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- Engerström, Lars, et al.
(författare)
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Prevalence and impact of early prone position on 30-day mortality in mechanically ventilated patients with COVID-19 : a nationwide cohort study
- 2022
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Ingår i: Critical Care. - : BMC. - 1364-8535 .- 1466-609X. ; 26:1
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Tidskriftsartikel (refereegranskat)abstract
- Background COVID-19 ARDS shares features with non-COVID ARDS but also demonstrates distinct physiological differences. Despite a lack of strong evidence, prone positioning has been advocated as a key therapy for COVID-19 ARDS. The effects of prone position in critically ill patients with COVID-19 are not fully understood, nor is the optimal time of initiation defined. In this nationwide cohort study, we aimed to investigate the association between early initiation of prone position and mortality in mechanically ventilated COVID-19 patients with low oxygenation on ICU admission. Methods Using the Swedish Intensive Care Registry (SIR), all Swedish ICU patients >= 18 years of age with COVID-19 admitted between March 2020, and April 2021 were identified. A study-population of patients with PaO2/FiO(2) ratio <= 20 kPa on ICU admission and receiving invasive mechanical ventilation within 24 h from ICU admission was generated. In this study-population, the association between early use of prone position (within 24 h from intubation) and 30-day mortality was estimated using univariate and multivariable logistic regression models. Results The total study cohort included 6350 ICU patients with COVID-19, of whom 46.4% were treated with prone position ventilation. Overall, 30-day mortality was 24.3%. In the study-population of 1714 patients with lower admission oxygenation (PaO2/FiO(2) ratio <= 20 kPa), the utilization of early prone increased from 8.5% in March 2020 to 48.1% in April 2021. The crude 30-day mortality was 27.2% compared to 30.2% in patients not receiving early prone positioning. We found no significant association between early use of prone positioning and survival. Conclusions During the first three waves of the COVID-19 pandemic, almost half of the patients in Sweden were treated with prone position ventilation. We found no association between early use of prone positioning and survival in patients on mechanical ventilation with severe hypoxemia on ICU admission. To fully elucidate the effect and timing of prone position ventilation in critically ill patients with COVID-19 further studies are desirable.
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- Sjödin, Johan
(författare)
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Steel-to-timber dowel joints : Influence of moisture induced stresses
- 2006
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Joints are critical parts of timber structures, transmitting static and dynamic forces between structural members. The ultimate behavior of a loaded building depends strongly on the structural configuration and the capacity of the joints. The collapse of a whole building or less extensive accidents that may occur is usually starting as a local failure inside or in the vicinity of a joint. Such serious failures have recently occurred in our Nordic countries. Especially the collapse of two large glued laminated timber structures clearly indicates the need of an improved joint design. The trend toward larger and more complex structures even further increases the importance of a safer design of the joints.An aim of this partly experimental and partly numerically based thesis has been to investigate if steel-to-timber dowel joints are affected by moisture-induced stresses. The experimental results showed that the load-bearing capacity of the joints is reduced by such a moisture influence. Most of the decrease in load-bearing capacity observed was found in joints initially exposed to restrained shrinkage deformations caused by the presence of dowel fasteners in the joint area. The load-bearing capacity was, however, also found to decrease in joints exposed to an initial decrease in moisture without any fasteners present in the specimens during storage before loading. An explanation of this unexpected behavior is that moisture gradients cause tensile stresses. It is shown by numerical simulations that the moisture-induced stresses are so large that they may have a considerable influence on the joint behavior.Use of contact-free measurement methods, used in some of the experimental tests, was in many ways found to be superior to traditional measurement techniques, but was also found to be a valuable complement to the numerical analysis performed. From numerical results obtained in combination with results from contact-free measurements several observations of considerable interest were made. For dowel-type joints loaded in tension parallel to the grain a strongly non-uniform strain distribution was found in the joint area. It was further observed that the shear and tensile strains were concentrated close to the fasteners in the joint area. These concentrations will influence the failure mode of the joint. A general observation was that the larger sized joints failed in a brittle manner.Keywords: constraint stresses, contact-free measurement, dowel-type joints, humidity variations, moisture-induced deformations, timber structures
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- Akner, Gunnar, 1953-, et al.
(författare)
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Vi står gärna bakom en utfallsbaserad vård
- 2017
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Ingår i: Dagens Samhälle. - 1652-6511.
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Tidskriftsartikel (populärvet., debatt m.m.)abstract
- Jörgen Nordenström försöker få det till att vår kritik av värdebaserad vård egentligen handlar om att vi vill ha mer resurser. Han har helt missuppfattat oss, skriver 26 specialistläkare i en replik.
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- Andersson, Magnus, et al.
(författare)
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Fiskbestånd och miljö i hav och sötvatten : Resurs- och miljööversikt 2012
- 2012
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Detta är den nionde utgåvan av den samlade översikten över fisk- och kräftdjursbeståndens status i våra vatten. Kunskap om fiskbestånden och miljön är en förutsättning för att utnyttjandet av fiskresurserna skall bli bärkraftigt. För svenska vattenområden beskrivs miljöutvecklingen i ett ekosystemsperspektiv, dels för att tydliggöra fiskens ekologiska roll och beskriva yttre miljöfaktorer som påverkar fiskbestånden, dels för att belysa fiskets effekter på miljön.Fiskbestånd och miljö i hav och sötvatten är utarbetad av Sveriges lantbruksuniversitet (SLU), Institutionen för akvatiska resurser (SLU Aqua), på uppdrag av Havs- och vattenmyndigheten. Rapporten sammanfattar utveckling och beståndsstatus för de kommersiellt viktigaste fisk- och kräftdjursarterna i våra vatten. Bedömningar och förvaltningsråd är baserade på Internationella Havsforskningsrådets (ICES) rådgivning, SLU Aquas nationella och regionala provfiskedata, samt yrkesfiskets rapportering.
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