Download or read book Molecular and serological tools for clinical diagnostics of Lyme borreliosis can the laboratory analysis be improved written by Malin Lager and published by Linköping University Electronic Press. This book was released on 2020-10-20 with total page 114 pages. Available in PDF, EPUB and Kindle. Book excerpt: Lyme borreliosis (LB) is caused by spirochetes within the Borrelia burgdorferi sensu lato complex and is the most common tick-transmitted disease in the northern hemisphere. The transmission of the spirochetes to humans in Europe is done by the Ixodes ricinus ticks, which can also transmit the relapsing fever species Borrelia miyamotoi. LB may cause clinical manifestations in the skin, in the central nervous system, in joints, and in the heart. Diagnosis of LB is mainly based on the patient´s medical history, self-described symptoms, and clinical signs in combination with the detection of Borrelia-specific antibodies (serological methods). In some cases/issues, detection of Borrelia-specific deoxyribonucleic acid (molecular methods) may be used as a complement to serology. All diagnosed LB infections are treated with antibiotics to prevent disease progression, and most patients fully recover without further sequelae. The overall aims of this thesis were to evaluate molecular and serological tools for laboratory diagnosis of LB, with a special focus on Lyme neuroborreliosis (LNB), and to identify potential improvements. The results presented in this thesis showed that the immunoglobulin (Ig) G assays, currently in use in northern Europe for detection of antibodies in serum, had high diagnostic sensitivity (88 %) together with comparable results both between and within assays. For the IgM assays, the diagnostic sensitivity was lower (59 %) with more heterogeneous results. Small variations in diagnostic performance for IgM and IgG were mainly presented for samples within the borderline zone. These results support the theory that separate testing of IgM antibodies in serum has low diagnostic value. However, simultaneous detection in serum and cerebrospinal fluid (CSF) for both IgM and IgG antibodies was essential for the diagnosis of LNB, at least for certain assays. So far (to our knowledge), no systematic evaluation and optimisation of the pre-analytical handling of CSF samples before molecular testing has been performed. By use of the precipitate concentrated by moderate centrifugation, extraction of total nucleic acid followed by reversetranscription to complementary deoxyribonucleic acid, in combination with the absence of polymerase chain reaction (PCR) inhibitors, detection of Borrelia garinii, Borrelia afzelii, Borrelia burgdorferi sensu stricto, and B. miyamotoi was possible. These four species are all known to be pathogenic to humans. The results revealed a high analytical sensitivity and specificity for the optimised pre-analytical conditions. The thesis also presents results showing that the real-time PCR protocols currently used in Scandinavia have high analytical sensitivity, specificity, and concordance. This indicates that the low diagnostic sensitivity for detection of Borrelia in CSF was not a result of poorly designed and evaluated PCR protocols, but was possibly due to the low number of spirochetes in the samples. However, to further evaluate the diagnostic performance for detection of Borrelia in CSF by PCR, clinical samples need to be evaluated based on our new recommendations for the pre-analytical handling of CSF samples. In conclusion, this thesis presents results revealing that both molecular and serological tools for detection of Borrelia have, in general high sensitivity and specificity with results comparable between different protocols and different laboratories. It also presents recommendations for pre-analytical handling of CSF samples before PCR-analysis, and shows the benefits in diagnostic performance by simultaneous detection of IgM and IgG antibodies in serum and CSF for accurate diagnosis of LNB. Even though the techniques mentioned above have high analytical performance, the ability to discriminate an active infection from a previous one is limited and further studies need to be carried out. These studies need to focus on finding diagnostic tools that can help physicians to determine ongoing infection to ensure adequate treatment. It is also desirable to improve the standardisation of the diagnostic tools and to find methods that can discriminate between different Borrelia species. Borrelios är den vanligaste fästingöverförda sjukdomen på norra halvklotet och orsakas av bakterier inom Borrelia burgdorferi sensu lato gruppen. Överföringen av bakterier till människa i Europa sker via Ixodes ricinus fästingar, vilka även överför bakterien Borrelia miyamotoi som ger återfallsfeber. Borreliainfektioner uppvisar kliniska uttryck i huden, i det centrala nervsystemet och i leder. En borrelia-diagnos baseras främst på patientens medicinska historia i kombination med kliniska tecken, egenbeskrivna symptom samt påvisning av Borrelia-specifika antikroppar (serologiska metoder). Vid vissa frågeställningar kan påvisning av Borrelia-bakteriens arvsmassa (molekylärbiologiska metoder) användas som komplement till antikroppstester. Alla diagnostiserade borreliainfektioner behandlas med antibiotika för att förhindra utveckling av sjukdomen och merparten av patienterna blir fullt återställda. Det övergripande syftet med avhandlingen var att utvärdera metoder för påvisning av Borrelia-specifika antikroppar samt Borrelia-specifik arvsmassa, men fokus på neuroborrelios, samt identifiera potentiella förbättringar. De metoder som används för påvisning av immunoglobulin (IgG)-antikroppar (uppträder sent i en infektion) i serum i norra Europa uppvisar hög känslighet (88 %) med jämförbara resultat både mellan och inom en analysmetod. Vid påvisning av IgM-antikroppar (uppträder tidigt i en infektion) i serum uppvisas lägre känslighet (59 %) och mer olikartade resultat. Små variationer i den diagnostiska förmågan att påvisa IgM och IgG-antikroppar beror till stor del på att flera prover erhållit gränsvärden d v s ett värde som inte kan anses som positivt men inte heller som negativt. Resultaten från denna studie indikerar att påvisning av IgM-antikroppar i serum har lågt värde vid diagnostik av Borrelia. Dock bör parallell analys av både IgM och IgG-antikroppar i serum och ryggmärgsvätska utföras vid påvisning av neuroborrelios. I dagsläget (till vår kännedom) har ingen systematisk utvärdering och optimering av det preanalytiska tillvägagångssättet vid påvisning av Borrelia-specifik arvsmassa i ryggmärgsvätska genomförts. Genom att använda pelleten (bottensatsen som erhålls genom måttlig centrifugering), framrening av total nukleinsyra i kombination med frånvaro av material som kan påverka PCR-reaktionen på ett negativt sätt (inhibitorer), kan påvisning av Borreliaarterna Borrelia garinii, Borrelia afzelii, Borrelia burgdorferi sensu stricto och B. miyamotoi ske. Dessa Borrelia-arter är alla patogena för människa. De realtids-PCR protokoll som i dagsläget används i Skandinavien har hög analytisk känslighet, tillförlitlighet och överensstämmelse. Detta tyder på att den låga känslighet som uppvisas vid påvisning av Borrelia-specifik arvsmassa i ryggmärgsvätska inte beror på dåligt utvärderade och designade PCR-protokoll, utan är troligtvis orsakad av låg bakteriemängd i proverna. För vidare utvärdering av den diagnostiska förmågan att påvisa Borrelia-specifik arvsmassa i ryggmärgsvätska med PCR, bör kliniska prover samlas in och analyseras utifrån de nya rekommendationerna för pre-analytiskt tillvägagångssätt vid analys av ryggmärgsprover. Sammanfattningsvis visar resultaten i denna avhandling på generellt hög känslighet och tillförlitlighet samt överensstämmelse mellan olika protokoll/test vid påvisningar av Borreliaspecifika antikroppar och Borrelia-specifik arvsmassa. I avhandlingen presenteras även rekommendationer för pre-analytiskt tillvägagångssätt vid omhändertagande och transport av ryggmärgsvätska till laboratoriet. Resultaten visar även på nyttan i att analysera ryggmärgsvätska och serum parallellt för både IgM och IgG-antikroppar för att erhålla rätt diagnos vid frågeställningen neuroborrelios. Ovan nämnda metoder har trots god prestanda svårt att i alla lägen särskilja en aktiv infektion från en tidigare genomgången, varpå vidare studier krävs. Framtida studier bör fokusera på att finna diagnostiska verktyg som hjälper läkarna att urskilja en pågående infektion så att patienten erhåller passande behandling. Det är också mycket viktigt att arbeta vidare mot en standardisering av de diagnostiska metoderna samt finna metoder som har möjlighet att särskilja mellan olika Borrelia-arter.

