| 1. |
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| 2. |
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| 3. |
- Flygt, Hjalmar, et al.
(författare)
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Successful tyrosine kinase inhibitor discontinuation outside clinical trials - data from the population-based Swedish chronic myeloid leukaemia registry
- 2021
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Ingår i: British Journal of Haematology. - : John Wiley & Sons. - 0007-1048 .- 1365-2141. ; 193:5, s. 915-921
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Tidskriftsartikel (refereegranskat)abstract
- Clinical trials show that tyrosine kinase inhibitor (TKI) treatment can be discontinued in selected patients with chronic myeloid leukaemia (CML). Although updated CML guidelines support such procedure in clinical routine, data on TKI stopping outside clinical trials are limited. In this retrospective study utilising the Swedish CML registry, we examined TKI discontinuation in a population-based setting. Out of 584 patients diagnosed with chronic-phase CML (CML-CP) in 2007-2012, 548 had evaluable information on TKI discontinuation. With a median follow-up of nine years from diagnosis, 128 (23%) discontinued TKI therapy (>= 1 month) due to achieving a DMR (deep molecular response) and 107 (20%) due to other causes (adverse events, allogeneic stem cell transplant, pregnancy, etc). Among those stopping in DMR, 49% re-initiated TKI treatment (median time to restart 4 center dot 8 months). In all, 38 patients stopped TKI within a clinical study and 90 outside a study. After 24 months 41 center dot 1% of patients discontinuing outside a study had re-initiated TKI treatment. TKI treatment duration pre-stop was longer and proportion treated with second-generation TKI slightly higher outside studies, conceivably affecting the clinical outcome. In summary we show that TKI discontinuation in CML in clinical practice is common and feasible and may be just as successful as when performed within a clinical trial.
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| 6. |
- Akil, Shahnaz, et al.
(författare)
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Influence of different time framings, reconstruction algorithms and post-processing methods on the quantification of myocardial blood flow from 13N-NH3 PET images
- 2024
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Ingår i: Clinical Physiology and Functional Imaging. - 1475-0961. ; 44:2, s. 154-163
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Tidskriftsartikel (refereegranskat)abstract
- Background: The aim was to investigate to what extent the quantification of myocardial blood flow (MBF) from dynamic 13N-NH3 positron emission tomography (PET) images is affected by time frame schemes, time-of-flight (ToF), reconstruction algorithms, blood pool volume of interest (VOI) locations and compartment models in patients with suspected chronic coronary syndrome. Methods: A standard MBF value was determined from 25 patients' rest/stress 13N-NH3 PET/CT images reconstructed with ordered subset expectation maximization (OSEM), 5 s time frame for the first frames without ToF, subsequently analyzed using a basal VOI and the deGrado compartment model. MBFs calculated using 2 or 10 s for the first frames, ToF, block-sequential regularized expectation maximization (BSREM), apical or large VOI, Hutchins or Krivokapich compartment models were compared to MBFstandard in Bland–Altman plots (bias ± SD). Results: Good agreement in global rest/stress MBF (mL/min/g) was found when changing the time frame scheme or reconstruction algorithm (MBFstandard vs. MBF2s: −0.02 ± 0.06; MBF10s: 0.01 ± 0.07; MBFBSREM: 0.01 ± 0.07), while a lower level of agreement was found when altering the other factors (MBFstandard vs. MBFToF: −0.07 ± 0.10; MBFapical VOI: −0.27 ± 0.25; MBFlarge VOI: −0.11 ± 0.10; MBFHutchins: −0.08 ± 0.10; MBFKrivokapich: −0.47 ± 0.50). Conclusions: Quantification of MBF from 13N-NH3 PET images is more affected by choice of compartment models, ToF and blood pool VOIs than by different time frame schemes and reconstruction algorithms.
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| 7. |
- Alkan Olsson, Johanna, et al.
