Financial Summary 2019 - Karolinska Institutet

Page 1

Financial Summary 2019

A medical university A


Karolinska Institutet's Financial Summary for 2019 Karolinska Institutet’s turnover remains essentially unchanged compared with the previous year and amounts to SEK 7,120 million for 2019.

KI’s activities consist predominately of research, which comprises 84 per cent of the total turnover (the same as last year). In 2019, KI experienced a decline in capital amounting to SEK 53 million, reducing the agency capital.

After many years of experiencing increases, Karolinska Institutet’s (KI’s) revenue for 2019 has decreased marginally, by 0.2 per cent compared to 2018. Declines in revenue were found in grants and fees and other remuneration, while central government funding and financial revenues increase slightly. For the rest of this section, comparative figures for 2018 will be shown in parentheses. KI’s activities are dominated by research activities, and they comprise approximately 84 per cent of total turnover, which is the same proportion as in the prior year. The change in capital for the year was negative amounted to SEK -53.3 million (SEK 0 million), of which KI’s regular activities account for SEK -50.9 million (SEK -1.5 million) and KI’s subsidiary Karolinska Institutet Holding AB for SEK -2,4 million (SEK 1.6 million).

nt. This is done at least twice a year and the last time is in December, for investments made up to the beginning of December. At the same time, amortisations are made corresponding to the depreciation and retirement of assets during the year. New investments were made in 2019 corresponding to SEK 177.8 million and reported depreciation amounted to SEK 276.5 million. Total debt with the Swedish National Debt Office is SEK 1,203 million. During the year, the loan limit was changed twice, via a change of the annual appropriation directions, and amounted to SEK 1,315 million at the end of the year. The average annual interest rate for 2019 interest rate was -0.25 per cent (-0.50 per cent). The negative interest rate means that KI has an interest income from the loans with the Swedish National Debt Office. In December 2019, the Riksbank raised the interest rate to 0 per cent as of January 2020. If the interest rate remains 0 per cent, in the future have neither KI will interest costs nor interest income from RGK.

Sources of funding

Agency capital

The diagram on the next page shows how KI’s activities for 2019 were financed, divided into financier categories. The distribution is essentially unchanged compared with the previous year. The total government financing of KI’s activities amounts to 63 per cent, which is an increase of one per cent compared to 2018 and is found in the category of direct government funding. The corresponding decrease, one per cent, is attributed to external financing in the category municipalities and Regions. The single largest external financiers are listed in the table on page 11.

Loans from the Swedish National Debt Office Every year loans are taken from the Swedish National Debt Office (RGK) for the fixed assets that are funded by the governme-

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The accumulated agency capital, including the change in capital for the year, amounts to SEK 1,557.2 million (SEK 1,609.5 million), distributed as follows: SEK 35.4 million (SEK 36.8 million) in subsidiaries, SEK 146.5 million (SEK 127.8 million) in asset management and SEK 1,375.3 million (SEK 1,444.9 million) in regular activities. Compared with 2018, a redistribution of agency capital within research activities has been made from government funding to grants. The explanation is that over the year, KI has used a larger part of the accumulated agency capital for financing activities within the government funding section than it did the previous year In grant-funded activities, projects have been recognised as surplus funds, which has contributed to a positive change in capital and an increase in the accumulated agency capital within the category.

KAROLINSKA INSTITUTET FINANCIAL SUMMARY 2019


Karolinska Institutet's revenue for 2019, total SEK 7,120 million

3% 4%

1%

8% Direct government funding 43 % (42 %) Research councils 15 % (15 %) Other government agencies 5 % (5 %)

43 %

16 %

Regions and municipalities 5 % (6 %) Swedish foundations and organisations 16 % (16 %) Foreign foundations and organisations 8 % (8 %) Swedish companies 4 % (4 %) Foreign companies 3 % (3 %) Financial income 1 % (1 %)

5% 5% 15 %

Accumulated agency capital for education and research, total SEK 1,522 million

12 %

Research appropriations 46 %

2%

8%

Research grants 32 % Research contracts 8 % Education appropriations 12 %

46 %

Education contracts 2 %

32 %

KAROLINSKA INSTITUTET FINANCIAL SUMMARY 2019

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Education at bachelor's and master's level In 2019, KI shows a positive growth in capital, which is explained by increased revenues in both government funding and contract-financed education, while expenses have not increased at the same rate.

