| 1. |
- Rickardsson, Jenny, et al.
(författare)
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Internet-delivered acceptance and commitment therapy (iACT) for chronic pain : feasibility and preliminary effects in clinical and self-referred patients
- 2020
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Ingår i: JMIR mhealth and uhealth. - : AME Publishing Company. - 2291-5222. ; 6
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Tidskriftsartikel (refereegranskat)abstract
- Background: Acceptance and commitment therapy (ACT) is an evidence-based treatment to improve functioning and quality of life (QoL) for chronic pain patients, but outreach of this treatment is unsatisfactory. Internet-delivery has been shown to increase treatment access but there is limited evidence regarding feasibility and effectiveness of web-based ACT for chronic pain. The aim of the study was to evaluate and iterate a novel internet-delivered ACT program, iACT, in a clinical and a self-referred sample of chronic pain patients. The intervention was developed in close collaboration with patients. To enhance learning, content was organized in short episodes to promote daily engagement in treatment. In both the clinical and self-referred samples, three critical domains were evaluated: (I) feasibility (acceptability, practicality and usage); (II) preliminary efficacy on pain interference, psychological inflexibility, value orientation, QoL, pain intensity, anxiety, insomnia and depressive symptoms; and (III) potential treatment mechanisms.Methods: This was an open pilot study with two samples: 15 patients from a tertiary pain clinic and 24 self-referred chronic pain participants, recruited from October 2015 until January 2017. Data were collected via an online platform in free text and self-report measures, as well as through individual oral feedback. Group differences were analyzed with Chi square-, Mann-Whitney U- or t-test. Preliminary efficacy and treatment mechanism data were collected via self-report and analyzed with multilevel linear modeling for repeated measures.Results: Feasibility: patient feedback guided modifications to refine the intervention and indicated that iACT was acceptable in both samples. User insights provided input for both immediate and future actions to improve feasibility. Comprehensiveness, workability and treatment credibility were adequate in both samples. Psychologists spent on average 13.5 minutes per week per clinical patient, and 8 minutes per self-referred patient (P=0.004). Recruitment rate was 24 times faster in the self-referred sample (24 patients in 1 month, compared to 15 patients in 15 months, P<0.001) and the median distance to the clinic was 40 km in the clinical sample, and 426 km in the self-referred sample (P<0.001). Preliminary effects: post-assessments were completed by 26 participants (67%). Significant effects of time were seen from pre- to post-treatment across all outcome variables. Within group effect sizes (Cohen’s d) at post-treatment ranged from small to large: pain interference (d=0.64, P<0.001), psychological inflexibility (d=1.43, P<0.001), value progress (d=0.72, P<0.001), value obstruction (d=0.42, P<0.001), physical QoL (d=0.41, P=0.005), mental QoL (d=0.67, P=0.005), insomnia (d=0.31, P<0.001), depressive symptoms (d=0.47, P<0.001), pain intensity (d=0.78, P=0.001) and anxiety (d=0.46, P<0.001). Improvements were sustained at 1-year follow-up. Psychological inflexibility and value progress were found to be potential treatment mechanisms.Conclusions: The results from the present study suggests that iACT was feasible in both the clinical and the self-referred sample. Together with the positive preliminary results on all outcomes, the findings from this feasibility study pave the way for a subsequent large randomized efficacy trial.
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| 2. |
- Sundström, Johan, Professor, 1971-, et al.
(författare)
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Weight gain and blood pressure
- 2020
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Ingår i: Journal of Hypertension. - : Lippincott Williams & Wilkins. - 0263-6352 .- 1473-5598. ; 38:3, s. 387-394
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Although the causality of the obesity—hypertension association is established, the potential for prevention is not. We hypothesized that weight gain between early adulthood and mid-life is associated with higher mid-life blood pressure.METHODS: We investigated the hypothesis using a large contemporaneous population-based mid-life cohort of men and women aged 50-64 years. Recalled body weight at age 20 years was self-reported, and mid-life body weight and office blood pressures were measured in accordance with a detailed protocol.RESULTS: On average, men had gained 14.9 (95% CI 14.6-15.2) kg of weight, and women 14.6 (95% CI 14.4-14.9) kg, between age 20 years and the mid-life examination, corresponding to 0.40 (95% CI 0.39-0.41) kg/year for men and women. Both weight at age 20 years and weight at the mid-life examination were associated with mid-life blood pressures. On average, a 10 kg weight increase between age 20 years and mid-life was associated with 2.2 (95% CI 0.9-3.5) mmHg higher systolic and 1.7 (95% CI 0.9-2.5) mmHg higher diastolic mid-life blood pressure in men, and 3.2 (2.5-4.0) mmHg higher systolic and 2.4 (1.9-2.9) mmHg higher diastolic mid-life blood pressure in women. Mid-life weight was more closely associated than weight at age 20 years with mid-life blood pressure. For a given mid-life weight, blood pressure was higher in persons with higher weight gain from age 20 years.CONCLUSION: In sum, weight gain between early adulthood and mid-life was associated with higher mid-life blood pressure. The magnitude of the association indicates a potentially great public health impact of strategies to prevent weight gain throughout adulthood.
