I det patientnära arbetet exponeras sjuksköterskor dagligen för kroppsvätskor. Det medför en risk för överföring av blodburna smittor såsom humant immunbristvirus (HIV), acquired immunodeficiency syndrome (AIDS), hepatit B och hepatit C (HBV och HCV). Tidigare forskning påvisar att sjuksköterskans vilja att vårda patienter med blodburen smitta skiljer sig från patienter utan en blodburen smitta. Syftet med litteraturöversikten är att belysa faktorer som påverkar sjuksköterskans vilja att vårda patienter med blodburen smitta. I litteraturöversikten inkluderas åtta kvantitativa artiklar och en kvalitativ artikel. I artikelgranskningen analyseras likheter respektive skillnader enligt Fribergs analysmetod (2017 ss. 141-152). I resultatet identifieras 10 faktorer i 4 kategorier som inverkar på sjuksköterskans vilja att vårda patienter med blodburen. I kategorin Känsla av oro och rädsla att själv bli smittad uttrycker sjuksköterskor en underliggande oro och rädsla av att själv bli smittad. Kategorin Kunskapsnivå, utbildning och yrkeserfarenhet belyser att en hög kunskapsnivå inom området påverkar sjuksköterskans vilja att vårda patienter med blodburen smitta. Kategorin Ålder, civilstatus och familjestatus visar att äldre sjuksköterskor har en större motvilja att vårda denna patientgrupp jämfört med yngre sjuksköterskor. Den sista kategorin, Patientens smittväg och typ av blodburen smitta visar att en del sjuksköterskor har en motvillighet att vårda de patienter som har blivit smittade genom ett intravenöst missbruk. Litteraturöversikten visar att det land sjuksköterskan befinner sig i har en inverkan i deras vilja att vårda patienter med blodburen smitta.

There is now a general consensus among scientists on occurrences of more and intense climatic disasters, floods and droughts, everywhere in the future. To act sooner and smarter against these negative impacts, we must shift our focus in better understanding of the future climate change and possible implications of that to better manage our water resources. Certainly, there is a link between the future effects of climate change on water resources and trends of climatic variables. In this study, by using Mann-Kendall trend analysis method, it is concluded that from 1961 to 2010 only temperature has an upward trend, in all the seasons and yearly, in all the 16 studied stations from north, middle and south of Sweden. Furthermore, runoff simulated by HBV model shows increasing trend in summer and winter which is in partially agreement with the recorded one that discerns a growth in the mentioned seasons, as well as yearly. What is more, potential evapotranspiration estimated by FAO Penman-Monteith equation and actual one simulated by CoupModel reveal a rise in spring for the former and both spring and winter for the latter. Other meteorological variables do not show any significant trend, while intensive precipitation increased in winter and summer in the majority of the stations. Comparing the runoffs simulated by CoupModel and HBV model shows that HBV works better for three selected stations which can enforce the claim that HBV works better for smaller fields.

Evapotranspiration (ET) is an essential component of water cycle as it is an interlinkage between atmosphere, vegetation and soil surface in terms of energy and water balance. However, whether potential ET has the same tendency to change as actual ET and how ET trend (based on the difference between precipitation and runoff) is directly driven by dominant meteorological factors alone or combined with ecosystem‘s feedbacks to climate change (like land-use change) is still under the discussion. In this report, five ET parameterizations within two rainfall-runoff models [Coupled Heat and Mass Transfer Model (CoupModel) and Hydrologiska Byråns Vattenbalansavdelning (HBV)] have been set up based on six subcatchments of Sweden. The scenario derived from CoupModel shows that the trend of ET is affected by the change of land-use, where soil evaporation tends to shift to transpiration and interception evaporation. However, HBV model produces the other scenario: the trend of ET is merely the consequence of meteorological factors. Increased ET is contributed by increased interception evaporation due to the increased precipitation. After identifying the time split of changing ET trends, a dynamic simulation constructed both from HBV and CoupModel indicate that the increased total ET is primarily from increased ET in winter time. More and more interceptive water loss and transpiration resulted from land-use change due to more vegetation. On the other hand, land-use change is also a feed back to climate change. Transpiration controlled by the mechanism of stomata and water uptake controlled by reduction of soil moisture is highly related to variations of climatic conditions.

