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The aim of this study is to examine intangible aspects of medieval church architecture from an art historical perspective, by using the theoretical frameworks of the theologist Alf Härdelin’s theory on multidimensionality and the philosopher of languages John Langshaw Austin’s the­ory on speech acts and performativity. It studies the relationship between church architecture and liturgy during the 15th century. This case study’s main material is the Upland parish church Ärentuna and the liturgical sources Missale Upsalense novum (1513) and the devotional book Siælinna thrøst (15th century). The interior of the church has been examined to understand how the church interior may have been furnished during the 15th century. During the 15th century the church had many more altars and devotion pictures than what one can see in the current furnishings of the church. There is a narratological succession in the construction of the building, as well as the iconographical motifs, from West to East, thus the meaning of it becomes increasingly sacred. In that way, the construction of the building, as well as the wall paintings converses, with the liturgy – which has its core in the choir. When lay­people entered the sacred space of the church, they perceived things in a specific order, which creates a sense of order and cohesion within the liturgy. The study found that liturgy produces meaning in the church architecture by giving a visual expression to faith through images. Through performative speech acts found in the liturgy, a multidimensional experience is created by the (theological) fact of Christ's presence in the church. The nave's paintings enhance the visitor’s experience of the church interior as an eternal heavenly presence with motifs such as the Seven days of Creation, the Ten Commandments, the Passion of Christ and finally the Last Judgment.

Motivation kan skilja sig åt mellan individer. Tidigare studier inom självbestämmande teorin visade på positiva och negativa effekter av inre motivation, yttre motivation och amotivation. Ingen studie hade, till kännedom, jämfört olika yrkeskategorier gällande motivationstyperna. Det resulterade i studiens syfte att jämföra 4 yrkeskategorier, män och kvinnor och undersöka interaktionsteffekten, vilket var grunden till studiens 9 frågeställningar. En digital enkät distribuerades bland poliser, sjuksköterskor, banktjänstemän och lagerpersonal. Enkäten inkluderade bakgrundsfrågor och 18 påståenden från en skala som mäter motivation. 130 respondenter deltog, varav 69 kvinnor. Tvåvägs variansanalyser för oberoende mätningar användes. Signifikanta skillnader fanns mellan yrkeskategorierna gällande de 3 motivationstyperna. Ingen signifikant skillnad fanns mellan kön, inte heller någon interaktionseffekt mellan kön och yrke. Poliser och sjuksköterskor hade hög grad inre motivation och lagerpersonal hade högre amotivation än övriga 3 yrken. Resultatet och kunskapen om motivationstyperna borde ligga i allas intresse för att skapa en optimal arbetsplats med drivna medarbetare.

Purpose Variability in cytochrome P450 3A4 (CYP3A4) metabolism is mainly caused by non-genetic factors, hence providing a need for accurate phenotype biomarkers. Although 4 beta-hydroxycholesterol (4 beta OHC) is a promising endogenous CYP3A4 biomarker, additional investigations are required to evaluate its ability to predict CYP3A4 activity. This study investigated the correlations between 4 beta OHC concentrations and hepatic and intestinal CYP3A4 protein expression and ex vivo microsomal activity in paired liver and jejunum samples, as well as in vivo CYP3A4 phenotyping (midazolam) in patients with a wide body weight range. Methods The patients (n = 96; 78 with obesity and 18 normal or overweight individuals) were included from the COCKTAIL-study (NCT02386917). Plasma samples for analysis of 4 beta OHC and midazolam concentrations, and liver (n = 56) and jejunal (n = 38) biopsies were obtained. The biopsies for determination of CYP3A4 protein concentration and microsomal activity were obtained during gastric bypass or cholecystectomy. In vivo CYP3A4 phenotyping was performed using semi-simultaneous oral (1.5 mg) and intravenous (1.0 mg) midazolam. Results 4 beta OHC concentrations were positively correlated with hepatic microsomal CYP3A4 activity (rho = 0.53, p < 0.001), and hepatic CYP3A4 concentrations (rho = 0.30, p = 0.027), but not with intestinal CYP3A4 concentrations (rho = 0.18, p = 0.28) or intestinal microsomal CYP3A4 activity (rho = 0.15, p = 0.53). 4 beta OHC concentrations correlated weakly with midazolam absolute bioavailability (rho = - 0.23, p = 0.027) and apparent oral clearance (rho = 0.28, p = 0.008), but not with systemic clearance (rho = - 0.03, p = 0.81). Conclusion These findings suggest that 4 beta OHC concentrations reflect hepatic, but not intestinal, CYP3A4 activity. Further studies should investigate the potential value of 4 beta OHC as an endogenous biomarker for individual dose requirements of intravenously administered CYP3A4 sub

