| 1. |
- Frigyesi, Attila, et al.
(författare)
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Plasma proenkephalin A 119-159 on intensive care unit admission is a predictor of organ failure and 30-day mortality
- 2021
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Ingår i: Intensive Care Medicine Experimental. - : Springer Science and Business Media LLC. - 2197-425X. ; 9:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Proenkephalin A 119-159 (penKid) has been suggested as a marker of renal failure and poor outcome. We aimed to investigate the association of penKid on ICU admission with organ dysfunction and mortality in a mixed ICU population. In this retrospective, observational study, admission penKid levels from prospectively collected blood samples of consecutive patients admitted to four Swedish ICUs were analysed. The association of penKid with day-two sequential organ failure assessment (SOFA) scores and 30-day mortality was investigated using (ordinal) logistic regression. The predictive power of penKid for 30-day mortality and dialysis was assessed using the area under the receiver operating characteristic curve (AUC).RESULTS: Of 1978 included patients, 632 fulfilled the sepsis 3-criteria, 190 had a cardiac arrest, and 157 had experienced trauma. Admission penKid was positively associated with 30-day mortality with an odds ratio of 1.95 (95% confidence interval 1.75-2.18, p < 0.001), and predicted 30-day mortality in the entire ICU population with an AUC of 0.71 (95% confidence interval 0.68-0.73) as well as in the sepsis, cardiac arrest and trauma subgroups (AUCs of 0.61-0.84). Correction for admission plasma creatinine revealed that penKid correlated with neurological dysfunction.CONCLUSION: Plasma penKid on ICU admission is associated with day-two organ dysfunction and predictive of 30-day mortality in a mixed ICU-population, as well as in sepsis, cardiac arrest and trauma subgroups. In addition to being a marker of renal dysfunction, plasma penKid is associated with neurologic dysfunction in the entire ICU population, and cardiovascular dysfunction in sepsis.
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| 2. |
- Hindorf, Marie, et al.
(författare)
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Workload of Swedish Special Forces Operators Experienced During Stressful Simulation Training: A Pilot Study
- 2022
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Ingår i: Journal of Special Operations Medicine. - : Breakaway Media, LLC. - 1553-9768. ; 22:3, s. 42-48
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Stress week was included during training of Special Forces (SF) Operators in Sweden to test their ability and limits for handling stress in different unknown situations and environments at a military training facility in Sweden. The aim of the study was to examine the effects of stress and workload experienced in various tasks during firefighting and military medicine simulation training.Methods: This pilot study was performed during the second day of stress week. The National Aeronautics and Space Administration Task Load Index (NASA-TLX) is a validated, subjective, and multidimensional assessment tool for rating perceived workload with six subscales: mental demand, physical demand, temporal demand, performance, effort, and frustration. These subscales were used as an indicator of stress experienced. The different tasks were assessed by the SF Operators by rating the NASA-TLX subscales for each task, which were then analyzed and compared using ANOVA.Results: There was a significant difference between the two simulation exercises assessed by the participants and instructors, and both groups considered firefighting to be more demanding than medical. The participants perceived the mental and physical demands as more demanding in the firefighting exercises, as well as for the level of frustration and effort. However, no differences regarding performance or temporal demands between the simulation exercises were found.Conclusion: The principle "train as you fight" implies difficult and demanding situations. When exposing Swedish SF Operators to challenging situations, assessment of perceived stress and performance are possible.
