| 1. |
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| 2. |
- Sumaila, U. Rashid, et al.
(författare)
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WTO must ban harmful fisheries subsidies
- 2021
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Ingår i: Science. - : American Association for the Advancement of Science (AAAS). - 0036-8075 .- 1095-9203. ; 374:6567, s. 544-544
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 3. |
- Assimes, Themistocles L., et al.
(författare)
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Lack of Association Between the Trp719Arg Polymorphism in Kinesin-Like Protein-6 and Coronary Artery Disease in 19 Case-Control Studies
- 2010
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Ingår i: Journal of the American College of Cardiology. - : Elsevier BV. - 0735-1097. ; 56:19, s. 1552-1563
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Tidskriftsartikel (refereegranskat)abstract
- Objectives We sought to replicate the association between the kinesin-like protein 6 (KIF6) Trp719Arg polymorphism (rs20455), and clinical coronary artery disease (CAD). Background Recent prospective studies suggest that carriers of the 719Arg allele in KIF6 are at increased risk of clinical CAD compared with noncarriers. Methods The KIF6 Trp719Arg polymorphism (rs20455) was genotyped in 19 case-control studies of nonfatal CAD either as part of a genome-wide association study or in a formal attempt to replicate the initial positive reports. Results A total of 17,000 cases and 39,369 controls of European descent as well as a modest number of South Asians, African Americans, Hispanics, East Asians, and admixed cases and controls were successfully genotyped. None of the 19 studies demonstrated an increased risk of CAD in carriers of the 719Arg allele compared with noncarriers. Regression analyses and fixed-effects meta-analyses ruled out with high degree of confidence an increase of >= 2% in the risk of CAD among European 719Arg carriers. We also observed no increase in the risk of CAD among 719Arg carriers in the subset of Europeans with early-onset disease (younger than 50 years of age for men and younger than 60 years of age for women) compared with similarly aged controls as well as all non-European subgroups. Conclusions The KIF6 Trp719Arg polymorphism was not associated with the risk of clinical CAD in this large replication study. (J Am Coll Cardiol 2010;56:1552-63) (C) 2010 by the American College of Cardiology Foundation
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| 4. |
- Bernal, Ximena E., et al.
(författare)
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Empowering Latina scientists
- 2019
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Ingår i: Science. - : American Association for the Advancement of Science (AAAS). - 0036-8075 .- 1095-9203. ; 363:6429, s. 825-826
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 5. |
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| 6. |
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| 7. |
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| 8. |
- Brownstein, Catherine A., et al.
(författare)
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An international effort towards developing standards for best practices in analysis, interpretation and reporting of clinical genome sequencing results in the CLARITY Challenge
- 2014
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Ingår i: Genome Biology. - : Springer Science and Business Media LLC. - 1465-6906 .- 1474-760X. ; 15:3, s. R53-
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Tidskriftsartikel (refereegranskat)abstract
- Background: There is tremendous potential for genome sequencing to improve clinical diagnosis and care once it becomes routinely accessible, but this will require formalizing research methods into clinical best practices in the areas of sequence data generation, analysis, interpretation and reporting. The CLARITY Challenge was designed to spur convergence in methods for diagnosing genetic disease starting from clinical case history and genome sequencing data. DNA samples were obtained from three families with heritable genetic disorders and genomic sequence data were donated by sequencing platform vendors. The challenge was to analyze and interpret these data with the goals of identifying disease-causing variants and reporting the findings in a clinically useful format. Participating contestant groups were solicited broadly, and an independent panel of judges evaluated their performance. Results: A total of 30 international groups were engaged. The entries reveal a general convergence of practices on most elements of the analysis and interpretation process. However, even given this commonality of approach, only two groups identified the consensus candidate variants in all disease cases, demonstrating a need for consistent fine-tuning of the generally accepted methods. There was greater diversity of the final clinical report content and in the patient consenting process, demonstrating that these areas require additional exploration and standardization. Conclusions: The CLARITY Challenge provides a comprehensive assessment of current practices for using genome sequencing to diagnose and report genetic diseases. There is remarkable convergence in bioinformatic techniques, but medical interpretation and reporting are areas that require further development by many groups.
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| 9. |
- Brudey, Karine, et al.
(författare)
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Molecular epidemiology of Mycobacterium tuberculosis in western Sweden.
- 2004
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Ingår i: Journal of clinical microbiology. - 0095-1137. ; 42:7, s. 3046-51
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Tidskriftsartikel (refereegranskat)abstract
- The genetic diversity of Mycobacterium tuberculosis isolates among patients from Sweden was determined by a combination of two PCR-based techniques (spoligotyping and variable number of tandem repeats analysis). It resulted in a clustering of 23.6% of the isolates and a rate of recent transmission of 14.1%. The clustered isolates mainly belonged to the Haarlem family (23.2%), followed by the Beijing (9.8%), Latin American and Mediterranean (LAM; 8%), and East African-Indian (EAI; 6.2%) families. A comparison of the spoligotypes with those in the international spoligotyping database showed that 62.5% of the clustered isolates and 36.6% of all isolates typed were grouped into six major shared types. A comparison of the spoligotypes with those in databases for Scandinavian countries showed that 33% of the isolates belonged to an ill-defined T family, followed by the EAI (22%), Haarlem (20%), LAM (11%), Central Asian (5%), X (5%), and Beijing (4%) families. Both the highest number of cases and the proportion of clustered cases were observed in patients ages 15 to 39 years. Nearly 10% of the isolates were resistant to one or more drugs (essentially limited to isoniazid monoresistance). However, none of the strains were multidrug resistant. Data on the geographic origins of the patients showed that more than two-thirds of the clustered patients with tuberculosis were foreign-born individuals or refugees. These results are explained on the basis of both the historical links within specific countries and recently imported cases of tuberculosis into Sweden.
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| 10. |
- Edling, Max, 1968-
(författare)
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A revolution in favour of government : the American constitution and ideas about state formation, 1787-1788
- 2000
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This dissertation analyses the debate over the ratification of the American Constitution between the Federalists, who supported the Constitution's adoption, and the Antifederalists, who opposed adoption. It challenges the traditional interpretation of the Federalist persuasion as primarily concerned with limited government and minority rights. Instead, it reveals a neglected aspect of Federalist thought by placing it in the context of early modern state formation. Far from being concerned with limits to government, the Federalists aimed to create a potentially powerful national state. With the adoption of the Constitution the central functions of the early modern state, i. e. war making and resource extraction, were transferred from the states to the national government. The fiscal and military powers of the new government were in every important respect unlimited and the institutional impediment made up by the state legislatures was removed. The Constitution created a state which held all the powers of the contemporary European 'fiscal-military states' in reserve. Yet it also created a state very different from the states of Europe.The political traditions and institutions of eighteenth-century America were averse to strong centralised government. In the debate over ratification this aversion was expressed by the Constitution's opponents. To provide an argument in support of the adoption of the Constitution, the Federalists had to show that it was possible to create a state that was both powerful and able to respect popular aversion to government. An important step towards the solution of this dilemma was federalism, which allowed the centralisation of only certain specified powers. Federalism would create a state focused on the fiscal-military sphere, but it said nothing about how to extract resources without exerting unacceptable pressure on the citizens. Here the solution offered lay in statecraft, which would create a national government that was both light and inconspicuous. It would be light in the sense that its demands would not press too heavily on the people and it would be inconspicuous in the sense that its actual physical presence would be limited. In short, the Federalists promised the benefits of government without its costs.
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| 11. |
- Gordon, Line J., et al.