Download or read book Logistics management operationalised in a healthcare context written by Malin Wiger and published by Linköping University Electronic Press. This book was released on 2018-05-14 with total page 455 pages. Available in PDF, EPUB and Kindle. Book excerpt: Healthcare improvements is constantly relevant and an important topic. Healthcare is frequently being called upon to be more cost-efficient and still fulfil demands regarding waiting times, quality and availability. Experience from structural changes in other contexts gives reason to be positive about the potential for logistics improvements in the healthcare sector as well. From a logistics perspective patients pass different care functions, units, organisations and health facilities. It is assumed that logistics management knowledge applied in healthcare can lead to lower costs, shorter waiting times, better patient service, shorter treatment times and increased capacity. This dissertation therefore presents an exploration of how logistics management theories can be operationalised in a healthcare context to understand care chain effectiveness. Theoretically, the operationalisation is done by systems theory creating compatibility between logistics management theories and the healthcare context. As a first step, features for a logistics system forms features for achieving care chain effectiveness. High care chain effectiveness is thus a desired condition and the care delivery system is the tool to achieve it. As the final step in the operationalisation the features for care chain effectiveness are in turn used to analyse today’s practices. Empirically, the research is based on qualitative data from a single case study with multiple units of analysis. It includes four care units at one of Sweden’s university hospitals, where the data is gathered through interviews, insight into management systems and document analysis. One of the main results is the 21 areas identified for analysing today’s practices by means of features for care chain effectiveness. Another main result is the four important concepts revealed through the operationalisation: Lead time - the episode of care from order to delivery as the amount of time for patient cases between first contact with healthcare and the last.Patient order fulfilment - fulfilment of patients’ needs, broken down into several smaller steps performed over time within different care units in one or several organisations, consisting of five sub-processes - order handling, diagnosis, treatment, follow-up, and discharge.True demand – patients’ needs that is to be met and thus sets what care to deliver, i.e. the production plan and the subordinate resource plan.System boundaries - defines which care units to include when focusing on the care delivery system’s performance as a whole and should be more important than the performance and productivity of each individual care unit. A number of direct suggestions for care chain improvement can also be found in the concluding remarks, for example that objectives linked to economic influx or penalty narrow the system and that lead time data on an aggregated level is needed to cover episodes of care. The theoretical contribution of the dissertation is to the field of logistics management through the methodological development of using these theories in a new context. The managerial contribution is to healthcare managers through providing opportunities to improve care chains primarily by means of a greater understanding of care delivery systems.

