| 1. |
- Ahle, Margareta, et al.
(författare)
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Epidemiology and Trends of Necrotizing Enterocolitis in Sweden: 1987-2009
- 2013
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Ingår i: Pediatrics. - : American Academy of Pediatrics. - 0031-4005 .- 1098-4275. ; 132:2, s. E443-E451
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To investigate temporal, seasonal, and geographic variations in the incidence of necrotizing enterocolitis (NEC) and its relation to early infant survival in the Swedish population and in subgroups based on gestational age, birth weight, and gender. less thanbrgreater than less thanbrgreater thanMETHODS: In the Swedish birth cohort of 1987 through 2009 all children with a diagnosis of NEC were identified in the National Patient Register, the Swedish Medical Birth Register, and the National Cause of Death Register. NEC incidence, early mortality, and seasonality were analyzed with descriptive statistics, Poisson regression, and auto regression. less thanbrgreater than less thanbrgreater thanRESULTS: The overall incidence of NEC was 3.4 in 10 000 live births, higher in boys than in girls (incidence rate ratio 1.22, 95% confidence interval 1.06-1.40, P = .005), with a peak in November and a trough in May, and increased with an average of similar to 5% a year during the study period. In most subgroups, except the most immature, an initial decrease was followed by a steady increase. Seven-day mortality decreased strongly in all subgroups over the entire study period (annual incidence rate ratio 0.96, 95% confidence interval 0.95-0.96, P andlt; .001). This was especially marked in the most premature and low birth weight infants. less thanbrgreater than less thanbrgreater thanCONCLUSIONS: After an initial decrease, the incidence of NEC has increased in Sweden during the last decades. An association with the concurrent dramatically improved early survival seems likely.
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| 2. |
- Ahle, Margareta, 1966-, et al.
(författare)
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Maternal, fetal and perinatal factors associated with necrotizing enterocolitis in Sweden. A national case-control study
- 2018
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Ingår i: Plos One. - San Francisco, United States : Public Library of Science (PLoS). - 1932-6203. ; 13:3
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Tidskriftsartikel (refereegranskat)abstract
- Objective To analyze associations of maternal, fetal, gestational, and perinatal factors with necrotizing enterocolitis in a matched case-control study based on routinely collected, nationwide register data. Study design All infants born in 1987 through 2009 with a diagnosis of necrotizing enterocolitis in any of the Swedish national health care registers were identified. For each case up to 6 controls, matched for birth year and gestational age, were selected. The resulting study population consisted of 720 cases and 3,567 controls. Information on socioeconomic data about the mother, maternal morbidity, pregnancy related diagnoses, perinatal diagnoses of the infant, and procedures in the perinatal period, was obtained for all cases and controls and analyzed with univariable and multivariable logistic regressions for the whole study population as well as for subgroups according to gestational age. Results In the study population as a whole, we found independent positive associations with necrotizing enterocolitis for isoimmunization, fetal distress, cesarean section, neonatal bacterial infection including sepsis, erythrocyte transfusion, persistent ductus arteriosus, cardiac malformation, gastrointestinal malformation, and chromosomal abnormality. Negative associations were found for maternal weight, preeclampsia, maternal urinary infection, premature rupture of the membranes, and birthweight. Different patterns of associations were seen in the subgroups of different gestational age. Conclusion With some interesting exceptions, especially in negative associations, the results of this large, population based study, are in keeping with earlier studies. Although restrained by the limitations of register data, the findings mirror conceivable pathophysiological processes and underline that NEC is a multifactorial disease. © 2018 Ahle et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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| 3. |
- Ahle, Margareta, 1966-
(författare)
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Necrotising Enterocolitis : epidemiology and imaging
