Swedish Civil Contingencies Agency

Primary aldosteronism (PA) is prevalent among hypertensive patients, and associated with worsened cardiovascular outcomes compared to essential hypertension (HT). Screening and diagnostics for PA are currently complicated and invasive, why new methods are needed. Unilateral PA (uPA) is best treated surgically, and bilateral PA (bPA) - medically. No validated proteomic diagnostic test has been found yet. Our aim was to explore proteomic markers in peripheral serum to discriminate between HT, PA, uPA and bPA. Eighty-eight hypertensive individuals were evaluated for PA, and diagnosed with HT (n = 30); bPA (n = 29); and uPA (n = 29). Serum samples from these study groups were analyzed by Olink® Explore 384 Cardiometabolic Panel. A machine learning model based on ridge logistic regression with a stratified 5-fold cross-validation was used to identify HT, PA, bPA and uPA. In the study groups, 56 circulating proteins were significantly different, and some of them specifically: 4 between PA vs. HT; 3 between bPA vs. uPA; 1 between bPA vs. HT; 9 between uPA vs. HT; 1 between HT vs. bPA vs. uPA. Three proteins with strongest differentiation (Coagulation factor IX for PA vs. HT; dipeptidyl peptidase 4 for uPA vs. HT and bPA; heat shock protein B1 for bPA vs. uPA) were validated by enzyme-linked immunosorbent assay. Our machine learning model could successfully identify 95% of HT, bPA, and uPA samples. Serum protein biomarkers may serve as a tool for discriminating HT, PA, uPA and bPA. Further studies are needed to support our results.

The aim of this thesis is to gain a deeper understanding of mentoring conversations as sites of professional knowledge-building. Specifically, the study seeks to identify the principles and processes that enable the formation and transformation of subject-specific knowledge of writing in Swedish as a first language (L1) in secondary education. The empirical material consists of 15 mentoring conversations from eight mentor–student pairs and interviews with all participants. The analyses draw on Ivanič’s (2004) framework of writing discourses and Legitimation Code Theory (Maton, 2014), which together clarify the relationship between knowledge and language. Findings show that the mentoring conversations provide opportunities to develop knowledge about text types, linguistic structures, and teaching approaches such as genre-based, skills-oriented, and process-oriented writing instruction. However, creative, cognitive, social-practice, and sociopolitical dimensions of writing are rarely addressed. The conversations are characterised by everyday representations, strong contextual anchoring, and conceptually simple reasoning. The study suggests that mentoring dialogue as a resource for building knowledge could be enhanced through semantic shifts from specific and concrete to general and abstract. Furthermore, comprehensive knowledge in writing pedagogy is more likely to develop when teaching content and methods are specified and integrated within a broader repertoire of writing discourses, supported by explicit pedagogical reasoning and networks of subject concepts. The thesis offers research-based perspectives on mentoring conversations as sites for knowledge-building in Swedish language education, with possible relevance for other school subjects and contexts. It also informs ongoing discussions about the types of knowledge Swedish language teachers need to support students’ writing development.

Life-sustaining treatment limitation (LSTL) on the intensive care unit (ICU) may affect the rate of organ donation after brain death (DBD). The primary aim of this study was to examine whether there is a relationship between LSTL and DBD. Furthermore, we aimed to determine the rate of LSTL involved in ICU deaths and to describe technical and procedural characteristics of LSTL on Swedish ICUs. This was an observational cohort study on all ICU deaths (n=13156) in Sweden between 2014 and 2017. We analysed differences in DBD rates between deaths in ICU with and those without LSTL, using descriptive statistics and logistic regression. After excluding 1084 deaths on specialised ICUs and units not registering goals of treatment, the study population comprised 12072 deaths including 615 DBDs, of which 7865 had LSTL, 1706 had no LSTL and 2501 had no stated goals of treatment. The final cohort on which the relationship between DBD and LSTL was analysed comprised 9571 deaths including 419 DBDs. When no LSTL was documented, the rate of organ donation was 9.5% compared to 3.3% when LSTL was documented (P<.001). LSTL was associated with a lower DBD rate after adjusting for patient- and ICU-related factors (OR 0.41, 95% CI 0.31-0.53, P<.001). There was an inverse relationship between LSTL and DBD amongst patients who died on the ICU. This relationship remained after adjusting for factors known to influence organ donation. The reason remains to be determined.

