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Sökning: WFRF:(Holmberg Andreas)

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1.
  • Bratt, Ola, et al. (författare)
  • The Study of Active Monitoring in Sweden (SAMS) : A randomized study comparing two different follow-up schedules for active surveillance of low-risk prostate cancer
  • 2013
  • Ingår i: Scandinavian Journal of Urology. - : Medical Journals Sweden AB. - 2168-1805 .- 2168-1813. ; 47:5, s. 347-355
  • Forskningsöversikt (refereegranskat)abstract
    • Objective. Only a minority of patients with low-risk prostate cancer needs treatment, but the methods for optimal selection of patients for treatment are not established. This article describes the Study of Active Monitoring in Sweden (SAMS), which aims to improve those methods. Material and methods. SAMS is a prospective, multicentre study of active surveillance for low-risk prostate cancer. It consists of a randomized part comparing standard rebiopsy and follow-up with an extensive initial rebiopsy coupled with less intensive follow-up and no further scheduled biopsies (SAMS-FU), as well as an observational part (SAMS-ObsQoL). Quality of life is assessed with questionnaires and compared with patients receiving primary curative treatment. SAMS-FU is planned to randomize 500 patients and SAMS-ObsQoL to include at least 500 patients during 5 years. The primary endpoint is conversion to active treatment. The secondary endpoints include symptoms, distant metastases and mortality. All patients will be followed for 10-15 years. Results. Inclusion started in October 2011. In March 2013, 148 patients were included at 13 Swedish urological centres. Conclusions. It is hoped that the results of SAMS will contribute to fewer patients with indolent, low-risk prostate cancer receiving unnecessary treatment and more patients on active surveillance who need treatment receiving it when the disease is still curable. The less intensive investigational follow-up in the SAMS-FU trial would reduce the healthcare resources allocated to this large group of patients if it replaced the present standard schedule.
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  • Alanentalo, Tomas, et al. (författare)
  • Quantification and 3-D imaging of the insulitis-induced destruction of β-cells in murine type 1 diabetes
  • 2010
  • Ingår i: Diabetes. - : American Diabetes Association. - 0012-1797 .- 1939-327X. ; 59:7, s. 1756-1764
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: The aim of this study was to refine the information regarding the quantitative and spatial dynamics of infiltrating lymphocytes and remaining beta-cell volume during the progression of type 1 diabetes in the NOD mouse model of the disease.Research design and methods: Using an ex vivo technique, optical projection tomography (OPT), we quantified and assessed the 3D spatial development and progression of insulitis and beta-cell destruction in pancreas from diabetes prone NOD and non-diabetes prone congenic NOD.H-2b mice between 3 and 16 weeks of age.Results: Together with results showing the spatial dynamics of the insulitis process we provide data of beta-cell volume distributions down to the level of the individual islets and throughout the pancreas during the development and progression of type 1 diabetes. Our data provide evidence for a compensatory growth potential of the larger insulin(+) islets during the later stages of the disease around the time point for development of clinical diabetes. This is in contrast to smaller islets, which appear less resistant to the autoimmune attack. We also provide new information on the spatial dynamics of the insulitis process itself, including its apparently random distribution at onset, the local variations during its further development, and the formation of structures resembling tertiary lymphoid organs at later phases of insulitis progression.Conclusions: Our data provides a powerful tool for phenotypic analysis of genetic and environmental effects on type 1 diabetes etiology as well as for evaluating the potential effect of therapeutic regimes.
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  • Almqvist, Andreas, et al. (författare)
  • A Scientific Perspective on Reducing Ski-Snow Friction to Improve Performance in Olympic Cross-Country Skiing, the Biathlon and Nordic Combined
  • 2022
  • Ingår i: Frontiers in Sports and Active Living. - : Frontiers Media S.A.. - 2624-9367. ; 4
  • Tidskriftsartikel (refereegranskat)abstract
    • Of the medals awarded at the 2022 Winter Olympics in Beijing, 24% were for events involving cross-country skiing, the biathlon and Nordic combined. Although much research has focused on physiological and biomechanical characteristics that determine success in these sports, considerably less is yet known about the resistive forces. Here, we specifically describe what is presently known about ski-snow friction, one of the major resistive forces. Today, elite ski races take place on natural and/or machine-made snow. Prior to each race, several pairs of skis with different grinding and waxing of the base are tested against one another with respect to key parameters, such as how rapidly and for how long the ski glides, which is dependent on ski-snow friction. This friction arises from a combination of factors, including compaction, plowing, adhesion, viscous drag, and water bridging, as well as contaminants and dirt on the surface of and within the snow. In this context the stiffness of the ski, shape of its camber, and material composition and topography of the base exert a major influence. An understanding of the interactions between these factors, in combination with information concerning the temperature and humidity of both the air and snow, as well as the nature of the snow, provides a basis for designing specific strategies to minimize ski-snow friction. In conclusion, although performance on “narrow skis” has improved considerably in recent decades, future insights into how best to reduce ski-snow friction offer great promise for even further advances.
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  • Andersson, Henrik, 1968-, et al. (författare)
  • Acute coronary syndrome in relation to the occurrence of associated symptoms : A quantitative study in prehospital emergency care.
  • 2017
  • Ingår i: International Emergency Nursing. - : Elsevier BV. - 1755-599X .- 1878-013X. ; 33, s. 43-47
  • Tidskriftsartikel (refereegranskat)abstract
    • INTRODUCTION: Acute chest pain is a common symptom among prehospital emergency care patients. Therefore, it is crucial that ambulance nurses (ANs) have the ability to identify symptoms and assess patients suffering from acute coronary syndrome (ACS). The aim of this study is to explore the occurrence of dyspnoea and nausea and/or vomiting in the prehospital phase of a suspected ACS and the associations with patients' outcome.METHODS: This study has a quantitative design based on data from hospital records and from a previous interventional study (randomised controlled trial) including five Emergency Medical Service (EMS) systems in western Sweden in the years 2008-2010.RESULTS: In all, 1836 patients were included in the interventional study. Dyspnoea was reported in 38% and nausea and/or vomiting in 26% of patients. The risk of death within one year increased with the presence of dyspnoea. The presence of nausea and/or vomiting increased the likelihood of a final diagnosis of acute myocardial infarction (AMI).CONCLUSION: This study shows that dyspnoea, nausea and/or vomiting increase the risk of death and serious diagnosis among ACS patients. This means that dyspnoea, nausea and/or vomiting should influence the ANs' assessment and that special education in cardiovascular nursing is required.
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  • Andersson, Henrik, et al. (författare)
  • Ethics education to support ethical competence learning in healthcare : an integrative systematic review
  • 2022
  • Ingår i: BMC Medical Ethics. - : BioMed Central. - 1472-6939. ; 23
  • Forskningsöversikt (refereegranskat)abstract
    • Background: Ethical problems in everyday healthcare work emerge for many reasons and constitute threats to ethi- cal values. If these threats are not managed appropriately, there is a risk that the patient may be inflicted with moral harm or injury, while healthcare professionals are at risk of feeling moral distress. Therefore, it is essential to support the learning and development of ethical competencies among healthcare professionals and students. The aim of this study was to explore the available literature regarding ethics education that promotes ethical competence learning for healthcare professionals and students undergoing training in healthcare professions.Methods: In this integrative systematic review, literature was searched within the PubMed, CINAHL, and PsycInfo databases using the search terms ‘health personnel’, ‘students’, ‘ethics’, ‘moral’, ‘simulation’, and ‘teaching’. In total, 40 arti- cles were selected for review. These articles included professionals from various healthcare professions and students who trained in these professions as subjects. The articles described participation in various forms of ethics education. Data were extracted and synthesised using thematic analysis.Results: The review identified the need for support to make ethical competence learning possible, which in the long run was considered to promote the ability to manage ethical problems. Ethical competence learning was found to be helpful to healthcare professionals and students in drawing attention to ethical problems that they were not previ- ously aware of. Dealing with ethical problems is primarily about reasoning about what is right and in the patient’s best interests, along with making decisions about what needs to be done in a specific situation.Conclusions: The review identified different designs and course content for ethics education to support ethical competence learning. The findings could be used to develop healthcare professionals’ and students’ readiness and capabilities to recognise as well as to respond appropriately to ethically problematic work situations.
