Practice patterns and clinical outcomes in acute appendicitis differ in the elderly patient

Background: Appendicitis is the most frequent global abdominal surgical emergency. An ageing population, who often exhibit atypical symptoms and delayed presentations, challenge conventional diagnostic and treatment paradigms. Objectives: This study aims to delineate disparities in presentation, management, and outcomes between elderly patients and younger adults suffering from acute appendicitis. Methods: This subgroup analysis forms part of ESTES SnapAppy, a time-bound multi-center prospective, observational cohort study. It includes patients aged 15 years and above who underwent laparoscopic appendectomy during a defined 90-day observational period across multiple centers. Statistical comparisons were performed using appropriate tests with significance set at p < 0.05. Results: The study cohort comprised 521 elderly patients (≥65 years) and 4,092 younger adults (18–64 years). Elderly patients presented later (mean duration of symptoms: 7.88 vs. 3.56 days; p < 0.001) and frequently required computed tomography (CT) scans for diagnosis (86.1% vs. 54.0%; p < 0.001). The incidence of complicated appendicitis was higher in the elderly (46.7% vs. 20.7%; p < 0.001). Delays in surgical intervention were notable in the elderly (85.0% operated within 24 h vs. 88.7%; p = 0.018), with longer operative times (71.1 vs. 60.3 min; p < 0.001). Postoperative complications were significantly higher in the elderly (27.9% vs. 12.9%; p < 0.001), including severe complications (6.9% vs. 2.4%; p < 0.001) and prolonged hospital stays (7.9 vs. 3.6 days; p < 0.001). Conclusions: Our findings highlight significant differences in the clinical course and outcomes of acute appendicitis in the elderly compared to younger patients, suggesting a need for age-adapted diagnostic pathways and treatment strategies to improve outcomes in this vulnerable population

Mobila turisttjänster - En fältstudie med fokus på användbarhetsaspekter

Denna uppsats behandlar design av mobila tjänster från ett användbarhetsperspektiv i en turismkontext. Studien hade flera syften, där det teoretiska bidraget var att ta fram ett teoretiskt ramverk för design av mobila tjänster. Detta ramverk innehåller bland annat begreppen kontext, informationspresentation och navigering. Det praktiska bidraget var att skapa en prototyp, utifrån det teoretiska ramverket, av en mobil turisttjänst som sedan utvärderades. Studien innehöll tre faser, den första var en litteraturstudie som resulterade i det teoretiska ramverket. Den andra delen var mer praktiskt inriktad och innehöll utveckling av prototypen. Från enkla pappersskisser utvecklade vi en prototyp som gick att interagera med. Detta gjordes i programmet Macromedia Flash. I denna utvecklingsfas gjordes även utvärderingar av prototypen där den bland annat presenterades och testades under en workshop. Den tredje fasen bestod av undersökningen och det efterföljande arbetet med resultat, analys och diskussion. Undersökningen genomfördes som en fältstudie, i centrala Halmstad, där sex respondentgrupper fick utföra en uppgiftsbaserad utvärdering. Därefter genomfördes semistrukturerade intervjuer med respondentgrupperna. Efter analys och diskussion av resultatet från undersökningen kunde ett antal slutsatser dras. Dessa slutsatser bekräftade att begreppen från det teoretiska ramverket var viktiga vid design av mobila turisttjänster. Slutligen kunde ett antal specifika designimplikationer för dessa tjänster föreslås utifrån de mer generella slutsatserna. Ett exempel på slutsats är att den fysiska kontexten är viktig, om en mobil turisttjänst ej är designad för olika omgivningar kan dessa påverka en användares interaktion med tjänsten negativt. För att en mobil turisttjänst ska fungera i olika fysiska- och användarkontexter rekommenderas att tjänsten ska vara möjlig att personalisera efter användarnas intresse och deras antal, vilket är ett exempel på en designimplikation

From Visions to Specification : Using user designed mock-ups for envisioning user requirements for the future e-newspaper

In this paper we have studied how user designed mock-ups, together with video recordings, can contribute in the process of generating user requirements when designing the future e- newspaper. The mock-ups originate from future workshop carried out within the DigiNews project. By analyzing user designed mock-ups to retrieve user requirements and evaluating the results against a focus group and newspaper designers we gained understanding on how mock-ups can contribute as data input in a user involved design process. The study concludes that mock-ups are an effective tool for making use of users’ visions and opinions in a dynamic design process

Tobacco Use During Pregnancy and Preeclampsia Risk

Preeclampsia is a leading cause of maternal and infant mortality and morbidity worldwide. Both Swedish snuff and cigarette smoke include nicotine, but combustion products accompany only smoking. The aims of this study were to compare the effects of Swedish snuff and cigarette smoking on preeclampsia risk and to estimate whether changes in tobacco habits during pregnancy affect the risk of developing term preeclampsia. We used information from the Swedish Birth Register on all singleton births in Sweden during the years 1999–2006 (n=612 712). Compared with nontobacco users, women who used snuff in early pregnancy had an adjusted odds ratio (OR) for preeclampsia of 1.11 (95% CI: 0.97 to 1.28). The corresponding ORs for light and heavy smokers were 0.66 (95% CI: 0.61 to 0.71) and 0.51 (95% CI: 0.44 to 0.58), respectively, with ORs lower for term than preterm preeclampsia. Compared with nontobacco users, women who smoked in early pregnancy but had quit smoking before late pregnancy (weeks 30 to 32) had an adjusted OR for term preeclampsia of 0.94 (95% CI: 0.83 to 1.08). The corresponding OR for women who did not use tobacco in early pregnancy but had started to smoke before late pregnancy was 0.65 (95% CI: 0.50 to 0.85). We conclude that tobacco combustion products rather than nicotine are the probable protective ingredients against preeclampsia in cigarette smoke. Because change of smoking habits during pregnancy influence risk, we further conclude that it is the smoking habits in the middle or late rather than in the beginning of pregnancy that seem to affect the risk of preeclampsia.</jats:p

Immunohistological Localization of the MrkD Adhesin in the Type 3 Fimbriae of <i>Klebsiella pneumoniae</i>

ABSTRACT The adhesive minor protein MrkD of the type 3 fimbria of Klebsiella pneumoniae was expressed and purified from Escherichia coli as a fusion protein with an N-terminal polyhistidine tail. Polyclonal antibodies raised against MrkD specifically recognized the MrkD peptide in Western blots of fimbrial preparations. Immunoelectron microscopic analyses showed that the anti-MrkD immunoglobulins bound to the tip of the plasmid-encoded variant of the type 3 fimbria of K. pneumoniae , whereas no binding to the chromosomally encoded MrkD-deficient type 3 fimbrial variant of K. pneumoniae was detected. Immunoglobulins from an antiserum raised against purified type 3 fimbrial filaments bound laterally to both type 3 fimbrial variants. The anti-MrkD antibodies also bound to the tip of a papG deletion derivative of the E. coli P fimbria complemented with mrkD , indicating that MrkD structurally complements a PapG mutation in the P fimbria of E. coli. </jats:p

\uc5rs-ber\ue4ttelse om botaniska arbeten och uppt\ue4ckter

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