Elderlys’ experiences of being discharged from the hospital followed by a close readmission

Background: Elderly who are admitted at the hospital can have a multifaceted scenario with chronic illnesses and disabilities. Readmission is a common problem amongst the elderly. Approximately 20 percent of the elderly patients discharged from hospitals in Sweden are readmitted within 30 days. Being admitted in the hospital involves risks of healthcare associated injuries such as pressure ulcers, falls and nosocomial infections. It is important that both the patient and closely related persons are involved in the planning at hospital discharge. By applying a person-centred approach based on the patient’s perspective and experiences, he or she can be seen as a person which may result in increased participation. Aim: To describe elderlys’ experiences of being discharged from the hospital followed by a close readmission. Method: The study has a qualitative approach and unstructured interviews were used. Six persons over 75 years of age who had been readmitted to hospital within 30 days were interviewed. A qualitative content analysis with an inductive approach was used as method of analysis. Results: The analysis of elderlys’ experiences of being discharged from the hospital followed by a closely readmission resulted in four main categories. Being safe in the hands of others is characterised by trust in others and support of others. To live in the present focus on insight of being old and to have confidence in oneself. Reduced self determination is characterised by others making decisions and being forced to relate to others. To be insecure at the hospital is featured by lack of information, not being ready for discharge and feeling vulnerable. Conclusion: The elderly have a desire to live in the present and they put faith in themselves. Expectations and the daily life are adjusted according to the state of health in order to achieve balance in life. Elderly often perceive the degradation as part of the natural aging process. Closely related persons have a significant role and there is great faith put in these while they are making crucial decisions for the elderly. The elderly may experience the stay in hospital as insecure which may be due to lack of information and a sense of vulnerability. Feelings of insecurity can be reduced by applying a person-centred approach. To reduce readmissions of the elderly it is most likely that person-centred care is needed to be complemented by additional actions. Key words: elderly, discharge, readmission, person-centredness, qualitative method, content analysisBakgrund: Äldre personer som vårdas på sjukhus kan ha en mångfacetterad problembild med kroniska sjukdomar och funktionsnedsättningar. Återinläggningar är ett problem som är vanligt hos äldre. Upp emot 20 procent av de äldre patienterna som skrivs ut från sjukhus i Sverige återinläggs inom 30 dagar. Att vara inneliggande på sjukhus innebär risk att drabbas av vårdskador så som trycksår, fallskador och vårdrelaterade infektioner. Att som patient och närstående vara delaktig i planeringen är av betydelse vid utskrivning från sjukhus. Genom att applicera ett personcentrerat synsätt med utgångspunkt från patientens perspektiv och upplevelser kan denne ses som en person vilket kan medföra ökad delaktighet. Syfte: Att beskriva äldre personers upplevelser i samband med utskrivning från sjukhus följt av en tät återinläggning. Metod: I studien har en kvalitativ ansats med ostrukturerade djupintervjuer använts. Sex personer över 75 år som blivit återinlagda på sjukhus inom 30 dagar intervjuades. Som analysmetod användes en kvalitativ innehållsanalys med induktiv ansats. Resultat: Analysen av äldre personers upplevelser i samband med återinläggning följt av en tät återinläggning resulterade i fyra huvudkategorier. Tryggt att vara i andras händer karaktäriseras av tilltro till andra och stöd av andra. Att leva i nuet fokuserar på insikten i vara gammal och att ha tilltro till sig själv. Minskat självbestämmande kännetecknas av att andra bestämmer och att tvingas förhålla sig till andra. Otryggt på sjukhuset utmärks av bristande information, av att ej vara redo för hemgång och att känna sig utsatt. Slutsats: De äldre personerna hyser en önskan om att leva i nuet och sätter tilltro till sig själva. Förväntningar och livsföring anpassas utifrån hälsotillståndet för att uppnå balans i tillvaron. Äldre ser ofta försämring som en del i det naturliga åldrandet. Närstående har en betydande roll och stor tilltro sätts till dessa samtidigt som de fattar avgörande beslut åt de äldre. Vistelsen på sjukhus kan hos de äldre upplevas som otrygg vilket kan bero på bristande information och en känsla av utsatthet. Upplevelser av otrygghet kan minskas genom att tillämpa ett personcentrerat synsätt. För att minska återinläggningar hos de äldre krävs troligtvis att personcentrerad vård kompletteras med ytterligare åtgärder

