| 1. |
- Villa, Luisa L., et al.
(författare)
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Quadrivalent vaccine against human papillomavirus to prevent high-grade cervical lesions
- 2007
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Ingår i: New England Journal of Medicine. - 0028-4793 .- 1533-4406. ; 356:19, s. 1915-1927
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Human papillomavirus types 16 (HPV-16) and 18 (HPV-18) cause approximately 70% of cervical cancers worldwide. A phase 3 trial was conducted to evaluate a quadrivalent vaccine against HPV types 6, 11, 16, and 18 (HPV-6/11/16/18) for the prevention of high-grade cervical lesions associated with HPV-16 and HPV-18. METHODS: In this randomized, double-blind trial, we assigned 12,167 women between the ages of 15 and 26 years to receive three doses of either HPV-6/11/16/18 vaccine or placebo, administered at day 1, month 2, and month 6. The primary analysis was performed for a per-protocol susceptible population that included 5305 women in the vaccine group and 5260 in the placebo group who had no virologic evidence of infection with HPV-16 or HPV-18 through 1 month after the third dose (month 7). The primary composite end point was cervical intraepithelial neoplasia grade 2 or 3, adenocarcinoma in situ, or cervical cancer related to HPV-16 or HPV-18. RESULTS: Subjects were followed for an average of 3 years after receiving the first dose of vaccine or placebo. Vaccine efficacy for the prevention of the primary composite end point was 98% (95.89% confidence interval [CI], 86 to 100) in the per-protocol susceptible population and 44% (95% CI, 26 to 58) in an intention-to-treat population of all women who had undergone randomization (those with or without previous infection). The estimated vaccine efficacy against all high-grade cervical lesions, regardless of causal HPV type, in this intention-to-treat population was 17% (95% CI, 1 to 31). CONCLUSIONS: In young women who had not been previously infected with HPV-16 or HPV-18, those in the vaccine group had a significantly lower occurrence of high-grade cervical intraepithelial neoplasia related to HPV-16 or HPV-18 than did those in the placebo group.
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| 2. |
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| 5. |
- Plos, M., et al.
(författare)
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Non-Linear Analysis and Remaining Fatigue Life of Reinforced Concrete Bridges
- 2007
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Rapport (refereegranskat)abstract
- The work provides methods for non-linear structural analysis and fatigue safety evaluation in assessment of existing railway bridges. The use of non-linear analysis leads to higher load carrying capacities, but also to improved understanding of the structural response, forming a better basis for decisions in the assessment. The methods for fatigue assessment lead to increased remaining service life of reinforced concrete railway bridges.The achievements of the work are:• Models for assessment of concrete bridges by non-linear analysis are described, and examples and general recommendations for practical application of the methods aregiven.• An overview of the effect of corrosion on the bond properties has been developed through non-linear analyses and tests found in literature. Recommendations for practical assessment of anchorage capacity in corroded railway concrete bridges are presented.• The determination of reliable in-situ material properties in old concrete bridges is described,including properties for fully probabilistic analysis. A particular aim was to develop better methods to describe development of concrete properties with age and degree of hydration.• Recommendations are given regarding re-distribution of sectional forces and moments, obtained through linear structural analysis (with FEM). In a case study, a typical slab bridge was designed using different methods, and its response evaluated through nonlinearanalyses.• A good understanding of the load-carrying mechanisms in combined bending-shear-torsion gives a possibility to make more accurate assessments than with standard code methods. Methods and examples are presented.• A state-of-the-art review of fatigue behaviour of reinforced concrete railway bridges is presented and a methodology to assess the remaining fatigue life of existing reinforced concrete bridges subjected to railway traffic is developed.
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| 6. |
- Plos, Mario, et al.