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Necrotising enterocolitis (NEC) is a potentially devastating intestinal inflammation of multifactorial aetiology in premature or otherwise vulnerable neonates. Because of the broad spectrum of presentations, diagnosis and timing of surgical intervention may be challenging, and imaging needs to be an integrated part of management.The first four studies included in this thesis used routinely collected, nationwide register data to describe the incidence of NEC in Sweden 1987‒2009, its variation with time, seasonality, space-time clustering, and associations with maternal, gestational, and perinatal factors, and the risk of intestinal failure in the aftermath of the disease.Early infant survival increased dramatically during the study period. The incidence rate of NEC was 0.34 per 1,000 live births, rising from 0.26 per 1,000 live births in the first six years of the study period to 0.57 in the last five. The incidence rates in the lowest birth weights were 100‒160 times those of the entire birth cohort. Seasonal variation was found, as well as space-time clustering in association with delivery hospitals but not with maternal residential municipalities.Comparing NEC cases with matched controls, some factors, positively associated with NEC, were isoimmunisation, fetal distress, caesarean section, persistent ductus arteriosus, cardiac and gastrointestinal malformations, and chromosomal abnormalities. Negative associations included maternal pre-eclampsia, maternal urinary infection, and premature rupture of the membranes. Intestinal failure occurred in 6% of NEC cases and 0.4% of controls, with the highest incidence towards the end of the study period.The last study investigated current practices and perceptions of imaging in the management of NEC, as reported by involved specialists. There was great consensus on most issues. Areas in need of further study seem mainly related to imaging routines, the use of ultrasound, and indications for surgery.Developing alongside the progress of neonatal care, NEC is a complex, multifactorial disease, with shifting patterns of predisposing and precipitating causes, and potentially serious long-term complications. The findings of seasonal variation, spacetime clustering, and negative associations with antenatal exposure to infectious agents, fit into the growing understanding of the central role of bacteria and immunological processes in normal maturation of the intestinal canal as well as in the pathogenesis of NEC. Imaging in the management of NEC may be developed through future studies combining multiple diagnostic parameters in relation to clinical outcome.
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| 4. |
- Andersson, Kent, et al.
(författare)
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Vitteneguldet ur europeisk synvinkel
- 1996
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Ingår i: En årskrönika från Statens historiska museum.. ; 1995, s. 9-10
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 5. |
- Andersson, Peder, et al.
(författare)
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High-sensitivity troponin T is an important independent predictor in addition to the Simplified Acute Physiology Score for short-term ICU mortality, particularly in patients with sepsis
- 2019
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Ingår i: Journal of Critical Care. - : Elsevier BV. - 0883-9441. ; 53, s. 218-222
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Elevated cardiac troponin levels have been shown to be associated with a poor prognosis under some intensive care conditions. This study investigated whether inclusion of high-sensitivity troponin T (hsTnT) increased the prognostic accuracy of the Simplified Acute Physiology Score (SAPS 3) for general intensive care unit (ICU) patients, cardiac arrest patients, or patients with a non-cardiac arrest diagnosis. Materials and methods: We performed a single-center cohort study of ICU patients with an hsTnT measurement on ICU admission at a tertiary university hospital between February 2010 and June 2017. Results: Of 4185 first-time admissions, 856 patients (20.5%) had hsTnT evaluated at ICU admission. Factoring in ICU admission hsTnT values increased the ability of SAPS 3 to accurately predict 30-day mortality (odds ratio 1.27, 95% confidence interval: 1.15–1.41, p < 0.001). Elevated hsTnT levels were not independently associated with 30-day mortality in cardiac arrest patients. In sepsis patients, hsTnT evaluation in addition to SAPS 3 evaluation improved the area under the receiver operating characteristic curve by >10%. Conclusion: Addition of hsTnT evaluation to SAPS 3 enhances the predictive capability of this model in relation to mortality. In sepsis, the hsTnT level may be an important prognostic marker.