Revenue The outcome for full-time equivalents (FTE) and annual performance equivalents (APE) is lower than what presented KI in October. The available funds for 2019, i.e. the funding cap for the year and the government funding from 2018 saved is SEK 765.3 million. The outcome, including the annual performance equivalents from December 2018, means that the available funds fall short. The end of year unspent grant fund surplus decreases slightly and amounts for 2019 to 32.9 million. Direct government funding has been adjusted for price and salary conversion with 1.22 per cent (1.84 per cent). ALF funding is reported as government funding revenue. Revenue from grants consists primarily of grants from other national government agencies transferred to KI for activities within the field of education, in accordance with each agency’s appropriation directions.

Expenses Costs for educational activities have increased by 1.8 per cent for the year compared to 2018. The educational activities represent approx. 16 per cent of KI’s total expenses overall. Costs for personnel increase by 3.4 per cent, which is a larger increase than for KI overall, its explanation lies in increased activities in educational programmes. Costs for premises for educational activities increased by 1.6 per cent, while the costs for premises for KI overall increased by 4.1 per cent, which shows that it is the research activities which are responsible for the greater part of the increase in costs for premises. Depreciation has increased, however not as markedly as occurred last year. The increase can be explained by continued investment in joint infrastructure for the university as a whole.

Research and education at doctoral level Revenue decreases by one per cent compared to the previous year. Costs for personnel increase marginally, while premises and depreciation increase at a higher rate.

Revenue Revenues for the year related to research activities amounted to SEK 5,963 million (6,024 million). Direct government funding increased by SEK 29.7 million, or 1.4 per cent compared

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Education at bachelor's and master's level, SEK million

Revenue

2016

2017

2018

2019

Direct government funding

907.2

920.5

940.4

984.3

129.4

138.1

139.8

146.0

22.7

24.9

26.8

26.6

0.0

0.0

0.0

0.0

1,059.3

1,083.5

1,107.0

1,156.9

579.9

573.7

614.6

635.8

88.2

96.3

96.3

97.8

359.6

368.1

391.1

386.1

Financial costs

0.1

0.1

0.1

0.1

Depreciation

14.2

13.8

20.6

23.6

1,042.1

1,051.9

1,122.6

1,143.3

Government funding

4.6

4.7

4.7

4.8

Funding from other government agencies

0.0

0.0

0.0

0.0

Fees and other remuneration Grants Financial income Total revenue Expenses Staff costs Premises costs Other operating expenses

Total expenses Transfers

0.5

0.0

0.2

0.2

-5.1

-4.7

-4.9

-5.0

17.2

31.6

-15.6

13.6

Balance brought forward

166.4

183.6

215.2

199.6

Total (balance carried forward)

183.6

215.2

199.6

213.1

Other funding Grants distributed Change in capital For the year

with 2018, and is in accordance with the appropriation directions. Direct government funding has been adjusted for price and salary conversion with 1.22 per cent (1.84 per cent). Fees and other income received decreased by SEK 37 million compared with 2018, which is explained primarily by the fact that KI will no longer receive revenue to run the Regional Ethics Review Board’s (EPN) office when they are reorganised to become their own public agency (the Ethical Review Authority), and that large assignments from the National Board of Health and Welfare were concluded in 2018. In 2018, many contract projects were completed, which led to higher recognition of revenue, which did not happen to the same extent during 2019. The greater part of the decrease in revenue is found in the item Revenue from grants, which decreased by SEK 60 mil-

