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- Almered-Olsson, G., et al.
(författare)
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Inte Bara Träd : Hållbart Mångbruk Av Skogslandskapet
- 2004
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Bok (övrigt vetenskapligt)abstract
- Skogslandskapen - hur skall vi värdera dem? Ska de betraktas som rekreationsområden och kulturlandskap eller som arena för konflikter och dragkamp om olika resurser?<br/><br/> Är skogsregionerna närande eller tärande?<br/><br/> Vilka viktiga samband finns mellan skandinaviska och tropiska landskap?<br/><br/><br/><br/>Detta är några av de teman som behandlas i denna spänannde bok om de många dimensionerna och resurserna som ryms i skogslandskapen.<br/><br/> Boken ger nya och stimulerande aspekter på framtidsmöjligheterna för en hållbar utveckling för boreala skogslandskap. Den tar också upp det nödvändiga mångbruket av skogens resurser liksom den förändrade synen på människans roll i skogen. Och inte minst behandlas den ekologiska paradoxen att störningar behövs för att bevara skogens ekologiska mångfald.<br/><br/><br/><br/>Boken är författad av samhällsvetare, miljöteknologer och ekologer inom den tvärvetenskapliga forskargruppen MiljöFocus vid Karlstads universitet
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- Eriksson, Ulf G, et al.
(författare)
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Pharmacokinetics of melagatran and the effect on ex vivo coagulation time in orthopaedic surgery patients receiving subcutaneous melagatran and oral ximelagatran : a population model analysis
- 2003
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Ingår i: Clinical Pharmacokinetics. - 0312-5963. ; 42:7, s. 687-701
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Forskningsöversikt (övrigt vetenskapligt)abstract
- OBJECTIVE: Ximelagatran, an oral direct thrombin inhibitor, is rapidly bioconverted to melagatran, its active form. The objective of this population analysis was to characterise the pharmacokinetics of melagatran and its effect on activated partial thromboplastin time (APTT), an ex vivo measure of coagulation time, in orthopaedic surgery patients sequentially receiving subcutaneous melagatran and oral ximelagatran as prophylaxis for venous thromboembolism. To support the design of a pivotal dose-finding study, the impact of individualised dosage based on bodyweight and calculated creatinine clearance was examined. DESIGN AND METHODS: Pooled data obtained in three small dose-guiding studies were analysed. The patients received twice-daily administration, with either subcutaneous melagatran alone or a sequential regimen of subcutaneous melagatran followed by oral ximelagatran, for 8-11 days starting just before initiation of surgery. Nonlinear mixed-effects modelling was used to evaluate rich data of melagatran pharmacokinetics (3326 observations) and the pharmacodynamic effect on APTT (2319 observations) in samples from 216 patients collected in the three dose-guiding trials. The pharmacokinetic and pharmacodynamic models were validated using sparse data collected in a subgroup of 319 patients enrolled in the pivotal dose-finding trial. The impact of individualised dosage on pharmacokinetic and pharmacodynamic variability was evaluated by simulations of the pharmacokinetic-pharmacodynamic model.RESULTS: The pharmacokinetics of melagatran were well described by a one-compartment model with first-order absorption after both subcutaneous melagatran and oral ximelagatran. Melagatran clearance was correlated with renal function, assessed as calculated creatinine clearance. The median population clearance (creatinine clearance 70 mL/min) was 5.3 and 22.9 L/h for the subcutaneous and oral formulations, respectively. The bioavailability of melagatran after oral ximelagatran relative to subcutaneous melagatran was 23%. The volume of distribution was influenced by bodyweight. For a patient with a bodyweight of 75kg, the median population estimates were 15.5 and 159L for the subcutaneous and oral formulations, respectively. The relationship between APTT and melagatran plasma concentration was well described by a power function, with a steeper slope during and early after surgery but no influence by any covariates. Simulations demonstrated that individualised dosage based on creatinine clearance or bodyweight had no clinically relevant impact on the variability in melagatran pharmacokinetics or on the effect on APTT. CONCLUSIONS: The relatively low impact of individualised dosage on the pharmacokinetic and pharmacodynamic variability of melagatran supported the use of a fixed-dose regimen in the studied population of orthopaedic surgery patients, including those with mild to moderate renal impairment.
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- Olsson, Eric, et al.
(författare)
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Change, reorganization and quality of home carefor elderly people in Sweden during the 1990s : paper to 17:e Nordiska konferensen i gerontologi 23-26 maj 2004 i Stockholm
- 2004
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Ingår i: Working paper-serien. - Lunds universitet : Socialhögskolan. - 91-89604-27-X ; 2004:2
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Annan publikation (övrigt vetenskapligt)abstract
- During the 1990s several kinds of reorganization has taken place in public services in Sweden. Reorganizations according to the idea of market economy have been most salient and debated. In many municipalities private companies have started to organize home care service for elderly, financed by tax. Public home care organizations have reorganized the working organization and managing structure, partly to save money and partly to reach better quality of care. The home care services have a key role in the care of the elderly in the society. The quality of care is important for the possibility for elderly to stay as long as possible in their ordinary homes. We have performed a longitudinal study of the reorganizations during the 1990s in order to explore the consequences for quality of care. The study was performed in seven districts in three different municipalities representing different types of municipalities and different kinds of reorganizations. It comprises private companies, traditional public organizations, public organizations with changed managing structure and co-ordination of home help and home health care. Quality of care is studied through assessment of the communication in the organization, the psychosocial working environment of the caregivers and the quality of the care work. Politicians, managers, ca. 100 care givers and ca. 500 elderly receiving help and care have been interviewed four times during the period (1993, 1995, 1997 and 2002/2003). The traditional organization within small districts with small autonomous working teams and easy accessible supervisor expose the best quality. There are no unambiguous differences between public and private organizations. There is however a tendency for successive decline of quality for private companies after they have been established. Other aspects of the reorganizations, e. g. to have special officials for assessment of help need, do not contribute to better quality but create new communication gaps in the organization and have negative influence on the working environment. Stability in the composition of the care worker teams, leadership, decision-making processes in the organization and the district area promote high quality of care. The reorganizations during the 1990s seem on the whole to function contrary to promotion of high quality in the care and service for the elderly.
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