| 31. |
- Dillenbeck, Emelie, et al.
(författare)
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The design of the PRINCESS 2 trial: A randomized trial to study the impact of ultrafast hypothermia on complete neurologic recovery after out-of-hospital cardiac arrest with initial shockable
- 2024
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Ingår i: American Heart Journal. - : MOSBY-ELSEVIER. - 0002-8703 .- 1097-6744. ; 271, s. 97-108
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Tidskriftsartikel (refereegranskat)abstract
- Background Delayed hypothermia, initiated after hospital arrival, several hours after cardiac arrest with 8-10 hours to reach the target temperature, is likely to have limited impact on overall survival. However, the effect of ultrafast hypothermia, i.e., delivered intra-arrest or immediately after return of spontaneous circulation (ROSC), on functional neurologic outcome after out -of -hospital cardiac arrest (OHCA) is unclear. In two prior trials, prehospital trans -nasal evaporative intra-arrest cooling was safe, feasible and reduced time to target temperature compared to delayed cooling. Both studies showed trends towards improved neurologic recovery in patients with shockable rhythms. The aim of the PRINCESS2-study is to assess whether cooling, initiated either intra-arrest or immediately after ROSC, followed by in -hospital hypothermia, significantly increases survival with complete neurologic recovery as compared to standard normothermia care, in OHCA patients with shockable rhythms. Methods/design In this investigator -initiated, randomized, controlled trial, the emergency medical services (EMS) will randomize patients at the scene of cardiac arrest to either trans -nasal cooling within 20 minutes from EMS arrival with subsequent hypothermia at 33 degrees C for 24 hours after hospital admission (intervention), or to standard of care with no prehospital or in -hospital cooling (control). Fever ( > 37,7 degrees C) will be avoided for the first 72 hours in both groups. All patients will receive post resuscitation care and withdrawal of life support procedures according to current guidelines. Primary outcome is survival with complete neurologic recovery at 90 days, defined as modified Rankin scale (mRS) 0-1. Key secondary outcomes include survival to hospital discharge, survival at 90 days and mRS 0-3 at 90 days. In total, 1022 patients are required to detect an absolute difference of 9% (from 45 to 54%) in survival with neurologic recovery (80% power and one-sided alpha= 0,025, beta = 0,2) and assuming 2,5% lost to follow-up. Recruitment starts in Q1 2024 and we expect maximum enrolment to be achieved during Q4 2024 at 20-25 European and US sites. Discussion This trial will assess the impact of ultrafast hypothermia applied on the scene of cardiac arrest, as compared to normothermia, on 90 -day survival with complete neurologic recover y in OHCA patients with initial shockable rhythm. Trial registration NCT06025123. (Am Heart J 2024;271:97-108.)
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| 32. |
- Elbakidze, Marine, et al.
(författare)
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How does forest certification contribute to boreal biodiversity conservation? Standards and outcomes in Sweden and NW Russia
- 2011
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Ingår i: Forest Ecology and Management. - : Elsevier BV. - 0378-1127 .- 1872-7042. ; 262, s. 1983-1995
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Tidskriftsartikel (refereegranskat)abstract
- Forest Stewardship Council (FSC) is one of the leading forest certification schemes. While many studies concern political aspects and social outcomes of FSC, little is known about the contribution of certification to biodiversity conservation. In Europe, the Russian Federation and Sweden have the largest areas of FSC-certified forest. We assessed the potential of FSC certification for boreal biodiversity conservation in terms of standard content, and outcomes as habitat area set aside and habitat network functionality. First, we compared the biodiversity conservation indicators at different spatial scales in Swedish and Russian FSC standards. Second, focusing on one large state forest management unit in each country, we compared the areas of formally and voluntarily set aside forests for biodiversity conservation. Third, we evaluated the structural habitat connectivity by applying morphological spatial pattern analysis, and potential functional connectivity by using habitat suitability index modelling for virtual species. The Russian standard included indicators for all spatial scales of biodiversity conservation, from tree and stand to landscape and ecoregions. The Swedish standard focused mainly on stand and tree scales. The area of voluntary set-asides for FSC was similar in Sweden and Russia, while formal protection in the Russian case study was three times higher than in the Swedish one. Swedish set-aside core areas were two orders of magnitude smaller, had much lower structural and potential functional connectivity and were located in a fragmented forestland holding. We conclude that to understand the potential of FSC certification for biodiversity conservation both the standard content, and its implementation on the ground, need to be assessed. We discuss the potential of FSC certification for biodiversity conservation with different levels of ambition. We stress the need for developing rapid assessment tools to evaluate outcomes of FSC for biodiversity conservation on the ground, which could be used by forest managers and FSC-auditors toward adaptive governance and management. (C) 2011 Elsevier B.V. All rights reserved.
