| 1. |
- Semb, Gunvor, et al.
(författare)
-
A Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate: 1. Planning and management.
- 2017
-
Ingår i: Journal of Plastic Surgery and Hand Surgery. - : Taylor & Francis. - 2000-656X .- 2000-6764. ; 51:1, s. 2-13
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND AIMS: Longstanding uncertainty surrounds the selection of surgical protocols for the closure of unilateral cleft lip and palate, and randomised trials have only rarely been performed. This paper is an introduction to three randomised trials of primary surgery for children born with complete unilateral cleft lip and palate (UCLP). It presents the protocol developed for the trials in CONSORT format, and describes the management structure that was developed to achieve the long-term engagement and commitment required to complete the project.METHOD: Ten established national or regional cleft centres participated. Lip and soft palate closure at 3-4 months, and hard palate closure at 12 months served as a common method in each trial. Trial 1 compared this with hard palate closure at 36 months. Trial 2 compared it with lip closure at 3-4 months and hard and soft palate closure at 12 months. Trial 3 compared it with lip and hard palate closure at 3-4 months and soft palate closure at 12 months. The primary outcomes were speech and dentofacial development, with a series of perioperative and longer-term secondary outcomes.RESULTS: Recruitment of 448 infants took place over a 9-year period, with 99.8% subsequent retention at 5 years.CONCLUSION: The series of reports that follow this introductory paper include comparisons at age 5 of surgical outcomes, speech outcomes, measures of dentofacial development and appearance, and parental satisfaction. The outcomes recorded and the numbers analysed for each outcome and time point are described in the series.TRIAL REGISTRATION: ISRCTN29932826.
|
|
| 2. |
- Arvidsson, Matilda, 1976, et al.
(författare)
-
Theoretical and Methodological Approaches to Gender and International Law
- 2022
-
Ingår i: Oxford Bibliographies in International Law. - Oxford : Oxford Universitty Press.
-
Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- ‘Gender’ as a specific topic of concern appeared gradually within international law and scholarship, initially by scholars drawing on feminist theories. A central concern in the scholarship is how gender relates to sex. For some scholars, gender is useful for distinguishing social constructions from biological sex. For others, this distinction is problematic as it conceals the way sex is also socially constructed. Reflecting these scholarly debates, the way gender is defined and relates to sex is not consistent in international legal instruments or scholarship. Another dividing question is how gender, sex, and ‘women’s situation’ relate. For some, gender means a focus on women. This conflation is questioned by others. The gender/woman question injects confusion and political force in international legal debates. More recently, gender identity has attracted attention, and while gender equality has long been a central topic of concern, states and scholars critical of what they consider ‘gender ideology’ in instruments such as the Yogyakarta Principles and the Istanbul Convention, have sought to advance ‘gender complementarity’ in its stead. For scholars committed to gender equality, ‘gender complementarity’ is conceived of as a backlash. These topics of concern do not reflect any specific theoretical or methodological approach and it is not possible to divide the theoretical and methodological approaches according to topic. Instead, the debates are pursued in a variety of ways: An early approach that remains significant seeks to identify structural biases in seemingly neutral or universal instruments. This can be contrasted to scholarship analyzing international instruments explicitly engaging with gender, the way international law partakes in forming gendered subjects, and processes of gender mainstreaming. The role of gender in gender based violence continues to be questioned. More recently, queer approaches have sought to question the normative in international law, and a theoretical focus on men and masculinity has emerged as a response to the focus on women in gender and international law debates. Aiming at granularity and ‘localizing’ gender, anthropological and ethnographic approaches contribute with narratives breaking with universalizing tendencies in international law. Similarly, intersectional, TWAIL and posthuman feminist debates approach gender as part of broader concerns, while some scholas have turned to history in order to rethink gendered aspects of international law. Natural science methods, including emerging technologies such as AI, are also used to analyze gender concerns. How gender is debated, analyzed, and questioned through different methodological and theoretical approaches demonstrate the political vibrancy of gender as a concept in international law.
|
|
| 3. |
- Asowed, Mustafa, et al.
(författare)
-
Activity and safety of KEES-an oral multi-drug chemo-hormonal metronomic combination regimen in metastatic castration-resistant prostate cancer
- 2023
-
Ingår i: BMC Cancer. - : BioMed Central (BMC). - 1471-2407. ; 23
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Metastatic castration-resistant prostate cancer (mCRPC) remains a therapeutic challenge and evidence for late-line treatments in real-life is limited. The present study investigates the efficacy and safety of an oral metronomic chemo-hormonal regimen including cyclophosphamide, etoposide, estramustine, ketoconazole and prednisolone (KEES) administered in a consecutive biweekly schedule.Methods: A retrospective cohort study in two Swedish regions was conducted. Overall (OS) and progression-free survival (PFS), biochemical response rate (bRR) and toxicities were analyzed.Results: One hundred and twenty-three patients treated with KEES after initial treatment with at least a taxane or an androgen-receptor targeting agents (ARTA) were identified. Of those, 95 (77%) had received both agents and were the primary analysis population. Median (95% CI) OS and PFS in the pre-treated population were 12.3 (10.1-15.0) and 4.4 (3.8-5.5) months, respectively. Biochemical response, defined as >= 50% prostate-specific antigen (PSA) reduction, occurred in 26 patients (29%), and any PSA reduction in 59 (65%). PFS was independent of prior treatments used, and KEES seemed to be effective in late treatment lines. The bRR was higher compared to historical data of metronomic treatments in docetaxel and ARTA pre-treated populations. In multivariable analyses, performance status (PS) >= 2 and increasing alkaline phosphatase (ALP) predicted for worse OS. Nausea, fatigue, thromboembolic events and bone marrow suppression were the predominant toxicities.Conclusions: KEES demonstrated meaningful efficacy in heavily pre-treated CRPC patients, especially those with PS 0-1 and lower baseline ALP, and had an acceptable toxicity profile.
|
|
| 4. |
- Cheng, Qing, et al.
(författare)
-
Preclinical PET imaging of EGFR levels : pairing a targeting with a non-targeting Sel-tagged Affibody-based tracer to estimate the specific uptake
- 2016
-
Ingår i: EJNMMI Research. - : Springer. - 2191-219X. ; 6
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Though overexpression of epidermal growth factor receptor (EGFR) in several forms of cancer is considered to be an important prognostic biomarker related to poor prognosis, clear correlations between biomarker assays and patient management have been difficult to establish. Here, we utilize a targeting directly followed by a non-targeting tracer-based positron emission tomography (PET) method to examine some of the aspects of determining specific EGFR binding in tumors. Methods: The EGFR-binding Affibody molecule Z(EGFR:2377) and its size-matched non-binding control Z(Taq:3638) were recombinantly fused with a C-terminal selenocysteine-containing Sel-tag (Z(EGFR:2377)-ST and Z(Taq:3638)-ST). The proteins were site-specifically labeled with DyLight488 for flow cytometry and ex vivo tissue analyses or with C-11 for in vivo PET studies. Kinetic scans with the C-11-labeled proteins were performed in healthy mice and in mice bearing xenografts from human FaDu (squamous cell carcinoma) and A431 (epidermoid carcinoma) cell lines. Changes in tracer uptake in A431 xenografts over time were also monitored, followed by ex vivo proximity ligation assays (PLA) of EGFR expressions. Results: Flow cytometry and ex vivo tissue analyses confirmed EGFR targeting by ZE(GFR:2377)-ST-DyLight488. [Methyl-C-11]-labeled Z(EGFR:2377)-ST-CH3 and Z(Taq:3638)-ST-CH3 showed similar distributions in vivo, except for notably higher concentrations of the former in particularly the liver and the blood. [Methyl-C-11]-Z(EGFR:2377)-ST-CH3 successfully visualized FaDu and A431 xenografts with moderate and high EGFR expression levels, respectively. However, in FaDu tumors, the non-specific uptake was large and sometimes equally large, illustrating the importance of proper controls. In the A431 group observed longitudinally, non-specific uptake remained at same level over the observation period. Specific uptake increased with tumor size, but changes varied widely over time in individual tumors. Total (membranous and cytoplasmic) EGFR in excised sections increased with tumor growth. There was no positive correlation between total EGFR and specific tracer uptake, which, since Z(EGFR:2377) binds extracellularly and is slowly internalized, indicates a discordance between available membranous and total EGFR expression levels. Conclusions: Same-day in vivo dual tracer imaging enabled by the Sel-tag technology and C-11-labeling provides a method to non-invasively monitor membrane-localized EGFR as well as factors affecting non-specific uptake of the PET ligand.
|
|
| 5. |
- Elander, Astrid, et al.