Download or read book The Sorrows of an American written by Siri Hustvedt and published by Henry Holt and Company. This book was released on 2008-04-01 with total page 320 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Sorrows of an American is a soaring feat of storytelling about the immigrant experience and the ghosts that haunt families from one generation to another When Erik Davidsen and his sister, Inga, find a disturbing note from an unknown woman among their dead father's papers, they believe he may be implicated in a mysterious death. Siri Hustvedt's The Sorrows of an American tells the story of the Davidsen family as brother and sister uncover its secrets and unbandage its wounds in the year following their father's funeral. Returning to New York from Minnesota, the grieving siblings continue to pursue the mystery behind the note. While Erik's fascination with his new tenants and emotional vulnerability to his psychiatric patients threaten to overwhelm him, Inga is confronted by a hostile journalist who seems to know a secret connected to her dead husband, a famous novelist. As each new mystery unfolds, Erik begins to inhabit his emotionally hidden father's history and to glimpse how his impoverished childhood, the Depression, and the war shaped his relationship with his children, while Inga must confront the reality of her husband's double life. A novel about fathers and children, listening and deafness, recognition and blindness; the pain of speaking and the pain of keeping silent, the ambiguities of memory, loneliness, illness, and recovery. Siri Hustvedt's exquisitely moving prose reveals one family's hidden sorrows through an extraordinary mosaic of secrets and stories that reflect the fragmented nature of identity itself.

