and they both express the problem and task of the youth that lies in the process of growing up and preparing for life as an adult. The studies show that teenagers are very aware of the environment that surrounds them and that it affects them in their process of personal development. The designprocess led to a design that was based on the thoughts and ideas of the students. The result was four courtyards with different mood and character. The project made me realise what an enourmous contribution an artist can make to the designprocess of landscape architects. People's relationship to the environment should be a core issue for anyone who creates environments for the use of other people and therefore I would like to see more people like Scott involved in shaping the environment. The physical result of the design process was a design, but I think what was most important for me was that through this dissertation I started questioning the design and the designprocess. Unanswered questions like: Did we control the answers of the students in the workshops and put words in their mouths? Did we really express the minds of the students or build a monument over ourselves? How will the students perceive the courtyards? Will the new design make a difference in the life of the students and help the students to develop their identities? Questioning is, in my opinion, the best way of growing, intellectually and personally.Detta arbete redogör för och reflekterar över den designprocess, från idé till färdigt förslag, som jag under hösten 2002 och våren 2003 utfört i samarbete med konstnären Scott G Burnham och som lett till en gestaltning av de fyra innergårdarna på The Mulberry School i östra London. Syftet med arbetet är att medvetandegöra hur designprocessen förlöpte och fördjupa förståelsen och kunskapen om denna. Inom arbetets ram vill jag även utforska hur en konstnär kan berika designprocessen för landskapsarkitekter samt studera ungdomars relation till omgivningen. För att uppnå detta har jag bearbetat materialet från projektet till en presentation och under tiden reflekterat över de tankar och insikter som uppenbarats under arbetets gång. Den första delen av arbetet utgörs av en presentation av designprocessen. I denna del beskrivs hur projektet inleddes under hösten 2002 med en platsanalys och hur jag utifrån denna utarbetade en designidentitet och ett första gestaltningsförslag. Jag fick av en slump reda på att en konstnär involverats på skolans initiativ och projektet utvecklades till ett samarbete i vilket konstnären genom en serie workshops blev till en länk mellan eleverna och de designteamet. Tillsammans utvecklade vi i ett antal designmöten elevernas tankar om och önskningar för omgivningen till en platsbunden gestaltning. Den andra delen av arbetet består av en reflektion över designprocessen. Projektet fick mig att inse hur mycket en konstnär kan bidra till designprocessen för landskapsarkitekter. Människans relation till omgivningen borde, enligt mig, utgöra en kärnfråga för alla som skapar miljöer för andra människor att vistas i. På grund av detta skulle jag vilja se flera konstnärer som Scott inblandade i dessa processer. Jag har även fått en inblick i vilken kreativ dynamik som kan uppstå då människor med olika kompetenser arbetar med samma mål och fördelarna med integrerade participatoriska designprocesser. I appendix finns en kort sammanfattning av den litteraturstudie som jag har genomfört inom ramen för detta arbete. Scotts inriktning på människors relation till omgivningen gjorde att workshopserien blev en slags kvalitativ vetenskaplig studie på ungdomars relation till omgivningen. I efterhand tyckte jag att det kändes intressant att utföra en teoretisk studie i ungdomsforskning som jag kunde jämföra resultaten från workshopserien med. Resultaten från detta arbete diskuteras i reflektionsdelen. Litteraturstudierna bekräftade de resultat som framkom i workshopserien och dessa visar på den utvecklingsprocess som ungdomar genomgår under tonåren och som innebär en strävan efter att kvalificera sig till vuxenlivet. Studierna visar att ungdomarna i denna process är mycket medvetna om och påverkas av den fysiska omgivningen. Resultatet av designprocessen blev fyra gårdar med olika karaktär. Om det blev lyckat är svårt att säga. Under examensarbetets gång har jag, bland annat med utgångspunkt i litteraturstudierna börjat ifrågasätta designen. Har vi uttryckt elevernas tankar och önskningar eller våra egna? Har vi tillgodosett deras behov? Har det egentligen någon betydelse för elevernas personliga utveckling hur skolgården är utformad och i sådana fall på vilket vis? Jag har funnit många svar under detta arbetes gång men frågorna fortsätter att flockas. Det känns bra, för att reflektera över sina handlingar är, enligt mig, det bästa sättet att utvecklas