(författare)
-
Inhaler Technique and Self-reported Adherence to Medications Among Hospitalised People with Asthma and COPD
- 2020
-
Ingår i: Drugs - real world outcomes. - : Springer. - 2199-1154 .- 2198-9788. ; 7:4, s. 317-323
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Metered dose inhalers (MDIs) and dry powder inhalers (DPIs) are devices used for the treatment of asthma and chronic obstructive pulmonary disease (COPD). Inhaler technique is important since incorrect technique can lead to a poorer prognosis and hospitalization.OBJECTIVE: The objective of this study was to investigate the inhaler technique and overall adherence to medications in an adult population with asthma and COPD.PATIENTS AND METHODS: Those invited to participate were people admitted to Umeå University Hospital in northern Sweden in October, November and December 2018, with inhaled medication prescribed prior to admission. Inhaler technique was assessed using checklists and observations with placebo-inhalers were conducted. The Medication Adherence Report Scale (MARS)-5 was used to measure self-reported overall adherence to drug medication.RESULTS: Of the 23 people included in the study, 26.1% had one or more critical errors in inhaler technique and 30.4% were considered overall non-adherent to drug medication. Among the 23 participants, the mean age, and the number of regularly prescribed medications were higher among those with poor inhaler technique than among people with no error in their inhaler technique.CONCLUSION: This study indicates that poor inhaler technique and overall non-adherence to medications occur among hospitalised people with asthma and COPD living in northern Sweden. Interventions to improve inhaler technique and adherence to drugs are needed.
|
|
| 6. |
- Elander, Johanna, et al.
(författare)
-
Extended genetic diagnostics for children with profound sensorineural hearing loss by implementing massive parallel sequencing. Diagnostic outcome, family experience and clinical implementation
- 2022
-
Ingår i: International Journal of Pediatric Otorhinolaryngology. - : Elsevier BV. - 0165-5876. ; 159
-
Tidskriftsartikel (refereegranskat)abstract
- Objectives: The aim of this study was to investigate genetic outcomes, analyze the family experience, and describe the process of implementing genetic sequencing for children with profound sensorineural hearing loss (SNHL) at a tertial audiological center in southern Sweden. Design: This is a prospective pilot study including eleven children with profound bilateral SNHL who underwent cochlear implant surgery. Genetic diagnostic investigation was performed with whole exome sequencing (WES) complemented with XON-array to identify copy number variants, using a manually curated gene panel incorporating 179 genes associated with non-syndromic and syndromic SNHL. Mitochondrial DNA (mtDNA) from blood was examined separately. A patient reported experience measures (PREM) questionnaire was used to evaluate parental experience. We also describe here the process of implementing WES in an audiology department. Results: Six female and five male children (mean 3.4 years, SD 3.5 years), with profound bilateral SNHL were included. Genetic variants of interest were found in six subjects (55%), where three (27%) could be classified as pathogenic or likely pathogenic. Among the six cases, one child was found to have a homozygous pathogenic variant in MYO7A and two children had homozygous likely pathogenic variants in SLC26A4 and PCDH15, respectively. One was carrying a compound heterozygote frameshift variant of uncertain significance (VUS) on one allele and in trans, a likely pathogenic deletion on the other allele in PCDH15. Two subjects had homozygous VUS in PCDH15 and ADGRV1, respectively. In five of the cases the variants were in genes associated with Usher syndrome. For one of the likely pathogenic variants, the finding was related to Pendred syndrome. No mtDNA variants related to SNHL were found. The PREM questionnaire revealed that the families had difficulty in fully understanding the results of the genetic analysis. However, the parents of all eleven (100%) subjects still recommended that other families with children with SNHL should undergo genetic testing. Specifically addressed referrals for prompt complementary clinical examination and more individualized care were possible, based on the genetic results. Close clinical collaboration between different specialists, including physicians of audiology, audiologists, clinical geneticists, ophthalmologists, pediatricians, otoneurologists, physiotherapists and hearing habilitation teams was initiated during the implementation of the new regime. For all professionals involved, a better knowledge of the diversity of the genetic background of hearing loss was achieved. Conclusions: Whole exome sequencing and XON-array using a panel of genes associated with SNHL had a high diagnostic yield, added value to the families, and provided guidance for further examinations and habilitation for the child. Great care should be taken to thoroughly inform parents about the genetic test result. Collaborations between departments were intensified and knowledge of hearing genomics was increased among the staff.
|
|
| 7. |
- Elander, Johanna, et al.
(författare)
-
Pathogenic mtDNA variants, in particular single large-scale mtDNA deletions, are strongly associated with post-lingual onset sensorineural hearing loss in primary mitochondrial disease
- 2022
-
Ingår i: Molecular Genetics and Metabolism. - : Elsevier BV. - 1096-7192. ; 137:3, s. 230-238
-
Tidskriftsartikel (refereegranskat)abstract
- In this retrospective cohort study of 193 consecutive subjects with primary mitochondrial disease (PMD) seen at the Children's Hospital of Philadelphia Mitochondrial Medicine Frontier Program, we assessed prevalence, severity, and time of onset of sensorineural hearing loss (SNHL) for PMD cases with different genetic etiologies. Subjects were grouped by genetic diagnosis: mitochondrial DNA (mtDNA) pathogenic variants, single large-scale mtDNA deletions (SLSMD), or nuclear DNA (nDNA) pathogenic variants. SNHL was audiometrically confirmed in 27% of PMD subjects (20% in mtDNA pathogenic variants, 58% in SLSMD and 25% in nDNA pathogenic variants). SLSMD had the highest odds ratio for SNHL. SNHL onset was post-lingual in 79% of PMD cases, interestingly including all cases with mtDNA pathogenic variants and SLSMD, which was significantly different from PMD cases caused by nDNA pathogenic variants. SNHL onset during school age was predominant in this patient population. Regular audiologic assessment is important for PMD patients, and PMD of mtDNA etiology should be considered as a differential diagnosis in pediatric patients and young adults with post-lingual SNHL onset, particularly in the setting of multi-system clinical involvement. Pathogenic mtDNA variants and SLSMD are less likely etiologies in subjects with congenital, pre-lingual onset SNHL.
|
|
| 8. |
- Elander, Maria, et al.
(författare)
-
Avfallsindikatorer - Vägledning för hur man kan mäta och följa utvecklingen mot en resurseffektiv avfallshantering
- 2014
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Det finns idag ett stort behov av att kunna mäta och förstå hur resurseffektiv vår avfallshantering är, både på nationell nivå och i våra kommuner. Vi har successivt infört allt fler mål, styrmedel och åtgärder för att utveckla avfallshanteringen och stora förändringar har därigenom skett. Allt talar för att utvecklingen kommer att fortsätta i samma takt, potentialen att förbättra svensk avfallshantering är stor. Hur mäter vi om vi blir bättre? Hur effektiv är avfallshanteringen? Hur väl uppfyller vi de avfallspolitiska målen? Finns det skillnader i utvecklingen mellan olika kommuner och vilka slutsatser kan vi i så fall lära oss av det? Hur stor klimatpåverkan orsakar avfallsbehandlingen på de olika stegen i avfallshierarkin? Frågorna är många, men svaren är svåra att få fram. Trots förbättrad information och kunskap om avfallshanteringen har utmaningarna med att mäta och följa upp utvecklingen bara ökat. Inte minst eftersom man idag strävar efter att hantera så mycket av de de uppkomna avfallsmängderna på de övre stegen i avfallshierkin, det vill säga avfallsförebyggande, återanvändning och materialåtervinning. Dessa delar är betydligt svårare att beskriva, mäta och följa upp jämfört med de nedre behandlingsstegen. Denna vägledning är en av tre rapporter från ett projekt som har haft som syfte att ta fram mätetal, eller ""avfallsindikatorer"", som ska kunna mäta och följa utvecklingen för vår avfallshantering. Syftet är att avfallsindikatorerna årsvis ska presentera utvecklingen och därmed kunna ge svar på bland annat de frågor som nämns ovan. Avfallsindikatorerna presenteras mer utförligt i rapporten ""Indikatorer för en resurseffektiv avfallshantering"" som finns att ladda ner på Waste Refinerys hemsida. I rapporten kan man följa beräknings-metoderna, val av indata och hur projektgruppen resonerade om vilka indikatorer som behövs för att kunna mäta resurseffektivitet. På Waste Refinerys hemsida finns även en rapport innehållande en litteraturstudie över vilka indikatorer som idag används i Europa: Litteraturstudie över indikatorer för en resurseffektiv avfallshantering.
|
|
| 9. |
- Elander, Maria, et al.
