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  • Dwibedi, Chinmay Kumar
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology. Umeå University, Faculty of Medicine, Molecular Infection Medicine Sweden (MIMS). Division of CBRN Security and Defence, Swedish Defense Research Agency, Umeå, Sweden.
    Birdsell, Dawn
    Larkeryd, Adrian
    Myrtennas, Kerstin
    Ohrman, Caroline
    Nilsson, Elin
    Karlsson, Edvin
    Hochhalter, Christian
    Rivera, Andrew
    Maltinsky, Sara
    Bayer, Brittany
    Keim, Paul
    Scholz, Holger C.
    Tomaso, Herbert
    Wittwer, Matthias
    Beuret, Christian
    Schuerch, Nadia
    Pilo, Paola
    Hernandez Perez, Marta
    Rodriguez-Lazaro, David
    Escudero, Raquel
    Anda, Pedro
    Forsman, Mats
    Wagner, David M.
    Larsson, Par
    Johansson, Anders
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology. Umeå University, Faculty of Medicine, Molecular Infection Medicine Sweden (MIMS).
    Long-range dispersal moved Francisella tularensis into Western Europe from the East2016In: Microbial Genomics, ISSN 2057-5858, Vol. 2, no 12Article in journal (Refereed)
    Abstract [en]

    For many infections transmitting to humans from reservoirs in nature, disease dispersal patterns over space and time are largely unknown. Here, a reversed genomics approach helped us understand disease dispersal and yielded insight into evolution and biological properties of Francisella tularensis, the bacterium causing tularemia. We whole-genome sequenced 67 strains and characterized by single-nucleotide polymorphism assays 138 strains, collected from individuals infected 1947-2012 across Western Europe. We used the data for phylogenetic, population genetic and geographical network analyses. All strains (n= 205) belonged to a monophyletic population of recent ancestry not found outside Western Europe. Most strains (n= 195) throughout the study area were assigned to a star-like phylogenetic pattern indicating that colonization of Western Europe occurred via clonal expansion. In the East of the study area, strains were more diverse, consistent with a founder population spreading from east to west. The relationship of genetic and geographic distance within the F. tularensis population was complex and indicated multiple long-distance dispersal events. Mutation rate estimates based on year of isolation indicated null rates; in outbreak hotspots only, there was a rate of 0.4 mutations/genome/year. Patterns of nucleotide substitution showed marked AT mutational bias suggestive of genetic drift. These results demonstrate that tularemia has moved from east to west in Europe and that F. tularensis has a biology characterized by long-range geographical dispersal events and mostly slow, but variable, replication rates. The results indicate that mutation-driven evolution, a resting survival phase, genetic drift and long-distance geographical dispersal events have interacted to generate genetic diversity within this species.

  • Bruening, Janina
    et al.
    Lasswitz, Lisa
    Banse, Pia
    Kahl, Sina
    Marinach, Carine
    Vondran, Florian W.
    Kaderali, Lars
    Silvie, Olivier
    Pietschmann, Thomas
    Meissner, Felix
    Gerold, Gisa
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Virology. Umeå University, Faculty of Medicine, Wallenberg Centre for Molecular Medicine at Umeå University (WCMM). Insitute for Experimental Virology, TWINCORE, Centre for Experimental and Clinical Infection Research, a joint venture between the Medical School Hannover and the Helmholtz Centre for Infection Research, Hannover, Germany.
    Hepatitis C virus enters liver cells using the CD81 receptor complex proteins calpain-5 and CBLB2018In: PLoS Pathogens, ISSN 1553-7366, E-ISSN 1553-7374, Vol. 14, no 7, article id e1007111Article in journal (Refereed)
    Abstract [en]

    Hepatitis C virus (HCV) and the malaria parasite Plasmodium use the membrane protein CD81 to invade human liver cells. Here we mapped 33 host protein interactions of CD81 in primary human liver and hepatoma cells using high-resolution quantitative proteomics. In the CD81 protein network, we identified five proteins which are HCV entry factors or facilitators including epidermal growth factor receptor (EGFR). Notably, we discovered calpain-5 (CAPN5) and the ubiquitin ligase Casitas B-lineage lymphoma proto-oncogene B (CBLB) to form a complex with CD81 and support HCV entry. CAPN5 and CBLB were required for a post-binding and pre-replication step in the HCV life cycle. Knockout of CAPN5 and CBLB reduced susceptibility to all tested HCV genotypes, but not to other enveloped viruses such as vesicular stomatitis virus and human coronavirus. Furthermore, Plasmodium sporozoites relied on a distinct set of CD81 interaction partners for liver cell entry. Our findings reveal a comprehensive CD81 network in human liver cells and show that HCV and Plasmodium highjack selective CD81 interactions, including CAPN5 and CBLB for HCV, to invade cells.

  • Nyberg, Björn
    Umeå University, Faculty of Arts, Department of language studies.
    Sociological Perspectives on Gender and Sexual Violence in The Handmaid's Tale2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    This essay aims to highlight and explain the gender inequality, the sexual assault and the rape in Atwood’s The Handmaid’s Tale from a feminist perspective, using the theory of the individualist, interactionist and institutional approach to gender found in Wharton’s The Sociology of Gender. Research questions: How does gender inequality shape the characters in the novel? What does it mean for them? How can the gender inequalities seen in Gilead society, as well as the sexual violence in the novel, be explained using sociological perspectives on gender? Gender inequality, which is what leads to the sexual violence, is produced on every level of society, and especially at the institutional level of society, that is, the culture of the society.

  • Ahlén Bergman, Emma
    et al.
    Hartana, Ciputra Adijaya
    Johansson, Markus
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology. Department of Urology, Sundsvall Hospital, Sundsvall, Sweden..
    Linton, Ludvig B
    Berglund, Sofia
    Hyllienmark, Martin
    Lundgren, Christian
    Holmström, Benny
    Palmqvist, Karin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology. Department of Surgery, Urology Section, Östersund County Hospital, Östersund, Sweden.
    Hansson, Johan
    Alamdari, Farhood
    Huge, Ylva
    Aljabery, Firas
    Riklund, Katrine
    Winerdal, Malin E
    Krantz, David
    Zirakzadeh, Ali A .
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology. Unit of Immunology and Allergy, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
    Marits, Per
    Sjöholm, Louise K
    Sherif, Amir
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology. Umeå University, Faculty of Medicine, Department of Radiation Sciences, Diagnostic Radiology.
    Winqvist, Ola
    Increased CD4+ T cell lineage commitment determined by CpG methylation correlates with better prognosis in urinary bladder cancer patients.2018In: Clinical Epigenetics, E-ISSN 1868-7083, Vol. 10, article id 102Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Urinary bladder cancer is a common malignancy worldwide. Environmental factors and chronic inflammation are correlated with the disease risk. Diagnosis is performed by transurethral resection of the bladder, and patients with muscle invasive disease preferably proceed to radical cystectomy, with or without neoadjuvant chemotherapy. The anti-tumour immune responses, known to be initiated in the tumour and draining lymph nodes, may play a major role in future treatment strategies. Thus, increasing the knowledge of tumour-associated immunological processes is important. Activated CD4+ T cells differentiate into four main separate lineages: Th1, Th2, Th17 and Treg, and they are recognized by their effector molecules IFN-γ, IL-13, IL-17A, and the transcription factor Foxp3, respectively. We have previously demonstrated signature CpG sites predictive for lineage commitment of these four major CD4+ T cell lineages. Here, we investigate the lineage commitment specifically in tumour, lymph nodes and blood and relate them to the disease stage and response to neoadjuvant chemotherapy.

    RESULTS: Blood, tumour and regional lymph nodes were obtained from patients at time of transurethral resection of the bladder and at radical cystectomy. Tumour-infiltrating CD4+ lymphocytes were significantly hypomethylated in all four investigated lineage loci compared to CD4+ lymphocytes in lymph nodes and blood (lymph nodes vs tumour-infiltrating lymphocytes: IFNG -4229 bp p < 0.0001, IL13 -11 bp p < 0.05, IL17A -122 bp p < 0.01 and FOXP3 -77 bp p > 0.05). Examination of individual lymph nodes displayed different methylation signatures, suggesting possible correlation with future survival. More advanced post-cystectomy tumour stages correlated significantly with increased methylation at the IFNG -4229 bp locus. Patients with complete response to neoadjuvant chemotherapy displayed significant hypomethylation in CD4+ T cells for all four investigated loci, most prominently in IFNG p < 0.0001. Neoadjuvant chemotherapy seemed to result in a relocation of Th1-committed CD4+ T cells from blood, presumably to the tumour, indicated by shifts in the methylation patterns, whereas no such shifts were seen for lineages corresponding to IL13, IL17A and FOXP3.

    CONCLUSION: Increased lineage commitment in CD4+ T cells, as determined by demethylation in predictive CpG sites, is associated with lower post-cystectomy tumour stage, complete response to neoadjuvant chemotherapy and overall better outcome, suggesting epigenetic profiling of CD4+ T cell lineages as a useful readout for clinical staging.

  • Klechikov, Alexey
    et al.
    Umeå University, Faculty of Science and Technology, Department of Physics.
    You, Shujie
    Umeå University, Faculty of Science and Technology, Department of Physics.
    Lackner, Lukas
    Umeå University, Faculty of Science and Technology, Department of Physics.
    Sun, Jinhua
    Umeå University, Faculty of Science and Technology, Department of Physics.
    Iakunkov, Artem
    Umeå University, Faculty of Science and Technology, Department of Physics.
    Rebrikova, Anastasia
    Umeå University, Faculty of Science and Technology, Department of Physics. Department of Chemistry, Moscow State University, Moscow, Russia.
    Korobov, Mikhail
    Baburin, Igor
    Seifert, Gotthard
    Talyzin, Aleksandr V.
    Umeå University, Faculty of Science and Technology, Department of Physics.
    Graphite oxide swelling in molten sugar alcohols and their aqueous solutions2018In: Carbon, ISSN 0008-6223, E-ISSN 1873-3891, Vol. 140, p. 157-163Article in journal (Refereed)
    Abstract [en]

    Graphite oxides (GO) are intercalated rapidly by one to several layers of solvent when immersed in liquid but the GO solvates are typically unstable on air due to solvent evaporation. Here we study swelling of GO in solvents (sugar alcohols) with melting temperature point above ambient. Using in situ synchrotron radiation XRD experiments we demonstrated GO swelling in molten xylitol and sorbitol. The expanded GO structure intercalated with one layer of xylitol or sorbitol is preserved upon solidification of melt and cooling back to ambient conditions. The structure of solid solvates of GO with xylitol and sorbitol is based on non-covalent interaction and pristine GO can be recovered by washing in water. Intercalation of xylitol and sorbitol into GO structure in aqueous solutions yields similar but less ordered structure of GO/sugar alcohol solid solvates. Very similar inter-layer distance was observed for GO intercalated by sugar alcohols in melt and for GO immersed in sugar solutions. This result shows that sugar alcohols penetrate into GO inter-layer space without hydration shell forming 2D layers with orientation parallel to graphene oxide sheets. Therefore, hydration diameter of molecules should not be considered as decisive factor for permeation through graphene oxide inter-layers in multilayered membranes.

  • Watt, Ruaridh
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Proof-of-Possession Tokens in Microservice Architectures2018Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    The popular OAuth 2.0 Framework specifies the use of Bearer Tokens for the transmission of authorization credentials. A Bearer Token has the property that any party in possession of it can use the it. Requests including Bearer Tokens are therefore performed over a secure channel t oensure that tokens cannot be obtained by eavesdroppers.

    There are, however, still ways in which tokens may be leaked, including cross-site scripting and man-in-the-middle attacks. In situations where Bearer Tokens do not provide adequate security, proof-of-possession techniques may be employed to bind tokens to clients, thereby mitigating token leakage.

    This project presents a method which can be used to bind tokens to clients based on authentication performed by an external identity provider. How clients form proof-of-possession tokens is also described. The resultis a token which may be used to transmit authorization credentials overan insecure channel.

    Token performance is measured in terms of client key generation time, token generation time, and authorization time. The effect different signing a lgorithms have on performance is measured and the proof-of-possession token is compared to Bearer Token based authorization.

    The results show that Elliptical Curve cryptography may be employed by lightweight devices to reduce client key and token generation times. The analysis also shows that an increase in authorization time by a factor of between six and nine can be expected when compared to Bearer Token based authorization.

  • Lindmark, Magnus
    et al.
    Umeå University, Faculty of Social Sciences, Department of Geography and Economic History, Economic history.
    Minde, Kjell-Björn
    Western Norway University of Applied Sciences.
    Et energiregnskap for Fastlands-Norge 1835–20122018In: Heimen, ISSN 0017-9841, E-ISSN 1894-3195, Vol. 55, no 2, p. 157-177Article in journal (Refereed)
    Abstract [en]

    Energy consumption in the Norwegian mainland economy 1835–2012

    A characteristic feature of the pre-industrial societies was that they relied on limited energy resources. It was only by using fossil fuels and new technologies that these societies could move the boundaries that the organic economy had set for production and consumption.