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  • Bennesved, Anna, et al. (författare)
  • Ambulance clinicians’ understanding of older patients’ self-determination : A vignette study
  • 2023
  • Ingår i: Nursing Ethics. - : Sage Publications. - 0969-7330 .- 1477-0989. ; , s. 1-13
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Older patients are often vulnerable and highly dependent on healthcare professionals’ assessment in the event of acute illness. In the context of ambulance services, this poses challenges as the assessment is normally conducted with a focus on identifying life-threatening conditions. Such assessment is not fully satisfactory in a patient relationship that also aims to promote and protect patient autonomy.Aim: To describe ambulance clinicians’ understanding of older patients’ self-determination when the pa- tient’s decision-making ability is impaired.Research design: A qualitative design with an inductive approach, guided by descriptive phenomenology.Participants: In total, 30 ambulance clinicians, comprised of 25 prehospital emergency nurses, 1 nurse and 4 emergency medical technicians participated in 15 dyadic interviews.Ethical considerations: The research was conducted in accordance with the Declaration of Helsinki, and permission was granted by the Swedish Ethical Review Authority.Findings: The findings are presented in two themes: (1) Movement between explicit and implicit will; and (2) Contradictions about the patient’s best interests. The clinicians’ interpretations are based on an understanding of the patient’s situation using substitute decision-making in emergency situations and conversations that reveal the patient’s explicit wishes. Sometimes the clinicians collaborate to validate the patient’s implicit will, while they at other times subordinate themselves to others’ opinions. The clinicians find themselves in conflict between personal values and organisational values as they try to protect the patient’s self-determination.Conclusion: The results indicate that older patients with an impaired decision-making ability risk losing the right to self-determination in the context of ambulance services. The clinicians face challenges that significantly affect their ability to handle the older patient’s unique needs based on a holistic perspective and their ability to be autonomous.
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  • Billsten, Johan, 1971-, et al. (författare)
  • Organizational Readiness for Change (ORC) test used in the implementation of assessment instruments and treatment methods in a Swedish National study
  • 2018
  • Ingår i: Journal of Substance Abuse Treatment. - Amsterdam : Elsevier. - 0740-5472 .- 1873-6483. ; 84, s. 9-16
  • Tidskriftsartikel (refereegranskat)abstract
    • Organizational climate and related factors are associated with outcome and are as such of vital interest for healthcare organizations. Organizational Readiness for Change (ORC) is the questionnaire used in the present study to assess the influence of organizational factors on implementation success. The respondents were employed in one of 203 Swedish municipalities within social work and psychiatric substance/abuse treatment services. They took part in a nationwide implementation project organized by the Swedish Association of Local Authorities and Regions (SALAR), commissioned by the Swedish National Board of Health and Welfare. Aim The aims were: (a) to identify classes (clusters) of employees with different ORC profiles on the basis of data collected in 2011 and (b) to investigate ORC profiles which predicted the use of assessment instruments, therapy methods and collaborative activities in 2011 and 2013. Design and recruitment The evaluation study applied a naturalistic design with registration of outcome at consecutive assessments. The participants were contacted via official e-mail addresses in their respective healthcare units and were encouraged by their officials to participate on a voluntary basis. Statistics Descriptive statistics were obtained using SPSS version 23. A latent profile analysis (LPA) using Mplus 7.3 was performed with a robust maximum likelihood estimator (MLR) to identify subgroups (clusters) based on the 18 ORC indexes. Results A total of 2402 employees responded to the survey, of whom 1794 (74.7%) completed the ORC scores. Descriptive analysis indicated that the respondents were a homogenous group of employees, where women (72.0%) formed the majority. Cronbach's alpha for the 18 ORC indexes ranged from α = 0.67 to α = 0.78. A principal component analysis yielded a four-factor solution explaining 62% of the variance in total ORC scores. The factors were: motivational readiness (α = 0.64), institutional resources (α = 0.52), staff attributes (α = 0.76), and organizational climate (α = 0.74). An LPA analysis of the four factors with their three distinct profiles provided the best data fit: Profile 3 (n = 614), Profile 2 (n = 934), and Profile 1 (n = 246). Respondents with the most favorable ORC scores (Profile 3) used significantly more instruments and more treatment methods and had a better collaborating network in 2011 as well as in 2013 compared to members in Profile 1, the least successful profile. Conclusion In a large sample of social work and healthcare professionals, ORC scores reflecting higher institutional resources, staff attributes and organizational climate and lower motivational readiness for change were associated with a successful implementation of good practice guidelines for the care and treatment of substance users in Sweden. Low motivational readiness as a construct may indicate satisfaction with the present situation. As ORC proved to be an indicator of successful dissemination of evidence-based guidelines into routine and specialist healthcare, it can be used to tailor interventions to individual employees or services and to improve the dissemination of and compliance with guidelines for the treatment of substance users. © 2017
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  • Bodén, Hans, 1954-, et al. (författare)
  • Experimental Techniques for Aeroacoustics in Low Mach Number Confined Flows : Keynote Paper
  • 2011
  • Ingår i: Proceedings of the International Conference on Mechanical Engineering 2011(ICME2011) 18-20 December 2011, Dhaka, Bangladesh. - : ICME.
  • Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
    • Measurement of plane wave acoustic transmission properties, so called two-port data, of flow duct components is important in many applications such as in the development of mufflers for IC-engines. Measurement of two-port data is difficult when the flow velocity in the measurement duct is high because of the flow noise contamination of the measured pressure signals. The wall mounted pressure transducers normally used will pick up unwanted flow noise mainly in the form of turbulent pressure fluctuations. The problem is then obtaining a signal-to- noise ratio high enough for quality measurements. Techniques to improve acoustic two-port determination have been developed in this paper, including test rig design, signal processing techniques and over-determination.
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  • Brandl, Andreas, et al. (författare)
  • Current practice in assessment and management of malnutrition in surgical oncology practice – An ESSO-EYSAC snapshot analysis
  • 2024
  • Ingår i: European Journal of Surgical Oncology. - 0748-7983 .- 1532-2157. ; 50:5
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: Malnutrition is common in patients suffering from malignant diseases and has a major impact on patient outcomes. Prevention and early detection are crucial for effective treatment. This study aimed to investigate current international practice in the assessment and management of malnutrition in surgical oncology departments. Material and methods: The survey was designed by European Society of Surgical Oncology (ESSO) and ESSO Young Surgeons and Alumni Club (EYSAC) Research Academy as an online questionnaire with 41 questions addressing three main areas: participant demographics, malnutrition assessment, and perioperative nutritional standards. The survey was distributed from October to November 2021 via emails, social media and the ESSO website to surgical networks focussing on surgical oncologists. Results were collected and analysed by an independent team. Results: A total of 156 participants from 39 different countries answered the survey, reflecting a response rate of 1.4%. Surgeons reported treating a mean of 22.4 patients per month. 38% of all patients treated in surgical oncology departments were routinely screened for malnutrition. 52% of patients were perceived as being at risk for malnutrition. The most used screening tool was the “Malnutrition Universal Screening Tool” (MUST). 68% of participants agreed that the surgeon is responsible for assessing preoperative nutritional status. 49% of patients were routinely seen by dieticians. In cases of severe malnutrition, 56% considered postponing the operation. Conclusions: The reported rate of malnutrition screening by surgical oncologists is lower than expected (38%). This indicates a need for improved awareness of malnutrition in surgical oncology, and nutritional screening.
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  • Bratt, Ola, 1963, et al. (författare)
  • The Value of an Extensive Transrectal Repeat Biopsy with Anterior Sampling in Men on Active Surveillance for Low-risk Prostate Cancer: A Comparison from the Randomised Study of Active Monitoring in Sweden (SAMS)
  • 2019
  • Ingår i: European Urology. - : Elsevier BV. - 0302-2838 .- 1873-7560. ; 76:4, s. 461-466
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: A systematic repeat biopsy is recommended for men starting on active surveillance for prostate cancer, but the optimal number and distribution of cores are unknown. Objective: To evaluate an extensive repeat transrectal biopsy with anterior sampling in men starting on active surveillance. Design, setting, and participants: Randomised multicentre trial. From 2012 to 2016, 340 Swedish men, aged 40-75 yr, with recently diagnosed low-volume Gleason grade group 1 prostate cancer were included. Intervention: Either an extensive transrectal biopsy with anterior sampling (median 19 cores) or a standard transrectal biopsy (median 12 cores). Outcome measurements and statistical analysis: Primary outcome measure: Gleason grade group >= 2 cancer. Secondary outcomes: Cancer in anteriorly directed biopsy cores and postbiopsy infection. Nonparametric statistical tests were applied. Results and limitations: Gleason grade group >= 2 cancer was detected in 16% of 156 men who had an extensive biopsy and in 10% of 164 men who had a standard biopsy, a 5.7% difference (95% confidence interval [CI]-0.2% to 13%, p = 0.09). There was a strong linear association between prostate-specific antigen (PSA) density and cancer in the anteriorly directed biopsy cores. The odds ratios for cancer in the anteriorly directed cores were for any cancer 2.2 (95% CI 1.3-3.9, p = 0.004) and for Gleason grade group >= 2 cancer 2.3 (95% CI 1.2-4.4, p = 0.015) per 0.1-ng/ml/cm(3) increments. Postbiopsy infections were equally common in the two groups. A limitation is that magnetic resonance imaging was not used. Conclusions: The trial did not support general use of the extensive transrectal repeat biopsy template, but cancer in the anteriorly directed cores was common, particularly in men with high PSA density. The higher the PSA density, the stronger the reason to include anterior sampling at a systematic repeat biopsy. Patient summary: This trial compared two different templates for transrectal prostate biopsy in men starting on active surveillance for low-risk prostate cancer. Cancer was often found in the front part of the prostate, which is not sampled on a standard prostate biopsy. (C) 2019 European Association of Urology. Published by Elsevier B.V. All rights reserved.
