| 1. |
- Svantesson, Mia, 1960-, et al.
(författare)
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Outcomes of Moral Case Deliberation : the development of an evaluation instrument for clinical ethics support (the Euro-MCD)
- 2014
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Ingår i: BMC Medical Ethics. - London : BioMed Central. - 1472-6939. ; 15
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Tidskriftsartikel (refereegranskat)abstract
- Background: Clinical ethics support, in particular Moral Case Deliberation, aims to support health care providers to manage ethically difficult situations. However, there is a lack of evaluation instruments regarding outcomes of clinical ethics support in general and regarding Moral Case Deliberation (MCD) in particular. There also is a lack of clarity and consensuses regarding which MCD outcomes are beneficial. In addition, MCD outcomes might be context-sensitive. Against this background, there is a need for a standardised but flexible outcome evaluation instrument. The aim of this study was to develop a multi-contextual evaluation instrument measuring health care providers' experiences and perceived importance of outcomes of Moral Case Deliberation.Methods: A multi-item instrument for assessing outcomes of Moral Case Deliberation (MCD) was constructed through an iterative process, founded on a literature review and modified through a multistep review by ethicists and health care providers. The instrument measures perceived importance of outcomes before and after MCD, as well as experienced outcomes during MCD and in daily work. A purposeful sample of 86 European participants contributed to a Delphi panel and content validity testing. The Delphi panel (n = 13), consisting of ethicists and ethics researchers, participated in three Delphi-rounds. Health care providers (n = 73) participated in the content validity testing through `think-aloud' interviews and a method using Content Validity Index.Results: The development process resulted in the European Moral Case Deliberation Outcomes Instrument (Euro-MCD), which consists of two sections, one to be completed before a participant's first MCD and the other after completing multiple MCDs. The instrument contains a few open-ended questions and 26 specific items with a corresponding rating/response scale representing various MCD outcomes. The items were categorised into the following six domains: Enhanced emotional support, Enhanced collaboration, Improved moral reflexivity, Improved moral attitude, Improvement on organizational level and Concrete results.Conclusions: A tentative instrument has been developed that seems to cover main outcomes of Moral Case Deliberation. The next step will be to test the Euro-MCD in a field study.
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| 2. |
- Breuer, L., et al.
(författare)
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Assessing the impact of land use change on hydrology by ensemble modeling (LUCHEM). I : Model intercomparison with current land use
- 2009
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Ingår i: Advances in Water Resources. - : Elsevier BV. - 0309-1708 .- 1872-9657. ; 32:2, s. 129-146
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Tidskriftsartikel (refereegranskat)abstract
- This paper introduces the project on 'Assessing the impact of land use change on hydrology by ensemble modeling (LUCHEM)' that aims at investigating the envelope of predictions on changes in hydrological fluxes due to land use change. As part of a series of four papers, this paper outlines the motivation and setup of LUCHEM, and presents a model intercomparison for the present-day simulation results. Such an intercomparison provides a valuable basis to investigate the effects of different model structures on model predictions and paves the ground for the analysis of the performance of multi-model ensembles and the reliability of the scenario predictions in companion papers. in this study, we applied a set of 10 lumped, semi-lumped and fully distributed hydrological models that have been previously used in land use change studies to the low mountainous Dill catchment. Germany. Substantial differences in model performance were observed with Nash-Sutcliffe efficiencies ranging from 0.53 to 0.92. Differences in model performance were attributed to (1) model input data, (2) model calibration and (3) the physical basis of the models. The models were applied with two sets of input data: an original and a homogenized data set. This homogenization of precipitation, temperature and leaf area index was performed to reduce the variation between the models. Homogenization improved the comparability of model simulations and resulted in a reduced average bias, although some variation in model data input remained. The effect of the physical differences between models on the long-term water balance was mainly attributed to differences in how models represent evapotranspiration. Semi-lumped and lumped conceptual models slightly outperformed the fully distributed and physically based models. This was attributed to the automatic model calibration typically used for this type of models. Overall, however, we conclude that there was no superior model if several measures of model performance are considered and that all models are suitable to participate in further multi-model ensemble set-ups and land use change scenario investigations.
