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A Mobility-as-a-Service (MaaS) concept, UbiGo, was implemented in Gothenburg, Sweden, and used for a 6-month period by 195 individuals in 83 households. Four participant subgroups were identified: Car shedders, Car accessors, Simplifiers, and Economizers. A qualitative analysis revealed that the subgroups had different reasons to join the service and different expectations of the change that would occur on the basis of the altered preconditions offered by the service. Previous car users reduced their use of private car and increased their use of public transport and active modes. Participants who did not have access to a privately-owned car but thought they needed one discovered that they managed well without. Other participants were reinforced in their existing behaviors but in ways they did not envisage, depending on which goals they had at the outset of the trial. Overall, the participants were also satisfied with the service, as well as with stated changes and non-changes, even if this in some cases meant more planning. Based on the empirical findings it could be argued that a service approach, such as UbiGo, has the potential to reduce the need for private car ownership, and enable people to change their mode choices and travel patterns. The potential relies however on a number of specific features of the service of which flexibility and a need- rather than a mode-based approach are key features.

A common approach for understanding people’s domestic energy behavior is to study the influence of deterministic factors, such as attitudes, norms and knowledge, on behavior. However, few studies have succeeded in fully explaining people’s behavior based on these factors alone. To further the understanding of people’s everyday energy use, a goal-oriented approach based on activity theory has been applied to discuss energy conservation from a multiple goal perspective based on the findings from an interview study with 42 informants. The findings show that the informants used energy to fulfill goals linked to basic needs or desires related to their well-being. Even though the majority of informants had an explicit goal to reduce their energy consumption, many experienced conflicts with other competing goals, which often made energy conservation undesirable or challenging. The findings suggest that actions to reduce energy use will most often not be prioritized if they cannot be integrated into people’s daily life without jeopardizing their possibilities to achieve their primary goals and satisfy their everyday needs. It is thus vital to consider people’s everyday life and the many conflicts they experience when aiming to understand why people do, or do not, prioritize energy conservation during everyday activities.

This paper presents findings from a study carried out to contribute to the growing knowledge base within the Design for Sustainable Behaviour research field. Coffee makers, electric kettles and toasters were evaluated to explore if and why particular appliances may mediate less energy-intensive use to a greater extent than others. Eighteen participants used three appliances of the same type for two weeks each, during which the participants’ use of the appliances and the resulting energy use were monitored. In addition, semi-structured interviews and online surveys were conducted to explore how the appliances’ functions and overall design influenced energy use. The findings show that both specific functions and the design as a whole form the design characteristics that set preconditions for energy use. The study thus suggests that if appliances are not designed to support energy conservation holistically, there is a risk that aspects that have not been addressed will lead to more energy-intensive use. This makes it essential for designers to consider the full variety of characteristics influencing energy use. Based on the findings, design opportunities were identified and design guidelines formulated. The insights gained highlight new opportunities for design practice that can aid designers in designing for less energy-intensive use.

This paper describes the development of a new navigational aid for the frail, elderly, and visually impaired person. The users were involved both in the user requirements study and in the evaluation of different prototypes. The results show that the users were able to provide information on their current aid, the use situation, and their preference regarding different solutions, but they had difficulties to provide the detailed answers on technical solutions required by the technical development team. Further, prototype evaluations with users enabled the technical team to understand the users and their use situation. [PUBLICATION ABSTRACT]

This study explores the end-user experiences of adaptive cruise control (ACC) systems. A qualitative approach has been applied and data have been collected by means of focus group interviews. A qualitative content analysis was carried out to analyse and interpret the collected data. The study consists of three focus group sessions with five to seven participants in each. Themes explored include interaction between user and system, functional limitations and trust, and system effects on driving behaviour. Key findings include reported driving behaviour changes, for instance, an increasing tendency to stay in the right lane as well as users' conception of system functionality from which it can be concluded that end-users of ACC carry rough mental models of the system. A potentially hazardous situation for other road-users following the use of ACC is highlighted and discussed. In addition, some features desired by the end-users are discussed like the call for conventional cruise control functionality when owing to apparent weather conditions' functional limitations.

CD8(+) T cell exhaustion represents a major hallmark of chronic HIV infection. Two key transcription factors governing CD8(+) T cell differentiation, T-bet and Eomesodermin (Eomes), have previously been shown in mice to differentially regulate T cell exhaustion in part through direct modulation of PD-1. Here, we examined the relationship between these transcription factors and the expression of several inhibitory receptors (PD-1, CD160, and 2B4), functional characteristics and memory differentiation of CD8(+) T cells in chronic and treated HIV infection. The expression of PD-1, CD160, and 2B4 on total CD8(+) T cells was elevated in chronically infected individuals and highly associated with a T-bet(dim)Eomes(hi) expressional profile. Interestingly, both resting and activated HIV-specific CD8(+) T cells in chronic infection were almost exclusively T-bet(dim)Eomes(hi) cells, while CMV-specific CD8(+) T cells displayed a balanced expression pattern of T-bet and Eomes. The T-bet(dim)Eomes(hi) virus-specific CD8(+) T cells did not show features of terminal differentiation, but rather a transitional memory phenotype with poor polyfunctional (effector) characteristics. The transitional and exhausted phenotype of HIV-specific CD8(+) T cells was longitudinally related to persistent Eomes expression after antiretroviral therapy (ART) initiation. Strikingly, these characteristics remained stable up to 10 years after ART initiation. This study supports the concept that poor human viral-specific CD8(+) T cell functionality is due to an inverse expression balance between T-bet and Eomes, which is not reversed despite long-term viral control through ART. These results aid to explain the inability of HIV-specific CD8(+) T cells to control the viral replication post-ART cessation.