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  • Call, Mikael, 1980- (författare)
  • Inverse Shortest Path Routing Problems in the Design of IP Networks
  • 2010
  • Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • This thesis is concerned with problems related to shortest pathrouting (SPR) in Internet protocol (IP) networks. In IP routing, alldata traffic is routed in accordance with an SPR protocol, e.g. OSPF.That is, the routing paths are shortest paths w.r.t. some artificialmetric. This implies that the majority of the Internet traffic isdirected by SPR. Since the Internet is steadily growing, efficientutilization of its resources is of major importance. In theoperational planning phase the objective is to utilize the availableresources as efficiently as possible without changing the actualdesign. That is, only by re-configuration of the routing. This isreferred to as traffic engineering (TE). In this thesis, TE in IPnetworks and related problems are approached by integer linearprogramming.Most TE problems are closely related to multicommodity routingproblems and they are regularly solved by integer programmingtechniques. However, TE in IP networks has not been studied as much,and is in fact a lot harder than ordinary TE problems without IProuting since the complicating shortest path aspect has to be takeninto account. In a TE problem in an IP network the routing isperformed in accordance with an SPR protocol that depends on a metric,the so called set of administrative weights. The major differencebetween ordinary TE problems and TE in IP networks is that all routingpaths must be simultaneously realizable as shortest paths w.r.t. thismetric. This restriction implies that the set of feasible routingpatterns is significantly reduced and that the only means available toadjust and control the routing is indirectly, via the administrativeweights.A constraint generation method for solving TE problems in IP networksis outlined in this thesis. Given an "original" TE problem, the ideais to iteratively generate and augment valid inequalities that handlethe SPR aspect of IP networks. These valid inequalities are derived byanalyzing the inverse SPR problem. The inverse SPR problem is todecide if a set of tentative routing patterns is simultaneouslyrealizable as shortest paths w.r.t. some metric. When this is not thecase, an SPR conflict exists which must be prohibited by a validinequality that is then augmented to the original TE problem. Toderive strong valid inequalities that prohibit SPR conflicts, athorough analysis of the inverse SPR problem is first performed. Inthe end, this allows us to draw conclusions for the design problem,which was the initial primary concern.
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  • Dellgren, Göran, 1961, et al. (författare)
  • Continuous improvement in outcome after heart transplantation - Long-term follow-up after three decades of experience.
  • 2017
  • Ingår i: International journal of cardiology. - : Elsevier BV. - 1874-1754 .- 0167-5273. ; 231, s. 188-194
  • Forskningsöversikt (refereegranskat)abstract
    • Heart transplantation (HTx) has become the standard treatment for patients with end-stage heart disease. We report on the long-term outcome after HTx at our centre and investigate trends in outcome over time.During the period, between 1984 and 2014, a total of 610 HTx procedures were performed in 595 patients (median 48years; IQR 31-57years; range 24days-71years; mean 43years; 75% male) in our institution. Long-term outcome was investigated in the whole cohort, among children (n=76), bridged with mechanical circulatory support (MCS, n=131), re-transplanted (n=17), and concomitant kidney transplantation (n=12).Long-term survival was at 1, 5, 10, 15 and 20years: 86% (95CI 0.83-0.89); 77% (95CI 0.73-0.80); 63% (95CI 0.59-0.68); 48% (95CI 0.43-0.54) and 30% (95CI 0.25-0.36), respectively. The median survival for the whole cohort was 14.1years. Patients transplanted during the most recent time period (2010-2014) had a better survival compared to previous eras, with a 1- and 3-year survival of 94% (95CI 0.89-0.97) and 93% (95CI 0.88-0.96), respectively (p<0.001). However, when survival was analysed for long-term MCS (n=80) versus short term MCS (n=35), there was a significantly poorer survival for the short-term MCS group (p=0.001). Independent predictors of long-term mortality included recipient age (p=0.041); previous smoking (p=0.034); ischemic heart disease (p=0.002); and preoperative ventilator therapy (p=0.004).We have shown that continuous improvement in outcome after HTx still occurs. In the last time era, direct transplantation from short-term MCS was abandoned, which may have inflicted outcome during the last time era.
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  • Du, Lin, et al. (författare)
  • Sound amplification at a rectangular T-junction with merging mean flows
  • 2016
  • Ingår i: Journal of Sound and Vibration. - : Academic Press. - 0022-460X .- 1095-8568. ; 367, s. 69-83
  • Tidskriftsartikel (refereegranskat)abstract
    • This paper reports a numerical study on the aeroacoustic response of a rectangular T-junction with merging mean flows. The primary motivation of the work is to explain the high sound amplification, recently seen experimentally, when introducing a small merging bias flow. The acoustic results are found solving the compressible Linearized Navier-Stokes Equations (LNSEs) in the frequency domain, where the base flow is first obtained using RANS with a k-epsilon turbulence model. The model predicts the measured scattering data well, including the amplitude and Strouhal number for the peak amplification, if the effect of eddy viscosity damping is included. It is found that the base flow changes significantly with the presence of a small bias flow. Compared to pure grazing flow a strong unstable shear layer is created in the downstream main duct starting from the T-junction trailing edge. This means that the main region of vortex-sound interaction is moved away from the junction to a downstream region much larger than the junction width. To analyze the sound amplification in this region Howe's energy corollary and the growth of acoustic density are used.
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  • Dueking, Peter, et al. (författare)
  • Comparison of Non-Invasive Individual Monitoring of the Training and Health of Athletes with Commercially Available Wearable Technologies
  • 2016
  • Ingår i: Frontiers in Physiology. - : Frontiers Media SA. - 1664-042X. ; 7
  • Forskningsöversikt (refereegranskat)abstract
    • Athletes adapt their training daily to optimize performance, as well as avoid fatigue, overtraining and other undesirable effects on their health. To optimize training load, each athlete must take his/her own personal objective and subjective characteristics into consideration and an increasing number of wearable technologies (wearables) provide convenient monitoring of various parameters. Accordingly, it is important to help athletes decide which parameters are of primary interest and which wearables can monitor these parameters most effectively. Here, we discuss the wearable technologies available for non-invasive monitoring of various parameters concerning an athlete's training and health. On the basis of these considerations, we suggest directions for future development. Furthermore, we propose that a combination of several wearables is most effective for accessing all relevant parameters, disturbing the athlete as little as possible, and optimizing performance and promoting health.
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  • Ekelund, Ulf, 1960-, et al. (författare)
  • Physical activity in relation to aerobic fitness and body fat in 14- to 15-year-old boys and girls
  • 2001
  • Ingår i: European Journal of Applied Physiology. - : Springer Science and Business Media LLC. - 1439-6319 .- 1439-6327. ; 85:3-4, s. 195-201
  • Tidskriftsartikel (refereegranskat)abstract
    • The purpose of this study was to examine the strength of the relationship between different variables of physical activity and aerobic fitness and body fat in adolescent boys and girls. Activity energy expenditure (AEE), time spent in a sedentary state, and time spent engaged in moderate and vigorous physical activity (MVPA, > or = 50% peak oxygen uptake, VO2peak) were assessed by the minute-by-minute heart rate monitoring method in 82 randomly selected 14- to 15-year olds (42 boys, 40 girls). Body fat was determined by measuring skinfold thicknesses. VO2peak was measured by indirect calorimetry. Somatic maturity level was determined by percentages of adult (i.e. 18 years) height attained at examination. AEE was related to aerobic fitness for both genders (boys, r = 0.30, P = 0.056; girls, r = 0.45, P = 0.003). For boys, there was a significant relationship between maturity level and VO2peak (r = 0.48, P < 0.001). For both genders, body fat was significantly and negatively related to VO2peak (r = -0.48 and r = -0.43, P < 0.01). Body fat and maturity explained 47% of the variation in VO2peak in boys, whereas AEE and body fat explained 22% of the variation in VO2peak in girls. No significant associations between physical activity variables and the data on body fat were observed. The total amount of physical activity (AEE) was related to VO2peak, at least in adolescent girls. Although VO2peak seems to be influenced by the maturity level in adolescent boys, the data support the promotion of a daily active lifestyle among young people.
