| 1. |
- Bäckman, Karin, et al.
(författare)
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Vårdens alltför svåra val? : kartläggning av prioriteringsarbete och analys av riksdagens principer och riktlinjer för prioriteringar i hälso- och sjukvården
- 2007
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- PrioriteringsCentrum har på uppdrag av Socialstyrelsen genomfört en kartläggning av på vilket sätt hälso- och sjukvårdens huvudmän och andra centrala aktörer arbetar med prioriteringar och har utvärderat hur detta arbete överensstämmer med intentionerna i riksdagens beslut om prioriteringar. Vi har även analyserat innehållet i och tillämpningen av riksdagens riktlinjer för prioriteringar i hälso- och sjukvården. Det har skett genom en etisk analys och mot bakgrund av ett stort antal intervjuer i landsting och kommuner samt med representanter för statliga myndigheter och yrkesorganisationer och med ledning av vad som framkommit i tidigare uppföljningar. Vi föreslår i rapporten ett anta förändringar och förtydliganden av riktlinjerna.Vi kan konstatera att sättet att arbeta med prioriteringar i landsting och kommuner inte är helt olikt det som gällde när Prioriteringsdelegationen redovisade en motsvarande uppföljning år 2001. Fortfarande finns knappast några öppna beslut om fördelning och prioritering av resurser om man med öppenhet avser att beslutsfattaren medvetet överväger flera alternativ och att grunderna för besluten är kända för dem som önskar ta del av dem.I situationer då tillgängliga resurser inte befinner sig i paritet med önskvärda ambitioner får sjukvårdspersonalen ta det största ansvaret för att besluta om och genomföra ransonering av vården. Förutom på chefsnivå tycks dock sjukvårdpersonal fortfarande i liten utsträckning vara medveten om de etiska principer som enligt riksdagsbeslutet ska styra prioriteringar i vården. Få känner till den etiska plattformen med de tre etiska principerna. Lokala mallar eller styrdokument för prioriteringar är ovanliga. Det saknas nödvändiga förutsättningar för att tillämpa riksdagens prioriteringsbeslut och det finns inte heller några tydliga strategier för hur man vill skapa sådana förutsättningar inom landstingen.Den kommunala vård- och omsorgsverksamheten upplever sig fortfarande i ringa utsträckning berörd av den etiska plattformen och prioriteringsprinciperna. Någon gemensam prioritering mellan huvudmännen sker knappast alls.Medborgarna är i mycket liten utsträckning involverade i prioriteringsarbetet. Den ökade öppenheten gentemot brukare innebär oftast att viss information om prioriteringar sker genom traditionella kanaler som patientorganisationer, pensionärsråd och handikappråd och synpunkter inhämtas via allmänna patientenkäter medan klagomål hanteras genom patientnämnder.Vi har också funnit tydliga skillnader när det gäller hur arbetet med prioriteringar bedrivs idag jämfört med för sex år sedan. Genom Socialstyrelsen och Läkemedelsförmånsnämnden har staten tagit ledningen när det gäller att visa hur prioriteringar kan göras på ett systematiskt och öppet sätt. Detta arbete har resulterat i en tydlig metodutveckling. Idag finns det dessutom flera exempel på konkret utvecklingsarbete och samverkan mellan huvudmän kring det vidare begreppet kunskapsstyrd vård till vilket systematiska prioriteringar är starkt relaterat. Vi kan också notera olika initiativ till vertikala prioriteringar i verksamheten där det framförallt är läkarkåren som engagerat sig; men också enstaka försök med systematiska politiska prioriteringar. Det finns dessutom flera lovande utvecklingsprojekt rörande prioriteringar som initierats av och drivs av sjukvårdspersonal både lokalt och nationellt. Yrkesförbunden är också mer aktiva idag när det gäller att sprida kunskap om prioriteringar....
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| 2. |
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| 3. |
- Ericsson, Per, et al.
(författare)
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Characterization of particulate emissions and methodology for oxidation of particulates from non-diesel combustion systems
- 2008
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Ingår i: SAE Technical Paper. - 400 Commonwealth Drive, Warrendale, PA, United States : SAE International. - 0148-7191.
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Tidskriftsartikel (refereegranskat)abstract
- Tailpipe particulate emissions, i.e., particle number, size distribution and total mass, from a series of four-cylinder engines with 2L displacement and power output of approximately 150 hp have been measured. The engines were in their respective vehicle installation, all midsize vehicles from various manufacturers, and represented different combustion concepts, i.e., port- and direct-injected vehicles and E5 and E85 fuels. The results are compared to post-Euro V emission standards for gasoline and biofuels using diesel as reference. The results show that the type of combustion and fuel significantly affect the particulate formation. In general, direct-injected engines show high particle numbers and mass compared to port-injected engines. The particulate number and total mass can be reduced by using biofuels, e.g., ethanol mixes, instead of gasoline. Moreover, an experimental procedure and setup facilitating precise studies of oxidation of particulates in realistic filter structures by well-controlled gas flow (composition and temperature) and sample (particulate load and temperature) conditions has been developed. The results from this method have been verified by using commercial soot as reference.