Purpose: The purpose of this study is to explore the factors that influence consumers to act socially responsible (CnSR) to provide guidance for CSR work practices in the context of fast food. Method: To answer the research questions a qualitative method has been used where empirical findings have been collected through secondary data and 16 semi-structured interviews. The study has been guided by a deductive approach where an analytical framework, based on previous research, has been the basis when collecting and analyzing the data. Conclusions: One conclusion that can be drawn is that fast food companies are working with the environmental aspect of CSR. Although, the current efforts are not enough to encourage consumers’ socially responsible (CnSR) behavior. Another conclusion of this study is that even though consumers have a positive attitude toward CSR, internal and external factors, especially environmental knowledge, motivation, and economic factors, have an influence on CnSR behavior not being achieved in the context of fast food. Value was the only factor that seemed to result in CnSR behavior. For this reason, fast food companies should provide more concrete information and offer smaller menus or trial samples at a lower price to increase consumers’ motivation to behave socially. Consequently, this could also make them value the more sustainable products in the future. Lastly, another conclusion is that Consumer-Company congruence (C-C congruence) was not achieved as there existed a lack in consumer CSR credibility and consumer CSR awareness. Based on this, it is obvious that fast food companies need to improve both their marketing communication on social media and their in-store promotion.

Bakgrund: Oro och ångest är vanligt förekommande hos äldre personer på särskilda boenden. Psykofarmaka är en vanlig behandling vid oro och ångest hos äldre personer och behandlingen kan leda till negativa effekter. Syfte: Syftet med studien var att undersöka sjuksköterskors erfarenheter av att använda omvårdnadsåtgärder vid oro och ångest i vårdandet av äldre personer på särskilda boenden. Metod: Kvalitativ intervjustudie med induktiv ansats. Intervjuer med åtta sjuksköterskor som arbetade på särskilda boenden genomfördes. Intervjuerna utgick från en semistrukturerad frågeguide. Materialet bearbetades genom kvalitativ innehållsanalys. Resultat: Analysen resulterade i fyra huvudkategorier; Sammanhang som ökar oro och ångest, arbetssätt för att minska oro och ångest, omvårdnadsåtgärder vid oro och ångest samt utmaningar förknippade med att tillämpa omvårdnadsåtgärder. Slutsats: Studien visade att sjuksköterskor önskade använda omvårdnadsåtgärder vid oro och ångest i större utsträckning än vad som gjordes, men deras erfarenhet visade på flera faktorer som försvårade tillämpandet av omvårdnadsåtgärder. Samtliga sjuksköterskor var positiva till att använda omvårdnadsåtgärder vid oro och ångest hos äldre personer då de erfor att det var det bästa förstahandsalternativet vid behandling av oro och ångest hos äldre personer. Samtal och ett bra bemötande var några av de mest effektiva omvårdnadsåtgärderna. Nyckelord: omvårdnadsåtgärder, oro, personcentrerat förhållningssätt, sjuksköterska, särskilda boenden, ångest, äldre personer, Title: “When you avoid medicine the elderly feel much better”. Subtitle: A qualitative interview study on nurses' experiences of nursing interventions in the care for anxiety at nursing homes. Background: Anxiety are common in elderly people at nursing homes. Psychotropic drugs are a common treatment for anxiety in the elderly and the treatment can lead to negative effects. Aim: The aim of this study was to investigate nurses' experience of using nursing interventions in the care for anxiety in elderly people at nursing homes. Method: Qualitative interviews with an inductive approach. It was conducted through eight interviews by nurses who were working at nursing homes. The interviews were carried out by using a semi-structured questionnaire. The data was then processed by qualitative content analysis. Results: The analysis of the study resulted in four main categories; contexts that increase anxiety, way of working to reduce anxiety, nursing interventions for anxiety, challenges associated with applying nursing interventions. Conclusion: The study demonstrated that nurses want to use nursing interventions at anxiety conditions in higher frequency than they currently do. However, their experiences displayed several factors that complicates the development to start using nursing interventions. In summary, all of the nurses were positive to use nursing interventions to address anxiety in elderly people, this because their experience were that this was the best first option in the treatment of anxiety in elderly people. Keywords: anxiety, elderly people, nurse, nursing homes, nursing interventions, person-centered approach

