| 1. |
- Arwidsson, Zandra, et al.
(författare)
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Remediation of soils and sludges containing organic contaminants as well as metals – soil-wash procedures combining biodegradation, chemical complexation and mechanical separation of particulate matter
- 2009
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Konferensbidrag (refereegranskat)abstract
- Soil contamination is an urgent issue world wide. More than 83,000 contaminated sites have been identified in Sweden alone, of which approximately some 4,000 require treatment in the near future. Most of the sites carry a mixture of contaminants, metals as well as persistent organics. Most soil remediation efforts are made ex situ, which means that the soil or sludge is dug up and transported to a facility for treatment, or simply for deposition. The aim of the present project is to design a strategy for ex situ treatment of soils with mixed contaminants. A variety of soils and sludges from different sites (around 10), essentially all with organic as well as inorganic (metallic) contaminants, have been selected for experimental studies in laboratory and pilot scale: Military sites (metals, explosives), wood preservation sites (PAHs, As, metals), industrial sites (metals, hydrocarbons, mercury, dioxins and others). Of particular importance in the present study are:Metals – Pb, Cu, Zn, Cr, Hg, as well as As Organics – PAHs, nitro aromatics, dioxinsA number of processes are selected and applied: •Biodegradation - use of commercially available cultures, as well as bacteria cultivated from the contaminated site itself •Mobilisation of organics - use of surface active agents •Mobilisation of metals - use of (1) complexing microbial metabolites produced in the soil (by fungii in paricular), (2) complexing agents generated by degradation of natural organic products (polyhydroxy carboxylic acids), and (3) artificial complexing agents (polyamino carboxylic acids).Biodegradation is performed in batches (anaerobic in most cases), while release and mobilisation of contaminants from soil aggregates are achieved during soil-wash performed in a dynamic system where wash solution is forced through the soil under high pressure (the WTC-process). The efficiency of biodegradation and subsequent soil-wash under various conditions is evaluated from chemical analysis, but also by several ecotoxicological tests. Some results are given that illustrates suitable strategies for treatment of mixed contaminated soil from real sites (soil) as well as for treatment of residues from industrial production (sludges etc).
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| 2. |
- Elgh-Dalgren, Kristin, 1980-, et al.
(författare)
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Laboratory and pilot scale soil washing of PAH and arsenic from a wood preservation site : Changes in concentration and toxicity
- 2009
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Ingår i: Journal of Hazardous Materials. - Amsterdam : Elsevier. - 0304-3894 .- 1873-3336. ; 172:2-3, s. 1033-1040
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Tidskriftsartikel (refereegranskat)abstract
- Soil washing of a soil with a mixture of both polycyclic aromatic hydrocarbons (PAH) and As was evaluated in laboratory and pilot scale, utilizing both single and mixtures of different additives. The highest level of decontamination was achieved with a combination of 0.213 M of the chelating agent MGDA and 3.2xCMC* of a nonionic, alkyl glucoside surfactant at pH 12 (Ca(OH)2). This combination managed to reach Swedish threshold values within 10 min of treatment when performed at elevated temperature (50°C), with initial contaminant concentrations of As = 105±4 mg/kg and US-EPA PAH16 = 46.0±2.3 mg/kg. The main mechanisms behind the removal were the pH-effect for As and a combination of SOM-ionization as a result of high pH and micellar solubilization for PAHs. Implementation of the laboratory results utilizing a pilot scale equipment did not improve the performance, which may be due to the shorter contact time between the washing solution and the particles, or changes in physical characteristics of the leaching solution due to the elevated pressure utilized. The ecotoxicological evaluation, Microtox®, demonstrated that all soil washing treatments increased the toxicity of soil leachates, possibly due to increased availability of contaminants and toxicity of soil washing solutions to the test organism.
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| 3. |
- Hoiom, Veronica, et al.
