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Heydecke, A., Sütterlin, S., Melhus, Å. & Gullsby, K. (2025). The frequency of SARS-CoV-2 in stool: A prospective study of healthy preschool children in Sweden. Diagnostic microbiology and infectious disease, 112(2), Article ID 116754.
Open this publication in new window or tab >>The frequency of SARS-CoV-2 in stool: A prospective study of healthy preschool children in Sweden
2025 (English)In: Diagnostic microbiology and infectious disease, ISSN 0732-8893, E-ISSN 1879-0070, Vol. 112, no 2, article id 116754Article in journal (Refereed) Published
Abstract [en]

The study investigated the frequency of SARS-CoV-2 among healthy preschool children in two Swedish municipalities, a country where preschools remained uniquely opened throughout the pandemic.

Stool samples were obtained from diapers collected at preschools in November-December 2021 and analyzed for SARS-CoV-2 using real-time reverse transcriptase polymerase chain reaction. Additionally, laboratory data concerning COVID-19 in the two regions were reviewed.

Sixty-seven percent of invited preschools participated, providing 350 stool samples (Uppsala n=231, Gävle n=119). The children had a median age of 24 months (range 12-72). SARS-CoV-2 was not detected in any stool sample during the study period, which coincided with the initial omicron wave. The first pediatric omicron case appeared nearly two weeks after the first adult case.

These findings suggest preschool children did not constitute a silent source nor played a major role in the transmission of SARS-CoV-2 during the first phases of the largest wave of COVID-19, so far.

Place, publisher, year, edition, pages
Elsevier, 2025
Keywords
COVID-19, Epidemiology, Omicron, Transmission sources
National Category
Public Health, Global Health and Social Medicine Infectious Medicine
Identifiers
urn:nbn:se:uu:diva-553414 (URN)10.1016/j.diagmicrobio.2025.116754 (DOI)001443389600001 ()40058191 (PubMedID)2-s2.0-86000284936 (Scopus ID)
Note

De två sista författarna delar sistaförfattarskapet

Available from: 2025-04-14 Created: 2025-04-14 Last updated: 2025-04-14Bibliographically approved
Montelin, H., Hugerth, L., Debelius, J., Melhus, Å., Cherif, H., Engstrand, L. & Tängdén, T. (2024). Antibiotic-induced microbiome disturbances in hematological patients undergoing hematopoietic stem cell transplantation: a prospective observational study.
Open this publication in new window or tab >>Antibiotic-induced microbiome disturbances in hematological patients undergoing hematopoietic stem cell transplantation: a prospective observational study
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2024 (English)Other (Other academic)
National Category
Infectious Medicine
Identifiers
urn:nbn:se:uu:diva-526644 (URN)
Available from: 2024-04-15 Created: 2024-04-15 Last updated: 2025-01-15
Rosenbacke, R., Melhus, Å. & Stuckler, D. (2024). False conflict and false confirmation errors are crucial components of AI accuracy in medical decision making. Nature Communications, 15(1), Article ID 6896.
Open this publication in new window or tab >>False conflict and false confirmation errors are crucial components of AI accuracy in medical decision making
2024 (English)In: Nature Communications, E-ISSN 2041-1723, Vol. 15, no 1, article id 6896Article in journal, Editorial material (Other academic) Published
Place, publisher, year, edition, pages
Springer Nature, 2024
Identifiers
urn:nbn:se:uu:diva-537584 (URN)10.1038/s41467-024-50952-3 (DOI)001291270300016 ()39138179 (PubMedID)
Available from: 2024-09-03 Created: 2024-09-03 Last updated: 2025-01-15Bibliographically approved
Rosenbacke, R., Melhus, Å., Mckee, M. & Stuckler, D. (2024). How Explainable Artificial Intelligence Can Increase or Decrease Clinicians' Trust in AI Applications in Health Care: Systematic Review. JMIR AI, 3, Article ID e53207.
Open this publication in new window or tab >>How Explainable Artificial Intelligence Can Increase or Decrease Clinicians' Trust in AI Applications in Health Care: Systematic Review
2024 (English)In: JMIR AI, ISSN 2817-1705, Vol. 3, article id e53207Article, review/survey (Refereed) Published
Abstract [en]