Hepatitis B Virus (HBV) is a DNA virus and belongs to the genus Orthohepadnavirus of the Hepadnaviridae family which represents one of two animal viruses with a DNA genome which replicates by reverse transcription of a viral RNA intermediate. Nucleotide variation led to further sub-classification into 8 genotypes (A to H). The reverse transcription step within its life cycle is prone to the introduction of errors and recombination when dually infected. This leads to a viral quasispecies which forms during the course of infection with many minor population variants; such variants can however only be detected by means of ultra-deep sequencing. A recent study in the Department of Medical Virology (UP) by Mayaphi et al. identified a number of the specimens that partitioned away from the typical subgenotype A1 clades with high bootstrap values and longer branch lengths. Thus, the main objective of the current study was to characterize the full genome of all variants for the outliers observed in the aforementioned study, inclusive of potential recombination, dual infection and minor populations. Twenty samples were selected from a previous cohort for purposes of the present study. The viral DNA was extracted and amplified by PCR according to the methods described by Günther et al. with modified primer sets. Nineteen of the samples were successfully amplified and 15 of these were sequenced. Specimens were sequenced by NGS on the Illumina MiSeq™ sequencer and sequence data used to reconstruct the viral quasispecies of each specimen. Further analyses of the reconstructed variants included molecular characterization as well as phylogenetic analysis and screening for recombination and drug resistance mutations. Full genome coverage was obtained for twelve of the fifteen samples and full genome variants reconstructed, generating nearly 40 full genomes. Phylogenetic analysis showed that the majority of the samples are of genotype A, more specifically of subgenotype A1, differing by less than 4% from known sequences. The phylogenetic analysis revealed a similar clade of outliers, where four samples clustered together with significant bootstrap support (75%) and a fifth sample partitioned separate from, yet close to, this clade, away from the typical African A1 clade. This clade was assigned to genogroup III. Three samples were of the Asian A1 clade (genogroup I) with remaining specimens grouping within genotype D and E. The variants showed low diversity within each specimen with some differing at but a few positions across the genome while even the most diverse quasispecies differed by less than a percentage (32 positions). Several unique and atypical positional variations were observed amongst study samples of which some were present in but one of the variants for that sample. Twenty-six lead to shared amino acid changes. Some observed changes, such as A1762T/G1764A and G1896A, could explain the serological patterns such as HBeAg negativity while others, such as C2002T, were previously implicated in disease progression and severity. Sample N199 presented a longer branch length and revealed short regions within the genome that display evidence of recombination between HBV/A1 and HBV/A2. The results illustrate the utility of NGS technology in characterizing viral variants. / Dissertation (MSc)--University of Pretoria, 2014. / lk2014 / Medical Virology / MSc / Unrestricted

Given the shared risk factors for transmission, co-infection of hepatitis B virus (HBV) with hepatitis C virus (HCV) and/or human immunodeficiency virus (HIV) is quite common, and may lead to increases in morbidity and mortality. As such, HBV vaccine is recommended as the primary means to prevent HBV super-infection in HCV- and/or HIV-infected individuals. However, vaccine response (sero-conversion with a hepatitis B surface antibody titer >10 IU/L) in this setting is often blunted, with poor response rates to standard HBV vaccinations in virally infected individuals when compared with the healthy subjects. This phenomenon also occurs to other vaccines in adults, such as pneumococcal and influenza vaccines, in other immunocompromised hosts who are really at risk for opportunistic infections, such as individuals with hemodialysis, transplant, and malignancy. In this review, we summarize the underlying mechanisms involving vaccine failure in these conditions, focusing on immune exhaustion and immune senescence - two distinct signaling pathways regulating cell function and fate. We raise the possibility that blocking these negative signaling pathways might improve success rates of immunizations in the setting of chronic viral infection.

