Coming dissertations at Uppsala university
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BK polyomavirus infection after kidney transplantation : Risk factors, viral transmission and immune response
Link: http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-540825
BK polyomavirus (BKPyV) is a significant cause of graft impairment or graft loss following kidney transplantation. BKPyV often causes asymptomatic infection during childhood, after which the virus establishes latency in the uroepithelial cells of the urinary tract. Seroprevalence in adults exceeds 90%. When the immune system is suppressed, the virus may reactivate and cause serious complications such as BKPyV-associated nephropathy (BKPyVAN) with the risk of permanent damage to the kidney. BKPyVAN affects 1-10% of all kidney transplant recipients.
There is currently no effective antiviral treatment against BKPyV. Tapering of immunosuppression, with the increased risk of rejection, is often the only option. Therefore, many transplant centres screen for BKPyV DNAemia after kidney transplantation. Since frequent screening is resource-intensive, it would be of clinical benefit to better predict who will be affected by BKPyV infection and BKPyVAN to more accurately target the screening.
The overall aim of this thesis was to identify risk factors for development of BKPyV to increase the precision of the diagnosis and to improve the clinical outcome in kidney transplant recipients.
In both a retrospective and a prospective study we found that male sex was a risk factor for BKPyVAN or high-level BKPyV DNAemia and in the prospective study we also identified older recipient age as a risk factor.
The incidence was approximately equal in both studies, 4.7% and 4.9%, respectively, despite the fact that screening for BKPyV had been introduced before the second study. It is likely that we found more BKPyV infections after the screening was introduced and also that they were found earlier.
In the prospective study most BKPyV infections were identified to be of donor origin. There was a higher risk of the recipient developing BKPyV infection if the donor had viruria in connection with the transplant. In addition, there was a higher risk of developing BKPyV infection if the donor had high BKPyV antibody levels at transplantation and if the donor and recipient were serologically mismatched.
When analysing immunological markers, a low CD4/CD8 ratio and a positive immune risk profile (CD4/CD8 ratio <1 and CMV seropositivity) in the recipient before transplantation were identified with increased risk of developing BKPyV infection.
In conclusion, this thesis has provided further insight into general and immunological risk factors for development of BKPyV infection after kidney transplantation and knowledge that is of benefit to improve BKPyV screening in the future.
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Religionskritik i islamisk tænkning : Korruption, krise og kritik
Link: http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-540765
This dissertation is motivated by two overall aims: Firstly, to rethink the critique of religion as a theological-philosophical phenomenon by investigating the origins of the concept of religion as a tradition-transcending universal category in the modern Western theological-philosophical tradition, which is the object of critique of religion (ch. 2). Secondly, based on this previous investigation which destabilizes the notion of critique of religion, to pursue an investigation of the Muslim critique of religion in the revivalist tradition (ch. 3, 4 and 5). Investigating the latter demands a novel methodological approach that can help us reread the revivalist tradition in a new way, and this approach is presented through the introduction of my theory of ”fasadology” (ch. 6).
This study will focus on the revivalist tradition in Muslim theological-philosophical tradition by paying close attention to three representatives of this tradition: the Sunni reformist Abu Hamid Al-Ghazali (ch. 3), the Sunni reformist of South Asian Islamic tradition Shah Wali Allah Dehlawi (ch. 4), and the Iranian imamiyyah-Shia reformist Ali Shariati (ch. 5). The study will look at their intellectual oeuvre by paying close attention to their theological anthropology, i.e. how they define the human condition, and thereby looks at the specific critique of the Islam of their age that they find to be discordant with the ideal notion of primordial Islam of the prophetic age.
My approach will show how a distinct notion of human subjectivity, based on previous Qur'anic anthropology, is the foundation of these revivalist thinkers' definition of the human condition that necessitates an intervention. Based on their reading of the human condition which entails moral corruption of historical Islam, they muster a potent critique of the Islam of their day. The investigation of the three abovementioned revivalist thinkers exemplifies the three moods of critique in Islamic thought: the anti-orthodoxy of Al-Ghazali, the anti-sectarianism of Shah Wali Allah and the anticlericalism of Shariati, whereby I put forward an argument for the capability of these critiques to be viewed as critique of religion because of the object of critique: Islam in its historical unfolding.
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Diagnostic boundaries and developmental pathways of borderline personality disorder
Link: http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-541012
Background: Borderline personality disorder (BPD) is a heterogenous disorder with indistinct developmental trajectories. Diagnosing BPD is challenging, partly due to overlapping features with disorders such as attention deficit hyperactivity disorder (ADHD) and bipolar disorder (BD). The main aims of this thesis were to explore models of BPD development and examine the diagnostic boundaries between BPD, ADHD, and BD.
Methods: In Study I we investigated the psychometric properties of the Swedish version of the Wender Utah Rating Scale (WURS) self-report questionnaire in 121 patients with BPD and/or AHD and/or BD.
In Study II we evaluated the temperament profiles and childhood trauma of 19 patients with BPD and compared them to 95 patients with ADHD, BD, and subclinical cases. We also explored a theoretical model of BPD development based on the interaction between temperament traits and childhood trauma.
In Study III we conducted a cluster analysis in 150 patients with BPD, and/or ADHD, and/or BD based on the Attachment Style Questionnaire (ASQ).
In Study IV we investigated the prevalence of autistic traits in patients with BPD. Autistic traits were measured by the Autism Spectrum Quotient (AQ). We compared autistic traits between three groups: 1) patients with BPD (n=20), 2) patients with BPD with comorbidity (n=37), and 3) patients without BPD but with BD, and/or ADHD, and subclinical cases (n=98). Additionally, we investigated the association between autistic traits, childhood trauma, gender and BPD.
Results: The Swedish version of the WURS displayed good psychometric properties and the proposed three-factor structure. Analyses suggested a cut-off score of 39.
The TCI subscales for Harm Avoidance (HA) and Novelty Seeking (NS) differed significantly between the groups. The interaction model between temperament (HA and NS) and trauma (TT) explained a small part of the variance of BPD.
Three clusters with adult attachment were identified. The three clusters differed in attachment characteristics, temperament, and percentage of patients with BPD with comorbidity and ADHD, but did not differ regarding frequency of childhood trauma.
Autistic traits were significantly higher in females with BPD with comorbidity compared to females without BPD. There was a correlation between autistic traits and the number of fulfilled BPD criteria in females. Autistic traits, childhood trauma, and gender individually predicted a BPD diagnosis.
Conclusions: Patients with BPD differed in temperament, attachment, and autistic traits compared to patients with ADHD and BD. A multifactorial model offers the best explanation for BPD development.