(författare)
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A model-supported participatory process for nutrient management: a socio-legal analysis of a bottom-up implementation of the EU Water Framework Directive
- 2011
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Ingår i: International Journal of Agricultural Sustainability. - : Informa UK Limited. - 1473-5903 .- 1747-762X. ; 9:2, s. 379-389
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Tidskriftsartikel (refereegranskat)abstract
- A methodology for local stakeholders' involvement in water management using a catchment model as a platform for dialogue has been developed and tested in the Kaggebo Bay drainage area in the southeast of Sweden. The process involved farmers, rural households not connected to municipal wastewater treatment facilities, local and regional authorities as well as different water and agricultural experts. This paper aims to assess whether and how the methodology has succeeded in encouraging social learning and promoting action and which barriers can be identified. The assessment shows that the methodology is able to create confidence in the process and increase the willingness to act as the methodology was able to adapt the form and content of the dialogue to better fit the cognitive and relational needs of involved stakeholders. It is also shown that the process may lead to a probable improvement of the eutrophication situation. However, if these types of processes are to serve not only as a basis for social learning and action at the local level, but also as the basis for a broader process of societal learning, then a mechanism to confer local ideas to the regional and national levels has to be clarified.
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| 8. |
- Alkan Olsson, Johanna, et al.
(författare)
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How participatory can participatory modeling be? Degrees of influence of stakeholder and expert perspectives in six dimensions of participatory modeling
- 2007
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Ingår i: Water Science and Technology. - : IWA Publishing. - 0273-1223 .- 1996-9732. ; 56:1, s. 207-214
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Tidskriftsartikel (refereegranskat)abstract
- The authors are involved in a project aiming at the development of a methodology for participatory modeling as a tool for public participation in water resource management. In this paper, some examples of different degrees of stakeholder influence in six key dimensions of participatory modeling are identified and discussed. Arnstein's (A ladder of citizen participation. Journal of the American Institute of Planners, 1969, 4, 216–224) critical discussion of different degrees of “real” decision-making power is taken as a point of departure to assess possible degrees of stakeholder influence. Can we as participatory modelers be sure that we are really inviting our research objects to an equal communicative relationship where local perspectives, knowledge and priorities are respected to the same extent as central and/or expert perspectives? This paper presents an approach that could be used as a tool for structured reflection to avoid unreflective tendencies towards expert knowledge dominance and low degree of stakeholders' real influence over the process.
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| 9. |
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| 10. |
- Andersson, Lena, et al.
(författare)
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Hydrolysis of galactolipids by human pancreatic lipolytic enzymes and duodenal contents
- 1995
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Ingår i: Journal of Lipid Research. - 1539-7262. ; 36:6, s. 1392-1400
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Tidskriftsartikel (refereegranskat)abstract
- Monogalactosyldiacylglycerols (MGDG), digalactosyldiacylglycerols (DGDG) and sulfoquinovosyldiacylglycerols (SQDG) are major lipids in vegetable food. Their digestion and absorption are unknown. This study examines the hydrolysis of galactolipids in vitro with human duodenal contents, pancreatic juice, and purified human pancreatic lipases. Galactolipids were incubated with human duodenal contents, pancreatic juice, pure pancreatic carboxyl ester lipase (CEL), and colipase-dependent lipase with colipase (Lip-Col). Hydrolysis was estimated as release of free fatty acids and by the use of [3H]galactose or [3H]fatty acid-labeled DGDG. Pancreatic juice and duodenal contents hydrolyzed DGDG to fatty acids, digalactosylmonoacylglycerol (DGMG) and water-soluble galactose-containing compounds. The hydrolysis of DGDG was bile salt-dependent and had a pH optimum at 6.5-7.5. Human pancreatic juice released fatty acids from MGDG, DGDG, and SQDG. Purified CEL hydrolyzed all three substrates; the hydrolysis rate was MGDG > SQDG > DGDG. Pure Lip-Col had activity toward MGDG but had little activity against DGDG. Separation of pancreatic juice by Sephadex G100 gel filtration chromatography revealed two peaks with galactolipase activity that coincided with CEL (molecular mass 100 kD) and lipase (molecular mass 50 kD) peaks. In contrast to pure Lip-Col enzymes of the latter peak were as active against DGDG as against MGDG. Thus, DGDG is hydrolyzed both by CEL and by a pancreatic enzyme(s) with a molecular mass of 40-50 kD to fatty acids and lyso DGDG. MGDG, DGDG, and SQDG are all hydrolyzed by human pancreatic juice. Pure CEL hydrolyzed all three substrates.
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| 11. |
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| 12. |
- Andersson, Lotta, et al.