    Norwegian energy history is, from the 1900th Century on, about the movement of those boundaries and is composed of two stories. One deals with the mainland economy, the other deals with the foreign economy (the merchant marine, etc.). These two stories are closely connected but are nonetheless dissimilar.

    In this article, we present a sketch of the first story about energy consumption in the mainland economy, in the form of an energy accounting for the Norwegian mainland 1835–2012. The accounts show the accumulated consumption of energy from nine selected energy carriers in Norway. Our work is the first overall accounting 1835–2012, and gives new insights into the field of energy consumption research. Specifically, we provide a new accounting of Norwegian energy consumption in the years 1835–1900 and 1950–1976.

    In the result section we first present figures for energy consumption 1835–2012. Secondly, we briefly outline an energy history for the foreign sector. We round out the result section with a brief reflection on whether the Norwegian energy history is so deviant from other countries that we can talk about a separate Norwegian development.

  • Wiklund, Benkt
    et al.
    Elmroth, Boel
    Umeå University, Faculty of Arts, Humlab.
    Three perspectives on intersectoral collaboration: the teacher the doctoral student and the experienced researcher2018Conference paper (Other academic)
    Abstract [en]

    Industrial Doctoral School, IDS encourage all kinds of intersectoral collaboration in order to strengthen knowledge transfer and understanding for the common research ground. Intersectoral collaboration within IDS, at Umeå University is of utmost importance for the ongoing success for educators, supervisors and doctoral candidates. These activities are also of huge importance to participating partners, as knowledge is transferred on different levels and between the collaborators.

    Therefore our doctoral school includes a three month period for collaboration between the doctoral candidate and the external partner. This period can be used for projects and work tasks that run parallel to the regular doctoral project. This will give the candidate a deeper and broader understanding for the external partner’s culture, business and challenges.. For the external partner it will add new knowledge that is of importance to daily work.

    At Umeå University, intersectoral collaboration and mobility is considered so important that it is highlighted in the strategic plan Vision 2020 as one of the sub goals.

     In this presentation we will give three different perspectives on intersectoral collaboration. The first perspective is that of the educator. Through collaboration with an external partner and using the skills taught to the students, she/he will experience how knowledge taught is utilized. The aim is to increase the quality of the education.

    The second perspective is that of the doctoral candidate. Through participating in actual cases and projects the candidate will be trained in how to applicate theoretical knowledge, but also gain understanding for problems that is common in daily work for the partner. Here the main goal is to broaden the views and background knowledge in order increase the quality of the research and thesis.

    The third perspective is focusing on the research process. Through intersectoral collaboration, the researcher has come across new and outstanding opportunities to find new research partners, current research issues and real-life scientific data leading to novel findings and research results.

    Industrial Doctoral School, IDS, is a doctoral education in collaboration with an external partner. Supervisors and external partners are focusing on a joint research question of importance and validity to both parties. IDS has since 2008 accepted 50 doctoral candidates, involving more than 30 external partners and supervisors in projects with huge importance and impact to both the research area and the economic development.

  • Kulén, Martina
    Umeå University, Faculty of Science and Technology, Department of Chemistry.
    New alternatives to combat Listeria monocytogenes and Chlamydia trachomatis: Design, synthesis, and evaluation of substituted ring-fused 2-pyridones as anti-virulent agents2018Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Antibiotic resistance has become a global health burden with the number of resistant bacteria continuously increasing. Antibiotic drugs act by being either bactericidal (killing bacteria) or bacteriostatic (inhibiting growth of bacteria). However, these modes of action increase the selective pressure on the bacteria. An alternative treatment strategy to antibiotics is anti-virulence therapies that inhibits virulence of the pathogenic bacteria. The term “virulence” summarises a number of factors that the bacteria need to colonise a new niche and as a consequence its ability to infect and cause diseases. By inhibiting virulence, instead of killing, the selective pressure on the bacteria can be reduced and consequently decreases the rapid development of resistance. This thesis describes two projects focusing on development of anti-virulence agents, with the ring-fused 2-pyridone scaffold as the central character, targeting the bacteria Listeria monocytogenes and Chlamydia trachomatis.

    The first project is targeting L. monocytogenes, which is the cause for listeriosis in humans. This can develop into life-threatening encephalitis and meningitis as well as cause severe complications for developing fetus. The target in L. monocytogenes is the transcriptional regulator PrfA that control almost all virulence factors in this bacterium. We have designed and synthesised potent substituted ring-fused 2-pyridones, which at low micromolar concentrations block activation of the virulence regulator PrfA and thus attenuate the bacterial infection. Co-crystallisation of the active ring-fused 2-pyridones with PrfA resulted in determination of the exact substance interaction site in the protein. This facilitated further structure-based design that resulted in improved compounds capable of attenuating L. monocytogenes in an in vivo model.

    The second project targets C. trachomatis, which is the causative agent behind the most common sexually transmitted infection as well as the eye infection trachoma. By structure-activity relationship analysis of previously tested ring-fused 2-pyridones, we have designed and synthesised non-hydrolysable ring-fused 2-pyridone amide isosteres. The most potent analogues inhibit C. trachomatis infectivity at low nanomolar concentrations, without showing host cell toxicity or affecting the viability of commensal microbiota. Introduction of heteroatom substituents at specific sites of the ring-fused 2-pyridone scaffold, resulted in improved pharmacokinetic properties of the analogues and further evaluation in vivo was performed.

  • Lagesson, Annelie
    Umeå University, Faculty of Science and Technology, Department of Ecology and Environmental Sciences.
    Fish on drugs: behaviour modifying contaminants in aquatic ecosystems2018Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Contamination of surface waters is a worldwide problem. One group of emerging contaminants that reach aquatic ecosystems via sewage treatment plant effluents and agricultural run-offs is pharmaceuticals. Impacts of pharmaceuticals on the behaviour of aquatic organisms can have important ecological and evolutionary consequences because behaviour is directly linked to fitness. The aim of my doctoral thesis was to increase our understanding of the fate and effects of behaviour modifying drugs in aquatic ecosystems.

    While studying an aquatic ecosystem spiked with pharmaceuticals, I found that the benthic species at the bottom of the food chain were the main receivers (highest bioaccumulation factor; BAF) while fish at the top of the food web had the lowest uptake of the studied drugs. Interestingly, the BAF of the anxiolytic pharmaceutical oxazepam, increased in fish (perch; Perca fluviatilis) over the study period, suggesting that this drug can be transferred between trophic levels in food webs. To assess whether oxazepam could affect growth and survival in perch, I exposed perch populations to oxazepam for 2-months in a replicated pond experiment. In this study, I tested the hypothesis that oxazepam exposed perch would grow faster but also suffer from increased predation. Oxazepam has been shown previously to induce ‘anti-anxiety’ behaviours that improve foraging but may also make individuals more exposed to predators. In contrast, I found no statistically significant increase in growth and mortality in the exposed perch. However, the study revealed that the natural predator of perch (pike; Esox lucius) became less effective at catching prey when exposed to oxazepam. This exposure effect on predation efficiency likely contributed to the absence of predation effects in the exposed ponds. In two following laboratory studies I investigated effects of behaviour modifying drugs (oxazepam and a growth hormone, 17β-trenbolone) in combination with additional stressors (temperature and predator cues). Drug and temperature interactions were found for 17β-trenbolone, where water temperature interacted with treatment to induce changes in predator escape behaviour, boldness, and exploration in mosquitofish (Gambusia holbrooki). However, in the other study, we found that oxazepam, temperature, and predator cue all affected perch ‘anti-anxiety’ behaviours, but independently.

    I conclude that pharmaceuticals can alter ecologically important behaviours in fish, and that at least some, can accumulate in aquatic food webs. It seems that in situ effects of behaviour modifying drugs in aquatic ecosystems depend on both species-specific responses and abiotic interactions. As such, it is far from straightforward to predict net ecosystem effects based on experiments conducted using single species and static conditions. Future studies should assess the effects of pharmaceuticals in aquatic ecosystems under more complex conditions for us to gain a better understanding of what consequences behaviour modifying drugs have in the environment.

  • Boström, Per
    Umeå University, Faculty of Arts, Department of language studies.
    ”Det här är ju dött tåg liksom…”: en studie av metaforer för ROMANTISK KÄRLEK i talad svenska2018Doctoral thesis, monograph (Other academic)
    Abstract [en]

    The purpose of this study is to investigate the metaphorization of ROMANTIC LOVE in spoken Swedish. The study is based on 4 semi-structured focus group conversations with participants in two age groups; 24–33 and 50–54. A Swedish short film and questions related to the film were used as stimuli for the conversations. Research questions asked are 1) How is the concept of ROMANTIC LOVE metaphorized in the recorded group conversations? 2) How does the metaphorization vary between the conversations? and 3) What cultural model for ROMANTIC LOVE in the conversations can be reconstructed based on identified metaphorizations? The study is situated within Cognitive Linguistics and the framework of Conceptual Metaphor Theory and a Discourse Dynamics Approach to Metaphor. Consequently, metaphor is seen as a cognitive, linguistic, socio-cultural and discursive phenomenon, where metaphorization is a dynamic process that develops, adapts and flows within the conversations and between the participants. Accordingly, the identified metaphorizations are considered to be influenced by the speakers and their embodied experiences, their embodied cognition, the discourse event, and socio-cultural aspects of metaphorization. The focus of the present study, ROMANTIC LOVE, is considered as a dynamic concept based on philosophical, feminist, psychological and metaphorical research. Metaphors are identified through a discourse dynamic version of MIP and MIPVU.

    From the analyses, 6 systematic metaphors are proposed, where ROMANTIC LOVE is metaphorized as a PHYSICAL OBJECT (incl. as a POSSESSION and as a LIVING ORGANISM), as a CONTAINER (incl. CONSTRUCTION and BODY as a CONTAINER), as TRAVELLING together (with primary focus on TRAVELLING together rather than SOURCE or TARGET), as a UNITY (with focus on how a UNITY is ESTABLISHED, MAINTAINED and DISSOLVED, ideally by two COMPATIBLE partners), as a PHYSICAL and NATURAL FORCE and as a DISEASE (where LOVE can affect a person’s perception and sanity). In addition, ROMANTIC LOVE is, in a small number of expressions, metaphorized as a CRIME, as a PHYSICAL CONFLICT and as a GAME. The variation in metaphorization is small between the conversations. Some metaphorizations seem to be related to the age of the participants. ROMANTIC LOVE ismoreover something people usually have influence over and in some ways can control. In total, 780 metaphorical expressions and 9 source domains are identified. Departing from the interplay betweenmetaphorization and culture, a cultural model for ROMANTIC LOVE is reconstructed, where a multifaceted, embodied and experiential concept of ROMANTIC LOVE emerges.

  • Khatami, Alireza
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    It is on my skin, on my soul, and on my life: development of a disease-specific quality of life instrument for adult patients with acute cutaneous leishmaniasis in Iran2018Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Cutaneous leishmaniasis (CL), is the most common form of a group of diseases known as leishmaniases. They are caused by obligatory intracellular protozoa from the genus Leishmania and transmitted by sandflies. Over 350 million people are at risk of getting leishmaniasis and 1,000,000 to 1,200,000 individual get CL each year, the majority of them are living in developing countries. CL may affect a patient’s physical and mental health, and social relations impairing his/her quality of life (QoL).

    Aim: The aim of this thesis was to develop a disease-specific instrument for measuring QoL in adult patients suffering from the acute form of CL in Iran according to a needs-based approach.

    Methods: This thesis used a mixed-method approach and was based on two quantitative studies and one qualitative study. The first study was a systematic review on the randomized controlled clinical trials (RCTs) conducted on acute CL in the Old World. The second one was a qualitative content analysis study conducted through interviews with patients with CL in Iran. The third study was a psychometric evaluation of an instrument that was developed according to the results of the second study. For making a QoL instrument with fundamental measurement properties, the Rasch method was used.