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| 3. |
- Isoz, Oscar
(författare)
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Interference detection and localization in the GPS L1 frequency band
- 2012
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The usage of Global Navigation Satellite Systems (GNSS) in general and the American GPS in particular increases everyday and so does the number of applications where it is used. The GNSS receivers relies on receiving signals from satellites orbiting the earth at an altitude of about 20 000 km and the signals received by the receiver are signicantly weaker then the background noise. Due to the weak signals it is fairly easy to intentionally or accidentally make it very hard or even impossible for a receiver to detect and track the satellites.With this in mind there is a need to develop cost eective methods to detect and localize interference so that appropriate counter measures can be taken. A number of methods have been proposed to detect and localize these sources. The complexity of these methods ranges from requiring future cellphones to contain software to monitor the GNSS environment to dedicated systems with multiple antennas and complicated hardware. In this thesis, two complementary methods will be presented which can detect and also localize interference in the GNSS bands using minimum amount of equipment. The equipment is based around a type of GNSS "receiver" that only samples the GNSS frequency so that it can be processed using a software dened GNSS eceiver. It will be shown that it is capable of detecting and localizing interference sources while also be cost eective and easily deployable. The rst technique is based on measuring the received power level. Since the GNSS signals are below the noise oor, the number of visible satellites will not aect the received power level. Instead the received power level will be aected by changes in the spectrum and changes in the receiver hardware. The GNSS signal is fairly robust against interference so an interferer usually has to have a signicantly higher signal power than the received power from the satellites in order to cause problems for the receiver. By monitoring the received signal power using multiple receivers it is possible to both detect interference and estimate the position of the transmitter. This method requires very little bandwidth but since the signal is measured in the analog domain it is sensitive to process variations between dierent receivers. Also, the nonlinear behaviour of the analog components in the receiver limits the accuracy of the position estimations. To improve the accuracy of the interference localization, a second method has been evaluated. In this method the GNSS samples recorded by dierent receivers at different locations is compared. When a GNSS receiver calculates a position it is actually calculating the time it takes for the signals to travel from the satellite to the receiver. This made it possible to synchronize data from multiple independent receivers both in time and frequency and then estimate the time dierence of arrival of the interfering signal between the dierent receivers. Both localization methods were evaluated during experiments done with assistance from the Swedish armed forces research agency (FOI). It will be shown that the signal power measurement can be used as a detector for interference and that the GPS signal can be used to synchronize data from independent stations so that the dierence in distance to a wideband transmitter can be estimated. To determine the amount of interference in the GPS L1 band two measurement campaigns were made. The rst campaign, measured where interference might be present in an urban area using a car mounted receiver. The other campaign took place at two airports in the summer and fall of 2011 and measured the interference level from xed antennas over an extended period of time.All research was done using the GPS L1 signal but the methods can easily be applied to other GNSS signals as well.
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| 4. |
- Lengquist, Maria, et al.
(författare)
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Sepsis Is Underreported in Swedish Intensive Care Units: A Retrospective Observational Multicentre Study
- 2020
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; , s. 1167-1167
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundSepsis is a common indication for admission to the intensive care unit (ICU). Since definitions vary across studies, comparisons of prevalence and outcomes have been challenging. We aimed to compare sepsis according to ICU discharge codes with sepsis according to Sepsis‐3 criteria and to investigate the epidemiology of sepsis in the ICU. We hypothesized that sepsis using discharge codes is underreported.MethodsAdult ICU admissions to four ICUs in Sweden between 2015 and 2017 were screened for sepsis according to the Sepsis‐3 criteria. Medical records were reviewed and data extracted from the Swedish Intensive Care Registry.ResultsOf 5990 adult ICU patients, 28% fulfilled the Sepsis‐3 criteria on admission, but only 31% of them had sepsis as the registered main diagnosis at ICU discharge. Of the 1654 Sepsis‐3 patients, 38% met the septic shock criteria. The Sepsis‐3 in‐hospital mortality was 26% compared to 33% in patients with septic shock. The incidence rate for ICU‐treated sepsis was 81 cases per 100 000 person‐years. One in four had a positive blood culture, and 44% were culture negative.ConclusionThis large Swedish multicentre study showed that 28% of adult ICU patients fulfilled the Sepsis‐3 criteria, but only one third of them had sepsis according to ICU discharge codes. We could confirm our hypothesis, that sepsis is severely underreported in Swedish ICUs, and we conclude that discharge codes should not be used for quality control or research purposes.
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| 5. |
- Lundberg, Oscar, et al.
