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- Ademuyiwa, Adesoji O., et al.
(författare)
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Determinants of morbidity and mortality following emergency abdominal surgery in children in low-income and middle-income countries
- 2016
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Ingår i: BMJ Global Health. - : BMJ Publishing Group Ltd. - 2059-7908. ; 1:4
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Tidskriftsartikel (refereegranskat)abstract
- Background: Child health is a key priority on the global health agenda, yet the provision of essential and emergency surgery in children is patchy in resource-poor regions. This study was aimed to determine the mortality risk for emergency abdominal paediatric surgery in low-income countries globally.Methods: Multicentre, international, prospective, cohort study. Self-selected surgical units performing emergency abdominal surgery submitted prespecified data for consecutive children aged <16 years during a 2-week period between July and December 2014. The United Nation's Human Development Index (HDI) was used to stratify countries. The main outcome measure was 30-day postoperative mortality, analysed by multilevel logistic regression.Results: This study included 1409 patients from 253 centres in 43 countries; 282 children were under 2 years of age. Among them, 265 (18.8%) were from low-HDI, 450 (31.9%) from middle-HDI and 694 (49.3%) from high-HDI countries. The most common operations performed were appendectomy, small bowel resection, pyloromyotomy and correction of intussusception. After adjustment for patient and hospital risk factors, child mortality at 30 days was significantly higher in low-HDI (adjusted OR 7.14 (95% CI 2.52 to 20.23), p<0.001) and middle-HDI (4.42 (1.44 to 13.56), p=0.009) countries compared with high-HDI countries, translating to 40 excess deaths per 1000 procedures performed.Conclusions: Adjusted mortality in children following emergency abdominal surgery may be as high as 7 times greater in low-HDI and middle-HDI countries compared with high-HDI countries. Effective provision of emergency essential surgery should be a key priority for global child health agendas.
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| 4. |
- Andersson, Martin, et al.
(författare)
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Dynamic pH determination at high pressure of aqueous additive mixtures in contact with dense CO2
- 2018
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Ingår i: Journal of Supercritical Fluids. - : Elsevier BV. - 0896-8446 .- 1872-8162. ; 136, s. 95-101
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Tidskriftsartikel (refereegranskat)abstract
- A system consisting of a high-pressure tolerant microfluidic glass chip, high-speed absorbance imaging, and image processing has been developed to study rapid dynamic events like pH change in a multiphase flow. The system gives both kinetic and quantitative equilibrated information. By tracking the interactions of aqueous additive mixtures and liquid CO2, at 80 bar and 24 °C, under flow, measurement at a given P, T condition is done in 0.25 s. The acidification rate to steady state was found to be mass transport limited, occurring in less than 1 s. For 30 mM of the additives ammonium acetate and ammonium formate, equilibrium pH of 4.5 and 4.1, respectively, was seen. These additives are of key importance in common mobile phases used in SFC.
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| 5. |
- Björkelund, Cecilia, 1948, et al.
(författare)
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Clinical effectiveness of care managers in collaborative care for patients with depression in Swedish primary health care: a pragmatic cluster randomized controlled trial
- 2018
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Ingår i: Bmc Family Practice. - : Springer Science and Business Media LLC. - 1471-2296. ; 19:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Depression is one of the leading causes of disability and affects 10-15% of the population. The majority of people with depressive symptoms seek care and are treated in primary care. Evidence internationally for high quality care supports collaborative care with a care manager. Our aim was to study clinical effectiveness of a care manager intervention in management of primary care patients with depression in Sweden. Methods: In a pragmatic cluster randomized controlled trial 23 primary care centers (PCCs), urban and rural, included patients aged >= 18 years with a new (< 1 month) depression diagnosis. Intervention consisted of Care management including continuous contact between care manager and patient, a structured management plan, and behavioral activation, altogether around 6-7 contacts over 12 weeks. Control condition was care as usual (CAU). Outcome measures: Depression symptoms (measured by Mongomery-Asberg depression score-self (MADRS-S) and BDI-II), quality of life (QoL) (EQ-5D), return to work and sick leave, service satisfaction, and antidepressant medication. Data were analyzed with the intention-to-treat principle. Results: One hundred ninety two patients with depression at PCCs with care managers were allocated to the intervention group, and 184 patients at control PCCs were allocated to the control group. Mean depression score measured by MADRS-S was 2.17 lower in the intervention vs. the control group (95% CI [0.56; 3.79], p = 0.009) at 3 months and 2.27 lower (95% CI [0.59; 3.95], p = 0.008) at 6 months; corresponding BDI-II scores were 1.96 lower (95% CI [-0.19; 4.11], p = 0.07) in the intervention vs. control group at 6 months. Remission was significantly higher in the intervention group at 6 months (61% vs. 47%, p = 0.006). QoL showed a steeper increase in the intervention group at 3 months (p = 0.01). During the first 3 months, return to work was significantly higher in the intervention vs. the control group. Patients in the intervention group were more consistently on antidepressant medication than patients in the control group. Conclusions: Care managers for depression treatment have positive effects on depression course, return to work, remission frequency, antidepressant frequency, and quality of life compared to usual care and is valued by the patients.
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| 6. |
- Brusini, Irene, et al.