(författare)
-
Impact assessment of policies promoting fiber-to-fiber recycling of textiles
- 2017
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- As part of the Mistra Future Fashion Research Program, IVL Swedish Environmental Research Institute (IVL), the International Institute for Industrial Environmental Economics (IIIEE) and PlanMiljø have investigated policy options promoting (fiber-to-fiber) recycling of textile waste. The ambition was to contribute to and broaden the discussion regarding potential policy measures in the textile field as well as potential elements that can be included in such policies.Ten policy measures promoting fiber-to-fiber recycling of textiles, contributing to circular flows of textile waste, were identified and described. Two policy measures were selected for impact assessment: mandatory extended producer responsibility (EPR) and refunded virgin payments (RVP). The policy evaluation was carried out as an ex-ante assessment with regard to eight policy goals. Stakeholder views on the identified and assessed policy measures were collected in a policy workshop and via an online questionnaire. There is a potential to broaden the scope of policy measures promoting fiber-to-fiber recycling of textiles compared to the policy recommendations made by the Swedish Environmental Protection Agency (EPA). New policy measures in the textile field should embrace potentials to generate upstream improvements and increasing the demand for recycled textile fibers.Although the Swedish EPA suggests a mandatory EPR for textiles as one of two alternative policy options for handling of textile waste, the proposal focuses almost exclusively on downstream improvements. The mandatory EPR assessed in this report includes additional elements, embracing also the potential of an EPR system to generate upstream improvements. Economic instruments have shown to be successful measures to reduce environmental externalities. The RVP system assessed in this report adds a new perspective on potential ways and means to promote recycling of textiles complementing the investigation on how public bodies can contribute to more reuse and recycling of textiles by green public procurement suggested by the Swedish EPA.Both a mandatory EPR and a RVP system have potentials to have large positive impacts on fiber-to-fiber recycling as well as overall recycling of textiles. A mandatory EPR system has the same or larger positive impacts on all eight policy goals defined in this report compared to a RVP system. A mandatory EPR system embodies the potential to integrate a range (combination) of complementing policy measures whereas an RVP system should be complemented by additional policy measures.
|
|
| 10. |
- Elander, Maria, et al.
(författare)
-
Indikatorer för en resurseffektiv avfallshantering
- 2014
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Det övergripande målet med projektet var att ta fram ett antal indikatorer för att kunna visa på hur resurseffektiv avfallshanteringen är och jämföra hur utvecklingen blir över tiden. Detta innebär att indikatorerna: ska åskådliggöra måluppfyllelsen för uppsatta mål samt göra det möjligt att följa upp utvecklingen för svensk avfallshantering på kommunal/regional och nationell nivå på ett enkelt sätt . Trots att informationen och kunskapen om avfallshanteringen ständigt har förbättrats i samhället så har ändå svårigheterna med att mäta och följa upp utvecklingen ökat. De mål som satts för avfallshanteringen har stadigt förstärkts vilket har skapat ett alltmer komplext avfallshanteringssystem. Det märks tydligt på dagens ambitioner att utveckla de övre delarna i avfallshierarkin, det vill säga avfallsprevention och materialåtervinning. Dessa delar är betydligt svårare att beskriva, mäta och följa upp jämfört med de nedre behandlingsstegen. Att utveckla indikatorer kring förebyggande och frikoppling har varit ett viktigt mål för indikatorprojektet. I projektet har indikatorerna analyserats och testats i fem olika fallstudier (tre på kommunal nivå och två på nationell nivå varav en för hushållsavfall enligt Avfall Sverige och en för nationellt totalt avfall kopplat till den officiella avfallsstatistiken). Följande kriterier har använts och uppfylls: Relevans Datatillgång Kvalitet Kommunicerbarhet och användbarhet Indikatorerna som har tagits fram: Är neutrala och användbara på den nivå de avser, det vill säga på kommunal/ regional och/eller nationell nivå. Är utformade för att kunna mäta förändring och/eller förändringstakten årsvis Täcker varje steg av avfallshierarkin (det vill säga ge en indikation på resurseffektiviteten för respektive steg samt totalt). Mäter förändringen i resurseffektivitet för hela systemet över tid (det vill säga beskriva en position i avfallshierarkin). Indikatorerna kan användas på kommunal nivå eller på nationell nivå. Indikatorerna avser att ge beslutsfattare, kommuner och kommunala avfallsbolag stöd i planeringen och uppföljningen av den kommunala avfallshanteringen. Tre typer av indikatorer är utvecklade: Förflyttningsindikatorer – speglar avfallshanteringssystemets nivå och utveckling i sin helhet. Trappstegsindikatorer – beskriver och mäter utvecklingen på varje enskilt trappsteg i avfallshierarkin (avfallstrappan) minus de rejektmängder som uppkommer innan själva behandlingen (till exempel sorteringsrester från materialåtervinning). Bakgrundsindikatorer – tar hänsyn till allt avfall som behandlas på respektive trappsteg även avfall som uppkommer vid annan behandling (till exempel askor från förbränning). Indikatorerna presenteras samlat i Bilaga A. Målsättningen är att de framtagna indikatorerna ska integreras med existerande avfallsrapportering i kommunerna (till exempel i Avfall Web) och i den nationella uppföljningen som Naturvårdsverket genomför. En användarvägledning har också producerats inom projektet med syfte att ge en lättöverskådlig bild över indikatorerna och vad de kan användas till.
|
|
| 11. |
|
|
| 12. |
- Elander, Maria
(författare)
-
Matavfall i Sverige : Uppkomst och behandling 2014
- 2016
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Vår produktion, distribution och konsumtion av mat står för en betydande del av vår miljöpåverkan. Naturvårdsverket arbetar sedan ett antal år med att ta fram uppgifter och beräkna mängderna matavfall.Här presenteras mängderna matavfall i hela livsmedelskedjan för 2012 och 2014. Även de metoder, definitioner och avgränsningar som används för att beräkna mängderna beskrivs.
|
|
| 13. |
- Elander, Maria, et al.
(författare)
-
Potentialer för materialåtervinning av byggplast från rivning - erfarenheter utifrån två fallstudier
- 2015
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- I Sverige uppkommer årligen runt 43 000 ton plastavfall från byggbranschen, varav endast 150 ton sorteras ut för materialåtervinning. Detta trots att livscykelanalyser visar att materialåtervinning generellt är betydligt resurseffektivare än tillverkning av plast från jungfruliga råvaror. I många andra europeiska länder materialåtervinns idag plast från byggsektorn, vilket skapat en marknad för den upparbetade plasten. Polyvinylklorid (PVC) utgör den vanligaste plasttypen inom byggbranschen. Totalt samlades år 2013 i Europa sammanlagt 435 000 ton PVC-avfall in för materialåtervinning, varav Tyskland och Storbritannien står för ca 50 procent. Det insamlade materialet utgjordes huvudsakligen av kabelskrot, styv PVC-folie, rör, golv och profiler. IVL Svenska Miljöinstitutet (IVL) har på uppdrag av Stiftelsen IVL (SIVL) och PVC Forum/IKEM - Innovations- och kemiindustrierna i Sverige undersökt potentialerna för en ökad insamling och materialåtervinning av byggplast i Sverige. Projektet genomfördes i form av två fallstudier, där plastavfall från en totalrivning respektive en ombyggnation sorterades ut, eftersorterades och delvis analyserades med avseende på materialegenskaper. This report is only available in Swedish. English summary is available in the report.
|
|
| 14. |
- Elander, Maria, et al.
(författare)
-
Återanvändning av textil via utvalda online marknadsplatser och appar : Undersökning avseende åren 2016 och 2017
- 2019
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- SMED har på uppdrag av Naturvårdsverket undersökt mängden textilier som förmedlades för återanvändning via online marknadsplatser och appar från utvalda företag. Undersökningen omfattar uppgifter från sex företag som tydligt är aktiva på den svenska marknaden. Ingen uppräkning har gjorts för företag som valt att inte lämna uppgifter (bortfall). Den totala mängden textilier som förmedlas mellan konsumenter i Sverige via online marknadsplatser och appar bedöms därför vara större.De sex företag som ingick i undersökningen förmedlade totalt 970 ton kläder och hemtextil för återanvändning år 2016. Motsvarande siffra för 2017 är 1 300 ton, vilket motsvarar en ökning med 32 procent. År 2017 dominerades de förmedlade textilierna av damkläder (46 procent), följt av barnkläder (31 procent) och herrkläder (15 procent). Endast mindre mängder hemtextil förmedlades.Den totala mängden textil som 2017 förmedlades för återanvändning via de sex företagen i undersökningen motsvarade 0,13 kilogram per person i Sverige. Det motsvarar runt en procent av nettoimporten av nya textilier till den svenska marknaden. År 2016 motsvarade den totala mängden textil som förmedlas för återanvändning via de sex företagen i undersökningen bara runt tre procent av den totala mängden begagnade textilier som återanvändes via välgörenhetsorganisationer men 12 procent av mängden begagnade textilier som återanvändes i Sverige via välgörenhetsorganisationer.
|
|
| 15. |
- Engström, Linda, et al.
