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The conventional view for corneal epithelial maintenance suggests that a stem cell population found in the limbus (at the rim of the cornea) produces daughter cells, called transient amplifying cells, which migrate centripetally. This limbal stem cell (LSC) hypothesis was recently questioned and the alternative model suggests that stem cells are present throughout the corneal epithelium. The main aims of this thesis were to investigate whether age and Pax6 genotype affect LSC function. Previous work with X-inactivation mosaics revealed radial stripes of β-galactosidase-expressing cells in the corneal epithelium (from about 5 weeks of age), which decreased with age and were reduced in Pax6+/- mice (a model for aniridia, a human eye disease). The reduction in Pax6+/- mice could be due to either reduced LSCs function or a more coarse-grained mosaicism caused by reduced cell mixing during development. Comparison of patch sizes in Pax6+/- and wild-type X-inactivation mosaics showed that patches were smaller in Pax6+/- cornea epithelia before the initiation of stripes (3 weeks of age). This implies that stripe-number reduction is not caused by reduced cell mixing, so an effect on LSC function remained a possibility. Thus, the numbers of label-retaining cells (putative stem cells) in Pax6+/- were compared to controls at 15 and 30 weeks old but they were not reduced at 30 weeks or in Pax6+/- mice, as had been predicted. The failure to demonstrate the predicted result suggests either that the hypothesis was incorrect or the experimental approach was inappropriate. Furthermore, it was discovered that mice expressing β-galactosidase under the keratin 5 promoter produced rare stripes in the corneal epithelium, which are likely to represent clonal lineages derived from individual stem cells. Older mice demonstrated a significantly lower frequency of stripes, a result compatible with the predicted reduction of active LSC with age. Pax6+/- corneas were highly abnormal and stripes were not formed properly, so direct comparison was not possible. Finally, pilot experiments with conditional expression of a reporter gene revealed the successful formation of a stripe, and hence provide a plausible alternative approach to compare stripe numbers reflecting active LSCs but the method has yet to be optimised. Overall, the results suggest that LSCs are reduced with age and support the limbal location of stem cells maintaining the corneal epithelium.

Despite increased awareness about patient safety and quality of care, errors and adverse outcomes occur frequently in clinical practice. An estimated 10% of the 35.1 million U.S. hospital patients suffered injuries caused by medical errors; the most common were medication errors, which accounted for more than 50% of all medical errors. Work-related stress is associated with medication errors for health care professionals (HCP) in Saudi Arabia (SA) hospitals; however, the specific types of stressors and their effect on the level of medication errors have not been studied in SA. The purpose of this quantitative correlational study was to examine the relationship between the overall level and sources of work-related stress using the job stress scale on the level of medication errors for a group of 269 HCPs working at King Abdul-Aziz Hospital (KAH) in SA. The theoretical framework for this research was the Donabedian patient safety model, which relates healthcare quality to personal, environmental, and organizational factors. Binary logistic regression analyses indicated there was no relationship between overall levels of stress and medication errors. However, specific sources of work related stress such as disruption to home life, excessive workload, and night/weekend call duties were associated with a significant increase in the medication error rate, while pressure to meet deadlines and difficulties with colleagues was associated with a significant decrease in the medication error rate. Positive social change implications include how understanding the impact of work-related stress on medication errors by SA HCPs may lead to specific interventions to reduce medication errors and improve patient care.

Bakgrund: Fetma och övervikt har blivit vanligare den senaste tiden och är idag ett stort hälsoproblem över hela världen. Många har svårt att gå ner i vikt på egen hand vilket har gjort att kirurgi har blivit allt vanligare de senaste åren. Gastric bypass är idag den vanligaste kirurgiska metoden för viktminskning och har visat goda resultat. Däremot kan den hälsorelaterade livskvalitén påverkas då operationen innebär en stor livsstilsförändring. Syfte: Syftet med denna studie var att beskriva vuxna personers upplevelse av hälsorelaterad livskvalité efter en gastric bypass operation. Metod: En litteraturöversikt med 11 kvantitativa och 3 kvalitativa vetenskapliga artiklar som ligger till grund för hur vuxna personer upplever sin hälsorelaterade livskvalité efter en gastric bypass operation. Resultat: Hälsorelaterad livskvalité (HRQOL) har visat en förbättring i samtliga studier efter en gastric bypass operation. HRQOL har haft sin topp efter 1 månad i samtliga skalor utifrån SF-36 frågeformulär. Slutsats: Den stora livsstilsförändringen som personer går igenom efter en gastric bypass operationen har visat förbättringar i HRQOL på både lång och kort sikt. Bidragande faktorer som kan påverka den förbättrade hälsorelaterade livskvalitén kan bland annat vara uppfyllda förväntningar av operationen och fysisk aktivitet. / Background: Obesity and overweight have become more frequent in recent years and is today a major health problem worldwide. A lot of people find it difficult to lose weight on their own which has made surgery become more common in recent years. Gastric bypass surgery is currently the most common surgical method of weight loss and have shown good results. However, the health-related quality of life is affected as the operation demand a major lifestyle change. Purpose: The purpose of this study was to describe adults’ experience of health-related quality of life after a gastric bypass surgery. Method: The study contains 11 quantitative and 3 qualitative scientific articles describing the adults’ experience of health-related quality of life after a gastric bypass surgery. Results: Health-related quality of life (HRQOL) has shown an improvement in all studies after a gastric bypass surgery. HRQOL has had its peak after 1 month in all scales based on the SF-36 questionnaire. Conclusion: The major lifestyle change that people go through after a gastric bypass surgery has shown improvements in HRQOL in both long and short term. Contributing factors that may affect the improved health-related quality of life can among other things be fulfilled expectations of the surgery and physical activity.

