| 1. |
- 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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| 2. |
- Bergh, Johan, et al.
(författare)
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Effekter av ett förändrat klimat på skogen och implikationer för skogsbruket : Bilaga B 19, Arbetsrapport 34
- 2007
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Ingår i: Sverige inför klimatförändringarna. - : Fritzes. ; , s. 1-71
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Bokkapitel (populärvet., debatt m.m.)abstract
- Att klimatet kan komma att förändras påverkar svenskt skogsbruk. Skogen har i sig en direkt inverkan på klimatet samtidigt som skogsbruket kan behöva anpassas till de nya förhållandena. Ett osäkert klimat sätter brukandet av skogen i ett nytt läge som vi inte har någon tidigare erfarenhet av. Scenarier för framtida klimatutveckling är behäftade med stor osäkerhet och de förväntade effekterna på skogen blir således ännu mer osäkra. Trots detta kan man ändå förutsäga några sannolika huvuddrag i effekterna på den svenska skogen vid ett framtida ändrat klimat. En ökad potential för biomassaproduktion kan förväntas, liksom ökade möjligheter att använda nya arter i skogsbruket. Samtidigt ökar sannolikt risken för vissa typer av skador.Att väga eventuella fördelar i form av ökad produktion och ökade möjligheter i trädslagsval mot ökade risker för skador är viktigt för att ge samhället ett helhetsperspektiv och för att en större grupp ska ha möjlighet att ta till sig frågan. Det är också viktigt att i största möjliga mån kvantifiera eller ge ramarna i ekonomiska termer för hur det förändrade klimatet kan tänkas påverka skogsbruket. Vidare kan det vara styrande för prioritering av fortsatta forskningsarbeten och riskbedömning och för att prioritera åtgärder. Därför har vi försökt utifrån befintlig kunskap idag, konstruera en Tabell över den ekonomiska betydelsen och forskningsbarheten för olika risk/ämnesområden (se Tabell 17 sidan 39). De kanske största effekterna av ett förändrat klimat på ekonomin inom skogsbruket skulle vara om vi lyckas utnyttja den ökade produktionspotentialen. Det förutsätter att vi kan bemästra de negativa effekterna i första hand av en ökad risk för vindfällning, skadeangrepp från insekter och svampar. Mot bakgrund av skogsbrukets stora betydelse som naturresurs och industriell bas, så finner vi att det är viktigt att vi står rustade inför en framtid med såväl ökade hot som nya möjligheter.I denna skrift försöker vi beskriva och analysera tänkbara effekter av ett förändrat klimat på skogen och bedömt deras implikationer för produktionsskogsbruket. Andra aspekter än produktionsaspekter på skogsbruket har inte behandlats. Analysen sker i fyra steg. Vi inleder med att, så långt nuvarande kunskapsläge tillåter, kvantifiera effekterna på den skogliga primärproduktionen – tillväxten i skogen. I ett andra steg omsätts dessa effekter till effekter på produktionsekonomin i ett bestånd. Därefter analyseras tänkbara effekter på risken för stormfällning i skogen. I ett sista steg breddas diskussionen till en något mera spekulativ bild av tänkbara effekter på skogsbrukets ekonomi.
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| 3. |
- Bergman, Peter, et al.
(författare)
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Safety and efficacy of the mRNA BNT162b2 vaccine against SARS-CoV-2 in five groups of immunocompromised patients and healthy controls in a prospective open-label clinical trial
- 2021
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Ingår i: EBioMedicine. - : Elsevier BV. - 2352-3964. ; 74
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Tidskriftsartikel (refereegranskat)abstract
- Background: Patients with immunocompromised disorders have mainly been excluded from clinical trials of vaccination against COVID-19. Thus, the aim of this prospective clinical trial was to investigate safety and efficacy of BNT162b2 mRNA vaccination in five selected groups of immunocompromised patients and healthy controls.Methods: 539 study subjects (449 patients and 90 controls) were included. The patients had either primary (n=90), or secondary immunodeficiency disorders due to human immunodeficiency virus infection (n=90), allogeneic hematopoietic stem cell transplantation/CAR T cell therapy (n=90), solid organ transplantation (SOT) (n=89), or chronic lymphocytic leukemia (CLL) (n=90). The primary endpoint was seroconversion rate two weeks after the second dose. The secondary endpoints were safety and documented SARS-CoV-2 infection.Findings: Adverse events were generally mild, but one case of fatal suspected unexpected serious adverse reaction occurred. 72.2% of the immunocompromised patients seroconverted compared to 100% of the controls (p=0.004). Lowest seroconversion rates were found in the SOT (43.4%) and CLL (63.3%) patient groups with observed negative impact of treatment with mycophenolate mofetil and ibrutinib, respectively.Interpretation: The results showed that the mRNA BNT162b2 vaccine was safe in immunocompromised patients. Rate of seroconversion was substantially lower than in healthy controls, with a wide range of rates and antibody titres among predefined patient groups and subgroups. This clinical trial highlights the need for additional vaccine doses in certain immunocompromised patient groups to improve immunity.
