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  • Public defence: 2017-05-12 10:15 Örebro universitet, Billbergska huset, Hörsal B, Örebro
    Riddell, Nicole
    Örebro University, School of Science and Technology, Örebro University, Sweden.
    Packed Column Supercritical Fluid Chromatography: Applications in Environmental Chemistry2017Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Although gas and liquid chromatography have emerged as dominant separation techniques in environmental analytical chemistry, these methods do not allow for the concurrent analysis of chemically diverse groups of persistent organic pollutants (POPs). There are also a small number of compounds which are not easily amenable to either of these traditional separation techniques. The main objective of this thesis was to address these issues by demonstrating the applicability of packed column supercritical fluid chromatography (pSFC) coupled to mass spectrometry (MS) in various aspects of environmental chemistry.

    First, pSFC/MS analytical methods were developed for legacy POPs (PCDDs, PCDFs, and PCBs) as well as the emerging environmental contaminant Dechlorane Plus (DP), and issues relating to the ionization of target analytes when pSFC was coupled to MS were explored. Novel APPI and APCI reagents (fluorobenzene and triethylamine) were optimized and real samples (water and soil) were analyzed to demonstrate environmental applicability.

    The possibility of chiral and preparative scale pSFC separations was then demonstrated through the isolation and characterization of thermally labile hexabromocyclododecane (HBCDD) stereoisomers. The analytical pSFC separation of the α-, β-, and γ-HBCDD enantiomers as well as the δ and ε meso forms was shown to be superior to results obtained using a published LC method.

    Finally, technical mixtures of phosphorus flame retardants (RBDPP, BPA-BDPP, and DOPO; a group of related compounds which are challenging to analyze concurrently) were examined using multiple analytical techniques and pSFC was found to be the only method which facilitated the accurate determination of the components of all 3 mixtures. This thesis confirms the potential of pSFC/MS as a fast, green, and cost effective means of separating and analyzing environmental contaminants.

    List of papers
    1. Comparative assessment of the chromatographic separation of 2,3,7,8-substituted polychlorinated dibenzo-p-dioxins and polychlorinated dibenzofurans using supercritical fluid chromatography and high resolution gas chromatography
    Open this publication in new window or tab >>Comparative assessment of the chromatographic separation of 2,3,7,8-substituted polychlorinated dibenzo-p-dioxins and polychlorinated dibenzofurans using supercritical fluid chromatography and high resolution gas chromatography
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    2015 (English)In: Analytical Methods, ISSN 1759-9660, E-ISSN 1759-9679, Vol. 7, no 21, 9245-9253 p.Article in journal (Refereed) Published
    Abstract [en]

    The analysis of legacy environmental contaminants, such as polychlorinated dibenzo-p-dioxins (PCDDs) and dibenzofurans (PCDFs), using high resolution gas chromatography (HRGC) is well established and universally accepted. The use of an alternative separation technique, such as packed column supercritical fluid chromatography (pSFC), may be of interest as a fast, green, and cost effective method of analyzing environmental samples. The technique is amenable to a broad range of chemical compounds and could facilitate the simultaneous analysis of multiple compound classes as well as the inclusion of thermally labile compounds in a single targeted analysis. The recent re-emergence of this technology due to the introduction of more robust and efficient instrumentation may result in an increased acceptance of pSFC analytical techniques in this area. Herein, the first reported analytical separation of PCDDs and PCDFs by pSFC is described and its separation capabilities are compared with established HRGC protocols. Elution profiles of 2,3,7,8-substituted PCDDs and PCDFs were examined and the separation of PCDD/PCDF homologue groups was found to be comparable to those accomplished using HRGC. Similarly, the resolution of tetrachlorodibenzo-p-dioxin (TCDD) congeners, as required by current regulatory methods utilizing HRGC, was demonstrated and the separation of possible co-eluting PCDD/PCDF congeners was examined and compared to that achieved using popular HRGC capillary columns. The possibility of concurrent analysis of toxic polychlorinated biphenyls (PCBs) with PCDDs and PCDFs using the developed pSFC method was also investigated. The effective separation of these environmental contaminants obtained using pSFC and subsequent detection utilizing atmospheric pressure photoionization tandem mass spectrometry at environmentally relevant levels demonstrates the promise associated with this technique for the analysis of environmental extracts.