    Results: The findings of the first paper demonstrated that the majority of the 50 reviewed RCTs were of poor quality of conduct and report. An important finding was that none of those studies included a patient-reported outcome in their primary, secondary, or even tertiary outcome assessments. To obtain the patients’ lived experience and perspectives on their disease, 12 individual in-depth interviews were conducted with patients with CL. Four themes were developed: "Fearing an agonizing disease" reflects patients' experiences of disease development resulting in sadness and depression, "struggling to cope" and "taking on the blame" both illustrate how patients experience living with the disease, which included both felt and enacted stigma as major social concerns. "Longing for being seen and heard" refers to patients' experiences with healthcare as well as their expectations and demands from communities and healthcare system to be involved in closing the knowledge and awareness gap. The third study was conducted as a survey on 107 patients with acute CL answering 50 questions with four response categories focusing different aspects of QoL, named “P-CL-QoL”, an acronym for Preliminary Cutaneous Leishmaniasis Quality of Life instrument. The Rasch fitness criteria for the original 50- item questionnaire indicated that it was not optimal for fundamental measurement of the QoL in CL patients. Two more Rasch models were developed by merging the last two response categories and making a 3-point Likert scale, and the three last response categories, making a dichotomized “Yes” and “No” response choices to each item. The final 34-item instrument with dichotomous responses showed improved measurement properties including very good targeting and item-separation index, internal consistency (Chronbach’s α=0.94), and a log-likelihood Chi square=2242.50 (degree of freedom=2640, and P=1.000) indicating excellent fitting to a Rasch model. This version was named Cutaneous Leishmaniasis Quality of Life instrument (CL-QoL). According our findings, the mean (±standard deviation) of raw scores and 0-34 scaled measures of the participants were 15.9 (±9.2) and 16.8 (±6.9), respectively. The impact of CL on the QoL of the patients was none to minimal in 17.0 %, mild in 25.0 %, moderate in 31.8 %, high in 12.5 %, and very high in 13.7 % of the participants. QoL impairment was not related to the sex and age of the individuals, geographic location where CL was caught, duration of the disease, and its severity (P>0.05).

    Conclusion: This thesis demonstrated that there is a lack of patients’ reported outcomes in clinical trials on CL, and that mental and social dimensions of CL are complex and adversely affect patients' lives by causing psychological burden and limiting their social interactions. The health authorities have to plan programs to increase the disease awareness in communities and among healthcare professionals to prevent the existing stigma and improve patients' social condition and medical care. While we could suggest a diseases-specific QoL measurement instrument through our third study, we acknowledge that the developed instrument may not be optimal and has to be validated in other populations, preferably using the Rasch method.

  • Ziegelasch, Michael
    et al.
    Forslind, Kristina
    Skogh, Thomas
    Riklund, Katrine
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Diagnostic Radiology. Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI).
    Kastbom, Alf
    Berglin, Ewa
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Rheumatology.
    Decrease in bone mineral density during three months after diagnosis of early rheumatoid arthritis measured by digital X-ray radiogrammetry predicts radiographic joint damage after one year2017In: Arthritis Research & Therapy, ISSN 1478-6354, E-ISSN 1478-6362, Vol. 19, no 1, article id 195Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Periarticular osteopenia is an early sign of incipient joint injury in rheumatoid arthritis (RA), but cannot be accurately quantified using conventional radiography. Digital X-ray radiogrammetry (DXR) is a computerized technique to estimate bone mineral density (BMD) from hand radiographs. The aim of this study was to evaluate whether decrease in BMD of the hands (BMD loss), as determined by DXR 3 months after diagnosis, predicts radiographic joint damage after 1 and 2 years in patients with early RA.

    METHODS: Patients (n = 176) with early RA (<12 months after onset of symptoms) from three different Swedish rheumatology centers were consecutively included in the study, and 167 of these patients were included in the analysis. Medication was given in accordance with Swedish guidelines, and the patients were followed for 2 years. Rheumatoid factor and antibodies to cyclic citrullinated peptides (anti-CCP) were measured at baseline, and 28-joint Disease Activity Score (DAS28) was assessed at each visit. Radiographs of the hands and feet were obtained at baseline, 3 months (hands only) and 1 and 2 years. Baseline and 1-year and 2-year radiographs were evaluated by the Larsen score. Radiographic progression was defined as a difference in Larsen score above the smallest detectable change. DXR-BMD was measured at baseline and after 3 months. BMD loss was defined as moderate when the decrease in BMD was between 0.25 and 2.5 mg/cm2/month and as severe when the decrease was greater than 2.5 mg/cm2/month. Multivariate regression was applied to test the association between DXR-BMD loss and radiographic damage, including adjustments for possible confounders.

    RESULTS: DXR-BMD loss during the initial 3 months occurred in 59% of the patients (44% moderate, 15% severe): 32 patients (19%) had radiographic progression at 1 year and 45 (35%) at 2 years. In multiple regression analyses, the magnitude of DXR-BMD loss was significantly associated with increase in Larsen score between baseline and 1 year (p = 0.033, adjusted R-squared = 0.069).

    CONCLUSION: DXR-BMD loss during the initial 3 months independently predicted radiographic joint damage at 1 year in patients with early RA. Thus, DXR-BMD may be a useful tool to detect ongoing joint damage and thereby to improve individualization of therapy in early RA.

  • Kampik, Timotheus
    et al.
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Nieves, Juan Carlos
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Lindgren, Helena
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Towards empathic autonomous agents2018In: / [ed] Viviana Mascardi, Alessandro Ricci, Danny Weyns, 2018Conference paper (Refereed)
    Abstract [en]

    Identifying and resolving conflicts of interests is a key challenge when designing autonomous agents. For example, such conflicts often occur when complex information systems interact persuasively with humans and are in the future likely to arise in non-human agent-to-agent interaction. We work towards a theoretical framework for an empathic autonomous agent that proactively identifies potential conflicts of interests in interactions with other agents (and humans) byl earning their utility functions and comparing them with its own preferences using a system of shared values to find a solution all agents consider acceptable.To provide a high-level overview of our work, we propose a reasoning-loop architecture to address the problem in focus. To realize specific components of the architecture, we suggest applying existing concepts in argumentation and utility theory. Reinforcement learning methods can be used by the agent to learn from and interact with its environment.

  • Kampik, Timotheus
    et al.
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Nieves, Juan Carlos
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Lindgren, Helena
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Coercion and deception in persuasive technologies2018In: Proceedings of the 20th International Trust Workshop / [ed] Robin Cohen, Murat Sensoy, Timothy J. Norman, CEUR-WS , 2018, p. 38-49Conference paper (Refereed)
    Abstract [en]

    Technologies that shape human behavior are of high societal relevance, both when considering their current impact and their future potential. In information systems research and in behavioral psychology, such technologies are typically referred to as persuasive technologies. Traditional definitions like the ones created by Fogg, and Harjumaa and Oinas-Kukkonen, respectively, limit the scope of persuasive technology to non-coercive, non-deceptive technologies that are explicitly designed for persuasion. In this paper we analyze existing technologies that blur the line between persuasion, deception,and coercion. Based on the insights of the analysis, we lay down an updated definition of persuasive technologies that includes coercive and deceptive forms of persuasion. Our definition also accounts for persuasive functionality that was not designed by the technology developers. We argue that this definition will help highlight ethical and societal challenges related to technologies that shape human behavior and encourage research that solves problems with technology-driven persuasion. Finally, we suggest multidisciplinary research that can help address the challenges our definition implies. The suggestions we provide range from empirical studies to multi-agent system theory.

  • Jarl, Josefina
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Självvald inläggning som krisintervention för personer med emotionell instabilitet och självskadebeteende: En kvalitativ intervjustudie om patienters erfarenheter2018Independent thesis Advanced level (degree of Master (Two Years)), 30 credits / 45 HE creditsStudent thesis
    Abstract [sv]

    Självvald inläggning är en vårdform som möjliggör för patienter inom psykiatrin att själv bestämma när en sjukhusinläggning är nödvändig. För patienter med emotionelltinstabiltpersonlighetsssyndrom(EIPS) och självskadebeteendehar denna vårdform kommit att ses som en lämplig intervention, eftersom studier visar att längre psykiatriska inläggningar är kontraproduktiva och således har en potentiell skadlig effektpå dessa patienter. Utöver dettaanses vårdformen passande utifrån de kliniska riktlinjer som lyfter främjandet av autonomi som särskilt viktig i behandlingen av patienter med EIPS. Några särskilda riktlinjer för hur autonomin i praktiken kan främjas ges dock inte, vilket innebär att det varit fritt för vårdgivare att omsätta dessa rekommendationer i den praktiska vården. Motbakgrund avdenna osäkerhetär det viktigt att utvärderaeffekterna av SI som vårdform.I dennauppsatsundersöktes patienternas syn och erfarenhet av vårdformen, med fokus på hur den ökade egenmakten upplevts i relation till de olika delkomponenterna i SI. Till hjälp i analysen av materialet användes de teoretiska begreppen autonomi, empowerment och paternalism. Analysen visar att patienterna upplevde vissa delar som egenmaktstärkande(empowering)och andra delar som svåra och ångestskapande. Vidare visar analysen att SI innebär ett lärande i att ta egenansvar. Etttydliggörande avmotiven bakomdelkomponenterna ökar patientens autonomi,samt kan hjälpa patienten att stå ut med svåra och ångestskapandekänslori läroprocessen mot att hantera egenansvaroch såledespå siktbli mer autonom.Analysen visar även attsjuksköterskan kan ha en viktig roll i att stödja patienten i denna process tillatt uppleva egenmaktoch utöva sin autonomi. Uppsatsens slutsatserangående de olika delkomponenternaär atttillgång till två stödsamtal per dag, egenhantering av medicin, tredagars-bestämmelsenkanbidra till attstärka patientens autonomiom motivenbakom dem tydliggörs för patienten.Möjligheten att själv bestämma tidpunkt för inläggning är särskilt gynnsamt för patienterna, eftersom de upplever en större trygghet i att få tillgång till vård i akuta situationer.En del patienter kan dock behöva stöd i att få veta att beslutet att lägga in sig själv var berättigat.Vid kontraktsskrivningen bör patienten bli ännu mer noggrant informerad om vårdformen med dess motiv och de eventuella utmaningar patienten kan uppleva i relation till de olika delkomponenterna. Vidare kan regeln om förtida utskrivning, i fall där en patient bryter mot avdelningens regler, leda till ettännu merakut försämrat psykiskt mående, eftersom patienten riskerar att uppleva utskrivningen som ett svek från vårdens sidaoch ett personligt misslyckande. I värsta fall kan detta få förödande konsekvenser såsom självmord. Regeln bör därför tas bort. SI-kontraktet bör inte ha formen för ett kontrakt, eftersom det implicerar att vården är villkorad, vilket kanha en negativ inverkan på patientens tillit till vården. Enkelrummet uppskattades i hög grad och bör utvärderas ytterligare, samtförslagsvis erbjudas som alternativ till delat ruminom ramen för den vanliga akutpsykiatriska slutenvården. Detta eftersom detkan vara gynnsamtför andra patientgrupper också.

  • olsen Nilsen, christine
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    En kvalitativ studie om hur skolkuratorer arbetar med att hantera mobbning2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    SAMMANFATTNINGSyftet med denna studie är att beskriva och analysera hur kuratorer arbetar med insatser gentemot mobbning på individ-grupp-och organisationsnivå i det skolkurativa arbetet. Med hjälp av en kvalitativ metod har författaren samlat in data. Fem intervjuer har genomförts med skolkuratorer på två mindre kommuner i Sverige. Under intervjuerna har författaren använt sig av semistrukturerade frågor utifrån en intervjuguide för att belysa hur kuratorernaarbetar kring mobbning. Vidare har en konventionell innehållsanalys används för att analysera fram studiens resultat.Resultatet visar att skolkuratorerna får till största del upplysningar om pågående mobbning av lärare, elever samt föräldrar. Kuratorerna använder sig inte av något specifikt mobbningsprogram ellermetod för att utreda mobbningsärenden. Istället visar resultatetpå att delar av ”Farstamodellen” används men också individ-och gruppsamtal och i samverkan med elevhälsoteam. Det förebyggande arbetet med ökad vuxennärvaro bland eleverna upplevs som ett positivt sätt att upptäcka gryende konflikter och stävja mobbning. Ett fungerande samarbete mellan föräldrar, elever och personal anses också vara betydelsefullt. Varje ärende behöver individanpassas för bästa slutresultat.

  • Brändström Nyström, Maja
    Umeå University, Faculty of Arts, Department of language studies.
    French is essentential because the school system demands it: Une étude sociolinguistique sur les attitudes envers le français aux Seychelles2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    This study takes off in is its confirmation of the result of previous research: within the

    population of the Seychelles, the general attitude towards the French language is negative rather

    than positive. Such a state of affairs is uncommon to find in postcolonial countries, where the

    occidental languages tend to be highly esteemed. Through qualitative interviewing of

    Seychellois teachers, this study examines the reasons for said negative attitudes, combining the

    result of the interviews with sociolinguistic and postcolonial theories on language, attitude and

    identity. As reasons for the negative attitudes, the study points out the lack of domains in which

    to make use of French, as well as inadequate identification opportunities. The colonial heritage

    plays an active role in the shaping of linguistic attitudes in modern day Seychelles.