Background:

Artificial intelligence (AI) has significant potential in clinical practice. However, its "black box" nature can lead clinicians to question its value. The challenge is to create sufficient trust for clinicians to feel comfortable using AI, but not so much that they defer to it even when it produces results that conflict with their clinical judgment in ways that lead to incorrect decisions. Explainable AI (XAI) aims to address this by providing explanations of how AI algorithms reach their conclusions. However, it remains unclear whether such explanations foster an appropriate degree of trust to ensure the optimal use of AI in clinical practice.

Objective:

This study aims to systematically review and synthesize empirical evidence on the impact of XAI on clinicians'

Methods:

A systematic review was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, searching PubMed and Web of Science databases. Studies were included if they empirically measured the impact of XAI on clinicians' trust using cognition- or affect-based measures. Out of 778 articles screened, 10 met the inclusion criteria. We assessed the risk of bias using standard tools appropriate to the methodology of each paper.

Results:

The risk of bias in all papers was moderate or moderate to high. All included studies operationalized trust primarily through cognitive-based definitions, with 2 also incorporating affect-based measures. Out of these, 5 studies reported that XAI increased clinicians' trust compared with standard AI, particularly when the explanations were clear, concise, and relevant to clinical practice. In addition, 3 studies found no significant effect of XAI on trust, and the presence of explanations does not automatically improve trust. Notably, 2 studies highlighted that XAI could either enhance or diminish trust, depending on the complexity and coherence of the provided explanations. The majority of studies suggest that XAI has the potential to enhance clinicians' trust in recommendations generated by AI. However, complex or contradictory explanations can undermine this trust. More critically, trust in AI is not inherently beneficial, as AI recommendations are not infallible. These findings underscore the nuanced role of explanation quality and suggest that trust can be modulated through the careful design of XAI systems.

Conclusions:

Excessive trust in incorrect advice generated by AI can adversely impact clinical accuracy, just as can happen when correct advice is distrusted. Future research should focus on refining both cognitive and affect-based measures of trust and on developing strategies to achieve an appropriate balance in terms of trust, preventing both blind trust and undue skepticism. Optimizing trust in AI systems is essential for their effective integration into clinical practice.

Place, publisher, year, edition, pages
JMIR Publications, 2024
Keywords
explainable artificial intelligence, XAI, trustworthy AI, clinician trust, affect-based measures, cognitive measures, clinical use, clinical decision-making, clinical informatics
National Category
Applied Psychology
Identifiers
urn:nbn:se:uu:diva-546582 (URN)10.2196/53207 (DOI)001374813000002 ()39476365 (PubMedID)
Available from: 2025-01-15 Created: 2025-01-15 Last updated: 2025-01-15Bibliographically approved
Nokso-Koivisto, J., Ehrlich, G. D., Enoksson, F., Komatsu, K., Mason, K., Melhus, Å., . . . Ryan, A. (2024). Otitis media: Interactions between host and environment, immune and inflammatory responses. International Journal of Pediatric Otorhinolaryngology, 176, Article ID 111798.
Open this publication in new window or tab >>Otitis media: Interactions between host and environment, immune and inflammatory responses
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2024 (English)In: International Journal of Pediatric Otorhinolaryngology, ISSN 0165-5876, E-ISSN 1872-8464, Vol. 176, article id 111798Article in journal (Refereed) Published
Abstract [en]

Objective

To review and highlight progress in otitis media (OM) research in the areas of immunology, inflammation, environmental influences and host-pathogen responses from 2019 to 2023. Opportunities for innovative future research were also identified.

Data sources

PubMed database of the National Library of Medicine.

Review methods

Key topics were assigned to each panel member for detailed review. Search of the literature was from June 2019 until February 2023. Draft reviews were collated, circulated, and discussed among panel members at the 22nd International Symposium on Recent Advances in Otitis Media in June 2023. The final manuscript was prepared and approved by all the panel members.