(författare)
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Managing water in agriculture for food production and other ecosystem services
- 2010
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Ingår i: Agricultural Water Management. - : Elsevier BV. - 0378-3774 .- 1873-2283. ; 97:4, s. 512-519
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Tidskriftsartikel (refereegranskat)abstract
- Agricultural systems as well as other ecosystems generate ecosystem services, i.e., societal benefits from ecological processes. These services include, for example, nutrient reduction that leads to water quality improvements in some wetlands and climatic regulation through recycling of precipitation in rain forests. While agriculture has increased ‘provisioning’ ecosystem services, such as food, fiber and timber production, it has, through time, substantially impacted other ecosystem services. Here we review the trade-offs among ecosystem services that have been generated by agriculture-induced changes to water quality and quantity in downstream aquatic systems, wetlands and terrestrial systems. We highlight emerging issues that need urgent attention in research and policy making. We identify three main strategies by which agricultural water management can deal with these large trade-offs: (a) improving water management practices on agricultural lands, (b) better linkage with management of downstream aquatic ecosystems, and (c) paying more attention to how water can be managed to create multifunctional agro-ecosystems. This can only be done if ecological landscape processes are better understood, and the values of ecosystem services other than food production are also recognized.
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| 12. |
- Gordon, Line J., et al.
(författare)
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Rewiring food systems to enhance human health and biosphere stewardship
- 2017
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Ingår i: Environmental Research Letters. - : IOP Publishing. - 1748-9326. ; 12:10
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Food lies at the heart of both health and sustainability challenges. We use a social-ecological framework to illustrate how major changes to the volume, nutrition and safety of food systems between 1961 and today impact health and sustainability. These changes have almost halved undernutrition while doubling the proportion who are overweight. They have also resulted in reduced resilience of the biosphere, pushing four out of six analysed planetary boundaries across the safe operating space of the biosphere. Our analysis further illustrates that consumers and producers have become more distant from one another, with substantial power consolidated within a small group of key actors. Solutions include a shift from a volume-focused production system to focus on quality, nutrition, resource use efficiency, and reduced antimicrobial use. To achieve this, we need to rewire food systems in ways that enhance transparency between producers and consumers, mobilize key actors to become biosphere stewards, and re-connect people to the biosphere.
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| 13. |
- Gordon, Max, et al.
(författare)
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Age- and health-related quality of life after total hip replacement.
- 2014
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Ingår i: Acta orthopaedica. - : Medical Journals Sweden AB. - 1745-3682 .- 1745-3674. ; 85:3, s. 244-249
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Tidskriftsartikel (refereegranskat)abstract
- Background - While age is a common confounder, its impact on health-related quality of life (HRQoL) after total hip replacement is uncertain. This could be due to improper statistical modeling of age in previous studies, such as treating age as a linear variable or by using age categories. We hypothesized that there is a non-linear association between age and HRQoL. Methods - We selected a nationwide cohort from the Swedish Hip Arthroplasty Register of patients operated with total hip replacements due to primary osteoarthritis between 2008 and 2010. For estimating HRQoL, we used the generic health outcome questionnaire EQ-5D of the EuroQol group that consits or 2 parts: the EQ-5D index and the EQ VAS estimates. Using linear regression, we modeled the EQ-5D index and the EQ VAS against age 1 year after surgery. Instead of using a straight line for age, we applied a method called restricted cubic splines that allows the line to bend in a controlled manner. Confounding was controlled by adjusting for preoperative HRQoL, sex, previous contralateral hip surgery, pain, and Charnley classification. Results - Complete data on 27,245 patients were available for analysis. Both the EQ-5D index and EQ VAS showed a non-linear relationship with age. They were fairly unaffected by age until the patients were in their late sixties, after which age had a negative effect. Interpretation - There is a non-linear relationship between age and HRQoL, with improvement decreasing in the elderly.
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| 14. |
- Gordon, Max
(författare)
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Evaluation of patient related factors influencing outcomes after total hip replacement
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Basic patient factors such as age, sex, and comorbidities are poorly understood in the context of re-operation rates and patient-reported outcome measures after total hip replacement (THR) surgery. Aims: The aims of this thesis were to investigate: 1. If comorbidity measures developed for mortality outcomes also are applicable for re-operations; 2. How age influences health-related quality of life (HRQoL); 3. If sex/age interacts with self-administered Charnley classification in regards to HRQoL; 4. The generalizability of HRQOL estimates; and 5. If antidepressant use impacts patient-reported outcomes. Methods: All studies were based upon the Swedish Hip Arthroplasty Register (SHAR) database. For study I, data from SHAR was cross-matched with the National Patient Register through which 3 different comorbidity measures were calculated: the Charlson score, the Elixhauser score, and the Royal College of Surgeons (RCS) Charlson’s score. The three scores were then compared using survival analysis with implant re-operation performed between 0 to 2 years and 2 to 12 years. In study II and III we used the SHAR’s PROM database with HRQoL outcomes as measured by EQ-5D and EQ-VAS. In study II we modeled age using linear regression in combination with restricted cubic splines in order to study the relationship between age and HRQoL. In study III we used linear regression with interaction terms evaluated by ANOVA-tests, subset, and EQ-5D dimension specific analyses. In study IV we linked the SHAR’s PROM database to the National Patient Register and a Danish cross-sectional sample. The Charlson comorbidity measure was calculated as in study I, and effect modification by country was investigated through terms of interaction, evaluated as in study III. In study V, we cross-matched the SHAR’s PROM database with the Prescribed Drug Register. We calculated the usage of antidepressants using regular expressions. Measures for compliance, treatment change, and indication were retrieved from the prescription text. Results: Study I. 0-2 years, only the Elixhauser score showed significant risk increase with increased score for both 1-2 and ≥ 3 comorbidities. The predictive C-statistic in this period for the Elixhauser score was poor, 0.52. None of the measures proved to be of any value between 2-12 years. Study II. Both the EQ-5D index and EQ VAS exhibited a non-linear relationship with age, they were fairly unaffected by age until the patient’s late sixties, after which it had a negative impact. Study III. We found that women in category C had a poorer EQ-5D outcome compared to men. This effect was mostly due to the fact that women failed to improve in the mobility dimension, only 40% improved, while 50% of men improved. Age did not interact with Charnley class. We also found that the classification performed best without splitting or aggregating classes. Study IV. Danish patients had an overall higher EQ-5D index and EQ VAS than Swedish patients (p-value < 0.001). After regression analysis, the estimated coefficients for sex, age, or the Charlson score did not differ between countries for either the EQ-5D index (p-value = 0.83) or EQ VAS (p-value = 0.41) one year after THR. Study V. Antidepressants were used by 9% of the cases (n = 954). Patients using antidepressants had poorer HRQoL, more pain, and experienced less satisfaction. Preoperative antidepressant use was independent of patient-reported anxiety/depression in predicting PROs one year after THR. Discontinuation of treatment was negatively associated with pain and satisfaction at one year. Conclusions: Study I. We failed to validate any of the scores for re-operations after total hip arthroplasties, although the Elixhauser score may be useful for estimating the comorbidities relevant to the risk of re-operation within 2 years. The comorbidity associated risk increase was small, and is undoubtedly best suited to the study of large samples and not individual patients. Study II. There is a non-linear relationship for age and HRQoL in patients receiving THR; resulting in residual confounding if treated as a simple linear term or categorically in the regression. The implication of this is important, as age is a common confounder. The same applies to the preoperative EQ-5D index and EQ VAS. Study III. The self-administered Charnley classification is a reliable instrument with interesting properties easy to utilize in everyday clinical practice. There is also strong evidence that women in Charnley class C fail to improve their mobility as much as men. Study IV. There are clear similarities in how basic predictors influence patient-reported outcomes in patients with THR in Sweden and Denmark. Apparent cultural, social, and other such differences among these countries are not reflected in these predictors. Study V. Antidepressants have a negative influence on patient-reported outcomes 1 year after THR, independent of the pre-operative EQ-5D anxiety/depression dimension. We also found that discontinuation of treatment prior to surgery is associated with poorer outcomes in the dimensions of pain and satisfaction.
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| 15. |
- Gordon, Max, et al.
(författare)
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Factors influencing health-related quality of life after total hip replacement - a comparison of data from the Swedish and Danish hip arthroplasty registers.
- 2013
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Ingår i: BMC musculoskeletal disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 14:1
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Tidskriftsartikel (refereegranskat)abstract
- There is an increasing focus on measuring patient-reported outcomes (PROs) as part of routine medical practice, particularly in fields such as joint replacement surgery where pain relief and improvement in health-related quality of life (HRQoL) are primary outcomes. Between-country comparisons of PROs may present difficulties due to cultural differences and differences in the provision of health care. However, in order to understand how these differences affect PROs, common predictors for poor and good outcomes need to be investigated. This cross-sectional study investigates factors influencing health-related quality of life (HRQoL) one year after total hip replacement (THR) surgery in Sweden and in Denmark.