  • Paulsson, Magnus
    et al.
    Che, Karlhans F.
    Ahl, Jonas
    Tham, Johan
    Sandblad, Linda
    Umeå University, Faculty of Medicine, Department of Molecular Biology (Faculty of Medicine).
    Smith, Margaretha E.
    Qvarfordt, Ingemar
    Su, Yu-Ching
    Linden, Anders
    Riesbeck, Kristian
    Bacterial Outer Membrane Vesicles Induce Vitronectin Release Into the Bronchoalveolar Space Conferring Protection From Complement-Mediated Killing2018In: Frontiers in Microbiology, ISSN 1664-302X, E-ISSN 1664-302X, Vol. 9, article id 1559Article in journal (Refereed)
    Abstract [en]

    Pathogens causing pneumonia utilize the complement regulator vitronectin to evade complement-mediated killing. Although vitronectin is associated with several chronic lung diseases, the role of bronchoalveolar vitronectin in pneumonia has not been studied. This study sought to reveal the involvement of vitronectin in the bronchoalveolar space during pneumonia, to assess the effect of outer membrane vesicles and endotoxin on vitronectin release, and to determine whether bacterial pathogens utilize pulmonary vitronectin for evasion. Vitronectin was analyzed in cell-free bronchoalveolar lavage fluid harvested from patients with pneumonia (n = 8) and from healthy volunteers after subsegmental endotoxin instillation (n = 13). Vitronectin binding by Pseudomonas aeruginosa and Haemophilus influenzae was analyzed, and subsequent complement evasion was assessed by serum challenge. The effects of outer membrane vesicles on vitronectin production in mouse lungs and human type II alveolar epithelial cells (A549) were determined. We detected increased vitronectin concentrations in lavage fluid during pneumonia (p = 0.0063) and after bronchial endotoxin challenge (p = 0.016). The capture of vitronectin by bacteria significantly reduced complement-mediated lysis. Following challenge with vesicles, vitronectin was detected in mouse bronchoalveolar space, and mouse alveolar epithelial cells in vivo as well as A549 cells in vitro contained increased levels of vitronectin. Taken together, outer membrane vesicles and endotoxin from Gram-negative bacteria induce vitronectin, which is released into the bronchoalveolar space, and used for evasion of complement-mediated clearance.

  • Håkansson Lindqvist, Marcia
    et al.
    Pettersson, Fanny
    Umeå University, Faculty of Social Sciences, Department of Education.
    Leading For Digitalization: Exploring The Leadership Perspective2018In: ICICTE 2018, the international conference on information communication technologies in education 2018: proceedings / [ed] Linda Morris, Costas Tsolakidis, Chania, Crete, 2018, p. 371-381Conference paper (Refereed)
    Abstract [en]

    This paper focuses on how school leaders understand digitalization and the digital competences needed for leading digitalization in Swedish schools. In this small study, 31 school leaders at the end of their studies in the Swedish national professional development program for school leaders answered a survey, mainly based on open questions, regarding professional development and leadership for digitalization. In the analysis, Dexter’s four categories of (a) setting the direction, (b) developing people, (c) developing the organization, and (d) developing teaching and learning, were used to bring order in the data. The results show that school leaders see digitalization as a wide and complex concept including technical, pedagogical, administrational and organizational challenges at all levels of the school organization.

  • Mostafavi, Ehsan
    et al.
    Ghasemi, Ahmad
    Rohani, Mahdi
    Molaeipoor, Leila
    Esmaeili, Saber
    Mohammadi, Zeinolabedin
    Mahmoudi, Ahmad
    Aliabadian, Mansour
    Johansson, Anders
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology. Umeå University, Faculty of Medicine, Molecular Infection Medicine Sweden (MIMS).
    Molecular Survey of Tularemia and Plague in Small Mammals From Iran2018In: Frontiers in Cellular and Infection Microbiology, E-ISSN 2235-2988, Vol. 8, article id 215Article in journal (Refereed)
    Abstract [en]

    Introduction: Plague and tularemia are zoonoses and their causative bacteria are circulating in certain regions of Iran. This study was conducted to investigate potential disease reservoirs amongst small wildlife species in different regions of Iran.

    Methods: Rodents, insectivores and hares from 17 different provinces of the country were collected in 2014 and 2015. Samples were taken from the spleens of the animals and Real-time PCR was applied to detect nucleic acid sequences that are specific to Francisella tularensis and Yersinia pestis, respectively.

    Results: Among 140 collected rodents, 25 distinct species were identified out of which five were the most common: Microtus paradoxus (21% out of 140 rodents), Apodemus witherbyi (12%), Microtus irani (11%), Mus musculus (11%) and Microtus socialis (10%). Seventeen insectivores were collected and identified as Crocidura suaveolens (82%) and C. leucodon (18%). Fifty-one hares were collected and identified as Lepus europaeus (57%), Lepus tolai (14%) and Lepus sp. (29%). Three out of 140 explored rodents (1.91%) were positive for F. tularensis, an A. witherbyi, a Mus musculus domesticus, and a Chionomys nivalis collected from Golestan, Khuzestan and Razavi Khorasan provinces, respectively. Two hares (3.92%) were F. tularensis-positive, a L. europaeus from Khuzestan and a Lepus sp. from the Sistan and Baluchistan province. None of the tested animals were positive for Y. pestis.

    Conclusion: This is the first report of direct detection of F. tularensis in mammals of Iran and the first-time observation of the agent in a snow vole, C. nivalis worldwide. The results indicate that tularemia is more widespread in Iran than previously reported including the Northeast and Southwestern parts of the country. Future studies should address genetic characterization of F. tularensis positive DNA samples from Iran to achieve molecular subtyping and rule out assay cross-reactivity with near neighbor Francisella species.

  • Gustafsson, Cecilia
    Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR). Umeå University, Faculty of Social Sciences, Department of Geography and Economic History.
    ‘“For a better life …“ A study on migration and health in Nicaragua’2018In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 11, no 1, article id 1428467Article, review/survey (Refereed)
    Abstract [en]

    Background: Nicaraguans have migrated internally and internationally for centuries due to economic, political and sociocultural factors. Deficiencies in the country’s health care system have produced inequities in people’s access to health care and medicines. Remittances have become an important source of income, partly invested in health.

    Objectives: The overall aim of the study was to analyse migration–health relations in contemporary Nicaragua within a broader context of socio-economic transformations.

    Methods: The study uses a mixed-methods approach, combining qualitative interview data and quantitative survey data.

    Results: The findings show that migration is commonly practised as a strategy for making a living and is related to the struggle for a better life. Health concerns are indirectly embedded in people’s mobile livelihoods, but also directly influence migration motives. Furthermore, migration involves both advantages and disadvantages for health. Physical and sexual violence can come to an end for migrating women, health care and medicine can become more accessible for internal migrants, and vulnerabilities caused by environmental disasters can be avoided by moving. Moreover, remittances can improve people’s everyday life and health. Yet migration can also be a stressful and health-damaging event. International migrants, particularly the undocumented, can have problems accessing health care, and also experience much danger at border crossings. Transnational families can suffer emotionally as well as physically due to separation. Findings from the survey show that family members of migrants do not rate their physical health as good as often as non-migrating families.

    Conclusions: The Nicaraguan population is not guaranteed its social rights of citizenship. This results in mobile livelihoods and the need for translocal social support (e.g. remittances). Migration can have both positive and negative effects on health for migrants and their family members; geographical distance and social differences are key to the outcome.

  • Abbara, Aula
    et al.
    Rawson, Timothy M.
    Karah, Nabil
    Umeå University, Faculty of Medicine, Department of Molecular Biology (Faculty of Medicine). Umeå University, Faculty of Medicine, Molecular Infection Medicine Sweden (MIMS). Umeå University, Faculty of Medicine, Umeå Centre for Microbial Research (UCMR).
    El-Amin, Wael
    Hatcher, James
    Tajaldin, Bachir
    Dar, Osman
    Dewachi, Omar
    Abu Sitta, Ghassan
    Uhlin, Bernt Eric
    Umeå University, Faculty of Medicine, Umeå Centre for Microbial Research (UCMR). Umeå University, Faculty of Medicine, Molecular Infection Medicine Sweden (MIMS). Umeå University, Faculty of Medicine, Department of Molecular Biology (Faculty of Medicine).
    Sparrow, Annie
    Antimicrobial resistance in the context of the Syrian conflict: Drivers before and after the onset of conflict and key recommendations2018In: International Journal of Infectious Diseases, ISSN 1201-9712, E-ISSN 1878-3511, Vol. 73, p. 1-6Article, review/survey (Refereed)
    Abstract [en]

    Current evidence describing antimicrobial resistance (AMR) in the context of the Syrian conflict is of poor quality and sparse in nature. This paper explores and reports the major drivers of AMR that were present in Syria pre-conflict and those that have emerged since its onset in March 2011. Drivers that existed before the conflict included a lack of enforcement of existing legislation to regulate over-the-counter antibiotics and notification of communicable diseases. This contributed to a number of drivers of AMR after the onset of conflict, and these were also compounded by the exodus of trained staff, the increase in overcrowding and unsanitary conditions, the increase in injuries, and economic sanctions limiting the availability of required laboratory medical materials and equipment. Addressing AMR in this context requires pragmatic, multifaceted action at the local, regional, and international levels to detect and manage potentially high rates of multidrug-resistant infections. Priorities are (1) the development of a competent surveillance system for hospital-acquired infections, (2) antimicrobial stewardship, and (3) the creation of cost-effective and implementable infection control policies. However, it is only by addressing the conflict and immediate cessation of the targeting of health facilities that the rehabilitation of the health system, which is key to addressing AMR in this context, can progress. 

  • Birdsell, D. N.
    et al.
    Özsürekci, Y.
    Rawat, A.
    Aycan, A. E.
    Mitchell, C. L.
    Sahl, J. W.
    Johansson, Anders
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology. Umeå University, Faculty of Medicine, Molecular Infection Medicine Sweden (MIMS).
    Colman, R. E.
    Schupp, J. M.
    Ceyhan, M.
    Keim, P. S.
    Wagner, D. M.
    Coinfections identified from metagenomic analysis of cervical lymph nodes from tularemia patients2018In: BMC Infectious Diseases, ISSN 1471-2334, E-ISSN 1471-2334, Vol. 18, article id 319Article in journal (Refereed)
    Abstract [en]

    Background: Underlying coinfections may complicate infectious disease states but commonly go unnoticed because an a priori clinical suspicion is usually required so they can be detected via targeted diagnostic tools. Shotgun metagenomics is a broad diagnostic tool that can be useful for identifying multiple microbes simultaneously especially if coupled with lymph node aspirates, a clinical matrix known to house disparate pathogens. The objective of this study was to analyze the utility of this unconventional diagnostic approach (shotgun metagenomics) using clinical samples from human tularemia cases as a test model. Tularemia, caused by the bacterium Francisella tularensis, is an emerging infectious disease in Turkey. This disease commonly manifests as swelling of the lymph nodes nearest to the entry of infection. Because swollen cervical nodes are observed from many different types of human infections we used these clinical sample types to analyze the utility of shotgun metagenomics.

    Methods: We conducted an unbiased molecular survey using shotgun metagenomics sequencing of DNA extracts from fine-needle aspirates of neck lymph nodes from eight tularemia patients who displayed protracted symptoms. The resulting metagenomics data were searched for microbial sequences (bacterial and viral).

    Results: F. tularensis sequences were detected in all samples. In addition, we detected DNA of other known pathogens in three patients. Both Hepatitis B virus (HBV) and Human Parvovirus B-19 were detected in one individual and Human Parvovirus B-19 alone was detected in two other individuals. Subsequent PCR coupled with Sanger sequencing verified the metagenomics results. The HBV status was independently confirmed via serological diagnostics, despite evading notice during the initial assessment.

    Conclusion: Our data highlight that shotgun metagenomics of fine-needle lymph node aspirates is a promising clinical diagnostic strategy to identify coinfections. Given the feasibility of the diagnostic approach demonstrated here, further steps to promote integration of this type of diagnostic capability into mainstream clinical practice are warranted.