(författare)
-
Acetaminophen reduces lipopolysaccharide-induced fever by inhibiting cyclooxygenase-2
- 2013
-
Ingår i: Neuropharmacology. - : Elsevier. - 0028-3908 .- 1873-7064. ; 71, s. 124-129
-
Tidskriftsartikel (refereegranskat)abstract
- Acetaminophen is one of the world's most commonly used drugs to treat fever and pain, yet its mechanism of action has remained unclear. Here we tested the hypothesis that acetaminophen blocks fever through inhibition of cyclooxygenase-2 (Cox-2), by monitoring lipopolysaccharide induced fever in mice with genetic manipulations of enzymes in the prostaglandin cascade. We exploited the fact that lowered levels of a specific enzyme make the system more sensitive to any further inhibition of the same enzyme. Mice were immune challenged by an intraperitoneal injection of bacterial wall lipopolysaccharide and their body temperature recorded by telemetry. We found that mice heterozygous for Cox-2, but not for microsomal prostaglandin E synthase-1 (mPGES-1), displayed attenuated fever, indicating a rate limiting role of Cox-2. We then titrated a dose of acetaminophen that did not inhibit the lipopolysaccharide-induced fever in wild-type mice. However, when the same dose of acetaminophen was given to Cox-2 heterozygous mice, the febrile response to lipopolysaccharide was strongly attenuated, resulting in an almost normalized temperature curve, whereas no difference was seen between wild-type and heterozygous mPGES-1 mice. Furthermore, the fever to intracerebrally injected prostaglandin E2 was unaffected by acetaminophen treatment. These findings reveal that acetaminophen, similar to aspirin and other non-steroidal anti-inflammatory drugs, is antipyretic by inhibiting cyclooxygenase-2, and not by inhibiting mPGES-1 or signaling cascades downstream of prostaglandin E2.
|
|
| 16. |
- Fröding, Karin, 1974-
(författare)
-
Public health, neighbourhood development and participation : research and practice in four Swedish partnership cities
- 2011
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Det finns betydande skillnader i hälsa beroende på utbildning, socioekonomisk status, etnicitet, ålder och kön och det har konsekvenser för människors livslängd, livskvalitet och hälsa. Ojämlikheter i hälsa blir särskilt tydliga när man jämför olika geografiska områden, där vissa områden har hög koncentration av fattiga och socialt utslagna människor med dålig hälsa, arbetslöshet och låg utbildning. Att vidta åtgärder mot de utbredda hälsoskillnader som finns mellan människor med vitt skilda förutsättningar är en viktig utmaning för hälsofrämjande arbete. En strategi för att minska skillnader i hälsa mellan människor är att arbeta med områdesutveckling i prioriterade bostadsområden. Ett svenskt samarbete, Partnerskap för Hållbar Välfärdsutveckling, bildades 2003 mellan Helsingborg, Norrköping, Västerås och Örebro, kommunala bostadsbolag i dessa städer, flera nationella parter samt forskare vid Örebro universitet. Det centrala i partnerskapet var att genom erfarenhetsutbyte, metodutveckling och kunskapsspridning arbeta för en hållbar välfärdsutveckling i prioriterade bostadsområden (ett område från varje stad valdes ut). Integrerat i detta arbete var forskningsprogrammet ”Den hälsosamma staden - social integration, nätverkspolitik och hållbar välfärdsutveckling”, som följt partnerskapet vetenskapligt mellan åren 2003 och 2010. Det är av stor betydelse att integrera politik, praxis och forskning för att få kunskap om förutsättningar för en hälsosam utveckling i utsatta bostadsområden. Detta är en unik del av det nästan sjuåriga partnerskapsarbetet. Avhandlingens övergripande syfte har varit att inom ramen för Partnerskap för Hållbar Välfärdsutveckling studera folkhälsostrategier och lokalt utvecklingsarbete i kommuner och bostadsområden med särskild betoning på boendes deltagande för en hälsosam utveckling. Avhandlingens första studie syftar till att beskriva och analysera strategiskt folkhälsoarbete och lokalt områdesutvecklingsarbetet i fyra svenska kommuner samt den tidiga implementeringsfasen av Partnerskap för Hållbar Välfärdsutveckling. Datamaterialet består av dokumenterade intervjuer med folkhälsosamordnare och områdesutvecklare, deltagande observationer och skriftliga dokument. Resultatet visar att det redan i början av partnerskapsperioden fanns formella strukturer för folkhälsoarbetet i kommunen, till exempel ett folkhälsopolitiskt program, en utsedd samordnare, ett kontor och administrativa resurser samt politiker med särskilt ansvar för folkhälsofrågor. I uppbyggandet av de formella strukturerna var också de svenska nationella folkhälsomålen ett viktigt underlag. Vad gäller det lokala bostadsområdes arbete kan det ta sig olika uttryck även om målet är det samma. I partnerskapet fanns också tidigt höga förväntningar KARIN FRÖDING Public Health, Neighbourhood Development, and Participation I 83 att det skulle fungera som en sammanhållande kraft för ömsesidigt lärande och en positiv utveckling av prioriterade bostadsområden. Avhandlingens andra studie syftar till att analysera vad som karaktäriserar människor som deltar i områdesutveckling. Boende från tre av partnerskapskommunerna svarade på en enkät och resultatet visade på att människor som försökt påverka politiken i kommunen på olika sätt i större utsträckning deltar i områdesutveckling. Denna påverkan kan ske genom att kontakta en politiker eller lämna in ett medborgarförslag. Högt engagemang och aktivt deltagande var oberoende av individens sociodemografiska faktorer såsom utbildning eller inkomstnivå. Det var endast personer födda utanför Norden som i mindre utsträckning deltog i områdesutveckling. Avhandlingens tredje studie syftar till att undersöka en områdesbaserad interaktion mellan professionella (anställda), boende och forskare i en av partnerskapets utvalda stadsdelar. Baserat på deltagande observation under två år visar studien ett entydigt resultat: för att processen skall fungera krävdes att deltagarna öppet diskuterade enskilda situationer, personliga åtaganden och ömsesidiga förväntningar. Vidare var det viktigt att demaskera makt och auktoritet bland dem som deltar i processen för att inte några skulle ha mer inflytande på arbetet än de andra. Tiden visade sig vara viktig, att processen fick ta den tid det tog med konsensus som ett ledord. Slutligen var det viktigt att acceptera olika nivåer av deltagande. Allt detta bidrar till att skapa en gemensam känsla av engagemang och demokratisk dialog som är så viktigt i ett interaktivt samarbete. I avhandlingens fjärde studie är syftet att studera utvecklingsprocesser för att nå hållbara strukturer för lokalt områdesutvecklingsarbete i de fyra partnerskapsstäderna. Arbetet i Partnerskap för Hållbar Välfärdsutveckling har liksom kommunerna och det lokal områdesarbetet följts mellan åren 2003-2009. Genom en serie studier inom forskningsprogrammet med intervjuer, enkäter, deltagande observation och dokumentanalys har det utformats en databas för fallstudier. Resultatet visar att det under partnerskapsperioden fanns byggstenar i form av politiskt stöd, lokala partnerskap och boendes deltagande i områdesarbetet. När Partnerskap för Hållbar Välfärdsutveckling upphörde fanns dock få hållbara strukturer för områdesutveckling kvar. Det politiska stödet för områdesutveckling var under partnerskapstiden konstant högt men cykliskt, vilket innebar att prioriteringar ändrades. I samtliga fyra studerade stadsdelar hade områdesarbetet delvis avstannat och politiskt stöd och resurser lagts på andra områden i respektive kommun. I ett lokalt partnerskapssamarbete mellan kommun och kommunalt bostadsbolag finns dock möjlighet att bilda hållbara strukturer när såväl det strategiska som det lokala involveras i den praktiska delen av områdesutveckling. Medborgarnas deltagande verkar också utgöra en viss hållbar struktur för områdesutveckling, trots minskat politiskt stöd och resurser. Sammanfattningsvis visar denna avhandling att ett partnerskap för lokalt folkhälsoarbete kan fungera som en sammanhållande länk för lärande och utveckling bland alla inblandade aktörer. För ett fungerande områdesutvecklingsarbete är den lokala kontexten av största vikt liksom formella strukturer och ett nationellt stöd. Det är dessutom nödvändigt att beakta alla boende som potentiella deltagare i områdesutveckling oberoende av utbildning, kön eller inkomstnivå. När ett projektbaserat partnerskap avslutas måste det dessutom finnas strukturer som kan ta vid efter projekttidens slut. Avslutningsvis visar avhandlingen att ett områdesbaserat samspel med deltagande av professionella, boende och forskare ställer krav på en öppen, jämbördig dialog med ett accepterande förhållningssätt till olika nivåer av deltagande samt stort tidsutrymme.
|
|
| 17. |
- Giunta, Riccardo E., et al.
