| 1. |
- A. Bateki, Christian, et al.
(författare)
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Of milk and mobiles: Assessing the potential of cellphone applications to reduce cattle milk yield gaps in Africa using a case study
- 2021
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Ingår i: Computers and Electronics in Agriculture. - : Elsevier BV. - 0168-1699. ; 191
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Tidskriftsartikel (refereegranskat)abstract
- There are growing expectations that Information and Communication Technology (ICT) applications could help improve on-farm yields amongst smallholder farmers in developing countries, and consequently, food and nutrition security. However, few studies have quantified the actual contribution of ICT applications on farmers’ yields, and these studies predominantly focused on crop production. We assessed the potential of ICT applications to close milk yield gaps among small- and medium scale dairy cattle farmers in Africa. First, we developed a theoretical framework summarizing biophysical and socio-economic constraints that foster milk yield gaps and discussed which constraints can be addressed using ICT applications. Second, using a case study of a feeding advice application for dairy cattle pre-tested with farmers in rural Kenya, we analyzed how much stand-alone the application could contribute to close dairy cattle milk yield gaps. Our findings suggest that ICT applications could help address some existing biophysical and socio-economic constraints fostering milk yield gaps, including data collection for breeding programs, feeding management advice, and facilitating access to markets and capital. Our stand-alone ICT application closed yield gaps by 2 % to 6 % on representative farms. Several factors may explain the limited actual contribution of selected ICT applications to reduce existing milk yield gaps, including the quality of the input data and models used in ICT applications, and more structural constraints that cannot be addressed by digital tools. Therefore, although ICT applications could help address constraints to achieving higher milk yields on dairy farms, a significant contribution to improve yields may only be achieved when conditions surrounding their use are adequate.
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| 2. |
- A, Dell'Isola, et al.
(författare)
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The role of pain and walking difficulties in shaping willingness to undergo joint surgery for osteoarthritis: Data from the Swedish BOA register
- 2021
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Ingår i: Osteoarthritis and Cartilage Open. - : Elsevier BV. - 2665-9131. ; 3:2
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To investigate whether the association between pain intensity and willingness to undergo surgery is explained by walking difficulties, in patients with knee or hip osteoarthritis (OA). Methods: This is an observational study using data from the Better management of patients with Osteoarthritis (BOA) register, which collects data from a publicly financed self-management programme for people with OA in Sweden. We included all patients with knee or hip OA who attended the baseline visit between 2008 and 2016. We conducted separate mediation analyses within a counterfactual framework to estimate the mediation effect of walking difficulties (yes/no) on willingness to undergo surgery (yes/no) for each one-point increase in pain (0–10 on a numeric rating scale), adjusted for relevant confounders. Results: We included 72,131 patients (69% women, mean age 66, mean pain 5.4, 81% had walking difficulties, 27% was willing to undergo surgery). A one-point increase in pain intensity was associated with 1.53 (95% CI: 1.51; 1.55) higher odds of being willing to undergo surgery. Walking difficulties mediated 10%–25% of the effect of one-point increase in pain when pain was <8/10, while at pain ≥8/10 this percentage decreased to 3%. Conclusions: More than 80% of the BOA patients have mild to moderate pain (<8/10) and walking difficulties can mediate up to a quarter of the total effect of pain on the willingness to undergo surgery in these patients. Trials to evaluate the potential to lower surgery demand by reducing walking difficulties in people with these characteristics are needed.
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| 3. |
- Aaen, J., et al.
(författare)
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Clinical and MRI findings in lumbar spinal stenosis: baseline data from the NORDSTEN study
- 2022
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Ingår i: European Spine Journal. - : Springer Science and Business Media LLC. - 0940-6719 .- 1432-0932. ; 31:6, s. 1391 - 1398
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Tidskriftsartikel (refereegranskat)abstract
- Purpose The aim was to describe magnetic resonance imaging findings in patients planned for lumbar spinal stenosis surgery. Further, to describe possible associations between MRI findings and patient characteristics with patient reported disability or pain. Methods The NORDSTEN spinal stenosis trial included 437 patients planned for surgical decompression of LSS. The following MRI findings were evaluated before surgery: morphological (Schizas) and quantitative (cross-sectional area) grade of stenosis, disk degeneration (Pfirrmann), facet joint tropism and fatty infiltration of the multifidus muscle. Patients were dichotomized into a moderate or severe category for each radiological parameter classification. A multivariable linear regression analysis was performed to investigate the association between MRI findings and preoperative scores for Oswestry Disability Index, Zurich Claudication Questionnaire and Numeric rating scale for back and leg pain. The following patient characteristics were included in the analysis: gender, age, smoking and weight. Results The percentage of patients with severe scores was as follows: Schizas (C + D) 71.3%, cross-sectional area (< 75 mm(2)) 86.8%, Pfirrmann (4 + 5) 58.1%, tropism (>= 15 degrees) 11.9%, degeneration of multifidus muscle (2-4) 83.7%. Regression coefficients indicated minimal changes in severity of symptoms when comparing the groups with moderate and severe MRI findings. Only gender had a significant and clinically relevant association with ODI score. Conclusion In this cross-sectional study, the majority of the patients had MRI findings classified as severe LSS changes, but the findings had no clinically relevant association with patient reported disability and pain at baseline. Patient characteristics have a larger impact on disability and pain than radiological findings.