This paper describes the relationship between the water flow rate applied by the Fire and Rescue Services (FRS) and the area of a fire; the limitations of the FRS in terms of water flow rate; and the most effective use of firefighting water across a broad range of fire areas. The paper is based on five sets of data gained by the FRS at the fire scene, in total almost 6000 fires. It shows a fundamental difference in fighting a small fire compared to fighting a large one. It also shows that the relationship between applied water flow rate and fire area is not best described by a continuous power function. It distinguishes between three different approaches or modes of firefighting: a standard nozzle approach (fires up to 20–50 m2, depending on context), a perimeter approach (fires up to 200–500 m2, depending on context) and a maximum flow approach (fires larger than 200–500 m2, depending on context). The transition between the approaches varies between the five data sets and can be distinguished using the optimum flow density (5.4–6.0 l/m2 min) or the water flow density giving the smallest total volume and the critical water flow density (3.5–4.0 l/m2 min). The two transitions vary with the context; they are not physical constants (the numbers corresponds to the most recent studies of Metro and County FRS). The study validates the strategic considerations that attack is more demanding than containment, that one should ensure containment and then attack; and that the earlier response, the better result.

Over the past 10 years, a number of safety measures for reducing firefighters’ exposure to combustion particles have been introduced in Sweden. The most important measure was the reduction in the time firefighters wear suits and handle contaminated equipment after turn-outs involving smoke diving. This study was divided into two parts, those being to investigate the level of protection obtained by multiple garment layers and to assess exposure during a standardized smoke diving exercise. First, realistic work protection factors (WPFs) were calculated by comparing air concentrations of the full suite of gaseous and particle-bound polycyclic aromatic hydrocarbons (PAHs) inside and outside structural ensembles, including jacket and thick base layer, during a tough fire extinguishing exercise using wood as the fuel. Second, during a standardized smoke diving exercise, exposure was assessed by measuring PAH skin deposition and levels of eight urinary PAH metabolites in 20 volunteer student firefighters before and after the exercise. The average WPF for the sum of 22 PAHs was 146 ± 33 suggesting a relatively high protective capacity but also indicating a substantial enrichment of contaminants with a risk of prolonged dermal exposure. Accordingly, in the second exercise, the median levels of skin-deposited Σ14-PAHs and urinary 1-hydroxypyrene significantly increased 5-fold (21 to 99 ng/wipe) and 8-fold (0.14 to 1.1 µmol mol−1 creatinine), respectively, post exposure. Among the PAH metabolites investigated, 1-hydroxypyrene proved to be the most useful indicator of exposure, with significantly elevated urinary levels at both 6 h and 20 h after the exercise and with the strongest correlation to dermal exposure. Metabolites from two-ring and three-ring PAHs were eliminated faster while levels of 3-hydroxy-benzo[a]pyrene did not meet the detection criteria. The results from correlation studies indicated that dermal uptake was a major route of exposure in accordance with previous findings. To summarize, this study shows that some of the newly adopted protective measures were correctly implemented, and should continue to be followed and be more widely adopted.

Vilka möjligheter till deltagande och handlingsutrymme har studenter och lärare i högre utbildning när det gäller den fysiska miljön på campus? Utifrån ett designteoretiskt perspektiv kommer jag i den här artikeln att resonera om vilken betydelse rum kan ha för både design för lärande och i lärande. I artikeln diskuteras hur rum utgör en del av lärares didaktiska design, som en inramning för lärande och får därmed konsekvenser för iscensättningen av en lärprocess. Rum är även något både studenter och lärare förhåller sig till och använder sig av som resurs under en lärprocess, design i lärande. Rum påverkar hur studenter och lärare interagerar och skapar mening i en lärprocess. Deltagarna förstår rummen på ett sätt vid iscensättningen, men måste förhålla sig till och ibland designa om rummen under processens gång. Särskilt intressant blir det därför att diskutera handlingsutrymme, både i relation till lärarens didaktiska design och förutsättningar för lärande, men framförallt i relation till studenters och lärares arbete med att tolka och omforma rummet som en del av den lärväg de designar.

Current trends in biosecurity and cybersecurity include (1) the wide availability of technology and specialized knowledge that previously were available only to governments; (2) the global economic recession, which may increase the spread of radical non-state actors; and (3) recent US and EU commission reports that reflect concerns about non-state actors in asymmetric threats. The intersectoral and international nature of bioterrorism and agroterrorism threats requires collaboration across several sectors including intelligence, police, forensics, customs, and other law enforcement organizations who must work together with public and animal health organizations as well as environmental and social science organizations. This requires coordinated decision making among these organizations, based on actionable knowledge and information sharing. The risk of not sharing information among organizations compared to the benefit of sharing information can be considered in an "information sharing risk-benefit analysis" to prevent a terrorism incident from occurring and to build a rapid response capability. In the EU project AniBioThreat, early warning is the main topic in work package 3 (WP 3). A strategy has been generated based on an iterative approach to bring law enforcement agencies and human and animal health institutes together. Workshops and exercises have taken place during the first half of the project, and spin-off activities include new preparedness plans for institutes and the formation of a legal adviser network for decision making. In addition, a seminar on actionable knowledge was held in Stockholm, Sweden, in 2012, which identified the need to bring various agency cultures together to work on developing a resilient capability to identify early signs of bio- and agroterrorism threats. The seminar concluded that there are a number of challenges in building a collaborative culture, including developing an education program that supports collaboration and shared situational awareness.