(författare)
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Structural assessment of railway concrete bridges : non-linear analysis and remaining fatigue life
- 2006
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Ingår i: Bridge Maintenance, Safety, Management, Life-Cycle Performance and Cost. - London : Taylor and Francis Group. - 0415403154 ; , s. 271-
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Konferensbidrag (refereegranskat)abstract
- For a sustainable development in Europe, there is a need to at least double the railway transports in the coming 20 years. In order to reach this, the residual service lives of existing concrete bridges need to be extended at the same time as they are subjected to higher axle loads, higher railway speeds and heavier traffic intensity. Today, many concrete bridges are replaced or strengthened because their reliability cannot be guaranteed based on the structural assessments made. The aim of the work presented here is to provide enhanced assessment methods that are able to prove higher load carrying capacities and longer fatigue lives for existing concrete railway bridges. One main objective is to facilitate the use of non-linear analysis for structural assessment. In addition to higher load carrying capacities, the methods give improved understanding of the structural response, forming a better basis for decisions in the assessment. Another main objective is to improve knowledge about the fatigue behaviour of concrete bridges and to develop realistic methods for the evaluation of remaining fatigue life of existing bridges. The emphasis here is on short-span bridges and secondary elements. The work presented is a part of the ongoing EU-project Sustainable Bridges. The results will be implemented in the Guideline for Load and Resistance Assessment of existing European Railway Bridges that is being developed
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| 8. |
- Airell, A, et al.
(författare)
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Chlamydia trachomatis PCR (Cobas Amplicor) in women: endocervical specimen transported in a specimen of urine versus endocervical and urethral specimens in 2-SP medium versus urine specimen only
- 2000
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Ingår i: International journal of STD & AIDS. - : SAGE Publications. - 0956-4624 .- 1758-1052. ; 11:10, s. 651-658
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Tidskriftsartikel (refereegranskat)abstract
- The sensitivity of Roche Cobas Amplicor Chlamydia trachomatis polymerase chain reaction (PCR) including the internal control (IC) programme to identify inhibition, was investigated on 3 different samples from women: (1) swab samples from the urethra and the cervix pooled in 2-SP transport medium, (2) swab sample from the cervix transported in a urine sample from the same patient, and (3) urine sample alone. Out of the 2412 patients, 193 (8.0%) were chlamydia positive and in 14 of these the results showed discrepancies between sampling methods. The sensitivity of PCR on urethra/cervix, urine/cervix and urine was 98.4% (190/193), 97.9% (189/193) and 93.3% (180/193) respectively. The higher sensitivity of PCR on urethra/cervix and urine/cervix as compared with urine alone was statistically significant. Without the IC, the sensitivity of PCR on urethra/ cervix, urine/cervix and urine would have been 95.9% (185/193), 94.8% (183/193) and 90.7% (175/193) respectively. Factors influencing the rate of inhibition were also studied.
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| 9. |
- Andersson, S, et al.
(författare)
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A comparison of the human papillomavirus test and Papanicolaou smear as a second screening method for women with minor cytological abnormalities
- 2005
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 84:10, s. 996-1000
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Tidskriftsartikel (refereegranskat)abstract
- Background. Of the estimated one million Papanicolaou (pap) smears performed annually in Sweden, about 4% show any degree of abnormality. Approximately, 1% of these cases contain moderate or severe atypia (high-grade squamous intraepithelial lesions) and the rest contain low-grade atypia. Recommendations for the management of minor abnormalities vary in various parts of Sweden. Generally, a second Pap smear is obtained 4-6 months after the first one showing low-grade atypia. The aim of this study is to compare the sensitivity of human papilloma virus (HPV)-DNA testing for the detection of cervical intraepithelial neoplasia (CIN) 2-3 with that of a second Pap smear in women, who had low-grade atypia in their first Pap smear. Methods. Women with low-grade atypia in the Stockholm area, detected at a population-based cytology screening, were enrolled. A repeat Pap smear, HPV test, and colposcopically directed biopsies were obtained. For the detection of HPV, Hybrid Capture II (HC II) was used. Results. The HPV-DNA test was positive in 66% of the 177 participating women. The sensitivity of the second Pap smear and HPV-DNA test to detect CIN 2-3 was 61 (95% CI = 45-74) and 82% (95% CI = 67-91), respectively. The positive and negative predictive values of HPV testing were 27 (95% CI = 18-35) and 89% (95% CI = 80-97), respectively. Conclusions. In Sweden, a second Pap smear is often obtained for the follow-up of women with low-grade atypia. The results of our study show that compared to the second Pap smear, HPV testing with HC II is a more sensitive method for detecting high-grade lesions.