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| 33. |
- Elfwén, Ludvig, et al.
(författare)
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Coronary angiography in out-of-hospital cardiac arrest without ST elevation on ECG-Short- and long-term survival.
- 2018
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Ingår i: American Heart Journal. - : Elsevier BV. - 0002-8703 .- 1097-6744. ; 200, s. 90-95
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The potential benefit of early coronary angiography in out-of-hospital cardiac arrest (OHCA) patients without ST elevation on ECG is unclear. The aim of this study was to evaluate the association between early coronary angiography and survival in these patients.METHODS: Nationwide observational study between 2008 and 2013. Included were patients admitted to hospital after witnessed OHCA, with shockable rhythm, age 18 to 80 years and unconscious. Patients with ST-elevation on ECG were excluded. Patients that underwent early CAG (within 24 hours) were compared with no early CAG (later during the hospital stay or not at all). Outcomes were survival at 30 days, 1 year, and 3 years. Multivariate analysis included pre-hospital factors, comorbidity and ECG-findings.RESULTS: In total, 799 OHCA patients fulfilled the inclusion criteria, of which 275 (34%) received early CAG versus 524 (66%) with no early CAG. In the early CAG group, the proportion of patients with an occluded coronary artery was 27% and 70% had at least one significant coronary stenosis (defined as narrowing of coronary lumen diameter of ≥50%). The 30-day survival rate was 65% in early CAG group versus 52% with no early CAG (P < .001). The adjusted OR was 1.42 (95% CI 1.00-2.02). The one-year survival rate was 62% in the early CAG group versus 48% in the no early CAG group with the adjusted hazard ratio of 1.35 (95% CI 1.04-1.77).CONCLUSION: In this population of bystander-witnessed cases of out-of-hospital cardiac arrest with shockable rhythm and ECG without ST elevation, early coronary angiography may be associated with improved short and long term survival.
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| 34. |
- Elfwen, Ludvig, et al.
(författare)
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Direct or subacute coronary angiography in out-of-hospital cardiac arrest (DISCO)-An initial pilot-study of a randomized clinical trial
- 2019
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Ingår i: Resuscitation. - : ELSEVIER IRELAND LTD. - 0300-9572 .- 1873-1570. ; 139, s. 253-261
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Tidskriftsartikel (refereegranskat)abstract
- Background: The clinical importance of immediate coronary angiography, with potentially subsequent percutaneous coronary intervention (PCI), in out-of-hospital cardiac arrest (OHCA) patients without ST-elevation on the ECG is unclear. In this study, we assessed feasibility and safety aspects of performing immediate coronary angiography in a pre-specified pilot phase of the 'DIrect or Subacute Coronary angiography in Out-of-hospital cardiac arrest' (DISCO) randomized controlled trial (ClinicalTrials.gov ID: NCT02309151). Methods: Resuscitated bystander witnessed OHCA patients > 18 years without ST-elevation on the ECG were randomized to immediate coronary angiography versus standard of care. Event times, procedure related adverse events and safety variables within 7 days were recorded. Results: In total, 79 patients were randomized to immediate angiography (n = 39) or standard of care (n = 40). No major differences in baseline characteristics between the groups were found. There were no differences in the proportion of bleedings and renal failure. Three patients randomized to immediate angiography and six patients randomized to standard care died within 24 h. The median time from EMS arrival to coronary angiography was 135 min in the immediate angiography group. In patients randomized to immediate angiography a culprit lesion was found in 14/38 (36.8%) and PCI was performed in all these patients. In 6/40 (15%) patients randomized to standard of care, coronary angiography was performed before the stipulated 3 days. Conclusion: In this out-of-hospital cardiac arrest population without ST-elevation, randomization to a strategy to perform immediate coronary angiography was feasible although the time window of 120 min from EMS arrival at the scene of the arrest to start of coronary angiography was not achieved. No significant safety issues were reported.
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| 35. |
- Elfwen, Ludvig, et al.
