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Additional file 3. List of excluded studies.

Additional file 4. Inclusion and exclusion criteria based on PICO.

Additional file 1. PRISMA table.

Additional file 2. Search strategy.

Original description of the hypermobility instruments, the Beighton score, the Contompasis score and the Hospital del Mar Criteria. (DOCX 20 kb)

Structured protocol for measurement of range of motion in joints included in the Beighton score, the Contompasis score and the Hospital del Mar Criteria. (DOCX 1226 kb)

Model consent forms. Provides a copy of the consent forms to be used for the interviews (phase 1) and the Delphi survey (phase 2). (PDF 108 kb)

Nahid Kondori1,*, Marcel Erhard2, Christina Welinder-Olsson1, Marizeth Groenewald3, Gerard Verkley3 and Edward R. B. Moore1,41Department of Infectious Diseases, Sahlgrenska Academy of the University of Gothenburg, SE-40234 Gothenburg, Sweden2RIPAC-LABOR GmbH, D-14476 Potsdam, Germany3Centraalbureau voor Schimmelcultures (CBS), CBS-KNAW Fungal Biodiversity Centre, 3584 CT Utrecht, Netherlands4Culture Collection University of Gothenburg, Sahlgrenska Academy of the University of Gothenburg, SE-40234 Gothenburg, Sweden↵*Corresponding author: Department of Infectious Diseases, University of Gothenburg, Box 7193, 40234 Gothenburg, Sweden. Tel: +46-31-342-4226; Fax: +46-31-342-4975; E-mail: nahid.kondori{at}microbio.gu.seRevision received July 8, 2014.Accepted November 3, 2014.AbstractConventional mycological identifications based on the recognition of morphological characteristics can be problematic. A relatively new methodology applicable for the identification of microorganisms is based on the exploitation of taxon- specific mass patterns recorded from abundant cell proteins directly from whole-cell preparations, using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). This study reports the application of MALDI-TOF MS for the differentiation and identifications of black yeasts, isolated from the respiratory tracts of patients with cystic fibrosis (CF). Initial phenotypic and DNA sequence-based analyses identified these isolates to be Exophiala dermatitidis. The type strains of E. dermatitidis (CBS 207.35T) and other species of Exophiala were included in the MALDI-TOF MS analyses to establish the references for comparing the mass spectra of the clinical isolates of Exophiala. MALDI-TOF MS analyses exhibited extremely close relationships among the clinical isolates and with the spectra generated from the type strain of E. dermatitidis. The relationships observed between the E. dermatitidis strains from the MALDI-TOF MS profiling analyses were supported by DNA sequence-based analyses of the rRNA ITS1 and ITS2 regions. These data demonstrated the applicability of MALDI-TOF MS as a reliable, rapid and cost-effective method for the identification of isolates of E. dermatitidis and other clinically relevant fungi and yeasts that typically are difficult to identify by conventional methods.Exophiala dermatitidisfungiMALDI-TOF MSwhole-cell protein profiling© FEMS 2014. All rights reserved. For permissions, please e-mail: journals.permissions{at}oup.com

Interview guide patient. (DOC 87 kb)

Interview guide PRE manager. (DOC 96 kb)

Interview guide POST staff. (DOC 91 kb)

Interview guide POST staff. (DOC 91 kb)

Interview guide PRE staff. (DOC 95 kb)

Interview guide patient. (DOC 87 kb)

Interview guide PRE manager. (DOC 96 kb)