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| 3. |
- Bengtsson, Eva, et al.
(författare)
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CD163+ macrophages are associated with a vulnerable plaque phenotype in human carotid plaques
- 2020
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Ingår i: Scientific Reports. - : Springer Science and Business Media LLC. - 2045-2322. ; 10:1
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Tidskriftsartikel (refereegranskat)abstract
- Macrophages are a functionally heterogeneous group of immune cells abundant in atherosclerotic plaques. Macrophages expressing CD163 are associated with intraplaque hemorrhage and have previously been considered atheroprotective. However, in a recent study CD163-deficient atherosclerotic ApoE−/− mice exhibited smaller and less complex plaques, suggesting a proatherogenic role of CD163. Previous smaller studies on CD163+ macrophages and plaque stability in humans have yielded diverging results. Here we assessed the association of CD163+ cells to plaque vulnerability in a large cohort of human carotid plaques. CD163 protein expression was analyzed by immunohistochemistry in 200 human carotid plaques removed by endarterectomy from 103 patients with and 93 patients without cerebrovascular symptoms. Furthermore, CD163 mRNA expression was analyzed in 66 of the plaques. Both protein and mRNA expression of CD163 was higher in plaques from symptomatic patients and in plaques with high vulnerability index. CD163+ macrophages were primarily found in shoulder regions and in the center of the plaques. The present data show that CD163 is associated with increased plaque vulnerability in human carotid plaques, supporting the notion that CD163+ macrophages could contribute to clinical events.
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| 4. |
- Berg, Ingrid L., et al.
(författare)
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MutS alpha deficiency increases tolerance to DNA damage in yeast lacking postreplication repair
- 2020
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Ingår i: DNA Repair. - : Elsevier BV. - 1568-7864 .- 1568-7856. ; 91-92
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Tidskriftsartikel (refereegranskat)abstract
- By combining mutations in DNA repair genes, important and unexpected interactions between different repair pathways can be discovered. In this study, we identified a novel link between mismatch repair (MMR) genes and postreplication repair (PRR) in Saccharomyces cerevisiae. Strains lacking Rad5 (HLTF in mammals), a protein important for restarting stalled replication forks in the error-free PRR pathway, were supersensitive to the DNA methylating agent methyl methanesulfonate (MMS). Deletion of the mismatch repair genes, MSH2 or MSH6, which together constitutes the MutS alpha complex, partially suppressed the MMS super-sensitivity of the rad5 Delta, strain. Deletion of MSH2 also suppressed the MMS sensitivity of mms2 Delta, which acts together with Rad5 in error-free PRR. However, inactivating the mismatch repair genes MSH3 and MLH1 did not suppress rad5 Delta, showing that the suppression was specific for disabling MutS alpha. The partial suppression did not require translesion DNA synthesis (REV1, REV3 or RAD30), base excision repair (MAGI) or homologous recombination (RAD51). Instead, the underlying mechanism was dependent on RAD52 while independent of established pathways involving RAD52, like single-strand annealing and break-induced replication. We propose a Rad5- and Rad51-independent template switch pathway, capable of compensating for the loss of the error-free template-switch subpathway of postreplication repair, triggered by the loss of MutS alpha.
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| 5. |
- Björkander, Sofia, et al.