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  • Fager, Cecilia, et al. (författare)
  • Nurses' use of an advisory decision support system in ambulance services : A qualitative study
  • 2024
  • Ingår i: Journal of Advanced Nursing. - : John Wiley & Sons. - 0309-2402 .- 1365-2648.
  • Tidskriftsartikel (refereegranskat)abstract
    • Aim: To illuminate from the perspective of nurses in ambulance services the experiences of using a web-based advisory decision support system to assess care needs and refer patients.Design: Inductive and descriptive approaches.Method: Thirteen semi-structured interviews were conducted in the spring of 2020. The data were analysed through the reflexive thematic analysis.Results: The Swedish web-based advisory decision support system (ADSS) was found to strengthen nurses' feelings of security when they assess patients' care needs, promote their competence and professional pride, and help them manage stress. However, the system also generated difficulties for nurses to adjust to the dynamic ambulance team and revealed a discrepancy between their professional roles and responsibilities to refer patients and provide self-care advice. The nurses thought that the support system facilitated their increased participation and helped them understand patients and significant others by offering transparency in assessment and decision making. Thus, the support system provides nurses with an opportunity to strengthen patients' independence through information and education. However, in the care relationship, nurses worked to overcome patients' expectations.Conclusion: Nurses using the ADSS increased their security while performing assessments and referrals and found new opportunities to provide information and promote understanding of their decisions. However, nursing care values can be threatened when new support systems are introduced, especially as ambulance services become increasingly protocol-driven.Implications for Profession and/or Patient Care: These findings have implications for nurses' work environments and help them maintain consistency in making medical assessments and in providing equivalent self-care advice when referring patients to the different levels of care. The findings will also impact researchers and policymakers who formulate decision support systems.Reporting Method: Consolidated criteria for reporting qualitative research (COREQ).Patient or Public Contribution: None.
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  • Forsberg, Anna, et al. (författare)
  • Once-only colonoscopy or two rounds of faecal immunochemical testing 2 years apart for colorectal cancer screening (SCREESCO): preliminary report of a randomised controlled trial
  • 2022
  • Ingår i: The Lancet Gastroenterology & Hepatology. - : ELSEVIER INC. - 2468-1253. ; 7:6, s. 513-521
  • Tidskriftsartikel (refereegranskat)abstract
    • Background Screening for colorectal cancer is done with lower gastrointestinal endoscopy or stool-based tests. There is little evidence from randomised trials to show primary colonoscopy reduces mortality in colorectal cancer We aimed to investigate the effect of screening with once-only colonoscopy or two rounds of faecal immunochemical test screening on colorectal cancer mortality and incidence. Methods We did a randomised controlled trial in Sweden (SCREESCO). Residents in 18 of 21 regions who were age 60 years in the year of randomisation were identified from a population register maintained by the Swedish Tax Agency. A statistician with no further involvement in the trial used a randomised block method to assign individuals to once-only colonoscopy, two rounds of faecal immunochemical testing (OC-Sensor; 2 years apart), or a control group (no intervention; standard diagnostic pathways), in a ratio of 1:6 for colonoscopy versus control and 1:2 for faecal immunochemical testing versus control. Masking was not possible due to the nature of the trial. The primary endpoints of the trial are colorectal cancer mortality and colorectal cancer incidence. Here, we report preliminary participation rates, baseline findings, and adverse events from March, 2014, to December, 2020, in the two intervention groups after completion of recruitment and screening, up to the completion of the second faecal immunochemical testing round. Analyses were done in the intention-to-screen population, defined as all individuals who were randomly assigned to the respective study group. This study is registered with Clinical Trials.gov, NCT02078804. Findings Between March 1, 2014, and Dec 31, 2020, 278 280 people were induded in the study; 31 140 were assigned to the colonoscopy group, 60 300 to the faecal immunochemical test group, and 186 840 to the control group. 10 679 (35.1%) of 30 400 people who received an invitation for colonoscopy participated. 33 383 (55.5%) of 60 137 people who received a postal faecal immunochemical test participated. In the intention-to-screen analysis, colorectal cancer was detected in 49 (0.16%) of 31140 people in the colonoscopy group versus 121 (0. 20%) of 60 300 in the faecal immunochemical test group (relative risk [RR] 0.78, 95% CI 0.56-1.09). Advanced adenomas were detected in 637 (2.05%) people in the colonoscopy group and 968 (1.61%) in the faecal immunochemical test group (RR 1.27, 95% CI 1.15-1.41). Colonoscopy detected more right-sided advanced adenomas than faecal immunochemical testing. There were two perforations and 15 major bleeds in 16 555 colonoscopies. No intervention-related deaths occurred. Interpretation The diagnostic yield and the low number of adverse events indicate that the design from this trial, both for once-only colonoscopy and faecal immunochemical test screening, could be transferred to a population-based screening service if a benefit in disease-specific mortality is subsequently shown. Copyright (C) 2022 Elsevier Ltd. All rights reserved.
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27.
  • Forsberg, A., et al. (författare)
  • Once-only colonoscopy or two rounds of faecal immunochemical testing 2 years apart for colorectal cancer screening (SCREESCO): preliminary report of a randomised controlled trial
  • 2022
  • Ingår i: Lancet Gastroenterology & Hepatology. - : Elsevier BV. - 2468-1253. ; 7:6, s. 513-521
  • Tidskriftsartikel (refereegranskat)abstract
    • Background Screening for colorectal cancer is done with lower gastrointestinal endoscopy or stool-based tests. There is little evidence from randomised trials to show primary colonoscopy reduces mortality in colorectal cancer We aimed to investigate the effect of screening with once-only colonoscopy or two rounds of faecal immunochemical test screening on colorectal cancer mortality and incidence. Methods We did a randomised controlled trial in Sweden (SCREESCO). Residents in 18 of 21 regions who were age 60 years in the year of randomisation were identified from a population register maintained by the Swedish Tax Agency. A statistician with no further involvement in the trial used a randomised block method to assign individuals to once-only colonoscopy, two rounds of faecal immunochemical testing (OC-Sensor; 2 years apart), or a control group (no intervention; standard diagnostic pathways), in a ratio of 1:6 for colonoscopy versus control and 1:2 for faecal immunochemical testing versus control. Masking was not possible due to the nature of the trial. The primary endpoints of the trial are colorectal cancer mortality and colorectal cancer incidence. Here, we report preliminary participation rates, baseline findings, and adverse events from March, 2014, to December, 2020, in the two intervention groups after completion of recruitment and screening, up to the completion of the second faecal immunochemical testing round. Analyses were done in the intention-to-screen population, defined as all individuals who were randomly assigned to the respective study group. This study is registered with Clinical Trials.gov, NCT02078804. Findings Between March 1, 2014, and Dec 31, 2020, 278 280 people were induded in the study; 31 140 were assigned to the colonoscopy group, 60 300 to the faecal immunochemical test group, and 186 840 to the control group. 10 679 (35.1%) of 30 400 people who received an invitation for colonoscopy participated. 33 383 (55.5%) of 60 137 people who received a postal faecal immunochemical test participated. In the intention-to-screen analysis, colorectal cancer was detected in 49 (0.16%) of 31140 people in the colonoscopy group versus 121 (0. 20%) of 60 300 in the faecal immunochemical test group (relative risk [RR] 0.78, 95% CI 0.56-1.09). Advanced adenomas were detected in 637 (2.05%) people in the colonoscopy group and 968 (1.61%) in the faecal immunochemical test group (RR 1.27, 95% CI 1.15-1.41). Colonoscopy detected more right-sided advanced adenomas than faecal immunochemical testing. There were two perforations and 15 major bleeds in 16 555 colonoscopies. No intervention-related deaths occurred. Interpretation The diagnostic yield and the low number of adverse events indicate that the design from this trial, both for once-only colonoscopy and faecal immunochemical test screening, could be transferred to a population-based screening service if a benefit in disease-specific mortality is subsequently shown. Copyright (C) 2022 Elsevier Ltd. All rights reserved.
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28.