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| 16. |
- Gordon, Max, et al.
(författare)
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Increased Long-Term Cardiovascular Risk After Total Hip Arthroplasty: A Nationwide Cohort Study.
- 2016
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Ingår i: Medicine. - 1536-5964 .- 0025-7974. ; 95:6
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Tidskriftsartikel (refereegranskat)abstract
- Total hip arthroplasty is a common and important treatment for osteoarthritis patients. Long-term cardiovascular effects elicited by osteoarthritis or the implant itself remain unknown. The purpose of the present study was to determine if there is an increased risk of late cardiovascular mortality and morbidity after total hip arthroplasty surgery.A nationwide matched cohort study with data on 91,527 osteoarthritis patients operated on, obtained from the Swedish Hip Arthroplasty Register. A control cohort (n=270,688) from the general Swedish population was matched 1:3 to each case by sex, age, and residence. Mean follow-up time was 10 years (range, 7-21).The exposure was presence of a hip replacement for more than 5 years. The primary outcome was cardiovascular mortality after 5 years. Secondary outcomes were total mortality and re-admissions due to cardiovascular events.During the first 5 to 9 years, the arthroplasty cohort had a lower cardiovascular mortality risk compared with the control cohort. However, the risk in the arthroplasty cohort increased over time and was higher than in controls after 8.8 years (95% confidence interval [CI] 7.0-10.5). Between 9 and 13 years postoperatively, the hazard ratio was 1.11 (95% CI 1.05-1.17). Arthroplasty patients were also more frequently admitted to hospital for cardiovascular reasons compared with controls, with a rate ratio of 1.08 (95% CI 1.06-1.11).Patients with surgically treated osteoarthritis of the hip have an increased risk of cardiovascular morbidity and mortality many years after the operation when compared with controls.
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| 17. |
- Gordon, Max, et al.
(författare)
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The influence of comorbidity scores on re-operations following primary total hip replacement: Comparison and validation of three comorbidity measures.
- 2013
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Ingår i: The bone & joint journal. - 2049-4408. ; 95-B:9, s. 1184-1191
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Tidskriftsartikel (refereegranskat)abstract
- While an increasing amount of arthroplasty articles report comorbidity measures, none have been validated for outcomes. In this study, we compared commonly used International Classification of Diseases-based comorbidity measures with re-operation rates after total hip replacement (THR). Scores used included the Charlson, the Royal College of Surgeons Charlson, and the Elixhauser comorbidity score. We identified a nationwide cohort of 134423 THRs from the Swedish Hip Arthroplasty Register. Re-operations were registered post-operatively for up to 12 years. The hazard ratio was estimated by Cox's proportional hazards regression, and we used C-statistics to assess each measure's ability to predict re-operation. Confounding variables were age, gender, type of implant fixation, hospital category, hospital implant volume and year of surgery. In the first two years only the Elixhauser score showed any significant relationship with increased risk of re-operation, with increased scores for both one to two and three or more comorbidities. However, the predictive C-statistic in this period for the Elixhauser score was poor (0.52). None of the measures proved to be of any value between two and 12 years. They might be of value in large cohort or registry studies, but not for the individual patient. Cite this article: Bone Joint J 2013;95-B:1184-91.
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| 18. |
- Gordon, Max, et al.
(författare)
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Women in Charnley class C fail to improve in mobility to a higher degree after total hip replacement.
- 2014
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Ingår i: Acta orthopaedica. - : Medical Journals Sweden AB. - 1745-3682 .- 1745-3674. ; 85:4, s. 335-41
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Tidskriftsartikel (refereegranskat)abstract
- The Charnley comorbidity classification organizes patients into 3 classes: (A) 1 hip involved, (B) 2 hips involved, and (C) other severe comorbidities. Although this simple classification is a known predictor of health-related quality of life (HRQoL) after total hip replacement (THR), interactions between Charnley class, sex, and age have not been investigated and there is uncertainty regarding whether A and B should be grouped together.
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| 19. |
- Greene, Meridith E, et al.
(författare)
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Education Attainment is Associated With Patient-reported Outcomes: Findings From the Swedish Hip Arthroplasty Register.
- 2014
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Ingår i: Clinical orthopaedics and related research. - : Ovid Technologies (Wolters Kluwer Health). - 1528-1132 .- 0009-921X. ; 472:6, s. 1868-76
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Tidskriftsartikel (refereegranskat)abstract
- Age, sex, and medical comorbidities may be associated with differences in patient-reported outcome scores after THA. Highest level of education may be a surrogate for socioeconomic status, but the degree to which this is associated with patient-reported outcomes after THA is not known.
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| 20. |
- Greene, Meridith E, et al.
(författare)
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Improved statistical analysis of pre- and post-treatment patient-reported outcome measures (PROMs): the applicability of piecewise linear regression splines
- 2015
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Ingår i: Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation. - : Springer Science and Business Media LLC. - 1573-2649. ; 24:3, s. 567-573
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Tidskriftsartikel (refereegranskat)abstract
- Patient-reported health-related quality-of-life (HRQoL) measures such as the EuroQol 5 dimension (EQ-5D) index are commonplace when assessing healthcare providers or efficiency of medical techniques. HRQoL measures are generally bounded, and the magnitude of possible improvement depends on the pre-treatment HRQoL value. This paper aimed to assess and illustrated the possibility of modelling the relationship between pre- and post-treatment HRQoL measures with piecewise linear splines.
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| 21. |
- Greene, Meridith E, et al.
(författare)
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Standard Comorbidity Measures Do Not Predict Patient-reported Outcomes 1 Year After Total Hip Arthroplasty
- 2015
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Ingår i: Clinical orthopaedics and related research. - : Ovid Technologies (Wolters Kluwer Health). - 1528-1132 .- 0009-921X. ; 473:11, s. 3370-3379
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Tidskriftsartikel (refereegranskat)abstract
- Comorbidities influence surgical outcomes and therefore need to be included in risk adjustment when predicting patient-reported outcomes. However, there is no consensus on how best to use the available data about comorbidities in registry-based predictive models.
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| 22. |
- Havervall, Sebastian, et al.
(författare)
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Antibody responses after a single dose of ChAdOx1 nCoV-19 vaccine in healthcare workers previously infected with SARS-CoV-2
- 2021
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Ingår i: EBioMedicine. - : Elsevier BV. - 2352-3964. ; 70
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Tidskriftsartikel (refereegranskat)abstract
- Background: Recent reports demonstrate robust serological responses to a single dose of messenger RNA (mRNA) vaccines in individuals previously infected with SARS-CoV-2. Data on immune responses following a single-dose adenovirus-vectored vaccine expressing the SARS-CoV-2 spike protein (ChAdOx1 nCoV-19) in individuals with previous SARS-CoV-2 infection are however limited, and current guidelines recommend a two-dose regimen regardless of preexisting immunity. Methods: We compared RBD-specific IgG and RBD-ACE2 blocking antibodies against SARS-CoV-2 wild type and variants of concern following two doses of the mRNA vaccine BNT162b2 in SARS-CoV-2 naive healthcare workers (n=65) and a single dose of the adenovector vaccine ChAdOx1 nCoV-19 in 82 healthcare workers more than (n=45) and less than (n=37) 11 months post mild SARS-CoV-2 infection at time of vaccination. Findings: The post-vaccine levels of RBD-specific IgG and neutralizing antibodies against the SARS-CoV-2 wild type and variants of concern including Delta lineage 1.617.2 were similar or higher in participants receiving a single dose of ChAdOx1 nCoV-19 vaccine post SARS-CoV-2 infection (both more than and less than 11 months post infection) compared to SARS-CoV-2 naive participants who received two doses of BNT162b2 vaccine. Interpretation: Our data support that a single dose ChAdOx1 nCoV-19 vaccine that is administered up to at least 11 months post SARS-CoV-2 infection serves as an effective immune booster. This provides a possible rationale for a single-dose vaccine regimen. (C) 2021 The Author(s). Published by Elsevier B.V.