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| 6. |
- Andersson, Peder
(författare)
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ICU prognostication: Time to re-evaluate? Register-based studies on improving prognostication for patients admitted to the intensive care unit (ICU)
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: ICU prognostication is difficult because of patients’ prior comorbidities and their varied reasons for admission. The model used for ICU prognostication in Sweden is the Simplified Acute Physiology Score 3 (SAPS 3), which uses information gathered within one hour of ICU admission to predict 30-day mortality. Since the SAPS 3 model was introduced, no biomarkers have been added to it to improve its prognostic performance. For comatose patients admitted to the ICU after cardiac arrest, the prognostication performed after 72 h will either result in the continued observation of the patient or the withdrawal of life-sustaining treatment.Purpose: 1) To investigate whether adding the biomarker lactate (study I) or high-sensitivity troponin T (hsTnT) (study II) to SAPS 3 adds prognostic value. 2) To investigate whether using a supervised machine learning algorithm called artificial neural networks (ANNs) can improve the prognostic performance of SAPS 3 (study III). 3) To explore whether ANNs can create reliable predictions for comatose patients at the time of hospital admission (study IV) and during the first three days after ICU admission, with or without promising biomarkers (study V).Methods: 1) To investigate whether the laboratory values of lactate or hsTnT could improve the performance of SAPS 3, we combined patients’ laboratory values on ICU admission at Skåne University Hospital with their SAPS 3 score. 2) Based on all first-time ICU admissions in Sweden from 2009–2017 as retrieved from the Swedish Intensive Care Registry (SIR), we investigated whether ANNs could improve SAPS 3 using the same variables. 3) All out-of-hospital cardiac arrest (OHCA) patients from the Target Temperature Management trial were included for data analysis. Background and prehospital data, along with clinical variables at admission, were used in study IV. Clinical variables from the first three days were used in study V along with different levels of biomarkers defined as clinically accessible (e.g. neuron-specific enolase, or NSE) and research-grade biomarkers (e.g. neurofilament light, or NFL). Patient outcome was the dichotomised Cerebral Performance Category scale (CPC); a CPC of 1–2 was considered a good outcome, and a CPC of 3–5 was considered a poor outcome.Results: 1) Both lactate and hsTnT were independent SAPS 3 predictors for 30-day mortality in the logistic regression model. In a subgroup analysis, the use of lactate improved the area under the receiver operating characteristic curve (AUROC) for cardiac arrest and septic patients, and the use of hsTnT improved the AUROC for septic patients. 2) The overall performance of the SAPS 3 model in Sweden was improved by the use of ANNs. Both the discrimination (AUROC 0.89 vs 0.85, p < 0.001) and the calibration were improved when the two models were compared on a separate test set (n = 36,214). 3) An ANN model outperformed a logistic-regression-based model in predicting poor outcome on hospital admission for OHCA patients. Incorporating biomarkers such as NSE improved the AUROC over the course of the first three days of the ICU stay; when NFL was incorporated, the prognostic performance was excellent from day 1.Conclusion: Lactate and hsTnT probably add prognostic value to SAPS 3 for patients admitted to the ICU with sepsis or after cardiac arrest (lactate only). An ANN model was found to be superior to the SAPS 3 model (Swedish modification) and corrected better for age than SAPS 3. A simplified ANN model with eight variables showed performance similar to that of the SAPS 3 model. For comatose OHCA patients, an ANN model improved the accuracy of the prediction of the long-term neurological outcome at hospital admission. Furthermore, when it used cumulative information from the first three days after ICU admission, an ANN model showed promising prognostic performance on day 3 when it incorporated clinically accessible biomarkers such as NSE, and it showed promising performance on days 1–3 when it incorporated research-grade biomarkers such as NFL.
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| 7. |
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| 8. |
- Andersson, Peder, et al.