  • Jonsson, Thim
    Umeå University, Faculty of Science and Technology, Department of Applied Physics and Electronics.
    Miljöcertifiering av befintlig byggnad: Utredning om tillvägagångssätt och tidsåtgång enligt Miljöbyggnad 3.02018Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    This report is a bachelor thesis at Umeå University. The purpose of this report is to show the choice of method, approach and timeframe according to the environmental building for existing buildings. \\ \\ Miljöbyggnad is a certification system in which indicators for energy, environment and materials are examined. If the building meets the requirements, it will receive an environmental certification. Miljöbyggnad started already in 2003, when it was called the Miljöklassad byggnad and was a cooperation between the municipality, companies and government for sustainable development in the construction and real estate sector. This was linked to the environmental goals set by the government in 1999. \\ \\The indicators investigated in this work have been linked to energy and the environment. According to the instructions for environmental construction, many of the indicators can be reported by simulated values or measured/calculated values. \\ The results associated with the indicators have been investigated by measurement, calculation and simulation where comparison of methods has been made. \\ \\ The work has resulted in a proposal for ways in which the company, in connection with an energy declaration, can make a rough estimate of whether an environmental construction process can be done. If the building is considered suitable for such certification, the proposal is that collection of necessary information about the building will take place in the first step. It includes everything from drawings of the entire property to inventory of the property's internal loads. Furthermore, the energy and environmental data of the building will be simulated in order to be able to compare against environmental building requirements. This approach is considered to be most appropriate for most properties. \\ There are easier ways to judge some of the indicators, but it also requires a room/officespace to meet certain conditions.

  • Picallo, Óscar
    Umeå University, Faculty of Social Sciences, Department of Psychology. Institutionen för integrativ medicinsk biologi (IMB), Department of Integrative Medical Biology (IMB).
    The effect of positive arousal on memory retrieval of advertisements: A neuromarketing approach2018Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    The objective of this neuromarketing study is to investigate the effect of positive emotional contexts in the recall of neutral stimuli. In the present fMRI experiment, 26 Russian participants of whom, 13 were women, and 13 were men, with an average age of 23.4 years and within a range of age between 18 and 35 years, were scanned while performing a recognition memory test composed of two phases: encoding phase and retrieval phase. In the encoding phase, different snacks products were shown on the monitor accompanied by emotional scenes (high arousal and low arousal scenes) and neutral scenes. Later, at the retrieval phase, the participants were shown the same products plus the same number of unseen products again. The participants had to answer if they remember the product or not. The results obtained showed that the two areas closely related to memory, such as the amygdala and the hippocampus, did not show greater activation when the subjects successfully recalled the neutral stimuli that had been exposed in emotional contexts. On the other hand, other areas related to episodic emotional memory, such as the temporal cortex, the insula or the cingulate cortex, did show greater activation. On the behavioural level, I did not find an improvement of the memory performance on the emotional condition compared to the neutral condition. This study shows a large number of brain areas involved in the retrieval process and the limitations that emotional scenarios have when it comes to improving memory performance.

  • Angelov, Angel G.
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Methods for interval-censored data and testing for stochastic dominance2018Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    This thesis includes four papers: the first three of them are concerned with methods for interval-censored data, while the forth paper is devoted to testing for stochastic dominance.

    In many studies, the variable of interest is observed to lie within an interval instead of being observed exactly, i.e., each observation is an interval and not a single value. This type of data is known as interval-censored. It may arise in questionnaire-based studies when the respondent gives an answer in the form of an interval without having pre-specified ranges. Such data are called self-selected interval data. In this context, the assumption of noninformative censoring is not fulfilled, and therefore the existing methods for interval-censored data are not necessarily applicable.

    A problem of interest is to estimate the underlying distribution function. There are two main approaches to this problem: (i) parametric estimation, which assumes a particular functional form of the distribution, and (ii) nonparametric estimation, which does not rely on any distributional assumptions. In Paper A, a nonparametric maximum likelihood estimator for self-selected interval data is proposed and its consistency is shown. Paper B suggests a parametric maximum likelihood estimator. The consistency and asymptotic normality of the estimator are proven.

    Another interesting problem is to infer whether two samples arise from identical distributions. In Paper C, nonparametric two-sample tests suitable for self-selected interval data are suggested and their properties are investigated through simulations.

    Paper D concerns testing for stochastic dominance with uncensored data. The paper explores a testing problem which involves four hypotheses, that is, based on observations of two random variables X and Y, one wants to discriminate between four possibilities: identical survival functions, stochastic dominance of X over Y, stochastic dominance of Y over X, or crossing survival functions. Permutation-based tests suitable for two independent samples and for paired samples are proposed. The tests are applied to data from an experiment concerning the individual's willingness to pay for a given environmental improvement.

  • Larsson, D. G. Joakim
    et al.
    Andremont, Antoine
    Bengtsson-Palme, Johan
    Brandt, Kristian Koefoed
    Husman, Ana Maria de Roda
    Fagerstedt, Patriq
    Fick, Jerker
    Umeå University, Faculty of Science and Technology, Department of Chemistry.
    Flach, Carl-Fredrik
    Gaze, William H.
    Kuroda, Makoto
    Kvint, Kristian
    Laxminarayan, Ramanan
    Manaia, Celia M.
    Nielsen, Kaare Magne
    Plant, Laura
    Ploy, Marie-Cécile
    Segovia, Carlos
    Simonet, Pascal
    Smalla, Kornelia
    Snape, Jason
    Topp, Edward
    van Hengel, Arjon J.
    Verner-Jeffreys, David W.
    Virta, Marko P. J.
    Wellington, Elizabeth M.
    Wernersson, Ann-Sofie
    Critical knowledge gaps and research needs related to the environmental dimensions of antibiotic resistance2018In: Environment International, ISSN 0160-4120, E-ISSN 1873-6750, Vol. 117, p. 132-138Article, review/survey (Refereed)
    Abstract [en]

    There is growing understanding that the environment plays an important role both in the transmission of antibiotic resistant pathogens and in their evolution. Accordingly, researchers and stakeholders world-wide seek to further explore the mechanisms and drivers involved, quantify risks and identify suitable interventions. There is a clear value in establishing research needs and coordinating efforts within and across nations in order to best tackle this global challenge. At an international workshop in late September 2017, scientists from 14 countries with expertise on the environmental dimensions of antibiotic resistance gathered to define critical knowledge gaps. Four key areas were identified where research is urgently needed: 1) the relative contributions of different sources of antibiotics and antibiotic resistant bacteria into the environment; 2) the role of the environment, and particularly anthropogenic inputs, in the evolution of resistance; 3) the overall human and animal health impacts caused by exposure to environmental resistant bacteria; and 4) the efficacy and feasibility of different technological, social, economic and behavioral interventions to mitigate environmental antibiotic resistance.

  • Kuhn, McKenzie
    et al.
    Umeå University, Faculty of Science and Technology, Department of Ecology and Environmental Sciences. Department of Renewable Resources, University of Alberta, 116 St & 85 Ave, Edmonton, AB, CA, T6G 2R3, Canada.
    Lundin, Erik J
    Umeå University, Faculty of Science and Technology, Department of Ecology and Environmental Sciences. Swedish Polar Research Secretariat, Abisko Scientific Research Station, SE-981 07, Abisko, Sweden.
    Giesler, Reiner
    Umeå University, Faculty of Science and Technology, Department of Ecology and Environmental Sciences.
    Johansson, Margareta
    Karlsson, Jan
    Umeå University, Faculty of Science and Technology, Department of Ecology and Environmental Sciences.
    Emissions from thaw ponds largely offset the carbon sink of northern permafrost wetlands2018In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 8, article id 9535Article in journal (Refereed)
    Abstract [en]

    Northern regions have received considerable attention not only because the effects of climate change are amplified at high latitudes but also because this region holds vast amounts of carbon (C) stored in permafrost. These carbon stocks are vulnerable to warming temperatures and increased permafrost thaw and the breakdown and release of soil C in the form of carbon dioxide (CO2) and methane (CH4). The majority of research has focused on quantifying and upscaling the effects of thaw on CO2 and CH4 emissions from terrestrial systems. However, small ponds formed in permafrost wetlands following thawing have been recognized as hotspots for C emissions. Here, we examined the importance of small ponds for C fluxes in two permafrost wetland ecosystems in northern Sweden. Detailed flux estimates of thaw ponds during the growing season show that ponds emit, on average (±SD), 279 ± 415 and 7 ± 11 mmol C m−2 d−1 of CO2 and CH4, respectively. Importantly, addition of pond emissions to the total C budget of the wetland decreases the C sink by ~39%. Our results emphasize the need for integrated research linking C cycling on land and in water in order to make correct assessments of contemporary C balances.

  • Reckien, Diana
    et al.
    Salvia, Monica
    Heidrich, Oliver
    Church, Jon Marco
    Pietrapertosa, Filomena
    De Gregorio-Hurtado, Sonia
    D'Alonzo, Valentina
    Foley, Aoife
    Simoes, Sofia G.
    Lorencova, Eliska Krkoska
    Orru, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Faculty of Medicine, University of Tartu, Ravila 19, 51007 Tartu, Estonia.
    Orru, Kati
    Wejs, Anja
    Flacke, Johannes
    Olazabal, Marta
    Geneletti, Davide
    Feliu, Efren
    Vasilie, Sergiu
    Nador, Cristiana
    Krook-Riekkola, Anna
    Matosovic, Marko
    Fokaides, Paris A.
    Ioannou, Byron I.
    Flamos, Alexandros
    Spyridaki, Niki-Artemis
    Balzan, Mario V.
    Fulop, Orsolya
    Paspaldzhiev, Ivan
    Grafakos, Stelios
    Dawson, Richard
    How are cities planning to respond to climate change?: Assessment of local climate plans from 885 cities in the EU-282018In: Journal of Cleaner Production, ISSN 0959-6526, E-ISSN 1879-1786, Vol. 191, p. 207-219Article in journal (Refereed)
    Abstract [en]

    The Paris Agreement aims to limit global mean temperature rise this century to well below 2 degrees C above pre-industrial levels. This target has wide-ranging implications for Europe and its cities, which are the source of substantial greenhouse gas emissions. This paper reports the state of local planning for climate change by collecting and analysing information about local climate mitigation and adaptation plans across 885 urban areas of the EU-28. A typology and framework for analysis was developed that classifies local climate plans in terms of their alignment with spatial (local, national and international) and other climate related policies. Out of eight types of local climate plans identified in total we document three types of stand-alone local climate plans classified as type Al (autonomously produced plans), A2 (plans produced to comply with national regulations) or A3 (plans developed for international climate networks). There is wide variation among countries in the prevalence of local climate plans, with generally more plans developed by central and northern European cities. Approximately 66% of EU cities have a type Al, A2, or A3 mitigation plan, 26% an adaptation plan, and 17% a joint adaptation and mitigation plan, while about 33% lack any form of stand-alone local climate plan (i.e. what we classify as Al, A2, A3 plans). Mitigation plans are more numerous than adaptation plans, but planning for mitigation does not always precede planning for adaptation. Our analysis reveals that city size, national legislation, and international networks can influence the development of local climate plans. We found that size does matter as about 80% of the cities with above 500,000 inhabitants have a comprehensive and stand-alone mitigation and/or an adaptation plan (Al). Cities in four countries with national climate legislation (A2), i.e. Denmark, France, Slovakia and the United Kingdom, are nearly twice as likely to produce local mitigation plans, and five times more likely to produce local adaptation plans, compared to cities in countries without such legislation. Al and A2 mitigation plans are particularly numerous in Denmark, Poland, Germany, and Finland: while Al and A2 adaptation plans are prevalent in Denmark, Finland, UK and France. The integration of adaptation and mitigation is country-specific and can mainly be observed in two countries where local climate plans are compulsory, i.e. France and the UK. Finally, local climate plans produced for international climate networks (A3) are mostly found in the many countries where autonomous (type Al) plans are less common. This is the most comprehensive analysis of local climate planning to date. The findings are of international importance as they will inform and support decision making towards climate planning and policy development at national, EU and global level being based on the most comprehensive and up-to-date knowledge of local climate planning available to date. 

  • Maier, Dominique Béatrice
    et al.
    Umeå University, Faculty of Science and Technology, Department of Ecology and Environmental Sciences.
    Gälman, Veronika
    Renberg, Ingemar
    Umeå University, Faculty of Science and Technology, Department of Ecology and Environmental Sciences.
    Bigler, Christian
    Umeå University, Faculty of Science and Technology, Department of Ecology and Environmental Sciences.
    Using a decadal diatom sediment trap record to unravel seasonal processes important for the formation of the sedimentary diatom signal2018In: Journal of Paleolimnology, ISSN 0921-2728, E-ISSN 1573-0417, Vol. 60, no 2, p. 133-152Article in journal (Refereed)
    Abstract [en]

    Sediment trap studies and high frequency monitoring are of great importance to develop a deeper understanding of how seasonal environmental processes are imprinted in sediment signal formation. We collected whole year diatom assemblages from 2002 to 2014 with a sequential sediment trap from a varved boreal lake (Nylandssjon, Sweden) together with environmental and limnological parameters, and compared them with the corresponding diatom record of the annual laminated sediment. Our data set indicates a large year-to-year variability of diatom succession and abundance patterns, which is well reflected in the varved sediments. Specifically, Cyclotella glomerata dominated the annual sediment trap record (as well as in the corresponding sediment varves) in years with warmer air temperatures in March/April, and Asterionella formosa dominated the annual sediment assemblages as a consequence of years characterized by higher runoff before lake over-turn. Years succeeding forest clearance in the lake catchment showed marked increase in diatom and sediment flux. The DCA scores of the yearly diatom trap assemblages clearly resemble the lake's thermal structure, which indicates that the relative abundance of major taxa seems primarily controlled by the timing of seasonal environmental events, such as above-average winter air temperature and/or autumn runoff and the current thermal structure of the lake. The high seasonal variability between environmental drivers in combination with the physical limnology leaves us with several possible scenarios leading to either an A. formosa versus C. glomerata dominated annual diatom sediment signal. With this study we highlight that short-term environmental events and seasonal limnological conditions are of major importance for interpreting annual sediment signals.