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| 3. |
- de Bekker-Grob, Esther W., et al.
(författare)
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The impact of vaccination and patient characteristics on influenza vaccination uptake of elderly people : A discrete choice experiment
- 2018
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Ingår i: Vaccine. - : Elsevier BV. - 0264-410X .- 1873-2518. ; 36:11, s. 1467-1476
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To improve information for patients and to facilitate a vaccination coverage that is in line with the EU and World Health Organization goals, we aimed to quantify how vaccination and patient characteristics impact on influenza vaccination uptake of elderly people.Methods: An online discrete choice experiment (DCE) was conducted among 1261 representatives of the Dutch general population aged 60 years or older. In the DCE, we used influenza vaccination scenarios based on five vaccination characteristics: effectiveness, risk of severe side effects, risk of mild side effects, protection duration, and absorption time. A heteroscedastic multinomial logit model was used, taking scale and preference heterogeneity (based on 19 patient characteristics) into account.Results: Vaccination and patient characteristics both contributed to explain influenza vaccination uptake. Assuming a base case respondent and a realistic vaccination scenario, the predicted uptake was 58%. One-way changes in vaccination characteristics and patient characteristics changed this uptake from 46% up to 61% and from 37% up to 95%, respectively. The strongest impact on vaccination uptake was whether the patient had been vaccinated last year, whether s/he had experienced vaccination side effects, and the patient's general attitude towards vaccination.Conclusions: Although vaccination characteristics proved to influence influenza vaccination uptake, certain patient characteristics had an even higher impact on influenza vaccination uptake. Policy makers and general practitioners can use these insights to improve their communication plans and information regarding influenza vaccination for individuals aged 60 years or older. For instance, physicians should focus more on patients who had experienced side effects due to vaccination in the past, and policy makers should tailor the standard information folder to patients who had been vaccinated last year and to patient who had not.
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| 4. |
- Froklage, Femke E, et al.
(författare)
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[11C]Flumazenil brain uptake is influenced by the blood-brain barrier efflux transporter P-glycoprotein.
- 2012
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Ingår i: EJNMMI Research. - 2191-219X. ; 2, s. 12-
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: [11C]Flumazenil and positron emission tomography (PET) are used clinically to assess gamma-aminobutyric acid (GABA)-ergic function and to localize epileptic foci prior to resective surgery. Enhanced P-glycoprotein (P-gp) activity has been reported in epilepsy and this may confound interpretation of clinical scans if [11C]flumazenil is a P-gp substrate. The purpose of this study was to investigate whether [11C]flumazenil is a P-gp substrate.METHODS: [11C]Flumazenil PET scans were performed in wild type (WT) (n = 9) and Mdr1a/1b, (the genes that encode for P-gp) double knockout (dKO) (n = 10) mice, and in naive rats (n = 10). In parallel to PET scanning, [11C]flumazenil plasma concentrations were measured in rats. For 6 of the WT and 6 of the dKO mice a second, [11C]flumazenil scan was acquired after administration of the P-gp inhibitor tariquidar. Cerebral [11C]flumazenil concentrations in WT and Mdr1a/1b dKO mice were compared (genetic disruption model). Furthermore, pre and post P-gp-blocking cerebral [11C]flumazenil concentrations were compared in all animals (pharmacological inhibition model).RESULTS: Mdr1a/1b dKO mice had approximately 70% higher [11C]flumazenil uptake in the brain than WT mice. After administration of tariquidar, cerebral [11C]flumazenil uptake in WT mice increased by about 80% in WT mice, while it remained the same in Mdr1a/1b dKO mice. In rats, cerebral [11C]flumazenil uptake increased by about 60% after tariquidar administration. Tariquidar had only a small effect on plasma clearance of flumazenil.CONCLUSIONS: The present study showed that [11C]flumazenil is a P-gp substrate in rodents. Consequently, altered cerebral [11C]flumazenil uptake, as observed in epilepsy, may not reflect solely GABAA receptor density changes but also changes in P-gp activity.