Conclusions

Important advances were identified in: environmental influences that enhance OM susceptibility; polymicrobial middle ear (ME) infections; the role of adaptive immunity defects in otitis-proneness; additional genes linked to OM; leukocyte contributions to OM pathogenesis and recovery; and novel interventions in OM based on host responses to infection. Innovative areas of research included: identification of novel bacterial genes and pathways important for OM persistence, bacterial adaptations and evolution that enhance chronicity; animal and human ME gene expression, including at the single-cell level; and Sars-CoV-2 infection of the ME and Eustachian tube.d

Place, publisher, year, edition, pages
Elsevier, 2024
Keywords
Otitis media, Immunology, Inflammatory, Bacteria, Virus, Environment
National Category
Microbiology in the medical area Otorhinolaryngology Infectious Medicine
Identifiers
urn:nbn:se:uu:diva-523249 (URN)10.1016/j.ijporl.2023.111798 (DOI)001131560000001 ()38041988 (PubMedID)
Funder
NIH (National Institutes of Health), R13 DC017389
Available from: 2024-02-16 Created: 2024-02-16 Last updated: 2025-01-15Bibliographically approved
Gideskog, M., Falkeborn, T., Welander, J. & Melhus, Å. (2023). Source Control of Gram-Negative Bacteria Using Self-Disinfecting Sinks in a Swedish Burn Centre. Microorganisms, 11(4), Article ID 965.
Open this publication in new window or tab >>Source Control of Gram-Negative Bacteria Using Self-Disinfecting Sinks in a Swedish Burn Centre
2023 (English)In: Microorganisms, E-ISSN 2076-2607, Vol. 11, no 4, article id 965Article in journal (Refereed) Published
Abstract [en]

Several retrospective studies have identified hospital sinks as reservoirs of Gram-negative bacteria. The aim of this study was to prospectively investigate the bacterial transmission from sinks to patients and if self-disinfecting sinks could reduce this risk. Samples were collected weekly from sinks (self-disinfecting, treated with boiling water, not treated) and patients in the Burn Centre at Linkoping University Hospital, Sweden. The antibiotic susceptibility of Gram-negative isolates was tested, and eight randomly chosen patient isolates and their connected sink isolates were subjected to whole genome sequencing (WGS). Of 489 sink samples, 232 (47%) showed growth. The most frequent findings were Stenotrophomonas maltophilia (n = 130), Pseudomonas aeruginosa (n = 128), and Acinetobacter spp. (n = 55). Bacterial growth was observed in 20% of the samplings from the self-disinfecting sinks and in 57% from the sinks treated with boiling water (p = 0.0029). WGS recognized one transmission of Escherichia coli sampled from an untreated sink to a patient admitted to the same room. In conclusion, the results showed that sinks can serve as reservoirs of Gram-negative bacteria and that self-disinfecting sinks can reduce the transmission risk. Installing self-disinfecting sinks in intensive care units is an important measure in preventing nosocomial infection among critically ill patients.

Place, publisher, year, edition, pages
MDPI, 2023
Keywords
sink, water trap, bacterial transmission, self-disinfecting sink, infection control, Pseudomonas aeruginosa, Stenotrophomonas maltophilia, Acinetobacter
National Category
Infectious Medicine Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-502195 (URN)10.3390/microorganisms11040965 (DOI)000977997100001 ()37110388 (PubMedID)
Available from: 2023-05-24 Created: 2023-05-24 Last updated: 2025-01-15Bibliographically approved
Fraenkel, C.-J., Starlander, G., Tano, E., Sütterlin, S. & Melhus, Å. (2023). The First Swedish Outbreak with VIM-2-Producing Pseudomonas aeruginosa, Occurring between 2006 and 2007, Was Probably Due to Contaminated Hospital Sinks. Microorganisms, 11(4), Article ID 974.
Open this publication in new window or tab >>The First Swedish Outbreak with VIM-2-Producing Pseudomonas aeruginosa, Occurring between 2006 and 2007, Was Probably Due to Contaminated Hospital Sinks
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2023 (English)In: Microorganisms, E-ISSN 2076-2607, Vol. 11, no 4, article id 974Article in journal (Refereed) Published
Abstract [en]