(författare)
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Childhood allergy is preceded by an absence of gut lactobacilli species and higher levels of atopy-related plasma chemokines
- 2020
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Ingår i: Clinical and Experimental Immunology. - : Oxford University Press (OUP). - 0009-9104 .- 1365-2249. ; 202:3, s. 288-299
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Tidskriftsartikel (refereegranskat)abstract
- Alterations in the composition and reduced diversity of the infant microbiome are associated with allergic disease in children. Further, an altered microbiota is linked to immune dysregulation, including skewing of different T helper (Th) subsets, which is also seen in atopic individuals. The aim of this study was, therefore, to investigate the associations between gut lactobacilli and Th‐related plasma factors in allergy development during childhood. A total of 194 children with known allergy status at 1 year of age were followed to 10 years of age. We used real‐time polymerase chain reaction (PCR) to investigate the presence of three lactobacilli species (Lactobacillus casei, L. paracasei, L. rhamnosus) in infant fecal samples (collected between 1 week and 2 months of age) from a subgroup of children. Plasma chemokines and cytokines were quantified at 6 months and at 1, 2, 5 and 10 years of age with Luminex or enzyme‐linked immunosorbent assay (ELISA). Fractional exhaled nitrogen oxide (FeNO) was measured and spirometry performed at 10 years of age. The data were analysed by non‐parametric testing and a logistic regression model adjusted for parental allergy. An absence of these lactobacilli and higher levels of the chemokines BCA‐1/CXCL13, CCL17/TARC, MIP‐3α/CCL20 and MDC/CCL22 in plasma at 6 months of age preceded allergy development. The presence of lactobacilli associated with lower levels of atopy‐related chemokines during infancy, together with higher levels of interferon (IFN)‐γ and lower FeNO during later childhood. The results indicate that the presence of certain lactobacilli species in the infant gut may influence allergy‐related parameters in the peripheral immune system, and thereby contribute to allergy protection.
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| 6. |
- Blennow, Kristina, et al.
(författare)
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The role of beliefs, expectations and values in decision-making favoring climate change adaptation : implications for communications with European forest professionals
- 2020
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Ingår i: Environmental Research Letters. - : IOP Publishing. - 1748-9326.
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Tidskriftsartikel (refereegranskat)abstract
- Beliefs, expectations and values are often assumed to drive decisions about climate change adaptation. We tested hypotheses based on this assumption using survey responses from 508 European forest professionals in 10 countries. We used the survey results to identify communication needs and the decision strategies at play, and to develop guidelines on adequate communications about climate change adaptation. We observed polarization in the positive and negative values associated with climate change impacts accepted by survey respondents. We identified a mechanism creating the polarization that we call the 'blocked belief' effect. We found that polarized values did not correlate with decisions about climate change adaptation. Strong belief in the local impacts of climate change on the forest was, however, a prerequisite of decision-making favoring adaptation. Decision-making in favor of adaptation to climate change also correlated with net values of expected specific impacts on the forest and generally increased with the absolute value of these in the absence of "tipping point" behavior. Tipping point behavior occurs when adaptation is not pursued in spite of the strongly negative or positive net value of expected climate change impacts. We observed negative and positive tipping point behavior, mainly in SW Europe and N-NE Europe, respectively. In addition we found that advice on effective adaptation may inhibit adaptation when the receiver is aware of effective adaptation measures unless it is balanced with information explaining how climate change leads to negative impacts. Forest professionals with weak expectations of impacts require communications on climate change and its impacts on forests before any advice on adaptation measures can be effective. We develop evidence-based guidelines on communications using a new methodology which includes Bayesian machine learning modeling of the equivalent of an expected utility function for the adaptation decision problem.
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| 7. |
- Bollino, Michele, et al.
(författare)
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Pelvic sentinel lymph node biopsy in endometrial cancer- A simplified algorithm based on histology and lymphatic anatomy
- 2020
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Ingår i: International Journal of Gynecological Cancer. - : BMJ. - 1048-891X .- 1525-1438. ; 30:3, s. 339-345
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To achieve the full potential of sentinel lymph node (SLN) detection in endometrial cancer, both presumed low- A nd high-risk groups should be included. Perioperative resource use and complications should be minimized. Knowledge on distribution and common anatomical sites for metastatic SLNs may contribute to optimizing the concept while maintaining sensitivity. Proceeding from previous studies, simplified algorithms based on histology and lymphatic anatomy are proposed. Methods: Data on mapping rates and locations of pelvic SLNs (metastatic and non-metastatic) from two previous prospective SLN studies in women with endometrial cancer were retrieved. Cervically injected indocyanine green was used as a tracer and an ipsilateral re-injection was performed in case of non-display of the upper and/or lower paracervical pathways. A systematic surgical algorithm was followed with clearly defined SLNs depicted on an anatomical chart. In high-risk endometrial cancer patients, removal of SLNs was followed by a pelvic and para-aortic lymphadenectomy. Results: 423 study records were analyzed. The bilateral mapping rates of the upper and lower paracervical pathways were 88.9% and 39.7%, respectively. 72% of all SLNs were typically positioned along the upper paracervical pathway (interiliac and/or proximal obturator fossa) and 71 of 75 (94.6%) of pelvic node positive women had at least one metastatic SLN at either of these positions. Women with grade 1-2 endometroid cancers (n=275) had no isolated metastases along the lower paracervical pathway compared with two women with high-risk histologies (n=148). Conclusion: SLNs along the upper paracervical pathway should be identified in all endometrial cancer histological subtypes; removal of nodes at defined typical positions along the upper paracervical pathway may replace a site-specific lymphadenectomy in case of non-mapping despite tracer re-injection. Detection of SLNs along the lower paracervical pathway can be restricted to high-risk histologies and a full pre-sacral lymphadenectomy should be performed in case of non-display.