(författare)
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Use of participatory scenario modelling as platforms in stakeholder dialogues
- 2008
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Ingår i: Water S.A.. - 0378-4738 .- 1816-7950. ; 34:4, s. 439-447
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Tidskriftsartikel (refereegranskat)abstract
- A participatory methodology, based on dialogues between stakeholders and experts has been developed and tested in the drainage area to Kaggebo Bay in the Baltic Sea. This study is focused on the EU Water Framework Directive, with emphasis on reduction of eutrophication. The drainage area is included in the WFD administrative area of the Motala Strom River basin. A similar approach is now applied in a recently initiated project in the Thukela River basin, with focus on impacts of climate change on water resources. The methodology is based on the idea that a catchment model serves as a platform for the establishment of a common view of present conditions and the causes behind these conditions. In the following steps, this is followed by model-assisted agreement on environmental goals (i.e. what do we want the future to look like?) and local agreement on a remedy or mitigation plans in order to reduce environmental impact (e. g. eutrophication); alternatively to adapt to conditions that cannot be determined by local actions (e. g. climate change). By involving stakeholder groups in this model-supported stepwise process, it is ensured that all stakeholder groups involved have a high degree of confidence in the presented model results, and thereby enable various actors involved to share a common view, regarding both present conditions, goals and the way to reach these goals. Although this is a process that is time-(and cost-) consuming, it is hypothesised that the use of this methodology is two-pronged: it increases the willingness to carry out remedies or necessary adaptations to a changing environment, and it increases the level of understanding between the various groups and therefore ameliorates the potential for future conflicts. Compared to traditional use of model results in environmental decision-making, the experts role is transformed from a one-way communication of final results to assistance in the various steps of the participatory process.
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| 13. |
- Arheimer, Berit, et al.
(författare)
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Using catchment models to establish measure plans according to the Water Framework Directive
- 2007
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Ingår i: Water Science and Technology. - : IWA Publishing. - 0273-1223 .- 1996-9732. ; 56:1, s. 21-28
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Tidskriftsartikel (refereegranskat)abstract
- A participatory modelling process (DEMO) has been developed and applied in a 350 km(2) catchment in southern Sweden. The overall goal is to improve the dialogues between experts and local stakeholders by using numerical models as a platform for discussions. The study is focused on reducing nutrient load and on the development of a locally established measure plan, which is requested by the European Water Framework Directive. The HBV-NP model was chosen as it can calculate effects and costs for different allocations of several combined measures in a catchment. This paper shows the impact of including local data in the modelling process vs. using more general data. It was found that modelled diffuse nutrient pollution was highly modified when including local know-how, soft information and more detailed field investigations. Leaching from arable land was found to be 35% higher using more detailed information on for instance, agricultural practices, crop and soil distribution. Moreover, the stakeholders' acceptance of model results and reliance on experts was increased by applying the participatory process and involving stakeholders in the modelling procedure.
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| 14. |
- Askling, Berit, et al.
(författare)
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Introduktionsperioden i förskollärarutbildningen.
- 1977
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Rapport (populärvet., debatt m.m.)abstract
- Avsikten med projektgruppens arbete har varit att sprida information om och erfarenheter av några olika modeller för introduktionsperioden i förskollärarutbildningen. De modeller, som presenteras i rapporten, är hämtade från förskoleseminarierna i Gävle och Södertälje samt lärarhögskolan i Växjö,
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| 15. |
- Bajc, Marika, et al.
(författare)
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Lung ventilation/perfusion SPECT in the artificially embolized pig.
- 2002
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Ingår i: Journal of Nuclear Medicine. - 0161-5505. ; 43:5, s. 640-647
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Tidskriftsartikel (refereegranskat)abstract
- Planar lung scintigraphy is a standard method used for the diagnosis of lung embolism, but it is hampered by the high incidence of nondiagnostic tests. Ventilation/perfusion SPECT may possibly improve this situation. The objective of this study was to compare planar lung scintigraphy with ventilation/perfusion SPECT using pigs with artificially engendered lung emboli labeled with (201)Tl. METHODS: Sixteen anesthetized pigs were each injected with zero to 4 latex emboli. Cylindric emboli were used in the first 7 pigs and flat 3-tailed emboli were used in the remaining 9 pigs. The pigs spontaneously inhaled 30 MBq (99m)Tc-diethylenetriaminepentaacetic acid aerosol for ventilation scintigraphy. Planar scintigraphy and SPECT were performed using a double-head gamma camera in (99m)Tc and (201)Tl windows. Immediately thereafter, 100 MBq (99m)Tc-labeled macroaggregated albumin were injected intravenously followed by SPECT and, finally, planar scintigraphy. The ventilation background was subtracted from the perfusion tomograms for calculation of a normalized ventilation/perfusion (V/P) quotient image set. RESULTS: The cylindric emboli caused artifacts in the ventilation images; therefore, these were excluded from the final analysis. However, for the planar perfusion images of these pigs, sensitivity and specificity were 71% and 91%, respectively, whereas SPECT yielded 100% for both. For the 3-tailed emboli and ventilation/perfusion images, the sensitivity and specificity were 64% and 79%, respectively, for the planar modality, whereas SPECT yielded values of 91% and 87%, respectively. CONCLUSION: V/P SPECT may improve the diagnostic power of lung scintigraphy.