  • Frank, Catharina, 1961-, et al. (författare)
  • Ethics rounds in the ambulance service: a qualitative evaluation
  • 2024
  • Ingår i: BMC Medical Ethics. - : Springer Nature. - 1472-6939. ; 25:1
  • Tidskriftsartikel (refereegranskat)abstract
    • BackgroundIt is a common ethical challenge for ambulance clinicians to care for patients with impaired decision-making capacities while assessing and determining the degree of decision-making ability and considering ethical values. Ambulance clinicians’ ethical competence seems to be increasingly important in coping with such varied ethical dilemmas. Ethics rounds is a model designed to promote the development of ethical competence among clinicians. While standard in other contexts, to the best of our knowledge, it has not been applied within the ambulance service context. Thus, the aim of this study was to describe ambulance clinicians’ experiences of participating in ethics rounds.MethodsThis was a qualitative descriptive study, evaluating an intervention. Data were collected through sixteen interviews with ambulance clinicians who had participated in an intervention involving ethics rounds. The analysis was performed by use of content analysis.ResultsTwo themes describe the participants’ experiences: (1) Reflecting freely within a given framework, and (2) Being surprised by new insights. The following categories form the basis of the themes; 1a) Gentle guidance by the facilitator, 1b) A comprehensible structure, 2a) New awareness in the face of ethical problems, and 2b) Shared learning through dialogue.ConclusionIncorporating structured ethics rounds seems to create a continuous development in ethical competence that may improve the quality of care in the ambulance service. Structured guidance and facilitated group reflections offer ambulance clinicians opportunities for both personal and professional development. An important prerequisite for the development of ethical competence is a well-educated facilitator. Consequently, this type of ethics rounds may be considered a useful pedagogical model for the development of ethical competence in the ambulance service.
  •  
29.
  • Fridell, Mats, et al. (författare)
  • Implementing guidelines for interventions in Swedish substance abuse treatment : A national evaluation of outcomes from 2010 to 2014
  • 2020
  • Ingår i: Journal of Substance Abuse Treatment. - Philadelphia : Elsevier. - 0740-5472 .- 1873-6483. ; 119, s. 1-12
  • Tidskriftsartikel (refereegranskat)abstract
    • In 2009, the Swedish government launched a nationwide dissemination and implementation project regarding substance abuse treatment, Knowledge to Practice (KTP), which was commissioned by the Swedish National Board of Health and Welfare (SoS). Aim: The study aimed to evaluate the effectiveness of a national project to disseminate and implement evidence-based assessment instruments and treatment methods, and to promote cross-sectional collaboration in substance abuse treatment. Design and recruitment: This study was a naturalistic prospective follow-up study of a sample of 3063 participants in 203 municipalities via five consecutive online surveys. Of the 21 Swedish regions, we included 20. All participants, representing 79.5% of the population, were employed in substance abuse treatment/care within social work and psychiatry. We used individual background variables and factors in the organizational readiness for change (ORC) questionnaire for prediction. Methods: We calculated descriptive statistics using SPSS 24.0. We applied latent profile analysis (LPA) to identify respondents with distinct growth profiles across five assessment points. Next, we calculated multilevel growth curve analyses using full information maximum likelihood analysis (FIML) in Mplus 8.3. In the analyses, we nested "within-person change" (level 1) in "between-persons analysis" (level 2). We, in turn, nested these in municipalities/regions (level 3). We included both respondents and organizational predictors in levels 2 and 3. We tested four statistical models in the multilevel analyses to predict the outcome. Results: The annual response rate was 59% on average across the five years. Respondents were a homogenous group with regard to education and years of employment, and two thirds were women. We identified four different trajectories nationwide, which showed different growth profiles for the use of methods and assessment instruments. Our results showed a larger between-region variation than within-region variation in outcome indicators. Some regions were more successful than others over the five years. At the respondent level, the years of employment in treatment work was associated with increased use of assessment instruments, while the ORC factor, institutional resources, predicted decreased use of assessment instruments. Specialist competence and the ORC factors staff attributes (job satisfaction, efficacy, and influence) and institutional resources predicted increased use of psychosocial treatment methods. The ORC factor organizational climate was positively associated with increased cross-sectional collaboration activities.
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30.
  • Funktionell textanalys
  • 2019. - 2
  • Samlingsverk (redaktörskap) (övrigt vetenskapligt/konstnärligt)abstract
    • Den systemisk-funktionella grammatiken (SFG) har på senare år blivit alltmer populär i Sverige. Skrivdidaktiker och textforskare tilltalas av modellen och använder de grammatiska kategorierna i analyser och undervisning. Kanske kan detta förklaras av den starka förankringen i kontexten - SFG fungerar helt enkelt bra för att beskriva språk i sammanhang, liksom för att analysera hur språket är med och skapar sammanhang. Analysen är dock inte alltid enkel, utan kräver att man vänder och vrider på perspektiven. En bra hjälp är förstås att titta på andras analyser. Den möjligheten erbjuder denna bok.Bokens tre redaktörer har samlat sina erfarenheter av grammatisk analys av texter, och inleder bokens olika avdelningar med kapitel som tar upp dels grunderna i analysen, dels tänkbara problem och överväganden.I kapitlen analyseras många olika slags texter, till exempel reklam, platsannonser, elevinsändare, vigselordningar och styrdokument för skolan. Författarnas ambition är att ge en god inblick i hur den systemisk-funktionella grammatiken kan användas för att analysera texter. Funktionell textanalys ges numera ut av Studentlitteratur AB. Denna andra upplaga innehåller dock inga förändringar av innehållet jämfört med den första upplagan.
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31.
  •  
32.
  • Gremyr, Andreas, et al. (författare)
  • How a Point-of-Care Dashboard Facilitates Co-production of Health Care and Health for and with Individuals with Psychotic Disorders : A Mixed-methods Case Study
  • 2022
  • Ingår i: BMC Health Services Research. - : BioMed Central (BMC). - 1472-6963. ; 22
  • Tidskriftsartikel (refereegranskat)abstract
    • BackgroundIndividuals with psychotic disorders experience widespread treatment failures and risk early death. Sweden’s largest department specializing in psychotic disorders sought to improve patients’ health by developing a point-of-care dashboard to support joint planning and co-production of care. The dashboard was tested for 18 months and included more than 400 patients at two outpatient clinics.MethodsThis study evaluates the dashboard by addressing two questions:Can differences in health-related outcome measures be attributed to the use of the dashboard?How did the case managers experience the accessibility, use, and usefulness of the dashboard for co-producing care with individuals with psychotic disorders? This mixed-method case study used both Patient-Reported Outcome Measures (PROM) and data from a focus group interview with case managers. Data collection and analysis were framed by the Clinical Adoption Meta Model (CAMM) phases: i) accessibility, ii) system use, iii) behavior, and iv) clinical outcomes. The PROM used was the 12-item World Health Organization Disability Assessment Schedule (WHODAS 2.0), which assesses functional impairment and disability. Patients at clinics using the dashboard were matched with patients at clinics not using the dashboard. PROM data were compared using non-parametric statistics due to skewness in distribution. The focus group included five case managers who had experience using the dashboard with patients.ResultsCompared to patients from clinics that did not use the dashboard, patients from clinics that did use the dashboard improved significantly overall (p = 0.045) and in the domain self-care (p = 0.041). Focus group participants reported that the dashboard supported data feedback-informed care and a proactive stance related to changes in patients’ health. The dashboard helped users identify critical changes and enabled joint planning and evaluation.ConclusionDashboard use was related to better patient health (WHODAS scores) when compared with matched patients from clinics that did not use the dashboard. In addition, case managers had a positive experience using the dashboard. Dashboard use might have lowered the risk for missing critical changes in patients’ health while increasing the ability to proactively address needs. Future studies should investigate how to enhance patient co-production through use of supportive technologies.
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33.
  •  
34.
  • Grundberg, Elin, et al. (författare)
  • The impact of estradiol on bone mineral density is modulated by the specific estrogen receptor-alpha cofactor retinoblastoma-interacting zinc finger protein-1 insertion/deletion polymorphism.