(författare)
-
ESPRAS Survey: National and European Societies for Plastic Surgeons
- 2024
-
Ingår i: HANDCHIRURGIE MIKROCHIRURGIE PLASTISCHE CHIRURGIE. - 0722-1819 .- 1439-3980.
-
Tidskriftsartikel (refereegranskat)abstract
- Background The European Society of Plastic, Reconstructive and Aesthetic Surgery (ESPRAS) comprises 40 national societies across Europe. In addition to ESPRAS, there are 8 different European Plastic Surgery societies representing Plastic Surgeons in Europe. The 4 th European Leadership Forum (ELF) of ESPRAS, held under the motto "Stronger together in Europe" in Munich in 2023, aimed to collect and disseminate information regarding the national member societies of ESPRAS and European societies for Plastic Surgeons. The purpose was to identify synergies and redundancies and promote improved cooperation and exchange to enhance coordinated decision-making at the European level. Material and methods An online survey was conducted regarding the organisational structures, objectives and challenges of national and European societies for Plastic Surgeons in Europe. This survey was distributed to official representatives (Presidents, Vice Presidents and General Secretaries) and delegates of national and European societies at the ELF meeting. Missing information was completed using data obtained from the official websites of the respective European societies. Preliminary results were discussed during the 4 th ELF meeting in Munich in March 2023. Results The ESPRAS survey included 22 national and 9 European Plastic Surgery societies representing more than 7000 Plastic Surgeons in Europe. Most national societies consist of less than 500 full members (median 182 members (interquartile range (IQR) 54-400); n=22). European societies, which covered the full spectrum or subspecialities, differed in membership types and congress cycles, with some requiring applications by individuals and others including national societies. The main purposes of the societies include research, representation against other disciplines, specialisation and education as well as more individual goals like patient care and policy regulation. Conclusion This ESPRAS survey offers key insights into the structures, requirements and challenges of national and European societies for Plastic Surgeons, highlighting the relevance of ongoing close exchange between the societies to foster professional advancement and reduce redundancies. Future efforts of the ELF will continue to further explore strategies for enhancing collaboration and harmonisation within the European Plastic Surgery landscape.
|
|
| 18. |
- Karlsson, Sandra, 1981-
(författare)
-
Områdesbaserad politik – möjligheter till strukturell förändring : Lokalt utvecklingsarbete i marginaliserade bostadsområden i Malmö
- 2016
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In 1995 the Swedish government launched the first area-based initiative Special initiatives in immigrant-dense neighbourhoods as a response to the current debate concerning the failings of the integration policy. The area-based policy and projects undertake the mission to reverse the trend in marginalized neighbourhoods in Sweden’s major cities from 1995 to 2014. The empirical material is from the projects Area-programs for a socially sustainable Malmö (2010-2015) and Lindängen towards the future (2012-2014), Malmö municipality. Adopting a social constructionist approach the study’s aim is to examine the projects’ assumptions concerning what – and who – should be changed and how. Based on the policy´s claim to achieve structural change the study also examines if, and if so what, possibilities the projects have to create opportunities for structural change. The study shows that the area-based projects cannot create opportunities for structural change but rather work to reduce the social consequences of structural deficiencies that are made visible through the reproduction of marginalised neighbourhoods. In the projects the social problem is constructed as consisting of four interrelated factors: long-term unemployment, foreign background, segregation and lack of social responsibility. The strategy is to mobilise public, private and civil sector actors so that they – despite society’s exclusion of people of foreign background in situations of long-term unemployment – take their social responsibility and make available resources to individual residents in order to prepare them for becoming active citizens. As they are not able to reduce poverty, promote inclusive political and economic processes or legitimate relationships between those in power and representatives of civil society with demands for changing conditions, their ability to create opportunities for structural change is found to be limited.
|
|
| 19. |
- Labori, Knut Jørgen, et al.
(författare)
-
Neoadjuvant FOLFIRINOX versus upfront surgery for resectable pancreatic head cancer (NORPACT-1) : a multicentre, randomised, phase 2 trial
- 2024
-
Ingår i: The Lancet Gastroenterology & Hepatology. - : The Lancet Group. - 2468-1253. ; 9:3, s. 205-217
-
Tidskriftsartikel (refereegranskat)abstract
- BackgroundIn patients undergoing resection for pancreatic cancer, adjuvant modified fluorouracil, leucovorin, irinotecan, and oxaliplatin (FOLFIRINOX) improves overall survival compared with alternative chemotherapy regimens. We aimed to compare the efficacy and safety of neoadjuvant FOLFIRINOX with the standard strategy of upfront surgery in patients with resectable pancreatic ductal adenocarcinoma.MethodsNORPACT-1 was a multicentre, randomised, phase 2 trial done in 12 hospitals in Denmark, Finland, Norway, and Sweden. Eligible patients were aged 18 years or older, with a WHO performance status of 0 or 1, and had a resectable tumour of the pancreatic head radiologically strongly suspected to be pancreatic adenocarcinoma. Participants were randomly assigned (3:2 before October, 2018, and 1:1 after) to the neoadjuvant FOLFIRINOX group or upfront surgery group. Patients in the neoadjuvant FOLFIRINOX group received four neoadjuvant cycles of FOLFIRINOX (oxaliplatin 85 mg/m2, irinotecan 180 mg/m2, leucovorin 400 mg/m2, and fluorouracil 400 mg/m2 bolus then 2400 mg/m2 over 46 h on day 1 of each 14-day cycle), followed by surgery and adjuvant chemotherapy. Patients in the upfront surgery group underwent surgery and then received adjuvant chemotherapy. Initially, adjuvant chemotherapy was gemcitabine plus capecitabine (gemcitabine 1000 mg/m2 over 30 min on days 1, 8, and 15 of each 28-day cycle and capecitabine 830 mg/m2 twice daily for 3 weeks with 1 week of rest in each 28-day cycle; four cycles in the neoadjuvant FOLFIRINOX group, six cycles in the upfront surgery group). A protocol amendment was subsequently made to permit use of adjuvant modified FOLFIRINOX (oxaliplatin 85 mg/m2, irinotecan 150 mg/m2, leucovorin 400 mg/m2, and fluorouracil 2400 mg/m2 over 46 h on day 1 of each 14-day cycle; eight cycles in the neoadjuvant FOLFIRINOX group, 12 cycles in the upfront surgery group). Randomisation was performed with a computerised algorithm that stratified for each participating centre and used a concealed block size of two to six. Patients, investigators, and study team members were not masked to treatment allocation. The primary endpoint was overall survival at 18 months. Analyses were done in the intention-to-treat (ITT) and per-protocol populations. Safety was assessed in all patients who were randomly assigned and received at least one cycle of neoadjuvant or adjuvant therapy. This trial is registered with ClinicalTrials.gov, NCT02919787, and EudraCT, 2015-001635-21, and is ongoing.FindingsBetween Feb 8, 2017, and April 21, 2021, 77 patients were randomly assigned to receive neoadjuvant FOLFIRINOX and 63 to undergo upfront surgery. All patients were included in the ITT analysis. For the per-protocol analysis, 17 (22%) patients were excluded from the neoadjuvant FOLFIRINOX group (ten did not receive neoadjuvant therapy, four did not have pancreatic ductal adenocarcinoma, and three received another neoadjuvant regimen), and eight (13%) were excluded from the upfront surgery group (seven did not have pancreatic ductal adenocarcinoma and one did not undergo surgical exploration). 61 (79%) of 77 patients in the neoadjuvant FOLFIRINOX group received neoadjuvant therapy. The proportion of patients alive at 18 months by ITT was 60% (95% CI 49–71) in the neoadjuvant FOLFIRINOX group versus 73% (62–84) in the upfront surgery group (p=0·032), and median overall survival by ITT was 25·1 months (95% CI 17·2–34·9) versus 38·5 months (27·6–not reached; hazard ratio [HR] 1·52 [95% CI 1·00–2·33], log-rank p=0·050). The proportion of patients alive at 18 months in per-protocol analysis was 57% (95% CI 46–67) in the neoadjuvant FOLFIRINOX group versus 70% (55–83) in the upfront surgery group (p=0·14), and median overall survival in per-protocol population was 23·0 months (95% CI 16·2–34·9) versus 34·4 months (19·4–not reached; HR 1·46 [95% CI 0·99–2·17], log-rank p=0·058). In the safety population, 42 (58%) of 73 patients in the neoadjuvant FOLFIRINOX group and 19 (40%) of 47 patients in the upfront surgery group had at least one grade 3 or worse adverse event. 63 (82%) of 77 patients in the neoadjuvant group and 56 (89%) of 63 patients in the upfront surgery group had resection (p=0·24). One sudden death of unknown cause and one COVID-19-related death occurred after the first cycle of neoadjuvant FOLFIRINOX. Adjuvant chemotherapy was initiated in 51 (86%) of 59 patients with resected pancreatic ductal adenocarcinoma in the neoadjuvant FOLFIRINOX group and 44 (90%) of 49 patients with resected pancreatic ductal adenocarcinoma in the upfront surgery group (p=0·56). Adjuvant modified FOLFIRINOX was given to 13 (25%) patients in the neoadjuvant FOLFIRINOX group and 19 (43%) patients in the upfront surgery group. During adjuvant chemotherapy, neutropenia (11 [22%] patients in the neoadjuvant FOLFIRINOX group and five [11%] in the upfront surgery group) was the most common grade 3 or worse adverse event.InterpretationThis phase 2 trial did not show a survival benefit from neoadjuvant FOLFIRINOX in resectable pancreatic ductal adenocarcinoma compared with upfront surgery. Implementation of neoadjuvant FOLFIRINOX was challenging. Future trials on treatment sequencing in resectable pancreatic ductal adenocarcinoma should be biomarker driven.