Promoting the Clinical Relevance of 3D Bioprinting

This thesis focuses on the development of methodologies enabling the reconstruction of autologous, functional, and long-term-stable cartilage-like tissue using 3D bioprinting technology and animal experiments. The stability, resilience, and in vivo viability of the printed cells and tissue vascularization, as well as the observed immunogenicity and safety, represent the main issues evaluated and discussed in this thesis. Furthermore, the mechanical properties of the applied biomaterials are evaluated in detail. Study I Background: This study quantitatively assessed the proliferative capacity of chondrocytes in the presence and absence of stem cells in the 3D bioprinting setting. Results: We observed significant increases in the number of chondrocytes and cluster formations during the study period. Compared with pure human nasal chondrocyte (hNC) group, we identified a significant additional proliferative effect in the group containing both hNCs and stem cells, and histologic analysis confirmed the expected production of collagen type II in the extracellular matrix, as well as the distribution of glycosaminoglycans in the cartilage-like tissue. Additionally, fluorescence in situ hybridization analysis confirmed that the chondrocytes were of human origin, and their male phenotype verified the male chon-drocyte-donor source. Study II Background: In this study, we evaluated the results of subcutaneous implantation of 3D-bioprinted constructs mixed with human chondrocytes and stem cells over the course of 10 months. Results: We observed no signs of necrosis, tumors, ossification, or other adverse effects. Moreover, the constructs remained well-preserved, and histologic analyses showed thriving, proliferating chondrocytes in cartilage-like formations. Study III Background: This study mapped the vascularization of gridded 3D-bioprinted constructs. Results: Perfusion data from magnetic resonance imaging revealed progressive vascularization inside of grid holes that were confirmed as being filled with blood vessels connected to host circulation according to histologic analysis. Additionally, immunohistochemical analysis of endothelial cells confirmed the vascular arrangement, with collagen II production further indi-cating chondrocyte proliferation and cartilage formation. Study IV Background: In this study, we evaluated the biocompatibility (according to ISO standards) and mechanical properties of tunicate-derived nanocellulose (TNC) as a novel biomaterial. Results: We determined TNC biocompatibility as equivalent to that of expanded polytetrafluoroethylene while also exhibiting excellent mechanical properties. Keywords 3D bioprinting, cartilage, chondrocytes, stem cells, tissue engineering, nanocellulose, hydrogel, bioink, vascularization, bio-compatibilit

Disabilities in equestrian sports from riding instructors´ perspective : a qualitative interview study