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| 23. |
- Havervall, Sebastian, et al.
(författare)
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Impact of SARS-CoV-2 infection on vaccine-induced immune responses over time
- 2022
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Ingår i: Clinical & Translational Immunology (CTI). - : Wiley. - 2050-0068. ; 11:4
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To determine the long-term impact of prior SARS-CoV-2 infection on immune responses after COVID-19 vaccination. Methods. Using longitudinally collected blood samples from the COMMUNITY study, we determined binding (WHO BAU mL(-1)) and neutralising antibody titres against ten SARS-CoV-2 variants over 7 months following BNT162b2 in SARS-CoV-2-recovered (n = 118) and SARS-CoV-2-naive (n = 289) healthcare workers with confirmed prior SARS-CoV-2 infection. A smaller group with (n = 47) and without (n = 60) confirmed prior SARS-CoV-2 infection receiving ChAdOx1 nCoV-19 was followed for 3 months. SARS-CoV-2-specific memory T-cell responses were investigated in a subset of SARS-CoV-2-naive and SARS-CoV-2-recovered vaccinees. Results. Vaccination with both vaccine platforms resulted in substantially enhanced T-cell responses, anti-spike IgG responses and neutralising antibodies effective against ten SARS-CoV-2 variants in SARS-CoV-2-recovered participants as compared to SARS-CoV-2-naive participants. The enhanced immune responses sustained over 7 months following vaccination. Conclusion. These findings imply that prior SARS-CoV-2 infection should be taken into consideration when planning booster doses and design of current and future COVID-19 vaccine programmes.
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| 24. |
- Jerjes, Waseem K., et al.
(författare)
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The future of medical diagnostics: review paper
- 2011
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Ingår i: Head & Neck Oncology. - : Springer Science and Business Media LLC. - 1758-3284. ; 3
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Tidskriftsartikel (refereegranskat)abstract
- While histopathology of excised tissue remains the gold standard for diagnosis, several new, non-invasive diagnostic techniques are being developed. They rely on physical and biochemical changes that precede and mirror malignant change within tissue. The basic principle involves simple optical techniques of tissue interrogation. Their accuracy, expressed as sensitivity and specificity, are reported in a number of studies suggests that they have a potential for cost effective, real-time, in situ diagnosis. We review the Third Scientific Meeting of the Head and Neck Optical Diagnostics Society held in Congress Innsbruck, Innsbruck, Austria on the 11th May 2011. For the first time the HNODS Annual Scientific Meeting was held in association with the International Photodynamic Association (IPA) and the European Platform for Photodynamic Medicine (EPPM). The aim was to enhance the interdisciplinary aspects of optical diagnostics and other photodynamic applications. The meeting included 2 sections: oral communication sessions running in parallel to the IPA programme and poster presentation sessions combined with the IPA and EPPM posters sessions.
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| 25. |
- Kelly-Pettersson, Paula, et al.
(författare)
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The influence of depression on patient-reported outcomes for hip-fracture patients 1 year after surgery : a prospective cohort study.
- 2020
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Ingår i: Aging Clinical and Experimental Research. - : Springer Science and Business Media LLC. - 1594-0667 .- 1720-8319. ; 32:2, s. 247-255
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Depression is common in elderly hip-fracture patients and together with cognitive impairment is associated with increased risk of mortality.AIM: We aimed to examine the influence depression has on patient-reported outcome up to 1 year after acute hip fracture.METHODS: 162 hip-fracture patients participated in the prospective observational cohort study and were followed up at baseline, and 3 and 12 months using patient-reported outcome scores. Patients with cognitive impairment were excluded. Depression was defined as a score ≥ 8 on the depression subscale of the Hospital Anxiety Depression Scale (HADS D), having a diagnosis of depression or being treated with anti-depressant medication. Hip function was assessed using Harris Hip Score (HHS), EQ-5D was used to assess health status and Quality of life, and the Pain Numerical Rating Scale (PRNS) was used to assess pain levels. A linear regression model adjusted for group, age, sex, and ASA class was used to identify risk factors for functional outcome 12 months after fracture.RESULTS: 35 patients were included in the depression group versus 127 in the control group. No statistical differences were found in the demographic data (age, sex, ASA class, fracture type, operation method, living situation, activities of daily living ADL and clinical pathway) between the groups. In the regression model, we found no correlation between depression and the patient-reported outcome.CONCLUSION: In young elderly hip fracture patients without cognitive dysfunction, depression may not be of major importance for the rehabilitation of hip function in the short term.
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| 26. |
- Kelly-Pettersson, Paula, et al.
(författare)
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Waiting time to surgery is correlated with an increased risk of serious adverse events during hospital stay in patients with hip-fracture : A cohort study.
- 2017
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Ingår i: International Journal of Nursing Studies. - : Elsevier BV. - 0020-7489 .- 1873-491X. ; 69, s. 91-97
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Hip fractures are common in the elderly and are associated with a high adverse event and mortality rate. Time to surgery is one of the major modifiable risk factors influencing adverse outcomes in hip-fracture patients. National guidelines and recommendations have been introduced which advocate specific time frames in which surgery should be performed i.e. within 24-48h. These time constraints have been arbitrarily set without being modelled on the linear assumption i.e. that risk increases continually over time and not within specific cut-off times.OBJECTIVES: To investigate how waiting time to surgery influenced the risk of serious adverse events in hip-fracture patients during the hospital stay and to examine how the risk increased over time.DESIGN: An observational single cohort study Participants 576 patients (72.4% females, mean [SD] age 82 [10]) years, with a hip fracture were included in the cohort study.METHODS: The outcomes of the study were the occurrence of serious adverse events during hospital stay, length of stay and one-year mortality. A structured medical record review was carried out to identify outcomes and mortality data was obtained from the Swedish National Death Registry. Waiting time to surgery was used as the exposure variable and age, sex, type of fracture, comorbidities using the American Society of Anaesthesiologists classification score and the presence of cognitive dysfunction were identified as confounders. A logistic regression analysis was performed to identify risk factors influencing outcomes.RESULTS: A total of 119 patients (20.6%) suffered 397 (range 1-5) serious adverse events during hospital stay. Every 10h of waiting time to surgery increased the risk of serious adverse events by 12% (odds ratio 1.12 [95% confidence interval 1.02-1.23]). We found no optimal cut-off times for waiting time to surgery. For every 24h of waiting time, the length of stay from surgery was increased by 0.6days (95% CI 0.1-1.1). We found no correlation between waiting time to surgery and one-year mortality.CONCLUSIONS: A large proportion of patients suffered from at least one serious adverse event after hip-fracture surgery and there are no safe limits for waiting time to surgery for hip-fracture patients. As the risk increases with every hour of waiting time, patients with higher American Society of Anesthesiologists classification scores, males and those with subtrochanteric fractures should be prioritized for surgery.
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| 27. |
- Kougia, Vasiliki, et al.
(författare)
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RTEX : A novel framework for ranking, tagging, and explanatory diagnostic captioning of radiography exams
- 2021
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Ingår i: JAMIA Journal of the American Medical Informatics Association. - : Oxford University Press (OUP). - 1067-5027 .- 1527-974X. ; 28:8, s. 1651-1659
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The study sought to assist practitioners in identifying and prioritizing radiography exams that are more likely to contain abnormalities, and provide them with a diagnosis in order to manage heavy workload more efficiently (eg, during a pandemic) or avoid mistakes due to tiredness.Materials and MethodsThis article introduces RTEx, a novel framework for (1) ranking radiography exams based on their probability to be abnormal, (2) generating abnormality tags for abnormal exams, and (3) providing a diagnostic explanation in natural language for each abnormal exam. Our framework consists of deep learning and retrieval methods and is assessed on 2 publicly available datasets.Results: For ranking, RTEx outperforms its competitors in terms of nDCG@k. The tagging component outperforms 2 strong competitor methods in terms of F1. Moreover, the diagnostic captioning component, which exploits the predicted tags to constrain the captioning process, outperforms 4 captioning competitors with respect to clinical precision and recall.Discussion: RTEx prioritizes abnormal exams toward the improvement of the healthcare workflow by introducing a ranking method. Also, for each abnormal radiography exam RTEx generates a set of abnormality tags alongside a diagnostic text to explain the tags and guide the medical expert. Human evaluation of the produced text shows that employing the generated tags offers consistency to the clinical correctness and that the sentences of each text have high clinical accuracy.Conclusions: This is the first framework that successfully combines 3 tasks: ranking, tagging, and diagnostic captioning with focus on radiography exams that contain abnormalities.