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| 10. |
- Carlander, C., et al.
(författare)
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Assessing cervical intraepithelial neoplasia as an indicator disease for HIV in a low endemic setting: a population-based register study
- 2017
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Ingår i: Bjog-an International Journal of Obstetrics and Gynaecology. - : Wiley. - 1470-0328 .- 1471-0528. ; 124:11, s. 1680-1687
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Tidskriftsartikel (refereegranskat)abstract
- Objectives To analyse whether the prevalence of undiagnosed HIV among (1) all women in Sweden and (2) migrant women, diagnosed with cervical intraepithelial neoplasia grade 2 or worse CIN2+ reaches the threshold of 0.1%, which has been suggested to be cost-effective for HIV testing. Design Population-based register study. Setting Counties of Stockholm and Gothenburg, Sweden, 1990-2014. Population All women, born between 1940 and 1990, with at least one cervical cytology or histology registered in the Swedish National Cervical Screening Register (NKCx). Methods Data were collected from the NKCx and the Swedish National HIV register. The proportion of women with undiagnosed HIV among women with CIN2+ compared with women with a normal/mildly abnormal cytology/histology was assessed. Results The proportion of undiagnosed HIV was higher among all women with CIN2+ than among those without CIN2+: 0.06% (95% CI 0.04-0.08) versus 0.04% (95% CI 0.04-0.04); P = 0.017). Among migrant women, the proportion of undiagnosed HIV was higher among those with CIN2+ than among those without [0.30% (95% CI 0.20-0.43) versus 0.08% (95% CI 0.07-0.10); P < 0.001] and exceeded 0.1%, suggesting the cost-effectiveness of HIV testing. Women with undiagnosed HIV at the time of CIN2+ had a significantly lower nadir CD4+ T-cell count, as a measure of immunosuppression, compared with women without CIN2+ before HIV diagnosis ( median nadir CD4, 95 cells/mm(3) versus 210 cells/mm(3); P < 0.01). Conclusions HIV testing should be performed in migrant women with unknown HIV status diagnosed with CIN2+.
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| 11. |
- Carlander, C., et al.
(författare)
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HPV Types in Cervical Precancer by HIV Status and Birth Region: A Population-Based Register Study
- 2020
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Ingår i: Cancer Epidemiology Biomarkers & Prevention. - 1055-9965. ; 29:12, s. 2662-2668
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Tidskriftsartikel (refereegranskat)abstract
- Background: Data are lacking regarding which human papillomavirus (HPV) types cause high-grade cervical neoplasia (CIN2+) in people with HIV in Europe. We assessed which HPV types are associated with CIN2+ in women living in Sweden by HIV status. Methods: The Swedish National HIV Registry, the Swedish Population Registry, and the Swedish National Cervical Screening Registry were linked. CIN2+ tissue blocks of 130 women living with HIV (WLWH) and 234 HIV-negative women, matched for country of birth (1:2), were retrieved from bio-banks and HPV genotyped. Adjusted ORs (adjOR), stratified by country of birth, were calculated using conditional logistic regression. Matching was broken for cross-group comparisons. Results: WLWH with CIN2 were less likely to have HPV16 [14% vs. 40%; adjOR 0.1; 95% confidence interval (CI), 0.04-0.56] than HIV-negative women, but among women with CIN3, there was no difference in HPV16 prevalence by HIV status (adjOR 0.9; 95% CI, 0.51-1.70). WLWH were six times more likely to have HPV35 in CIN3 than HIV-negative women (adjOR 6.2; 95% CI, 1.3-30.4). WLWH from sub-Saharan Africa (SSA) had less 9-valent vaccine types, compared with both HIV-negative women born in Sweden (adjOR 0.1; 95% CI, 0.02-0.44) and WLWH born in Sweden (adjOR 0.1; 95% CI, 0.01-0.73), mostly because of decreased HPV16 and increased HPV35. Conclusions: WLWH from SSA were less likely to be covered by the 9-valent vaccine, mostly due to less HPV16 and more HPV35. Impact: This could have implications for HPV vaccines, currently not including HPV35, and for HPV-screening algorithms in women with origin from SSA.