  • 2007
  • Ingår i: The Journal of clinical endocrinology and metabolism. - : The Endocrine Society. - 0021-972X .- 1945-7197. ; 92:6, s. 2300-6
  • Tidskriftsartikel (refereegranskat)abstract
    • CONTEXT: Estrogens regulate bone mass by binding to the estrogen receptor (ER)-alpha as well as ER-beta. The specific ERalpha cofactor retinoblastoma-interacting zinc finger protein (RIZ)-1 enhances ERalpha function in the presence of estrogen. OBJECTIVE: The objective of the study was to determine whether a RIZ P704 insertion (+)/deletion (-) (indel) polymorphism modulates the impact of estradiol on bone mineral density (BMD) and study the association between the polymorphism and BMD in elderly subjects. DESIGN: This was a population-based, prospective, and cross-sectional study, the Swedish MrOS Study, and the Malmö OPRA Study, respectively. SETTING: The study was conducted at three academic medical centers: Sahlgrenska Academy in Gothenburg, Malmö University Hospital, and Uppsala University Hospital. PARTICIPANTS: In total, 4058 men and women, aged 69-81 yr, were randomly selected from population registries. MAIN OUTCOME MEASURES: BMD (grams per square centimeter) was measured at femoral neck, trochanter, lumbar spine, and total body. RESULTS: The RIZ P704(+/+) genotype was associated with low BMD in both women (femoral neck, P < 0.001; trochanter, P < 0.01; lumbar spine, P < 0.05; total body, P < 0.01) and men (lumbar spine, P < 0.05). However, the association between the polymorphism and BMD was dependent on estradiol status. The positive correlation between serum estradiol and BMD was significantly modulated by the genotype with a stronger correlation in the P704(+/+) group than the P704(-/-) group (r = 0.19 vs. r = 0.08, P < 0.05). CONCLUSIONS: These large-scale studies of elderly men and women indicate that the ERalpha cofactor RIZ gene has a prominent effect on BMD, and the P704 genotype modulates the impact of estradiol on BMD. Further studies are required to determine whether this polymorphism modulates the estrogenic response to estradiol treatment.
  •  
35.
  • Grundberg, Elin, et al. (författare)
  • The Impact of Estradiol on Bone Mineral Density is modulated by The Specific Estrogen Receptor-{alpha} Cofactor RIZ1 Insertion/Deletion Polymorphism.
  • 2007
  • Ingår i: Journal of Clinical Endocrinology and Metabolism. - : The Endocrine Society. - 1945-7197 .- 0021-972X. ; 92:Mar 13, s. 2300-2306
  • Tidskriftsartikel (refereegranskat)abstract
    • Context: Estrogens regulate bone mass by binding to the estrogen receptor (ER)-alpha as well as ER-beta. The specific ER -cofactor retinoblastoma-interacting zinc finger protein (RIZ)-1 enhances ER alpha function in the presence of estrogen. Objective: The objective of the study was to determine whether a RIZ P704 insertion (+)/ deletion (-) (indel) polymorphism modulates the impact of estradiol on bone mineral density (BMD) and study the association between the polymorphism and BMD in elderly subjects. Design: This was a population-based, prospective, and cross-sectional study, the Swedish MrOS Study, and the Malmo OPRA Study, respectively. Setting: The study was conducted at three academic medical centers: Sahlgrenska Academy in Gothenburg, Malmo University Hospital, and Uppsala University Hospital. Participants: In total, 4058 men and women, aged 69 -81 yr, were randomly selected from population registries. Main Outcome Measures: BMD(grams per square centimeter) was measured at femoral neck, trochanter, lumbar spine, and total body. Results: The RIZ P704(+/+) genotype was associated with low BMD in both women (femoral neck, P < 0.001; trochanter, P < 0.01; lumbar spine, P < 0.05; total body, P < 0.01) and men (lumbar spine, P < 0.05). However, the association between the polymorphism and BMD was dependent on estradiol status. The positive correlation between serum estradiol and BMD was significantly modulated by the genotype with a stronger correlation in the P704(+/+) group than the P704(+/+) group (r = 0.19 vs. r = 0.08, P < 0.05). Conclusions: These large-scale studies of elderly men and women indicate that the ER alpha cofactor RIZ gene has a prominent effect on BMD, and the P704 genotype modulates the impact of estradiol on BMD. Further studies are required to determine whether this polymorphism modulates the estrogenic response to estradiol treatment.
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36.
  • Grundberg, Elin, et al. (författare)
  • Vitamin D receptor 3' haplotypes are unequally expressed in primary human bone cells and associated with increased fracture risk: the MrOS Study in Sweden and Hong Kong.
  • 2007
  • Ingår i: Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research. - : Wiley. - 0884-0431. ; 22:6, s. 832-40
  • Tidskriftsartikel (refereegranskat)abstract
    • The VDR is a prime candidate gene for osteoporosis. Here, we studied three common VDR haplotypes in relation to bone phenotypes in 5014 participants of the global MrOS Study. We also studied the relative expression of the haplotypes in human bone cells. One haplotype was associated with increased fracture risk and differently expressed in primary human bone cells. INTRODUCTION: Vitamin D plays an essential role in skeletal metabolism by binding to its nuclear steroid receptor, the vitamin D receptor (VDR). The heritability of BMD is well established, and the VDR gene is considered a prime candidate suggested to partially account for genetically controlled BMD variance in the population. MATERIALS AND METHODS: Here, we reconstructed common haplotypes in the VDR 3' untranslated region (UTR) and studied the association to BMD and risk of vertebral fractures in elderly men from Sweden (n = 3014) and Hong Kong (n = 2000), all participants of the global MrOS Study. To assess any functional implications of the VDR polymorphisms, we studied allele-specific expressions of the different VDR 3' UTR haplotypes in the normal chromosomal context of 70 unrelated human trabecular bone samples. This was performed by quantitative genotyping of coding polymorphisms in RNA samples and in corresponding DNA samples isolated from the bone samples. RESULTS: Three major haplotypes were reconstructed and in agreement with the previously well-defined baT, BAt, and bAT haplotypes, herein denoted Hap1, Hap2, and Hap3. The Hap1 haplotype was independently associated with increased risk of vertebral fractures in Swedish men (OR, 1.655; 95% CI, 1.146-2.391; p < 0.01) and with lower lumbar spine BMD in elderly men from Sweden (p < 0.01) and Hong Kong (p < 0.05). The VDR gene was also shown to exhibit a 3' UTR haplotype dependent allelic imbalance, indicating that the VDR Hap1 allele was overexpressed in human trabecular bone samples. CONCLUSIONS: The results indicate that the relatively overexpressed VDR Hap1 haplotype could be considered a risk allele for osteoporosis regardless of ethnicity.
  •  
37.
  • Grundberg, Elin, et al. (författare)
  • Vitamin D receptor 3 ' haplotypes are unequally expressed in primary human bone cells and associated with increased fracture risk: The MrOS study in Sweden and Hong kong
  • 2007
  • Ingår i: Journal of Bone and Mineral Research. - : Wiley. - 1523-4681 .- 0884-0431. ; 22:6, s. 832-840
  • Tidskriftsartikel (refereegranskat)abstract
    • The VDR is a prime candidate gene for osteoporosis. Here, we studied three common VDR haplotypes in relation to bone phenotypes in 5014 participants of the global MrOS Study. We also studied the relative expression of the haplotypes in human bone cells. One haplotype was associated with increased fracture risk and differently expressed in primary human bone cells. Introduction: Vitamin D plays an essential role in skeletal metabolism by binding to its nuclear steroid receptor, the vitamin D receptor (VDR). The heritability of BMD is well established, and the VDR gene is considered a prime candidate suggested to partially account for genetically controlled BMD variance in the population. Materials and Methods: Here, we reconstructed common haplotypes in the VDR 3 ' untranslated region (UTR) and studied the association to BMD and risk of vertebral fractures in elderly men from Sweden (n = 3014) and Hong Kong (n = 2000), all participants of the global MrOS Study. To assess any functional implications of the VDR polymorphisms, we studied allele-specific expressions of the different VDR 3 ' UTR haplotypes in the normal chromosomal context of 70 unrelated human trabecular bone samples. This was performed by quantitative genotyping of coding polymorphisms in RNA samples and in corresponding DNA samples isolated from the bone samples. Results: Three major haplotypes were reconstructed and in agreement with the previously well-defined baT, BAt, and bAT haplotypes, herein denoted Hap1, Hap2, and Hap3. The Hap1 haplotype was independently associated with increased risk of vertebral fractures in Swedish men (OR, 1.655; 95% Cl, 1.146-2.391;p < 0.01) and with lower lumbar spine BMD in elderly men from Sweden (p < 0.01) and Hong Kong (P < 0.05). The VDR gene was also shown to exhibit a 3 ' UTR haplotype dependent allelic imbalance, indicating that the VDR Hap1 allele was overexpressed in human trabecular bone samples. Conclusions: The results indicate that the relatively overexpressed VDR Hap1 haplotype could be considered a risk allele for osteoporosis regardless of ethnicity.
  •  
38.