  • Allaberdyev, Maksat
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Economics.
    Universal Basic Income and Sweden: -A simulation of the Swedish economy2018Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    What if you could separate your salary from work, what would happen? How would individuals in a society react? Would they invest more in human capital, would they work halftime or at all? These are questions that follows if Universal Basic Income (UBI) would be implemented. What is Universal Basic Income? UBI is a suggestion of a welfare system where every month the state gives its citizens a sum of money without conditions. The idea is old but has resurfaced lately due to the fear that automation is destroying jobs in a faster rate than new jobs can be created. But Sweden also faces other challenges. After the crisis in Syria, Germany and Sweden were the two European countries who took in the most refugees which will contribute to the rising gap of unemployment between natives and people who are born outside of the country. Research done by Försäkringskassan, a public institute in Sweden shows that people who end up in long term illness has increased over time, and the prediction is that more people are heading towards that direction. With these challenges, the potential of UBI was interesting to examine.

    With an DSGE-model, the behaviour of the agents in the economy was simulated in a closed economy. The results showed that the UBI grew the sectors size compared to the baseline model without the UBI. Households of various skills increased their purchsing power with UBI compared to households without UBI. The simulations also showed that the price that the firms had to pay to compensate workers for labour increased with UBI, indicating that UBI is possibly inflationary. The simulations were compared with two surveys about the attitudes towards UBI and the labour market. Some of the answers about labour hours were in line with the simulations, while others were not. The majority of the respondents answered that UBI would not affect their labour hours, indicating that the model with rational expectations does a poor job of catching attitudes, because agents don’t always act rational. It could also depend on that most of the respondents are highly educated and have different preferences compared with other individuals who have lower skills. An improvement of the study is firstly to include a central bank as an additional agent to capture the effects of monetary policy and inflation, secondly open up the economy to capture the effects of trade.

  • Nyman, Emma
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Lindqvist, Per
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Näslund, Ulf
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Grönlund, Christer
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Risk marker variability in subclinical carotid plaques based on ultrasound is influenced by cardiac phase, echogenicity and size2018In: Ultrasound in Medicine and Biology, ISSN 0301-5629, E-ISSN 1879-291X, Vol. 44, no 8, p. 1742-1750Article in journal (Refereed)
    Abstract [en]

    Identification of risk markers based on quantitative ultrasound texture analysis of carotid plaques has the ability to define vulnerable components that correlate with increased cardiovascular risk. However, data describing factors with the potential to influence the measurement variability of risk markers are limited. The aim of this study was to evaluate the influence of electrocardiogram-guided image selection, plaque echogenicity and area on carotid plaque risk markers and their variability in asymptomatic carotid plaques. Plaque risk markers were measured in 57 plaques during three consecutive heartbeats at two cardiac cycle time instants corresponding to the electrocardiogram R-wave (end diastole) and end of T-wave (end systole), resulting in six measurements for each plaque. Risk marker variability was quantified by computing the coefficient of variation (CV) across the three heartbeats. The CV was significantly higher for small plaques (area <15 mm2, 10%) than for large plaques (area >15 mm2, 6%) (p <0.001) in measurements of area, and the CV for measurements of gray-scale median were higher for echolucent plaques (<40, 15%) than for echogenic plaques (>40, 9%) (p <0.001). No significant differences were found between systole and diastole for the mean of any risk marker or the corresponding CV value. However, in a sub-analysis, the echolucent plaques were found to have a higher CV during systole compared with diastole. The variability also caused plaque type reclassification in 16% to 25% of the plaques depending on cutoff value. The results of this study indicate that echolucent and small plaques each contribute to increased risk marker variability. Based on these results, we recommend that measurements in diastole arc preferred to reduce variation, although we found that it may not be possible to characterize small plaques accurately using contemporary applied risk markers. 

  • Byenfeldt, Marie
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Elvin, Anders
    Fransson, Per
    Umeå University, Faculty of Medicine, Department of Nursing.
    On patient related factors and their impact on ultrasound-based shear wave elastography of the liver2018In: Ultrasound in Medicine and Biology, ISSN 0301-5629, E-ISSN 1879-291X, Vol. 44, no 8, p. 1606-1615Article in journal (Refereed)
    Abstract [en]

    The aim of the study was to investigate patient-related factors associated with either reliable or poorly reliable measurement results of ultrasound-based shear wave elastography (SWE) of the liver. A total of 188 patients were analyzed prospectively with binary logistic regression using the interquartile range/median as cutoff to define two groups based on reliable and poorly reliable SWE results. SWE results correlated significantly with liver biopsy. Factors associated with reliable SWE results (i.e., no negative impact on measurements) were age, sex, cirrhosis, antiviral and/or cardiovascular medication, smoking habits and body mass index. Factors associated with poorly reliable SWE results were increased skin-to-liver capsule distance (odds ratio = 3.08, 95% confidence interval: 1.70-5.60) and steatosis (odds ratio =2.89, 95% confidence interval: 1.33-6.28). These findings indicate that the interquartile range/median as a quality parameter is useful in avoiding poorly reliable SWE results. How best to examine patients with increased skin-to-liver capsule distance is a matter of some controversy, as the incidences of obesity, diabetes and metabolic syndrome are increasing worldwide; however, our results indicate that reliable SWE results can be obtained in this group of patients by using ultrasound-based SWE. (Email:, ) 

  • Pettifor, Audrey
    et al.
    Lippman, Sheri A.
    Gottert, Ann
    Suchindran, Chirayath M.
    Selin, Amanda
    Peacock, Dean
    Maman, Suzanne
    Rebombo, Dumisani
    Twine, Rhian
    Gómez-Olivé, Francesc Xavier
    Tollman, Stephen M.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
    Kahn, Kathleen
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
    MacPhail, Catherine
    Community mobilization to modify harmful gender norms and reduce HIV risk: results from a community cluster randomized trial in South Africa2018In: Journal of the International AIDS Society, ISSN 1758-2652, E-ISSN 1758-2652, Vol. 21, no 7, article id e25134Article in journal (Refereed)
    Abstract [en]

    Introduction: Community mobilization (CM) is increasingly recognized as critical to generating changes in social norms and behaviours needed to achieve reductions in HIV. We conducted a CM intervention to modify negative gender norms, particularly among men, in order to reduce associated HIV risk.

    Methods: Twenty two villages in the Agincourt Health and Socio-Demographic Surveillance Site in rural Mpumalanga, South Africa were randomized to either a theory-based, gender transformative, CM intervention or no intervention. Two cross-sectional, population-based surveys were conducted in 2012 (pre-intervention, n = 600 women; n = 581 men) and 2014 (pos-tintervention, n = 600 women; n = 575 men) among adults ages 18 to 35 years. We used an intent-to-treat (ITT) approach using survey regression cluster-adjusted standard errors to determine the intervention effect by trial arm on gender norms, measured using the Gender Equitable Mens Scale (GEMS), and secondary behavioural outcomes.

    Results: Among men, there was a significant 2.7 point increase (Beta Coefficient 95% CI: 0.62, 4.78, p = 0.01) in GEMS between those in intervention compared to control communities. We did not observe a significant difference in GEMS scores for women by trial arm. Among men and women in intervention communities, we did not observe significant differences in perpetration of intimate partner violence (IPV), condom use at last sex or hazardous drinking compared to control communities. The number of sex partners in the past 12 months (AOR 0.29, 95% CI 0.11 to 0.77) were significantly lower in women in intervention communities compared to control communities and IPV victimization was lower among women in intervention communities, but the reduction was not statistically significant (AOR 0.53, 95% CI 0.24 to 1.16).

    Conclusion: Community mobilization can reduce negative gender norms among men and has the potential to create environments that are more supportive of preventing IPV and reducing HIV risk behaviour. Nevertheless, we did not observe that changes in attitudes towards gender norms resulted in desired changes in risk behaviours suggesting that more time may be necessary to change behaviour or that the intervention may need to address behaviours more directly.

  • Scortichini, Matteo
    et al.
    de'Donato, Francesca
    De Sario, Manuela
    Leone, Michela
    Åström, Christofer
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Ballester, Ferran
    Basagaña, Xavier
    Bobvos, Janos
    Gasparrini, Antonio
    Katsouyanni, Klea
    Lanki, Timo
    Menne, Bettina
    Pascal, Mathilde
    Michelozzi, Paola
    The inter-annual variability of heat-related mortality in nine European cities (1990–2010)2018In: Environmental health, ISSN 1476-069X, E-ISSN 1476-069X, Vol. 17, no 1, article id 66Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The association between heat and daily mortality and its temporal variation are well known. However, few studies have analyzed the inter-annual variations in both the risk estimates and impacts of heat. The aim is to estimate inter-annual variations in the effect of heat for a fixed temperature range, on mortality in 9 European cities included in the PHASE (Public Health Adaptation Strategies to Extreme weather events) project for the period 1990-2010. The second aim is to evaluate overall summer effects and heat-attributable deaths for each year included in the study period, considering the entire air temperature range (both mild and extreme temperatures).

    METHODS: A city-specific daily time-series analysis was performed, using a generalized additive Poisson regression model, restricted to the warm season (April-September). To study the temporal variation for a fixed air temperature range, a Bayesian Change Point analysis was applied to the relative risks of mortality for a 2 °C increase over the 90th percentile of the city-specific distribution. The number of heat attributable deaths in each summer were also calculated for mild (reference to 95th percentile) and extreme heat (95th percentile to maximum value).

    RESULTS: A decline in the effects of heat over time was observed in Athens and Rome when considering a fixed interval, while an increase in effects was observed in Helsinki. The greatest impact of heat in terms of attributable deaths was observed in the Mediterranean cities (Athens, Barcelona and Rome) for extreme air temperatures. In the other cities the impact was mostly related to extreme years with 2003 as a record breaking year in Paris (+ 1900 deaths) and London (+ 1200 deaths).

    CONCLUSIONS: Monitoring the impact of heat over time is important to identify changes in population vulnerability and evaluate adaptation measures.

  • Kärnebro, Katarina
    et al.
    Umeå University, Faculty of Social Sciences, Department of applied educational science, Umeå Centre for Evaluation Research (UCER).
    Carlbaum, Sara
    Umeå University, Faculty of Social Sciences, Department of applied educational science, Umeå Centre for Evaluation Research (UCER).
    Utvärdering av Läslyftet. Delrapport 6: En fallstudie av Läslyftets avtryck och effekter i grundskolan2018Report (Other academic)
  • Holmberg, Carl
    Umeå University, Faculty of Science and Technology, Department of Physics.
    Cut finite element methods for incompressibleflows with unfitted interfaces2018Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Problems with time-evolving domains are frequently occurring in computationalfluid dynamics and many other fields of science and engineering.Unfitted methods, where the computational mesh does not conform to thegeometry, are of great interest for handling such problems, since they removethe burden of mesh generation. We work towards the goal of developingan unfitted solver for Navier-Stokes equations on time-evolving domainsby developing and presenting cut finite element (CutFEM) splitting methodsfor solving Navier-Stokes equations. These CutFEM splitting methodsuse Nitsche’s method for incorporating boundary conditions and employpatch-based ghost penalty stabilization of the cut elements to achieve stabilityand optimal order error estimates. Numerical benchmarks are used toverify the methods and implementations. The methods are tested against aproblem with known analytical solution, the Taylor-Green vortex, and alsocompared to the classical Deutsche Forschungsgemeinschaft (DFG) benchmarkproblem with channel flow around a cylinder. For both benchmarks,the methods was shown to be stable when satisfying the parabolic Courant–Friedrichs–Lewy (CFL) condition, and to produce optimal convergencerates.