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| 16. |
- Bajc, Marika, et al.
(författare)
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V/P SPECT as a diagnostic tool for pregnant women with suspected pulmonary embolism.
- 2015
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Ingår i: European Journal of Nuclear Medicine and Molecular Imaging. - : Springer Science and Business Media LLC. - 1619-7070 .- 1619-7089. ; 42:8, s. 1325-1330
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of the study was to assess the prevalence of pulmonary embolism (PE) and other lung diseases among pregnant women with suspected PE and to calculate the radiation exposure to patient and fetus in this population. As a secondary aim, we evaluated the negative predictive value of a normal ventilation/perfusion single photon emission computed tomography (V/P SPECT) examination in pregnancy.
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| 17. |
- Bajc, Marika, et al.
(författare)
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Ventilation/Perfusion SPECT for diagnostics of pulmonary embolism in clinical practice.
- 2008
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Ingår i: Journal of Internal Medicine. - : Wiley. - 1365-2796 .- 0954-6820. ; 264:4, s. 379-387
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Tidskriftsartikel (refereegranskat)abstract
- AIM: The aim of this retrospective study is to illustrate clinical utility and impact of pulmonary embolism (PE) diagnostics of up to date Ventilation/Perfusion SPECT (V/P (SPECT)) applying holistic interpretation criteria. MATERIAL AND METHODS: During a 2-year period 2328 consecutive patients referred to V/P(SPECT) for clinically suspected PE were examined. Final diagnosis was established by physicians clinically responsible for patient care. To establish the performance of V/P(SPECT) negative for PE, patients were followed up by medical records for 6 months. RESULTS: Ventilation/Perfusion SPECT was feasible in 99% of the patients. Data for follow-up were available in 1785 patients (77%). PE was reported in 607 patients (34%). Normal pattern was described in 420 patients (25%). Pathology other than PE such as a pneumonia, left heart failure, obstructive lung disease, tumour was described in 724 patients (41%). Report was nondiagnostic in 19 patients (1%). Six cases were classified as falsely negative because PE was diagnosed at follow-up and was fatal in one case. Six cases were classified as falsely positive because the clinician decided not to treat. In 608 patients with final PE diagnosis, 601 patients had positive V/P(SPECT) (99%). In 1177 patients without final PE diagnosis 1153 patients had negative V/P(SPECT) (98%). CONCLUSIONS: Holistic interpretation of V/P(SPECT,) yields high negative and positive predictive values and only 1% of nondiagnostic findings and was feasible in 99% of patients. It is a responsibility and a challenge of nuclear medicine to provide optimal care of patients with suspected PE by making V/P(SPECT) available.
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| 18. |
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| 19. |
- Christiansson, Lisa, et al.