(författare)
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Post-resuscitation myocardial dysfunction in out-of-hospital cardiac arrest patients randomized to immediate coronary angiography versus standard of care
- 2020
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Ingår i: IJC Heart & Vasculature. - : ELSEVIER IRELAND LTD. - 2352-9067. ; 27
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Tidskriftsartikel (refereegranskat)abstract
- Background: Immediate coronary angiography with subsequent percutaneous coronary intervention (PCI) has the potential to reduce post-resuscitation myocardial dysfunction in out-of-hospital cardiac arrest (OHCA) patients. The aim of this study was to see if immediate coronary angiography, with potential PCI, in patients without ST-elevation on the ECG, influenced post-resuscitation myocardial function and cardiac biomarkers.Methods: A secondary analysis of the Direct or Subacute Coronary Angiography in Out-of-Hospital Cardiac Arrest (DISCO) trial (ClinicalTrials.gov ID: NCT02309151). Patients with bystander-witnessed OHCA, without ST-elevations on the ECG were randomly assigned to immediate coronary angiography within two hours of cardiac arrest (n = 38) versus standard-of-care with deferred angiography (n = 40). Outcome measures included left ventricle ejection fraction (LVEF) at 24 h, peak Troponin T levels, lactate clearance and NT-proBNP at 72 h.Results: In the immediate-angiography group, median LVEF at 24 h was 47% (Q1-Q3; 30-55) vs. 46% (Q1-Q3; 35-55) in the standard-of-care group. Peak Troponin-T levels during the first 24 h were 362 ng/L (Q1-Q3; 174-2020) in the immediate angiography group and 377 ng/L (Q1-Q3; 205-1078) in the standard-of-care group. NT-proBNP levels at 72 h were 931 ng/L (Q1-Q3; 396-2845) in the immediate-angiography group and 1913 ng/L (Q1-Q3; 489-3140) in the standard-of-care group.Conclusion: In this analysis of OHCA patients without ST-elevation on the ECG randomized to immediate coronary angiography or standard-of-care, no differences in post-resuscitation myocardial dysfunction parameters between the two groups were found. This finding was consistent also in patients randomized to immediate coronary angiography where PCI was performed compared to those where PCI was not performed.
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| 36. |
- Ericsson, Niclas, et al.
(författare)
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Climate impact and energy efficiency from electricity generation through anaerobic digestion or direct combustion of short rotation coppice willow
- 2014
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Ingår i: Applied Energy. - : Elsevier BV. - 0306-2619 .- 1872-9118. ; 132, s. 86-98
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Tidskriftsartikel (refereegranskat)abstract
- Short rotation coppice willow is an energy crop used in Sweden to produce electricity and heat in combined heat and power plants. Recent laboratory-scale experiments have shown that SRC willow can also be used for biogas production in anaerobic digestion processes.Here, life cycle assessment is used to compare the climate impact and energy efficiency of electricity and heat generated by these measures. All energy inputs and greenhouse gas emissions, including soil organic carbon fluxes were included in the life cycle assessment. The climate impact was determined using time-dependent life cycle assessment methodology.Both systems showed a positive net energy balance, but the direct combustion system delivered ninefold more energy than the biogas system. Both systems had a cooling effect on the global mean surface temperature change. The cooling impact per hectare from the biogas system was ninefold higher due to the carbon returned to soil with the digestate.Compensating the lower energy production of the biogas system with external energy sources had a large impact on the result, effectively determining whether the biogas scenario had a net warming or cooling contribution to the global mean temperature change per kWh of electricity. In all cases, the contribution to global warming was lowered by the inclusion of willow in the energy system. The use of time-dependent climate impact methodology shows that extended use of short rotation coppice willow can contribute to counteract global warming. (C) 2014 Elsevier Ltd. All rights reserved.
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| 37. |
- Ericsson, Niclas, et al.
(författare)
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The effect of Soil Organic Carbon and the Time Frame on the GWP in a Short Rotation Coppice LCA
- 2012
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Ingår i: European Biomass Conference and Exhibition Proceedings. - 2282-5819. ; , s. 2235-2237
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- The energy delivered from short rotation coppice willow is expected to increase in Sweden. Expanding the area of willow will lead to land use changes which may affect soil organic carbon stocks. Many previous life cycle assessments on climate impact of willow exclude soil organic stock changes. These studies also use different system time frames, depending on how long the plantation is expected to prevail. In the present work the global warming potential was assessed for a short rotation coppice willow system established on a 20-year old fallow, including and excluding soil organic carbon, using different time frames and functional units. The global warming potential using a time frame of 24 years was -16.3 kg CO2-eq • GJ-1 including soil organic carbon compared to 6.7 kg CO2-eq • GJ-1 when excluded, showing the importance to consider soil organic carbon changes in life cycle assessments of short rotation coppice when a land use change take place. The time frame and the functional unit chosen were also shown to have an influence on the climate impact.