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| 28. |
- Krupic, Ferid, et al.
(författare)
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Different patient-reported outcomes in immigrants and patients born in Sweden.
- 2014
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Ingår i: Acta orthopaedica. - : Medical Journals Sweden AB. - 1745-3682 .- 1745-3674. ; 85:3, s. 221-228
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose - Some patients have persistent symptoms after total hip arthroplsty (THA). We investigated whether the proportions of inferior clinical results after total hip arthroplasty-according to the 5 dimensions in the EQ-5D form, and pain and satisfaction according to a visual analog scale (VAS)-are the same in immigrants to Sweden as observed in those born in Sweden. Methods - Records of total hip arthroplasties performed between 1992 and 2007 were retrieved from the Swedish Hip Arthroplasty Register (SHAR) and cross-matched with data from the National Board of Health and Welfare and also Statistics, Sweden. 18,791 operations (1,451 in immigrants, 7.7%) were eligible for analysis. Logistic and linear regression models including age, sex, diagnosis, type of fixation, comorbidity, surgical approach, marital status, and education level were analyzed. Outcomes were the 5 dimensions in EQ-5D, EQ-VAS, VAS pain, and VAS satisfaction. Preoperative data and data from 1 year postoperatively were studied. Results - Preoperatively (and after inclusion of covariates in the regression models), all immigrant groups had more negative interference concerning self-care. Immigrants from the Nordic countries outside Sweden and Europe tended to have more problems with their usual activities and patients from Europe and outside Europe more often reported problems with anxiety/depression. Patients born abroad showed an overall tendency to report more pain on the VAS than patients born in Sweden. After the operation, the immigrant groups reported more problems in all the EQ-5D dimensions. After adjustment for covariates including the preoperative baseline value, most of these differences remained except for pain/discomfort and-concerning immigrants from the Nordic countries-also anxiety/depression. After the operation, pain according to VAS had decreased substantially in all groups. The immigrant groups indicated more pain than those born in Sweden, both before and after adjustment for covariates. Conclusion - The frequency of patients who reported moderate to severe problems, both before and 1 year after the operation, differed for most of the dimensions in EQ-5D between patients born in Sweden and those born outside Sweden.
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| 29. |
- Krupic, Ferid, et al.
(författare)
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No influence of immigrant background on the outcome of total hip arthroplasty.
- 2013
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Ingår i: Acta orthopaedica. - : Medical Journals Sweden AB. - 1745-3682 .- 1745-3674. ; 84:1, s. 18-24
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Tidskriftsartikel (refereegranskat)abstract
- Total Hip Replacement (THA) is one of the most successful and cost-effective operations. Despite its benefits, marked ethnic differences in the utilization of THA are well documented. However, very little has been published on the influence of ethnicity on outcome. We investigate whether the outcome-in terms of reoperation within 2 years or revision up to 14 years after the primary operation-varies depending on ethnic background.
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| 30. |
- Lindgren, J Viktor, et al.
(författare)
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Validation of reoperations due to infection in the Swedish Hip Arthroplasty Register.
- 2014
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Ingår i: BMC musculoskeletal disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 15:1
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Tidskriftsartikel (refereegranskat)abstract
- Complete or almost complete recording of reoperations is essential to enable a correct interpretation of data in arthroplasty registers. The completeness of recordings due to infection is unknown in the Swedish Hip Arthroplasty Register (SHAR). We therefore used a combination of data from the Swedish Prescribed Drug Register (SPDR) and studies of medical records to validate the data of reoperations due to infection in the SHAR.
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| 31. |
- Lindgren, Viktor, et al.
(författare)
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Deep infection after total hip replacement: a method for national incidence surveillance.
- 2014
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Ingår i: Infection control and hospital epidemiology : the official journal of the Society of Hospital Epidemiologists of America. - : Cambridge University Press (CUP). - 1559-6834 .- 0899-823X. ; 35:12, s. 1491-6
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Tidskriftsartikel (refereegranskat)abstract
- Objective.The purpose of this study was to estimate the incidence of deep periprosthetic joint infections (PJIs) after primary total hip replacement (THR) in Sweden prior to the introduction of a national initiative to reduce these infections. Design.Prospective open cohort study with 2 years follow-up of each subject. Setting.All THR-performing clinics in Sweden. Methods.All patients registered for a primary THR in the Swedish Hip Arthroplasty Register between July 1, 2005, and December 31, 2008, were selected for the study (45,531 patients with 49,219 THRs) and were matched with the Swedish Prescribed Drug Register. All patients with a minimum of 4 weeks of continuous outpatient antibiotic treatment within 2 years after their primary THR (1,989 patients with 2,219 THRs) were selected for a medical records review, and the number of cases with PJI was determined. Results.The cumulative incidence of PJI within 2 years after primary THR was 0.9% (95% confidence interval, 0.85-1.02; n = 443), and 405 of these had been reoperated. The incidence rate of PJI for the first 3 months was 5 per 10,000 THR-weeks and, thereafter, 0.3 per 10,000 THR-weeks. Staphylococcus aureus and coagulase-negative staphylococci were the most common bacteria isolated. Conclusions.This study describes a new method of national postoperative infection surveillance. The incidence is similar to previous smaller reports and is useful for monitoring changes over time to evaluate the national initiative to reduce infections.
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| 32. |
- Magnéli, Martin, et al.
(författare)
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Only 8% of major preventable adverse events after hip arthroplasty are filed as claims : a Swedish multi-center cohort study on 1,998 patients
- 2020
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 91:1, s. 20-25
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose — Hip arthroplasty is one of the most performed surgeries in Sweden, and the rate of adverse events (AEs) is fairly high. All patients in publicly financed healthcare in Sweden are insured by the Mutual Insurance Company of Swedish County Councils (Löf). We assessed the proportion of patients that sustained a major preventable AE and filed an AE claim to Löf. Patients and methods — We performed retrospective record review using the Global Trigger Tool to identify AEs in a Swedish multi-center cohort consisting of 1,998 patients with a total or hemi hip arthroplasty. We compared the major preventable AEs with all patient-reported claims to Löf from the same cohort and calculated the proportion of filed claims. Results — We found 1,066 major preventable AEs in 744 patients. Löf received 62 claims for these AEs, resulting in a claim proportion of 8%. 58 of the 62 claims were accepted by Löf and received compensation. The claim proportion was 13% for the elective patients and 0.3% for the acute patients. The most common AE for filing a claim was periprosthetic joint infection; of the 150 infections found 37 were claimed. Interpretation — The proportion of filed claims for major preventable AEs is very low, even for obvious and serious AEs such as periprosthetic joint infection.
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| 33. |
- Magnéli, Martin, et al.
(författare)
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Validation of adverse events after hip arthroplasty : a Swedish multi-centre cohort study.