Objective: To examine trends and effects of weight loss treatment on health-related quality of life (HRQL) in the severely obese over 10 years. Design: Swedish obese subjects (SOS) intervention study is a controlled, longitudinal trial of the health effects of weight loss in the severely obese. Subjects: A total of 655 of 851 surgically treated and 621 of 852 conventionally treated obese men (body mass index, BMI greater than or equal to 34) and women (BMI greater than or equal to 38) who completed 10 years of the study. Measurements: HRQL was assessed before treatment and after 0.5, 1, 2, 3, 4, 6, 8 and 10 years. Results: HRQL change during the 10-year observation period largely followed phases of weight loss, weight regain and weight stability. Improvements and deteriorations in HRQL were associated with the magnitude of weight loss or regain, except regarding anxiety. Peak improvements in the surgical group were observed during the first year of weight loss, whereas the weight regain phase (mainly between 1 - and 6-year follow-up) was accompanied by a gradual decline in HRQL. The period from 6- to 10-year follow-up was characterized by relatively stable observations in both weight and HRQL. At 10 years, net gains were noted in all HRQL domains compared to baseline. Comparisons of treatment effects on HRQL in the surgical vs conventional group after 10 years showed significantly better outcome in the surgical group on current health perceptions, social interaction, psychosocial functioning and depression, whereas no significant differences were found for overall mood and anxiety. Long-term results of the study suggest that a maintained weight loss of about 10% is sufficient for positive long-term effects on HRQL, a limit that was reached in about two-thirds of the surgically treated patients who completed 10 years of the study. Conclusion: Long-lasting weight reduction in the severely obese has a general long-standing positive outcome on HRQL. Bariatric surgery is a favorable option for the treatment of severe obesity, resulting in long-term weight loss and HRQL improvements in a majority of patients. However, difficulties among some surgical patients to control and maintain weight loss over time should not be ignored. Future research should study if the long-term efficacy of bariatric surgery may be further enhanced by implementing lifestyle modification techniques in the postoperative management of patients.

The prospective, controlled Swedish Obese Subjects study enrolled 4047 subjects who either underwent bariatric surgery or received conventional treatment. The results of follow-up for up to 15 years suggest that bariatric surgery for severe obesity is associated with long-term weight loss and decreased overall mortality. The results suggest that bariatric surgery for severe obesity is associated with long-term weight loss and decreased overall mortality. In the United States from 1980 through 2004, the prevalence of obesity — defined as a body-mass index (BMI) (the weight in kilograms divided by the square of the height in meters) of 30 or more — doubled, rising to include more than 30% of the population. 1 , 2 The majority of large and long-term epidemiologic studies have indicated that obesity is associated with increased mortality. 3 – 9 The life expectancy of severely obese persons is reduced by an estimated 5 to 20 years. 10 Weight loss is known to be associated with improvement of intermediate risk factors for disease, 11 suggesting that weight . . .

PurposeNecrotising soft-tissue infections (NSTI) are characterised by necrosis, fast progression, and high rates of morbidity and mortality, but our knowledge is primarily derived from small prospective studies and retrospective studies.MethodsWe performed an international, multicentre, prospective cohort study of adults with NSTI describing patient’s characteristics and associations between baseline variables and microbiological findings, amputation, and 90-day mortality.ResultsWe included 409 patients with NSTI; 402 were admitted to the ICU. Cardiovascular disease [169 patients (41%)] and diabetes [98 (24%)] were the most common comorbidities; 122 patients (30%) had no comorbidity. Before surgery, bruising of the skin [210 patients (51%)] and pain requiring opioids [172 (42%)] were common. The sites most commonly affected were the abdomen/ano-genital area [140 patients (34%)] and lower extremities [126 (31%)]. Monomicrobial infection was seen in 179 patients (44%). NSTI of the upper or lower extremities was associated with monomicrobial group A streptococcus (GAS) infection, and NSTI located to the abdomen/ano-genital area was associated with polymicrobial infection. Septic shock [202 patients (50%)] and acute kidney injury [82 (20%)] were common. Amputation occurred in 22% of patients with NSTI of an extremity and was associated with higher lactate level. All-cause 90-day mortality was 18% (95% CI 14–22); age and higher lactate levels were associated with increased mortality and GAS aetiology with decreased mortality.ConclusionsPatients with NSTI were heterogeneous regarding co-morbidities, initial symptoms, infectious localisation, and microbiological findings. Higher age and lactate levels were associated with increased mortality, and GAS infection with decreased mortality.