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| 38. |
- Ericsson, Niclas, et al.
(författare)
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Time-dependent climate impact and energy efficiency of combined heat and power production from short-rotation coppice willow using pyrolysis or direct combustion
- 2017
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Ingår i: Global Change Biology Bioenergy. - : Blackwell Publishing Ltd. - 1757-1693 .- 1757-1707. ; 9:5, s. 876-890
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Tidskriftsartikel (refereegranskat)abstract
- A life cycle assessment of a Swedish short-rotation coppice willow bioenergy system generating electricity and heat was performed to investigate how the energy efficiency and time-dependent climate impact were affected when the feedstock was converted into bio-oil and char before generating electricity and heat, compared with being combusted directly. The study also investigated how the climate impact was affected when part of the char was applied to soil as biochar to act as a carbon sequestration agent and potential soil improver. The energy efficiencies were calculated separately for electricity and heat as the energy ratios between the amount of energy service delivered by the system compared to the amount of external energy inputs used in each scenario after having allocated the primary energy related to the inputs between the two energy services. The energy in the feedstock was not included in the external energy inputs. Direct combustion had the highest energy efficiency. It had energy ratios of 10 and 36 for electricity and heat, respectively. The least energy-efficient scenario was the pyrolysis scenario where biochar was applied to soils. It had energy ratios of 4 and 12 for electricity and heat, respectively. The results showed that pyrolysis with carbon sequestration might be an option to counteract the current trend in global warming. The pyrolysis system with soil application of the biochar removed the largest amount of CO2 from the atmosphere. However, compared with the direct combustion scenario, the climate change mitigation potential depended on the energy system to which the bioenergy system delivered its energy services. A system expansion showed that direct combustion had the highest climate change mitigation potential when coal or natural gas were used as external energy sources to compensate for the lower energy efficiency of the pyrolysis scenario.
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| 39. |
- Ericsson, Niclas, et al.
(författare)
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Time-dependent climate impact of a bioenergy system - methodology development and application to Swedish conditions
- 2013
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Ingår i: GCB Bioenergy. - : Wiley. - 1757-1693 .- 1757-1707. ; 5, s. 580-590
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Tidskriftsartikel (refereegranskat)abstract
- The area of dedicated energy crops is expected to increase in Sweden. This will result in direct land use changes, which may affect the carbon stocks in soil and biomass, as well as yield levels and the use of inputs. Carbon dioxide (CO2) fluxes of biomass are often not considered when calculating the climate impact in life cycle assessments (LCA) assuming that the CO2 released at combustion has recently been captured by the biomass in question. With the extended time lag between capture and release of CO2 inherent in many perennial bioenergy systems, the relation between carbon neutrality and climate neutrality may be questioned. In this paper, previously published methodologies and models are combined in a methodological framework that can assist LCA practitioners in interpreting the time-dependent climate impact of a bioenergy system. The treatment of carbon differs from conventional LCA practice in that no distinction is made between fossil and biogenic carbon. A time-dependent indicator is used to enable a representation of the climate impact that is not dependent on the choice of a specific characterization time horizon or time of evaluation and that does not use characterization factors, such as global warming potential and global temperature potential. The indicator used to aid in the interpretation phase of this paper is global mean surface temperature change (T-s(n)). A theoretical system producing willow for district heating was used to study land use change effects depending on previous land use and variations in the standing biomass carbon stocks. When replacing annual crops with willow this system presented a cooling contribution to T-s(n). However, the first years after establishing the willow plantation it presented a warming contribution to T-s(n). This behavior was due mainly to soil organic carbon (SOC) variation. A rapid initial increase in standing biomass counteracted the initial SOC loss.
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| 40. |
- Eriksdotter-Jönhagen, Maria, et al.
(författare)
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Encapsulated cell biodelivery of nerve growth factor to the Basal forebrain in patients with Alzheimer's disease.
- 2012
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Ingår i: Dementia and geriatric cognitive disorders. - : S. Karger AG. - 1421-9824 .- 1420-8008. ; 33:1, s. 18-28
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Tidskriftsartikel (refereegranskat)abstract
- Degeneration of cholinergic neurons in the basal forebrain correlates with cognitive decline in patients with Alzheimer's disease (AD). Targeted delivery of exogenous nerve growth factor (NGF) has emerged as a potential AD therapy due to its regenerative effects on the basal forebrain cholinergic neurons in AD animal models. Here we report the results of a first-in-man study of encapsulated cell (EC) biodelivery of NGF to the basal forebrain of AD patients with the primary objective to explore safety and tolerability.
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