|
|
| 20. |
- Labori, Knut Jørgen, et al.
(författare)
-
Neoadjuvant FOLFIRINOX versus upfront surgery for resectable pancreatic head cancer (NORPACT-1) : a multicentre, randomised, phase 2 trial
- 2024
-
Ingår i: The Lancet Gastroenterology & Hepatology. - : Elsevier. - 2468-1253. ; 9:3, s. 205-217
-
Tidskriftsartikel (refereegranskat)abstract
- Background: In patients undergoing resection for pancreatic cancer, adjuvant modified fluorouracil, leucovorin, irinotecan, and oxaliplatin (FOLFIRINOX) improves overall survival compared with alternative chemotherapy regimens. We aimed to compare the efficacy and safety of neoadjuvant FOLFIRINOX with the standard strategy of upfront surgery in patients with resectable pancreatic ductal adenocarcinoma.Methods: NORPACT-1 was a multicentre, randomised, phase 2 trial done in 12 hospitals in Denmark, Finland, Norway, and Sweden. Eligible patients were aged 18 years or older, with a WHO performance status of 0 or 1, and had a resectable tumour of the pancreatic head radiologically strongly suspected to be pancreatic adenocarcinoma. Participants were randomly assigned (3:2 before October, 2018, and 1:1 after) to the neoadjuvant FOLFIRINOX group or upfront surgery group. Patients in the neoadjuvant FOLFIRINOX group received four neoadjuvant cycles of FOLFIRINOX (oxaliplatin 85 mg/m2, irinotecan 180 mg/m2, leucovorin 400 mg/m2, and fluorouracil 400 mg/m2 bolus then 2400 mg/m2 over 46 h on day 1 of each 14-day cycle), followed by surgery and adjuvant chemotherapy. Patients in the upfront surgery group underwent surgery and then received adjuvant chemotherapy. Initially, adjuvant chemotherapy was gemcitabine plus capecitabine (gemcitabine 1000 mg/m2 over 30 min on days 1, 8, and 15 of each 28-day cycle and capecitabine 830 mg/m2 twice daily for 3 weeks with 1 week of rest in each 28-day cycle; four cycles in the neoadjuvant FOLFIRINOX group, six cycles in the upfront surgery group). A protocol amendment was subsequently made to permit use of adjuvant modified FOLFIRINOX (oxaliplatin 85 mg/m2, irinotecan 150 mg/m2, leucovorin 400 mg/m2, and fluorouracil 2400 mg/m2 over 46 h on day 1 of each 14-day cycle; eight cycles in the neoadjuvant FOLFIRINOX group, 12 cycles in the upfront surgery group). Randomisation was performed with a computerised algorithm that stratified for each participating centre and used a concealed block size of two to six. Patients, investigators, and study team members were not masked to treatment allocation. The primary endpoint was overall survival at 18 months. Analyses were done in the intention-to-treat (ITT) and per-protocol populations. Safety was assessed in all patients who were randomly assigned and received at least one cycle of neoadjuvant or adjuvant therapy. This trial is registered with ClinicalTrials.gov, NCT02919787, and EudraCT, 2015-001635-21, and is ongoing.Findings: Between Feb 8, 2017, and April 21, 2021, 77 patients were randomly assigned to receive neoadjuvant FOLFIRINOX and 63 to undergo upfront surgery. All patients were included in the ITT analysis. For the per-protocol analysis, 17 (22%) patients were excluded from the neoadjuvant FOLFIRINOX group (ten did not receive neoadjuvant therapy, four did not have pancreatic ductal adenocarcinoma, and three received another neoadjuvant regimen), and eight (13%) were excluded from the upfront surgery group (seven did not have pancreatic ductal adenocarcinoma and one did not undergo surgical exploration). 61 (79%) of 77 patients in the neoadjuvant FOLFIRINOX group received neoadjuvant therapy. The proportion of patients alive at 18 months by ITT was 60% (95% CI 49–71) in the neoadjuvant FOLFIRINOX group versus 73% (62–84) in the upfront surgery group (p=0·032), and median overall survival by ITT was 25·1 months (95% CI 17·2–34·9) versus 38·5 months (27·6–not reached; hazard ratio [HR] 1·52 [95% CI 1·00–2·33], log-rank p=0·050). The proportion of patients alive at 18 months in per-protocol analysis was 57% (95% CI 46–67) in the neoadjuvant FOLFIRINOX group versus 70% (55–83) in the upfront surgery group (p=0·14), and median overall survival in per-protocol population was 23·0 months (95% CI 16·2–34·9) versus 34·4 months (19·4–not reached; HR 1·46 [95% CI 0·99–2·17], log-rank p=0·058). In the safety population, 42 (58%) of 73 patients in the neoadjuvant FOLFIRINOX group and 19 (40%) of 47 patients in the upfront surgery group had at least one grade 3 or worse adverse event. 63 (82%) of 77 patients in the neoadjuvant group and 56 (89%) of 63 patients in the upfront surgery group had resection (p=0·24). One sudden death of unknown cause and one COVID-19-related death occurred after the first cycle of neoadjuvant FOLFIRINOX. Adjuvant chemotherapy was initiated in 51 (86%) of 59 patients with resected pancreatic ductal adenocarcinoma in the neoadjuvant FOLFIRINOX group and 44 (90%) of 49 patients with resected pancreatic ductal adenocarcinoma in the upfront surgery group (p=0·56). Adjuvant modified FOLFIRINOX was given to 13 (25%) patients in the neoadjuvant FOLFIRINOX group and 19 (43%) patients in the upfront surgery group. During adjuvant chemotherapy, neutropenia (11 [22%] patients in the neoadjuvant FOLFIRINOX group and five [11%] in the upfront surgery group) was the most common grade 3 or worse adverse event.Interpretation: This phase 2 trial did not show a survival benefit from neoadjuvant FOLFIRINOX in resectable pancreatic ductal adenocarcinoma compared with upfront surgery. Implementation of neoadjuvant FOLFIRINOX was challenging. Future trials on treatment sequencing in resectable pancreatic ductal adenocarcinoma should be biomarker driven.
|
|
| 21. |
- Ljungkvist Norden, Hanna, et al.
(författare)
-
Key aspects for introducing an extended producer responsibility for textiles in Sweden
- 2019
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Mistra Future Fashion Phase 2, IVL Swedish Environment Institute (IVL), PlanMiljø and the International Institute of Industrial Environmental Economics (IIIEE) at Lund University have investigated a selection of important aspects to consider when implementing an Extended Producer Responsibility (EPR) for textiles in Sweden. The focus of the work was to identify, analyse and promote aspects that could help to balance upstream and downstream effects of an EPR. Large emphasis has been put on dialogue with actors in the textile value chain, to gather as much different knowledge and varying opinions as possible.
|
|
| 22. |
- Moellhoff, Nicholas, et al.
(författare)
-
ESPRAS Survey on Continuing Education in Plastic, Reconstructive and Aesthetic Surgery in Europe. : ESPRAS Umfrage zur Weiterbildung in der Plastischen Rekonstruktiven und Ästhetischen Chirurgie in Europa.