KAROLINSKA INSTITUTET FINANCIAL SUMMARY 2019


lion or 1.8 per cent. The decrease is due to a lower consumption of external grants received as a result of the greater part of the research activity being financed by accumulated government capital in the category government funding compared to 2018. In 2019, grant projects corresponding to SEK 50 million were recognised as surplus funds, which contributes to the positive change in capital. This has also meant that the net advance payment of grants has increased during the year. The Swedish Research Council represents an increase in revenue in the amount of SEK 43 million compared to 2018. Within the organisations and foundations category, the largest contributor is the Swedish Cancer Society, closely followed by the Wallenberg Foundations. Financing from Regions and municipalities has decreased in 2019, with the Stockholm Regional Council decreasing by SEK 87 million, which is a reduction of 20 per cent. This large decrease is explained by the fact that in 2018 KI received reimbursement for costs in connection with the relocation of research groups to BioClinicum and that many ongoing projects financed by the Stockholm Regional Council were recognised as surplus. In the company category, AstraZeneca remains the largest financier. The EU is the largest financier in the category of foreign organisations, but its contributions have decreased by about 15 per cent compared to 2018. The decrease can be explained by the fact that presently we are in-between three framework programmes, which means that many projects have been completed. The first projects within Horizon 2020 have been completed and the last projects within FP 7 have also been completed during the year. The new Horizon Europe Framework Program will commence in 2020. More on this in the table on page 11. Financial income increases, which is primarily due to an upward revaluation of financial assets and unrealised exchange gains on foreign currency. The annual average interest rate on the interest-bearing account in the Swedish National Debt Office in 2019 is -0.25 per cent (-0.50). Interest income from the Swedish National Debt Office is SEK 3.3 million (SEK 5.3 million), which is attributed to negative interest costs on the agency’s demand deposits. Other financial income consists primarily of dividends from shares and exchange gains on foreign currency.

Expenses This year’s total costs for research and education at the doctoral studies level increased by SEK 17 million, or 0.3 per cent, compared to 2018. Personnel costs increased by 0.7 per cent compared with the previous year. A salary review has been carried out during the year and the increase in personnel costs is in line with the effect of the salary review revision of 2.3 per cent for the last three months of the year. The posted costs for premises increased markedly compared to 2018, however the increase is primarily due to that in 2018 a reallocation of approximately SEK 23 million was made from the post costs for premises to the post expenses incurred

KAROLINSKA INSTITUTET FINANCIAL SUMMARY 2019

Research and education at doctoral level (including asset management), SEK million Revenue Direct government funding Fees and other remuneration

2016

2017

2018

2019

1,959.4

1,997.2

2,054.8

2,084.5

608.3

580.1

610.5

573.5

3,002.4

3,198.1

3,310.4

3,250.4

37.3

30.9

48.2

54.4

5,607.3

5,806.3

6,023.9

5,962.8

2,881.9

2,950.5

2,948.7

2,968.9

667.1

725.9

834.6

871.7

1,728.8

1,797.7

1,886.2

1,863.3

Financial costs

28.1

33.8

46.1

18.7

Depreciation

230.2

234.5

294.3

304.7

5,536.2

5,742.4

6,009.8

6,027.3

13.4

13.0

13.1

15.3

Grants Financial income Total revenue Expenses Staff costs Premises costs Other operating expenses

Total expenses Transfers Government funding Funding from other government agencies

56.2

50.1

45.0

60.8

130.1

117.8

120.7

120.4

-199.7

-180.9

-178.8

-196.5

71.1

63.9

14.1

-64.5

Balance brought forward

1,224.3

1,295.2

1,359.1

1,373.2

Total (balance carried forward)

1,295.4

1,359.1

1,373.2

1,308.7

Other funding Grants distributed Change in capital For the year

without a corresponding benefit, which means that the real increase in costs for premises between the two years is SEK 14 million or 1.6 per cent. Operating costs are reduced, which is largely explained by the fact that KI in 2018 had to take a charge for expenses incurred without a corresponding benefit the amount of SEK 42 million. After excluding the expenses incurred without a corresponding benefit, operating costs increased, and are primarily linked to laboratory activities. The financial costs consist primarily of interest costs SEK 10 million (SEK 18.7 million) for holdings in the Swedish National Debt Office’s interest account, and exchange rate losses amounting to SEK 5.3 million (SEK 4 million). The annual average for the interest rate on the interest account in 2019 is -0.25 per cent (-0.50 per cent).

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Depreciation has increased by SEK 10.4 million or 3.5 per cent. The increase is due to large new investments that were implemented during the year and that many investments were activated at the end of 2018.

Distribution of investment fund portfolio 2019-12-31*

28 %

29 %

Asset management Karolinska Institutet manages donations from private individuals intended for medical sciences at KI. These donations are divided into:

2% 9%

1. Endowment funds, which are included in KL’s financial reporting. 2. Independent foundations, which are separate legal entities, whose administration is tied to KI. For the endowment funds which are managed and reported within KI, both the yield and capital may be utilised. The foundations are separate legal entities and produce their own annual reports. The yield from the foundations that is distributed to KI is reported as external grants in KI’s accounts. The accounts of KI’s foundations are presented in summary so as to provide a complete picture of KI’s donation assets, regardless of the legal format they are held in.