(författare)
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MC1R variation and melanoma risk in the Swedish population in relation to clinical and pathological parameters
- 2009
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Ingår i: Pigment Cell & Melanoma Research. - 1755-148X .- 1755-1471. ; 22:2, s. 196-204
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Tidskriftsartikel (refereegranskat)abstract
- The genetic background of cutaneous malignant melanoma (CMM) includes both germ line aberrations in high-penetrance genes, like CDKN2A, and allelic variation in low-penetrance genes like the melanocortin-1 receptor gene, MC1R. Red-hair colour associated MC1R alleles (RHC) have been associated with red hair, fair skin and risk of CMM. We investigated MC1R and CDKN2A variation in relation to phenotype, clinical factors and CMM risk in the Swedish population. The study cohort consisted of sporadic primary melanoma patients, familial melanoma patients and a control group. An allele-dose dependent increase in melanoma risk for carriers of variant MC1R alleles (after adjusting for phenotype), with an elevated risk among familial CMM patients, was observed. This elevated risk was found to be significantly associated with an increased frequency of dysplastic nevi (DN) among familial patients compared to sporadic patients. MC1R variation was found to be less frequent among acral lentiginous melanomas (ALM) and dependent on tumour localisation. No association was found between CDKN2A gene variants and general melanoma risk. Two new variants in the POMC gene were identified in red haired individuals without RHC alleles.
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| 4. |
- Rendo, Verónica, et al.
(författare)
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Exploiting loss of heterozygosity for allele-selective colorectal cancer chemotherapy
- 2020
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Ingår i: Nature Communications. - : Springer Science and Business Media LLC. - 2041-1723. ; 11
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Tidskriftsartikel (refereegranskat)abstract
- Allelic losses occurring in cancer cells have been suggested as potential targets for therapy. Here, the authors show how recurring loss of heterozygosity of a drug metabolic gene in colorectal cancers can be exploited using a low molecular weight compound. Cancer chemotherapy targeting frequent loss of heterozygosity events is an attractive concept, since tumor cells may lack enzymatic activities present in normal constitutional cells. To find exploitable targets, we map prevalent genetic polymorphisms to protein structures and identify 45 nsSNVs (non-synonymous small nucleotide variations) near the catalytic sites of 17 enzymes frequently lost in cancer. For proof of concept, we select the gastrointestinal drug metabolic enzyme NAT2 at 8p22, which is frequently lost in colorectal cancers and has a common variant with 10-fold reduced activity. Small molecule screening results in a cytotoxic kinase inhibitor that impairs growth of cells with slow NAT2 and decreases the growth of tumors with slow NAT2 by half as compared to those with wild-type NAT2. Most of the patient-derived CRC cells expressing slow NAT2 also show sensitivity to 6-(4-aminophenyl)-N-(3,4,5-trimethoxyphenyl)pyrazin-2-amine (APA) treatment. These findings indicate that the therapeutic index of anti-cancer drugs can be altered by bystander mutations affecting drug metabolic genes.
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| 5. |
- Sjöberg, Veronica, et al.
(författare)
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Content Validity and Feasibility of the eVISualisation of physical activity and pain (eVIS) intervention in Interdisciplinary Pain Rehabilitation Programs : Valuable steps in a systematical development and evaluation process
- 2022
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Konferensbidrag (refereegranskat)abstract
- Background and aims: *Low physical health is one consequence that chronic pain encompasses. To improveeffectiveness of Interdisciplinary pain rehabilitation programs (IPRP) theeVISualisation of physical activity and pain (eVIS) intervention was developed. Thepurpose of this study was to evaluate eVIS validity by the aspects of content validityand clinical feasibility in IPRP-context.Methods: *This observational study was performed in 3 phases. Twenty-two field experts (patients,caregivers, researchers) participated, and provided quantitative scores and qualitativecomments on eVIS and its included elements (data collection, visualization,communication). In phase 1, ratings on a four-point Likert scale of each element´scontent validity (relevance, simplicity, safety) were collected through digitalquestionnaires. Three iterative assessment loops were completed, each followed byconsensus panel protocol revisions. Item-level content validity index (I-CVI), averageand overall CVI were calculated, and free-text comments were analyzed. In phase 2,ratings of content validity and elements’ clinical feasibility categorized in 5 focus areas(acceptability, demand, implementation, limited efficacy, practicality), were collectedfrom patients and caregivers after 2-3 weeks test trial. Phase 3 involved follow-up focusgroup interview with caregivers on specific ratings, as well as interviews with expertsin clinical pain management pharmacology.Results: *CVI for relevance, simplicity and safety improved over time and were all rated abovecut-off (0.78). Revisions were mainly made in the visualization element. In phase 2,participants rated eVIS as relevant and feasible to use in clinical IPRP-context.Conclusions: *Patients, caregivers, and researchers found eVIS valid in IPRP-context. Methodicalvalidation was essential to ascertain eVIS’ substantiality before clinical trial.