(författare)
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The Tyrosine Kinase Inhibitors Imatinib and Dasatinib Reduce Myeloid Suppressor Cells and Release Effector Lymphocyte Responses
- 2015
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Ingår i: Molecular Cancer Therapeutics. - : American Association for Cancer Research. - 1535-7163 .- 1538-8514. ; 14:5, s. 1181-1191
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Tidskriftsartikel (refereegranskat)abstract
- Immune escape mechanisms promote tumor progression and are hurdles of cancer immunotherapy. Removing immunosuppressive cells before treatment can enhance efficacy. Tyrosine kinase inhibitors (TKI) may be of interest to combine with immunotherapy, as it has been shown that the inhibitor sunitinib reduces myeloid suppressor cells in patients with renal cell carcinoma and dasatinib promotes expansion of natural killer-like lymphocytes in chronic myeloid leukemia (CML). In this study, the capacity of dasatinib and imatinib to reduce myeloid suppressor cells and to induce immunomodulation in vivo was investigated ex vivo. Samples from CML patients treated with imatinib (n = 18) or dasatinib (n = 14) within a Nordic clinical trial (clinicalTrials.gov identifier: NCT00852566) were investigated for the presence of CD11b(+)CD14(-)CD33(+) myeloid cells and inhibitorymolecules (arginase I, myeloperoxidase, IL10) as well as the presence of natural killer cells, T cells (naive/memory), and stimulatory cytokines (IL12, IFN gamma, MIG, IP10). Both imatinib and dasatinib decreased the presence of CD11b(+)CD14(-)CD33(+) myeloid cells as well as the inhibitory molecules and the remaining myeloid suppressor cells had an increased CD40 expression. Monocytes also increased CD40 after therapy. Moreover, increased levels of CD40, IL12, natural killer cells, and experienced T cells were noted after TKI initiation. The presence of experienced T cells was correlated to a higher IFNg and MIG plasma concentration. Taken together, the results demonstrate that both imatinib and dasatinib tilted the immunosuppressive CML tumor milieu towards promoting immune stimulation. Hence, imatinib and dasatinib may be of interest to combine with cancer immunotherapy. (C) 2015 AACR.
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| 20. |
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| 21. |
- Dalin, Frida, 1984-, et al.
(författare)
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Clinical and immunological characteristics of Autoimmune Addison's disease : a nationwide Swedish multicenter study
- 2017
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Ingår i: Journal of Clinical Endocrinology and Metabolism. - : Oxford University Press. - 0021-972X .- 1945-7197. ; 102:2, s. 379-389
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Tidskriftsartikel (refereegranskat)abstract
- CONTEXT: Studies on clinical and immunological features of Autoimmune Addison's disease (AAD) are needed to understand the disease burden and increased mortality.OBJECTIVE: To provide upgraded data on autoimmune comorbidities, replacement therapy, autoantibody profiles and cardiovascular risk factors.DESIGN, SETTING AND PARTICIPANTS: Cross sectional, population-based study. 660 AAD patients were included utilizing the Swedish Addison Registry (SAR) 2008-2014. When analyzing cardiovascular risk factors, 3,594 individuals from the population-based survey in Northern Sweden, MONICA (MONItoring of Trends and Determinants of CArdiovascular Disease), served as controls.MAIN OUTCOME MEASURE: Prevalence of autoimmune comorbidities and cardiovascular risk factors. Autoantibodies against 13 autoantigens were determined.RESULTS: Sixty percent of the SAR cohort consisted of females. Mean age at diagnosis was significantly higher for females than for males (36.8 vs. 31.1 years). The proportion of 21-hydroxylase autoantibody positive patients was 83% and 62% of patients had one or more associated autoimmune diseases, more frequently coexisting in females (p<0.0001). AAD patients had lower BMI (p<0.0001) and prevalence of hypertension (p=0.027) compared with controls. Conventional hydrocortisone tablets were used by 89% of patients; with the mean dose 28.1±8.5 mg/day. The mean hydrocortisone equivalent dose normalized to body surface was 14.8±4.4 mg/m(2)/day. Higher hydrocortisone equivalent dose was associated with higher incidence of hypertension (p=0.046).CONCLUSIONS: Careful monitoring of AAD patients is warranted to detect associated autoimmune diseases. Contemporary Swedish AAD patients do not have increased prevalence of overweight, hypertension, T2DM or hyperlipidemia. However, high glucocorticoid replacement doses may be a risk factor for hypertension.
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| 22. |
- Eek, Meta N, et al.
(författare)
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Intrathecal baclofen in dyskinetic cerebral palsy: effects on function and activity.