- 2019
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 9:3
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Preventing adverse events (AEs) after orthopaedic surgery is a field with great room for improvement. A Swedish instrument for measuring AEs after hip arthroplasty based on administrative data from the national patient register is used by both the Swedish Hip Arthroplasty Register and the Swedish Association of Local Authorities and Regions. It has never been validated and its accuracy is unknown. The aim of this study was to validate the instrument's ability to detect AEs, and to calculate the incidence of AEs following primary hip arthroplasties.DESIGN: Retrospective cohort study using retrospective record review with Global Trigger Tool methodology in combination with register data.SETTING: 24 different hospitals in four major regions of Sweden.PARTICIPANTS: 2000 patients with either total or hemi-hip arthroplasty were recruited from the SHAR. We included both acute and elective patients.PRIMARY AND SECONDARY OUTCOME MEASURES: The sensitivity and specificity of the instrument. Adjusted cumulative incidence and incidence rate.RESULTS: The sensitivity for all identified AEs was 5.7% (95% CI: 4.9% to 6.7%) for 30 days and 14.8% (95% CI: 8.2 to 24.3) for 90 days, and the specificity was 95.2% (95% CI: 93.5% to 96.6%) for 30 days and 92.1% (95% CI: 89.9% to 93.8%) for 90 days. The adjusted cumulative incidence for all AEs was 28.4% (95% CI: 25.0% to 32.3%) for 30 days and 29.5% (95% CI: 26.0% to 33.8%) for 90 days. The incidence rate was 0.43 AEs per person-month (95% CI: 0.39 to 0.47).CONCLUSIONS: The AE incidence was high, and most AEs occurred within the first 30 days. The instrument sensitivity for AEs was very low for both 30 and 90 days, but the specificity was high for both 30 and 90 days. The studied instrument is insufficient for valid measurements of AEs after hip arthroplasty.
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| 34. |
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| 35. |
- Marking, Ulrika, et al.
(författare)
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Correlates of protection and viral load trajectories in omicron breakthrough infections in triple vaccinated healthcare workers
- 2023
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Ingår i: Nature Communications. - : Springer Nature. - 2041-1723. ; 14:1
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Tidskriftsartikel (refereegranskat)abstract
- Vaccination offers protection against severe COVID-19 caused by SARS-CoV-2 omicron but is less effective against infection. Characteristics such as serum antibody titer correlation to protection, viral abundance and clearance of omicron infection in vaccinated individuals are scarce. We present a 4-week twice-weekly SARS-CoV-2 qPCR screening in 368 triple vaccinated healthcare workers. Spike-specific IgG levels, neutralization titers and mucosal spike-specific IgA-levels were determined at study start and qPCR-positive participants were sampled repeatedly for two weeks. 81 (cumulative incidence 22%) BA.1, BA.1.1 and BA.2 infections were detected. High serum antibody titers are shown to be protective against infection (p < 0.01), linked to reduced viral load (p < 0.01) and time to viral clearance (p < 0.05). Pre-omicron SARS-CoV-2 infection is independently associated to increased protection against omicron, largely mediated by mucosal spike specific IgA responses (nested models lr test p = 0.02 and 0.008). Only 10% of infected participants remain asymptomatic through the course of their infection. We demonstrate that high levels of vaccine-induced spike-specific WT antibodies are linked to increased protection against infection and to reduced viral load if infected, and suggest that the additional protection offered by pre-omicron SARS-CoV-2 infection largely is mediated by mucosal spike-specific IgA.
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| 36. |
- Marking, Ulrika, et al.
(författare)
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Duration of SARS-CoV-2 Immune Responses Up to Six Months Following Homologous or Heterologous Primary Immunization with ChAdOx1 nCoV-19 and BNT162b2 mRNA Vaccines
- 2022
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Ingår i: Vaccines. - : MDPI AG. - 2076-393X. ; 10:3, s. 359-
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Tidskriftsartikel (refereegranskat)abstract
- Heterologous primary immunization against SARS-CoV-2 is part of applied recommendations. However, little is known about duration of immune responses after heterologous vaccine regimens. To evaluate duration of immune responses after primary vaccination with homologous adeno-vectored ChAdOx1 nCoV-19 vaccine (ChAd) or heterologous ChAd/BNT162b2 mRNA vaccine (BNT), anti-spike-IgG and SARS-CoV-2 VOC-neutralizing antibody responses were measured in 354 healthcare workers (HCW) at 2 weeks, 3 months, 5 months and 6 months after the second vaccine dose. T-cell responses were investigated using a whole blood interferon gamma (IFN-gamma) release assay 2 weeks and 3 months post second vaccine dose. Two hundred and ten HCW immunized with homologous BNT were enrolled for comparison of antibody responses. In study participants naive to SARS-CoV-2 prior to vaccination, heterologous ChAd/BNT resulted in 6-fold higher peak anti-spike IgG antibody titers compared to homologous ChAd vaccination. The half-life of antibody titers was 3.1 months (95% CI 2.8-3.6) following homologous ChAd vaccination and 1.9 months (95% CI 1.7-2.1) after heterologous vaccination, reducing the GMT difference between the groups to 3-fold 6 months post vaccination. Peak T-cell responses were stronger in ChAd/BNT vaccinees, but no significant difference was observed 3 months post vaccination. SARS-CoV-2 infection prior to vaccination resulted in substantially higher peak GMTs and IFN-gamma levels and enhanced SARS-CoV-2 specific antibody and T cell responses over time. Heterologous primary SARS-CoV-2 immunization with ChAd and BNT elicits a stronger initial immune response compared to homologous vaccination with ChAd. However, although the differences in humoral responses remain over 6 months, the difference in SARS-CoV-2 specific T cell responses are no longer significant three months after vaccination.
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| 37. |
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| 38. |
- Mohammed, Jabbar, et al.
(författare)
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Reduced periprosthetic fracture rate when changing from a tapered polished stem to an anatomical stem for cemented hip arthroplasty : an observational prospective cohort study with a follow-up of 2 years
- 2019
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Ingår i: Acta Orthopaedica. - : Taylor & Francis. - 1745-3674 .- 1745-3682. ; 90:5, s. 427-432
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose - Straight collarless polished tapered stems have been linked to an increased risk for periprosthetic femur fractures in comparison with anatomically shaped stems, especially in elderly patients. Therefore, we evaluated the effect of an orthopedic department's full transition from the use of a cemented collarless, polished, tapered stem to a cemented anatomic stem on the cumulative incidence of postoperative periprosthetic fracture (PPF). Patients and methods - This prospective single-center cohort study comprises a consecutive series of 1,077 patients who underwent a cemented hip arthroplasty using either a collarless polished tapered stem (PTS group, n = 543) or an anatomic stem (AS group, n = 534). We assessed the incidence of PPF 2 years postoperatively and used a Cox regression model adjusted for age, sex, ASA class, cognitive impairment, BMI, diagnosis, and surgical approach for outcome analysis. Results - Mean age at primary surgery was 82 years (49-102), 73% of the patients were female, and 75% underwent surgery for a femoral neck fracture. The PPF rate was lowered from 3.3% (n = 18) in the PTS group to 0.4% (n = 2) in the AS group. The overall complication rate was also lowered from 8.8% in the PTS group to 4.5% in the AS group. In the regression model only cognitive dysfunction (HR 3.8, 95% CI 1.4-10) and the type of stem (PTS vs AS, HR 0.1, CI 0.0-0.5) were correlated with outcome. Interpretation - For elderly patients with poor bone quality use of cemented anatomic stems leads to a substantial reduction in periprosthetic fracture rate without increasing other complications.
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| 39. |
- Nemes, Szilard, 1977, et al.
(författare)
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Projections of total hip replacement in Sweden from 2013 to 2030.
- 2014
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Ingår i: Acta orthopaedica. - : Medical Journals Sweden AB. - 1745-3682 .- 1745-3674. ; 85:3, s. 238-243
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose - The continuously increasing demand for joint replacement surgery in the past decades imposes higher constraints on the budgets of hospitals and healthcare providers. We undertook an analysis of historical trends in total hip replacement performed in Sweden between 1968 and 2012 in order to provide projections of future demand. Data and methods - We obtained data on total hip replacements registered every year and on the evolution of the Swedish population between 1968 and 2012. We assumed the existence of a maximum incidence. So we adopted a regression framework that assumes the existence of an upper limit of total hip replacement incidence. Results - We found that the incidence of total hip replacement will continue to increase until a projected upper incidence level of about 400 total hip replacements per 10(5) Swedish residents aged 40 years and older will be reached around the year 2107. In 2020, the estimated incidence of total hip replacement will be 341 (95% prediction interval (PI): 302-375) and in 2030 it will be 358 (PI: 317-396). Using official forecasted population growth data, about 18,000 operations would be expected to be performed in 2020 and 20,000 would be expected to be performed in 2030. Interpretation - Growing incidence, population growth, and increasing life expectancy will probably result in increased demand for hip replacement surgery. Our findings could serve as a basis for decision making.
