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1.	Falkenström, Fredrik, et al. (author) Development and Validation of a 6-item Working Alliance Questionnaire for Repeated Administrations During Psychotherapy 2015 In: Psychological Assessment. - : American Psychological Association. - 1040-3590 .- 1939-134X. ; 27:1, s. 169-183 Journal article (peer-reviewed)abstract Recently, researchers have started to measure the working alliance repeatedly across sessions of psychotherapy, relating the working alliance to symptom change session by session. Responding to questionnaires after each session can become tedious, leading to careless responses and/or increasing levels of missing data. Therefore, assessment with the briefest possible instrument is desirable. Because previous research on the Working Alliance Inventory has found the separation of the Goal and Task factors problematic, the present study examined the psychometric properties of a 2-factor, 6-item working alliance measure, adapted from the Working Alliance Inventory, in 3 patient samples (ns = 1,095, 235, and 234). Results showed that a bifactor model fit the data well across the 3 samples, and the factor structure was stable across 10 sessions of primary care counseling/psychotherapy. Although the bifactor model with 1 general and 2 specific factors outperformed the 1-factor model in terms of model fit, dimensionality analyses based on the bifactor model results indicated that in practice the instrument is best treated as unidimensional. Results support the use of composite scores of all 6 items. The instrument was validated by replicating previous findings of session-by-session prediction of symptom reduction using the Autoregressive Latent Trajectory model. The 6-item working alliance scale, called the Session Alliance Inventory, is a promising alternative for researchers in search for a brief alliance measure to administer after every session.
2.	Falkenström, Fredrik, Professor, 1972-, et al. (author) Patient Attachment and Reflective Functioning as Predictors for Therapist In-Session Feelings 2024 In: Journal of counseling psychology. - : American Psychological Association (APA). - 0022-0167 .- 1939-2168. ; 71:3, s. 190-201 Journal article (peer-reviewed)abstract Therapists' in-session feelings in psychotherapy can be seen as indications of the development of the therapeutic relationship and the therapeutic process. To manage them appropriately, it is important to know to what extent they may be influenced by patients' pretreatment characteristics. This study aims to improve the understanding of therapists' emotional reactions in the psychotherapeutic setting by investigating if patients' pretreatment mentalization ability and attachment style predicted therapist in-session feelings. In a sample of 87 therapy dyads treated with interpersonal psychotherapy and cognitive behavioral therapy for depression, patient attachment was measured using self-reported Experiences in Close Relationships (ECR) and mentalization using Reflective Functioning (RF). ECR and RF were hypothesized to predict therapist feelings measured by the Feeling Word Checklist-24 at different treatment phases over the full course of treatment. Treatment method, patient age, gender, and pretreatment depression were evaluated as potential confounders. Multilevel modeling was used to analyze the data. Lower RF in patients predicted more negative therapist feelings in the mid- to late-treatment phases and less positive feelings in the late-treatment phase. Self-reported attachment anxiety or avoidance did not predict therapist feelings. Findings indicate that patients' ability to mentalize is important to consider when conducting psychotherapy, as it can influence therapists' feelings in the therapeutic process. Limitations of the present study's approach are discussed, and directions for future research are considered.
3.	Falkenström, Fredrik, et al. (author) Therapeutic Alliance Predicts Symptomatic Improvement Session by Session 2013 In: Journal of counseling psychology. - : American Psychological Association. - 0022-0167 .- 1939-2168. ; 60:3, s. 317-328 Journal article (peer-reviewed)abstract The therapeutic alliance has been found to predict psychotherapy outcome in numerous studies. However, critics maintain that the therapeutic alliance is a by-product of prior symptomatic improvements. Moreover, almost all alliance research to date has used differences between patients in alliance as predictor of outcome, and results of such analyses do not necessarily mean that improving the alliance with a given patient will improve outcome (i.e., a within-patient effect). In a sample of 646 patients (76% women, 24% men) in primary care psychotherapy, the effect of working alliance on next session symptom level was analyzed using multilevel models. The Clinical Outcomes in Routine Evaluation–Outcome Measure was used to measure symptom level, and the patient version of the Working Alliance Inventory–Short form revised (Hatcher & Gillaspy, 2006) was used to measure alliance. There was evidence for a reciprocal causal model, in which the alliance predicted subsequent change in symptoms while prior symptom change also affected the alliance. The alliance effect varied considerably between patients. This variation was partially explained by patients with personality problems showing stronger alliance effect. These results indicate that the alliance is not just a by-product of prior symptomatic improvements, even though improvement in symptoms is likely to enhance the alliance. Results also point to the importance of therapists paying attention to ruptures and repair of the therapy alliance. Generalization of results may be limited to relatively brief primary care psychotherapy.
4.	Falkenström, Fredrik, et al. (author) Working alliance predicts psychotherapy outcome even while controlling for prior symptom improvement 2014 In: Psychotherapy Research. - : Routledge. - 1050-3307 .- 1468-4381. ; 24:2, s. 146-159 Journal article (peer-reviewed)abstract Objective: Although the working alliance as been found to be a robust predictor of psychotherapy outcome, critics have questioned the causal status of this effect. Specifically, the effect of the alliance may be confounded with the effect of prior symptom improvement. The objective of the present study was to test this possibility. Method: A large dataset from primary care psychotherapy was used to study relationships between alliance and outcome using piecewise multilevel path analysis. Results: Initial symptom level and symptom change up to session three predicted the alliance at session three. Working alliance significantly predicted symptom change rate from session three to termination, even while controlling for several possible confounds. Conclusions: The alliance predicts outcome over and above the effect of prior symptom improvement, supporting a reciprocal influence model of the relationship between alliance and symptom change.
5.	Holmqvist Larsson, Mattias, 1977-, et al. (author) Alliance ruptures and repairs in psychotherapy in primary care 2018 In: Psychotherapy Research. - : Routledge. - 1050-3307 .- 1468-4381. ; 28:1, s. 123-136 Journal article (peer-reviewed)abstract OBJECTIVE: The association between alliance level and outcome in psychotherapy has been extensively studied. One way to expand this knowledge is to study alliance patterns. The main aims of this study were to examine how frequent alliance patterns with ruptures or rupture-repair episodes were in a naturalistic sample of psychotherapies in primary care, and if three alliance patterns (a Rupture pattern, a Repair pattern, and a No Rupture pattern) were differentially associated with treatment outcome.METHOD: The psychotherapies (N = 605) included a wide range of different treatment orientations and patient diagnoses. Alliance patterns were studied at session-to-session level, using patient-rated alliance scores. Outcome data were analyzed using longitudinal multilevel modeling with a slopes-as-outcomes model.RESULTS: The Repair pattern accounted for 14.7% (n = 89) of the treatments, 10.7% (n = 65) exhibited a Rupture pattern, and 74.5% (n = 451) contained no ruptures. The Rupture pattern was associated with inferior treatment outcomes. The Repair pattern was, in longer treatments, associated with better outcomes than the No Rupture pattern.CONCLUSIONS: The results support theory about the importance of ruptures in the therapeutic alliance and suggest that identification of alliance ruptures is important in alliance-outcome research, for feedback purposes in clinical practice, and in training of therapists.
6.	Holmqvist Larsson, Mattias, 1977- (author) Rupture and Repair in the Working Alliance : Relation to Psychotherapy Outcome and Within-Session Interaction 2019 Doctoral thesis (other academic/artistic)abstract Ruptures and repairs are processes related to shifts in the collaborative relationship Cthe working allianceJ between patient and therapist in psychotherapy. Ta study ruptures and repairs is one way ta disentangle mechanisms that might underlie the association between the working alliance and psychotherapy outcome. The overarching aim af this thesis was ta analyze the clinical relevance af the rupture and repair concepts at different process levels. The same three alliance patterns were investigated in the three empirical studies: the rupture pattern, the repair pattern, and the no-rupture/stable pattern. The analyses af the alliance patterns moved fromwhole treatments ta session segments. In Study I ruptures were found ta be associated with worse outcomes than treatments without ruptures. Repairs were, in longer therapies, shown ta be related ta better outcomes than norupture treatments. In Study Il it was found that the three alliance patterns could be discerned within sessions. Ruptures and repairs within sessions were found ta be associated with patient-ratings af the working alliance. In Study 111 the alliance patterns were found ta be related ta different interaction patterns within sessions. In these analyses, importont patient contributions ta repairs af ruptures were found.
7.	Holmqvist Larsson, Mattias, 1977-, et al. (author) The Alliance and Rupture Observation Scale (AROS) : Development and validation of an alliance and rupture measure for repeated observations within psychotherapy sessions 2019 In: Journal of Clinical Psychology. - : John Wiley & Sons. - 0021-9762 .- 1097-4679. ; 75:3, s. 404-417 Journal article (peer-reviewed)abstract Objective: The aim of this study was to test a new observer-rated instrument, the Alliance and Rupture Observation Scale (AROS). It was designed for repeated measurements of the alliance within sessions and to detect alliance ruptures.Method: Videotaped therapy sessions with depressed adults were analyzed. Reliability was mainly assessed as inter-rater reliability. Convergent, predictive, and discriminant validity of the AROS was assessed by comparing the instrument with both observer-rated and patient-rated measures.Results: The AROS exhibited excellent inter-rater reliability. Alliance levels measured with the AROS predicted patients’ ratings of the alliance in the same session and were highly correlated with another observer-rated alliance measure. Alliance patterns (rupture; repair; and no-rupture) based on AROS scores were significantly correlated with patients’ ratings of the alliance.Conclusions: Preliminary support for convergent and predictive validity was found. It is yet to be determined whether AROS scores are related to psychotherapy outcomes.