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| 8. |
- Dytckov, Sergei, 1986-, et al.
(författare)
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Modelling Commuting Activities for the Simulation of Demand Responsive Transport in Rural Areas
- 2020
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Ingår i: Proceedings of the 6th International Conference on Vehicle Technology and Intelligent Transport Systems. - : SciTePress. - 9789897584190 ; , s. 89-97
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Konferensbidrag (refereegranskat)abstract
- For the provision of efficient and high-quality public transport services in rural areas with a low population density, the introduction of Demand Responsive Transport (DRT) services is reasonable. The optimal design of such services depends on various socio-demographical and environmental factors, which is why the use of simulation is feasible to support planning and decision-making processes. A key challenge for sound simulation results is the generation of realistic demand, i.e., requests for DRT journeys. In this paper, a method for modelling and simulating commuting activities is presented, which is based on statistical real-world data. It is applied to Sjöbo and Tomelilla, two rural municipalities in southern Sweden.
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| 9. |
- Ekdahl, Linnea, et al.
(författare)
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Increased Institutional Surgical Experience in Robot-Assisted Radical Hysterectomy for Early Stage Cervical Cancer Reduces Recurrence Rate: Results from a Nationwide Study
- 2020
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Ingår i: JOURNAL OF CLINICAL MEDICINE. - : MDPI AG. - 2077-0383. ; 9:11
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to evaluate the impact of institutional surgical experience on recurrence following robotic radical hysterectomy (RRH) for early stage cervical cancer. All women in Sweden who underwent an RRH for stage IA2-IB1 cervical cancer at tertiary referral centers from its implementation in December 2005 until June 2017 were identified using a Swedish nationwide register and local hospital registers. Registry data were controlled by a chart review of all women. Recurrence rates and patterns of recurrence were compared between early and late (<= 50 vs. >50 procedures) institutional series. Six hundred and thirty-five women were included. Regression analysis identified a lower risk of recurrence with increased experience but without a clear cut off level. Among the 489 women who did not receive adjuvant radio chemotherapy (RC-T), the rate of recurrence was 3.6% in the experienced cohort (>50 procedures) compared to 9.3% in the introductory cohort (p < 0.05). This was also seen in tumors < 2 cm regardless of RC-T (p < 0.05), whereas no difference in recurrence was seen when analyzing all women receiving RC-T. In conclusion, the rate of recurrence following RRH for early stage cervical cancer decreased with increased institutional surgical experience, in tumors < 2 cm and in women who did not receive adjuvant RC-T.
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| 10. |
- Ghajargar, Maliheh, 1980-, et al.
(författare)
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The UX of Interactive Machine Learning
- 2020
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Ingår i: NordiCHI 2020, 11th Nordic Conference on Human-Computer Interaction: Shaping Experiences, Shaping Society. - New York, USA : Association for Computing Machinery (ACM).
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Konferensbidrag (refereegranskat)abstract
- Machine Learning (ML) has been a prominent area of research within Artificial Intelligence (AI). ML uses mathematical models to recognize patterns in large and complex data sets to aid decision making in different application areas, such as image and speech recognition, consumer recommendations, fraud detection and more. ML systems typically go through a training period in which the system encounters and learns about the data; further, this training often requires some degree of human intervention. Interactive machine learning (IML) refers to ML applications that depend on continuous user interaction. From an HCI perspective, how humans interact with and experience ML models in training is the main focus of this workshop proposal. In this workshop we focus on the user experience (UX) of Interactive Machine Learning, a topic with implications not only for usability but also for the long-term success of the IML systems themselves.
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