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| 14. |
- Elfgren, Kristina, et al.
(författare)
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Colposcopic and histopathologic evaluation of women participating in population-based screening for human papillomavirus deoxyribonucleic acid persistence
- 2005
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Ingår i: Am J Obstet Gynecol. - : Elsevier BV. ; 193:3, s. 650-657
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Evaluation of colposcopic and histopathological findings in women screened for cervical human papillomavirus deoxyribonucleic acid persistence. STUDY DESIGN: A total of 12 527 women, aged 32 to 38 years old, attending the population-based cervical cancer screening program in Sweden were randomized 1:1 to mock testing or human papillomavirus deoxyribonucleic acid testing by general primer 5+/6+ polymerase chain reaction and subsequent typing. Human papillomavirus deoxyribonucleic acid-positive women with a normal Papanicolaou smear (n=341) and an equal number from the control group were human papillomavirus tested on average 19 months later. One hundred nineteen women with type-specific human papillomavirus persistence and 111 controls were referred to colposcopy, and 84.8% attended. RESULTS: Histopathology from colposcopically directed biopsies confirmed cervical intraepithelial neoplasia grade 2 or 3 in 28 of 100 of the women with human papillomavirus deoxyribonucleic acid persistence and in 2 of 95 among controls. CONCLUSION: Among women with normal Papanicolaou smear attending population-based screening, the positive predictive value of human papillomavirus deoxyribonucleic acid persistence for detection of biopsy-confirmed cervical intraepithelial neoplasia 2 or 3 was 29%.
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| 22. |
- Petersson, K M, et al.
(författare)
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A dynamic role of the medial temporal lobe during retrieval of declarative memory in man
- 1997
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Ingår i: NeuroImage. - : Elsevier BV. - 1053-8119. ; 6:1, s. 1-11
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Tidskriftsartikel (refereegranskat)abstract
- Understanding the role of the medial temporal lobe (MTL) in learning and memory is an important problem in cognitive neuroscience. Memory and learning processes that depend on the function of the MTL and related diencephalic structures (e.g., the anterior and mediodorsal thalamic nuclei) are defined as declarative. We have studied the MTL activity as indicated by regional cerebral blood flow with positron emission tomography and statistical parametric mapping during recall of abstract designs in a less practiced memory state as well as in a well-practiced (well-encoded) memory state. The results showed an increased activity of the MTL bilaterally (including parahippocampal gyrus extending into hippocampus proper, as well as anterior lingual and anterior fusiform gyri) during retrieval in the less practiced memory state compared to the well-practiced memory state, indicating a dynamic role of the MTL in retrieval during the learning processes. The results also showed that the activation of the MTL decreases as the subjects learn to draw abstract designs from memory, indicating a changing role of the MTL during recall in the earlier stages of acquisition compared to the well-encoded declarative memory state.
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| 23. |
- Petersson, K M, et al.