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| 5. |
- Hallin, Caroline, et al.
(författare)
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Impact of sediment supply on decadal-scale dune evolution — Analysis and modelling of the Kennemer dunes in the Netherlands
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Ingår i: Geomorphology. - 0169-555X. ; 337, s. 94-110
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Tidskriftsartikel (refereegranskat)abstract
- This study investigates the impact of beach sediment supply on dune volume evolution through data analysis and model simulations of the Kennemer dunes in the Netherlands. A cross-shore sediment transport model (the CS-model) is applied with local time-averaged longshore sediment transport gradients derived from bathymetric and topographic observations. The model is used to study the relative importance of different transport processes on dune volume evolution, assuming that aeolian transport from the beach to the dune is supply-limited. The wave-driven longshore transport gradients are found to explain a large part of the observed variation in the dune evolution within the study area. In accreting parts of the coast, dunes are growing due to sediment supply from longshore transport, whereas in eroding parts, dune growth depends on supply from artificial nourishments. Seasonal constructions on the beach and vegetation removal from the dunes partly impede dune growth along the considered stretch of coast. The model performance is satisfactory, being able to reproduce a considerable part of the large variation in the alongshore dune response observed in the study area. Overall, the results are a promising contribution to the capability of simulating decadal-scale dune evolution, which is important for long-term flood risk assessments and safe designs of nature-based solutions.
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| 6. |
- Huisman, J. A., et al.
(författare)
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Assessing the impact of land use change on hydrology by ensemble modeling (LUCHEM) III : Scenario analysis
- 2009
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Ingår i: Advances in Water Resources. - : Elsevier BV. - 0309-1708 .- 1872-9657. ; 32:2, s. 159-170
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Tidskriftsartikel (refereegranskat)abstract
- An ensemble of 10 hydrological models was applied to the same set of land use change scenarios. There was general agreement about the direction of changes in the mean annual discharge and 90% discharge percentile predicted by the ensemble members, although a considerable range in the magnitude of predictions for the scenarios and catchments under consideration was obvious. Differences in the magnitude of the increase were attributed to the different mean annual actual evapotranspiration rates for each land use type. The ensemble of model runs was further analyzed with deterministic and probabilistic ensemble methods. The deterministic ensemble method based on a trimmed mean resulted in a single somewhat more reliable scenario prediction. The probabilistic reliability ensemble averaging (REA) method allowed a quantification of the model structure uncertainty in the scenario predictions. It was concluded that the use of a model ensemble has greatly increased our confidence in the reliability of the model predictions.
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| 7. |
- Lidén, Tomas, 1961-
(författare)
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Concurrent planning of railway maintenance windows and train services
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Efficiency in public and freight transportation systems is of great importance for a society. Railways can other high capacity and relatively low environmental impact, but require that several technical systems are tuned and operate well. Specifically there is a tight interdependency between infrastructure and trains. The consequences are that all subsystems must be maintained and that the coordination of infrastructure activities and train operations is essential.Railway infrastructure maintenance and train services should ideally be planned together, but practice and research about railway scheduling has historically focused mainly on train operations and timetabling while maintenance planning has received less attention | and little research have considered the joint scheduling of both types of activities. Instead the traditional approach has been a sequential and iterative planning procedure, where train timetabling often has precedence over infrastructure maintenance.This thesis studies how maintenance windows, which are regular time windows reserved for maintenance work, can be dimensioned and jointly scheduled with train services in a balanced and efficient way for both maintenance contractors and train operators. Mathematical methods are used, with the aim of advancing the knowledge about quantitative methods for solving such coordination problems.The thesis contributes with new optimization models that jointly schedule maintenance windows and train services, investigates the solving efficiency of these models, and studies crucial extensions of the planning problem | primarily for the consideration of maintenance resources. Furthermore, the models are applied to, verified and validated on a demanding real-life problem instance. The main results are that integrated and optimal scheduling of maintenance windows and train services is viable for problems of practical size and importance, and that substantial maintenance cost savings can be achieved with such an integrated approach as compared to a traditional sequential planning process.The thesis consists of an introduction and overview of the research, followed by six papers which present: (1) A cost benefit model for assessment of competing capacity requests at a single location; (2) An optimization model for integrated scheduling of both maintenance windows and train services; (3) Mathematical reformulations that strengthen the optimization model; (4) Extensions for handling resource considerations and cyclic schedules; (5) A case study for a major single track line in Sweden; and (6) A mathematical study of length-restricted sequences under cyclic conditions.