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| 4. |
- Hägg, Daniel, 1974, et al.
(författare)
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Expression profiling of macrophages from subjects with atherosclerosis to identify novel susceptibility genes.
- 2008
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Ingår i: International journal of molecular medicine. - 1107-3756. ; 21:6, s. 697-704
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Tidskriftsartikel (refereegranskat)abstract
- Although a number of environmental risk factors for atherosclerosis have been identified, heredity seems to be a significant independent risk factor. The aim of our study was to identify novel susceptibility genes for atherosclerosis. The screening process consisted of three steps. First, expression profiles of macrophages from subjects with atherosclerosis were compared to macrophages from control subjects. Secondly, the subjects were genotyped for promoter region polymorphisms in genes with altered gene expression. Thirdly, a population of subjects with coronary heart disease and control subjects were genotyped to test for an association with identified polymorphisms that affected gene expression. Twenty-seven genes were differentially expressed in both macrophages and foam cells from subjects with atherosclerosis. Three of these genes, IRS2, CD86 and SLC11A1 were selected for further analysis. Foam cells from subjects homozygous for the C allele at the -765C-->T SNP located in the promoter region of IRS2 had increased gene expression compared to foam cells from subjects with the nonCC genotype. Also, macrophages and foam cells from subjects homozygous for allele 2 at a repeat element in the promoter region of SLC11A1 had increased gene expression compared to macrophages and foam cells from subjects with the non22 genotype. Genotyping of 512 pairs of subjects with coronary heart disease (CHD) and matched controls revealed that subjects homozygous for C of the IRS2 SNP had an increased risk for CHD; odds ratio 1.43, p=0.010. Immunohistochemical staining of human carotid plaques showed that IRS2 expression was localised to macrophages and endothelial cells in vivo. Our method provides a reliable approach for identifying susceptibility genes for atherosclerosis, and we conclude that elevated IRS2 gene expression in macrophages may be associated with an increased risk of CHD.
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| 6. |
- Lau, Joey, et al.
(författare)
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Implantation site-dependent dysfunction of transplanted pancreatic islets
- 2007
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Ingår i: Diabetes. - : American Diabetes Association. - 0012-1797 .- 1939-327X. ; 56:6, s. 1544-1550
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE—Clinical islet transplantations are performed through infusion of islets via the portal vein into the liver. This study aimed at characterizing the influence of the implantation microenvironment on islet graft metabolism and function. RESEARCH DESIGN AND METHODS—Islets were transplanted into their normal environment, i.e., the pancreas, or intraportally into the liver of mice. One month posttransplantation, the transplanted islets were retrieved and investigated for changes in function and gene expression. RESULTS—Insulin content, glucose-stimulated insulin release, (pro)insulin biosynthesis, and glucose oxidation rate were markedly decreased in islets retrieved from the liver, both when compared with islets transplanted into the pancreas and endogenous islets. Islets transplanted into the pancreas showed normal insulin content, (pro)insulin biosynthesis, and glucose oxidation rate but increased basal insulin secretion and impaired glucose stimulation index. Gene expression data for retrieved islets showed downregulation of pancreatic and duodenal homeobox gene-1, GLUT-2, glucokinase, mitochondrial glycerol-phosphate dehydrogenase, and pyruvate carboxylase, preferentially in intraportally transplanted islets. CONCLUSIONS—Islets transplanted into their normal microenvironment, i.e., the pancreas, display gene expression changes when compared with endogenous islets but only moderate changes in metabolic functions. In contrast, site-specific properties of the liver markedly impaired the metabolic functions of intraportally transplanted islets.
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| 7. |
- Margolin, Sara, et al.
(författare)
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A randomised feasibility/phase II study (SBG 2004-1) with dose-dense/tailored epirubicin, cyclophoshamide (EC) followed by docetaxel (T) or fixed dosed dose-dense EC/T versus T, doxorubicin and C (TAC) in node-positive breast cancer.
- 2011
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Ingår i: Acta Oncologica. - : Informa Healthcare. - 0284-186X .- 1651-226X. ; 50:1, s. 35-41
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the study was to evaluate the feasibility of tailored and dose-dense epirubicin and cyclophosphamide followed by docetaxel as adjuvant breast cancer therapy. Material and methods. Patients with node-positive breast cancer received either four cycles of biweekly and tailored EC (epirubicin 38-60-75-90-105-120 mg/m(2), cyclophosphamide 450-600-900-1200 mg/m(2)) followed by four cycles of docetaxel (60-75-85-100 mg/m(2)) (arm A) or the same regimen with fixed doses (E(90)C(600) + 4 → T(75) + 4) (arm B) or docetaxel, doxorubicin and cyclophosphamide (T(75)A(50)C(500)) every three weeks for six cycles (arm C). All patients received G-CSF support and prophylactic ciprofloxacin. Results. One-hundred and twenty-four patients were randomised in the study. In the A, B and C arm, 17% 19% and 3% of the patients had one or more cycles delayed due to side-effects whereas 24%, 5% and 15% experienced a grade 3 infection or febrile neutropenia. After the introduction of an extra week between the EC and T parts in the A and B arms, grade 3 hand-foot-skin reactions were reduced from 5 to 0.2%. Twenty-nine percent (A and B) and 20% (C) of the patients were hospitalised due to side-effects. Discussion. Dose-dense and tailored EC/T can be given with manageable toxicity and is after adjustment presently studied in the phase III Panther trial.