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| 6. |
- Sjöberg, Veronica, et al.
(författare)
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Effectiveness of the eVISualisation of physical activity and pain (eVIS) intervention in Interdisciplinary Pain Rehabilitation Programs : Study Protocol for a Registry-based Randomised Controlled Clinical Trial
- 2022
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Konferensbidrag (refereegranskat)abstract
- Background and aims: * Interdisciplinary Pain Rehabilitation Programs (IPRPs) are considered to be superior to single-treatment measures in chronic pain treatment. However, the effects of IPRPs are moderate and as many as 30% of patients deteriorate in some outcomes. Although physical activity and exercise are central components in IPRPs, many patients struggle to achieve and maintain the recommended levels. An intervention, entitled eVISualisation of physical activity and pain (eVIS), has now been systematically developed and designed to facilitate patients with chronic pain in achieving and maintaining recommended physical activity levels. The aim of the present study protocol is to transparently report on the methodology, outcomes, and processes for an initiated registry-based randomized controlled trial (R-RCT), which will evaluate the effectiveness of eVIS on the primary outcome physical health and defined secondary outcomes. Methods: * Participants (approximately 400) will be recruited from IPRP units and randomly allocated to either IPRP with an addition of eVIS or to treatment as usual by IPRP. eVIS entails objectively measured physical activity and patient-reported outcomes of pain intensity, effect on daily activities and pharmaceutical consumption. Data is collected and visualized in a web application, PATRON. Pilot analyses evaluating the feasibility of the R-RCT will be performed on data from initial 30 participants. Outcomes will be extracted from PATRON and from six national registries. Multivariate statistics and repeated measures analyses will be performed. Results: * Recruitment will be initiated in late 2021. ClinicalTrials.gov identifier: NCT05009459. Conclusions: * This study protocol describes a R-RCT that is designed to provide robust data on the feasibility and effectiveness of eVIS as an addition to IPRPs.
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| 7. |
- Sjöberg, Veronica, et al.
(författare)
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Effectiveness of the eVISualisation of physical activity and pain intervention (eVIS) in Swedish Interdisciplinary Pain Rehabilitation Programmes: study protocol for a registry-based randomised controlled clinical trial
- 2022
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Ingår i: BMJ open. - : BMJ. - 2044-6055. ; 12:4, s. e055071-
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Tidskriftsartikel (refereegranskat)abstract
- Living with chronic pain often involves negative consequences. Interdisciplinary Pain Rehabilitation Programmes (IPRP) is considered superior to single-treatment measures in patients with chronic pain. Despite this, effects emerge suboptimal and more than 20% of patients deteriorate in patient-reported physical health outcomes after IPRP. A novel e-Health intervention, eVISualisation (eVIS) of physical activity and pain, was systematically developed to facilitate individualisation of physical activity levels. By adding elements of data collection, visualisation and communication of objectively measured physical activity and patient-reported outcomes (pain intensity, interference of pain, pharmaceutical consumption) to existing treatment modalities in IPRP, the IPRP team acquires prerequisites to adapt advice and physical activity prescriptions and to evaluate set activity goals. The overall aim is twofold. First, the aim is to evaluate the feasibility of the subsequent registry-based randomised controlled clinical trial (R-RCT). Second, the aim is to prospectively evaluate the effectiveness of the eVIS-intervention as a supplement to IPRP on our defined primary (physical health) and secondary outcomes.Methods and analysisIn the R-RCT, recruitment of 400 patients with chronic pain will be performed at 15 IPRP units. A random allocation to either IPRP + eVIS or to control group that will receive IPRP only will be performed. Data from the initial 30 participants completing the study period (6 months) will be included in a pilot study, where key feasibility outcomes (recruitment, randomisation, implementation, treatment integrity, data collection procedure, preliminary outcome measures) will be evaluated. Outcome variables will be extracted from the web application Pain And TRaining ON-line (PATRON) and from six national registries. Multivariate statistics and repeated measure analyses will be performed. Quality-adjusted life years and incremental cost-effectiveness ratio will be calculated for cost-effectiveness evaluation.Ethics/disseminationThe Swedish Ethics Review Board granted approval (Dnr 2021/02109). Results will be disseminated through peer-reviewed journals.Trial registration numberNCT05009459. Protocol V.1.