8.	Möller, Clara, et al. (author) Mentalizing in Young Offenders 2014 In: Psychoanalytic psychology. - : American Psychological Association (APA). - 0736-9735 .- 1939-1331. ; 31:1, s. 84-99 Journal article (peer-reviewed)abstract In order to prevent relapse into criminality, it is important to understand what precedes criminal behavior. Two earlier studies found deficits in mentalizing ability to be related to violent and criminal actions. Mentalizing refers to the ability to make human behavior predictable and meaningful by inferring mental states (thoughts, feelings, etc.) as explaining behavior. In this study, mentalizing ability was assessed by rating 42 Adult Attachment Interviews with young male offenders with the Reflective Functioning (RF) scale. In addition, specific mentalizing ability about their crimes was assessed, as well as psychopathy traits (Psychopathy Checklist, Screening Version [PCL: SV]) and alexithymia (Toronto Alexithymia Scale [TAS]). Results suggest impaired mentalizing in criminal offenders. Examples of anti- and prementalizing reasoning about crimes are presented. RF scores were not correlated with the PCL:SV or TAS.
9.	Söderberg, Anna Karin, et al. (author) Emotional availability in psychotherapy : The usefulness and validity of the Emotional Availability Scales for analyzing the psychotherapeutic relationship 2014 In: Psychotherapy Research. - : Informa UK Limited. - 1050-3307 .- 1468-4381. ; 24:1, s. 91-102 Journal article (peer-reviewed)abstract The aim of this study was to assess whether a modified version of the Emotional Availability Scales (EAS), created to assess interaction quality between parents and children, could be applied to psychotherapy sessions and whether emotional availability (EA), as assessed by the modified EAS-T, was associated with client- and therapist-rated working alliance. EAS-T was used to assess 42 sessions from 16 therapies. The therapies came from the LURIPP project, comparing IPT with BRT for depressed clients. The results showed that sessions could be reliably rated with EAS-T. Most rating scales had acceptable variance. The client's perception of task alliance was associated with several of the EA subscales (sensitivity, nonhostility, responsiveness) assessed over therapies, whereas the perception of bond was associated with Structure on EAS.
10.	van der Pals, Jesper, et al. (author) Characteristics and outcomes in patients with atrial fibrillation and acute coronary syndrome treated with ticagrelor and novel oral anticoagulants 2021 In: Thrombosis Update. - : Elsevier BV. - 2666-5727. ; 3 Journal article (peer-reviewed)abstract Introduction: Optimal antithrombotic treatment after an acute coronary syndrome (ACS) in patients with atrial fibrillation is unclear. Data on outcomes in patients on concomitant ticagrelor and the novel oral anticoagulants (NOAC) is scarce. This study therefore sought to describe patient characteristics and treatment outcomes in patients with atrial fibrillation and ACS treated with concomitant ticagrelor and NOACs (double antithrombotic therapy, DT). Materials and methods: We retrospectively identified all ACS patients with atrial fibrillation on DT upon discharge from Skåne University Hospital in Lund, Sweden, between 2016 and 2019. Identified patients were compared with age and sex matched controls with ACS alone treated with ticagrelor and aspirin (DAPT). Major bleeding was defined in accordance with the HAS-BLED derivation study. Patients were retrospectively followed for six months. Results: In total, 341 patients on DT were identified and compared with 341 controls on DAPT. Mean HAS-BLED bleeding risk score was higher in patients on DT (2.9 ± 1.0 vs 2.6+/0.9 units, p < 0.001; DT vs DAPT). The incidence of major bleeding was higher in patients on DT (31 (9.1%) vs 10 (2.9%), p = 0.001; DT vs DAPT), while a composite of all thrombotic events was found to be similar between the groups (8 (2.3%) vs 5 (1.5%), p = NS; DT vs DAPT). Conclusions: While thrombotic events occur at a similar rate, the bleeding rate is higher in patients with atrial fibrillation and ACS treated with DT than in patients with ACS alone treated with DAPT. Patients with atrial fibrillation also have a higher basal bleeding risk.
11.	Abdollahpur, Mostafa, et al. (author) Respiratory Induced Modulation in f-Wave Characteristics During Atrial Fibrillation 2021 In: Frontiers in Physiology. - : Frontiers Media SA. - 1664-042X. ; 12 Journal article (peer-reviewed)abstract The autonomic nervous system (ANS) is an important factor in cardiac arrhythmia, and information about ANS activity during atrial fibrillation (AF) may contribute to personalized treatment. In this study we aim to quantify respiratory modulation in the f-wave frequency trend from resting ECG. First, an f-wave signal is extracted from the ECG by QRST cancelation. Second, an f-wave model is fitted to the f-wave signal to obtain a high resolution f-wave frequency trend and an index for signal quality control ((Formula presented.)). Third, respiratory modulation in the f-wave frequency trend is extracted by applying a narrow band-pass filter. The center frequency of the band-pass filter is determined by the respiration rate. Respiration rate is estimated from a surrogate respiration signal, obtained from the ECG using homomorphic filtering. Peak conditioned spectral averaging, where spectra of sufficient quality from different leads are averaged, is employed to obtain a robust estimate of the respiration rate. The envelope of the filtered f-wave frequency trend is used to quantify the magnitude of respiratory induced f-wave frequency modulation. The proposed methodology is evaluated using simulated f-wave signals obtained using a sinusoidal harmonic model. Results from simulated signals show that the magnitude of the respiratory modulation is accurately estimated, quantified by an error below 0.01 Hz, if the signal quality is sufficient ((Formula presented.)). The proposed method was applied to analyze ECG data from eight pacemaker patients with permanent AF recorded at baseline, during controlled respiration, and during controlled respiration after injection of atropine, respectively. The magnitude of the respiratory induce f-wave frequency modulation was 0.15 ± 0.01, 0.18 ± 0.02, and 0.17 ± 0.03 Hz during baseline, controlled respiration, and post-atropine, respectively. Our results suggest that parasympathetic regulation affects the magnitude of respiratory induced f-wave frequency modulation.
12.	Abdollahpur, Mostafa, et al. (author) Respiratory Modulation in Permanent Atrial Fibrillation 2020 In: 2020 Computing in Cardiology, CinC 2020. - 2325-8861 .- 2325-887X. - 9781728173825 ; 2020-September Conference paper (peer-reviewed)abstract Several studies have shown that the autonomic nervous system (ANS) can induce changes during atrial fibrillation (AF). There is currently a lack of methods for quantifying ANS induced variations during AF. The purpose of this study is to quantify respiratory induced modulation in the f-wave frequency trend. Following qrst-cancellation, the local f-wave frequency is estimated by fitting a harmonic f-wave model signal and a quality index (SQI) is computed based on the model fit. The resulting frequency trend is filtered using a narrow bandpass filter with a center frequency corresponding to the local respiration rate. The magnitude of the respiratory induced f-wave frequency modulation is estimated by the envelope of the filtered frequency trend. The performance of the method is validated using simulations and the method is applied to analyze ECG data from eight patients with permanent AF recorded during 0.125 Hz frequency controlled respiration before and after the full vagal blockade, respectively. Results from simulated data show the magnitude of the respiratory induced f-wave frequency modulation can be estimated with an error of less than = 0.005Hz if the SQI is above 0.45. The signal quality was sufficient for analysis in 7 out of 8 patients. In 4 patients the magnitude decreased and in 3 patients there was no change.
13.	Alexandersson, Klas, et al. (author) Session-to-session effects of therapist adherence and facilitative conditions on symptom change in CBT and IPT for depression 2023 In: Psychotherapy Research. - : Taylor & Francis Group. - 1050-3307 .- 1468-4381. ; 33:1, s. 57-69 Journal article (peer-reviewed)abstract Objective: The objective of this study was to analyze the effect of adherence to both specific technique factors and facilitative condition variables (e.g., therapists' involvement, understanding and support) in Cognitive Behavior Therapy (CBT) and Interpersonal Psychotherapy (IPT). In addition, we were interested in whether the effect of therapist adherence would depend on the level of the working alliance. Method: Three sessions each from 74 patients diagnosed with Major Depressive Disorder who were randomized to 14 sessions of IPT or CBT were rated for adherence using a modified version of The Collaborative Study Psychotherapy Rating Scale-6 (CSPRS-6). Data was analyzed using Multilevel Modeling. Results: No effects of adherence to specific factors on outcome were found in neither CBT nor IPT. Facilitative conditions were associated with better outcome in CBT but not in IPT, even after adjustment for the quality of the working alliance. No interaction effects were found. Conclusions: Our findings highlight the importance of relational factors in CBT, but do not support the need for specific adherence to any of the two treatments. Possible explanations of the findings and directions for future research are discussed.
14.	Askling, J., et al. (author) How comparable are rates of malignancies in patients with rheumatoid arthritis across the world? A comparison of cancer rates, and means to optimise their comparability, in five RA registries 2016 In: Annals of the Rheumatic Diseases. - : BMJ. - 0003-4967 .- 1468-2060. ; 75:10, s. 1789-1796 Journal article (peer-reviewed)abstract Background The overall incidence of cancer in patients with rheumatoid arthritis (RA) is modestly elevated. The extent to which cancer rates in RA vary across clinical cohorts and patient subsets, as defined by disease activity or treatment is less known but critical for understanding the safety of existing and new antirheumatic therapies. We investigated comparability of, and means to harmonise, malignancy rates in five RA registries from four continents. Methods Participating RA registries were Consortium of Rheumatology Researchers of North America (CORRONA) (USA), Swedish Rheumatology Quality of Care Register (SRR) (Sweden), Norfolk Arthritis Register (NOAR) (UK), CORRONA International (several countries) and Institute of Rheumatology, Rheumatoid Arthritis (IORRA) (Japan). Within each registry, we analysed a main cohort of all patients with RA from January 2000 to last available data, and sensitivity analyses of sub-cohorts defined by disease activity, treatment change, prior comorbidities and restricted by calendar time or follow-up, respectively. Malignancy rates with 95% CIs were estimated, and standardised for age and sex, based on the distributions from a typical RA clinical trial programme population (fostamatinib). Results There was a high consistency in rates for overall malignancy excluding non-melanoma skin cancer (NMSC), for malignant lymphomas, but not for all skin cancers, across registries, in particular following age/sex standardisation. Standardised rates of overall malignancy excluding NMSC varied from 0.56 to 0.87 per 100 person-years. Within each registry, rates were generally consistent across sensitivity analyses, which differed little from the main analysis. Conclusion In real-world RA populations, rates of both overall malignancy and of lymphomas are consistent.