It remains uncertain whether pharmacokinetic changes following Roux-en-Y gastric bypass (RYGB) can be attributed to surgery-induced gastrointestinal alterations per se and/or the subsequent weight loss. The aim was to compare short- and long-term effects of RYGB and calorie restriction on CYP3A-activity, and cross-sectionally compare CYP3A-activity with normal weight to overweight controls using midazolam as probe drug. This three-armed controlled trial included patients with severe obesity preparing for RYGB (n = 41) or diet-induced (n = 41) weight-loss, and controls (n = 18). Both weight-loss groups underwent a 3-week low-energy-diet (<1200 kcal/day) followed by a 6-week very-low-energy-diet or RYGB (both <800 kcal/day). Patients were followed for 2 years, with four pharmacokinetic investigations using semisimultaneous oral and intravenous dosing to determine changes in midazolam absolute bioavailability and clearance, within and between groups. The RYGB and diet groups showed similar weight-loss at week 9 (13 ± 2.4% vs. 11 ± 3.6%), but differed substantially after 2 years (−30 ± 7.0% vs. −3.1 ± 6.3%). At baseline, mean absolute bioavailability and clearance of midazolam were similar in the RYGB and diet groups, but higher compared with controls. On average, absolute bioavailability was unaltered at week 9, but decreased by 40 ± 7.5% in the RYGB group and 32 ± 6.1% in the diet group at year 2 compared with baseline, with no between-group difference. No difference in clearance was observed over time, nor between groups. In conclusion, neither RYGB per se nor weight loss impacted absolute bioavailability or clearance of midazolam short term. Long term, absolute bioavailability was similarly decreased in both groups despite different weight loss, suggesting that the recovered CYP3A-activity is not only dependent on weight-loss through RYGB.

Previous studies have not accounted for the close link between type 2 diabetes mellitus (T2DM) and obesity when investigating the impact of T2DM on cytochrome P450 (CYP) activities. The aim was to investigate the effect of T2DM on in vivo activities and protein expressions of CYP2C19, CYP3A, CYP1A2, and CYP2C9 in patients with obesity. A total of 99 patients from the COCKTAIL study (NCT02386917) were included in this cross-sectional analysis; 29 with T2DM and obesity (T2DM-obesity), 53 with obesity without T2DM (obesity), and 17 controls without T2DM and obesity (controls). CYP activities were assessed after the administration of a cocktail of probe drugs including omeprazole (CYP2C19), midazolam (CYP3A), caffeine (CYP1A2), and losartan (CYP2C9). Jejunal and liver biopsies were also obtained to determine protein concentrations of the respective CYPs. CYP2C19 activity and jejunal CYP2C19 concentration were 63% (-0.39 [95% CI: -0.82, -0.09]) and 40% (-0.09 fmol/mu g protein [95% CI: -0.18, -0.003]) lower in T2DM-obesity compared with the obesity group, respectively. By contrast, there were no differences in the in vivo activities and protein concentrations of CYP3A, CYP1A2, and CYP2C9. Multivariable regression analyses also indicated that T2DM was associated with interindividual variability in CYP2C19 activity, but not CYP3A, CYP1A2, and CYP2C9 activities. The findings indicate that T2DM has a significant downregulating impact on CYP2C19 activity, but not on CYP3A, CYP1A2, and CYP2C9 activities and protein concentrations in patients with obesity. Hence, the effect of T2DM seems to be isoform-specific.

Aim Roux-en-Y gastric bypass (RYGB) may influence drug disposition due to surgery-induced gastrointestinal alterations and/or subsequent weight loss. The objective was to compare short- and long-term effects of RYGB and diet on the metabolic ratios of paraxanthine/caffeine (cytochrome P450 [CYP] 1A2 activity), 5-hydroxyomeprazole/omeprazole (CYP2C19 activity) and losartan/losartan carboxylic acid (CYP2C9 activity), and cross-sectionally compare these CYP-activities with normal-to-overweight controls. Methods This trial included patients with severe obesity preparing for RYGB (n = 40) or diet-induced (n = 41) weight loss, and controls (n = 18). Both weight loss groups underwent a 3-week low-energy diet (<1200 kcal/day, weeks 0-3) followed by a 6-week very-low-energy diet or RYGB (both <800 kcal/day, weeks 3-9). Follow-up time was 2 years, with four pharmacokinetic investigations. Results Mean +/- SD weight loss from baseline was similar in the RYGB-group (13 +/- 2.4%) and the diet group (10.5 +/- 3.9%) at week 9, but differed at year 2 (RYGB -30 +/- 6.9%, diet -3.1 +/- 6.3%). From weeks 0 to 3, mean (95% confidence interval [CI]) CYP2C19 activity similarly increased in both groups (RYGB 43% [16, 55], diet 48% [22, 60]). Mean CYP2C19 activity increased by 30% (2.6, 43) after RYGB (weeks 3-9), but not in the diet-group (between-group difference -0.30 [-0.63, 0.03]). CYP2C19 activity remained elevated in the RYGB group at year 2. Baseline CYP2C19 activity was 2.7-fold higher in controls compared with patients with obesity, whereas no difference was observed in CYP1A2 and CYP2C9 activities. Conclusion Our findings suggest that CYP2C19 activity is lower in patients with obesity and increases following weight loss. This may be clinically relevant for drug dosing. No clinically significant effect on CYP1A2 and CYP2C9 activities was observed.