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| 4. |
- Aaen, J., et al.
(författare)
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Is the presence of foraminal stenosis associated with outcome in lumbar spinal stenosis patients treated with posterior microsurgical decompression
- 2023
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Ingår i: ACTA NEUROCHIRURGICA. - 0001-6268. ; 165
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Tidskriftsartikel (refereegranskat)abstract
- Background We aim to investigate associations between preoperative radiological findings of lumbar foraminal stenosis with clinical outcomes after posterior microsurgical decompression in patients with predominantly central lumbar spinal stenosis (LSS). Methods The study was an additional analysis in the NORDSTEN Spinal Stenosis Trial. In total, 230 men and 207 women (mean age 66.8 ( SD 8.3)) were included. All patients underwent an MRI including T1- and T2-weighted sequences. Grade of foraminal stenosis was dichotomized into none to moderate (0-1) and severe (2-3) category using Lee's classification system. The Oswestry Disability Index (ODI), Zurich Claudication Questionnaire (ZCQ), and numeric rating scale (NRS) for back and leg pain were collected at baseline and at 2-year follow-up. Primary outcome was a reduction of 30% or more on the ODI score. Secondary outcomes included the mean improvement on the ODI, ZCQ, and NRS scores. We performed multivariable regression analyses with the radiological variates foraminal stenosis, Pfirrmann grade, Schizas score, dural sac cross-sectional area, and the possible plausible confounders: patients' gender, age, smoking status, and BMI. Results The cohort of 437 patients presented a high degree of degenerative changes at baseline. Of 414 patients with adequate imaging of potential foraminal stenosis, 402 were labeled in the none to moderate category and 12 in the severe category. Of the patients with none to moderate foraminal stenosis, 71% achieved at least 30% improvement in ODI. Among the patients with severe foraminal stenosis, 36% achieved at least 30% improvement in ODI. A significant association between severe foraminal stenosis and less chance of reaching the target of 30% improvement in the ODI score after surgery was detected: OR 0.22 (95% CI 0.06, 0.83), p=0.03. When investigating outcome as continuous variables, a similar association between severe foraminal stenosis and less improved ODI with a mean difference of 9.28 points (95%CI 0.47, 18.09; p=0.04) was found. Significant association between severe foraminal stenosis and less improved NRS pain in the lumbar region was also detected with a mean difference of 1.89 ( 95% CI 0.30, 3.49; p=0.02). No significant association was suggested between severe foraminal stenosis and ZCQ or NRS leg pain. Conclusion In patients operated with posterior microsurgical decompression for LSS, a preoperative severe lumbar foraminal stenosis was associated with higher proportion of patients with less than 30% improvement in ODI. Trial registration The study is registered at ClinicalTrials. gov (22.11.2013) under the identifier NCT02007083.
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| 5. |
- Aaen, J., et al.