    Place, publisher, year, edition, pages
    Royal Society of Chemistry, 2015
    National Category
    Chemical Sciences Food Science
    Research subject
    Chemistry
    Identifiers
    urn:nbn:se:oru:diva-46699 (URN)10.1039/c5ay01644d (DOI)000363732900034 ()2-s2.0-84945421701 (ScopusID)
    Available from: 2015-11-23 Created: 2015-11-23 Last updated: 2017-04-21Bibliographically approved
    2. Coupling Supercritical Fluid Chromatography to Positive Ion Atmospheric Pressure Ionization Mass Spectrometry: Ionization Optimization of Halogenated Environmental Contaminants
    Open this publication in new window or tab >>Coupling Supercritical Fluid Chromatography to Positive Ion Atmospheric Pressure Ionization Mass Spectrometry: Ionization Optimization of Halogenated Environmental Contaminants
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    (English)Manuscript (preprint) (Other academic)
    National Category
    Other Chemistry Topics
    Identifiers
    urn:nbn:se:oru:diva-57150 (URN)
    Available from: 2017-04-21 Created: 2017-04-21 Last updated: 2017-04-21Bibliographically approved
    3. Coupling of Supercritical Fluid Chromatography to Mass Spectrometry for the Analysis of Dechlorane Plus: Examination of Relevant Negative Ion Atmospheric Pressure Chemical Ionization Mechanisms
    Open this publication in new window or tab >>Coupling of Supercritical Fluid Chromatography to Mass Spectrometry for the Analysis of Dechlorane Plus: Examination of Relevant Negative Ion Atmospheric Pressure Chemical Ionization Mechanisms
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    (English)Manuscript (preprint) (Other academic)
    National Category
    Other Chemistry Topics
    Identifiers
    urn:nbn:se:oru:diva-57152 (URN)
    Available from: 2017-04-21 Created: 2017-04-21 Last updated: 2017-04-21Bibliographically approved
    4. Enantioselective Analytical- and Preparative-Scale Separation of Hexabromocyclododecane Stereoisomers Using Packed Column Supercritical Fluid Chromatography
    Open this publication in new window or tab >>Enantioselective Analytical- and Preparative-Scale Separation of Hexabromocyclododecane Stereoisomers Using Packed Column Supercritical Fluid Chromatography
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    2016 (English)In: Molecules, ISSN 1420-3049, E-ISSN 1420-3049, Vol. 21, no 11, 1509Article in journal (Refereed) Published
    Abstract [en]

    Hexabromocyclododecane (HBCDD) is an additive brominated flame retardant which has been listed in Annex A of the Stockholm Convention for elimination of production and use. It has been reported to persist in the environment and has the potential for enantiomer-specific degradation, accumulation, or both, making enantioselective analyses increasingly important. The six main stereoisomers of technical HBCDD (i.e., the (+) and (-) enantiomers of α-, β-, and γ-HBCDD) were separated and isolated for the first time using enantioselective packed column supercritical fluid chromatography (pSFC) separation methods on a preparative scale. Characterization was completed using published chiral liquid chromatography (LC) methods and elution profiles, as well as X-ray crystallography, and the isolated fractions were definitively identified. Additionally, the resolution of the enantiomers, along with two minor components of the technical product (δ- and ε-HBCDD), was investigated on an analytical scale using both LC and pSFC separation techniques, and changes in elution order were highlighted. Baseline separation of all HBCDD enantiomers was achieved by pSFC on an analytical scale using a cellulose-based column. The described method emphasizes the potential associated with pSFC as a green method of isolating and analyzing environmental contaminants of concern.