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| 8. |
- Sjöberg, Veronica
(författare)
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eVIS – A digital support for physical activity in patients with chronic pain
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Chronic pain is a significant contemporary health challenge, exerting enormous impact on both individuals and societies. Although physical activity is the primary treatment, many patients struggle with incorporating it into their lives. In order to facilitate individualised physical activity within Interdisciplinary Pain Rehabilitation Programs (IPRP), the eVISualisation of physical activity and pain intervention was developed. This intervention consists of device-based measured physical activity, jointly visualised with patient-reported pain intensity, pain interference, and pharmaceutical consumption. Overall aim: To i) develop the eVIS intervention as a digital support for physical activity in IPRP, ii) to evaluate eVIS’s validity, feasibility, and acceptability as a supplementary treatment for patients taking part of IPRP, and iii) to evaluate the feasibility and acceptability of the trial design and conduct of an ongoing Registry-based Randomised Clinical Trial (R-RCT), where the effectiveness of eVIS as an addition to IPRP is evaluated.Methods: The Medical Research Council’s updated framework for development and evaluation of complex interventions guided study designs and methodologies. This thesis contains four papers: I. Evaluation of the criterion validity of a wrist-worn activity tracker, II. Evaluation of pre-clinical content validity of eVIS, III. A study protocol outlining trial design and trial conduct of an ongoing R-RCT, and IV. Evaluation of the aforementioned trial design and trial conduct. Results: The wrist-worn activity tracker provided fair to acceptable measurements of SR. In collaboration with relevant stakeholders, eVIS was continuously developed and found to be relevant, simple, and safe for use by patients, clinicians, and researchers. The first real-world test of the clinical feasibility of the intervention motivated further development in the web application and procedures relating to recruitment and data collection. The evaluation of the acceptability and feasibility of the trial design and conduct provided promising results, with mainly satisfactory feasibility. However, minor revisions are required to safeguard the external validity of the ongoing R-RCT. Conclusions: Through continuous refinement in collaboration with stakeholders and careful consideration of the intervention’s complexity, key uncertainties, and context, indicate that the intervention is relevant, valid, feasible, and well prepared for effectiveness testing.
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| 9. |
- Sjöberg, Veronica, et al.