- 2022
-
Ingår i: Handchirurgie, Mikrochirurgie, plastische Chirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft fur Handchirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft fur Mikrochirurgie der Peripheren Nerven und Gefasse : Organ der V.... - : Georg Thieme Verlag KG. - 1439-3980. ; 54:4, s. 365-373
-
Tidskriftsartikel (refereegranskat)abstract
- Specialty training in plastic, reconstructive and aesthetic surgery is a prerequisite for safe and effective provision of care. The aim of this study was to assess and portray similarities and differences in the continuing education and specialization in plastic surgery in Europe.A detailed questionnaire was designed and distributed utilizing an online survey administration software. Questions addressed core items regarding continuing education and specialization in plastic surgery in Europe. Participants were addressed directly via the European Leadership Forum (ELF) of the European Society of Plastic, Reconstructive and Aesthetic Surgery (ESPRAS). All participants had detailed knowledge of the organization and management of plastic surgical training in their respective country.The survey was completed by 29 participants from 23 European countries. During specialization, plastic surgeons in Europe are trained in advanced tissue transfer and repair and aesthetic principles in all parts of the human body and within several subspecialties. Moreover, rotations in intensive as well as emergency care are compulsory in most European countries. Board certification is only provided for surgeons who have had multiple years of training regulated by a national board, who provide evidence of individually performed operative procedures in several anatomical regions and subspecialties, and who pass a final oral and/or written examination.Board certified plastic surgeons meet the highest degree of qualification, are trained in all parts of the body and in the management of complications. The standard of continuing education and qualification of European plastic surgeons is high, providing an excellent level of plastic surgical care throughout Europe.Die Facharzt-Weiterbildung für Plastische und Ästhetische Chirurgie ist eine Grundvoraussetzung für sichere und effektive Patientenversorgung. Ziel der vorliegenden Studie war die Darstellung von Gemeinsamkeiten und Unterschieden in der Weiterbildung für Plastische Chirurgie innerhalb von Europa.Ein internetbasierter Fragebogen wurde mit Hilfe eines kostenlosen Formularerstellungstools erstellt und verteilt. Die Fragen betrafen Kernpunkte der Weiterbildung für Plastische Chirurgie in Europa. Die Teilnehmer wurden direkt über das European Leadership Forum (ELF) der European Society of Plastic, Reconstructive and Aesthetic Surgery (ESPRAS) kontaktiert. Alle Teilnehmer hatten weitreichende Kenntnisse über die Organisation und Struktur der plastisch-chirurgischen Weiterbildung in ihrem jeweiligen Land.29 Teilnehmer*innen aus 23 europäischen Ländern nahmen an der Umfrage teil. Die Weiterbildung für Plastische Chirurgie beinhaltet grundlegende Prinzipien und Techniken zur Wiederherstellung von Form und Funktion innerhalb der verschiedenen Säulen der Plastischen Chirurgie, sowie in allen Körperregionen. In den meisten europäischen Ländern ist eine Rotation in der Intensiv- und Notfallmedizin und die Behandlung kritisch kranker Patienten obligatorisch. Voraussetzung für die Facharztbezeichnung ist die mehrjährige, national organisierte Weiterbildung, der Nachweis einer festgelegten Anzahl selbstständig durchgeführter Operationen, sowie die mündliche und/oder schriftliche Abschlussprüfung.Fachärzte für Plastische und Ästhetische Chirurgie sind hochqualifiziert und auch im Umgang mit Komplikationen geschult. Der Standard der Weiterbildung der europäischen Plastischen Chirurgen ist hoch, so dass innerhalb Europas eine hohe Qualität plastisch-chirurgischer Versorgung gewährleistet ist.
|
|
| 23. |
- Nilsberth, Camilla, et al.
(författare)
-
The Role of Interleukin-6 in Lipopolysaccharide-Induced Fever by Mechanisms Independent of Prostaglandin E-2
- 2009
-
Ingår i: Endocrinology. - : The Endocrine Society. - 0013-7227 .- 1945-7170. ; 150:4, s. 1850-1860
-
Tidskriftsartikel (refereegranskat)abstract
- Fever has been shown to be elicited by prostaglandin E-2 (PGE(2)) binding to its receptors on thermoregulatory neurons in the anterior hypothalamus. The signals that trigger PGE(2) production are thought to include proinflammatory cytokines, such as IL-6. However, although the presence of IL-6 is critical for fever, IL- 6 by itself is not or only weakly pyrogenic. Here we examined the relationship between IL-6 and PGE(2) in lipopolysaccharide (LPS)-induced fever. Immune-challenged IL- 6 knockout mice did not produce fever, in contrast to wild-type mice, but the expression of the inducible PGE(2)-synthesizing enzymes, cyclooxygenase-2 and microsomal prostaglandin E synthase-1, was similarly up-regulated in the hypothalamus of both genotypes, which also displayed similarly elevated PGE(2) levels in the cerebrospinal fluid. Nevertheless, both wild-type and knockout mice displayed a febrile response to graded concentrations of PGE(2) injected into the lateral ventricle. There was no major genotype difference in the expression of IL-1 beta and TNF alpha or their receptors, and pretreatment of IL- 6 knockout mice with soluble TNF alpha receptor ip or intracerebroventricularly or a cyclooxygenase-2 inhibitor ip did not abolish the LPS unresponsiveness. Hence, although IL- 6 knockout mice have both an intact PGE(2) synthesis and an intact fever-generating pathway downstream of PGE(2), endogenously produced PGE(2) is not sufficient to produce fever in the absence of IL-6. The findings suggest that IL- 6 controls some factor(s) in the inflammatory cascade, which render(s) IL- 6 knockout mice refractory to the pyrogenic action of PGE(2), or that it is involved in the mechanisms that govern release of synthesized PGE(2) onto its target neurons.
|
|
| 24. |
- Stafford, William C., et al.
(författare)
-
Irreversible inhibition of cytosolic thioredoxin reductase 1 as a mechanistic basis for anticancer therapy
- 2018
-
Ingår i: Science Translational Medicine. - : AMER ASSOC ADVANCEMENT SCIENCE. - 1946-6234 .- 1946-6242. ; 10:428
-
Tidskriftsartikel (refereegranskat)abstract
- Cancer cells adapt to their inherently increased oxidative stress through activation of the glutathione (GSH) and thioredoxin (TXN) systems. Inhibition of both of these systems effectively kills cancer cells, but such broad inhibition of antioxidant activity also kills normal cells, which is highly unwanted in a clinical setting. We therefore evaluated targeting of the TXN pathway alone and, more specifically, selective inhibition of the cytosolic selenocysteine-containing enzyme TXN reductase 1 (TXNRD1). TXNRD1 inhibitors were discovered in a large screening effort and displayed increased specificity compared to pan-TXNRD inhibitors, such as auranofin, that also inhibit the mitochondrial enzyme TXNRD2 and additional targets. For our lead compounds, TXNRD1 inhibition correlated with cancer cell cytotoxicity, and inhibitor-triggered conversion of TXNRD1 from an antioxidant to a pro-oxidant enzyme correlated with corresponding increases in cellular production of H2O2. In mice, the most specific TXNRD1 inhibitor, here described as TXNRD1 inhibitor 1 (TRi-1), impaired growth and viability of human tumor xenografts and syngeneic mouse tumors while having little mitochondrial toxicity and being better tolerated than auranofin. These results display the therapeutic anticancer potential of irreversibly targeting cytosolic TXNRD1 using small molecules and present potent and selective TXNRD1 inhibitors. Given the pronounced up-regulation of TXNRD1 in several metastatic malignancies, it seems worthwhile to further explore the potential benefit of specific irreversible TXNRD1 inhibitors for anticancer therapy.
|
|
| 25. |
- Stenmarck, Åsa, et al.
(författare)
-
Styrmedel för ökad materialåtervinning - En kartläggning
- 2014
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Syftet med projektet var att sammanställa ännu outnyttjade potentialer för materialåtervinning i Sverige samt att kartlägga, analysera och föreslå styrmedel som kan bidra till en ökad materialåtervinning.Projektet genomfördes som en litteraturstudie av potentiella styrmedel för ökad materialåtervinning, en fördjupad analys av styrmedel som bedömdes särskilt intressanta att beskriva och värdera närmare samt en analys av två utvalda styrmedel.Sammanlagt beskrevs tio olika styrmedel som bedömdes ha potential att öka materialåtervinningen i Sverige. Två av dessa, Krav på materialåtervinning för bygg- och rivningsprojekt samt Krav på utsortering och materialåtervinning av avfall från verksamheter och hushåll analyserades närmare utifrån olika aspekter (t.ex. potentiell miljövinst genom materialåtervinning, kostnad för implementering och acceptans). Valet motiverades med att mycket avfall från bygg- och rivningssektorn inte sorteras och att det finns stora mängder återvinningsbart material i blandat avfall. Potentialen att öka materialåtervinningen bedömdes som stor och förutsättningarna för genomförande vara relativt goda.
|
|
| 26. |
- Sörme, Louise, et al.