15.	Azouri, Kristian, et al. (author) Hotellrapport Stockholm 2011 Reports (pop. science, debate, etc.)abstract Stockholm är Sveriges största stad och marknadsför sig som ”The Capital of Scandinavia”. De flesta resenärer som besöker Sverige åker till just Stockholm. År 2010 nådde Stockholms län 10 miljoner kommersiella övernattningar. Det är lätt att ta sig till Stockholm med både flyg, tåg, båt, bil och buss. Stockholm har ett brett utbud av kongress- och mässanläggningar. År 2009 var Stockholm den sjunde mest populära staden i världen att förlägga kongresser på. I dagsläget är Sverige på väg ur den lågkonjunktur som startade år 2008. Sveriges BNP och valuta är på väg att stabiliseras och stärkas. Regeringen har även lagt in ett förslag om att sänka tjänstemomsen inom hotell- och restaurangbranschen. I denna rapport har vi valt att avgränsa oss till ett eget utvalt område inom Stockholm. Detta område innefattar 143 hotell med 20 054 hotellrum.De prognoser vi gjort gällande staden Stockholm och segmenten affärsresenärer och fritidsresenärer pekar på en ökning av besökare till staden. Detta kommer resultera i att hotellens beläggning, snittpris och RevPAR kommer att öka framtill år 2013. Efter år 2013 tror vi att segmentet affärsresenärer kommer att minska något procentuellt och kurvan för belagda nätter kommer att stabiliseras. Dock tror vi att segmentet fritidsresenärer kommer att öka procentuellt efter år 2013 och antalet belagda hotellrum kommer att successivt öka mellan åren 2011 – 2015. Vi tror att snittpris och RevPAR kommer att sjunka på grund av att en fritidsresenär generellt sätt inte betalar lika mycket för ett hotellrum som en affärsresenär gör.
16.	Back, Malin, et al. (author) Reduction in depressive symptoms predicts improvement in eating disorder symptoms in interpersonal psychotherapy : results from a naturalistic study 2020 In: Journal of Eating Disorders. - : BioMed Central. - 2050-2974. ; 8:1 Journal article (peer-reviewed)abstract Background: Interpersonal psychotherapy (IPT) can be effective for both Bulimia Nervosa (BN) and co-occurring depression. While changes in symptoms of Eating disorder (ED) and depression have been found to correlate, it is unclear how they interact during treatment and in which order the symptoms decrease.Methods: Thirty-one patients with BN and depressive symptoms received IPT using the manual IPT-BNm in a naturalistic design. The outcome was measured with the Eating Disorder Examination Questionnaire (EDE-Q) and the Montgomery Åsberg Depression Rating Scale (MADRS-S). Symptom improvement at each session was measured with Repeated Evaluation of Eating Disorder Symptoms (REDS) and the Patient Health Questionnaire-9 (PHQ-9).Results: Significant improvements with large effect sizes were found on both ED symptoms and depression. The rates of change were linear for both BN and depression. A strong correlation between reduction of depressive symptoms and ED symptoms was found. Depressive symptom reduction at one session predicted improvement of ED symptoms at the next session.Conclusions: IPT-BNm had an effect on both BN and co-occurring depressive symptoms. The analyses indicated that reduction in depressive symptoms preceded reduction in bulimic symptoms.
17.	Bazsefidpay, Nikoo, 1984-, et al. (author) Antibiotic prescription in bone augmentation and dental implant procedures : a multi-center study 2023 In: BMC Oral Health. - : BioMed Central (BMC). - 1472-6831. ; 23:1 Journal article (peer-reviewed)abstract BACKGROUND: Adherence to antibiotic recommendations and safety aspects of restrictive use are important components when combating antibiotic resistance. The primary aim of this study was to assess the impact of national guidelines on antibiotic prescriptions for bone augmentation procedures among dentists working at three specialized clinics. The secondary aim was to assess the occurrence of postoperative infections.METHODS: Medical charts of 400 patients treated with bone augmentation were reviewed: 200 in the years 2010-2011 and 200 in 2014-2015. The Swedish national recommendations for antibiotic prophylaxis were published in 2012.RESULTS: There was a wide variation in antibiotic regiments prescribed throughout the study. The number of patients treated with antibiotic prophylaxis in a single dose of 2 g amoxicillin, and treated as advocated in the national recommendations, was low and decreasing between the two time periods from 25% (n = 50/200) in 2010-2011 to 18.5% (n = 37/200) in 2014-2015. The number of patients not given any antibiotics either as a prophylactic single dose or during the postoperative phase increased (P < 0.001). The administration of a 3-7-days antibiotic prescription increased significantly from 25.5% in 2010-2011 to 35% in 2014-2015. The postoperative infection rates (4.5% and 6.5%) were without difference between the studied periods. Smoking and omitted antibiotic prophylaxis significantly increased the risk of postoperative infection. Logistic regression analyses showed that patient male gender and suffering from a disease were predictive factors for the clinician to adhere to the guidelines.CONCLUSIONS: After introduction of national recommendations for antibiotic prophylaxis before bone augmentation procedures, the patient group receiving a single preoperative dose decreased while the group not given antibiotic prophylaxis increased. There was no difference in occurrence of postoperative infections between the two time periods. The results indicate a need for educational efforts and strategies for implementation of antibiotic prudence and awareness among surgeons performing bone augmentation procedures.
18.	Berggren, Sofia, et al. (author) ProQ-dependent activation of Salmonella virulence genes mediated by post-transcriptional control of PhoP synthesis 2024 In: mSphere. - : American Society for Microbiology. - 2379-5042. ; 9:3 Journal article (peer-reviewed)abstract Gastrointestinal disease caused by Salmonella enterica is associated with the pathogen's ability to replicate within epithelial cells and macrophages. Upon host cell entry, the bacteria express a type-three secretion system encoded within Salmonella pathogenicity island 2, through which host-manipulating effector proteins are secreted to establish a stable intracellular niche. Transcription of this intracellular virulence program is activated by the PhoPQ two-component system that senses the low pH and the reduced magnesium concentration of host cell vacuoles. In addition to transcriptional control, Salmonella commonly employ RNA-binding proteins (RBPs) and small regulatory RNAs (sRNAs) to regulate gene expression at the post-transcriptional level. ProQ is a globally acting RBP in Salmonella that promotes expression of the intracellular virulence program, but its RNA repertoire has previously been characterized only under standard laboratory growth conditions. Here, we provide a high-resolution ProQ interactome during conditions mimicking the environment of the Salmonella-containing vacuole (SCV), revealing hundreds of previously unknown ProQ binding sites in sRNAs and mRNA 3 ' UTRs. ProQ positively affected both the levels and the stability of many sRNA ligands, some of which were previously shown to associate with the well-studied and infection-relevant RBP Hfq. We further show that ProQ activates the expression of PhoP at the post-transcriptional level, which, in turn, leads to upregulation of the intracellular virulence program.
19.	Bollmann, Andreas, et al. (author) Atrial fibrillatory rate and risk of left atrial thrombus in atrial fibrillation. 2007 In: Europace. - : Oxford University Press (OUP). - 1532-2092. ; 9:8, s. 6-621 Journal article (peer-reviewed)abstract ims In atrial fibrillation (AF), a relation between electrocardiogram (ECG) fibrillatory wave amplitude and thrombus formation has been sought for long with conflicting results. In contrast, the possible relation between atrial fibrillatory rate obtained from the surface ECG and left atrial thrombus formation in patients with AF is unknown and was consequently evaluated in this study. Methods and results One-hundred and twenty-five patients (mean age 64 ± 12 years, 72% male) with persistent non-valvular AF (mean duration 28 ± 80 days) undergoing transesophageal echocardiography were studied. In all patients, standard 12-lead ECG recordings were acquired before the examination. Atrial fibrillatory rate was determined using spatiotemporal QRST cancellation and time–frequency analysis of lead V1. Atrial fibrillatory rate measured 401 ± 63 fibrillations per minute (fpm, range 235–566 fpm) and was related with age (R = −0.326, P < 0.001), ventricular rate (R = −0.202, P = 0.024), gender (407 ± 62 in males vs. 387 ± 64 fpm in females, P = 0.038) but not AF duration (R = 0.088, P = 0.374), presence of lone AF (408 ± 66 vs. 394 ± 58 fpm, P = 0.228), or beta-blocker or calcium channel blocker treatment (398 ± 63 vs. 405 ± 62 fpm, P = 0.556). Age was the only independent predictor of fibrillatory rate (B = −1.714, P < 0.001). In patients with left atrial thrombus (n = 10), spontaneous echo contrast (SEC) was more frequently present (70 vs. 29 %, p = 0.007) and left atrial appendage (LAA) outflow velocity was lower (26 ± 20 vs. 37 ± 15 cm/s, P = 0.012) than in patients without thrombus (n = 115). In contrast, mean fibrillatory rate, which showed a weak inverse correlation with LAA velocity (R = −0.118, P = 0.048) was not different between both groups (380 ± 56 vs. 403 ± 63 fpm, P = 0.226). Similarly, presence of thrombus and SEC combined was not related with fibrillatory rate. Conclusion Atrial fibrillatory rate obtained from surface ECG lead V1 is not a risk marker for left atrial thrombus formation in AF.