Architectural Competitions as Institution and Process

The present book revolves around four key concepts. These concepts are architectural competition, institution, process and adjustments of contemporary competition structures. They may seem randomly assembled in order to form a pertinent book title, but considered as individual entities, they may also characterise the contemporaneous status of architectural competitions in the second decade of the new millennium. For clarity’s sake, what then is an architectural competition? Besides being an intentional combination of words, which etymologically suggests that architecture is not only the art of building, but in conjunction with competition also implies a mutual struggle between architects and other stakeholders to land the ideal design and constructive solution for a particular design problem, competitions in architecture are a phenomenon that is closely related to the practice of architecture, i.e. in a noble and fair spirit think outside established values and norms in order to renew spatial thinking (Cuff, 1992).

The Appearance of a Candidate Site for a Primary Melanoma: A 5 Year-gap with a Melanoma of an Unknown Site

Although more than 90% of melanomas have cutaneous origins, melanomas sometimes present metastatically with no apparent primary lesion. A 62-year-old female presented with black pigmentation on her left thumbnail that had begun 2 years earlier and after the biopsy, she was diagnosed with malignant melanoma. Interestingly, 7 years earlier, a 4 cm palpable mass on her left axilla had been diagnosed as melanoma from an unknown primary site (MUP) with the involvement of an axillary lymph node. We speculate that the melanoma of the left thumb was the primary site and the melanoma in the axilla was a metastasis from the left thumb, and suggest several hypotheses explaining the appearance of the primary lesion as acral lentiginous melanoma after detecting a metastatic site. We consider this case interesting because it helps us to understand the pathogenesis of MUP and reminds physicians to conduct careful periodical work-ups of melanoma patients, and highlights the importance of continued long-term follow-up, especially for patients with MUP

Building a collaborative Psychological Science: Lessons Learned from ManyBabies 1

The field of infancy research faces a difficult challenge: Some questions require samples that are simply too large for any 1 lab to recruit and test. ManyBabies aims to address this problem by forming large-scale collaborations on key theoretical questions in developmental science, while promoting the uptake of Open Science practices. Here, we look back on the first project completed under the ManyBabies umbrella—ManyBabies 1—which tested the development of infant-directed speech preference. Our goal is to share the lessons learned over the course of the project and to articulate our vision for the role of large-scale collaborations in the field. First, we consider the decisions made in scaling up experimental research for a collaboration involving 100+ researchers and 70+ labs. Next, we discuss successes and challenges over the course of the project, including the following: protocol design and implementation, data analysis, organisational structures and collaborative workflows, securing funding, and encouraging broad participation in the project. Finally, we discuss the benefits we see both in ongoing ManyBabies projects and in future large-scale collaborations in general, with a particular eye toward developing best practices and increasing growth and diversity in infancy research and psychological science in general. Throughout the article, we include first-hand narrative experiences to illustrate the perspectives of researchers playing different roles within the project. Although this project focused on the unique challenges of infant research, many of the insights we gained can be applied to large-scale collaborations across the broader field of psychology

Quantifying Sources of Variability in Infancy Research Using the Infant-Directed-Speech Preference

Psychological scientists have become increasingly concerned with issues related to methodology and replicability, and infancy researchers in particular face specific challenges related to replicability: For example, high-powered studies are difficult to conduct, testing conditions vary across labs, and different labs have access to different infant populations. Addressing these concerns, we report on a large-scale, multisite study aimed at (a) assessing the overall replicability of a single theoretically important phenomenon and (b) examining methodological, cultural, and developmental moderators. We focus on infants’ preference for infant-directed speech (IDS) over adult-directed speech (ADS). Stimuli of mothers speaking to their infants and to an adult in North American English were created using seminaturalistic laboratory-based audio recordings. Infants’ relative preference for IDS and ADS was assessed across 67 laboratories in North America, Europe, Australia, and Asia using the three common methods for measuring infants’ discrimination (head-turn preference, central fixation, and eye tracking). The overall meta-analytic effect size (Cohen’s d) was 0.35, 95% confidence interval = [0.29, 0.42], which was reliably above zero but smaller than the meta-analytic mean computed from previous literature (0.67). The IDS preference was significantly stronger in older children, in those children for whom the stimuli matched their native language and dialect, and in data from labs using the head-turn preference procedure. Together, these findings replicate the IDS preference but suggest that its magnitude is modulated by development, native-language experience, and testing procedure