(författare)
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Shifting roles : physiotherapists’ perception of person-centered care during a pre-implementation phase in the acute hospital setting - A phenomenographic study
- 2022
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Ingår i: Physiotherapy Theory and Practice. - : Taylor & Francis. - 0959-3985 .- 1532-5040. ; 38:7, s. 879-889
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Tidskriftsartikel (refereegranskat)abstract
- Background: Person-centered care (PCC) is an acknowledged health care practice involving increased patient influence regarding decisions and deliberation. Research indicates that physiotherapists (PTs) embrace patient participation, but that PCC is difficult to grasp and fully implement.Objective: To contribute to knowledge about how PCC influences physiotherapy by eliciting PTs’ experiences from the acute care setting, this study aims to describe and illuminate variations in perceptions of PCC during a pre-implementation phase, among PTs in acute hospital care.Methods: Phenomenological approach: individual interviews with PTs in acute care (n = 7) combined with focus group interviews (n = 3).Findings: The analysis yielded two main categories: 1) Physiotherapists perceived a transformed patient role involved in the transition from patient to person; and 2) Physiotherapists perceived a challenged professional role when departing from the expert role, and entailed restrictions to prescribing the best treatment and, instead, meant aiming for a collaborative and equal relationship with the patient.Conclusion: Although the interviewed PTs embraced PCC in principle, PCC does seem to challenge the professional roles of patient and PT. The findings indicate that theories of power relations need to be considered, and further reflection may facilitate implementation. More research is needed to deepen the knowledge of how PTs perceive PCC during all implementation phases.
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| 10. |
- Sjöberg, Veronica, et al.
(författare)
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Wrist-Worn Activity Trackers in Laboratory and Free-Living Settings for Patients With Chronic Pain : Criterion Validity Study
- 2021
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Ingår i: JMIR mhealth and uhealth. - : JMIR Publications. - 2291-5222. ; 9:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Physical activity is evidently a crucial part of the rehabilitation process for patients with chronic pain. Modern wrist-worn activity tracking devices seemingly have a great potential to provide objective feedback and assist in the adoption of healthy physical activity behavior by supplying data of energy expenditure expressed as metabolic equivalent of task units (MET). However, no studies of any wrist-worn activity tracking devices & rsquo; have examined criterion validity in estimating energy expenditure, heart rate, or step count in patients with chronic pain.Objective: The aim was to determine the criterion validity of wrist-worn activity tracking devices for estimations of energy expenditure, heart rate, and step count in a controlled laboratory setting and free-living settings for patients with chronic pain.Methods: In this combined laboratory and field validation study, energy expenditure, heart rate, and step count were simultaneously estimated by a wrist-worn activity tracker (Fitbit Versa), indirect calorimetry (Jaeger Oxycon Pro), and a research-grade hip-worn accelerometer (ActiGraph GT3X) during treadmill walking at 3 speeds (3.0 km/h, 4.5 km/h, and 6.0 km/h) in the laboratory setting. Energy expenditure and step count were also estimated by the wrist-worn activity tracker in free-living settings for 72 hours. The criterion validity of each measure was determined using intraclass and Spearman correlation, Bland-Altman plots, and mean absolute percentage error. An analysis of variance was used to determine whether there were any significant systematic differences between estimations.Results: A total of 42 patients (age: 25-66 years; male: 10/42, 24%; female: 32/42, 76%), living with chronic pain (duration, in years: mean 9, SD 6.72) were included. At baseline, their mean pain intensity was 3.5 (SD 1.1) out of 6 (Multidimensional Pain Inventory, Swedish version). Results showed that the wrist-worn activity tracking device (Fitbit Versa) systematically overestimated energy expenditure when compared to the criterion standard (Jaeger Oxycon Pro) and the relative criterion standard (ActiGraph GT3X). Poor agreement and poor correlation were shown between Fitbit Versa and both Jaeger Oxycon Pro and ActiGraph GT3X for estimated energy expenditure at all treadmill speeds. Estimations of heart rate demonstrated poor to fair agreement during laboratory-based treadmill walks. For step count, the wrist-worn devices showed fair agreement and fair correlation at most treadmill speeds. In free-living settings; however, the agreement for step count between the wrist-worn device and waist-worn accelerometer was good, and the correlation was excellent.Conclusions: The wrist-worn device systematically overestimated energy expenditure and showed poor agreement and correlation compared to the criterion standard (Jaeger Oxycon Pro) and the relative criterion standard (ActiGraph GT3X), which needs to be considered when used clinically. Step count measured with a wrist-worn device, however, seemed to be a valid estimation, suggesting that future guidelines could include such variables in this group with chronic pain.
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