Funds The market value, excluding the Ming Wai Lau Centre for Reparative Medicine (MWLC), amounted to approx. SEK 240 million (SEK 199.5 million) at the end of the year. In 2019, the inflow in the form of donations and dividends from financial investments has exceeded outflows in the form of research grants. The donation for the Ming Wai Lau Centre (MWLC) has been invested in two separate portfolios, denominated in SEK and USD respectively, containing only interest-bearing securities. Interest-bearing investments in MWLC have had an overall positive yield, despite the prevailing low interest rates. The Swedish donation funds have experienced a yield of 0.2 per cent. The donation funds in USD had a return of 2.8 per cent. The market value of these two portfolios at year end was a total of SEK 264.2 million (SEK 324.7 million). The holdings in the investment fund portfolio are distributed as shown below.

Yield Investments that entail assuming a risk, such as equities, have shown a very good yield during 2019, with the Swedish stock exchange increasing by some 30 per cent. To a large extent, this can be explained by that the economic activity weakened to a lesser extent than what the average party in the market was anticipating, and due to that the US central bank lowered the key rate on three occasions during the year.

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32 % Interest-bearing securities 28 %

Swedish equity funds 9 %

Cash 2 %

Alternative investments 29 %

Global equity funds 32 % * Excluding the MWLC portfolio, which is placed in two separate portfolios with interest-bearing securities.

The actual yield has exceeded 12 percentage points during the year, which may be considered an exceptional event. This means that the requirement of actual yield of two per cent was exceeded by a wide margin during the year, however this should be considered in the context of a longer-term perspective. The table below shows that the required rate of return has been met during the past five-year period (since inflation has been below two per cent on average). The required nominal yield, which consists of risk-free interest (measured as six-month treasury bills) plus two percentage points, is met both during the year and in a long-term perspective. In the last five-year period, the average annual yield has exceeded this yield requirement by close to five percentage points, which is regarded as highly satisfactory. Yield in per cent compared with the reference index 2015

2016

2017

2018

2019

KI's funds Reference index

5.2 4.8

5.8 7.9

5.9 6.6

-1.9 -0.8

14.3 11.9

Deviation

0.4

-2.1

-0.8

-1.1

2.4

Yield is stated net, i.e. including dividends and deductions for administrative costs. Share indicies are stated inclusive of reinvested dividends.r.

Indices used for comparison in 2019

Swedish fixed interest Swedish Shares Emerging Markets Developed Markets Alternative investments

OMRX Bond SBX-CAP Etiskt MSCI EM NR USD MSCI AXWI SEB OMRX T-bill + 3%

30% 8% 16% 16% 30%

KAROLINSKA INSTITUTET FINANCIAL SUMMARY 2019


Furthermore, the relative return on the benchmark index is also satisfactory, as the portfolio’s return overperformed by 2.4 percentage points. This is primarily due to the fact that all asset classes outperformed the market return. In 2019, net inflow (difference between purchased and sold unit trusts) amounted to SEK 27.6 million (SEK -5.1 million) and the change in value amounted to SEK 12.4 million (SEK 10.9 million). Interest-bearing investments in MWLC have had an overall positive yield, despite the prevailing low interest rates. The Swedish donation funds had a return of -0.1 per cent. Donations in US dollars had a return of 2.4 per cent.

Dividends received from KI’s funds and MWLC During 2019, SEK 144.6 million was distributed to activities within KI. These are distributed per category of purpose according to the table below. The increase is due to the receipt of dividends from MWLC in a greater amount as a result of more extensive operations.