(författare)
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The association between preoperative MRI findings and clinical improvement in patients included in the NORDSTEN spinal stenosis trial
- 2022
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Ingår i: European Spine Journal. - : Springer Science and Business Media LLC. - 0940-6719 .- 1432-0932. ; 31:10, s. 2777-2785
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Tidskriftsartikel (refereegranskat)abstract
- Purpose To investigate potential associations between preoperative MRI findings and patient reported outcome measures (PROMs) after surgery for lumbar spinal stenosis (LSS). Methods The NORDSTEN trial included 437 patients. We investigated the association between preoperative MRI findings such as morphological grade of stenosis (Schizas grade), quantitative grade of stenosis (dural sac cross-sectional area), disc degeneration (Pfirrmann score), facet joint tropism and fatty infiltration of the multifidus muscle, and improvement in patient reported outcome measures (PROMs) 2 years after surgery. We dichotomized each radiological parameter into a moderate or severe category. PROMs i.e., Oswestry Disability Index (ODI), Zurich Claudication Questionnaire (ZCQ) and Numeric rating scale (NRS) for back and leg pain were collected before surgery and at 2 year follow-up. In the primary analysis, we investigated the association between MRI findings and ODI score (dichotomized to >= 30% improvement or not). In the secondary analysis, we investigated the association between MRI findings and the mean improvement on the ODI-, ZCQ- and NRS scores. We used multivariable regression models adjusted for patients' gender, age, smoking status and BMI. Results The primary analysis showed that severe disc degeneration (Pfirrmann score 4-5) was significantly associated with less chance of achieving a 30% improvement on the ODI score (OR 0.54, 95% CI 0.34, 0.88). In the secondary analysis, we detected no clinical relevant associations. Conclusion Severe disc degeneration preoperatively suggest lesser chance of achieving 30% improvement in ODI score after surgery for LSS. Other preoperative MRI findings were not associated with patient reported outcome.
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| 6. |
- Aakre, K. M., et al.
(författare)
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Analytical Considerations in Deriving 99th Percentile Upper Reference Limits for High-Sensitivity Cardiac Troponin Assays: Educational Recommendations from the IFCC Committee on Clinical Application of Cardiac Bio-Markers
- 2022
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Ingår i: Clinical chemistry. - : Oxford University Press (OUP). - 0009-9147 .- 1530-8561. ; 68:8
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Tidskriftsartikel (refereegranskat)abstract
- The International Federation of Clinical Chemistry Committee on Clinical Application of Cardiac Bio-Markers provides evidence-based educational documents to facilitate uniform interpretation and utilization of cardiac biomarkers in clinical laboratories and practice. The committee's goals are to improve the understanding of certain key analytical and clinical aspects of cardiac biomarkers and how these may interplay in clinical practice. Measurement of high-sensitivity cardiac troponin (hs-cTn) assays is a cornerstone in the clinical evaluation of patients with symptoms and/or signs of acute cardiac ischemia. To define myocardial infarction, the Universal Definition of Myocardial Infarction requires patients who manifest with features suggestive of acute myocardial ischemia to have at least one cTn concentration above the sex-specific 99th percentile upper reference limit (URL) for hs-cTn assays and a dynamic pattern of cTn concentrations to fulfill the diagnostic criteria for MI. This special report provides an overview of how hs-cTn 99th percentile URLs should be established, including recommendations about prescreening and the number of individuals required in the reference cohort, how statistical analysis should be conducted, optimal preanalytical and analytical protocols, and analytical/biological interferences or confounds that can affect accurate determination of the 99th percentile URLs. This document also provides guidance and solutions to many of the issues posed.
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| 7. |
- Aakre, Kristin M, et al.
(författare)
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Lower Limits for Reporting High-Sensitivity Cardiac Troponin Assays and Impact of Analytical Performance on Patient Misclassification.
- 2024
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Ingår i: Clinical chemistry. - 0009-9147 .- 1530-8561. ; 70:3, s. 497-505
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Tidskriftsartikel (refereegranskat)abstract
- Cardiac troponin measurements are indispensable for the diagnosis of myocardial infarction and provide useful information for long-term risk prediction of cardiovascular disease. Accelerated diagnostic pathways prevent unnecessary hospital admission, but require reporting cardiac troponin concentrations at low concentrations that are sometimes below the limit of quantification. Whether analytical imprecision at these concentrations contributes to misclassification of patients is debated.The International Federation of Clinical Chemistry Committee on Clinical Application of Cardiac Bio-Markers (IFCC C-CB) provides evidence-based educational statements on analytical and clinical aspects of cardiac biomarkers. This mini-review discusses how the reporting of low concentrations of cardiac troponins impacts on whether or not assays are classified as high-sensitivity and how analytical performance at low concentrations influences the utility of troponins in accelerated diagnostic pathways. Practical suggestions are made for laboratories regarding analytical quality assessment of cardiac troponin results at low cutoffs, with a particular focus on accelerated diagnostic pathways. The review also discusses how future use of cardiac troponins for long-term prediction or management of cardiovascular disease may require improvements in analytical quality.Clinical guidelines recommend using cardiac troponin concentrations as low as the limit of detection of the assay to guide patient care. Laboratories, manufacturers, researchers, and external quality assessment providers should extend analytical performance monitoring of cardiac troponin assays to include the concentration ranges applicable in these pathways.