(författare)
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Dynamic changes in the functional anatomy of the human brain during recall of abstract designs related to practice
- 1999
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Ingår i: Neuropsychologia. - 0028-3932. ; 37:5, s. 87-567
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Tidskriftsartikel (refereegranskat)abstract
- In the present PET study we explore some functional aspects of the interaction between attentional/control processes and learning/memory processes. The network of brain regions supporting recall of abstract designs were studied in a less practiced and in a well practiced state. The results indicate that automaticity, i.e., a decreased dependence on attentional and working memory resources, develops as a consequence of practice. This corresponds to the practice related decreases of activity in the prefrontal, anterior cingulate, and posterior parietal regions. In addition, the activity of the medial temporal regions decreased as a function of practice. This indicates an inverse relation between the strength of encoding and the activation of the MTL during retrieval. Furthermore, the pattern of practice related increases in the auditory, posterior insular-opercular extending into perisylvian supramarginal region, and the right mid occipito-temporal region, may reflect a lower degree of inhibitory attentional modulation of task irrelevant processing and more fully developed representations of the abstract designs, respectively. We also suggest that free recall is dependent on bilateral prefrontal processing, in particular non-automatic free recall. The present results confirm previous functional neuroimaging studies of memory retrieval indicating that recall is subserved by a network of interacting brain regions. Furthermore, the results indicate that some components of the neural network subserving free recall may have a dynamic role and that there is a functional restructuring of the information processing networks during the learning process.
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| 24. |
- Petersson, K M, et al.
(författare)
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Learning-related effects and functional neuroimaging
- 1999
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Ingår i: Human Brain Mapping. - 1065-9471. ; 7:4, s. 43-234
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Tidskriftsartikel (refereegranskat)abstract
- A fundamental problem in the study of learning is that learning-related changes may be confounded by nonspecific time effects. There are several strategies for handling this problem. This problem may be of greater significance in functional magnetic resonance imaging (fMRI) compared to positron emission tomography (PET). Using the general linear model, we describe, compare, and discuss two approaches for separating learning-related from nonspecific time effects. The first approach makes assumptions on the general behavior of nonspecific effects and explicitly models these effects, i.e., nonspecific time effects are incorporated as a linear or nonlinear confounding covariate in the statistical model. The second strategy makes no a priori assumption concerning the form of nonspecific time effects, but implicitly controls for nonspecific effects using an interaction approach, i.e., learning effects are assessed with an interaction contrast. The two approaches depend on specific assumptions and have specific limitations. With certain experimental designs, both approaches may be used and the results compared, lending particular support to effects that are independent of the method used. A third and perhaps better approach that sometimes may be practically unfeasible is to use a completely temporally balanced experimental design. The choice of approach may be of particular importance when learning-related effects are studied with fMRI.
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| 29. |
- Scordelis, Alex C, et al.
(författare)
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Time-dependent behavior of concrete box girder bridges
- 1979
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Ingår i: Journal of the American Concrete Institute. - 0002-8061. ; 76:1, s. 159-177
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Tidskriftsartikel (refereegranskat)abstract
- Time-dependent deflections and strain histories under sustained dead load, after successively increasing overload conditions, are presented for two 1:2.82 scale reinforced concrete models of a two-lane prototype bridge in California having two 30. 9 m spans with a single column bent at the center. The two models had the same four cell cross section but one was straight in plan, while the other was curved. The experimental data for the two bridge models are presented and compared with each other as well as with theoretical predictions. Time-dependent responses of the two bridges were quite similar. Maximum dead load deflection after 4 months and the application and removal of heavy overloads was about 4 times the initial deflection.
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| 30. |
- Scordelis, Alexander C, et al.
(författare)
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Ultimate strength of curved RC box girder bridge
- 1977
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Ingår i: Journal of the Structural division (1956-1982). - 0044-8001. ; 103:8, s. 1525-1542
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Tidskriftsartikel (refereegranskat)abstract
- Results obtained in a study of a large-scale curved two-span four-cell reinforced concrete box girder bridge model are presented. The model, which was a 1:2. 82 scale replica of a prototype, had overall plan dimensions of 72 ft (21 m) long by 12 ft (3. 7 m) wide. The radius of curvature was 100 ft (30. 5 m). This represents the sharpest curvature normally used for bridges in the California highway system. Experimental and theoretical results are considered for reactions, steel and concrete strains, deflections, and moments due to conditioning overloads producing stress values as high as 2. 5 times the nominal design stress. The loading to failure and the ultimate strength behavior is examined. The excellent live-load overload capacity of the bridge is evaluated and comparisons are made with the similar behavior of an earlier tested straight bridge model. Conclusions appropriate for the design of this type of bridge are given.
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