External funds for asset management In 2019, KI’s asset management has received SEK 89 million (SEK 79.9 million) from external donors. Individual donations amounting to SEK 2.0 million or more are reported in the table below. Dividend from KI's funds, SEK million

Research grants Travel grants Education Other Total

2016

2017

2018

2019

94.6 0.5 0.3 0.0 95.4

121.9 0.7 0.3 0.0 122.9

69.5 0.6 0.3 0.0 70.4

66.6 0.4 0.9 0.0 67.9

MWLC donation, SEK million

Yield Total

KI Foundations There are 167 (170) foundations at Karolinska Institutet for which the management is tied to KI. The purpose of the foundations is to promote medical research and education in the field of medicine. One (two) foundations were closed during the year, after a decision was made either by the Swedish Legal, Financial and Administrative Services Agency or by the former Board of Research at KI. The entire capital may be used to fulfil the purpose of the foundation. No (0) new foundations were formed or otherwise added during the year. New gifts and donations of SEK 20.7 million (SEK 13 million) have been received, which have been added to the assets of the existing foundations. Of the previously granted research grants and grants to cover travel expenses, SEK 0.4 million (SEK 0.1 million) was reversed. The reported net financial gains for the year amounted to SEK 64.5 million (SEK 44.6 million), of which SEK 15.1 million (SEK 3 million) was attributable to capital gains in connection with sale and reinvestment of the assets in holdings of financial securities, SEK 0 million (SEK 0 million) to value adjustment of financial securities, and SEK 49.4 million (SEK 41.6 million) to gains on funds under management. The management costs include the cost for 1.85 employees (FTEs). The fluctuation in granted funding is due to that a call for applications for KI Research Grants is made every other year, and no call for new applications was made in 2019.

Foundations, SEK million

2016

2017

2018

2019

80.6 80.6

13.4 13.4

30.6 30.6

76.7 76.7

Asset value

2015

2016

2017

2018

2019

1,683

1,794

1,923

1,834

2,231

28.8

56.8

16.4

68.1

18.4

Grants awarded

External resources to asset management Donation purpose

Donor

Birgitta and Carl-Axel Rydbeck’s donation to Paediatric research, prinicipally within the field of fertility

Birgitta Rydbeck’s testament

22.4

Medical research and doctoral education

Gustav and Tyra Svenssons memorial foundation

10.0

Scientific research, prinicipally within the field of cancer disease

Sune and Charlotta Hay’s foundation

5.9

Cognitive neuroscience with a focus on ageing of the healthy brain

Stichting Af Jochnick Foundation

5.0

Donation to research on chronic pain

Donation from the Lundblad family

5.0

Donation to research activities at KI

Bertil Hållsten’s Research foundation

3.0

Scientific medical research

Elvy Brodd’s testament

2.9

Research within the field of haematology

Dr Åke Olssons foundation

2.0

Donation to research project “When, where and how should diseases in the aorta be operated on (NVH-study)”

Fredrik Lundberg

2.0

KAROLINSKA INSTITUTET FINANCIAL SUMMARY 2019

Amount (SEK m.)

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Statement of financial performance (SEK in thousands) Outcome

Outcome

01/01/2019

01/01/2018

31/12/2019

31/12/2018

3,068,861

2,995,228

719,434

750,283

3,277,045

3,337,193

54,385

48,193

7,119,725

7,130,898

-3,604,672

-3,563,292

-969,560

-930,873

-2,249,372

-2,277,310

Operating revenue Direct government funding Fees and other remuneration Grants Financial income Total revenue Operating expenses Staff costs Premises costs Other operating expenses Financial costs

-18,813

-46,130

Depreciation

-328,248

-314,841

-7,170,665

-7,132,447

-50,940

-1,549

-2,394

1,591

20,053

17,837

Total expenses Operating profit/loss Profit/loss from holdings in associated companies and subsidiaries Transfers Funding received from the Government budget for the financing of grants Funding received from Government agencies for the financing of grants Other funding received for the financing of grants Grants distributed Balance

CHANGE IN CAPITAL FOR THE YEAR

8

60,800

45,000

120,584

120,843

-201,438

-183,680

0

0

-53,334

42

KAROLINSKA INSTITUTET FINANCIAL SUMMARY 2019


Balance sheet (SEK in thousands) ASSETS

31/12/2019

31/12/2018

Capitalised expenditure for development

2,019

4,101

Rights and other intangible fixed assets

3,242

1,050

5,261

5,151

218,244

205,620

1,116,750

1 107 220

168,998

223,701

1,503,991

1,536,540

35,412

36,806

497,832

503,785

2,321

2,222

535,564

542,813

Accounts receivable

207,176

206,760

Receivables from other Government agencies

248,661

161,164

Intangible fixed assets

Total intangible fixed assets Tangible fixed assets Expenditure for improvements to leased property Machinery, equipment, installations etc. Fixed assets under construction Total tangible fixed assets Financial fixed assets Holdings in associated companies and subsidiaries Other long-term securities holdings Other long-term recievables Total financial fixed assets Receivables