    Place, publisher, year, edition, pages
    Basel, Switzerland: MDPI AG, 2016
    Keyword
    hexabromocyclododecane, enantiomeric separation, supercritical fluid chromatography
    National Category
    Analytical Chemistry
    Identifiers
    urn:nbn:se:oru:diva-53487 (URN)10.3390/molecules21111509 (DOI)000389918200091 ()27834934 (PubMedID)2-s2.0-84997428723 (ScopusID)
    Available from: 2016-11-15 Created: 2016-11-14 Last updated: 2017-04-21Bibliographically approved
    5. Examination of technical mixtures of halogen-free phosphorus based flame retardants using multiple analytical techniques
    Open this publication in new window or tab >>Examination of technical mixtures of halogen-free phosphorus based flame retardants using multiple analytical techniques
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    2017 (English)In: Chemosphere, ISSN 0045-6535, E-ISSN 1879-1298, Vol. 176, 333-341 p.Article in journal (Refereed) Published
    Abstract [en]

    The application of phosphorus based flame retardants as replacements for commonly used halogenated flame retardants has been gaining interest due to the possibility that these compounds may have a less significant impact on human and environmental health. Unfortunately, little is known about the chemical compositions of many of the technical products (which often are mixtures) and a single separation technique for concurrent analysis of these types of compounds has not been identified. This paper reports the results of an investigation into the constituents of three halogen free organophosphate flame retardants (OPFRs), resorcinol bis(diphenyl phosphate) (RDBPP), bisphenol A bis(diphenyl phosphate) (BPA-BDPP), and 9,10-dihydro-9-oxa-10-phosphaphenanthrene-10-oxide (DOPO). The major components of commercial samples of RDBPP and BPA-BDPP were isolated by preparative TLC and characterized by NMR. A commercial sample of DOPO was found to be essentially pure, but its analysis is complicated by the fact that it can exist in ring-open and ring-closed forms. With the structures of the components confirmed by NMR, multiple analytical separation techniques (gas chromatography (GC), liquid chromatography (LC), and packed column supercritical fluid chromatography (pSFC)) were investigated for the analysis of these three technical products. Packed column supercritical fluid chromatography allows the separation of the components of all three OPFRs, including the two forms of DOPO, in a single run.

    Place, publisher, year, edition, pages
    Elsevier, 2017
    Keyword
    BPA-BDPP, DOPO, NMR, Organophosphate flame retardants (OPFRs), pSFC/MS method, RDBPP
    National Category
    Other Chemistry Topics
    Identifiers
    urn:nbn:se:oru:diva-57461 (URN)10.1016/j.chemosphere.2017.02.129 (DOI)2-s2.0-85015851681 (ScopusID)
    Available from: 2017-04-25 Created: 2017-04-25 Last updated: 2017-04-25Bibliographically approved
  • Public defence: 2017-05-19 09:00 Universitetssjukhuset, Wilandersalen, Örebro
    Sundqvist, Ann-Sofie
    Örebro University, School of Health Sciences.
    Perioperative patient advocacy: having the patient's best interests at heart2017Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Patient advocacy implies taking action on someone else’s behalf, and has been described as a key element of nurses’ professional care. In the perioperative setting, it involves not only critical decision making, but also all the small things that the nurses do for the sake of the patients during their working day. Since previous research on the advocacy role of a registered nurse anesthetist (RNA) is sparse, and has not been conducted in a Swedish context, this thesis was intended to contribute to a greater understanding of advocacy in the perioperative context. The overall aim was therefore to explore the characteristics and consequences of perioperative patient advocacy (Study I), and to describe RNAs’ views of advocacy in anesthetic nursing through interviews (Study II), a questionnaire (Study III), and observations (Study IV).

    The synthesis of the characteristics and consequences of perioperative patient advocacy was interpreted in this thesis as the RNAs having the patient’s best interests at heart, in that they (1) had control of the situation, (2) preserved human values, and finally (3) were emotionally affected, as the results from the four studies suggested this as the core of perioperative patient advocacy.

    Perioperative patient advocacy is not always perceived as easy. In praxis, it is linked to the code of ethics outlined by the International Council of Nurses, which states that all registered nurses, regardless of their working context, shall respect human rights, promote health, prevent illness, and ensure that the individual receives accurate and sufficient information. This thesis elaborates on how this is done by describing how RNAs exert perioperative patient advocacy and how they interact in order to facilitate the best possible care for the patient. The results deepen the understanding of perioperative patient advocacy from the RNA’s perspective and contribute to a new insight in the RNA’s professional role.