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| 40. |
- Olczak, Jakub, et al.
(författare)
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Artificial intelligence for analyzing orthopedic trauma radiographs Deep learning algorithms-are they on par with humans for diagnosing fractures?
- 2017
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 88:6, s. 581-586
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose - Recent advances in artificial intelligence (deep learning) have shown remarkable performance in classifying non-medical images, and the technology is believed to be the next technological revolution. So far it has never been applied in an orthopedic setting, and in this study we sought to determine the feasibility of using deep learning for skeletal radiographs. Methods - We extracted 256,000 wrist, hand, and ankle radiographs from Danderyd's Hospital and identified 4 classes: fracture, laterality, body part, and exam view. We then selected 5 openly available deep learning networks that were adapted for these images. The most accurate network was benchmarked against a gold standard for fractures. We furthermore compared the network's performance with 2 senior orthopedic surgeons who reviewed images at the same resolution as the network. Results - All networks exhibited an accuracy of at least 90% when identifying laterality, body part, and exam view. The final accuracy for fractures was estimated at 83% for the best performing network. The network performed similarly to senior orthopedic surgeons when presented with images at the same resolution as the network. The 2 reviewer Cohen's kappa under these conditions was 0.76. Interpretation - This study supports the use for orthopedic radiographs of artificial intelligence, which can perform at a human level. While current implementation lacks important features that surgeons require, e.g. risk of dislocation, classifications, measurements, and combining multiple exam views, these problems have technical solutions that are waiting to be implemented for orthopedics.
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| 41. |
- Olczak, Jakub, et al.
(författare)
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Presenting artificial intelligence, deep learning, and machine learning studies to clinicians and healthcare stakeholders : an introductory reference with a guideline and a Clinical AI Research (CAIR) checklist proposal
- 2021
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Ingår i: Acta Orthopaedica. - : Taylor & Francis. - 1745-3674 .- 1745-3682. ; 92:5, s. 513-525
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose - Artificial intelligence (AI), deep learning (DL), and machine learning (ML) have become common research fields in orthopedics and medicine in general. Engineers perform much of the work. While they gear the results towards healthcare professionals, the difference in competencies and goals creates challenges for collaboration and knowledge exchange. We aim to provide clinicians with a context and understanding of AI research by facilitating communication between creators, researchers, clinicians, and readers of medical AI and ML research. Methods and results - We present the common tasks, considerations, and pitfalls (both methodological and ethical) that clinicians will encounter in AI research. We discuss the following topics: labeling, missing data, training, testing, and overfitting. Common performance and outcome measures for various AI and ML tasks are presented, including accuracy, precision, recall, F1 score, Dice score, the area under the curve, and ROC curves. We also discuss ethical considerations in terms of privacy, fairness, autonomy, safety, responsibility, and liability regarding data collecting or sharing. Interpretation - We have developed guidelines for reporting medical AI research to clinicians in the run-up to a broader consensus process. The proposed guidelines consist of a Clinical Artificial Intelligence Research (CAIR) checklist and specific performance metrics guidelines to present and evaluate research using AI components. Researchers, engineers, clinicians, and other stakeholders can use these proposal guidelines and the CAIR checklist to read, present, and evaluate AI research geared towards a healthcare setting.
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| 42. |
- Rief, Winfried, et al.
(författare)
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The future of psychological treatments : The Marburg Declaration
- 2024
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Ingår i: Clinical Psychology Review. - : Elsevier. - 0272-7358 .- 1873-7811. ; 110
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Forskningsöversikt (refereegranskat)abstract
- Although psychological treatments are broadly recognized as evidence-based interventions for various mental disorders, challenges remain. For example, a substantial proportion of patients receiving such treatments do not fully recover, and many obstacles hinder the dissemination, implementation, and training of psychological treatments. These problems require those in our field to rethink some of our basic models of mental disorders and their treatments, and question how research and practice in clinical psychology should progress. To answer these questions, a group of experts of clinical psychology convened at a Think-Tank in Marburg, Germany, in August 2022 to review the evidence and analyze barriers for current and future developments. After this event, an overview of the current state-of-the-art was drafted and suggestions for improvements and specific recommendations for research and practice were integrated. Recommendations arising from our meeting cover further improving psychological interventions through translational approaches, improving clinical research methodology, bridging the gap between more nomothetic (group-oriented) studies and idiographic (person-centered) decisions, using network approaches in addition to selecting single mechanisms to embrace the complexity of clinical reality, making use of scalable digital options for assessments and interventions, improving the training and education of future psychotherapists, and accepting the societal responsibilities that clinical psychology has in improving national and global health care. The objective of the Marburg Declaration is to stimulate a significant change regarding our understanding of mental disorders and their treatments, with the aim to trigger a new era of evidence-based psychological interventions.
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| 43. |
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| 44. |
- Rosenberg, Guillermo Sanchez, et al.
(författare)
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ChatGPT-4 generates orthopedic discharge documents faster than humans maintaining comparable quality : a pilot study of 6 cases
- 2024
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden. - 1745-3674 .- 1745-3682. ; 95, s. 152-156
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose - Large language models like ChatGPT-4 have emerged. They hold the potential to reduce the administrative burden by generating everyday clinical documents, thus allowing the physician to spend more time with the patient. We aimed to assess both the quality and efficiency of discharge documents generated by ChatGPT-4 in comparison with those produced by physicians.Patients and methods - To emulate real -world situations, the health records of 6 fictional orthopedic cases were created. Discharge documents for each case were generated by a junior attending orthopedic surgeon and an advanced orthopedic resident. ChatGPT-4 was then prompted to generate the discharge documents using the same health record information. The quality assessment was performed by an expert panel (n = 15) blinded to the source of the documents. As secondary outcome, the time required to generate the documents was compared, logging the duration of the creation of the discharge documents by the physician and by ChatGPT-4.Results - Overall, both ChatGPT-4 and physiciangenerated notes were comparable in quality. Notably, ChatGPT-4 generated discharge documents 10 times faster than the traditional method. 4 events of hallucinations were found in the ChatGPT-4-generated content, compared with 6 events in the human/physician produced notes.Conclusion - ChatGPT-4 creates orthopedic discharge notes faster than physicians, with comparable quality. This shows it has great potential for making these documents more efficient in orthopedic care. ChatGPT-4 has the potential to significantly reduce the administrative burden on healthcare professionals.
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| 45. |
- Schmidt, Viktor, et al.
(författare)
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Association between radiographic and clinical outcomes following distal radial fractures : a prospective cohort study with 1-year follow-up in 366 patients
- 2023
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Ingår i: Journal of Bone and Joint Surgery. American volume. - : Wolters Kluwer. - 0021-9355 .- 1535-1386. ; 105:15, s. 1156-1167
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Several studies of distal radial fractures have investigated final displacement and its association with clinical outcomes. There is still no consensus on the importance of radiographic outcomes, and published studies have not used the same criteria for acceptable alignment. Previous reports have involved the use of linear or dichotomized analyses.METHODS: The present study included 438 patients who were managed with either reduction and cast immobilization or surgery for the treatment of distal radial fractures. Radiographic outcomes were determined on the basis of radiographs that were made 3 months after the injury. Clinical outcome was determined on the basis of the QuickDASH (an abbreviated version of the Disabilities of the Arm, Shoulder and Hand [DASH] questionnaire) score, range of motion, and grip strength at 1 year after the injury. Nonlinear relations were analyzed with cubic splines.RESULTS: Three hundred and sixty-six patients (84%) had both radiographic and clinical follow-up. Seventy patients were lost to follow-up. The mean age was 57 years (range, 18 to 75 years), and 79% of the patients were female. Dorsal tilt was the radiographic parameter that was most strongly associated with the QuickDASH score, grip strength, and range of motion. We found nonlinear relations. Clinical outcomes were found to worsen with increasing dorsal tilt, with the cutoff value being approximately 5°.CONCLUSIONS: We found that clinical outcomes following distal radial fractures have a nonlinear relationship with dorsal tilt, with worse outcomes being associated with increasing dorsal tilt. The decline in clinical outcome starts at 5°, but there is unlikely to be a noticeable difference in capability as measured with the QuickDASH until 20° of dorsal tilt (based on the minimum clinically important difference) in a population up to 75 years old.LEVEL OF EVIDENCE: Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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| 46. |
- Schmidt, Viktor, et al.