Other receivables

1,806

286

457,644

368,209

Prepaid expenses

244,877

240,171

Accrued grant revenue

505,837

583,730

Other accrued revenue

5,130

6,120

755,843

830,022

-32,932

-34,192

-32,932

-34,192

3,925,596

4,008,004

117,573

179,850

Total cash and bank balances

4,043,170

4,187,854

TOTAL ASSETS

7,268,541

7,436,397

Total receivables Cut-off items

Total cut-off items Settlement with the Government Settlement with the Government Total settlement with the Government Cash and bank balances Balance of the interest-bearing account at the Swedish National Dept Office Cash and bank

KAROLINSKA INSTITUTET FINANCIAL SUMMARY 2019

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Balance sheet (SEK in thousands) CAPITAL AND LIABILITIES

31/12/2019

31/12/2018

9,000

8,000

28,806

27,215

1,572,721

1,574,270

-53,334

42

1,557,193

1,609,527

Agency capital Government capital Shares of earnings in associated companies and subsidiaries Capital brought forward Change in capital according to the statement of financial performance Total agency capital Provisions Provisions for pensions and similar obligations

4,431

4,654

45,618

47,412

50,050

52,066

1,202,801

1,301,452

Liabilities to other Government agencies

217,406

152,064

Accounts payable

314,269

498,791

Other liabilities

161,039

151,599

1,895,515

2,103,906

186,514

162,699

3,285,084

3,224,972

294,186

283,227

Total cut-off items

3,765,784

3,670,898

TOTAL CAPITAL AND LIABILITIES

7 ,268,541

7,436,397

19,676

15,458

19,676

15,458

Other provisions Total provisions Liabilities etc. Loans at the Swedish National Debt Office

Total liabilities etc. Cut-off items Accrued expenses Unexpended grants bidrag Other prepaid revenue

Contingent liabilities Other contingent liabilities Total contingent liabilities

10

KAROLINSKA INSTITUTET FINANCIAL SUMMARY 2019


Revenue 2019, largest sources of funding, SEK million Research councils

County and municipal councils

The Swedish Research Council

915,4

Stockholm County Council

Forte

142,2

Västra Götaland County Council

4,5

Stockholm Municipality

3,9

Formas

19,1

Government agencies

341,0

Companies

Royal Institute of Technology

159,9

AstraZeneca

140,7

Sweden's Innovation Agency

35,0

AFA Insurance

32,1

Kammarkollegiet

33,9

Ferring Pharmaceuticals

25,6

The National Board of Health and Welfare

23,3

Johnson & Johnson

20,8

The Public Health Agency of Sweden

17,9

Pfizer

15,8

Stockholm University

16,6

Novo Nordisk

14,5

The Swedish Armed Forces

14,9

Biogen Idec

10,8

Uppsala University

10,0

Vycellix Inc

8,3

Swedish International Development Cooperation Agency

8,5

Evox Therapeutics

8,1

Försäkringskassan

6,5

Merck & Co

7,5

Organisations and foundations

Foreign organisations

The Swedish Cancer Society

185,3

European Union (EU)

225,2

The Wallenberg Foundations

183,6

National Institute of Health

48,6

The Swedish Foundation for Strategic Research

110,0

Ming Wai Lau

40,1

The Swedish Childhood Cancer Foundation

107,0

The Novo Nordisk Foundation

34,2

The Erling-Persson Family Foundation

79,4

Patient-Centered Outcomes Research Institute

17,5

The Swedish Heart-Lung Foundation

69,0

Stichting af Jochnick Foundation

9,5

Karolinska Institutet Foundations

38,8

CHDI Foundation

8,4

The Swedish Brain Foundation

29,1

Kingdom of Saudi Arabia

7,6

Torsten and Ragnar Söderberg Foundations

25,7

OECD

7,5

The Swedish Society of Medicine

18,7

NordForsk

6,6

KAROLINSKA INSTITUTET FINANCIAL SUMMARY 2019

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Karolinska Institutet Financial Summary 2019 Cover photo: Erik Cronberg Compiled by: The Central Administration, Karolinska Institutet Published by: Karolinska Institutet 171 77 Stockholm ki.se

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