(författare)
-
Indikatorer för att följa konsumenters omställning till en hållbar konsumtion
- 2015
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Generationsmålet är det övergripande målet för miljöpolitiken i Sverige och innebär att vi till nästa generation ska kunna lämna över ett samhälle där de stora miljöproblemen är lösta, utan att orsaka ökade miljö- och hälsoproblem utanför Sveriges gränser. Som del av detta mål ska miljöpolitiken bland annat fokusera på att konsumtionsmönstren av varor och tjänster orsakar så små miljö- och hälsoproblem som möjligt. Naturvårdsverket ska på uppdrag av Regeringen redovisa en fördjupad utvärdering av generationsmålet och miljökvalitetsmålen 2015. Uppdraget ska redovisas senast den 1 september 2015. Redovisningen ska bland annat innehålla en målövergripande analys av utvecklingen mot generationsmålet och miljökvalitetsmålen. En del av denna analys genomförs inom ramen för tre utvalda fokusområden, däribland hållbar konsumtion. Projektet syftade till att ta fram ett av flera faktaunderlag till Regeringens ovanstående uppdrag om fördjupad utvärdering av miljökvalitetsmålen. Det konkreta målet var att ta fram förslag på möjliga indikatorer samt att beskriva för- och nackdelar med olika förslag samt att dataförsörja fyra indikatorer som följer konsumenters/individers omställning till en mer hållbar konsumtion. De fyra indikatorerna valdes ut av Naturvårdsverket. För att få fram det preliminära indikatorurvalet hämtades bland annat inspiration från andra projekt och sammanställningar av indikatorer i Sverige och utomlands, samt från aktuell diskussion i media och liknande. Därefter gjordes en genomgång ifall det fanns data tillgängliga eller inte. Fanns det data tillgängligt och indikatorn i övrigt uppfyllde kriterier som Naturvårdsverket satt upp ingick den i det urval av 27 indikatorer som beskrevs mer utförligt. I beskrivningen ingick enhet, för- och nackdelar, tidsserie och datakälla. Indikatorerna delades upp i olika områden; mat, textil, elektronik, boende samt transporter. Rapporten nämner också indikatorer som skulle vara önskvärda men där det saknas data, totalt 42 stycken. Naturvårdsverket valde ut följande indikatorer som också har dataförsörjts inom projektet: M1 - Konsumtion av nötkött, kg/person och år M8 - Energiöverskott i matkonsumtionen, procent Tr1 - Persontransporter (totalt och uppdelat på gång/cykel, kollektivtrafik, bil, och övrigt), km/person och år B3 - Uppvärmd boendeyta i hushåll, m2/person
|
|
| 27. |
- Willadsen, Elisabeth, et al.
(författare)
-
Scandcleft Project, Trial 1: Comparison of Speech Outcome in Relation to Timing of Hard Palate Closure in 5-Year-Olds With UCLP.
- 2019
-
Ingår i: The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association. - : SAGE Publications. - 1545-1569. ; 56:10, s. 1276-1286
-
Tidskriftsartikel (refereegranskat)abstract
- To compare in-depth speech results in Scandcleft Trial 1 as well as reference data from peers without cleft palate (CP).A prospective randomized clinical trial.A Danish and a Swedish CP center.143 of 148 randomized 5-year-olds with unilateral cleft lip and palate. All received lip and velum closure at 4 months, and hard palate closure at 12 months (arm A) or 36 months (arm B).A composite measure based on velopharyngeal competence (VPC) or velopharyngeal incompetence (VPI), an overall assessment of VPC from connected speech (VPC-Rate), Percentage of Consonants Correct (PCC-score), and consonant errors. Speech therapy visits, average hearing thresholds, and secondary pharyngeal surgeries documented burden of treatment.Across the trial, 61.5% demonstrated VPC and 38.5% VPI. Twenty-two percent of participants achieved age appropriate PCC-scores. There were no statistically significant differences between arms or centers for these measures. In the Danish center, arm B: achieved lower PCC-scores (P = .01); obtained PCC-scores without s-errors below 79% (P = .002); produced ≥3 active oral cleft speech characteristics (P = .004) than arm A. In both centers, arm B attended more speech visits.At age 5, differences between centers and treatment arms were not statistically significant for VPC/VPI, but consonant proficiency differed between treatment arms in the Danish center. Poor speech outcomes were seen for both treatment arms. Variations between centers were observed. As the Swedish center had few participants, intercenter comparisons should be interpreted with caution.
|
|
| 28. |
- Wållberg, Helena, et al.
(författare)
-
HER2-Positive Tumors Imaged Within 1 Hour Using a Site-Specifically C-11-Labeled Sel-Tagged Affibody Molecule
- 2012
-
Ingår i: Journal of Nuclear Medicine. - Stockholm : Society of Nuclear Medicine. - 0161-5505 .- 1535-5667 .- 2159-662X. ; 53:9, s. 1446-1453
-
Tidskriftsartikel (refereegranskat)abstract
- A rapid, reliable method for distinguishing tumors or metastases that overexpress human epidermal growth factor receptor 2 (HER2) from those that do not is highly desired for individualizing therapy and predicting prognoses. In vivo imaging methods are available but not yet in clinical practice; new methodologies improving speed, sensitivity, and specificity are required. Methods: A HER2-binding Affibody molecule, Z(HER2:342), was recombinantly fused with a C-terminal selenocysteine-containing tetrapeptide Sel-tag, allowing site-specific labeling with either C-11 or Ga-68, followed by biodistribution studies with small-animal PET. Dosimetry data for the 2 radiotracers were compared. Imaging of HER2-expressing human tumor xenografts was performed using the C-11-labeled Affibody molecule. Results: Both the C-11- and Ga-68-labeled tracers initially cleared rapidly from the blood, followed by a slower decrease to 4-5 percentage injected dose per gram of tissue at 1 h. Final retention in the kidneys was much lower (>5-fold) for the C-11-labeled protein, and its overall absorbed dose was considerably lower. C-11-Z(HER2:342) showed excellent tumor-targeting capability, with almost 10 percentage injected dose per gram of tissue in HER2-expressing tumors within 1 h. Specificity was demonstrated by preblocking binding sites with excess ligand, yielding significantly reduced radiotracer uptake (P = 0.002), comparable to uptake in tumors with low HER2 expression. Conclusion: To our knowledge, the Sel-tagging technique is the first that enables site-specific C-11-radiolabeling of proteins. Here we present the finding that, in a favorable combination between radionuclide half-life and in vivo pharmacokinetics of the Affibody molecules, C-11-labeled Set-tagged Z(HER2:342) can successfully be used for rapid and repeated PET studies of HER2 expression in tumors.
|
|
| 29. |
- Wållberg, Helena, et al.
(författare)
-
Specific in vivo imaging of HER2-positive tumors within one hour using a site-specifically 11C-labeled Sel-tagged Affibody molecule
-
Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- A rapid, reliable method for distinguishing tumors or metastases that overexpress human epidermal growth factor receptor 2 (HER2) from those that do not is highly desired for improvement of cancer care. In v ivo imaging methods are available, but are not yet in clinical practice; new methodologies improving speed, sensitivity and specificity are required. Here we describe promising results with a HER2‐binding Affibody molecule, ZHER2:342, recombinantly fused with a C‐terminal selenocysteine‐containing tetrapeptide Sel‐tag and site‐specifically labeled with either 11C or 68Ga for molecular imaging applications with positron emissiontomography (PET). In mice, both the 11C‐ and 68Ga‐labeled tracers initially cleared rapidly from the blood, followed by a slower decrease to 4‐5 %ID/g at 1 h. Final uptake in kidneys was much lower (> 5‐fold) for the 11C‐labeled protein, leading to markedly reduced background radioactivity in the abdomen. Furthermore, 11C‐labeled Sel‐tagged ZHER2:342 showed excellent tumor targeting capability, with almost 10 %ID/g in HER2 expressing tumors within the first hour. High specificity was demonstrated by preblocking the binding sites with excess ligand, which yielded low radiotracer uptakes, comparable to those in tumors with low endogenous HER2 expression. To our knowledge the Sel‐tagging technique is the first that enables site‐specific 11C radiolabelingof proteins. Here we present that, in a favorable combination between radionuclide half‐life and in vivo pharmacokinetics of the Affibody molecules, 11C‐labeled Sel taggedZHER2:342 can successfully be used for rapid and repeated PET studies of HER2 expression in tumors.
|
|