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| 8. |
- Aalders, Johannes Theodor
(författare)
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Building on the ruins of empire: the Uganda Railway and the LAPSSET corridor in Kenya
- 2021
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Ingår i: Third World Quarterly. - : Informa UK Limited. - 0143-6597 .- 1360-2241. ; 42:5, s. 996-1013
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Tidskriftsartikel (refereegranskat)abstract
- This article explores colonial (dis-)continuities between the planned Lamu Port–South Sudan–Ethiopia Transport (LAPSSET) development corridor and the Uganda Railway (UR). The historical approach to infrastructure studies highlights the effects of large-scale infrastructures beyond their immediate material impact, and reveals their potential power to structure mobilities, historicities and politics of scale. With reference to relational theories, it is argued that the two projects gain their respective significance not only through their ability to connect distant places, but also by blocking and severing other competing ways of being mobile. Particularly, both infrastructure projects create technologies enabling easier and faster flow of capital and commodities but limit previously prevalent mobilities practised by caravans and semi-nomadic people in the region. Both projects, furthermore, produce particular ways of remembering the past and anticipating the future. The article identifies a major discontinuity in the politics of scale they respectively imply: while the UR aimed at producing a clear scalar hierarchy between empire and colony, the LAPSSET alleges to dissolve hard boundaries between scalar instances. This article is based on qualitative data collected during fieldwork along the proposed route of the LAPSSET corridor, as well as archive work regarding the UR.
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| 9. |
- Aalders, Johannes Theodor, et al.
(författare)
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Drawing together: Making Marginal Futures Visible through Collaborative Comic Creation (CCC)
- 2020
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Ingår i: Geographica Helvetica. The Swiss Journal of Geography. - : Copernicus GmbH. - 0016-7312. ; 75, s. 415-430
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Tidskriftsartikel (refereegranskat)abstract
- The article introduces collaborative comic creation (CCC) as a methodological tool. The central question it addresses is how marginalised imaginations of futures can be made visible in the context of the planned Lamu Port-South Sudan-Ethiopia-Transport (LAPSSET) in Kenya. The question assumes that infrastructure projects such as the LAPSSET corridor inscribe not only particular ways of moving into a landscape but also one specific temporality that marginalises other future-making practices. The paper participates in the ongoing debate about how imagined futures and future-making practices can be appreciated and analysed methodologically. It thus contributes to the literature on geographies of the future by drawing together conceptual insights from anthropology, infrastructure studies, and critical cartography. Based on these different approaches, the paper proposes to regard future-making practices not only in relation to contentious timelines but also in terms of lines made by moving and drawing on landscapes and surfaces. Using a review of existing social foresight methods as a basis, we describe the practical implementation of CCC. Subsequently, the analysis of one collaboratively produced comic illustrates how the method can help to visualise ambivalent and uncertain imaginations of different futures that oppose the unitary vision of modernity produced by dominant infrastructural visions of a single future. We conclude by reflecting on possible ways of developing the method further.
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| 10. |
- Aalders, Johannes Theodor, et al.
(författare)
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The Making and Unmaking of a Megaproject: Contesting Temporalities along the LAPSSET Corridor in Kenya
- 2021
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Ingår i: Antipode. - : Wiley. - 0066-4812 .- 1467-8330. ; 53:5, s. 1273-1293
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Tidskriftsartikel (refereegranskat)abstract
- In this paper, we show how communities in Northern Kenya proactively engage an unfolding megaproject and the temporalities it evokes—the Lamu Port South Sudan Ethiopia Transport Corridor (LAPSSET). We argue that the latitude communities have in contending with megaprojects is broader and more dynamic than passive reception of or outright resistance against the futures promised. By introducing the concepts of entangling and fraying, we emphasise the agency communities create for themselves by appreciating their strategies and expressions of stabilising or troubling the “megaproject”. While entangling refers to practices through which communities attach additional features to an otherwise rather stable vision of its “meganess”, fraying, in contrast, describes the strands that splice off towards different spatio‐temporal imaginaries. We discuss these practices in four instances of engaging LAPSSET: constructing temporary homes at project sites; engaging in land reform; disputing land acquisition at oil exploration sites; and contesting a planned resort city.
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