  • Hallqvist, Andreas, 1973, et al. (författare)
  • Concurrent cetuximab and radiotherapy after docetaxel-cisplatin induction chemotherapy in stage III NSCLC : Satellite-A phase II study from the Swedish Lung Cancer Study Group
  • 2011
  • Ingår i: Lung Cancer. - : Elsevier BV. - 0169-5002 .- 1872-8332. ; 71:2, s. 166-172
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Several attempts to increase the locoregional control in locally advanced lung cancer including concurrent chemotherapy, accelerated fractionation and dose escalation have been made during the last years. As the EGFR directed antibody cetuximab has shown activity concurrent with radiotherapy in squamous cell carcinoma of the head and neck, as well as in stage IV NSCLC combined with chemotherapy, we wanted to investigate radiotherapy with concurrent cetuximab in locally advanced NSCLC, a tumour type often over expressing the EGF-receptor. Methods: Between February 2006 and August 2007 75 patients in stage Ill NSCLC with good performance status (PS 0 or 1) and adequate lung function (FEV1 > 1.0) were enrolled in this phase II study at eight institutions. Treatment consisted of 2 cycles of induction chemotherapy, docetaxel 75 mg/m(2) and cisplatin 75 mg/m(2) with 3 weeks interval. An initial dose of cetuximab 400 mg/m(2) was given before start of 3D-CRT to 68 Gy with 2 Gy per fraction in 7 weeks concurrent with weekly cetuximab 250 mg/m(2). Toxicity was scored weekly during radiotherapy (CTC 3.0), and after treatment the patients were followed every third month with CT-scans, toxicity scoring and QLQ. Results: Seventy-one patients were eligible for analysis as four were incorrectly enrolled. Histology: adenocarcinoma 49%, squamous cell carcinoma 39% and other NSCLC 12%. The majority had PS 0 (62.5%), median age 62.2 (42-81), 50% were women and 37% had a pre-treatment weight loss > 5%. Toxicity: esophagitis grade 1-2: 72%; grade 3:1.4%. Hypersensitivity reactions grade 3-4: 5.6%. Febrile neutropenia grade 3-4: 15.4%. Skin reactions grade 1-2: 74%; grade 3: 4.2%. Diarrhoea grade 1-2: 38%; grade 3: 11.3%. Pneumonitis grade 1-2: 26.8%; grade 3: 4.2%; grade 5:1.4%. The median follow-up was 39 months for patients alive and the median survival was 17 months with a 1-, 2- and 3-year OS of 66%, 37% and 29% respectively. Until now local or regional failure has occurred in 20 patients and 22 patients have developed distant metastases. Weight loss, PS and stage were predictive for survival in univariate as well as in multivariate analysis. Conclusion: Induction chemotherapy followed by concurrent cetuximab and RT to 68 Gy is clearly feasible with promising survival. Toxicity, e.g. pneumonitis and esophagitis is low compared to most schedules with concurrent chemotherapy. This treatment strategy should be evaluated in a randomised manner vs. concurrent chemoradiotherapy to find out if it is a valid treatment option.
  •  
39.
  • Hallqvist, Andreas, 1973, et al. (författare)
  • Dose escalation to 84 Gy with concurrent chemotherapy in stage III NSCLC appears excessively toxic: Results from a prematurely terminated randomized phase II trial
  • 2018
  • Ingår i: Lung Cancer. - : Elsevier BV. - 0169-5002 .- 1872-8332. ; 122, s. 180-186
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: Concurrent chemoradiotherapy is the mainstay treatment for NSCLC stage III disease. To investigate whether radiation dose escalation based on individual normal tissue constraints can improve outcome, the Swedish lung cancer study group launched this randomized phase II trial. Materials and Methods: NSCLC patients with stage III disease, good performance status (0-1) and adequate lung function (FEV1 > 1.0 L and CO diffusion capacity > 40%) received three cycles of cisplatin (75 mg/m(2) day 1) and vinorelbine (25 mg/m(2) day 1 and 8) every third week. Radiotherapy started concurrently with the second cycle, with either 2 Gy daily, 5 days a week, to 68 Gy (A) or escalated therapy (B) based on constraints to the spinal cord, esophagus and lungs up to 84 Gy by adding an extra fraction of 2 Gy per week. Results: A pre-planned safety analysis revealed excessive toxicity and decreased survival in the escalated arm, and the study was stopped. Thirty-six patients were included during 2011-2013 (56% male, 78% with adenocarcinoma, 64% with PS 0 and 53% with stage IIIB). The median progression-free survival (PFS) and overall survival (OS) were 11 and 17 months in arm B compared to the encouraging results of 28 and 45 months in the standard arm. The 1- and 3-year survival rates were 56% and 33% (B) and 72% and 56% (A), respectively. There were seven toxicity-related deaths due to esophageal perforations and pneumonitis: five in the escalated group and two with standard treatment. Conclusion: Dose-escalated concurrent chemoradiotherapy to 84 Gy to primary tumor and nodal disease is hazardous, with a high risk of excessive toxicity, whereas modern standard dose chemoradiotherapy with proper staging given in the control arm shows a promising outcome with a median survival of 45 months and a 3-year survival of 56% (NCT01664663).
  •  
40.
  • Hallqvist, Andreas, 1973, et al. (författare)
  • Mutated KRAS is an independent negative prognostic factor for survival in NSCLC stage III disease treated with high-dose radiotherapy.
  • 2012
  • Ingår i: Lung Cancer International. - : Hindawi Limited. - 2090-3200 .- 2090-3197. ; 2012
  • Tidskriftsartikel (refereegranskat)abstract
    • Background. The main attention regarding prognostic and predictive markers in NSCLC directs towards the EGFR-targeted pathway, where the most studied genetic alterations include EGFR mutations, EGFR copy number, and KRAS mutations. We wanted to explore the prognostic impact of mutated KRAS in the stage III setting treated with high-dose radiochemotherapy. Methods. Samples were obtained from patients participating in two prospective studies of locally advanced NSCLC receiving combined radiochemotherapy: the RAKET study, a randomized phase II study where patients were treated with induction chemotherapy (carboplatin/paclitaxel) followed by concurrent radiochemotherapy, and the Satellite trial, a phase II study with induction chemotherapy (cisplatin/docetaxel) followed by radiotherapy concurrent cetuximab. The samples were analysed regarding KRAS mutations, EGFR mutations, and EGFR FISH positivity. Results. Patients with mutated KRAS had a significantly inferior survival, which maintained its significance in a multivariate analysis when other possible prognostic factors were taken into account. The prevalence of KRAS mutations, EGFR mutations, and EGFR FISH positivity were 28.8%, 7.5%, and 19.7%, respectively. Conclusion. Mutated KRAS is an independent negative prognostic factor for survival in NSCLC stage III disease treated with combined radiochemotherapy. The prevalence of KRAS mutations and EGFR mutations are as expected in this Scandinavian population.
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41.
  •  
42.
  • Hindér, Gustav, et al. (författare)
  • On Ski–Snow Contact Mechanics During the Double Poling Cycle in Cross-Country Skiing
  • 2024
  • Ingår i: Tribology letters. - : Springer. - 1023-8883 .- 1573-2711. ; 72:2
  • Tidskriftsartikel (refereegranskat)abstract
    • Of the medals awarded during the Winter Olympics Games, most are awarded for sports involving cross-country (XC) skiing. The Double Poling (DP) technique, which is one of the sub-techniques used most frequently in XC skiing, has not yet been studied using simulations of the ski–snow contact mechanics. This work introduces a novel method for analysing how changes in the distribution of pressure on the sole of the foot (Plantar Pressure Distribution or PPD) during the DP motion affect the contact between the ski and the snow. The PPD recorded as the athlete performed DP, along with an Artificial Neural Network trained to predict the geometry of the ski (ski-camber profile), were used as input data for a solver based on the boundary element method, which models the interaction between the ski and the snow. This solver provides insights into how the area of contact and the distribution of pressure on the ski-snow interface change over time. The results reveal that variations in PPD, the type of ski, and the stiffness of the snow all have a significant impact on the contact between the ski and the snow. This information can be used to improve the Double Poling technique and make better choices of skis for specific snow conditions, ultimately leading to improved performance.
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43.