    List of papers
    1. Perioperative Patient Advocacy: An Integrative Review
    Open this publication in new window or tab >>Perioperative Patient Advocacy: An Integrative Review
    2016 (English)In: Journal of Perianesthesia Nursing, ISSN 1089-9472, E-ISSN 1532-8473, Vol. 31, no 5, 422-433 p.Article in journal (Refereed) Published
    Abstract [en]

    Purpose: The purpose of this review was to identify the characteristics and consequences of perioperative patient advocacy.

    Design: An integrative review method was employed.

    Methods: A database search to identify peer-reviewed articles that focused on perioperative patient advocacy was conducted in PubMed and CINAHL, followed by a manual search for additional articles. Studies were selected if they reported original empirical research findings with regard to perioperative patient advocacy. The data abstraction and synthesis were achieved with an inductive qualitative content analysis.

    Finding: The analysis resulted in seven categories, two subthemes, and one main theme. The main theme, “Doing good for another human being—a balancing act between philanthropy and personal gratification,” was the core of perioperative patient advocacy.

    Conclusion: Perioperative patient advocacy is part of the professional role of the perioperative nurse, and it affects the perioperative nurse emotionally. This advocacy shares similarities with descriptions of patient advocacy in general nursing.

    Place, publisher, year, edition, pages
    New York, USA: Elsevier, 2016
    Keyword
    Advocacy, integrative review, perioperative nursing
    National Category
    Nursing
    Research subject
    Caring sciences
    Identifiers
    urn:nbn:se:oru:diva-49820 (URN)10.1016/j.jopan.2014.12.001 (DOI)000385340100010 ()27667349 (PubMedID)2-s2.0-84962502652 (ScopusID)
    Projects
    Anestesisjuksköterskan, patientens advokat
    Note

    Funding Agencies:

    Örebro University

    Research Committee at Örebro County Council, Örebro, Sweden OLL-426621

    Available from: 2016-04-14 Created: 2016-04-14 Last updated: 2017-04-24Bibliographically approved
    2. Holding the patient's life in my hands: Swedish registered nurse anaesthetists' perspective of advocacy
    Open this publication in new window or tab >>Holding the patient's life in my hands: Swedish registered nurse anaesthetists' perspective of advocacy
    2014 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 28, no 2, 281-288 p.Article in journal (Refereed) Published
    Abstract [en]

    Background: Anaesthesia often induces a state of unconsciousness that includes inability to communicate and influence the situation. The patient has to rely on the nurse anaesthetist to speak up for her/him as well as maintain her/his dignity and safety. Consequently, the nurse anaesthetist can be likened to the patient's advocate.

    Aim: The aim of the study was to describe advocacy in anaesthesia care during the perioperative phase from the perspective of the registered nurse anaesthetist.

    Method: Data for this qualitative descriptive study were collected during March and April, 2011. Individual interviews were conducted with a purposive sample of 20 nurse anaesthetists from two hospitals in Sweden. The audio-taped interviews were transcribed verbatim and analysed by means of qualitative content analysis.

    Findings: The main theme, Holding the patient's life in my hands, described the nurse anaesthetists' perception of advocacy and comprised three subthemes: providing dignified care, providing safe care and a moral commitment.

    Conclusion: Acting as the patient's advocate includes important health and well-being issues and could be stressful for the nurse anaesthetists'. A work environment where the nurse anaesthetists' can make their voices heard and feel that their opinion regarding the patient's best interests is taken seriously would be desirable, as all health professionals should ideally focus on those in their care.