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| 8. |
- Rönnbäck, Annica, et al.
(författare)
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Gene expression profiling of the rat hippocampus one month after focal cerebral ischemia followed by enriched environment
- 2005
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Ingår i: Neuroscience Letters. - : Elsevier BV. - 0304-3940 .- 1872-7972. ; 385:2, s. 173-178
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Tidskriftsartikel (refereegranskat)abstract
- Functional recovery after experimental stroke in rats is enhanced by environmental enrichment by stimulating plastic changes in brain regions outside the lesion, but the molecular mechanisms are not known. We investigated the effect of environmental enrichment after focal cerebral ischemia on cognitive recovery and hippocampal gene expression using microarray analysis. Rats placed in enriched environment (EE) for 1 month after middle cerebral artery occlusion (MCAo) showed significantly improved spatial memory in the Morris water maze compared to rats housed alone after MCAo. Microarray analysis suggested several EE-induced differences in neuronal plasticity-related genes, but these changes could not be confirmed by quantitative real-time PCR. This study highlights some of the potential problems associated with gene expression profiling of brain tissues. Further studies at earlier time points and in additional subregions of the brain are of interest in the search for molecular mechanisms behind EE-induced neuronal plasticity after ischemic stroke.
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| 9. |
- Svensson, Per Anders, 1959, et al.
(författare)
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Identification of genes predominantly expressed in human macrophages
- 2004
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Ingår i: Atherosclerosis. - : Elsevier BV. ; 177, s. 287-290
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Tidskriftsartikel (refereegranskat)abstract
- Identification of cell and tissue specific genes may provide novel insights to signaling systems and functions. Macrophages play a key role in many diseases including atherosclerosis. Using DNA microarrays we compared the expression of approximately 10,000 genes in 56 human tissues and identified 23 genes with predominant expression in macrophages. The identified genes include both genes known to be macrophage specific and genes previously not well described in this cell type. Tissue distribution of two genes, liver X receptor (LXR) alpha and interleukin-1 receptor antagonist (IL1RN), was verified by real-time RT-PCR. We conclude that comparison of expression profiles from a large number of tissues can be used to identify genes that are predominantly expressed in certain tissues. Identification of novel macrophage specific genes may increase our understanding of the role of this cell in different diseases.
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| 10. |
- Svensson, Per-Arne, 1969, et al.
(författare)
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Regulation and splicing of scavenger receptor class B type I in human macrophages and atherosclerotic plaques
- 2005
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Ingår i: BMC Cardiovasc Disord. - : Springer Science and Business Media LLC. - 1471-2261. ; 5
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The protective role of high-density lipoprotein (HDL) in the cardiovascular system is related to its role in the reverse transport of cholesterol from the arterial wall to the liver for subsequent excretion via the bile. Scavenger receptor class B type I (SR-BI) binds HDL and mediates selective uptake of cholesterol ester and cellular efflux of cholesterol to HDL. The role of SR-BI in atherosclerosis has been well established in murine models but it remains unclear whether SR-BI plays an equally important role in atherosclerosis in humans. The aim of this study was to investigate the expression of SR-BI and its isoforms in human macrophages and atherosclerotic plaques. METHODS: The effect of hypoxia and minimally modified low-density lipoprotein (mmLDL), two proatherogenic stimuli, on SR-BI expression was studied in human monocyte-derived macrophages from healthy subjects using real-time PCR. In addition, SR-BI expression was determined in macrophages obtained from subjects with atherosclerosis (n = 15) and healthy controls (n = 15). Expression of SR-BI isoforms was characterized in human atherosclerotic plaques and macrophages using RT-PCR and DNA sequencing. RESULTS: SR-BI expression was decreased in macrophages after hypoxia (p < 0.005). In contrast, SR-BI expression was increased by exposure to mmLDL (p < 0.05). There was no difference in SR-BI expression in macrophages from patients with atherosclerosis compared to controls. In both groups, SR-BI expression was increased by exposure to mmLDL (p < 0.05). Transcripts corresponding to SR-BI and SR-BII were detected in macrophages. In addition, a third isoform, referred to as SR-BIII, was discovered. All three isoforms were also expressed in human atherosclerotic plaque. Compared to the other isoforms, the novel SR-BIII isoform was predicted to have a unique intracellular C-terminal domain containing 53 amino acids. CONCLUSION: We conclude that SR-BI is regulated by proatherogenic stimuli in humans. However, we found no differences between subjects with atherosclerosis and healthy controls. This indicates that altered SR-BI expression is not a common cause of atherosclerosis. In addition, we identified SR-BIII as a novel isoform expressed in human macrophages and in human atherosclerotic plaques.
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