(författare)
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Functional outcomes are restored a decade after a distal radius fracture : a prospective long-term follow-up study
- 2024
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Ingår i: Journal of Hand Surgery, European Volume. - : Sage Publications. - 1753-1934 .- 2043-6289. ; 49:3, s. 322-328
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Tidskriftsartikel (refereegranskat)abstract
- We performed an 11-13-year prospective follow-up of patients after a distal radial fracture (DRF) to investigate the association between fracture malunion, radiocarpal osteoarthritis and clinical outcome. In total, 292 patients responded to patient-reported outcome measures; of them, 242 underwent clinical examination. Clinical outcomes improved with time. A decade after fracture, median Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score was 5, EuroQol Five-dimensions score was 1.0, and range of motion and grip strength were 96% of the contralateral side. Neither osteoarthritis (6%) nor pseudoarthrosis of the ulnar styloid (30%) affected the outcomes. Dorsal tilt, radial inclination, ulnar variance and intra-articular extension did not affect long-term clinical outcomes or the risk of osteoarthritis. Recovery after a DRF is an ongoing process that lasts years. A decade after the injury event, range of motion, grip strength and QuickDASH were recovered to population normal, regardless of radiological outcomes.Level of evidence: II.
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| 47. |
- Sjöholm, Pontus, et al.
(författare)
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Posterior and anterior tilt increases the risk of failure after internal fixation of Garden I and II femoral neck fracture
- 2019
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Ingår i: Acta Orthopaedica. - : Taylor & Francis. - 1745-3674 .- 1745-3682. ; 90:6, s. 537-541
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose - Preoperative posterior tilt of the femoral head as seen on lateral radiographs has been reported to affect the risk of fixation failure in cases of minimally displaced femoral neck fractures (Garden I-II). We investigated radiological risk factors of treatment failure.Patients and methods - We included 417 patients (68% women, median age: 78 years (50-108) with a minimally displaced femoral neck fracture (Garden I-II) treated with internal fixation in a retrospective cohort study. The patients were followed for 3.4 years (2-14). Data on age, sex, housing, cognitive impairment, implant angulation, pre- and postoperative tilt, hip complications, and reoperations were recorded. The risk of fixation failure was assessed using Cox proportional hazards regression analysis.Results - The overall reoperation rate was 17%, and the rate of treatment failure (fixation failure, nonunion, avascular necrosis, or posttraumatic osteoarthritis) was 13%. Cox proportional hazard analysis revealed an increased risk of treatment failure with a preoperative posterior tilt of at least 20° and a preoperative anterior tilt greater than 10°. A failure occurred in 13 of the 65 patients with a posterior tilt of at least 20° and in 5 of the 9 patients with an anterior tilt greater than 10°.Interpretation - A preoperative posterior tilt of 20° and an anterior tilt greater than 10° in cases of Garden I and II femoral neck fractures increase the risk of fixation failure necessitating additional surgery. In this group of patients, there is a need for future interventional studies regarding the feasibility of primary hip arthroplasty.
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| 48. |
- Sjöholm, Pontus, et al.
(författare)
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Preoperative Anterior and Posterior Tilt of Garden I-II Femoral Neck Fractures Predict Treatment Failure and Need for Reoperation in Patients Over 60 Years
- 2021
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Ingår i: JBJS Open Access. - : The Journal of Bone and Joint Surgery. - 2472-7245. ; 6:4
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Tidskriftsartikel (refereegranskat)abstract
- Background: The purpose of the present study was to estimate the effect of preoperative fracture tilt and to scrutinize the effect of anterior tilt on the risk of treatment failure in patients with Garden Type-I and II femoral neck fractures that are treated with internal fixation.Methods: A retrospective multicenter study was performed on a consecutive series of patients ≥60 years of age who had undergone primary internal fixation for the treatment of Garden Type-I and II femoral neck fractures. The study included 1,505 patients with a minimum follow-up of 2 years. Radiographic assessments encompassed preoperative and postoperative tilt, implant inclination, and treatment failure. Data on reoperation and mortality were collected. The risk of treatment failure was assessed with use of Cox proportional hazard regression analysis.Results: The study comprised 1,505 patients (71% female) with a median age of 81 years (range, 60 to 108 years). Overall, 234 patients (16%) were classified as having a treatment failure and 251 patients (17%) underwent reoperation. A preoperative anterior tilt of >10° and a posterior tilt of >20° were predictors of treatment failure and reoperation, respectively. Treatment failure occurred in 74 (25%) of 301 patients with a posterior tilt of >20° and in 17 (43%) of 40 patients with an anterior tilt of >10°.Conclusions: This multicenter cohort study identified a subgroup of patients with Garden Type-I and II femoral neck fractures with an anterior tilt of >10° as having high treatment failure rates and major reoperation rates comparable with those associated with displaced femoral neck fractures. A preoperative posterior tilt of >20° increases the risk of treatment failure, and the potential benefit of arthroplasty in this subgroup of patients remains to be further investigated.Level of Evidence: Prognostic Level III. See Instructions to Authors for a complete description of levels of evidence.
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| 49. |
- Springmann, Marco, et al.
(författare)
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Options for keeping the food system within environmental limits
- 2018
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Ingår i: Nature. - : Springer Science and Business Media LLC. - 0028-0836 .- 1476-4687. ; 562:7728, s. 519-
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Tidskriftsartikel (refereegranskat)abstract
- The food system is a major driver of climate change, changes in land use, depletion of freshwater resources, and pollution of aquatic and terrestrial ecosystems through excessive nitrogen and phosphorus inputs. Here we show that between 2010 and 2050, as a result of expected changes in population and income levels, the environmental effects of the food system could increase by 50-90% in the absence of technological changes and dedicated mitigation measures, reaching levels that are beyond the planetary boundaries that define a safe operating space for humanity. We analyse several options for reducing the environmental effects of the food system, including dietary changes towards healthier, more plant-based diets, improvements in technologies and management, and reductions in food loss and waste. We find that no single measure is enough to keep these effects within all planetary boundaries simultaneously, and that a synergistic combination of measures will be needed to sufficiently mitigate the projected increase in environmental pressures.
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| 50. |
- Thelaus, Åsa, et al.
(författare)
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A Prospective Observational Cohort Study on Orthopaedic and Anaesthetic Registrars Performing Femoral Nerve Block on Patients with an Acute Hip Fracture.
- 2016
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Ingår i: Surgery research and practice. - : Hindawi Limited. - 2356-7759 .- 2356-6124. ; 2016
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Tidskriftsartikel (refereegranskat)abstract
- We investigated if a femoral nerve block (FNB) for patients with a proximal femoral fracture (PFF) and administered by an orthopaedic registrar (OR) instead of an anaesthesiology registrar (AR) lowers the lead time to block and reduces the total amount of rescue analgesics during the preoperative phase. 205 patients were included in a prospective observational cohort study. The main outcome variable was rescue analgesics as total intravenous morphine prior to surgery. All results were adjusted for confounding using age, sex, cognitive dysfunction, and ASA classification. The OR group (n = 135) was over 2 hours faster in performing the block compared to the AR group (n = 70) but was nonetheless correlated with an increased amount of rescue analgesics during the study, 2.4mg morphine (95% CI 0.0-4.9) more compared to the AR group. We found no difference between the groups in the risk of adverse events. We conclude that, for patients with an acute PFF and with morphine consumption as end point, how soon from arrival to hospital the patients receive a FNB is of lesser importance than who is administering it. Based on our results we recommend that emergency hospitals should have routines for anaesthesiologists performing FNB on this frail patient group.
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