    Place, publisher, year, edition, pages
    Hoboken: Wiley-Blackwell, 2014
    Keyword
    advanced practice nursing, nurse anaesthetist, advocacy, content analysis, nursing
    National Category
    Nursing
    Research subject
    Caring sciences
    Identifiers
    urn:nbn:se:oru:diva-34993 (URN)10.1111/scs.12057 (DOI)000334503400009 ()23713584 (PubMedID)2-s2.0-84898893862 (ScopusID)
    Available from: 2014-05-09 Created: 2014-05-09 Last updated: 2017-04-24Bibliographically approved
    3. Protective Nursing Advocacy: Translation and Psychometric Evaluation of an Instrument and a Descriptive Study of Swedish Registered Nurse Anesthetists' Beliefs and Actions
    Open this publication in new window or tab >>Protective Nursing Advocacy: Translation and Psychometric Evaluation of an Instrument and a Descriptive Study of Swedish Registered Nurse Anesthetists' Beliefs and Actions
    2017 (English)In: Journal of Perianesthesia Nursing, ISSN 1089-9472, E-ISSN 1532-8473Article in journal (Refereed) Epub ahead of print
    Abstract [en]

    Purpose: To translate and adapt the Protective Nursing Advocacy Scale (PNAS) into a Swedish version (PNAS-Swe), evaluate its psychometric properties, and describe registered nurse anesthetists' (RNAs) advocacy beliefs and actions from a protective perspective.

    Design: A cross-sectional design was used.

    Methods: First, the PNAS was translated into Swedish. Next, the content and construct validity of the PNAS four subscales was evaluated. Finally, the PNAS-Swe was used to describe Swedish RNA beliefs and actions regarding protective nursing advocacy.

    Finding: The final PNAS-Swe has 29 items in four subscales. The RNAs reported that they feel that they should provide protective nursing advocacy for their patients. There were no differences in gender, or associations with age, or work experience regarding their advocacy beliefs or actions.

    Conclusions: The PNAS-Swe is valid for use in a Swedish context. Protective nursing advocacy is important to the RNAs, which is in congruence with earlier qualitative studies.

    Place, publisher, year, edition, pages
    WB Saunders, 2017
    Keyword
    nursing advocacy, Protective Nursing Advocacy Scale, psychometrics, Rasch analysis
    National Category
    Nursing
    Research subject
    Caring Sciences w. Medical Focus
    Identifiers
    urn:nbn:se:oru:diva-57127 (URN)10.1016/j.jopan.2016.10.002 (DOI)
    Available from: 2017-04-20 Created: 2017-04-20 Last updated: 2017-04-24Bibliographically approved
    4. Registered nurse anaesthetists practicing of perioperative patient advocacy: an observational study
    Open this publication in new window or tab >>Registered nurse anaesthetists practicing of perioperative patient advocacy: an observational study
    (English)Manuscript (preprint) (Other academic)
    National Category
    Other Health Sciences
    Identifiers
    urn:nbn:se:oru:diva-57177 (URN)
    Available from: 2017-04-24 Created: 2017-04-24 Last updated: 2017-04-24Bibliographically approved
  • Public defence: 2017-05-19 13:00 Örebro universitet, Campus USÖ, hörsal C3, Örebro
    Cajander, Sara
    Örebro University, School of Medical Sciences.
    Dynamics of Human Leukocyte Antigen-D Related expression in bacteremic sepsis2017Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Monocytic human leukocyte antigen-D related (mHLA-DR) expression determined by flow cytometry has been suggested as a biomarker of sepsisinduced immunosuppression.

    In order to facilitate use of HLA-DR in clinical practice, a quantitative real-time PCR technique measuring HLA-DR at the transcription level was developed and evalutated. Levels of HLA-DR mRNA correlated to mHLADR expression and were robustly measured, with high reproducibility, during the course of infection. Dynamics of mHLA-DR expression was studied during the first weeks of bloodstream infection (BSI) and was found to be dependent on the bacterial etiology of BSI. Moreover, mHLA-DR was shown to be inversely related to markers of inflammation. In patients with unfavourable outcome, sustained high C-reactive protein level and high neutrophil count were demonstrated along with low mHLA-DR expression and low lymphocyte count. This supports the theory of sustained inflammation in sepsis-induced immunosuppression. The association between mHLA-DR and bacterial etiology may be linked to the clinical trajectory via differences in ability to cause intractable infection. Staphylococcus aureus was the dominating etiology among cases with unfavourable outcome. With focus on patients with S. aureus BSI, those with complicated S. aureus BSI were found to have lower HLA-DR mRNA expression during the first week than those with uncomplicated S. aureus BSI. If these results can be confirmed in a larger cohort, HLA-DR measurement could possibly become an additional tool for early identification of patients who require further investigation to clear infectious foci and achieve source control.