20.	Carlson, Jonas, et al. (author) Non-invasive assessment of direction of right atrial activation during atrial fibrillation using correlation function analysis. 2007 In: Computers in Cardiology. - 0276-6574. ; 34, s. 277-280 Journal article (peer-reviewed)abstract ECGs were recorded from three electrodes attached at the corners of an equilateral triangle positioned around the location of electrode V1. The atrial signal between QRST complexes was subjected to correlation function analysis to reveal differences in activation times between the electrode sites. The time differences found were used to calculate the direction of activation across the body surface. Twenty-three subjects were studied during sinus rhythm (SR), intraoperatively confirmed typical and reverse typical atrial flutter, or during paroxysmal or permanent atrial fibrillation (AF). Subjects studied during SR and patients with typical atrial flutter exhibited a uniform direction of activation, with the main vector pointing downwards. The propagation of atrial activation during permanent AF did not show a consistent direction, while patients with paroxysmal AF exhibited more uniform activation vectors, corresponding to the direction observed in patients with atrial flutter.
21.	Choudhary, Mariam B, et al. (author) Low atrial fibrillatory rate is associated with spontaneous conversion of recent-onset atrial fibrillation. 2013 In: Europace. - : Oxford University Press (OUP). - 1532-2092. ; 15:10, s. 1445-1452 Journal article (peer-reviewed)abstract AIMS: Atrial fibrillatory rate (AFR) is considered a non-invasive index of atrial remodelling. Low AFR has been associated with favourable outcome of interventions in patients with persistent atrial fibrillation (AF). However, AFR has never been studied in unselected patients with short duration of AF, prone to regain sinus rhythm (SR) spontaneously. The aim of the study was to assess if AFR can predict spontaneous conversion in patients with recent-onset AF.METHODS AND RESULTS: Files of consecutive patients with AF < 48 h seeking emergency room care during a 12-month period were screened (n = 225). Patients with thyroid illness, acute ischaemic heart disease (IHD) or acute congestive heart failure, significant valvular heart disease, congenital heart disease, history of cardiac surgery or catheter ablation, or on class I/III antiarrhythmics were excluded. Atrial fibrillatory rate was obtained by QRST cancellation and time frequency analysis of electrocardiogram at admission. The study population comprised 148 patients (age 64 ± 13 years, 52 men), of whom 48 converted to SR within 18 h. Those converting spontaneously comprised more women, had a higher prevalence of first-ever AF episode, IHD, and a lower AFR. The multivariate analysis revealed: AFR < 350 fibrillations per minute [odds ratio (OR) 3.7, 95% confidence interval (CI) 1.3-10.5, P = 0.016], IHD (OR 5.7, 95% CI 1.5-22.4, P = 0.012) and first-ever AF episode (OR 4.1, 95% CI 1.3-13.0, P = 0.015) as independent predictors of spontaneous conversion.CONCLUSION: A low AFR was predictive of spontaneous conversion in patients with recent-onset AF. Along with first-ever AF episode and IHD, AFR can be used in assessing likelihood of spontaneous conversion, if proven in prospective studies.
22.	Corino, Valentina D. A., et al. (author) Association between Atrial Fibrillatory Rate and Heart Rate Variability in Patients with Atrial Fibrillation and Congestive Heart Failure 2013 In: Annals of Noninvasive Electrocardiology. - : Wiley. - 1082-720X. ; 18:1, s. 41-50 Journal article (peer-reviewed)abstract Background Even if atrial fibrillatory rate (AFR) has been related to clinical outcome in patients with atrial fibrillation (AF), its relation with ventricular response has not been deeply studied. The aim of this study was to investigate the relation between AFR and RR series variability in patients with AF. Methods Twenty-minute electrocardiograms in orthogonal leads were processed to extract AFR, using spatiotemporal QRST cancellation and time frequency analysis, and RR series in 127 patients (age 69 +/- 11 years) with congestive heart failure (NYHA IIIII) enrolled in the MUSIC study (MUerte Subita en Insufficiencia Cardiaca). Heart rate variability and irregularity were assessed by time domain parameters and entropy-based indices, respectively and their correlation with AFR investigated. Results Variability measures seem not to be related to AFR, while irregularity measures do. A significant correlation between AFR and variability parameters of heart rate variability during AF was found only in patients not treated with antiarrhythmics drugs (correlation = 0.56 P < 0.05 for pNN50), while this correlation was lost in patients taking rate- or rhythm-control drugs. A significant positive correlation between AFR and indices of RR irregularity was found, showing that a higher AFR is related to a less organized RR series (correlation = 0.33 P < 0.05 for regularity index for all patients, correlation increased in subgroups of patients treated with the same drug). Conclusions These results suggest that a higher AFR is associated with a higher degree of irregularity of ventricular response that is observed regardless of the use of rate-controlling drugs. Ann Noninvasive Electrocardiol 2013;18(1):41-50
23.	Corino, Valentina D. A., et al. (author) Beta-blockade and A1-adenosine receptor agonist effects on atrial fibrillatory rate and atrioventricular conduction in patients with atrial fibrillation 2014 In: Europace. - : Oxford University Press (OUP). - 1532-2092 .- 1099-5129. ; 16:4, s. 587-594 Journal article (peer-reviewed)abstract Reduced irregularity of RR intervals in permanent atrial fibrillation (AF) has been associated with poor outcome. It is not fully understood, however, whether modification of atrioventricular (AV) conduction using rate-control drugs affects RR variability and irregularity measures. We aimed at assessing whether atrial fibrillatory rate (AFR) and variability and irregularity of the ventricular rate are modified by a selective A1-adenosine receptor agonist tecadenoson, beta-blocker esmolol, and their combination. Twenty-one patients (age 58 7 years, 13 men) with AF were randomly assigned to either 75, 150, or 300 g intravenous tecadenoson. Tecadenoson was administered alone (Dose Period 1) and in combination (Dose Period 2) with esmolol (100 g/kg/min for 10 min then 50 g/kg/min for 50 min). Heart rate (HR) and AFR were estimated for every 10 min long recording segment. Similarly, for every 10 min segment, the variability of RR intervals was assessed, as standard deviation, pNN20, pNN50, pNN80, and the root of the mean squared differences of successive RR intervals, and irregularity was assessed by non-linear measures such as regularity index (R) and approximate entropy. A marked decrease in HR was observed after both tecadenoson injections, whereas almost no changes could be seen in the AFR. The variability parameters were increased after the first tecadenoson bolus injection. In contrast, the irregularity parameters did not change after tecadenoson. When esmolol was infused, all the variability parameters further increased. Modification of AV node conduction can increase RR variability but does not affect regularity of RR intervals or AFR.
24.	Demidova, Marina M., et al. (author) Ventricular arrhythmias during ST-segment elevation myocardial infarction and arrhythmic complications during recurrent ischaemic events 2024 In: European Heart Journal. - 0195-668X. ; 45:5, s. 393-395 Journal article (peer-reviewed)
25.	Demidova, Marina, et al. (author) Prognostic impact of early ventricular fibrillation in patients with ST-elevation myocardial infarction treated with primary PCI. 2012 In: European Heart Journal: Acute Cardiovascular Care. - : Oxford University Press (OUP). - 2048-8734 .- 2048-8726. ; 1:4, s. 302-311 Journal article (peer-reviewed)abstract Current guidelines do not advocate implantation of cardioverter-defibrillators (ICD) for survivors of ventricular fibrillation (VF) during the first 48 hours of ST-elevation myocardial infarction (STEMI). However, contemporary studies in a real-life setting with long-term follow-up are lacking. We assessed the prognostic impact of early VF in a non-selected population of STEMI patients treated with primary percutaneous coronary intervention (PCI).
26.	Ekeblad, Annika, et al. (author) Change in reflective functioning in interpersonal psychotherapy and cognitive behavioral therapy for major depressive disorder 2023 In: Psychotherapy Research. - : Routledge; Taylor & Francis. - 1050-3307 .- 1468-4381. ; 33:3, s. 342-349 Journal article (peer-reviewed)abstract Background Patients with Major Depressive Disorder (MDD) have been found to have restricted capacity for mentalization, and it is possible that this constitutes a vulnerability factor for developing depression. Due to its focus on linking depressive symptomatology to emotions and interpersonal relations, it was hypothesized that Interpersonal Psychotherapy (IPT) would improve mentalization more than Cognitive Behavioral Therapy (CBT). Methods In a randomized controlled trial of 90 patients undergoing IPT and CBT for MDD, Reflective Functioning (RF) was rated from Adult Attachment and from Depression-Specific Reflective Functioning (DSRF) Interviews before and after therapy. Treatment outcome was assessed using the Beck Depression Inventory-II. Results The interaction between time and treatment approach was statistically significant, with RF improving significantly more in IPT than in CBT. Change in RF was not correlated with change in depression. The difference in DSRF ratings before and after therapy was not statistically significant for any of the treatments. Conclusions IPT may improve mentalization more than CBT. However, although RF increased significantly in IPT, the mean level was still low after therapy. A limitation of the study is the large amount of post-treatment missing data. More research is needed to understand the potential role of mentalization in symptom reduction.