Given the shared risk factors for transmission, co-infection of hepatitis B virus (HBV) with hepatitis C virus (HCV) and/or human immunodeficiency virus (HIV) is quite common, and may lead to increases in morbidity and mortality. As such, HBV vaccine is recommended as the primary means to prevent HBV super-infection in HCV- and/or HIV-infected individuals. However, vaccine response (sero-conversion with a hepatitis B surface antibody titer >10 IU/L) in this setting is often blunted, with poor response rates to standard HBV vaccinations in virally infected individuals when compared with the healthy subjects. This phenomenon also occurs to other vaccines in adults, such as pneumococcal and influenza vaccines, in other immunocompromised hosts who are really at risk for opportunistic infections, such as individuals with hemodialysis, transplant, and malignancy. In this review, we summarize the underlying mechanisms involving vaccine failure in these conditions, focusing on immune exhaustion and immune senescence - two distinct signaling pathways regulating cell function and fate. We raise the possibility that blocking these negative signaling pathways might improve success rates of immunizations in the setting of chronic viral infection.

Background: Hepatitis B virus (HBV) infection constitutes a major health problem for homeless persons. Ability to complete an HBV vaccination series is complicated by the need to prioritize competing needs, such as addiction issues, safe places to sleep, and food, over health concerns. Objectives: The objectives of this study were to evaluate the effectiveness of a nurse-case-managed intervention compared with that of two standard programs on completion of the combined hepatitis A virus (HAV) and HBV vaccine series among homeless adults and to assess sociodemographic factors and risk behaviors related to the vaccine completion. Methods: A randomized, three-group, prospective, quasiexperimental design was conducted with 865 homeless adults residing in homeless shelters, drug rehabilitation sites, and outdoor areas in the Skid Row area of Los Angeles. The programs included (a) nurse-case-managed sessions plus targeted hepatitis education, incentives, and tracking (NCMIT); (b) standard targeted hepatitis education plus incentives and tracking (SIT); and (c) standard targeted hepatitis education and incentives only (SI). Results: Sixty-eight percent of the NCMIT participants completed the three-series vaccine at 6 months, compared with 61% of SIT participants and 54% of SI participants. NCMIT participants had almost 2 times greater odds of completing vaccination than those of participants in the SI program. Completers were more likely to be older, to be female, to report fair or poor health, and not to have participated in a self-help drug treatment program. Newly homeless White adults were significantly less likely than were African Americans to complete the vaccine series. Discussion: The use of vaccination programs incorporating nurse case management and tracking is critical in supporting adherence to completion of a 6-month HAV/HBV vaccine. The finding that White homeless persons were the least likely to complete the vaccine series suggests that programs tailored to address their unique cultural issues are needed.

京都大学 / 0048 / 新制・課程博士 / 博士(生命科学) / 甲第21227号 / 生博第396号 / 新制||生||52(附属図書館) / 京都大学大学院生命科学研究科高次生命科学専攻 / (主査)教授 朝長 啓造, 教授 米原 伸, 教授 千坂 修 / 学位規則第4条第1項該当 / Doctor of Philosophy in Life Sciences / Kyoto University / DFAM