  • Jin, Jing
    et al.
    Sherman, Michael B.
    Chafets, Daniel
    Dinglasan, Nuntana
    Lu, Kai
    Lee, Tzong-Hae
    Carlson, Lars-Anders
    Umeå University, Faculty of Medicine, Department of Medical Biochemistry and Biophysics.
    Muench, Marcus O.
    Simmons, Graham
    An attenuated replication-competent chikungunya virus with a fluorescently tagged envelope2018In: PLoS Neglected Tropical Diseases, ISSN 1935-2727, E-ISSN 1935-2735, Vol. 12, no 7, article id e0006693Article in journal (Refereed)
    Abstract [en]

    Background: Chikungunya virus (CHIKV) is the most common alphavirus infecting humans worldwide, causing acute and chronically debilitating arthralgia at a great economic expense.

    Methodology/Principal findings: To facilitate our study of CHIKV, we generated a mCherry tagged replication-competent chimeric virus, CHIKV 37997-mCherry. Single particle cryoEM demonstrated icosahedral organization of the chimeric virus and the display of mCherry proteins on virus surface. CHIKV 37997-mCherry is attenuated in both IFN alpha R knockout and wild-type mice. Strong antiCHIKV and anti-mCherry antibody responses were induced in CHIKV 37997-mCherry infected mice.

    Conclusions/Significance: Our work suggests that chimeric alphaviruses displaying foreign antigen can serve as vaccines against both aphaviruses and other pathogens and diseases.

  • Liedgren, Lars
    et al.
    Bergman, Ingela
    Ramqvist, Per H.
    Umeå University, Faculty of Arts, Department of historical, philosophical and religious studies. Institute for Sub-Arctic Landscape Research (INSARC), Silvermuseet, Arjeplog, Sweden.
    Hörnberg, Greger
    Hearths in the coastal areas of northernmost Sweden, from the period AD 800 to 19502016In: Rangifer, ISSN 0333-256X, E-ISSN 1890-6729, Vol. 36, no 1, p. 25-50Article in journal (Refereed)
    Abstract [en]

    This paper presents a study of the chronological setting of hearths registered in FMIS (digital register containing records of all known ancient monuments in Sweden) in the provinces of Västerbotten and Norrbotten, Northern Sweden. A total of c. 1500 hearths are known in the area, mainly situated north of the river Skellefteälven. Within a study area of 107 x 94 km, 32 hearths were randomly selected for excavation, each site embracing 1-14 hearths. The sites were scanned using a metal detector and nearly all artifacts found were from the period AD 1600-1900. 14C-datings of charcoal and burned bones corroborated that most hearths were used during this period, with a large number dating to the 19th and 20th centuries. Many hearths contained bones from mature reindeer, indicating that the hearths were related to reindeer herding. We suggest that most hearths are related to nomadic Sami reindeer herders using coastal areas for winter pasture, possibly resulting from the breakdown of the “lappskatteland” (taxation lands) system and an increase in reindeer numbers.

  • Hartana, Ciputra Adijaya
    et al.
    Bergman, Emma Ahlén
    Zirakzadeh, A. Ali
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology.
    Krantz, David
    Winerdal, Malin E.
    Winerdal, Max
    Johansson, Markus
    Alamdari, Farhood
    Jakubczyk, Tomasz
    Glise, Hans
    Riklund, Katrine
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Diagnostic Radiology.
    Sherif, Amir
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology.
    Winqvist, Ola
    Urothelial bladder cancer may suppress perforin expression in CD8+ T cells by an ICAM-1/TGFβ2 mediated pathway2018In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 7, article id e0200079Article in journal (Refereed)
    Abstract [en]

    The immune system plays a significant role in urothelial bladder cancer (UBC) progression, with CD8+ T cells being capable to directly kill tumor cells using perforin and granzymes. However, tumors avoid immune recognition by escape mechanisms. In this study, we aim to demonstrate tumor immune escape mechanisms that suppress CD8+ T cells cytotoxicity. 42 patients diagnosed with UBC were recruited. CD8+ T cells from peripheral blood (PB), sentinel nodes (SN), and tumor were analyzed in steady state and in vitro-stimulated conditions by flow cytometry, RT-qPCR, and ELISA. Mass spectrometry (MS) was used for identification of proteins from UBC cell line culture supernatants. Perforin was surprisingly found to be low in CD8+ T cells from SN, marked by 1.8-fold decrease of PRF1 expression, with maintained expression of granzyme B. The majority of perforin-deficient CD8+ T cells are effector memory T (TEM) cells with exhausted Tc2 cell phenotype, judged by the presence of PD-1 and GATA-3. Consequently, perforin-deficient CD8+ T cells from SN are low in T-bet expression. Supernatant from muscle invasive UBC induces perforin deficiency, a mechanism identified by MS where ICAM-1 and TGFβ2 signaling were causatively validated to decrease perforin expression in vitro. Thus, we demonstrate a novel tumor escape suppressing perforin expression in CD8+ T cells mediated by ICAM-1 and TGFβ2, which can be targeted in combination for cancer immunotherapy.

  • Spinord, Linda
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine. Department of Research, Region Norrbotten, Luleå.
    Kassberg, Ann-Charlotte
    Stenberg, Gunilla
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Lundqvist, Robert
    Stålnacke, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Comparison of two multimodal pain rehabilitation programmes, in relation to sex and age2018In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 50, no 7, p. 619-628Article in journal (Refereed)
    Abstract [en]

    Objective: To evaluate patient-reported outcome measures in 2 different multimodal pain rehabilitation programmes and to determine whether outcomes are related to sex or age at 1-year follow-up.

    Design: Longitudinal retrospective study.

    Subjects: Patients who had participated in 1 of 2 multimodal pain rehabilitation programmes at 2 rehabilitation centres. A total of 356 women and 83 men, divided into 3 age groups.

    Methods: Data from the Swedish Quality Registry for Pain Rehabilitation regarding activity and physical functions, pain intensity, health status and emotional functions analysed with descriptive statistics.

    Results: Significant improvements in activity and physical functions, pain intensity and emotional functions were found in both multimodal pain rehabilitation programmes. Women improved more than men. The older group improved in all emotional functions (depression, anxiety, mental component summary), while the younger group improved only in depression. The intermediate group improved in all variables except anxiety.

    Conclusion: Patients improved regardless of the design of the multimodal pain rehabilitation programme. Although only small differences were found between men and women and among the 3 age groups in terms of the measured variables, these findings may have clinical relevance and indicate a need to vary the design of the interventions in multimodal rehabilitation programmes for these subgroups.

  • Karat, Aaron S.
    et al.
    Maraba, Noriah
    Tlali, Mpho
    Charalambous, Salome
    Chihota, Violet N.
    Churchyard, Gavin J.
    Fielding, Katherine L.
    Hanifa, Yasmeen
    Johnson, Suzanne
    McCarthy, Kerrigan M.
    Kahn, Kathleen
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana.
    Chandramohan, Daniel
    Grant, Alison D.
    Performance of verbal autopsy methods in estimating HIV-associated mortality among adults in South Africa2018In: BMJ Global Health, E-ISSN 2059-7908, Vol. 3, no 4, article id e000833Article in journal (Refereed)
    Abstract [en]

    Introduction: Verbal autopsy (VA) can be integrated into civil registration and vital statistics systems, but its accuracy in determining HIV-associated causes of death (CoD) is uncertain. We assessed the sensitivity and specificity of VA questions in determining HIV status and antiretroviral therapy (ART) initiation and compared HIV-associated mortality fractions assigned by different VA interpretation methods.

    Methods: Using the WHO 2012 instrument with added ART questions, VA was conducted for deaths among adults with known HIV status (356 HIV positive and 103 HIV negative) in South Africa. CoD were assigned using physician-certified VA (PCVA) and computer-coded VA (CCVA) methods and compared with documented HIV status.

    Results: The sensitivity of VA questions in detecting HIV status and ART initiation was 84.3% (95% CI 80 to 88) and 91.0% (95% CI 86 to 95); 283/356 (79.5%) HIV-positive individuals were assigned HIV-associated CoD by PCVA, 166 (46.6%) by InterVA-4.03, 201 (56.5%) by InterVA-5, and 80 (22.5%) and 289 (81.2%) by SmartVA-Analyze V.1.1.1 and V.1.2.1. Agreement between PCVA and older CCVA methods was poor (chance-corrected concordance [CCC] <0; cause-specific mortality fraction [CSMF] accuracy <= 56%) but better between PCVA and updated methods (CCC 0.21-0.75; CSMF accuracy 65%-98%). All methods were specific (specificity 87% to 96%) in assigning HIV-associated CoD.

    Conclusion: All CCVA interpretation methods underestimated the HIV-associated mortality fraction compared with PCVA; InterVA-5 and SmartVA-Analyze V. 1.2.1 performed better than earlier versions. Changes to VA methods and classification systems are needed to track progress towards targets for reducing HIV-associated mortality.

  • Lindqvist, Maria
    Umeå University, Faculty of Arts, Department of language studies.
    La triple identidad del personaje Sayonara en La novia oscura de Laura Restrepo2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [es]

    En el presente trabajo hacemos un análisis de la novela La novia oscura de la escritora colombiana Laura Restrepo. El objetivo de este trabajo es investigar la triple identidad de la protagonista Sayonara. Ella representa tres personajes; La Niña, Sayonara y Amanda y juntas foman una triple identidad. La trama se desarolla en la epoca de los años cuarenta, allí trabajaba Sayonara como prostituta. A través del estudio del texto nos aproxiamaremos a la transición de Sayonara de una identidad a otra. Analizamos La novia oscura desde la perspectiva poscolonial y feminista. Aplicamos las teorías de Mary Louise Pratt, sobre  la perspectiva euro-centrista que presenta en su libro Imperial Eyes:Travel writing and transculturation. Nos referimos también a Raewyn Connell, una investigadora australiense, que ha investigado las relaciones del género y las estructuras patriarcales en la sociedad. 

  • Kailembo, Alexander
    et al.
    Quiñonez, Carlos
    Lopez Mitnik, Gabriela V.
    Weintraub, Jane A.
    Stewart Williams, Jennifer
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Research Centre for Generational Health and Ageing, University of Newcastle, Callaghan, Australia.
    Preet, Raman
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Iafolla, Timothy
    Dye, Bruce A.
    Income and wealth as correlates of socioeconomic disparity in dentist visits among adults aged 20 years and over in the United States, 2011–20142018In: BMC Oral Health, ISSN 1472-6831, E-ISSN 1472-6831, Vol. 18, no 1, article id 147Article in journal (Refereed)
    Abstract [en]

    Background: Most studies in the United States (US) have used income and education as socioeconomic indicators but there is limited information on other indicators, such as wealth. We aimed to assess how two socioeconomic status measures, income and wealth, compare as correlates of socioeconomic disparity in dentist visits among adults in the US.

    Methods: Data from the National Health and Nutrition Examination Survey (NHANES) 2011–2014 were used to calculate self-reported dental visit prevalence for adults aged 20 years and over living in the US. Prevalence ratios using Poisson regressions were conducted separately with income and wealth as independent variables. The dependent variable was not having a dentist visit in the past 12 months. Covariates included sociodemographic factors and untreated dental caries. Parsimonious models, including only statistically significant (p < 0.05) covariates, were derived. The Akaike Information Criterion (AIC) measured the relative statistical quality of the income and wealth models. Analyses were additionally stratified by race/ethnicity in response to statistically significant interactions.

    Results: The prevalence of not having a dentist visit in the past 12 months among adults aged 20 years and over was 39%. Prevalence was highest in the poorest (58%) and lowest wealth (57%) groups. In the parsimonious models, adults in the poorest and lowest wealth groups were close to twice as likely to not have a dentist visit (RR 1.69; 95%CI: 1.51–1.90) and (RR 1.68; 95%CI: 1.52–1.85) respectively. In the income model the risk of not having a dentist visit were 16% higher in the age group 20–44 years compared with the 65+ year age group (RR 1.16; 95%CI: 1.04–1.30) but age was not statistically significant in the wealth model. The AIC scores were lower (better) for the income model. After stratifying by race/ethnicity, age remained a significant indicator for dentist visits for non-Hispanic whites, blacks, and Asians whereas age was not associated with dentist visits in the wealth model.

    Conclusions: Income and wealth are both indicators of socioeconomic disparities in dentist visits in the US, but both do not have the same impact in some populations in the US.