Peritoneal adhesions occur in up to 93% of adults after peritoneal trauma during surgery. Most adhesions are asymptomatic but can cause female infertility, small bowel obstruction (SBO) and chronic abdominal pain. Adhesion prophylaxis is needed to reduce the significant morbidity and increased health care costs resulting from peritoneal adhesions. This thesis aims to establish a relevant and reproducible experimental adhesion model to simultaneously study the healing processs and adhesion formation and later to examine whether carbazate-activated polyvinyl alcohol (PVAC), an aldehyde-carbonyl scavenger, can reduce adhesion formation or not; and, in a long-term follow-up, to investigate the incidence of and identify risk factors for adhesive SBO requiring surgical treatment after laparotomy during infancy and to survey the prevalence of self-reported chronic abdominal pain and female infertility. Male Sprague-Dawley rats were subjected to laparotomy, cecal abrasion, and construction of a small bowel anastomosis and examined at various time points after surgery. Early elevation of IL-6, IL-1β and TNF-α concentrations in peritoneal fluid but not in plasma correlate to adhesion formation in this rodent adhesion model, indicating that anti-adhesion treatment should be early, local and not systemic. The animals were treated with either peritoneal instillation of PVAC, or the anastomosis was sutured with PVAC-impregnated resorbable polyglactin sutures. At day 7, bursting pressure of the anastomosis was measured and adhesions were blindly evaluated using Kennedy- and Nair scoring systems. PVAC-impregnated sutures reduced adhesion formation without reducing bursting pressure. Infants who underwent laparotomy between 1976 and 2011 were identified (n=1185) and 898 patients were included with a median follow-up time of 14.7 (range 0.0-36.0) years. The median age at first laparotomy was 6 (range 1.0-365.0) days. There were 113 patients (12.6%) with adhesive SBO, with the highest incidence found in patients with Hirschsprung’s disease (19 of 65, 29%), malrotation (13 of 45, 29%), intestinal atresia (11 of 40, 28%) and necrotizing enterocolitis (16 of 64, 25%). Lengthy duration of surgery (hazard ratio (HR) 1.25, 95% CI, 1.07 to 1.45), stoma formation (HR 1.72, 1.15 to 2.56) and postoperative complications (HR 1.81, 1.12 to 2.92) were independent risk factors. Chronic abdominal pain was reported in 180 (24.0%) of 750 patients, and 17 (13.8%) of 123 women reported infertility. The morbidity after laparotomy in neonates and infants is high. Awareness of the risk factors may promote changes in surgical practice.

Sjuksköterskans ansvar är att lindra lidande. Vårdverksamheten och vårdforskningens största utmaningar är att förstå hur lidande bäst kan lindras. Lidande som orsakas av vården kallas vårdlidande. Den systematiska litteraturstudiens syfte var att pröva Katie Erikssons teori om vårdlidande inom omvårdnad. En deduktiv ansats användes vid genomförandet av studien. Studien genererade tolv resultatartiklar som analyserades enligt Erikssons följande kategorier om vårdlidande kränkning av värdighet, fördömelse och straff, maktutövning och utebliven vård. De mest förekommande kategorierna som identifierades utifrån resultatet var kränkning av värdighet och utebliven vård. En ytterligare kategori som framkom benämdes vårdens prioriteringar. Den kan ses som en utveckling av Erikssons kategori utebliven vård. Resultatet bekräftade Erikssons teori om vårdlidande. Rekommendationer för klinisk verksamhet är att patienten ska få möjlighet att utvärdera vården i efterhand, för att skapa en medvetenhet hos vårdpersonalen kring patientens upplevelse. Vidare rekommenderas forskning om vårdens prioriteringar. / Nurses’ responsibility is to alleviate suffering. The main challenge for healthcare organisation and the science of caring and nursing is to understand how suffering could be alleviated. Suffering caused by care is called suffering related to care. The aim of the study was to test and imply Katie Erikssons theory about suffering related to care in nursing. The systematic review was performed with a deductive research method. Twelve articles was analysed according to Erikssons theory about suffering related to care. The theory includes three themes: violating the patients dignity, condemnation and punishment, exert of power and absence of care. The themes that occurred the most in the results were violating the patients’ dignity and absence of care. Another theme was developed through the results was healthcare priorities. The theory can be interpreted as a subtheme to absence of care. Erikssons theory was validated by the results of the study. One implication for clinical practice is to give the patients ability to evaluate their received healthcare. The purpose of the evaluation is to make the health care professionals aware of the patients’ experience. Further research about healthcare priorities are suggested.

