| 1. |
- Jones, Robert P., et al.
(författare)
-
Patterns of Recurrence After Resection of Pancreatic Ductal Adenocarcinoma : A Secondary Analysis of the ESPAC-4 Randomized Adjuvant Chemotherapy Trial
- 2019
-
Ingår i: JAMA Surgery. - : AMER MEDICAL ASSOC. - 2168-6254 .- 2168-6262. ; 154:11, s. 1038-1048
-
Tidskriftsartikel (refereegranskat)abstract
- Importance: The patterns of disease recurrence after resection of pancreatic ductal adenocarcinoma with adjuvant chemotherapy remain unclear.Objective: To define patterns of recurrence after adjuvant chemotherapy and the association with survival.Design, Setting, and Participants: Prospectively collected data from the phase 3 European Study Group for Pancreatic Cancer 4 adjuvant clinical trial, an international multicenter study. The study included 730 patients who had resection and adjuvant chemotherapy for pancreatic cancer. Data were analyzed between July 2017 and May 2019.Interventions: Randomization to adjuvant gemcitabine or gemcitabine plus capecitabine.Main Outcomes and Measures: Overall survival, recurrence, and sites of recurrence.Results: Of the 730 patients, median age was 65 years (range 37-81 years), 414 were men (57%), and 316 were women (43%). The median follow-up time from randomization was 43.2 months (95% CI, 39.7-45.5 months), with overall survival from time of surgery of 27.9 months (95% CI, 24.8-29.9 months) with gemcitabine and 30.2 months (95% CI, 25.8-33.5 months) with the combination (HR, 0.81; 95% CI, 0.68-0.98; P=.03). The 5-year survival estimates were 17.1% (95% CI, 11.6%-23.5%) and 28.0% (22.0%-34.3%), respectively. Recurrence occurred in 479 patients (65.6%); another 78 patients (10.7%) died without recurrence. Local recurrence occurred at a median of 11.63 months (95% CI, 10.05-12.19 months), significantly different from those with distant recurrence with a median of 9.49 months (95% CI, 8.44-10.71 months) (HR, 1.21; 95% CI, 1.01-1.45; P=.04). Following recurrence, the median survival was 9.36 months (95% CI, 8.08-10.48 months) for local recurrence and 8.94 months (95% CI, 7.82-11.17 months) with distant recurrence (HR, 0.89; 95% CI, 0.73-1.09; P=.27). The median overall survival of patients with distant-only recurrence (23.03 months; 95% CI, 19.55-25.85 months) or local with distant recurrence (23.82 months; 95% CI, 17.48-28.32 months) was not significantly different from those with only local recurrence (24.83 months; 95% CI, 22.96-27.63 months) (P=.85 and P=.35, respectively). Gemcitabine plus capecitabine had a 21% reduction of death following recurrence compared with monotherapy (HR, 0.79; 95% CI, 0.64-0.98; P=.03).Conclusions and Relevance: There were no significant differences between the time to recurrence and subsequent and overall survival between local and distant recurrence. Pancreatic cancer behaves as a systemic disease requiring effective systemic therapy after resection.Trial Registration: ClinicalTrials.gov identifier: NCT00058201, EudraCT 2007-004299-38, and ISRCTN 96397434. This secondary analysis of a randomized clinical trial investigates patterns of recurrence after adjuvant chemotherapy in pancreatic cancer and the association with survival.
|
|
| 2. |
|
|
| 3. |
- McGale, Paul, et al.
(författare)
-
Incidence of heart disease in 35,000 women treated with radiotherapy for breast cancer in Denmark and Sweden
- 2011
-
Ingår i: Radiotherapy and Oncology. - Amsterdam : Elsevier. - 0167-8140 .- 1879-0887. ; 100:2, s. 167-175
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose: To study incidence of radiation-related heart disease in a large population of breast cancer patients followed for up to 30 years. Material and methods: 72,134 women diagnosed with breast cancer in Denmark or Sweden during 1976-2006 and followed prospectively. Radiation-related risk was studied by comparing women with left-sided and right-sided tumours. Results: 34,825 women (48%) received radiotherapy. Among unirradiated women tumour laterality had little relevance to heart disease. Among irradiated women mean dose to the whole heart was 6.3 Gy for left-sided tumours and 2.7 Gy for right-sided tumours. Mortality was similar in irradiated women with left-sided and right-sided tumours, but incidence ratios, left-sided versus right-sided, were raised: acute myocardial infarction 1.22 (95% CI 1.06-1.42), angina 1.25 (1.05-1.49), pericarditis 1.61 (1.06-2.43), valvular heart disease 1.54 (1.11-2.13). Incidence ratios for all heart disease were as high for women irradiated since 1990 (1.09 [1.00-1.19]) as for women irradiated during 1976-1989 (1.08 [0.99-1.17]), and were higher for women diagnosed with ischaemic heart disease prior to breast cancer than for other women (1.58 [1.19-2.10] versus 1.08 [1.01-1.15], p for difference = 0.01). Conclusions: Breast cancer radiotherapy has, at least until recently, increased the risk of developing ischaemic heart disease, pericarditis and valvular disease. Women with ischaemic heart disease before breast cancer diagnosis may have incurred higher risks than others. (C) 2011 Elsevier Ireland Ltd. All rights reserved. Radiotherapy and Oncology 100 (2011) 167-175
|
|
| 4. |
- Palm, Jenny, et al.