Det kan ibland vara svårt för personer som lever med funktionsnedsättningar att få en fungerande vardag. En del anser att det är svårt att resa och ta sig runt själva och andra känner sig som en börda för sin omgivning. Det finns studier som visar att idrottsaktiviteter inte förekommer i samma utsträckning för unga personer med funktionsnedsättningar som det gör för unga personer utan dem. Det saknas forskning som belyser ridlärares upplevelser och erfarenheter av att undervisa och leda personer med funktionsnedsättningar inom ridsporten. Det finns behov av att synliggöra vilka utmaningar och möjligheter som föreligger med pararidningen och dess framtid. Syftet med den här studien är att undersöka verksamma ridlärares erfarenheter och tankar kring att undervisa elever med funktionsnedsättningar på ridskola. Frågeställningarna till studien är: Vilka utmaningar och möjligheter ser verksamma ridlärare med ridundervisning för ryttare med funktionsnedsättningar? Hur förhåller sig ridlärare kring frågan angående pararidningens utvecklingsmöjligheter på Sveriges ridskolor? Den här studien grundades på intervjuer med sex verksamma ridlärare på sex olika ridskolor under februari till mars månad år 2021. Ridskolorna valdes ut via handplockat urval och var de som erbjöd pararidning till sina elever. På grund av rådande situation med Covid-19 genomfördes intervjuerna digitalt då fysiska besök inte var lämpligt. Frågorna som ställdes i intervjuerna var semistrukturerade vilket resulterade i att alla respondenter inte fick exakt samma frågor även om de 20 grundfrågorna var samma för samtliga. Svaren analyserades genom tematiska innehållsanalyser och jämfördes sinsemellan vilket sedan genererade i kategorier kopplade till frågeställningarna. Kategorierna blev följande: Ridgrupperna där resultat som antal elever, antal grupper och antal minuter per lektion ingick. Mål för eleverna bestod av resultat om gruppernas mål eller ryttarnas individuella mål. Målen kunde antingen vara personlighetsmässiga eller prestationsmässiga men också om verksamheten hade mål om anläggningens utveckling. I kategorin utmaningar och möjligheter beskrivs de största skillnaderna med att undervisa personer med funktionsnedsättningar och personer utan dem samt hur respondenterna ser på verksamhetens utveckling inom området. Sista kategorin var utveckling och framtid där resultat beskrivs om hur respondenterna på respektive anläggning arbetar för att få fler medlemmar, hur eleverna anmäler sig samt om de aktivt arbetar för att bli mer attraktiva på marknaden. Genom att även redogöra för marknadsföringen blev det tydligt hur respondenterna såg på frågan kring ridskolornas framtid och utveckling. Ridlärarnas perspektiv på utvecklingen och framtiden för pararidning på ridskolor skiljde sig åt beroende på hur stor verksamheten var och hur väl ekonomin tillät förändringar. Resultaten i studien visade på att de största utmaningarna med undervisning av funktionsnedsatta personer var att nå fram till eleverna på ett sätt som fick alla att förstå. Eleverna med funktionsnedsättningar behövde fler resurser och mer pedagogiska instruktörer. Möjligheterna som betonades var att ridningen gav en lycka för både elever och instruktörer att uppnå något tillsammans. Såväl kroppslig och rörlig utveckling som personlig utveckling. Det var tydligt att ridlärare bör vara både flexibla och uppfinningsrika i sin undervisning. Slutsatsen av den här intervjustudien var att utmaningarna av att undervisa ryttare med funktionsnedsättningar är fler än möjligheterna. Utmaningarna var att skapa en säker miljö och att kunna nå fram till eleverna på ett pedagogisk vis. Ytterligare utmaningar var anläggningarnas faciliteter samt att få verksamheten att gå runt ekonomiskt. Möjligheterna som framhölls var främst att verksamheten skapade gemenskap och gav eleverna mål att se fram emot, exempelvis tävling. Det fanns stor utvecklingspotential gällande utvecklingsmöjligheterna på ridskolorna. Ridlärarna hade en ambition och önskan att ridskolorna ska kunna erbjuda en ännu mer anpassad anläggning. De avsåg därför att kunna utveckla anläggningen i form av: fler ramper, bättre utrustning och pedagogiska läromedel.There is not enough research on riding instructors´ perspective of teaching riders with disabilities. It is important to acknowledge challenges and possibilities of the development for the future on riding schools in Sweden. The aim of this study is to investigate how riding instructors on Swedish riding schools teach students with disabilities to ride. The questions that were to be answered in the study was: What are the challenges and possibilities for riding instructors to teach riders with disabilities? What perspective does riding instructors´ have on the possible development for people with disabilities to ride at Swedish riding schools? In this study, six riding instructors from six different riding schools were interviewed during the months of February to Mars year of 2021. The interviews took place through digital meetings due to the situation of Covid-19. Since the questions were semi-structured the instructors were not given the exact same questions, but the 20 main questions were the same. The answers were analyzed through qualitative data analysis which were coded into categories based on the study’s questions. The results show that it is a challenge to make sure that all riders understand the instructions. Riders with disabilities needed more resources and pedagogical teachers. The main possibilities were that riders and teachers together create a social community with both bodily and personal development. The opinions of the riding instructors were very variated considering what was most challenging with their job and what the possibilities were. The conclusion of the study was that the challenges of teaching riders with disabilities were greater than the possibilities. The challenge was to create a safe environment and good communication between riders and teacher. Another challenge was to make the activity profitable. The possibilities they considered, were the fact that they create a social community in the stable and give riders with disabilities at riding schools goals to look forward to, such as competition. There was great potential regarding the opportunity of development at the riding schools. The riding instructors had an ambition and dream for riding schools to offer more adapted facilities. They wanted to develop facilities in the form of: more ramps, better equipment and pedagogical teaching aids

What ‘children’ experience and ‘adults’ may overlook: phenomenological approaches to media practice, education and research

This paper argues that each utterance of media should be seen as in dialogue with each other utterance, and that children, being the phenomenological hub to their lived media experience, should be recognised as engaging with media holistically. Argument draws upon two recent qualitative studies with children between six and eleven years of age. These studies, although separate, shared certain phenomenology orientated conceptual underpinnings and arrived at relatable findings. Notably that participating children tended to address media in a platform agnostic manner and offered little sense that they saw the media platform itself as being of overriding significance to their holistic media engagement. Ultimately, if children’s lived media engagement is dialogic and holistic, then focusing on only one discreet media utterance (like television for example) can be said to become deeply problematic to those within children’s media practice, education and research

Increasing the Practical Resolution of Projection Lithography Using a Phase-Shifting Mask

A phase shifting mask, to be used for the purpose of improving the resolution of a projection lithography system, was fabricated. This type of mask consists of line-space pairs in which every other aperture induces a 180 degree phase shift in the transmitted radiation. In order to obtain this phase shift there must be a thickness difference between the apertures. Etching of the glass mask plate in 3:100 HF to DI water was used to obtain the required • etch depth

Chondrocytes and stem cells in 3D-bioprinted structures create human cartilage in vivo