Sjuksköterskor arbetar ofta i en miljö med stort ansvar och höga krav som kan leda till arbetsrelaterad stress som kan hota sjuksköterskornas hälsa och patientsäkerheten. Syftet med studien var att få ökad kunskap om sjuksköterskors upplevelser av arbetsrelaterad stress. Studien genomfördes som en litteraturstudie med sju vetenskapliga artiklar som låg till grund för studiens resultat. Efter granskning och analys av artiklarna framkom tre kategorier: kommunikationens och personalrelationers betydelse för upplevelsen av arbetsrelaterad stress, arbetsbelastningens betydelse för upplevelsen av arbetsrelaterad stress samt sjuksköterskeyrkets värde ur organisatoriskt-, samhälls- och personligt perspektiv. Studiens resultat visade att sjuksköterskor i flera länder upplevde stress i arbetet. Faktorer som i huvudsak bidrog till ökad arbetsrelaterad stress var brister i kommunikationen i sjuksköterskegruppen och även med olika professioner, hög arbetsbelastning samt sjuksköterskeyrkets nedvärdering ur organisatorisk-, samhälls- och ett personligt perspektiv. Det framkom även faktorer som bidrog till minskad arbetsrelaterad stress, till exempel reflektion i personalgruppen, möjlighet till rast samt delaktigtighet i organisationen. Vidare forskning för att belysa patienters, samt samhällets perspektiv på arbetsrelaterad stress hade varit av vikt för att uppmärksamma arbetsrelaterad stress inom sjukvården. / Nurses do often work in an environment with a big responsibility and high demands that can lead to work-related stress and can become a threat to nurses health and the patient safety. The aim of this study was to gain better knowledge about nurses ́ experiences of work-related stress. The study was performed as a literature study with seven scientific articles which formed the base for the result. After reviewing and analyzing the articles three themes occurred: The role of communication and relationship between workers for the experience of work- related stress, the role of workload for the experience of work-related stress and the worth of the nurse profession in an organizational-, societal- and a personal perspective. The result showed that nurses in several countries experienced stress in their work. The main factors for work- related stress were poor communication within a professional group and between nurses and other healthcare professionals, high workload, and the depreciation from an organizational-, societal- and personal perspective. The result also showed that work- related stress could be reduced with reflection, the opportunity to take breaks and participation in the organization. Further research to enlighten patients ́ and the society ́s perspective on work- related stress would be important to draw attention to work-related stress in healthcare.

Statistical learning (SL) is believed to be a mechanism that enables successful language acquisition. Language acquisition in turn is heavily influenced by environmental factors such as socioeconomic status (SES). However, it is unknown to what extent SL abilities interact with SES in affecting language outcomes. To examine this potential interaction, we measured event-related potentials (ERPs) in 38 children aged 7-12 while performing a visual SL task consisting of a sequence of stimuli that contained covert statistical probabilities that predicted a target stimulus. Hierarchical regression results indicated that SL ability moderated the relationship between SES (average of both caregiver’s education level) and language scores (grammar, and marginally with receptive vocabulary). For children with high SL ability, SES had a weaker effect on language compared to children with low SL ability, suggesting that having good SL abilities could help ameliorate the disadvantages associated with being raised in a family with lower SES.

<p>The notochord plays critical structural and signaling roles during vertebrate development. At the center of the vertebrate notochord is a large fluid-filled organelle, the notochord vacuole. While these highly conserved intracellular structures have been described for decades, little is known about the molecular mechanisms involved in their biogenesis and maintenance. Here we show that zebrafish notochord vacuoles are specialized lysosome-related organelles whose formation and maintenance requires late endosomal trafficking regulated by the vacuole-specific Rab32a, and H+-ATPase-dependent acidification. We establish that notochord vacuoles are required for body axis elongation during embryonic development and identify a novel role for notochord vacuoles in spine morphogenesis. Thus, the vertebrate notochord plays important structural roles beyond early development.</p> / Dissertation

Non-suicidal self-injury (NSSI) is considered a strong predictor of suicidal behavior, although the exact relationship between NSSI and suicide is not clear. Several factors have been suggested in previous research, including attitudes toward one’s own body, thoughts and beliefs regarding death and suicide, and the ability to cause physical harm to oneself. In the current study, the researcher obtained data from 285 young adult participants who reported a history of NSSI. Two multiple mediation models were tested in which body protection, suicide-related concerns, and acquired capability for suicide were examined as mediators of the relationship between NSSI and suicide attempt frequency. The first model, in which the predictor was NSSI frequency, was not supported. The second model, in which the predictor was NSSI versatility of methods, was partially supported; the only significant mediator was suicide-related concerns. These results add to the literature regarding the relationship between NSSI and suicide.