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| 8. |
- van Es, Michael A, et al.
(författare)
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Genome-wide association study identifies 19p13.3 (UNC13A) and 9p21.2 as susceptibility loci for sporadic amyotrophic lateral sclerosis
- 2009
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Ingår i: Nature genetics. - : Springer Science and Business Media LLC. - 1546-1718 .- 1061-4036. ; 41:10, s. 1083-1087
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Tidskriftsartikel (refereegranskat)abstract
- We conducted a genome-wide association study among 2,323 individuals with sporadic amyotrophic lateral sclerosis (ALS) and 9,013 control subjects and evaluated all SNPs with P < 1.0 x 10(-4) in a second, independent cohort of 2,532 affected individuals and 5,940 controls. Analysis of the genome-wide data revealed genome-wide significance for one SNP, rs12608932, with P = 1.30 x 10(-9). This SNP showed robust replication in the second cohort (P = 1.86 x 10(-6)), and a combined analysis over the two stages yielded P = 2.53 x 10(-14). The rs12608932 SNP is located at 19p13.3 and maps to a haplotype block within the boundaries of UNC13A, which regulates the release of neurotransmitters such as glutamate at neuromuscular synapses. Follow-up of additional SNPs showed genome-wide significance for two further SNPs (rs2814707, with P = 7.45 x 10(-9), and rs3849942, with P = 1.01 x 10(-8)) in the combined analysis of both stages. These SNPs are located at chromosome 9p21.2, in a linkage region for familial ALS with frontotemporal dementia found previously in several large pedigrees.
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| 9. |
- Viney, N. R., et al.
(författare)
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Assessing the impact of land use change on hydrology by ensemble modelling (LUCHEM) II : Ensemble combinations and predictions
- 2009
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Ingår i: Advances in Water Resources. - : Elsevier BV. - 0309-1708 .- 1872-9657. ; 32:2, s. 147-158
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Tidskriftsartikel (refereegranskat)abstract
- This paper reports on a project to compare predictions from a range of catchment models applied to a mesoscale river basin in central Germany and to assess various ensemble predictions of catchment streamflow. The models encompass a large range in inherent complexity and input requirements. In approximate order of decreasing complexity, they are DHSVM, MIKE-SHE, TOPLATS, WASIM-ETH, SWAT, PRMS, SLURP, HBV, LASCAM and IHACRES. The models are calibrated twice using different sets of input data. The two predictions from each model are then combined by simple averaging to produce a single-model ensemble. The 10 resulting single-model ensembles are combined in various ways to produce multi-model ensemble predictions. Both the single-model ensembles and the multi-model ensembles are shown to give predictions that are generally superior to those of their respective constituent models, both during a 7-year calibration period and a 9-year validation period. This occurs despite a considerable disparity in performance of the individual models. Even the weakest of models is shown to contribute useful information to the ensembles they are part of. The best model combination methods are a trimmed mean (constructed using the central four or six predictions each day) and a weighted mean ensemble (with weights calculated from calibration performance) that places relatively large weights on the better performing models. Conditional ensembles. in which separate model weights are used in different system states (e.g. summer and winter, high and low flows) generally yield little improvement over the weighted mean ensemble. However a conditional ensemble that discriminates between rising and receding flows shows moderate improvement. An analysis of ensemble predictions shows that the best ensembles are not necessarily those containing the best individual models. Conversely, it appears that some models that predict well individually do not necessarily combine well with other models in multi-model ensembles. The reasons behind these observations may relate to the effects of the weighting schemes, non-stationarity of the climate series and possible cross-correlations between models.
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