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| 4. |
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| 5. |
- Blennow, Kristina, et al.
(författare)
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Climate change and the probability of wind damage in two Swedish forests
- 2010
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Ingår i: Forest Ecology and Management. - : Elsevier BV. - 0378-1127 .- 1872-7042. ; 259, s. 818-830
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Tidskriftsartikel (refereegranskat)abstract
- We simulated how possible changes in wind and ground-frost climate and state of the forest due to changes in the future climate may affect the probability of exceeding critical wind speeds expected to cause wind damage within one northern and one southern study area in Sweden, respectively. The topography of the study areas was relatively gentle and the forests were dominated by Norway spruce (Picea abies (L.) Karst.) and Scots pine (Pinus sylvestris L.). Using estimated changes in the net primary production (NPP) due to climate change and assuming a relative change in the site productivity equal to a relative change in NPP, we simulated possible future states of the forest under gradual adjustment of the site index in response to climate change using the model The Forest Time Machine. Global climate change scenarios based on two emission scenarios and one general circulation model were downscaled to the regional level. The modified WINDA model was used to calculate the sensitivity of the forest to wind and the probability of wind damage for individual forest stands for the periods 2011–2041 and 2071–2100 and for a control period 1961–1990. This was done while taking into account effects on stability of the forest from expected changes in the occurrence of ground frost. Increasing sensitivity of the forest to wind was indicated for both study areas when adhering to recommended management rules of today. Adding also a changed wind climate further increased the probability of wind damage. Calculated probabilities of wind damage were generally higher in the southern study area than in the northern one and were explained by differences in wind climate and the state of the forests, for example with respect to tree species composition. The indicated increase in sensitivity of the forest to wind under the current management regime, and possibly increasing windiness, motivate further analysis of the effects of different management options on the probability of wind damage and what modifications of Swedish forest management are possibly warranted.
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| 6. |
- Blennow, Kristina, et al.
(författare)
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Evaluating WINDA : a tool for assessing the probability of wind damage to forest stands
- 2003
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Ingår i: Proceedings of the International Conference Wind Effects on Trees. ; , s. 137-144
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- WINDA is an integrated system of models for calculating the stand-wise probability of wind damage of trees within a landscape (Blennow & Sallnäs, submitted). It integrates a modified version of the dose/response model HWIND (Peltola et al., 1999), the airflow model WASP (Mortensen et al., 1998), and a component for calculating the zero-plane displacement and surface roughness. WINDA uses a GIS for geographical computations. The calculations are made point-wise at exposed stand edges and the results are combined for each stand. The likelihood of damage is calculated using extreme value theory. The mechanistic modelling approach makes WINDA useful for evaluating effects on the probability of wind damage of silvicultural treatments and forestry activities as well as of a changed climate. This paper briefly outlines WINDA and evaluates output by comparing predicted damage with observed damage for two landscapes in southern Sweden.
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| 7. |
- Blennow, Kristina, et al.
(författare)
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”Modul 1 Skogsbruk”. Klimatet och skogen – underlag för nationell forskning
- 2006
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Ingår i: Kungl. Skogs- och Lantbruksakademiens tidskrift. - 0023-5350. ; 145:9, s. 13-18
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Behovet av ny kunskap i anslutning till klimatförändringen är enormt. Det behövs ny kunskap om hur • klimatet kan komma att utvecklas. • skogsekosystemet kan komma att utvecklas. • dessa system interagerar. Detta kunskapsuppbyggande är högst angeläget att påbörja men kommer att ta tid. Många beslut inom skogsbruket måste fattas redan idag utan tillgång till forskningsresultaten. Man tvingas alltså redan nu förhålla sig till ett osäkert klimat. Därför, och för att det trots allt alltid kommer att finnas osäkerhet inför framtiden, vill vi stödja besluten genom att utveckla ett rationellt förhållningssätt till osäkerhet och risk. För att snabbt kunna ta fram praktiskt användbar kunskap vill vi i hög grad utgå från skogliga beslutssituationer när vi väljer vilka problemställningar vi ska hantera inom programmet. Framtagandet av ny kunskap skapar i sig ett problem för riskkommunikation. Kunskapsklyftan i förhållande till mottagaren ökar. Att överbrygga den klyftan är en av de viktigaste faktorerna för att lyckas förändra mottagarens kunskapsläge, och därigenom dennes beteende.
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| 8. |
- Blennow, Kristina, et al.