Rapporten ämnar utvärdera potentiella begränsningar inom vattenkraftsindustrin i relation till högvattenföring under ett skiftande klimat. Detta görs genom en litteraturstudie gällande lagar och föreskrifter, samt med en modellering av de flödesförändringar som uppstår i den övre delen av Pite älv i norra Sverige som en konsekvens av ett skiftande klimat. Modelleringen görs med HBV-96 och fyra olika scenarion med ett modellerat referensflöde. Vattenkraftsindustrin är för det mesta reglerad privat med egenkontroller, med krav för inrapportering till länsstyrelsen för de dammar vars bristning kan orsaka stor skada.Modelleringen och scenarierna fann en tendens till svagare vårfloder som en konsekvens av ökad medeltemperatur. Ökningen i medeltemperatur har inga observerade direkta effekter på vattenföring under sensommar och höst, men potential för indirekt påverkan finns. Om nederbörd ökar, som förväntat, kommer vi se en ökning i volym av vatten i älven. Resultatet ser ingen krav för anpassning till större flöden i en snar framtid då de kraftigaste flödena under våren kommer minska, däremot lär ett skifte i beteendet av den årliga vattenföringen ske med ett flöde som är mer beroende av nederbörd istället för snösmältning. Detta medför en uppmaning till förändring i korttidsstrategi med hjälp av större marginal i dammens vattenhöjd tillsammans med modellering och väderprognoser, främst under sensommar och höst. / The focus of this paper is on the changing conditions in the hydrological flow of the upper half of Pite älv in Northern Sweden as a consequence of the changes that comes with global warming. This was done by modelling the water flow with the HBV-96 model as its basis which then ran four different scenarios based on predictions for how the climate will have changed by year 2100. The paper also discusses the limitations with this applied method. The study found that in the case of dam failure the owner is responsible for the damages, furthermore the owner is recommended to model potential limitations and dangers, but there is no requirement for this. State actors which oversees and keep tabs on all issues regarding water safety exists for every county, though their involvement appear somewhat limited and does not extend to close monitoring of the dams. The study found a decrease in the volume of spring floods due to a decrease in snow storage because of increasing temperatures. Furthermore, the increase in mean temperature has no notable direct effect on the autumn precipitation and water flow but potential indirect consequences are discussed. If precipitation were to increase during autumn as predicted, we will see an increase in both the peaks and amount of autumn high flows. However, these peaks will be lower than the current spring floods. We conclude that in large there is no reason for large changes in how the hydro industry conducts itself in relation to regulation of water flow in terms of infrastructure. There is however, possibly a need to increase the margin which one can store water in dams during longer periods with high flow together with more reliance on meteorological short term analysis to be better prepared for more sudden high flows.

T cells play an important role in adaptive immune system against viral infections, while premature aging and dysfunction of T cells induced by unrepaired DNA damages are always non-negligible snags during the long-term of fighting with chronic viral infections, such as Hepatitis B virus (HBV), Hepatitis C virus (HCV) or Human Immunodeficiency Virus (HIV) infection. In this dissertation, we investigated the role of topological DNA damage in reprogramming telomeric DNA damage responses (DDR), mitochondrial metabolisms, and T cell functions using CD4+ T cells derived from individuals with chronic viral infections or healthy subjects treated with topoisomerase inhibitors. The healthy human T cells were treated with camptothecin (CPT) for mitochondrial topoisomerases I (Top1mt) or ICRF-193 or etoposide (ETP) for topoisomerases IIα (Top2α) as models. We found a significant suppression of Top2α and Top1mt protein levels and enzymatic activity in CD4+ T cells in chronically HCV/HIV-infected patients compared to age and gender-matched healthy subjects, along with an accumulation of the topoisomerase cleavage complex (Topcc) in genomic DNA as well as mitochondrial DNA (mtDNA). Mechanistically, topoisomerase inhibition in healthy CD4+ T cells caused topological DNA damage, telomere attrition, mitochondrial metabolic disorder and T cell apoptosis or dysfunction via inducing Topcc accumulation, PARP1 cleavage and failure in DNA repair, thus recapitulating T cell dysregulation in the setting of chronic viral infections. In addition, T cells from virally infected subjects with lower topoisomerase levels were vulnerable to the inhibitor-induced cell apoptosis, indicating an important role for Top2α and Top1mt in preventing DNA topological disruption and cell death. These results demonstrate that accumulation of Topcc and topoisomerase deficiency lead to unrepaired DNA damage and render virally infected patients’ T cells prone to senescence and apoptosis, thus contributing to mitochondrial metabolic disturbance or dysfunction in CD4+ T cell during chronic HCV or HIV infection. This study reveals a novel mechanism by which topoisomerase deficiency promotes telomeric DNA or mtDNA damage and premature T cell aging, and provides a new therapeutic target for restoring the DNA topologic machinery protecting T cells from unwanted DNA damage and to maintain immune competence.