(författare)
-
New Clean Energy Communities in a Changing European Energy System (NEWCOMERS) : Deliverable D3.1 Description of polycentric settings in the partner countries
- 2020
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- This deliverable maps the prevailing polycentric settings of six studied countries. The studied countries are the partner countries for the NEWCOMERS project, i.e. Germany, Italy, the Netherlands, Slovenia, Sweden and the United Kingdom. In this report, the countries' polycentric settings will be described in relation to the polycentric framework developed in WP 2, with specific focus on the technical system and actors. The factors in focus for the country descriptions are socio-economic conditions, technical system (electricity and heat), institutional arrangements as well as actors. Additionally, a description of energy communities in each country is presented, showing different developments in this area.The research was conducted through a desktop research. Existing literature, reports as well as statistical information were gathered and then organised according to the factors chosen.The aim in this delivery is to describe and understand the national polycentric settings as a first step to understand the emergence of new forms of energy communities. This deliverable is the basis for delivery 3.2, which will compare different polycentric national settings and delivery 3.3, which will evaluate what forms of energy communities work best in different polycentric setting and what are the potentials for learning between different polycentric settings.
|
|
| 5. |
- Palm, Jenny, 1973-, et al.
(författare)
-
The meanings of practices for energy consumption – a comparison of homes and workplaces
- 2014
-
Ingår i: Science and Technology Studies. - : Finnish Society for Science and Technology Studies. - 2243-4690. ; 27:2, s. 72-92
-
Tidskriftsartikel (refereegranskat)abstract
- We examine how building and appliance technologies relate to their use by occupants through practices at home and at work. The aim is to analyse how practices are influenced by buildings and other technologies, and by social requirements, and to add to ongoing research on how to contribute to a transition to more sustainable everyday practices. Interview, quantitative and observational material is used to compare experiences of occupying and using two different types of building, passive housing and large modern research buildings, by applying practice theory. The passive house case showed that the main project of a liveable, low-impact new building was on a fairly manageable scale, given a suitable design and occupants who were prepared to adapt to it. The research lab study showed however the configuration to unsustainable technologies and practices that can occur at the design stage, and how most actors then had very limited room for manoeuvre.
|
|
| 6. |
- Pyrko, Jurek, et al.
(författare)
-
Conditions of energy efficient behaviour-a comparative study between Sweden and the UK
- 2011
-
Ingår i: Energy Efficiency. - : Springer Science and Business Media LLC. - 1570-646X .- 1570-6478. ; 4:3, s. 393-408
-
Tidskriftsartikel (refereegranskat)abstract
- The main aim of this study is to compare how specific conditions in certain countries (in this case, the UK and Sweden) can stimulate or oblige householders to be more energy efficient, or can obstruct this. European goals for energy and emission reductions now constitute the main frame for long-term energy policy changes, but national governments develop and implement policy in contrasting ways and in different contexts. Important aspects are: geographical context, degree of liberalisation of electricity and gas industry, structure and composition of energy systems, metering and billing infrastructure, and the nature of electrical load problems. The following conditions are described and compared in this paper: (1) regulation to control residential consumption and emissions; (2) energy systems; (3) electricity pricing; (4) the role of utilities and other agents in residential demand reduction; (5) quality of feedback on energy use to the householder; and (6) customer behaviour and perceptions of energy use. The analysis is carried out with a view to ecological, economic and social aspects of energy systems. The comparison shows the significance of factors that are sometimes overlooked when considering the potential for demand reduction and load management, and produces some lessons and questions that are widely applicable.
|
|
| 7. |
- Robison, Rosie, et al.