Download or read book Praktisk l robok Engelska spr ket inneh llande spr kl ra skrif och l se ffningar samt ordbok written by C.N. Oehrlander and published by . This book was released on 1849 with total page 438 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Acta Universitatis Gotoburgensis written by and published by . This book was released on 1926 with total page 734 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Lomelino s Cakes written by Linda Lomelino and published by Shambhala Publications. This book was released on 2014-11-11 with total page 153 pages. Available in PDF, EPUB and Kindle. Book excerpt: 27 beautiful and delicious layer cakes, baked with love (and plenty of butter). Simple recipes, modern styling--no baking expertise required! Inside this look-book of all things layered, frosted, creamy, and indulgent you’ll find cakes so heavenly you’ll wonder if you could possibly make them at home. But Ms. Lomelino’s stylish cakes are simpler than they seem. Impress your family and friends with cakes crafted from her unique recipes and detailed photos. Learn step-by-step how to decorate with frosting, stack multiple layers, create perfect ganache, and make the most of seasonal ingredients. Be inspired to layer your cakes with fresh fruit, top with fresh flowers, slather with buttercreams, and even play with color, ombré style. Discover just how sweet life can be! MAKE LIFE SWEETER — EAT MORE CAKE!

Download or read book Allting Suger written by Stefan KG Woldekidan and published by Woldekidan Songs. This book was released on 2014-07-25 with total page 289 pages. Available in PDF, EPUB and Kindle. Book excerpt: Sugbloggen är en blogg som började som två bloggar. Saker Som Suger och Dagens Gnäll. Som den vakne och språkbegåvade läsaren förstår är konceptet för bloggen att dryfta och belysa saker och ting från ett gnällaktigt perspektiv. Men som ofta med allt man företar sig så blir det aldrig som man tänkt och ibland spårar bloggaren ut totalt och tar upp saker som inte har den minsta sugfaktorn i sig. Och på något avigt plan borde detta suga som mest men ­ingen verkar bry sig. Boken är en sammanställning av sådant som likt en elak klåda ­retade undertecknad det fula året 2007.

Download or read book Alena written by Kim W. Andersson and published by Dark Horse Comics. This book was released on 2016-09-13 with total page 140 pages. Available in PDF, EPUB and Kindle. Book excerpt: Alena's life is a living hell. Since starting at the snobbish boarding school Alena's been harassed every day by Philippa and the girls on the lacrosse team. But Alena's best friend Josephine is not going to accept that anymore-not from the counselor or principal, not from Philippa, and not from anyone at that horrid school. If Alena does not fight back then Josephine will take matters into her own hands. There's just one problem-Josephine has been dead for a year. English adaption of the award-winning Swedish graphic novel Alena, Movie adaptation made its US debut in February! "Let the Right One In meets Show Me Love set in a boarding school. Count on vengeance, violence and broken teenage hearts."-Stockholm Filme Festival

Download or read book Studies in the literature of northern Europe written by sir Edmund William Gosse and published by . This book was released on 1879 with total page 432 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Northern Studies written by Edmund Gosse and published by . This book was released on 1890 with total page 302 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Swedish Design written by Denise Hagströmer and published by . This book was released on 2001 with total page 140 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book The Augustana Quarterly written by and published by . This book was released on 1922 with total page 396 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Psykologen written by Marcus Ström and published by Lulu.com. This book was released on 2013-07-28 with total page 261 pages. Available in PDF, EPUB and Kindle. Book excerpt: Thomas Erlander blir involverad i en mordhärva när han kontaktas av kriminalkommissarien Martin Edström medan han håller på att lansera sin nya klinik i den norrländska huvudstaden Umeå.

Download or read book Samlade skrifter Prosaskrifter 1791 1793 Odaterade prosaskrifter p svenska written by Thomas Thorild and published by . This book was released on 1944 with total page 474 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book An English and Swedish dictionary written by Jacob Serenius and published by . This book was released on 1757 with total page 668 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Engelsk svensk Ordbok written by Erik Lindgren and published by . This book was released on 1909 with total page 732 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Christakis s Rebellious Wife written by Lynne Graham and published by Harlequin. This book was released on 2014-06-17 with total page 193 pages. Available in PDF, EPUB and Kindle. Book excerpt: Nik Christakis had once been her Prince Charming, the indecently rich and devilishly handsome tycoon who took Betsy away from her life as a waitress and did the unimaginable, made her his wife! But married life wasn't the fantasy she'd envisioned.