    In conclusion, PCR-based measurement of HLA-DR is a promising method for measurements of the immune state in BSI, but needs further evaluation in the intensive care unit setting to define the predictive and prognostic value for deleterious immunosuppression. The etiology of infection should be taken into consideration in future studies of translational immunology in sepsis.

    List of papers
    1. Preliminary results in quantitation of HLA-DRA by real-time PCR: a promising approach to identify immunosuppression in sepsis
    Open this publication in new window or tab >>Preliminary results in quantitation of HLA-DRA by real-time PCR: a promising approach to identify immunosuppression in sepsis
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    2013 (English)In: Critical Care, ISSN 1364-8535, E-ISSN 1466-609X, Vol. 17, no 5, R223Article in journal (Refereed) Published
    Abstract [en]

    Introduction: Reduced monocyte human leukocyte antigen (mHLA)-DR surface expression in the late phase of sepsis is postulated as a general biomarker of sepsis-induced immunosuppression and an independent predictor of nosocomial infections. However, traditional monitoring of mHLA-DR by flow cytometry has disadvantages due to specific laboratory requirements. An mRNA-based HLA-DR monitoring by polymerase chain reaction (PCR) would improve the clinical usage and facilitate conduction of large multicenter studies. In this study, we evaluated an mRNA-based HLA-DR monitoring by quantitative real-time PCR (qRT-PCR) as an alternative method to traditional flow cytometry.

    Methods: Fifty-nine patients with sepsis and blood culture growing pathogenic bacteria were studied. Blood samples were collected at day 1 or 2 after admission, for measurement of mHLA-DR by flow cytometry and mRNA expression of HLA-DRA and class II transactivator (CIITA) by qRT-PCR. Blood samples from blood donors were used as controls (n = 30).

    Results: A significant reduced expression of mHLA-DR, HLA-DRA, and CIITA was seen in septic patients compared with controls. HLA-DRA mRNA level in whole blood was highly correlated with surface expression of mHLA-DR.

    Conclusions: Patients with sepsis display a diminished expression of HLA-DR at the monocyte surface as well as in the gene expression at the mRNA level. The mRNA expression level of HLA-DRA monitored by qRT-PCR correlates highly with surface expression of HLA-DR and appears to be a possible future biomarker for evaluation of immunosuppression in sepsis.

    Place, publisher, year, edition, pages
    London, United Kingdom: BioMed Central, 2013
    National Category
    Medical and Health Sciences Clinical Laboratory Medicine
    Research subject
    Medicine
    Identifiers
    urn:nbn:se:oru:diva-34293 (URN)10.1186/cc13046 (DOI)000331540900039 ()24093602 (PubMedID)2-s2.0-84884967732 (ScopusID)
    Note

    Funding Agencies:

    Nyckelfonden (Örebro, Sweden)

    Research committee of Örebro County Council

    Available from: 2014-03-13 Created: 2014-03-13 Last updated: 2017-04-25Bibliographically approved
    2. Quantitative Real-Time Polymerase Chain Reaction Measurement of HLA-DRA Gene Expression in Whole Blood Is Highly Reproducible and Shows Changes That Reflect Dynamic Shifts in Monocyte Surface HLA-DR Expression during the Course of Sepsis
    Open this publication in new window or tab >>Quantitative Real-Time Polymerase Chain Reaction Measurement of HLA-DRA Gene Expression in Whole Blood Is Highly Reproducible and Shows Changes That Reflect Dynamic Shifts in Monocyte Surface HLA-DR Expression during the Course of Sepsis
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    2016 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 5, e0154690Article in journal (Refereed) Published
    Abstract [en]

    Introduction: A decrease in the expression of monocyte surface protein HLA-DR (mHLA-DR), measured by flow cytometry (FCM), has been suggested as a marker of immunosuppression and negative outcome in severe sepsis. However, FCM is not always available due to sample preparation that limits its use to laboratory operational hours. In this prospective study we evaluated dynamic changes in mHLA-DR expression during sepsis in relation to changes in HLA-DRA gene expression and Class II transactivator (CIITA), measured by quantitative Real-Time Polymerase Chain Reaction (qRT-PCR).