(författare)
-
Shifts in the smart research agenda? 100 priority questions to accelerate sustainable energy futures
- 2023
-
Ingår i: Journal of Cleaner Production. - : Elsevier Ltd. - 0959-6526 .- 1879-1786. ; 419
-
Tidskriftsartikel (refereegranskat)abstract
- Energy transitions are at the top of global agendas in response to the growing challenges of climate change and international conflict, with the EU positioning itself as playing a pivotal role in addressing climate risks and sustainability imperatives. European energy transition policies identify ‘smart consumption’ as a key element of these efforts, which have previously been explored from a predominantly technical perspective thus often failing to identify or address fundamental interlinkages with social systems and consequences. This paper aims to contribute to interdisciplinary energy research by analysing a forward looking ‘Horizon Scan’ research agenda for smart consumption, driven by the Social Sciences and Humanities (SSH). Reflecting on an extensive systematic Delphi Method exercise surveying over 70 SSH scholars from various institutional settings across Europe, we highlight what SSH scholars see as future directions for smart consumption research. Building from seven thematic areas (under which are grouped 100 SSH research questions), the study identifies three key ‘shifts’ this new smart research agenda represents, when compared to previous agendas: (1) From technological inevitability to political choice, highlighting the need for a wider political critique, with the potential to open up discussions of the instrumentalisation of smart research; (2) From narrow representation to diverse inclusion, moving beyond the shortcomings of current discourses for engaging marginalised communities; and (3) From individual consumers to interconnected citizens, reframing smart consumption to offer a broader model of social change and governance. Social Sciences and Humanities scholarship is essential to address these shifts in meaningful (rather than tokenistic) ways. This agenda and the shifts it embodies represent key tools to enable better interdisciplinary working between SSH and teams from the technical and natural sciences.
|
|
| 8. |
- Stanaway, Jeffrey D., et al.
(författare)
-
Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: A systematic analysis for the Global Burden of Disease Study 2017
- 2018
-
Ingår i: The Lancet. - 1474-547X .- 0140-6736. ; 392:10159, s. 1923-1994
-
Tidskriftsartikel (refereegranskat)abstract
- Background The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 comparative risk assessment (CRA) is a comprehensive approach to risk factor quantification that offers a useful tool for synthesising evidence on risks and risk-outcome associations. With each annual GBD study, we update the GBD CRA to incorporate improved methods, new risks and risk-outcome pairs, and new data on risk exposure levels and risk- outcome associations. Methods We used the CRA framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or groups of risks from 1990 to 2017. This study included 476 risk-outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk and exposure estimates from 46 749 randomised controlled trials, cohort studies, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. We explored the relationship between development and risk exposure by modelling the relationship between the Socio-demographic Index (SDI) and risk-weighted exposure prevalence and estimated expected levels of exposure and risk-attributable burden by SDI. Finally, we explored temporal changes in risk-attributable DALYs by decomposing those changes into six main component drivers of change as follows: (1) population growth; (2) changes in population age structures; (3) changes in exposure to environmental and occupational risks; (4) changes in exposure to behavioural risks; (5) changes in exposure to metabolic risks; and (6) changes due to all other factors, approximated as the risk-deleted death and DALY rates, where the risk-deleted rate is the rate that would be observed had we reduced the exposure levels to the TMREL for all risk factors included in GBD 2017.
|
|
| 9. |
- van der Grijp, Nicolien, et al.
(författare)
-
Theoretical framework focusing on learning in polycentric settings
- 2019
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- This deliverable provides the theoretical underpinning of the NEWCOMERS project, including the key concepts and definitions as well as the formulation of research propositions in order to enhance the project’s coherence. To this end, it develops a novel theoretical framework based on polycentric governance theory, combined with elements from socio-technical systems theory, social innovationtheory, and value theory in order to facilitate the analysis of the emergence and diffusion of new clean energy communities and explore opportunities for learning in different national and local polycentric settings.The deliverable is structured as follows. Chapter 2 provides the background of the NEWCOMERS project and introduces the theoretical perspectives that will be used in the analyses, including polycentric governance theory, socio-technical systems theory, and social innovation theory. Chapter 3 explores the concept of clean energy communities and develops a definition of new clean energycommunities to be used in the project. Chapter 4 provides a state-of-the-art account of current thinking about polycentric governance and identifies the main themes of polycentric governance theory that are relevant for studying new clean energy communities. Chapter 5 summarises the set of research propositions to be tested in the NEWCOMERS project.
|
|
| 10. |
- Wang, Haidong, et al.