27.	Ekeblad, Annika, et al. (author) Randomized Trial of Interpersonal Psychotherapy and Cognitive Behavioral Therapy for Major Depressive Disorder in a Community-Based Psychiatric Outpatient Clinic 2016 In: Depression and anxiety (Print). - : WILEY-BLACKWELL. - 1091-4269 .- 1520-6394. ; 33:12, s. 1090-1098 Journal article (peer-reviewed)abstract BackgroundInterpersonal psychotherapy (IPT) and cognitive behavioral therapy (CBT) are both evidence-based treatments for major depressive disorder (MDD). Several head-to-head comparisons have been made, mostly in the United States. In this trial, we compared the two treatments in a small-town outpatient psychiatric clinic in Sweden. The patients had failed previous primary care treatment and had extensive Axis-II comorbidity. Outcome measures were reduction of depressive symptoms and attrition rate. MethodsNinety-six psychiatric patients with MDD (DSM-IV) were randomized to 14 sessions of CBT (n = 48) or IPT (n = 48). A noninferiority design was used with the hypothesis that IPT would be noninferior to CBT. A three-point difference on the Beck Depression Inventory-II (BDI-II) was used as noninferiority margin. ResultsIPT passed the noninferiority test. In the ITT group, 53.5% (23/43) of the IPT patients and 51.0% (24/47) of the CBT patients were reliably improved, and 20.9% (9/43) and 19.1% (9/47), respectively, were recovered (last BDI score amp;lt;10). The dropout rate was significantly higher in CBT (40%; 19/47) compared to IPT (19%; 8/43). Statistically controlling for antidepressant medication use did not change the results. ConclusionsIPT was noninferior to CBT in a sample of depressed psychiatric patients in a community-based outpatient clinic. CBT had significantly more dropouts than IPT, indicating that CBT may be experienced as too demanding. Since about half the patients did not recover, there is a need for further treatment development for these patients. The study should be considered an effectiveness trial, with strong external validity but some limitations in internal validity.
28.	Ekeblad, Annika, et al. (author) Reflective Functioning as Predictor of Working Alliance and Outcome in the Treatment of Depression 2016 In: Journal of Consulting and Clinical Psychology. - : American Psychological Association (APA). - 0022-006X .- 1939-2117. ; 84:1, s. 67-78 Journal article (peer-reviewed)abstract Aims: Although considerable attention has been paid to the concept of mentalization in psychotherapy, there is little research on mentalization as predictor of psychotherapy process and outcome. Using data from a randomized controlled trial of cognitive-behavioral therapy and interpersonal psychotherapy for depression, we studied mentalization in 85 outpatients with major depressive disorder (MDD) according to the Diagnostic and Statistical Manual of Mental Disorders. It was hypothesized that patients showing lower capacity for mentalization would experience poorer quality of alliance and worse outcome. Method: Depressive symptoms were measured each session using the Beck Depression Inventory-II. Mentalization was measured as reflective functioning (RF) on a slightly shortened version of the Adult Attachment Interview. A measure of depression-specific reflective functioning (DSRF), measuring mentalization about depressive symptoms, was also used. The Working Alliance Inventory-Short Form Revised was completed after each session by both therapist and patient. Longitudinal multilevel modeling was used to analyze data. Results: The patients had on average very low RF (M = 2.62, SD = 1.22). Lower pretreatment RF/DSRF predicted significantly lower therapist-rated working alliance during treatment. RF did not affect patient-rated alliance, but lower DSRF predicted lower patient-rated alliance across treatment. Patients with higher RF/DSRF had better outcomes on self-rated depression. Conclusions: The findings showed lower than normal capacity for mentalization in patients with MDD. Lower RF/DSRF predicted worse treatment outcome. More research is needed to understand how RF affects psychotherapy response and how RF is affected after recovery from depression.
29.	Enerbäck, Charlotta, 1965, et al. (author) Cytogenetic analysis of 477 psoriatics revealed an increased frequency of aberrations involving chromosome region 11q 1999 In: Eur J Hum Genet. ; 7:3, s. 339-44 Journal article (peer-reviewed)abstract Psoriasis is an inflammatory skin disorder affecting approximately 3% of the population. Genetic studies published so far have shown a complex genetic inheritance with heterogeneity and a putative major susceptibility locus in the HLA region on chromosome 6. We have collected a large amount of material consisting mostly of small nuclear families in order to perform a genome-wide scan for psoriasis-associated genes. In order to focus the scan properly on possible candidate regions, we performed a cytogenetic analysis of 477 unrelated psoriatics. We divided our findings into sporadic, affecting a minor fraction of the cells, and constitutional, i.e. they were present in all cells examined. We found three cases of balanced translocation, all of which involved chromosome 11q. Two of these had a breakpoint in q12-13, whilst one involved the telomeric part of chromosome 11q. In order to characterise further the breakpoint on 11q12-13, we used bacterial artificial chromosomes (BACs) analysed by fluorescent in situ hybridisation (FISH). We were able to show that the persons had a close, but not identical breakpoints; they were separated by at least 5 cM. The major atopy locus is located in this region, as well as a locus for insulin-dependent diabetes mellitus, both being conditions with a pathogenetic mechanism involving antigen presentation.
30.	Eranti, Antti, et al. (author) Orthogonal P-wave morphology, conventional P-wave indices, and the risk of atrial fibrillation in the general population using data from the Finnish Hospital Discharge Register 2020 In: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. - : Oxford University Press (OUP). - 1532-2092. ; 22:8, s. 1173-1181 Journal article (peer-reviewed)abstract AIMS: Identifying subjects at high and low risk of atrial fibrillation (AF) is of interest. This study aims to assess the risk of AF associated with electrocardiographic (ECG) markers linked to atrial fibrosis: P-wave prolongation, 3rd-degree interatrial block, P-terminal force in lead V1, and orthogonal P-wave morphology. METHODS AND RESULTS: P-wave parameters were assessed in a representative Finnish population sample aged ≥30 years (n = 7217, 46.0% male, mean age 51.4 years). Subjects (n = 5489) with a readable ECG including the orthogonal leads, sinus rhythm, and a predefined orthogonal P-wave morphology type [positive in leads X and Y and either negative (Type 1) or ± biphasic (Type 2) in lead Z; Type 3 defined as positive in lead X and ± biphasic in lead Y], were followed 10 years from the baseline examinations (performed 1978-80). Subjects discharged with AF diagnosis after any-cause hospitalization (n = 124) were defined as having developed AF. Third-degree interatrial block was defined as P-wave ≥120 ms and the presence of ≥2 ± biphasic P waves in the inferior leads. Hazard ratios (HRs) and confidence intervals (CIs) were assessed with Cox models. Third-degree interatrial block (n = 103, HR 3.18, 95% CI 1.66-6.13; P = 0.001) and Type 3 morphology (n = 216, HR 3.01, 95% CI 1.66-5.45; P < 0.001) were independently associated with the risk of hospitalization with AF. Subjects with P-wave <110 ms and Type 1 morphology (n = 2074) were at low risk (HR 0.46, 95% CI 0.26-0.83; P = 0.006), compared to the rest of the subjects. CONCLUSION: P-wave parameters associate with the risk of hospitalization with AF.
31.	Falkenström, Fredrik, et al. (author) Can psychotherapists function as their own controls? Meta-analysis of the crossed therapist design in comparative psychotherapy trials 2013 In: Journal of Clinical Psychiatry. - : Physicians Postgraduate Press. - 0160-6689 .- 1555-2101. ; 74:5, s. 482-491 Journal article (peer-reviewed)abstract OBJECTIVE:Clinical trials sometimes have the same therapists deliver more than 1 psychotherapy, ostensibly to control for therapist effects. This "crossed therapist" design makes controlling for therapist allegiance imperative, as therapists may prefer one treatment they deliver to the other(s). Research has established a strong relationship between principal investigators' allegiances and treatment outcome. Study therapists' allegiances probably also influence outcome, yet this moderating factor on outcome has never been studied.DATA SOURCES:English language abstracts in PsycINFO and MEDLINE from January 1985 to December 2011 were searched for keywords psychotherapy and randomized trial.STUDY SELECTION:The search yielded 990 abstracts that were searched manually. Trials using the same therapists in more than 1 condition were included.DATA EXTRACTION:Thirty-nine studies fulfilled inclusion criteria. Meta-regression analyses assessed the influence of researchers' allegiance on treatment outcome, testing the hypothesis that studies poorly controlling for therapist allegiance would show stronger influence of researcher allegiance on outcome. A single-item measure assessed researchers' reported attempts to control for therapist allegiance.RESULTS:Only 1 of 39 studies (3%) measured therapist treatment allegiance. Another 5 (13%) mentioned controlling for, without formally assessing, therapist allegiance. Most publications (67%) did not even mention therapist allegiance. In studies not controlling for therapist allegiance, researcher allegiance strongly influenced outcome, whereas studies reporting control for therapist allegiance showed no differential researcher allegiance. Researchers with cognitive-behavioral therapy allegiance described controlling for therapist allegiance less frequently than other researchers.CONCLUSIONS:The crossed therapist design is subject to bias due to differential psychotherapist allegiance. Worrisome results suggest that researchers strongly allied to a treatment may ignore therapist allegiance, potentially skewing outcomes. All clinical trials, and especially crossed therapist designs, should measure psychotherapist allegiance to evaluate this possible bias.
32.	Falkenström, Fredrik, et al. (author) Confirmatory Factor Analysis of the Patient Version of the Working Alliance Inventory-Short Form Revised 2015 In: Assessment (Odessa, Fla.). - : SAGE PUBLICATIONS INC. - 1073-1911 .- 1552-3489. ; 22:5, s. 581-593 Journal article (peer-reviewed)abstract The working alliance concerns the quality of collaboration between patient and therapist in psychotherapy. One of the most widely used scales for measuring the working alliance is the Working Alliance Inventory (WAI). For the patient-rated version, the short form developed by Hatcher and Gillaspy (WAI-SR) has shown the best psychometric properties. In two confirmatory factor analyses of the WAI-SR, approximate fit indices were within commonly accepted norms, but the likelihood ratio chi-square test showed significant ill-fit. The present study used Bayesian structural equations modeling with zero mean and small variance priors to test the factor structure of the WAI-SR in three different samples (one American and two Swedish; N = 235, 634, and 234). Results indicated that maximum likelihood confirmatory factor analysis showed poor model fit because of the assumption of exactly zero residual correlations. When residual correlations were estimated using small variance priors, model fit was excellent. A two-factor model had the best psychometric properties. Strong measurement invariance was shown between the two Swedish samples and weak factorial invariance between the Swedish and American samples. The most important limitation concerns the limited knowledge on when the assumption of residual correlations being small enough to be considered trivial is violated.