    Aims: The aims of this study were: 1. to validate the robustness of qRT-PCR measurement of HLA-DRA- and CIITA-mRNA expression, in terms of reproducibility; and 2. to see if changes in expression of these genes reflect changes in mHLA-DR expression during the course of severe and non-severe bacteraemic sepsis.

    Methods and Findings: Blood samples were collected from 60 patients with bacteraemic sepsis on up to five occasions during Days 1-28 after hospital admission. We found the reproducibility of the qRT-PCR method to be high by demonstrating low threshold variations (<0.11 standard deviation (SD)) of the qRT-PCR system, low intra-assay variation of Ct-values within triplicates (≤0.15 SD) and low inter-assay variations (12%) of the calculated target gene ratios. Our results also revealed dynamic HLA-DRA expression patterns during the course of sepsis that reflected those of mHLA-DR measured by FCM. Furthermore, HLA-DRA and mHLA-DR recovery slopes in patients with non-severe sepsis differed from those in patients with severe sepsis, shown by mixed model for repeated measurements (p<0.05). However, during the first seven days of sepsis, PCR-measurements showed a higher magnitude of difference between the two sepsis groups. Mean differences (95% CI) between severe sepsis (n = 20) and non-severe sepsis (n = 40) were; on day 1-2, HLA-DRA 0.40 (0.28-0.59) p<0.001, CIITA 0.48 (0.32-0.72) p = 0.005, mHLA-DR 0.63 (0.45-1.00) p = 0.04, day 7 HLA-DRA 0.59 (0.46-0.77) p<0.001, CIITA 0.56 (0.41-0.76) p<0.001, mHLA-DR 0.81 (0.66-1.00) p = 0.28.

    Conclusion: We conclude that qRT-PCR measurement of HLA-DRA expression is robust, and that this method appears to be preferable to FCM in identifying patients with severe sepsis that may benefit from immunostimulation.

    Place, publisher, year, edition, pages
    San Francisco, USA: Public Library of Science, 2016
    National Category
    Infectious Medicine
    Identifiers
    urn:nbn:se:oru:diva-50323 (URN)10.1371/journal.pone.0154690 (DOI)000375676400061 ()27144640 (PubMedID)
    Note

    Funding Agencies:

    Nyckelfonden (Örebro, Sweden)

    Research committee of Örebro County Council

    Available from: 2016-05-27 Created: 2016-05-16 Last updated: 2017-04-25Bibliographically approved
    3. Monocytic HLA-DR expression differs between bacterial etiologies and is inversely related to C-reactive protein and neutrophil count during the course of bloodstream infection
    Open this publication in new window or tab >>Monocytic HLA-DR expression differs between bacterial etiologies and is inversely related to C-reactive protein and neutrophil count during the course of bloodstream infection
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    (English)Manuscript (preprint) (Other academic)
    National Category
    Family Medicine
    Identifiers
    urn:nbn:se:oru:diva-57488 (URN)
    Available from: 2017-04-25 Created: 2017-04-25 Last updated: 2017-04-25Bibliographically approved
    4. Expression of HLA-DRA and CD74 mRNA in whole blood during the course of complicated and uncomplicated Staphylococcus aureus bacteraemia
    Open this publication in new window or tab >>Expression of HLA-DRA and CD74 mRNA in whole blood during the course of complicated and uncomplicated Staphylococcus aureus bacteraemia
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    (English)Manuscript (preprint) (Other academic)
    National Category
    Family Medicine
    Identifiers
    urn:nbn:se:oru:diva-56198 (URN)
    Available from: 2017-03-08 Created: 2017-03-08 Last updated: 2017-04-25Bibliographically approved
  • Public defence: 2017-05-19 13:15 Örebro universitet, Gymnastikhuset, Hörsal G, Örebro
    Tolgfors, Björn
    Örebro University, School of Health Sciences.
    Bedömning för vilket lärande?: En studie av vad bedömning för lärande blir och gör i ämnet idrott och hälsa2017Doctoral thesis, monograph (Other academic)
    Abstract [en]