(författare)
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Predicting neurological outcome after out-of-hospital cardiac arrest with cumulative information; development and internal validation of an artificial neural network algorithm
- 2021
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Ingår i: Critical Care. - : Springer Science and Business Media LLC. - 1364-8535. ; 25:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundPrognostication of neurological outcome in patients who remain comatose after cardiac arrest resuscitation is complex. Clinical variables, as well as biomarkers of brain injury, cardiac injury, and systemic inflammation, all yield some prognostic value. We hypothesised that cumulative information obtained during the first three days of intensive care could produce a reliable model for predicting neurological outcome following out-of-hospital cardiac arrest (OHCA) using artificial neural network (ANN) with and without biomarkers.MethodsWe performed a post hoc analysis of 932 patients from the Target Temperature Management trial. We focused on comatose patients at 24, 48, and 72 h post-cardiac arrest and excluded patients who were awake or deceased at these time points. 80% of the patients were allocated for model development (training set) and 20% for internal validation (test set). To investigate the prognostic potential of different levels of biomarkers (clinically available and research-grade), patients' background information, and intensive care observation and treatment, we created three models for each time point: (1) clinical variables, (2) adding clinically accessible biomarkers, e.g., neuron-specific enolase (NSE) and (3) adding research-grade biomarkers, e.g., neurofilament light (NFL). Patient outcome was the dichotomised Cerebral Performance Category (CPC) at six months; a good outcome was defined as CPC 1-2 whilst a poor outcome was defined as CPC 3-5. The area under the receiver operating characteristic curve (AUROC) was calculated for all test sets.ResultsAUROC remained below 90% when using only clinical variables throughout the first three days in the ICU. Adding clinically accessible biomarkers such as NSE, AUROC increased from 82 to 94% (p<0.01). The prognostic accuracy remained excellent from day 1 to day 3 with an AUROC at approximately 95% when adding research-grade biomarkers. The models which included NSE after 72 h and NFL on any of the three days had a low risk of false-positive predictions while retaining a low number of false-negative predictions.ConclusionsIn this exploratory study, ANNs provided good to excellent prognostic accuracy in predicting neurological outcome in comatose patients post OHCA. The models which included NSE after 72 h and NFL on all days showed promising prognostic performance.
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| 9. |
- Andersson, Sven, 1968, et al.
(författare)
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Sulphur recirculation for high temperature corrosion and dioxin abatement in Waste-to-Energy boilers
- 2018
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Ingår i: Sulphur 2018 + Sulphuric Acid. ; , s. 315-320
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Konferensbidrag (refereegranskat)abstract
- Sulphur Recirculation is a new patented technology for reducing high temperature boiler corrosion and dioxin formation in Waste-to-Energy plants. SO2 is separated from a tail end wet scrubber using H2O2, producing a 15-25wt% H2SO4 solution, which is injected into the boiler producing SO2, thus creating a sulphur loop. The recirculated sulphur will increase the gas concentration of SO2 in the boiler and decrease the Cl/S ratio of the deposits and ashes, thus producing a less corrosive environment for the superheaters. Furthermore, the lower chlorine content of the boiler deposits also significantly decreased the dioxin formation rates as well as dioxin emissions. Sulphur Recirculation was initially demonstrated in pilot plant tests as well as full-scale tests at a Waste to Energy plant in Göteborg (Sweden) during nearly two months of operation. Babcock & Wilcox Vølund AB in Sweden has installed their Sulphur Recirculation technology in one of the two Waste-to Energy lines at Maabjerg Energy Center (MEC) in Denmark in order to combat high temperature corrosion and dioxin formation. This is the first commercial installation and it has been operating since mid-October 2016. Sulphur Recirculation decreased the high temperature corrosion rates of the superheaters in this full-scale installation by approximately 50%, which may increase green electricity production from combustion of biomass and waste in the future. Furthermore, the dioxin gas concentrations decreased by 72%. Sulphur Recirculation almost entirely decreased the need for costly road transports of effluent sulphate water for the Sulphur Recirculation line, since most sulphur from the waste now ends up in the ashes instead of creating a surplus dilute Na2SO4 solution. The sulphur content of the waste varies with time, which may create periods of sulphur surplus and deficit respectively. Most of these variations are being evened out by a storage vessel for H2SO4. These variations may facilitate a small market of waste sulphuric acid between plants in the future.
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| 10. |
- Berggren, Magnus, et al.
(författare)
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Controlling inter-chain and intra-chain excitations of a poly(thiophene) derivative in thin films
- 1999
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Ingår i: Chemical Physics Letters. - : Elsevier. - 0009-2614 .- 1873-4448. ; 304:1-2, s. 84-90
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Tidskriftsartikel (refereegranskat)abstract
- The decay of photoexcitations in polythiophene chains has been studied in solid solutions of the polymer from room temperature to 4 K. A strong blue shift of the emission spectrum is observed in the polymer blend, as compared to the homopolymer. Dispersion of the polythiophene suppresses the non-radiative processes, which are suggested to be correlated to close contacts of polymer chains. Quantum chemistry modeling of the excited state distributed on two chains corroborate this conclusion.
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