33.	Falkenström, Fredrik, et al. (author) Dynamic Models of Individual Change in Psychotherapy Process Research 2017 In: Journal of Consulting and Clinical Psychology. - : AMER PSYCHOLOGICAL ASSOC. - 0022-006X .- 1939-2117. ; 85:6, s. 537-549 Journal article (peer-reviewed)abstract Objective: There is a need for rigorous methods to study the mechanisms that lead to individual-level change (i.e., process-outcome research). We argue that panel data (i.e., longitudinal study of a number of individuals) methods have 3 major advantages for psychotherapy researchers: (1) enabling microanalytic study of psychotherapeutic processes in a clinically intuitive way, (2) modeling lagged associations over time to ensure direction of causality, and (3) isolating within-patient changes over time from between-patient differences, thereby protecting against confounding influences because of the effects of unobserved stable attributes of individuals. However, dynamic panel data methods present a complex set of analytical challenges. We focus on 2 particular issues: (1) how long-term trajectories in the variables of interest over the study period should be handled, and (2) how the use of a lagged dependent variable as a predictor in regression-based dynamic panel models induces endogeneity (i.e., violation of independence between predictor and model error term) that must be taken into account in order to appropriately isolate within-and between-person effects. Method: An example from a study of working alliance in psychotherapy in primary care in Sweden is used to illustrate some of these analytic decisions and their impact on parameter estimates. Results: Estimates were strongly influenced by the way linear trajectories were handled; that is, whether variables were "detrended" or not. Conclusions: The issue of when detrending should be done is discussed, and recommendations for research are provided. What is the public health significance of this article? This article provides recommendations on how to study psychotherapy processes using dynamic panel data models to strengthen causal inferences. Accurate estimates of what drives individual development in psychotherapy are needed to generate recommendations on what therapists should focus on in therapy. Using the alliance-outcome association as an example, we show that estimated effect sizes may vary greatly depending on which modeling approach is used, with the decision on whether to remove time-trends from the outcome variable making the largest difference.
34.	Falkenström, Fredrik, et al. (author) How Much Therapy Is Enough? : Comparing Dose-Effect and Good-Enough Models in Two Different Settings 2016 In: Psychotherapy. - : American Psychological Association (APA). - 0033-3204 .- 1939-1536. ; 53:1, s. 130-139 Journal article (peer-reviewed)abstract The Dose-Effect model holds that longer therapy leads to better outcome, although increasing treatment length will yield diminishing returns, as additional sessions lead to progressively less change in a negatively accelerating fashion. In contrast, the Good-Enough-Level (GEL) model proposes that patients, therapists, or patients-with-therapists decide on ending treatment when treatment outcome is satisfactory, meaning that patients who change faster will have shorter treatments. If true, this means that aggregating among patients with different treatment lengths would yield biased results. Most previous research has shown that symptom change rate depends on treatment length, but all of these studies used data from University counseling centers in the United States. There is a need to test if previous results hold in different settings. Two datasets from Swedish community-based primary care (n = 640) and psychiatric care (n = 284) were used. Patients made session-wise ratings on the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM). Multilevel models indicated better fit for a model in which treatment length moderated symptom change rate. In the primary care sample, patients in longer treatments achieved more symptom change from pre- to posttreatment, despite having slower rate of improvement. The most important aspect of the GEL model was supported, and no evidence was found for a negatively accelerating Dose-Effect curve. Results cannot be generalized beyond about 12 sessions, due to scarcity of data for longer treatments.
35.	Falkenström, Fredrik, et al. (author) Improvement of the Working Alliance in One Treatment Session Predicts Improvement of Depressive Symptoms by the Next Session 2016 In: Journal of Consulting and Clinical Psychology. - : American Psychological Association (APA). - 0022-006X .- 1939-2117. ; 84:8, s. 738-751 Journal article (peer-reviewed)abstract Objective: Developments in working alliance theory posit that the therapist's attention to fluctuations in the alliance throughout treatment is crucial. Accordingly, researchers have begun studying the alliance as a time-varying mechanism of change rather than as a static moderator. However, most studies to date suffer from bias owing to the nonindependence of error term and predictors (endogeneity). Method: Patients with major depressive disorder (N = 84) from a randomized trial comparing cognitive-behavioral therapy with interpersonal psychotherapy filled out the Beck Depression Inventory-II before each session. After each session, patients and therapists filled out the Working Alliance Inventory short forms. Data were analyzed using the generalized method of moments for dynamic panel data, a method commonly applied in econometrics to eliminate endogeneity bias. Results: Improvement of the alliance predicted significant reduction of depressive symptoms by the next session (patient rating: b = -4.35, SE = 1.96, p = .026, 95% confidence interval [CI] [-8.19, -0.51]; therapist rating: b = -4.92, SE = 1.84, p = .008, 95% CI [-8.53, -1.31]). In addition, there was a significant delayed effect on the session after the next (patient rating: b = -3.25, SE = 1.20, p = .007, 95% CI [-5.61, -0.89]; therapist rating: b = -5.44, SE = 1.92, p = .005, 95% CI [-9.20, -1.68]). Conclusion: If the quality of patient-therapist alliance is improved in a given treatment session, depressive symptoms will likely decrease by the next session. The most important limitation of this study is its relatively small sample size.
36.	Falkenström, Fredrik, et al. (author) Patient Reflective Functioning as Predictor of Early Psychotherapy Process in the Treatment of Depression Other publication (other academic/artistic)abstract Aims: Despite considerable clinical attention to the concept of mentalization in psychotherapy, research on mentalization and the psychotherapy process is virtually absent. Using data from two ongoing randomized controlled trials of psychotherapy for depression, we studied mentalization in 45 patients diagnosed with DSM-IV Major Depressive Disorder. The initial psychotherapy process was hypothesized to be experienced as more difficult with patients showing lower capacity for mentalization because of their difficulty understanding behavior in terms of mental states.Methods: Mentalization was measured as Reflective Functioning (RF) on the Adult Attachment Interview, conducted before therapy start. Additionally, a measure of Depression-Specific Reflective Functioning (DSRF) measuring mentalization about depressive symptoms was tested. Psychotherapy process was measured by the Working Alliance Inventory – Short form (WAI-S) and the Feeling Checklist (FC), which were completed after each session by both therapist and patient.Results: Pre-treatment RF on the AAI was on average low (M = 3.1), but variation in RF did not predict any aspect of the initial (first four sessions) psychotherapy process. Higher DSRF predicted better working alliance and more positive feelings as rated by the patient. RF on the AAI did not predict any process measure significantly.Discussion: The low RF in depression replicates two previous studies, and may help explaining why maternal depression is a risk factor for infant developmental problems. If the results for DSRF are replicated, this measure might be used for identifying patients who are not easy candidates for psychotherapy.
37.	Falkenström, Fredrik, et al. (author) Reflective Functioning, Affect Consciousness, and Mindfulness : Are These Different Functions? 2014 In: Psychoanalytic psychology. - : American Psychological Association (APA). - 0736-9735 .- 1939-1331. ; 31:1, s. 26-40 Journal article (peer-reviewed)abstract Concepts of mentalization, affect consciousness, and mindfulness have been increasingly emphasized as crucial in psychotherapy of diverse orientations. Different measures have been developed that purportedly measure these concepts, but little is known about their interrelationships. We discuss conceptual overlaps and distinctions between these three concepts, and present results from a preliminary empirical study comparing their measures. To study the relationships between these concepts, data from a group of psychotherapy students (N = 46) was used. Mentalization operationalized as Reflective Functioning (RF) was rated on transcripts of a brief version of the Adult Attachment Interview; the Five Facet Mindfulness Questionnaire (FFMQ) was used to measure mindfulness; and the Affect Consciousness Interview-Self/Other version (ACI-S/O) to measure affect consciousness. There was a small but statistically significant relationship between RF and FFMQ, but surprisingly no relationship between AC-S/O and RF or FFMQ. A post hoc analysis showed a relationship between consciousness of others' affects and a reduced version of the RF scale. Results confirm that mentalization and mindfulness share some common variance, but contrary to expectations, affect consciousness seems to be more different from RF and mindfulness than expected. A possible explanation for the counterintuitive finding of no relationship between RF and affect consciousness is that the high end of the affect consciousness scale measures a mature capacity for mentalized affectivity, while RF is largely a buffer against trauma and adversity. Low or absent findings for the FFMQ are explained more in terms of different methods variance.
38.	Falkenström, Fredrik, et al. (author) Review of organizational effects on the outcome of mental health treatments 2018 In: Psychotherapy Research. - : Taylor & Francis Group. - 1050-3307 .- 1468-4381. ; 28:1, s. 76-90 Research review (peer-reviewed)abstract OBJECTIVE: As there are theoretical, clinical, and "common sense" reasons to expect a relationship between organizational factors and outcome in clinics providing psychotherapy and other mental health treatments, a review of empirical research in this area was undertaken with the aim of finding empirical evidence for organizational effects.METHODS: A structured search for studies on organizational differences in patient mental health outcomes was performed using EBSCO host, Cochrane Library Database, and the Health Systems Evidence database at McMasters University. Finished studies published in English were included if they presented data from more than one mental health service and used change in symptom, level of functioning, or quality of life as outcome.RESULTS: The search yielded not more than 19 studies fulfilling inclusion criteria. All studies showed some evidence for organization effects, and there was some evidence for organizational climate and culture explaining differences in outcome.CONCLUSION: Given that mental health treatments are likely to be especially susceptive to organizational effects, it is remarkable that not more research has been devoted to this. Clearly, more research is needed to study the consequences of work organization for the outcome of psychotherapy. Methodological issues in organizational studies are discussed.