    This dissertation deals with the didactic consequences of assessment for learning (AfL) in the subject of physical education and health (PEH) at three upper secondary schools in Sweden. The purpose of the study is to investigate how assessment for learning is realised in PEH and what triadic relations between the teacher, student and subject content are established in the formative assessment practice. The empirical material consists of group reflections within a Teacher Learning Community (TLC) as well as field studies, including lesson observations and semi structured interviews with both students and teachers. In the first step of the analysis the material is categorized by means of the five key strategies (Wiliam, 2010a), in order to identify different ways of working with AfL in upper secondary PEH. The second step is a combination of a governmentality (Foucault, 1978/1991b), a performativity (Ball, 2003) and a didactic (Hudson, 2002) analysis, which illuminates what triadic relations are established under different conditions of governance.

    The findings highlight five fabrications of AfL in PEH, named after their most prominent features or functions, AfL as: i) Empowerment, ii) Physical Activation, iii) Grade Generation, iv) Constructive Alignment, v) Negotiation. ”Among the products of discursive practices are the very persons who engage in them” (Davies & Harré, 2001, p. 263). Accordingly, different teacher and student subjects as well as characteristics of the subject content are constituted in each of these fabrications.

    Moreover, the so called ‘backwash effect’ (Torrance, 2012) implies that the contrasting versions of AfL promote different kinds of learning, such as: i) increased autonomy, ii) participation in a community of practice, iii) criteria compliance, iv) acquisition of prescribed abilities, v) group development. However, the big idea of AfL is to adapt the teaching to the students and not the students to the knowledge requirements. Hence, this dissertation could serve as a basis for discussion on possible didactic implications of AfL in PEH.

  • Public defence: 2017-05-26 09:00 Campus USÖ, hörsal C3, Örebro
    Wickbom, Anna
    Örebro University, School of Medical Sciences.
    Epidemiological aspects of microscopic colitis2017Doctoral thesis, comprehensive summary (Other academic)
  • Public defence: 2017-06-01 09:00 Örebro universitet, Gymnastikhuset, hörsalen, Örebro
    Rasoal, Dara
    Örebro University, School of Health Sciences.
    Perspectives on clinical ethics support and ethically difficult situations: reflections and experiences2017Doctoral thesis, comprehensive summary (Other academic)
  • Public defence: 2017-06-02 13:00 Campus USÖ, hörsal C3, Örebro
    Zetterlund, Christina
    Örebro University, School of Medical Sciences.
    Visual, musculoskeletal, and balance symptoms in people with visual impairments2017Doctoral thesis, comprehensive summary (Other academic)
  • Public defence: 2017-06-09 13:00 Örebro universitet, Prismahuset, Hörsal 2, Örebro
    Englund, Ulrika
    Örebro University, School of Health Sciences.
    Samverkansprojekt, och sen då? - en uppföljande studie av samverkansprocessen kring barn och unga som far illa eller riskerar att fara illa2017Doctoral thesis, monograph (Other academic)
  • Public defence: 2017-06-12 13:00 Örebro universitet, Hörsalen, Musikhögskolan, Örebro
    Nhavoto, José António
    Örebro University, Orebro University School of Business, Örebro University, Sweden.
    Integration of Mobile Technologies with Routine Healthcare Services in Mozambique2017Doctoral thesis, comprehensive summary (Other academic)
  • Public defence: 2017-06-16 10:15 Örebro universitet, Långhuset, Hörsal 2, Örebro
    Hämberg, Eva
    Örebro University, School of Law, Psychology and Social Work, Örebro University, Sweden.
    Tillsyn i teori och praktik: om statlig styrning och kontroll av socialtjänstens individ och familjeomsorg2017Doctoral thesis, comprehensive summary (Other academic)
  • Public defence: 2017-06-16 13:00 Örebro universitet, Prismahuset, Hörsal 2, Örebro
    Warnicke, Camilla
    Örebro University, School of Health Sciences.
    Tolkning vid förmedlade samtal via Bildtelefoni.net: interaktion och gemensamt meningsskapande2017Doctoral thesis, comprehensive summary (Other academic)