  • Holmberg, Andreas, et al. (författare)
  • A frequency domain linearized Navier-Stokes method including acoustic damping by eddy viscosity using RANS
  • 2015
  • Ingår i: Journal of Sound and Vibration. - : Elsevier BV. - 0022-460X .- 1095-8568. ; 346, s. 229-247
  • Tidskriftsartikel (refereegranskat)abstract
    • In this paper, a method for including damping of acoustic energy in regions of strong turbulence is derived for a linearized Navier-Stokes method in the frequency domain. The proposed method is validated and analyzed in 2D only, although the formulation is fully presented in 3D. The result is applied in a study of the linear interaction between the acoustic and the hydrodynamic held in a 2D T-junction, subject to grazing flow at Mach 0.1. Part of the acoustic energy at the upstream edge of the junction is shed as harmonically oscillating disturbances, which are conveyed across the shear layer over the junction, where they interact with the acoustic field. As the acoustic waves travel in regions of strong shear, there is a need to include the interaction between the background turbulence and the acoustic field. For this purpose, the oscillation of the background turbulence Reynolds stress, due to the acoustic Field, is modeled using an eddy Newtonian model assumption. The time averaged flow is first solved for using RANS along with a k-epsilon turbulence model. The spatially varying turbulent eddy viscosity is then added to the spatially invariant kinematic viscosity in the acoustic set of equations. The response of the 2D T-junction to an incident acoustic field is analyzed via a plane wave scattering matrix model, and the result is compared to experimental data for a T-junction of rectangular ducts. A strong improvement in the agreement between calculation and experimental data is found when the modification proposed in this paper is implemented. Discrepancies remaining are likely due to inaccuracies in the selected turbulence model, which is known to produce large errors e.g. for flows with significant rotation, which the grazing flow across the T-junction certainly is A natural next step is therefore to test the proposed methodology together with more sophisticated turbulence models.
  •  
44.
  • Holmberg, Andreas, et al. (författare)
  • A linearized Navier-Stokes method including turbulence damping
  • 2013
  • Ingår i: 19th AIAA/CEAS Aeroacoustics Conference. - Reston, Virginia : American Institute of Aeronautics and Astronautics. - 9781624102134
  • Konferensbidrag (refereegranskat)abstract
    • In this paper, a method for including damping of acoustic energy in regions of strong turbulence is derived for a linearized Navier-Stokes method in the frequency domain. The result is applied in a study of the linear interaction of the acoustic and the hydrodynamic field in a 2D T-junction, subject to grazing flow at Mach 0.1. As the acoustic waves travel in regions of strong shear, there is a need to include the interaction between the background turbulence and the acoustic field. For this purpose, the oscillation of the background turbulence Reynold's stress, due to the acoustic field, is modeled using an eddy Newtonian model assumption. The time averaged flow is first solved for using RANS along with a k-ε turbulence model. The spatially varying turbulent viscosity is then added to the spatially invariant kinematic viscosity in the acoustic set of equations. The response of the 2D T-junction to an incident acoustic field is analyzed via a plane wave scattering matrix model, and the result is compared to experimental data for a T-junction of rectangular ducts. A strong improvement in the agreement between calculation and experimental data is found when the modification proposed in this paper is implemented.
  •  
45.
  •  
46.
  • Holmberg, Andreas, 1982-, et al. (författare)
  • A test rig and experimental procedure to determine the aeroacoustic properties of a splitter plate
  • 2009
  • Ingår i: 15th AIAA/CEAS Aeroacoustics Conference (30th AIAA Aeroacoustics Conference). - 9781563479748 ; , s. 2009-3258-
  • Konferensbidrag (refereegranskat)abstract
    • A test rig for a study of aero-acoustic phenomena over a sharp edge inside a duct is developed and described. The aero-acoustic losses over the edge are experimentally determined in quiescent air by measurements of a three-port, from which a power balance analysis yields the dissipated acoustic energy. The phenomenon of interest is interaction between the vortices shed by an acoustic wave propagating over a sharp edge and the wave itself. However, this phenomenon require high levels of particle velocity. The levels achieved are low, thus the dominating losses seen in the results are instead due to transfer of acoustic energy from sound waves into vibration energy in the splitter plate. This fact was observed by calculating the two-port scattering matrix over each sidebranch.
  •  
47.
  • Holmberg, Andreas, et al. (författare)
  • Accurate experimental two-port analysis of flow generated sound
  • 2011
  • Ingår i: Journal of Sound and Vibration. - : Elsevier BV. - 0022-460X .- 1095-8568. ; 330:26, s. 6336-6354
  • Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
    • In the study of in-duct aero-acoustic phenomena two-port analysis based upon in-duct measurements has become an important method for the plane wave region. However already at moderate Mach numbers (0.2 - 0.3) the errors in the results can be hard to suppress. Ways of dealing with this includes the use of over-determination methods and methods of obtaining more accurate wave numbers. In this paper different methods for the determination of the source data and the scattering matrix are evaluated. For the source data in the form of a cross spectrum matrix an over-determination method is introduced. In addition, a method of obtaining the mean Mach number from experimentally determined wave numbers is described.In order to evaluate the methods measurements are conducted at a mean Mach number of 0.2 for two test cases – an empty duct and a mixer plate inside the duct. The main improvements in the scattering matrix results are achieved by discarding measurements from an abundant set, based upon the measured coherence between excitation and fluctuating pressures. For the source part, it is shown that the error in the magnitude of the source cross spectrum matrix can be significantly suppressed by having additional (> 2) reference microphones on each side of the two-port.The mean Mach number obtained from an experimentally determined wave number is observed to yield more accurate scattering matrix results in both phase and magnitude, than that based upon flow velocity measurements at one point and an assumed flow profile.
  •  
48.
  • Holmberg, Andreas, 1982- (författare)
  • Aeroacoustic Characterization using Multiport Methods
  • 2012
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Noise is a major environmental pollutant, which can inict physical and psychologicalinjury. An important noise contribution stems from aeroacousticsources, which are found in e.g., ventilation ducts, engine exhaust systems andairplane engines.In this thesis, research methods for low Mach number aeroacoustic sourcesin ducts are developed. The basis of the methods is the ability to describe theintrinsic linear properties of the source as an N-port (multiport), where theoutput sound eld is related to the input sound eld and the generated soundeld, all consisting of plane waves. The methods presented are both numericaland experimental. The numerical method treats the passive properties, i.e.,scattering, attenuation and amplication of incident sound, while the experimentalmethod treats the active part (intrinsic sound generation) as well. Themethods are applied in the study of noise generation by a vortex mixer plate,placed in an airow of Mach 0.2, and in the study of acoustic-hydrodynamicinteraction in a T-junction of rectangular ducts.It is found that the accuracy of the experimental methods is signicantly increasedwhen the equations are over-determined, which is achieved by addingadditional microphones to the test rig. In the frequency range studied, themixer plate is found to generate less sound when made exible, without disturbingthe mixing quality.For the numerical method { based on the linearized Navier-Stokes equations,a model of the oscillation of the Reynolds stress (\turbulent damping")due to the acoustic eld is introduced. By comparing with experimental results,it is found that not using this model results in an over-prediction of theamplication at higher frequencies with several factors in magnitude, whileimplementing the model results in a much better agreement.
  •  
49.
  • Holmberg, Andreas, et al. (författare)
  • Aeroacoustics of rectangular T-junctions subject to combined grazing and bias flows - An experimental investigation
  • 2013
  • Ingår i: 19th AIAA/CEAS Aeroacoustics Conference. - 9781624102134
  • Konferensbidrag (refereegranskat)abstract
    • Experimentally determined scattering matrices are used to study the low-amplitude interaction between the acoustic and the hydrodynamic fields in a T-junction of rectangular ducts. In particular, combinations of grazing and bias flows are investigated in the study. Common for all flow combinations is that waves incident on the junction at the downstream side are only attenuated, while waves incident at the other branches may be amplified or attenuated, depending on the Strouhal number. When bias in-flow is introduced to a grazing flow, there is first an increase and then a decrease in both amplification and attenuation, as the bias in-flow Mach number is increased. Comparing with T junctions of circular ducts, the interaction is stronger for rectangular duct junctions.
  •  
50.
  • Holmberg, Andreas, 1982-, et al. (författare)
  • Aeroacoustics of rectangular T-junctions subject to combined grazing and bias flows - An experimental investigation
  • 2015
  • Ingår i: Journal of Sound and Vibration. - : Elsevier BV. - 0022-460X .- 1095-8568. ; 340, s. 152-166
  • Tidskriftsartikel (refereegranskat)abstract
    • Scattering matrices are determined experimentally and used to study the low amplitude interaction, between the acoustic and the hydrodynamic fields in a T-junction of rectangular ducts. In particular, combinations of grazing and bias flows are investigated in the study. It is observed that for all flow combinations, waves incident on the junction at the downstream side only are attenuated, while waves incident at the other branches may be amplified or attenuated, depending on the Strouhal number. When bias in flow is introduced to a grazing flow, there is first an increase and then a decrease in both amplification and attenuation, as the bias in-flow Mach number is increased. Comparing with T-junctions of circular ducts, the interaction is stronger for rectangular duct junctions.
  •  
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