39.	Falkenström, Fredrik (author) The Capacity for Self-Observation in Psychotherapy 2012 Doctoral thesis (other academic/artistic)abstract The phenomena of self-awareness and self-observation are thought by many to be uniquely human qualities, and questions about how they develop have engaged philosophers and spiritual thinkers throughout history. More recently these issues have come to interest psychologists, psychotherapists, and researchers of diverse clinical psychology orientations as well. This dissertation explored conceptual issues and empirical measurement methods related to self-awareness and self-observation capacities. The four studies approached this from different angles: Study I used mainly qualitative methods to study post-treatment processes related to continuing clinical improvement after termination of long-term psychotherapeutic treatments. The main finding was that self-analysis seemed to be related to continued improvement after ending of therapy, but contrary to our hypothesis there was no difference between psychotherapy and the more intensive psychoanalysis in this regard. Study II tested the measurement of mindfulness by self report in a sample of experienced Buddhist meditators. The findings confirmed relationships between mindfulness and psychological well-being, but raised doubt about the instruments’ sensitivity to change. Study III compared different methods for measuring theoretically related concepts of self-observation: mindfulness, mentalization, and affect consciousness. This study showed surprisingly little common variance between affect consciousness and mentalization/mindfulness. Finally, the results of Study IV showed that in patients diagnosed with clinical depression, mentalization about depressive symptoms predicted aspects of the initial psychotherapy process better than mentalization about attachment. Taken together, these studies show the complexity of the phenomenon of self-observation and the corresponding complexity of research on it. The relationships between variables related to self-observation, their measurements, and their relationships to the psychotherapy process seem more complex than would be expected from current theories. A model for types of self-observation in the process of change in psychotherapy is tentatively proposed.
40.	Falkenström, Fredrik, et al. (author) The Working Alliance: From Global Outcome Prediction to Micro-Analyses of Within-Session Fluctuations 2017 In: Psychoanalytic inquiry. - : ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD. - 0735-1690 .- 1940-9133. ; 37:3, s. 167-178 Journal article (peer-reviewed)abstract The working alliance, originally a psychoanalytic concept, is probably the most empirically studied psychotherapy process variable. There are many studies showing that a better alliance predicts better outcomes (e.g., Horvath et al., 2011), although the causal direction of this relationship is still debated (Barber et al., 2000; DeRubeis, Brotman, and Gibbons, 2005; Falkenstrom, Granstrom, and Holmqvist, 2013). Additionally, most of the empirical research on the working alliance is limited in clinical utility because of the relative simplicity of the research. Specifically, most empirical research on the working alliance has aimed to link patient-therapist dyads overall level of working alliance with global treatment outcomes. In actual clinical practice, therapists may be most interested in the fluctuations in the alliance from one session to the next, or even from one moment to the next within a session. There is a rich tradition in psychoanalysis of evaluating the results of therapeutic interventions by examining the patients responses. With the help of modern statistical methods, we believe the impact of a single intervention or series of interventions on factors such as working alliance, symptomatic improvement, or emotional experiences can be studied. Although this research is still in its infancy, we believe it is the future of scientific investigation of the talking cure.
41.	Falkenström, Fredrik, 1972-, et al. (author) Therapist in-session feelings predict change in depressive symptoms in interpersonal and brief relational psychotherapy 2022 In: Psychotherapy Research. - : Taylor & Francis Group. - 1050-3307 .- 1468-4381. ; 32:5, s. 571-584 Journal article (peer-reviewed)abstract Objective: Brief Relational Therapy (BRT) includes the idea that the therapists use their in-session feelings in meta-communications about the therapy relationship to facilitate resolution of alliance ruptures. The current study aimed to explore the effect of therapist feelings on patient depressive symptoms in BRT compared to Interpersonal Psychotherapy (IPT). Methods: The effects of therapist feelings were studied in 40 patients randomized to 16 sessions of IPT or BRT, using the Feeling Word Checklist-24, the Patient Health Questionnaire-9 and the Working Alliance Inventory. Data was analyzed using dynamic structural equation modeling. Results: Negative therapist feelings predicted increase and positive feelings decrease in next-session PHQ-9 via the alliance and the patients' engaged feelings, in both treatments. The direct effect of negative therapist feelings on PHQ-9 differed significantly between BRT and IPT, with more negative feelings predicting a decrease in PHQ-9 in BRT but not in IPT. Conclusion: Negative therapist feelings may cause increase/less decrease and positive feelings more decrease in depressive symptoms via disruptions in the alliance. In BRT, if the alliance is unaffected by negative therapist feelings, the patient's depressive symptoms may improve. Findings need replication in a larger sample.
42.	Hamrefors, Viktor, et al. (author) Gut microbiota composition is altered in postural orthostatic tachycardia syndrome and post-acute COVID-19 syndrome 2024 In: Scientific Reports. - 2045-2322. ; 14:1 Journal article (peer-reviewed)abstract Postural Orthostatic Tachycardia Syndrome (POTS) reflects an autonomic dysfunction, which can occur as a complication to COVID-19. Our aim was to examine gastrointestinal symptoms and gut microbiota composition in patients with POTS and post-acute COVID-19 syndrome (PACS), compared with controls. POTS patients (n = 27), PACS patients (n = 32) and controls (n = 39) delivered fecal samples and completed a 4-day food diary, irritable bowel syndrome-severity scoring system (IBS-SSS), and visual analog scale for IBS (VAS-IBS). A total of 98 DNA aliquots were sequenced to an average depth of 28.3 million (M) read pairs (Illumina 2 × 150 PE) per sample. Diversity and taxonomic levels of the microbiome, as well as functional abundances were calculated for POTS and PACS groups, then compared with controls. There were several differences in taxonomic composition between POTS and controls, whereas only the abundance of Ascomycota and Firmicutes differed between PACS and controls. The clinical variables total IBS-SSS, fatigue, and bloating and flatulence significantly correlated with multiple individual taxa abundances, alpha diversity, and functional abundances. We conclude that POTS, and to a less extent PACS, are associated with differences in gut microbiota composition in diversity and at several taxonomic levels. Clinical symptoms are correlated with both alpha diversity and taxonomic and functional abundances.
43.	Havmöller, Rasmus, et al. (author) Age-related changes in P wave morphology in healthy subjects. 2007 In: BMC Cardiovascular Disorders. - : Springer Science and Business Media LLC. - 1471-2261. ; 7:22 Journal article (peer-reviewed)abstract Background We have previously documented significant differences in orthogonal P wave morphology between patients with and without paroxysmal atrial fibrillation (PAF). However, there exists little data concerning normal P wave morphology. This study was aimed at exploring orthogonal P wave morphology and its variations in healthy subjects. Methods 120 healthy volunteers were included, evenly distributed in decades from 20–80 years of age; 60 men (age 50+/-17) and 60 women (50+/-16). Six-minute long 12-lead ECG registrations were acquired and transformed into orthogonal leads. Using a previously described P wave triggered P wave signal averaging method we were able to compare similarities and differences in P wave morphologies. Results Orthogonal P wave morphology in healthy individuals was predominately positive in Leads X and Y. In Lead Z, one third had negative morphology and two-thirds a biphasic one with a transition from negative to positive. The latter P wave morphology type was significantly more common after the age of 50 (P < 0.01). P wave duration (PWD) increased with age being slightly longer in subjects older than 50 (121+/-13 ms vs. 128+/-12 ms, P < 0.005). Minimal intraindividual variation of P wave morphology was observed. Conclusion Changes of signal averaged orthogonal P wave morphology (biphasic signal in Lead Z), earlier reported in PAF patients, are common in healthy subjects and appear predominantly after the age of 50. Subtle age-related prolongation of PWD is unlikely to be sufficient as a sole explanation of this finding that is thought to represent interatrial conduction disturbances. To serve as future reference, P wave morphology parameters of the healthy subjects are provided.
44.	Havmöller, Rasmus, et al. (author) Evolution of P-wave morphology in healthy individuals: a 3-year follow-up study. 2009 In: Annals of Noninvasive Electrocardiology. - 1082-720X. ; 14:3, s. 226-233 Journal article (peer-reviewed)abstract BACKGROUND: Orthogonal P-wave morphology in healthy men and women has been described using unfiltered signal-averaged technique and holds information on interatrial conduction. The stability of P-wave morphology in healthy subjects over time is not fully known. METHODS: Sixty-seven healthy volunteers were investigated (29 males, aged 63 +/- 14 years, 48 females, 60 +/- 13 years). Orthogonal lead data (X, Y, and Z) were derived from standard 12-lead ECGs (recording length 6 minutes, sampling rate 1kHz, resolution 0.625 muV) recorded at baseline (BL), and 3 years later at follow-up (FU). P waves were then signal-averaged and analyzed regarding P-wave morphology, locations of maxima, minima, zero-crossings, and P-wave duration (PWD). RESULTS: No differences of P-wave variables were observed at FU compared to BL, including PWD (127 +/- 12 vs 125 +/- 14 ms at BL and FU, respectively, n.s.). In 59 of the 67 subjects (88%), the P-wave morphology was unaltered at FU. However, in the remaining eight cases a distinctively different morphology was observed. The most common change (P=0.030) was from negative polarity to biphasic (-/+) in Lead Z (n=5). In one case the opposite change was observed and in two cases transition into advanced interatrial block morphology was evident at FU. CONCLUSIONS: In the majority of healthy subjects, P-wave morphology is stable at 3-year FU. Subtle morphological changes, observed principally in Lead Z, suggest variation of interatrial conduction. These changes could not be detected by measuring conventional PWD that remained unchanged in the total population.