Aims: To assess the effect of sodium-glucose cotransporter-2 inhibitor dapagliflozin on natriuresis, blood pressure (BP) and volume status in patients with chronic kidney disease (CKD) without diabetes. Materials and methods: We performed a mechanistic open-label study (DAPASALT) to evaluate the effects of dapagliflozin on 24-hour sodium excretion, 24-hour BP, extracellular volume, and markers of volume status during a standardized sodium diet (150 mmol/d) in six patients with CKD. In parallel, in a placebo-controlled double-blind crossover trial (DIAMOND), we determined the effects of 6 weeks of dapagliflozin on markers of volume status in 53 patients with CKD. Results: In DAPASALT (mean age 65 years, mean estimated glomerular filtration rate [eGFR] 39.4 mL/min/1.73 m2, median urine albumin:creatinine ratio [UACR] 111 mg/g), dapagliflozin did not change 24-hour sodium and volume excretion during 2 weeks of treatment. Dapagliflozin was associated with a modest increase in 24-hour glucose excretion on Day 4, which persisted at Day 14 and reversed to baseline after discontinuation. Mean 24-hour systolic BP decreased by −9.3 (95% confidence interval [CI] −19.1, 0.4) mmHg after 4 days and was sustained at Day 14 and at wash-out. Renin, angiotensin II, urinary aldosterone and copeptin levels increased from baseline. In DIAMOND (mean age 51 years, mean eGFR 59.0 mL/min/1.73 m2, median UACR 608 mg/g), compared to placebo, dapagliflozin increased plasma renin (38.5 [95% CI 7.4, 78.8]%), aldosterone (19.1 [95% CI −5.9, 50.8]%), and copeptin levels (7.3 [95% CI 0.1, 14.5] pmol/L). Conclusions: During a standardized sodium diet, dapagliflozin decreased BP but did not increase 24-hour sodium and volume excretion. The lack of increased natriuresis and diuresis may be attributed to activation of intra-renal compensatory mechanisms to prevent excessive water loss.

Background: Chronic kidney disease and heart failure are insulin resistant states associated with a high incidence of diabetes. We assessed the effect of dapagliflozin on new-onset type 2 diabetes in a pooled analysis of patient-level data from the DAPA-CKD and DAPA-HF trials. Methods: This study is a pooled analysis of individual participant data from two phase 3, randomised, double-blind, placebo-controlled, multicentre, clinical trials. Participants with no history of diabetes and HbA1c less than 6·5% (48 mmol/mol) at baseline were included in this pooled analysis. New-onset type 2 diabetes was a prespecified exploratory endpoint in both DAPA-CKD and DAPA-HF trials and is the focus of this analysis. New-onset type 2 diabetes was identified by serial trial measurements of HbA1c (two consecutive values ≥6·5% [≥48 mmol/mol]) or following a clinical diagnosis of diabetes between trial visits. Time to new-onset type 2 diabetes was analysed in a Cox proportional Hazards model from random assignment to end of treatment. Findings: 4003 participants (1398 [34·9%] from the DADA-CKD trial and 2605 [65·1%] from the DAPA-HF trial) were included in our analysis: 1995 (49·8%) had received dapagliflozin and 2008 (50·2%) had received placebo. Over a median follow-up of 21·2 months (IQR 16·0 to 25·4), 126 (6·3%) of 2008 patients in the placebo group (event rate 3·9 per 100 patient-years) and 85 (4·3%) of 1995 patients in the dapagliflozin group (event rate 2·6 per 100 patient-years) developed type 2 diabetes (hazard ratio 0·67 [95% CI 0·51 to 0·88]; p=0·0040). There was no heterogeneity between studies (p interaction 0·77) and there was no clear evidence that the effect of dapagliflozin varied in prespecified subgroups including sex, age, glycaemic status, BMI, glomerular filtration rate, systolic blood pressure, and baseline cardiovascular medication use. More than 90% of the participants who developed type 2 diabetes had prediabetes at baseline (HbA