- 2018
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Ingår i: Developmental medicine and child neurology. - : Wiley. - 1469-8749 .- 0012-1622. ; 60:1, s. 94-99
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Tidskriftsartikel (refereegranskat)abstract
- To investigate the effect of intrathecal baclofen (ITB) on function and activity in dyskinetic cerebral palsy (CP).A retrospective cohort study of records from 25 children (15 males, 10 females; mean age 10y 11mo, SD 4y 9mo). Five were classified in Gross Motor Function Classification level IV and 20 in level V. Parents were interviewed about activities in daily life, sitting, communication, pain, sleep, and gross and fine motor function. Differences before and 1 year after ITB were graded as positive, no change, or negative. Assessments of dystonia (using the Barry-Albright Dystonia Scale) and muscle tone (Ashworth Scale) were made. Joint range of motion (ROM) was measured.Both dystonia and increased muscle tone, present in all participants before ITB, decreased after (p<0.001). Passive ROM was restricted, with no difference after. Parents reported improvements in activities in daily life (p<0.001), sitting (p<0.001), communication (p<0.001), and fine motor function (p=0.013), but no change in gross motor function. Before ITB, pain and disturbed sleep were reported. There was a reduction in pain (p=0.002) and sleep improved (p=0.004) after ITB.After ITB in individuals with dyskinetic CP, improvements were found in sitting, communication, and fine motor skills. There was a reduction in dystonia and muscle tone, and pain and sleep improved.Intrathecal baclofen can affect specific aspects of functioning in dyskinetic cerebral palsy. Sitting, communication, and fine motor function improved. Dystonia and spasticity were reduced. Pain was reduced and sleep improved.
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| 23. |
- El Missiry, Mohamed, et al.
(författare)
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Assessment of bone marrow lymphocytic status during tyrosine kinase inhibitor therapy and its relation to therapy response in chronic myeloid leukaemia
- 2016
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Ingår i: Journal of Cancer Research and Clinical Oncology. - : Springer Science and Business Media LLC. - 0171-5216 .- 1432-1335. ; 142:5, s. 1041-1050
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Tidskriftsartikel (refereegranskat)abstract
- Tyrosine kinase inhibitors (TKIs) used in the treatment of chronic myeloid leukaemia have been reported to induce immunomodulatory effects. We aimed to assess peripheral blood (PB) and bone marrow (BM) lymphocyte status at the diagnosis and during different TKI therapies and correlate it with treatment responses. BM and PB samples were acquired from 105 first-line TKI-treated patients. Relative number of BM lymphocytes was evaluated from MGG-stained BM aspirates, and immunophenotypic analyses were performed with multicolour flow cytometry. Early 3-month expansion of BM lymphocytes was found during all different TKIs (imatinib n = 71, 20 %; dasatinib n = 25, 21 %; nilotinib n = 9, 22 %; healthy controls n = 14, 12 %, p < 0.0001). Increased PB lymphocyte count was only observed during dasatinib therapy. The BM lymphocyte expansion was associated with early molecular response; patients with 3-month BCR-ABL1 < 10 % showed higher lymphocyte counts than patients with BCR-ABL1 > 10 % (23 vs. 17 %, p < 0.05). Detailed phenotypic analysis showed that BM lymphocyte expansion consisted of various lymphocyte subclasses, but especially the proportion of CD19+ B cells and CD3negCD16/56+ NK cells increased from diagnostic values. During dasatinib treatment, the lymphocyte balance in both BM and PB was shifted more to cytotoxic direction (increased CD8+CD57+ and CD8+HLA-DR+ cells, and low T regulatory cells), whereas no major immunophenotypic differences were observed between imatinib and nilotinib patients. Early BM lymphocytosis occurs with all current first-line TKIs and is associated with better treatment responses. PB and BM immunoprofile during dasatinib treatment markedly differs from both imatinib- and nilotinib-treated patients.
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| 24. |
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| 25. |
- Fernell, Elisabeth, 1948, et al.
(författare)
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Autistic disorders in children with CHARGE association
- 1999
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Ingår i: Developmental Medicine and Child Neurology. - 0012-1622. ; 41:4, s. 270-272
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Tidskriftsartikel (refereegranskat)abstract
- Three children with CHARGE association (coloboma, heart defect, atresia of the choanae, retarded growth and development, genital hypoplasia, ear anomalies and hearing defects) as well as concomitant autistic disorder are reported. Two of the children also had mental retardation. Several types of cerebral maldevelopment/dysfunction have been reported in CHARGE association. With regard to aetiology, involvement of the neural crest has been suggested. Autism in CHARGE association may represent a neuro-endocrine dysfunction. Children with a CHARGE association have many medical problems and therefore autistic behaviour can easily be overlooked. A multidisciplinary approach with respect to assessment, treatment, and habilitation is of vital importance.
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