45.	Holmqvist, Anders, et al. (author) Dynamic Multi-Objective Optimization of Batch Chromatographic Separation Processes 2015 In: Computer Aided Chemical Engineering. - 1570-7946. - 9780444634290 ; 37, s. 815-820 Conference paper (peer-reviewed)abstract This contribution presents a novel offline dynamic multi-objective optimization framework for high-pressure liquid chromatographic (HPLC) processes in batch elution mode. The framework allows for optimization of general elution trajectories parametrized with piecewise constant control signals. It is based on a simultaneous method where both the control and state variables are fully discretized in the temporal domain, using orthogonal collocations on finite elements, and the state variables are discretized in the spatial domain, using a finite volume weighted essentially non-oscillatory (WENO) scheme. The resulting finite dimensional nonlinear program (NLP) is solved using a primal-dual interior point method and automatic differentiation techniques. The advantages of this open-loop optimal control methodology are highlighted through the solution of a challenging ternary complex mixture separation problem for a hydrophobic interaction chromatography (HIC) system. For a bi-objective optimization of the target component productivity and yield, subject to a purity constraint, the set of Pareto solutions generated with general elution trajectories showed considerable improvement in the productivity objective when compared to the Pareto set obtained using conventional linear elution trajectories.
46.	Holmqvist, Anders, et al. (author) Dynamic parameter estimation of atomic layer deposition kinetics applied to in situ quartz crystal microbalance diagnostics 2014 In: Chemical Engineering Science. - : Elsevier BV. - 0009-2509 .- 1873-4405. ; 111, s. 15-33 Journal article (peer-reviewed)abstract This paper presents the elaboration of an experimentally validated model of a continuous cross flow atomic layer deposition (ALD) reactor with temporally separated precursor pulsing encoded in the Moclelica language. For the experimental validation of the model, in situ quartz crystal microbalance (QCM) diagnostics was used to yield submonolayer resolution of mass deposition resulting from thin film growth of ZnO from Zn(C-2)(2) and H2O precursors. The ZnO ALD reaction intrinsic kinetic mechanism that was developed accounted for the temporal evolution of the equilibrium fractional surface concentrations of precursor adducts and their transition states for each half reaction, This mechanism was incorporated into a rigorous model of reactor transport, which comprises isothermal compressible equations for the conservation of mass, momentum and gas-phase species. The physically based model in this way relates the local partial pressures of precursors to the dynamic composition of the growth surface, and ultimately governs the accumulated mass trajectory at the QCM sensor. Quantitative rate information can then be extracted by means of dynamic parameter estimation. The continuous operation of the reactor is described by limit-cycle dynamic solutions and numerically computed using Radau collocation schemes and solved using CasADi's interface to [PORT. Model predictions of the transient mass gain per unit area of exposed surface QCM sensor, resolved at a single pulse sequence, were in good agreement with experimental data under a wide range of operating conditions. An important property of the limit-cycle solution procedure is that it enables the systematic approach to analyze the dynamic nature of the growth surface composition as a function of process operating parameters. Especially, the dependency of the film growth rate per limit-cycle on the half-cycle precursor exposure close and the process temperature was thoroughly assessed and the difference between ALD in saturating and in non-saturating film growth conditions distinguished. (c) 2014 Elsevier Ltd. All rights reserved.
47.	Holmqvist, Anders, et al. (author) Methods and Tools for Robust Optimal Control of Batch Chromatographic Separation Processes 2015 In: Processes. - : MDPI AG. - 2227-9717. ; 3:3, s. 568-606 Journal article (peer-reviewed)abstract This contribution concerns the development of generic methods and tools for robust optimal control of high-pressure liquid chromatographic separation processes. The proposed methodology exploits a deterministic robust formulation, that employs a linearization of the uncertainty set, based on Lyapunov differential equations to generate optimal elution trajectories in the presence of uncertainty. Computational tractability is obtained by casting the robust counterpart problem in the framework of bilevel optimal control where the upper level concerns forward simulation of the Lyapunov differential equation, and the nominal open-loop optimal control problem augmented with the robustified target component purity inequality constraint margin is considered in the lower level. The lower-level open-loop optimal control problem, constrained by spatially discretized partial differential equations, is transcribed into a finite dimensional nonlinear program using direct collocation, which is then solved by a primal-dual interior point method. The advantages of the robustification strategy are highlighted through the solution of a challenging ternary complex mixture separation problem for a hydrophobic interaction chromatography system. The study shows that penalizing the changes in the zero-order hold control gives optimal solutions with low sensitivity to uncertainty. A key result is that the robustified general elution trajectories outperformed the conventional linear trajectories both in terms of recovery yield and robustness.
48.	Holmqvist, Anders, et al. (author) Open-loop optimal control of batch chromatographic separation processes using direct collocation 2016 In: Journal of Process Control. - : Elsevier BV. - 0959-1524. ; 46, s. 55-74 Journal article (peer-reviewed)abstract This contribution presents a novel model-based methodology for open-loop optimal control of batch high-pressure liquid chromatographic (HPLC) separation processes. The framework allows for simultaneous optimization of target component recovery yield and production rate with respect to a parameterization of the input elution trajectory and fractionating interval endpoints. The proposed methodology implies formulating and solving a large-scale dynamic optimization problem (DOP) constrained by partial differential equations (PDEs) governing the multi-component system dynamics. It is based on a simultaneous method where both the control and state variables are fully discretized in the temporal domain, using direct local collocation on finite elements, and the state variables are discretized in the spatial domain, using an adaptive finite volume weighted essentially non-oscillatory (WENO) scheme. The direct transcription of the DOP described by Modelica, and its extension Optimica, code into a sparse nonlinear programming problem (NLP) is thoroughly presented. The NLP was subsequently solved using CasADi's (Computer algebra system with Automatic Differentiation) interface to the primal-dual interior point method IPOPT. The advantages of the open-loop optimal control strategy are highlighted through the solution of a challenging ternary complex mixture separation problem of human insulin analogs, with the intermediately eluting component as the target, for a hydrophobic interaction chromatography system. Moreover, the high intercorrelation between the shape of the optimal elution trajectories and the fractionation interval endpoints is thoroughly investigated. It is also demonstrated that the direct transcription methodology enabled accurate and efficient computation of optimal cyclic-steady-state solutions, which govern that state and control variables conform to periodicity constraints imposed on column re-generation and re-equilibration. By these means, the generic methods and tools developed here are applicable to continuous chromatographic separation technologies, including the continuous simulated moving bed (SMB) and the multicolumn counter-current solvent gradient purification (MCSGP) process.
49.	Holmqvist, Anders, et al. (author) Scale-up Analysis of Continuous Cross-flow Atomic Layer Deposition Reactor Designs 2014 In: Chemical Engineering Science. - : Elsevier BV. - 0009-2509. ; 117, s. 301-317 Journal article (peer-reviewed)abstract This paper presents the development of a non-dimensional model of a continuous cross-flow atomic layer deposition (ALD) reactor with temporally separated precursor pulsing and a structured model-based methodology for scaling up the substrate dimensions. The model incorporates an ALD gas–surface reaction kinetic mechanism for the deposition of thin ZnO films from Zn(C2H5)2 and H2O precursors that was experimentally validated in our previous work (Holmqvist et al., 2012, 2013a). In order to maintain dynamic similarity, a scaling analysis was applied based on the dimensionless numbers, appearing in non-dimensionalized momentum and species mass conservation equations, that describe the convective laminar flow, mass transfer and heterogeneous reaction. The impact on these dimensionless numbers and, more importantly, the impact on the limit-cycle deposition rate and its relative uniformity was thoroughly investigated when linearly scaling up the substrate dimensions. In the scale-up procedure, the limit-cycle precursor utilization was maximized by means of dynamic optimization, while ensuring that identical deposition profiles were obtained in the scaled-up system. The results presented here demonstrated that the maximum precursor yields were promoted at higher substrate dimensions. Limit-cycle dynamic solutions to the non-dimensionalized model, computed with a collocation discretization in time, revealed that it is a combination of the degree of precursor depletion in the flow direction and the magnitude of the pressure drop across the reactor chamber that governs the extent of the deposition profile non-uniformity. A key finding of this study is the identification of optimal scaling rules for maximizing precursor utilization in the scaled-up system while maintaining fixed absolute growth rate and its relative uniformity.
50.	Holmqvist, Fredrik, et al. (author) A decade of catheter ablation of cardiac arrhythmias in Sweden : ablation practices and outcomes 2019 In: European Heart Journal. - : Oxford University Press (OUP). - 0195-668X .- 1522-9645. ; 40:10, s. 820-830 Journal article (peer-reviewed)abstract Aims: Catheter ablation is considered the treatment of choice for many tachyarrhythmias, but convincing 'real-world' data on efficacy and safety are lacking. Using Swedish national registry data, the ablation spectrum, procedural characteristics, as well as ablation efficacy and reported adverse events are reported.Methods and Results: Consecutive patients (≥18 years of age) undergoing catheter ablation in Sweden between 01 January 2006 and 31 December 2015 were included in the study. Follow-up (repeat ablation and vital status) was collected through 31 December 2016. A total of 26 642 patients (57 ± 15 years, 62% men), undergoing a total of 34 428 ablation procedures were included in the study. In total, 4034 accessory pathway/Wolff-Parkinson-White syndrome (12%), 7358 AV-nodal re-entrant tachycardia (21%), 1813 atrial tachycardia (5.2%), 5481 typical atrial flutter (16%), 11 916 atrial fibrillation (AF, 35%), 2415 AV-nodal (7.0%), 581 premature ventricular contraction (PVC, 1.7%), and 964 ventricular tachycardia (VT) ablations (2.8%) were performed. Median follow-up time was 4.7 years (interquartile range 2.7-7.0). The spectrum of treated arrhythmias changed over time, with a gradual increase in AF, VT, and PVC ablation (P < 0.001). Decreasing procedural times and utilization of fluoroscopy with time, were seen for all arrhythmia types. The rates of repeat ablation differed between ablation types, with the highest repeat ablation seen in AF (41% within 3 years). The rate of reported adverse events was low (n = 595, 1.7%). Death in the immediate period following ablation was rare (n = 116, 0.34%).Conclusion: Catheter ablations have shifted towards more complex procedures over the past decade. Fluoroscopy time has markedly decreased and the efficacy of catheter ablation seems to improve for AF.

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