  • Kjellsson, Anton
    Umeå University, Faculty of Science and Technology, Department of Applied Physics and Electronics.
    Analys av energi, kostnad och CO2-utsläpp med/utan ångtork och förbränning/sluttäckning med slam rörande slamhantering på ett avloppsreningsverk i Umeå2018Independent thesis Advanced level (professional degree), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    De ökade deponi- och transportkostnaderna har skapat ett ökat intresse att effektivisera hanteringen av avloppsslam. Umeås allmänna avloppsreningsverk (Vakin) tar emot avloppsvatten från mer än 80 000 hushåll och företag och det mesta leds till reningsverket på Ön. Efter 2020 upphör avtalet med Dåva deponi om att avloppsreningsverket får använda slammet till sluttäckning av deponier. Ett alternativ till deponering är torkning med efterföljande förbränning.Detta examensarbete har genomförts på uppdrag av Vakin och syftet var att kartlägga energiflödena och CO2-utsläppen före och efter en implementering av en ångtork i byggnaderna rörande slamhantering. Även effekter av förbränning respektive deponering av slam har inkluderats. Ett mål var presentera ett systemförslag för hur ångtorken kan implementeras till befintlig anläggning. För att uppnå syftet inhämtades data genom inventering på plats och i projektplaneringsverktyget Projectplace. Därefter beräknades och sammanställdes energibehovet, kostnaden och klimatpåverkan för respektive energiförbrukande enhet i Microsoft Excel Förslaget till implementering av ångtorken är baserat på litteraturdata.Resultatet visar att det årliga energibehovet för slamhantering skulle öka från cirka 2 700 MWh till cirka 3 000 MWh. Vilket resulterar i att den årliga kostnaden för slamhantering ökar från cirka 6,2 miljoner kronor till cirka 7,5 miljoner kronor. Men den årliga klimatpåverkan skulle minska från cirka 930 ton CO2 till cirka 490 ton CO2 med en ångtork. Det årliga elbehovet för slamhantering ökar från inget energibehov till 2 100 MWh vid en installation av en ångtork. Detta eftersom cirka hälften av biogasen som tidigare användes till att producera el- och värmeenergi förväntas användas i ångtorken. Detta resulterar i att den årliga elkostnaden minskar från en intäkt på 650 000 kronor till en kostnad på cirka 4,6 miljoner kronor. Vidare ökar den årliga klimatpåverkan för elen från cirka 10 ton CO2 till cirka 180 ton CO2.Det årliga energibehovet för transporten minskar från cirka 2 700 MWh till cirka 900 MWh vid en installation av en ångtork. Eftersom ångtorken reducerar mängden slam som ska transporteras. Vilket resulterar i att den årliga kostnaden för transporten minskar från cirka 4,1 miljoner kronor till cirka 1,4 miljoner kronor. Även klimatpåverkan för transporten minskar från cirka 720 ton CO2 till cirka 240 ton CO2. Det årliga energibehovet idag är oförändrat när Vakin förbränner det torkade slammet. Eftersom energibehovet för sluttäckning inte beaktats och energibehovet för förbränning av torkat slam är noll. Den årliga kostnaden minskar från cirka 2,8 miljoner kronor till cirka 1,6 miljoner kronor. Eftersom mängden slam minskar mer än vad kostnaden för att förbränna slammet ökar. Den årliga klimatpåverkan minskar från cirka 180 ton CO2 till inget CO2-utsläpp. Eftersom klimatpåverkan att förbränna förnybart biologiskt material är noll.

    Energikartläggningen av fastigheterna visar att idag förbrukar utrustningen och belysningen rörande slamhantering cirka 760 MWh respektive 25 MWh el. Byggnaderna rörande slamhantering förbrukar idag cirka 1 200 MWh (byggnad 4) respektive 500 MWh (byggnad 5) värmeenergi. Dessa värden är jämförbara med andra liknande slamhanteringsanläggningar. Ur ett hållbarhetsperspektiv rekommenderas att Vakin installerar en ångtork, vilket medför bland annat en minskad årlig transportsträcka och därav reduceras CO2-utsläppen från transporten. Den mest lämpliga integreringen av en ångtork till ett avloppsreningsverk är att upprätthålla en arbetstemperatur för rötkamrarna med värmen från kondensationen av det förångade vattnet, återcirkulera den överhettade ångan som värms av förbränningen av metangasen från rötkamrarna samt blanda torkat slam med blöt slam för att undvika slammets klibbiga fas.

  • Otten, Julia
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Stomby, Andreas
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Waling, Maria
    Umeå University, Faculty of Social Sciences, Department of Food and Nutrition.
    Isaksson, Andreas
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Sports medicine.
    Söderström, Ingegerd
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Ryberg, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Svensson, Michael
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Sports medicine.
    Hauksson, Jón
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Radiation Physics.
    Olsson, Tommy
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    A heterogeneous response of liver and skeletal muscle fat to the combination of a Paleolithic diet and exercise in obese individuals with type 2 diabetes: a randomised controlled trial2018In: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428, Vol. 61, no 7, p. 1548-1559Article in journal (Refereed)
    Abstract [en]

    Aims/hypothesis: The aim of the study was to investigate ectopic fat deposition and insulin sensitivity, in a parallel single-blinded randomised controlled trial, comparing Paleolithic diet alone with the combination of Paleolithic diet and exercise in individuals with type 2 diabetes. Methods: Thirty-two individuals with type 2 diabetes with BMI 25-40 kg/m(2) and 30-70 years of age followed a Paleolithic diet ad libitum for 12 weeks. In addition, study participants were randomised by computer program to either supervised combined exercise training (PD-EX group) or standard care exercise recommendations (PD group). Staff performing examinations and assessing outcomes were blinded to group assignment. Thirteen participants were analysed in each group: hepatic and peripheral insulin sensitivity were measured using the hyperinsulinaemic-euglycaemic clamp technique combined with [6,6-H-2(2)]glucose infusion, and liver fat was assessed by proton magnetic resonance spectroscopy; both analyses were secondary endpoints. Intramyocellular lipid (IMCL) content was measured by magnetic resonance spectroscopy as a secondary analysis. All examinations were performed at Umca University Hospital, Umca, Sweden. Results: Both study groups showed a median body weight loss of 7 kg. Fat mass decreased by 5.7 kg in the PD group and by 6.5 kg in the PD-EX group. Maximum oxygen uptake increased in the PD-EX group only. Liver fat showed a consistent reduction (74% decrease) in the PD group, while the response in the PD-EX group was heterogeneous (p < 0.05 for the difference between groups). IMCL content of the soleus muscle decreased by 40% in the PD group and by 22% in the PD-EX group (p < 0.05 for the difference between groups). Both groups improved their peripheral and adipose tissue insulin sensitivity, but not their hepatic insulin sensitivity. Plasma fetuin-A decreased by 11% in the PD group (p < 0.05) and remained unchanged in the PD-EX group. Liver fat changes during the intervention were correlated with changes in fetuin-A (r(S) = 0.63, p < 0.01). Participants did not report any important adverse events caused by the intervention. Conclusions/interpretation: A Paleolithic diet reduced liver fat and IMCL content, while there was a tissue-specific heterogeneous response to added exercise training.

  • Guo, Yuming
    et al.
    Gasparrini, Antonio
    Li, Shanshan
    Sera, Francesco
    Vicedo-Cabrera, Ana Maria
    de Sousa Zanotti Stagliorio Coelho, Micheline
    Saldiva, Paulo Hilario Nascimento
    Lavigne, Eric
    Tawatsupa, Benjawan
    Punnasiri, Kornwipa
    Overcenco, Ala
    Correa, Patricia Matus
    Ortega, Nicolas Valdes
    Kan, Haidong
    Osorio, Samuel
    Jaakkola, Jouni J K
    Ryti, Niilo R I
    Goodman, Patrick G
    Zeka, Ariana
    Michelozzi, Paola
    Scortichini, Matteo
    Hashizume, Masahiro
    Honda, Yasushi
    Seposo, Xerxes
    Kim, Ho
    Tobias, Aurelio
    Íñiguez, Carmen
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Oudin Åström, Daniel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Guo, Yue Leon
    Chen, Bing-Yu
    Zanobetti, Antonella
    Schwartz, Joel
    Dang, Tran Ngoc
    Van, Dung Do
    Bell, Michelle L
    Armstrong, Ben
    Ebi, Kristie L
    Tong, Shilu
    Quantifying excess deaths related to heatwaves under climate change scenarios: A multicountry time series modelling study2018In: PLoS Medicine, ISSN 1549-1277, E-ISSN 1549-1676, Vol. 15, no 7, article id e1002629Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Heatwaves are a critical public health problem. There will be an increase in the frequency and severity of heatwaves under changing climate. However, evidence about the impacts of climate change on heatwave-related mortality at a global scale is limited.

    METHODS AND FINDINGS: We collected historical daily time series of mean temperature and mortality for all causes or nonexternal causes, in periods ranging from January 1, 1984, to December 31, 2015, in 412 communities within 20 countries/regions. We estimated heatwave-mortality associations through a two-stage time series design. Current and future daily mean temperature series were projected under four scenarios of greenhouse gas emissions from 1971-2099, with five general circulation models. We projected excess mortality in relation to heatwaves in the future under each scenario of greenhouse gas emissions, with two assumptions for adaptation (no adaptation and hypothetical adaptation) and three scenarios of population change (high variant, median variant, and low variant). Results show that, if there is no adaptation, heatwave-related excess mortality is expected to increase the most in tropical and subtropical countries/regions (close to the equator), while European countries and the United States will have smaller percent increases in heatwave-related excess mortality. The higher the population variant and the greenhouse gas emissions, the higher the increase of heatwave-related excess mortality in the future. The changes in 2031-2080 compared with 1971-2020 range from approximately 2,000% in Colombia to 150% in Moldova under the highest emission scenario and high-variant population scenario, without any adaptation. If we considered hypothetical adaptation to future climate, under high-variant population scenario and all scenarios of greenhouse gas emissions, the heatwave-related excess mortality is expected to still increase across all the countries/regions except Moldova and Japan. However, the increase would be much smaller than the no adaptation scenario. The simple assumptions with respect to adaptation as follows: no adaptation and hypothetical adaptation results in some uncertainties of projections.

    CONCLUSIONS: This study provides a comprehensive characterisation of future heatwave-related excess mortality across various regions and under alternative scenarios of greenhouse gas emissions, different assumptions of adaptation, and different scenarios of population change. The projections can help decision makers in planning adaptation and mitigation strategies for climate change.

  • Nyberg, Viktor
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Simulatorbaserad träning av Eco-driving2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    The use of of simulators in education is increasing. The aviation and medical education have a long history of implementing simulator training and education. With a strong body of scientific research that validates their use in education. As the technical development has increased, the availability of affordable simulators has increased their use in driver education. Unfortunately the research is not as strong as with the aviation or medical education. There are some support that simulator-based education can improve hazard perception but not so many other skills. Therefore I want to examine the effectiveness of a simulator in teaching Eco-driving skills to drivers. 20 students from Yrkesakademin were recruited as they were learning to drive trucks. The study is of between group design where the experimental group practiced Eco-driving skills in the simulator. Data were collected of the participants fuel consumption and speed. The control group were shown a video lecture on Eco-driving. The experimental group did significant improve while the control group did not. These results support the effectiveness of simulator-based education of Eco-driving skills. It also is encouraging for similar driving skills that can have a significant effect on traffic safety. While there is encouraging evidence for reducing the cost of driver education at the same time the students learning is enhanced.

  • Orvegård, Rikard
    Umeå University, Faculty of Science and Technology, Department of Ecology and Environmental Sciences.
    MARKÄGARE OCH SKOTERTURISM: En undersökning baserad på intervjuer med markägare i västra Härjedalen2018Independent thesis Basic level (university diploma), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    This study aimed to examine the possible conflicts between a rapidly growing snow mobile tourism and landowners of the region Funäsfjällen in the west of Sweden, close to the border of Norway. The newspapers of early 2018 was filled with landowner’s complaints about snowmobile users riding in areas where it was illegal and considered destructive by the landowners in big parts of northern Sweden. The landowners of the area of Funäsfjällen now threatened to tear up the agreement they had with the snowmobile trail. The method which was used in collecting opinions from landowners was through interview questions. Furthermore, the report is supposed to describe the current trends in snowmobile driving and sales, as well as describe the forest in the area. The study shows that land owners are overall positive to snow mobile tourism, but still showed that a majority of the landowners had been thinking about the trail agreement, and was prepared to tear it up if they did not see any improvements concerning destruction from free riding. Earlier studies showed that snow mobile sales from the latest years made new records, selling about 2 000 more units than average over the last ten years, where a majority of these were so called mountain snow mobiles, made for climbing steep hills and through deep snow. This study shows that the land owners experience an increase of general snow mobile tourism in the area. An earlier study published in the early 2000 showed that the problematic and destructive free riding had decreased quite a lot since the snow mobile trail in Funäsfjällen was opened. In this study though, it seems as something has changed over time, and the land owners now experience quite a big increase of illegal free riding in the area during the last five years, and that the economic compensation from the trail was not enough to cover the potential costs from the snow mobiles destruction on the land. The study also shows that the type of forest in the area was found to be a low productive one, where felling of trees needs a special permit from Skogsstyrelsen.