Cartilage repair and replacement is a major challenge in plastic reconstructive surgery. The development of a process capable of creating a patient-specific cartilage framework would be a major breakthrough. Here, we described methods for creating human cartilage in vivo and quantitatively assessing the proliferative capacity and cartilage-formation ability in mono- and co-cultures of human chondrocytes and human mesenchymal stem cells in a three-dimensional (3D)-bioprinted hydrogel scaffold. The 3D-bioprinted constructs (5 7 5 7 1.2 mm) were produced using nanofibrillated cellulose and alginate in combination with human chondrocytes and human mesenchymal stem cells using a 3D-extrusion bioprinter. Immediately following bioprinting, the constructs were implanted subcutaneously on the back of 48 nude mice and explanted after 30 and 60 days, respectively, for morphological and immunohistochemical examination. During explantation, the constructs were easy to handle, and the majority had retained their macroscopic grid appearance. Constructs consisting of human nasal chondrocytes showed good proliferation ability, with 17.2% of the surface areas covered with proliferating chondrocytes after 60 days. In constructs comprising a mixture of chondrocytes and stem cells, an additional proliferative effect was observed involving chondrocyte production of glycosaminoglycans and type 2 collagen. This clinically highly relevant study revealed 3D bioprinting as a promising technology for the creation of human cartilage

Long-term in vivo survival of 3D-bioprinted human lipoaspirate-derived adipose tissue: proteomic signature and cellular content

Three-dimensional (3D)-bioprinted lipoaspirate-derived adipose tissue (LAT) is a potential alternative to lipo-injection for correcting soft-tissue defects. This study investigated the long-term in vivo survival of 3D-bioprinted LAT and its proteomic signature and cellular composition. We performed proteomic and multicolour flow cytometric analyses on the lipoaspirate and 3D-bioprinted LAT constructs were transplanted into nude mice, followed by explantation after up to 150\ua0days. LAT contained adipose-tissue-derived stem cells (ASCs), pericytes, endothelial progenitor cells (EPCs) and endothelial cells. Proteomic analysis identified 6,067 proteins, including pericyte markers, adipokines, ASC secretome proteins, proangiogenic proteins and proteins involved in adipocyte differentiation and developmental morphogenic signalling, as well as proteins not previously described in human subcutaneous fat. 3D-bioprinted LAT survived for 150\ua0days in vivo with preservation of the construct shape and size. Furthermore, we identified human blood vessels after 30 and 150\ua0days in vivo, indicating angiogenesis from capillaries. These results showed that LAT has a favourable proteomic signature, contains ASCs, EPCs and blood vessels that survive 3D bioprinting and can potentially facilitate angiogenesis and successful autologous fat grafting in soft-tissue reconstruction

Biomaterial and biocompatibility evaluation of tunicate nanocellulose for tissue engineering

Extracellular matrix fibril components, such as collagen, are crucial for the structural properties of several tissues and organs. Tunicate-derived cellulose nanofibrils (TNC) combined with living cells could become the next gold standard for cartilage and soft-tissue repair, as TNC fibrils present similar dimensions to collagen, feasible industrial production, and chemically straightforward and cost-efficient extraction procedures. In this study, we characterized the physical properties of TNC derived from aquaculture production in Norwegian fjords and evaluated its biocompatibility regarding induction of an inflammatory response and foreign-body reactions in a Wistar rat model. Additionally, histologic and immunohistochemical analyses were performed for comparison with expanded polytetrafluoroethylene (ePTFE) as a control. The average length of the TNC as determined by atomic force microscopy was tunable from 3 mu m to 2.4 mu m via selection of a various number of passages through a microfluidizer, and rheologic analysis showed that the TNC hydrogels were highly shear-thinning and with a viscosity dependent on fibril length and concentration. As a bioink, TNC exhibited excellent rheological and printability properties, with constructs capable of being printed with high resolution and fidelity. We found that post-print cross-linking with alginate stabilized the construct shape and texture, which increased its ease of handling during surgery. Moreover, after 30 days in vivo, the constructs showed a highly-preserved shape and fidelity of the grid holes, with these characteristics preserved after 90 days and with no signs of necrosis, infection, acute inflammation, invasion of neutrophil granulocytes, or extensive fibrosis. Furthermore, we observed a moderate foreign-body reaction involving macrophages, lymphocytes, and giant cells in both the TNC constructs and PTFE controls, although TNC was considered a nonirritant biomaterial according to ISO 10993-6 as compared with ePTFE. These findings represent a milestone for future clinical application of TNC scaffolds for tissue repair. One sentence summary: In this study, the mechanical properties of tunicate nanocellulose are superior to nanocellulose extracted from other sources, and the biocompatibility is comparable to that of ePTFE