(författare)
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Potential climate change impacts on the probability of wind damage in a south Swedish forest
- 2010
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Ingår i: Climatic Change. - : Springer Science and Business Media LLC. - 0165-0009 .- 1573-1480. ; 99, s. 261-278
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Tidskriftsartikel (refereegranskat)abstract
- We estimated how the possible changes in wind climate and state of the forest due to climate change may affect the probability of exceeding critical wind speeds expected to cause wind damage within a forest management unit located in Southern Sweden. The topography of the management unit was relatively gentle and the forests were dominated by Norway spruce (Picea abies (L.) Karst.). We incorporated a model relating the site index (SI) to the site productivity into the forest projection model FTM. Using estimated changes in the net primary production (NPP) due to climate change and assuming a relative change in NPP equal to a relative change in the site productivity, we simulated possible future states of the forest under gradual adjustment of SI in response to climate change. We estimated changes in NPP by combining the boreal-adapted BIOMASS model with four regional climate change scenarios calculated using the RCAO model for the period 2071-2100 and two control period scenarios for the period 1961-1990. The modified WINDA model was used to calculate the probability of wind damage for individual forest stands in simulated future states of the forest. The climate change scenarios used represent non-extreme projections on a 100-year time scale in terms of global mean warming. A 15-40% increase in NPP was estimated to result from climate change until the period 2071-2100. Increasing sensitivity of the forest to wind was indicated when the management rules of today were applied. A greater proportion of the calculated change in probability of wind damage was due to changes in wind climate than to changes in the sensitivity of the forest to wind. While regional climate scenarios based on the HadAM3H general circulation model (GCM) indicated no change (SRES A2 emission scenario) or a slightly reduced (SRES B2 emission scenario) probability of wind damage, scenarios based on the ECHAM4/OPYC3 GCM indicated increased probability of wind damage. The assessment should, however, be reviewed as the simulation of forest growth under climate change as well as climate change scenarios are refined.
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| 9. |
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| 10. |
- Blennow, Ola
(författare)
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Diagnostic and clinical aspects of invasive fungal disease after allogeneic hematopoietic stem cell transplantation
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In paper I, 99 patients who received reduced-intensity conditioning (RIC) were followed with weekly fungal PCR during the first 100 days after HSCT. Patients with a positive fungal PCR result were randomized to either treatment with liposomal amphotericin B or no treatment. We found that a single positive PCR test was not associated with IFD, irrespective of treatment. The cumulative incidence rate of proven or probable IA during the first year after transplantation was 9%, and significant risk factors in a multivariate model were grades II–IV acute-graft-versus host disease (aGVHD), cytomegalovirus- (CMV-) seronegative recipient with CMV-seropositive donor, and conditioning with alemtuzumab. In paper II, a possible influence of the intensity of the conditioning on pneumonia-related death was investigated. We found no significant differences in the cumulative incidence of pneumonia-related death between patients receiving myeloablative conditioning (MAC) and those receiving RIC: early death (< 100 days after HSCT) 2.8% vs. 2.1%, and overall death 8.2% vs. 10.5%. Etiology could be established in 40 of 60 patients (67%) who died from pneumonia, with proven or probable IMI in 19 patients (48% of patients with established etiology, 32% of all patients with pneumonia-related death). In the multivariate analyses, grades II–IV aGVHD, CMV infection, and treatment with mesenchymal stromal cells (MSCs) were factors associated with overall pneumonia-related death. In paper III, posaconazole tissue concentrations were examined in vivo. Tissue concentrations of posaconazole were analyzed in biopsies taken at autopsy of seven patients who received posaconazole prophylaxis, and they were compared with plasma concentrations in samples taken before death. Accumulation of posaconazole was found in heart, lung, kidney, and liver tissue, while concentrations in brain were approximately equal to the concentrations in plasma. The apparent tissue accumulation in vivo is in agreement with earlier in vitro findings and may explain the low incidence of breakthrough infections seen in prophylaxis trials despite low serum concentrations. In paper IV, incidence and risk factors for IMI were retrospectively investigated in 843 patients. The cumulative incidences of proven and probable IMI were 2.2% at day 100, 5.2% after 1 year, and 6.3% after 2 years. Factors significantly associated with a new IMI were older age (risk hazard 4.26 for 41–60 years of age and 9.0 for > 60 years of age, with 0–20 years as reference), grades II–IV aGVHD, treatment with MSCs, and transplantation with female donor to male recipient. In patients with grade II aGVHD, no IMIs were seen after onset of GVHD in 113 HSCTs performed in patients < 40 years of age, compared to 14 IMIs in 106 HSCTs (13.2%) in patients > 40 years of age (p < 0.001). Twelve of these 14 patients had signs of poor immune reconstitution
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