(författare)
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Adrenomedullin and endothelin-1 are associated with myocardial injury and death in septic shock patients
- 2016
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Ingår i: Critical Care. - : Springer Science and Business Media LLC. - 1364-8535 .- 1466-609X. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- AbstractBackgroundAdrenomedullin and endothelin-1 are hormones with opposing effects on the cardiovascular system. Adrenomedullin acts as a vasodilator and seems to be important for the initiation and continuation of the hyperdynamic circulatory response in sepsis. Endothelin-1 is a vasoconstrictor and has been linked to decreased cardiac performance. Few studies have studied the relationship between adrenomedullin and endothelin-1, and morbidity and mortality in septic shock patients. High-sensitivity troponin T (hsTNT) is normally used to diagnose acute cardiac injury but is also prognostic for outcome in intensive care. We investigated the relationship between mid-regional pro-adrenomedullin (MR-proADM), C-terminal pro-endothelin-1 (CT-proET-1), and myocardial injury, measured using transthoracic echocardiography and hsTNT in septic shock patients. We were also interested in the development of different biomarkers throughout the ICU stay, and how early measurements were related to mortality. Further, we assessed if a positive biomarker panel, consisting of MR-proADM, CT-proET-1, and hsTNT changed the odds for mortality.MethodsA cohort of 53 consecutive patients with septic shock had their levels of MR-proADM, CT-proET-1, hsTNT, and left ventricular systolic functions prospectively measured over 7 days. The relationship between day 1 levels of MR-proADM/CT-proET-1 and myocardial injury was studied. We also investigated the relationship between biomarkers and early (7-day) and later (28-day) mortality. Likelihood ratios, and pretest and posttest odds for mortality were calculated.ResultsLevels of MR-proADM and CT-proET-1 were significantly higher among patients with myocardial injury and were correlated with left ventricular systolic dysfunction. MR-proADM and hsTNT were significantly higher among 7-day and 28-day non-survivors. CT-proET-1 was also significantly higher among 28-day but not 7-day non-survivors. A positive biomarker panel consisting of the three biomarkers increased the odds for mortality 13-fold to 20-fold.ConclusionsMR-proADM and CT-proET-1 are associated with myocardial injury. A biomarker panel combining MR-proADM, CT-proET-1, and hsTNT increases the odds ratio for death, and may improve currently available scoring systems in critical care.Keywords: Sepsis, Shock, Adrenomedullin, Endothelin-1, High-sensitivity troponin, Echocardiography, Myocardial injury, Mortality, Likelihood ratio
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| 6. |
- Lundberg, Oscar
(författare)
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Adrenomedullin in sepsis
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- AbstractBackgroundSepsis is a syndrome difficult to diagnose and stratify. The epidemiology of sepsis and consistency of criteria fulfillment with diagnosis coding in Swedish intensive care units (ICU) are largely unknown. Biomarkers can be of help to understand pathophysiology, identify clusters within sepsis and to individualize treatment.AimThe overarching aim of this thesis was to explore how adrenomedullin (ADM) relates, alone or in combination with other biomarkers, to sepsis in regard to mortality and illness severity among patients in the ICU and emergency department (ED). Due to the suspected underreporting of sepsis, and in order to relate admission ADM levels with sepsis definitions, the epidemiology of sepsis at ICU admission was described.MethodsThe cohorts included in this thesis, formed by sepsis and non-sepsis patients admitted to the ICU as well as sepsis patient in the ED, had their levels of ADM and other biomarkers measured and related to mortality, organ failure, need for organ support, and, when possible, to ICU admission and ED discharge.ResultsThe levels of ADM, endothelin-1 (ET-1) and high-sensitivity troponin t (hsTNT) were described during the first 7 days of ICU admission in a septic shock cohort and showed a significant association with mortality and myocardial injury. A positive biomarker panel with all three biomarkers increased the odds for mortality 13 to 20-fold.Approximately one third of all ICU admissions fulfilled the sepsis-3 criteria, but the consistency with diagnosis coding was poor, as only 31% of these patients had sepsis as main diagnosis.Among sepsis and non-sepsis ICU patients alike, increasing levels of ADM were associated with mortality and need for organ support. After adjusting for severity of disease an association of ADM with sepsis was seen.ADM measured among ED sepsis patients showed significant association with mortality, severe organ failure, ICU admission and ED discharge. Further, ADM added information to other known demographic predictors and routine biomarkers.ConclusionsADM, alone or in combination with other biomarkers, adds information to known prognostic factors and seems to be of aid in triaging, stratification and prognostication of sepsis patients in the ED and ICU.
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| 7. |
- Lundberg, Oscar, et al.
(författare)
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Bioactive adrenomedullin in sepsis patients in the emergency department is associated with mortality, organ failure and admission to intensive care
- 2022
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Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 17:4, s. 1-16
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundAdrenomedullin is a vasoactive hormone with potentially prognostic and therapeutic value, which mainly has been investigated in intensive care unit (ICU) settings. The triaging in the emergency department (ED) of patients to the right level of care is crucial for patient outcome.ObjectivesThe primary aim of this study was to investigate the association of bioactive adrenomedullin (bio-ADM) with mortality among sepsis patients in the ED. Secondary aims were to investigate the association of bio-ADM with multiple organ failure (MOF), ICU admission and ED discharge.MethodsIn this prospective observational cohort study, adult sepsis patients in the ED (2013–2015) had blood samples collected for later batch analysis of bio-ADM. Odds ratios (OR) with 95% confidence interval (CI) for bio-ADM were calculated.ResultsBio-ADM in 594 sepsis patients was analyzed of whom 51 died within 28 days (8.6%), 34 developed severe MOF, 27 were ICU admitted and 67 were discharged from the ED. The median (interquartile range) bio-ADM was 36 (26–56) and 63 (42–132) pg/mL among survivors and non-survivors, respectively, 81 (56–156) pg/mL for patients with severe MOF and 77 (42–133) pg/mL for ICU admitted patients. Each log-2 increment of bio-ADM conferred an OR of 2.30 (95% CI 1.74–3.04) for mortality, the adjusted OR was 2.39 (95% CI 1.69–3.39). The area under the receiver operating characteristic curve of a prognostic mortality model based on demographics and biomarkers increased from 0.80 to 0.86 (p = 0.02) when bio-ADM was added. Increasing bio-ADM was associated with severe MOF, ICU admission and ED discharge with adjusted ORs of 3.30 (95% CI 2.13–5.11), 1.75 (95% CI 1.11–2.77) and 0.46 (95% CI 0.32–0.68), respectively.ConclusionBio-ADM in sepsis patients in the ED is associated with mortality, severe MOF, ICU admission and ED discharge, and may be of clinical importance for triage of sepsis patients in the ED.