Multidrug-resistant Pseudomonas aeruginosa is an increasing clinical problem worldwide. The aim of this study was to describe the first outbreak of a Verona integron-borne metallo-ss-lactamase (VIM)-2-producing P. aeruginosa strain in Sweden and its expansion in the region. A cluster of multidrug-resistant P. aeruginosa appeared at two neighbouring hospitals in 2006. The isolates were characterized by PCR, pulsed-field gel electrophoresis (PFGE), and whole-genome sequencing. Patient charts, laboratory records, and hygiene routines were reviewed, and patients, staff, and the environment were screened. The investigation revealed a clonal outbreak of a VIM-2-producing P. aeruginosa strain belonging to the high-risk clonal complex 111, susceptible only to gentamicin and colistin. No direct contact between patients could be established, but most of them had stayed in certain rooms/wards weeks to months apart. Cultures from two sinks yielded growth of the same strain. The outbreak ended when control measures against the sinks were taken, but new cases occurred in a tertiary care hospital in the region. In conclusion, when facing prolonged outbreaks with this bacterium, sinks and other water sources in the hospital environment should be considered. By implementing proactive control measures to limit the bacterial load in sinks, the waterborne transmission of P. aeruginosa may be reduced.

Place, publisher, year, edition, pages
MDPIMDPI, 2023
Keywords
Pseudomonas aeruginosa, sink, nosocomial outbreak, MBL, VIM-2
National Category
Infectious Medicine Microbiology in the medical area Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-501956 (URN)10.3390/microorganisms11040974 (DOI)000977995400001 ()37110397 (PubMedID)
Available from: 2023-05-23 Created: 2023-05-23 Last updated: 2025-01-15Bibliographically approved
Tegehall, A., Ingvast, S., Melhus, Å., Skog, O. & Korsgren, O. (2022). A decisive bridge between innate immunity and the pathognomonic morphological characteristics of type 1 diabetes demonstrated by instillation of heat-inactivated bacteria in the pancreatic duct of rats. Acta Diabetologica, 59(8), 1011-1018
Open this publication in new window or tab >>A decisive bridge between innate immunity and the pathognomonic morphological characteristics of type 1 diabetes demonstrated by instillation of heat-inactivated bacteria in the pancreatic duct of rats
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2022 (English)In: Acta Diabetologica, ISSN 0940-5429, E-ISSN 1432-5233, Vol. 59, no 8, p. 1011-1018Article in journal (Refereed) Published
Abstract [en]

Aims Periductal inflammation and accumulation of granulocytes and monocytes in the periislet area and in the exocrine pancreas is observed within hours after instillation of heat-inactivated bacteria in the ductal compartment of the pancreas in healthy rats. The present investigation was undertaken to study how the acute inflammation developed over time. Methods Immunohistochemical evaluation of the immune response triggered by instillation of heat-inactivated bacteria in the ductal compartment in rats. Results After three weeks, the triggered inflammation had vanished and pancreases showed normal morphology. However, a distinct accumulation of both CD4+ and CD8+ T cells within and adjacent to affected islets was found in one-third of the rats instilled with heat-inactivated E. faecalis, mimicking the insulitis seen at onset of human T1D. As in T1D, this insulitis affected a minority of islets and only certain lobes of the pancreases. Notably, a fraction of the T cells expressed the CD103 antigen, mirroring the recently reported presence of tissue resident memory T cells in the insulitis in humans with recent onset T1D. Conclusions The results presented unravel a previously unknown interplay between innate and acquired immunity in the formation of immunopathological events indistinguishable from those described in humans with recent onset T1D.