(författare)
-
Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015 : a systematic analysis for the Global Burden of Disease Study 2015
- 2016
-
Ingår i: The Lancet. - 0140-6736 .- 1474-547X. ; 388:10053, s. 1459-1544
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Improving survival and extending the longevity of life for all populations requires timely, robust evidence on local mortality levels and trends. The Global Burden of Disease 2015 Study (GBD 2015) provides a comprehensive assessment of all-cause and cause-specific mortality for 249 causes in 195 countries and territories from 1980 to 2015. These results informed an in-depth investigation of observed and expected mortality patterns based on sociodemographic measures.METHODS: We estimated all-cause mortality by age, sex, geography, and year using an improved analytical approach originally developed for GBD 2013 and GBD 2010. Improvements included refinements to the estimation of child and adult mortality and corresponding uncertainty, parameter selection for under-5 mortality synthesis by spatiotemporal Gaussian process regression, and sibling history data processing. We also expanded the database of vital registration, survey, and census data to 14 294 geography-year datapoints. For GBD 2015, eight causes, including Ebola virus disease, were added to the previous GBD cause list for mortality. We used six modelling approaches to assess cause-specific mortality, with the Cause of Death Ensemble Model (CODEm) generating estimates for most causes. We used a series of novel analyses to systematically quantify the drivers of trends in mortality across geographies. First, we assessed observed and expected levels and trends of cause-specific mortality as they relate to the Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Second, we examined factors affecting total mortality patterns through a series of counterfactual scenarios, testing the magnitude by which population growth, population age structures, and epidemiological changes contributed to shifts in mortality. Finally, we attributed changes in life expectancy to changes in cause of death. We documented each step of the GBD 2015 estimation processes, as well as data sources, in accordance with Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER).FINDINGS: Globally, life expectancy from birth increased from 61·7 years (95% uncertainty interval 61·4-61·9) in 1980 to 71·8 years (71·5-72·2) in 2015. Several countries in sub-Saharan Africa had very large gains in life expectancy from 2005 to 2015, rebounding from an era of exceedingly high loss of life due to HIV/AIDS. At the same time, many geographies saw life expectancy stagnate or decline, particularly for men and in countries with rising mortality from war or interpersonal violence. From 2005 to 2015, male life expectancy in Syria dropped by 11·3 years (3·7-17·4), to 62·6 years (56·5-70·2). Total deaths increased by 4·1% (2·6-5·6) from 2005 to 2015, rising to 55·8 million (54·9 million to 56·6 million) in 2015, but age-standardised death rates fell by 17·0% (15·8-18·1) during this time, underscoring changes in population growth and shifts in global age structures. The result was similar for non-communicable diseases (NCDs), with total deaths from these causes increasing by 14·1% (12·6-16·0) to 39·8 million (39·2 million to 40·5 million) in 2015, whereas age-standardised rates decreased by 13·1% (11·9-14·3). Globally, this mortality pattern emerged for several NCDs, including several types of cancer, ischaemic heart disease, cirrhosis, and Alzheimer's disease and other dementias. By contrast, both total deaths and age-standardised death rates due to communicable, maternal, neonatal, and nutritional conditions significantly declined from 2005 to 2015, gains largely attributable to decreases in mortality rates due to HIV/AIDS (42·1%, 39·1-44·6), malaria (43·1%, 34·7-51·8), neonatal preterm birth complications (29·8%, 24·8-34·9), and maternal disorders (29·1%, 19·3-37·1). Progress was slower for several causes, such as lower respiratory infections and nutritional deficiencies, whereas deaths increased for others, including dengue and drug use disorders. Age-standardised death rates due to injuries significantly declined from 2005 to 2015, yet interpersonal violence and war claimed increasingly more lives in some regions, particularly in the Middle East. In 2015, rotaviral enteritis (rotavirus) was the leading cause of under-5 deaths due to diarrhoea (146 000 deaths, 118 000-183 000) and pneumococcal pneumonia was the leading cause of under-5 deaths due to lower respiratory infections (393 000 deaths, 228 000-532 000), although pathogen-specific mortality varied by region. Globally, the effects of population growth, ageing, and changes in age-standardised death rates substantially differed by cause. Our analyses on the expected associations between cause-specific mortality and SDI show the regular shifts in cause of death composition and population age structure with rising SDI. Country patterns of premature mortality (measured as years of life lost [YLLs]) and how they differ from the level expected on the basis of SDI alone revealed distinct but highly heterogeneous patterns by region and country or territory. Ischaemic heart disease, stroke, and diabetes were among the leading causes of YLLs in most regions, but in many cases, intraregional results sharply diverged for ratios of observed and expected YLLs based on SDI. Communicable, maternal, neonatal, and nutritional diseases caused the most YLLs throughout sub-Saharan Africa, with observed YLLs far exceeding expected YLLs for countries in which malaria or HIV/AIDS remained the leading causes of early death.INTERPRETATION: At the global scale, age-specific mortality has steadily improved over the past 35 years; this pattern of general progress continued in the past decade. Progress has been faster in most countries than expected on the basis of development measured by the SDI. Against this background of progress, some countries have seen falls in life expectancy, and age-standardised death rates for some causes are increasing. Despite progress in reducing age-standardised death rates, population growth and ageing mean that the number of deaths from most non-communicable causes are increasing in most countries, putting increased demands on health systems.
|
|