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| 8. |
- Lundberg, Oscar, et al.
(författare)
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Cycles of innovation and alignment in digital transformation : investigating the dynamics of resource recombination in a construction firm
- 2020
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Ingår i: Proceedings of the 53rd Hawaii International Conference on System Sciences, HICSS 2020. - : IEEE Computer Society. - 9780998133133 ; , s. 4346-4355
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Konferensbidrag (refereegranskat)abstract
- The generative nature of digital technology implies that during digital transformation (DT), organizations traverse multiple cycles of innovation and resource alignment. Still, extant research mainly chronicles DT as linear and contained phenomenon occurring in response to a dramatic environmental change event. How new resources align with previous ones into novel combinations, the work that supports continuous organizational capability building, and the temporal relationships between cycles of change in DT has received scant attention. Drawing on dynamic capability theory, we analyze innovation and resource alignment cycles driving DT at Lundqvist Trävaru AB, a small Swedish construction firm. Our study has at least two contributions. First, the analysis reveals three types of dynamic capabilities that shape resource generation and alignment in DT. Second, we provide a process model outlining the innovation and alignment cycles that fuel DT as they scale in the focal firm.
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| 9. |
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| 10. |
- Lundberg, Oscar H.M., et al.
(författare)
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Circulating bioactive adrenomedullin as a marker of sepsis, septic shock and critical illness
- 2020
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Ingår i: Critical Care. - : Springer Science and Business Media LLC. - 1364-8535. ; 24:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Biomarkers can be of help to understand critical illness and to identify and stratify sepsis. Adrenomedullin is a vasoactive hormone, with reported prognostic and potentially therapeutic value in sepsis. The primary aim of this study was to investigate the association of circulating bioactive adrenomedullin (bio-ADM) levels at intensive care unit (ICU) admission with mortality in sepsis patients and in a general ICU population. Secondary aims included the association of bio-ADM with organ failure and the ability of bio-ADM to identify sepsis. Methods: In this retrospective observational study, adult patients admitted to one of four ICUs during 2016 had admission bio-ADM levels analysed. Age-adjusted odds ratios (OR) with 95% CI for log-2 transformed bio-ADM, and Youden’s index derived cut-offs were calculated. The primary outcome was 30-day mortality, and secondary outcomes included the need for organ support and the ability to identify sepsis. Results: Bio-ADM in 1867 consecutive patients were analysed; 632 patients fulfilled the sepsis-3 criteria of whom 267 had septic shock. The median bio-ADM in the entire ICU population was 40 pg/mL, 74 pg/mL in sepsis patients, 107 pg/mL in septic shock and 29 pg/mL in non-septic patients. The association of elevated bio-ADM and mortality in sepsis patients and the ICU population resulted in ORs of 1.23 (95% CI 1.07–1.41) and 1.22 (95% CI 1.12–1.32), respectively. The association with mortality remained after additional adjustment for lactate in sepsis patients. Elevated bio-ADM was associated with an increased need for dialysis with ORs of 2.28 (95% CI 2.01–2.59) and 1.97 (95% CI 1.64–2.36) for the ICU population and sepsis patients, respectively, and with increased need of vasopressors, OR 1.33 (95% CI 1.23–1.42) (95% CI 1.17–1.50) for both populations. Sepsis was identified with an OR of 1.78 (95% CI 1.64–1.94) for bio-ADM, after additional adjustment for severity of disease. A bio-ADM cut-off of 70 pg/mL differentiated between survivors and non-survivors in sepsis, but a Youden’s index derived threshold of 108 pg/mL performed better. Conclusions: Admission bio-ADM is associated with 30-day mortality and organ failure in sepsis patients as well as in a general ICU population. Bio-ADM may be a morbidity-independent sepsis biomarker.
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