Place, publisher, year, edition, pages
Springer Nature, 2022
Keywords
Type 1 Diabetes, Innate immunity, Acquired immunity, Insulitis, Bacteria, Animal model
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:uu:diva-483597 (URN)10.1007/s00592-022-01881-4 (DOI)000786563500001 ()35461380 (PubMedID)
Funder
Swedish Child Diabetes FoundationDiabetesfonden
Available from: 2022-09-01 Created: 2022-09-01 Last updated: 2025-01-15Bibliographically approved
Edner, A., Lindström Nilsson, M. & Melhus, Å. (2021). Low risk of transmission of pathogenic bacteria between children and the assistance dog during animal-assisted if strict rules are followed. Journal of Hospital Infection, 115, 5-9
Open this publication in new window or tab >>Low risk of transmission of pathogenic bacteria between children and the assistance dog during animal-assisted if strict rules are followed
2021 (English)In: Journal of Hospital Infection, ISSN 0195-6701, E-ISSN 1532-2939, Vol. 115, p. 5-9Article in journal (Refereed) Published
Abstract [en]

This study explored the bacterial transmission between patients and dogs during dog assisted therapy (DAT). Twenty children (55% girls) with a median age of 7 years (range 3-17 years) were included. Two dogs assisted and the conditions were more restricted hygienically with dog 2. Samples from child and dog were collected and cultured before and after each DAT visit. The results showed that dog 1 transmitted bacteria repeatedly to the children. No bacteria were transmitted with dog 2. In conclusion, exchange of bacteria can occur between dog and child during DAT, but it can be reduced by simple infection control measures. (c) 2021 Published by Elsevier Ltd on behalf of The Healthcare Infection Society.

Place, publisher, year, edition, pages
ElsevierElsevier BV, 2021
Keywords
Assistance dog, Dog-assisted therapy, Bacterial transmission, Zoonotic infections, Hygiene routines
National Category
Clinical Science Infectious Medicine
Identifiers
urn:nbn:se:uu:diva-456306 (URN)10.1016/j.jhin.2021.04.025 (DOI)000691276700002 ()33940092 (PubMedID)
Available from: 2021-10-21 Created: 2021-10-21 Last updated: 2025-01-15Bibliographically approved
Gideskog, M., Welander, J. & Melhus, Å. (2020). Cluster of S. maltophilia among patients with respiratory tract infections at an intensive care unit. Infection Prevention in Practice, 2(4), Article ID 100097.
Open this publication in new window or tab >>Cluster of S. maltophilia among patients with respiratory tract infections at an intensive care unit
2020 (English)In: Infection Prevention in Practice, E-ISSN 2590-0889, Vol. 2, no 4, article id 100097Article in journal (Refereed) Published
Abstract [en]

Background: Stenotrophomonas maltophilia is associated with respiratory tract infections in immunocompromised patients, and it has emerged as an important nosocomial patho- gen, with admission to intensive care units (ICUs) and ventilators as recognized risk factors.

Aim: To describe the investigation of a sudden increase in patients with pneumonia caused by S. maltophilia at a Swedish ICU and the control measures taken.

Methods: Lower respiratory tract cultures from patients admitted to the ICU were obtained, and environmental cultures were collected from sink drains and medical equipment. Isolates identified as S. maltophilia were subjected to antibiotic susceptibility testing and whole genome sequencing (WGS).

Findings: A total of 17 S. maltophilia isolates were found (four from patients and 13 from the environment). The WGS identified two outbreak clones, sequence type (ST) 361 and ST138, and seven unique ones. Most likely, the outbreak clones originated from two sinks, and transmission was enhanced by a calorimeter. After changing the sink and calorimeter routines, no more cases were registered.

Conclusion: Acquisition of S. maltophilia from the hospital environment appears to be easy, especially if water is involved. To control this bacterium, better knowledge of its transmission routes in hospital environments is required.

Place, publisher, year, edition, pages
Elsevier, 2020
Keywords
S, maltophilia, respiratory tract infection, calorimeter, sink
National Category
Infectious Medicine
Identifiers
urn:nbn:se:uu:diva-511329 (URN)10.1016/j.infpip.2020.100097 (DOI)001021833200012 ()34368727 (PubMedID)
Funder
Region Uppsala
Available from: 2023-09-12 Created: 2023-09-12 Last updated: 2025-01-15Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0009-0006-1191-4061

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