Enterohemorrhagic Escherichia coli (EHEC) constitutes a group of E. coli that in the past two decades has been the cause of several outbreaks of gastrointestinal disease. The microorganism causes hemorrhagic colitis (HC) and haemolytic uremic syndrome (HUS) in 5-10% of the patients, 30% of the HUS patients develop remaining kidney injuries. The capacity to control EHEC disease and to limit the scale of outbreaks is dependent upon prompt diagnosis and identification of the source of infection. Cattle are the principal reservoir of EHEC and foodstuffs, which presumably have come into contact with domestic animal manure and/or are inadequately pasteurised, are important vehicles of infection. The predominating virulence factor of EHEC is the verocytotoxin first identified in an E. coli of serogroup O157:H7. In the present study, the PCR technique with primers detecting the verocytotoxin genes was shown to be a fast, sensitive and specific method to screen for and identify EHEC. The study contributes to the knowledge and understanding that also EHEC non-O157 are pathogenic and that all verocytotoxin producing E. coli should be looked after among patients with diarrhoea, HC and HUS. The importance of quick identification was exemplified in an outbreak of EHEC among the staff at the children s hospital in Göteborg, Sweden. As the outbreak was promptly identified, partly thanks to the PCR technique, no further spread to other staff members or patients occurred. In the present thesis, pulsed-field gel electrophoresis (PFGE) was used and the method was shown to be very useful in the epidemiological work to separate single cases of EHEC from outbreaks. In order to further characterise EHEC non-O157, the presence of additional chromosomal and plasmid genes probably involved in the pathogenesis were analysed as these genes have been found in EHEC O157. The gene coding for intimin, enabling tight attachment to epithelial cells of the intestine was also often present among EHEC non-O157. Moreover, the gene coding for an enterohemolysin possibly supporting the bacterial need for iron was especially often present among EHEC isolated from patients with severe symptoms. Further, the study has shown that the gene coding for aerobactin seems to be able to compensate for the absence of enterohemolysin and that also the type 1 fimbriae may be valuable to obtain a niche in the gut. A comparative study of verocytotoxin producing E. coli in cattle showed that there is a significantly lower amount of E. coli harbouring the intimin gene and the gene coding for aerobactin, supporting the assumption that not all verocytotoxin producing E. coli in cattle are pathogenic. In conclusion, methods identifying the verocytotoxines or their genes should be used to identify EHEC of all serogroups. PCR is preferable as it is a fast, sensitive and specific method. Genes coding for intimin, enterohemolysin and aerobactin adds to the pathogenicity of EHEC. These genes are not that common among isolates from cattle. PFGE is a most valuable tool for epidemiological tracing of EHEC.

This thesis consists of four papers, all of which are concerned with the demand for and consumption of dental care services. In Paper [I] the presence of supplier induced demand is studied in the Swedish market for dental care. A two-part, hurdle model is used to capture the fact that the decision whether or not to visit a dentist, and the decision on how many times to visit a dentist, may be governed by different processes. In the analysis, we account for the distinction between dentists working within the National Dental Service and private practitioners, as potentially they have different incentives regarding supplier induced demand. We find evidence of supplier induced demand among private practitioners in the Swedish market for dental care. In Paper [II], the choice of not visiting, or of making one or more visits to a dentist in 1973, 1980 and 1990 is studied. In 1973 there was no dental insurance, and there were different insurance regimes in 1980 and 1990. Separate models are estimated for the three years. In all three years it is found that the probability of visiting a dentist increases with income and years of education, and that women are more likely to visit a dentist than men. We can also conclude that there has been structural change in the probability of visiting a dentist for the period under scrutiny. In Paper [III] the number of visits to a dentist is analyzed for a sample of adult Swedes. Particular interest is in the long term effect of regular visits to a dentist during childhood and adolescence. The data used contain many zeros and, because of the nature of the institutional framework, many one time visits. The zero-inflated Poisson model is extended to a zero-and-one-inflated Poisson. For those with healthy teeth, the visiting habits during childhood and adolescence have no significant effect on the number of visits to a dentist as an adult. For those with problematic teeth, the visit frequency to a dentist as an adult is reduced by about 18 percent if regular visits to a dentist are made during the individual's youth. Paper [IV] studies the design of an optimal insurance scheme with an application to the Swedish dental insurance system in 1993. In Sweden, dental health has improved since the 1974 reform of the dental insurance system. The cost for dental insurance, which in Sweden is financed through taxes and social insurance fees, is nevertheless still high. In this paper, we formulate a non-linear dental insurance scheme financed through premium payments and compare individuals' expected utility in this system to the expected utility in the Swedish dental insurance system from 1993.