| 61. |
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| 62. |
- Joensuu, Heikki, et al.
(författare)
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Effect of Adjuvant Trastuzumab for a Duration of 9 Weeks vs 1 Year With Concomitant Chemotherapy for Early Human Epidermal Growth Factor Receptor 2-Positive Breast Cancer The SOLD Randomized Clinical Trial
- 2018
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Ingår i: JAMA Oncology. - : AMER MEDICAL ASSOC. - 2374-2437 .- 2374-2445. ; 4:9, s. 1199-1206
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Tidskriftsartikel (refereegranskat)abstract
- Importance: Trastuzumab plus chemotherapy is the standard adjuvant treatment for patients with human epidermal growth factor receptor 2 (HER2)-positive early breast cancer. While the standard duration of trastuzumab treatment is 12 months, the benefits and harms of trastuzumab continued beyond the chemotherapy are unclear.Objective: To evaluate the efficacy and safety of adjuvant trastuzumab continued beyond chemotherapy in women treated with up-front chemotherapy containing a taxane and trastuzumab.Design, Setting, and Participants: Open-label, randomized (1:1) clinical trial including women with HER2-positive breast cancer. Chemotherapy was identical in the 2 groups, consisting of 3 cycles of 3-weekly docetaxel (either 80 or 100 mg/m2) plus trastuzumab for 9 weeks, followed by 3 cycles of fluorouracil, epirubicin, and cyclophosphamide. Thereafter, no trastuzumab was administered in the 9-week group, whereas controls received trastuzumab to complete 1 year of administration. Disease-free survival (DFS) was compared between the groups using a Cox model and the noninferiority approach. The estimated sample size was 2168 patients (1-sided testing, with a relative noninferiority margin of 1.3). From January 3, 2008, to December 16, 2014, 2176 patients were accrued from 7 countries.Intervention: Docetaxel plus trastuzumab for 9 weeks, followed by 3 cycles of fluorouracil, epirubicin, and cyclophosphamide in both groups. Controls continued trastuzumab to 1 year.Main Outcomes and Measures: The primary objective was DFS; secondary objectives included distant disease–free survival, overall survival, cardiac DFS, and safety.Results: In the 2174 women analyzed, median age was 56 (interquartile range [IQR], 48-64) years. The median follow-up was 5.2 (IQR, 3.8-6.7) years. Noninferiority of the 9-week treatment could not be demonstrated for DFS (hazard ratio, 1.39; 2-sided 90% CI, 1.12-1.72). Distant disease–free survival and overall survival did not differ substantially between the groups. Thirty-six (3%) and 21 (2%) patients in the 1-year and the 9-week groups, respectively, had cardiac failure; the left ventricle ejection fraction was better maintained in the 9-week group. An interaction was detected between the docetaxel dose and DFS; patients in the 9-week group treated with 80 mg/m2 had inferior and those treated with 100 mg/m2 had similar DFS as patients in the 1-year group.Conclusions and Relevance: Nine weeks of trastuzumab was not noninferior to 1 year of trastuzumab when given with similar chemotherapy. Cardiac safety was better in the 9-week group. The docetaxel dosing with trastuzumab requires further study.Trial Registration: ClinicalTrials.gov Identifier: NCT00593697
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| 63. |
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| 64. |
- Johansson, Emma, et al.
(författare)
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Participatory future visions of collaborative agroecological farmer-pastoralist systems in Tanzania
- 2023
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Ingår i: Agroecology and Sustainable Food Systems. - : Informa UK Limited. - 2168-3565 .- 2168-3573. ; 47:4, s. 548-578
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Tidskriftsartikel (refereegranskat)abstract
- Agroecology is increasingly promoted as a way to create just and sustainable farm- and food systems. Although there are multiple initiatives to scale up agroecology, current socio-political structures often hinder its potential to transform food systems. This study uses participatory approaches to create paintings that envision agroecological futures in the context of increased farmer-pastoralist collaborations in Tanzania, how they would function, and what political action is needed to support such futures. The visions are based on focus group discussions with agroecological farmers and pastoralists, and a multi-stakeholder workshop with farmer and pastoralist representatives, innovative food system actors, and researchers. We find that the envisioned transformation of the food system would lead to positive effects on farmers’ and pastoralists’ income, autonomy, long-term planning, and producers’ and consumers’ health. We conclude that new policies and financial support systems are needed to enable the expansion of agroecological farming and food systems, by increasing the availability of organic markets, supporting domestic botanicals production, and by creating more inclusive and just food value chains.
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| 65. |
- Johansson, Göran, 1975, et al.
(författare)
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Computational modeling of inelastic large ratcheting strains
- 2005
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Ingår i: International Journal of Plasticity. ; 21:5, s. 955-980
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Tidskriftsartikel (refereegranskat)abstract
- A framework forphenomenological hyperelasto-plasticity with initial anisotropy,kinematic hardening as well as anisotropic damage is presented inMenzel et al. (2003a).In this contribution we exploit and extend this framework toinclude several back-stresses in order to capture the ratchettingresponse of polycrystalline metals subjected to cyclic stress withnon-zero mid-value. The evolution equations for kinematichardening resemble a linear combination of the multiple-Armstrong-Frederic and the Burlet-Cailletaudmodels, which are extended to the large strain setting. Thecapability of the model to capture various phenomenologicalcharacteristics, in particular multi-axial ratchetting, isillustrated by numerical examples. Comparisons with uni-axial andbi-axial experimental ratchetting results for carbon steel aregiven. Finally, the finite element analysis of a simplifiedrailway turnout component subjected to cyclic loading ispresented.
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| 66. |
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| 67. |
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| 68. |
- Johansson, Göran, 1975, et al.
(författare)
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Modeling of anisotropic inelasticity in pearlitic steel at large strains due to deformation induced substructure evolution
- 2005
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Ingår i: European Journal of Mechanics - A/Solids. ; 24:6, s. 899-1088
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Tidskriftsartikel (refereegranskat)abstract
- A macroscopic model for deformation induced anisotropy due to substructure evolution at large strains in pearlitic steel is proposed within a thermodynamically consistent framework. The model is motivated via experimental observations, e.g., [Ivanisenko, Y., Lojkowski, W., Valiev, R.Z., Fecht, H.-J., 2003. The mechanism of formation of nanostructure and dissolution of cementite in a pearlitic steel during high pressure. Acta Mater. 51, 55555570]. Although each pearlitic grain has a preferred direction determined by cementite lamellas, initial random orientation of the grains is interpreted as initial macroscopic isotropy. However, the oriented grains tend to align after large shear deformation. The proposed model for evolution of orientation and stiffness is inspired by recent developments in bio-mechanics, e.g., [Imatani, S., Maugin, G.A., 2002. A constitutive model for material growth and its application to three-dimensional finite element analysis. Mech. Res. Commun. 29, 477483; Menzel, A., 2004. Modelling of anisotropic growth in biological tissues. Biomech. Model. Mechanobiol. 3, 147171]. One important application is large irreversible shear deformations in the surface layer of railway track components.
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