(författare)
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Changes in brain architecture are consistent with altered fear processing in domestic rabbits
- 2018
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Ingår i: Proceedings of the National Academy of Sciences of the United States of America. - : National Academy of Sciences. - 0027-8424 .- 1091-6490. ; 115:28, s. 7380-7385
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Tidskriftsartikel (refereegranskat)abstract
- The most characteristic feature of domestic animals is their change in behavior associated with selection for tameness. Here we show, using high-resolution brain magnetic resonance imaging in wild and domestic rabbits, that domestication reduced amygdala volume and enlarged medial prefrontal cortex volume, supporting that areas driving fear have lost volume while areas modulating negative affect have gained volume during domestication. In contrast to the localized gray matter alterations, white matter anisotropy was reduced in the corona radiata, corpus callosum, and the subcortical white matter. This suggests a compromised white matter structural integrity in projection and association fibers affecting both afferent and efferent neural flow, consistent with reduced neural processing. We propose that compared with their wild ancestors, domestic rabbits are less fearful and have an attenuated flight response because of these changes in brain architecture.
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| 7. |
- Cornacchia, Irene, et al.
(författare)
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Strontium stratigraphy of the upper Miocene Lithothamnion Limestone in the Majella Mountain, central Italy, and its palaeoenvironmental implications
- 2017
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Ingår i: Lethaia. - London : John Wiley & Sons. - 0024-1164 .- 1502-3931. ; 50:4, s. 561-575
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Tidskriftsartikel (refereegranskat)abstract
- The87Sr/86Sr isotope ratio has been widely used as aphysical tool to date and correlate carbonate successions due to the long Srresidence time in comparison with the ocean mixing time. If this method workson oceanic successions, marginal basins may show different Sr isotope recordsin comparison with the coeval ocean one due to sea-level variations,continental run-off and restricted water exchanges. In this work, we present the87Sr/86Sr isotope record of the upper Miocene carbonateramp of the Lithothamnion Limestone(Majella Mountain, central Apennines), as an example of the onset of restrictedwater exchanges between a marginal basin and the ocean water masses. The overalllatemost Tortonian–earlyMessinian Sr isotope record of the Lithothamnion Limestonefits below the global reference line. This deviation has been interpreted as dueto the strong control that freshwater input and enhanced continental run-off,linked to the migration of the Apennine accretionary wedge and foredeep system,have had on the central Adriatic water chemistry. These results imply that anaccurate oceanographic and geodynamic framework along with diagenetic overprintinvestigation has to be taken into consideration prior to apply SIS oncarbonate successions on marginal basins, even when facies analyses indicatefully marine conditions. This seems to be the case for the upper MioceneCentral Mediterranean carbonate successions, but may have more general validityand be extended to other recent or past marginal basins.
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| 8. |
- de Las Heras Gala, Hugo, et al.
(författare)
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Quality control in cone-beam computed tomography (CBCT): EFOMP-ESTRO-IAEA protocol
- 2017
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Rapport (refereegranskat)abstract
- Quality control of cone-beam computed tomography (CBCT) systems is an essential part of quality assurance to periodically check that quality requirements are met, reduce uncertainties and errors and reduce the likelihood of accidents and incidents. Radiation exposure levels must be measured to ensure that patient doses associated with CBCT examinations are kept as low as reasonably achievable consistent with the required diagnostic information. The main purpose of this document is to present procedures for quality control of CBCT systems used for dental, radiotherapy, interventional radiology and guided surgery applications.
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| 9. |
- de Las Heras Gala, Hugo, et al.
(författare)
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Quality control in cone-beam computed tomography (CBCT) EFOMP-ESTRO-IAEA protocol (summary report)
- 2017
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Ingår i: Physica medica (Testo stampato). - : Elsevier BV. - 1120-1797 .- 1724-191X. ; 39, s. 67-72
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the guideline presented in this article is to unify the test parameters for image quality evaluation and radiation output in all types of cone-beam computed tomography (CBCT) systems. The applications of CBCT spread over dental and interventional radiology, guided surgery and radiotherapy. The chosen tests provide the means to objectively evaluate the performance and monitor the constancy of the imaging chain. Experience from all involved associations has been collected to achieve a consensus that is rigorous and helpful for the practice. The guideline recommends to assess image quality in terms of uniformity, geometrical precision, voxel density values (or Hounsfield units where available), noise, low contrast resolution and spatial resolution measurements. These tests usually require the use of a phantom and evaluation software. Radiation output can be determined with a kerma-area product meter attached to the tube case. Alternatively, a solid state dosimeter attached to the flat panel and a simple geometric relationship can be used to calculate the dose to the isocentre. Summary tables including action levels and recommended frequencies for each test, as well as relevant references, are provided. If the radiation output or image quality deviates from expected values, or exceeds documented action levels for a given system, a more in depth system analysis (using conventional tests) and corrective maintenance work may be required.
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| 10. |
- de las Heras, Hugo, et al.
(författare)
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Quality control for cone beam CT devices: The EFOMP guidelines for assessing image quality and dose
- 2016
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Ingår i: ECR 2016.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Learning objectives: Learn about an objective, practical and unifying methodology for quality control of all cone beam CT (CBCT) modalities. Understand the choice and justification of the proposed tests Learn how to perform the tests on a routine basis.Background: Current guidelines for quality control of CBCT devices consider the available applications (dental, radiotherapy, interventional radiology and guided surgery) as different entities [1], [2]. However, the data acquisition and reconstruction methods are similar. Henceforth, the evaluation parameters for image quality and dose can be unified.Findings and procedure details: The parameters used for image quality assessment are uniformity, accuracy of density values (or Hounsfield units where appropriate), geometrical evaluation, noise, low-contrast resolution (including contrast-to-noise ratio) and high-contrast resolution. Detailed procedures using free software and commercially available test phantoms are described in the guidelines, which are currently under external review.Conclusion: These guidelines include the minimum tests that should be performed to ensure reliable, safe and consistent performance of CBCT devices. This minimum has been sought to guarantee compatibility with all manufacturers, all cone beam modalities and existing national and international documents.
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