| 1. |
- Otero, Jaime, et al.
(författare)
-
Basin-scale phenology and effects of climate variability on global timing of initial seaward migration of Atlantic salmon (Salmo salar)
- 2014
-
Ingår i: Global Change Biology. - : Wiley. - 1354-1013 .- 1365-2486. ; 20:1, s. 61-75
-
Tidskriftsartikel (refereegranskat)abstract
- Migrations between different habitats are key events in the lives of many organisms. Such movements involve annually recurring travel over long distances usually triggered by seasonal changes in the environment. Often, the migration is associated with travel to or from reproduction areas to regions of growth. Young anadromous Atlantic salmon (Salmo salar) emigrate from freshwater nursery areas during spring and early summer to feed and grow in the North Atlantic Ocean. The transition from the freshwater ('parr') stage to the migratory stage where they descend streams and enter salt water ('smolt') is characterized by morphological, physiological and behavioural changes where the timing of this parr-smolt transition is cued by photoperiod and water temperature. Environmental conditions in the freshwater habitat control the downstream migration and contribute to within- and among-river variation in migratory timing. Moreover, the timing of the freshwater emigration has likely evolved to meet environmental conditions in the ocean as these affect growth and survival of the post-smolts. Using generalized additive mixed-effects modelling, we analysed spatio-temporal variations in the dates of downstream smolt migration in 67 rivers throughout the North Atlantic during the last five decades and found that migrations were earlier in populations in the east than the west. After accounting for this spatial effect, the initiation of the downstream migration among rivers was positively associated with freshwater temperatures, up to about 10 °C and levelling off at higher values, and with sea-surface temperatures. Earlier migration occurred when river discharge levels were low but increasing. On average, the initiation of the smolt seaward migration has occurred 2.5 days earlier per decade throughout the basin of the North Atlantic. This shift in phenology matches changes in air, river, and ocean temperatures, suggesting that Atlantic salmon emigration is responding to the current global climate changes.
|
|
| 2. |
|
|
| 3. |
- Grip, Carl Erik, et al.
(författare)
-
Numerical prediction and experimental verification of thermal stratification during holding in pilot plant and production ladles
- 1999
-
Ingår i: ISIJ International. - : Iron and Steel Institute of Japan. - 0915-1559 .- 1347-5460. ; 39:7, s. 715-721
-
Tidskriftsartikel (refereegranskat)abstract
- A 3-dimensional CFD-model has been developed to simulate the natural convection flow in ladles. Qualified measurements of temperature and velocities in 107 and 7 tonne ladles have been made to verify the model. The downward convection flow at the ladle wall has been studied using radioactive isotopes and the thermal stratification has been studied by means of continuous temperature measurements. The experimental techniques are complex and additional numerical simulations have been carried out to study the effect of the measurement technique on the measurement error. The result indicates that the measurements are of sufficient accuracy for the validation. The measurements are compared to predictions from the numerical model. The main conclusion is that the theoretical CFD model gives a very accurate estimation of the temperature distribution during holding.
|
|
| 4. |
- Grip, Carl-Erik, et al.
(författare)
-
Theoretical and practical study of thermal stratification and drainage in ladles of different geometry
- 2000
-
Ingår i: Scandinavian journal of metallurgy. - : Wiley. - 0371-0459 .- 1600-0692. ; 29:1, s. 30-38
-
Tidskriftsartikel (refereegranskat)abstract
- SSAB Lulea, SSAB Oxelosund, MEFOS and Lulea University of Technology have cooperated in developing theoretical models for prediction of thermal stratification and drainage in steel ladles. Predicted results have been verified by measurements done in production ladles with heat weighs of 105 and 200 tonne as well as in a 7-tonne pilot plant ladle. The thermal stratification was measured by thermocouples at different depths. The drainage flow was studied by means of tracer experiments. Numerical simulation models of the steel flow were developed for 7, 105 and 200 tonne steel ladles. The agreement between predictions and measurements was found to be good. The conclusion is that CFD simulation gives a good prediction of stratification and drainage flows in production ladles.
|
|
| 5. |
|
|
| 6. |
|
|
| 7. |
|
|
| 8. |
|
|
| 9. |
- Andersson, Jan, 1973-
(författare)
-
Laborativt arbete i fysikundervisningen : Något som behöver diskuteras!
- 2015
-
Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- BaksidestextI gymnasieskolans kursplaner för ämnet fysik framhålls det undersökande arbetssättet genom att betona att eleverna ska ges förutsättningar att utveckla förmågan att söka svar på frågor, planera, genomföra, tolka och redovisa experiment. Eleverna ska dessutom ges möjligheter att använda sina kunskaper i fysik för att kommunicera, argumentera och presentera slutsatser. Utgångspunkten i den här avhandlingen är att laborationsmomentet skapar en speciell diskurs där eleverna blir aktörer och läraren iträder rollen som observatör. I en sådan miljö skapas förutsättningar för att eleverna på ett naturligt sätt får möjlighet att prata och diskutera fysik, utifrån sina egna förutsättningar. Syftet med denna avhandling är att genom praktikbaserade studier tydliggöra hur fysiklaborationens utformning påverkar elevernas kommunikation och vidare hur eleverna använder språket vid laborationstillfället för att skapa förståelse. Detta bidrar till debatten om fysiklaborationens effektivitet, sett både ur ett undervisnings- och inlärningsperspektiv. Resultaten visar att olika laborationsformer är uppbyggda av liknande aktiviteter, men varierar i tid som ägnas åt de olika aktiviteterna. Aktiviteterna i sin tur skapar samtal av olika karaktär. Olika samtalsformer används för skilda syften. Ett analytiskt ramverk har skapats för att ingående kunna studera hur och vad eleverna talar om både på en lingvistisk och kognitiv nivå.
|
|
| 10. |
|
|
| 11. |
- Angelstam, Per, et al.
(författare)
-
Protecting forest areas for biodiversity in Sweden 1991–2010: the policy implementation process and outcomes on the ground
- 2011
-
Ingår i: Silva Fennica. - : Finnish Society of Forest Science. - 0037-5330 .- 2242-4075. ; 45, s. 1111-1133
-
Tidskriftsartikel (refereegranskat)abstract
- Swedish forest and environmental policies imply that forests should be managed so that all naturally occurring species are maintained in viable populations. This requires maintenance of functional networks of representative natural forest and cultural woodland habitats. We first review the policy implementation process regarding protected areas in Sweden 1991-2010, how ecological knowledge was used to formulate interim short-term and strategic long-term biodiversity conservation goals, and the development of a hierarchical spatial planning approach. Second, we present data about the amount of formally protected and voluntarily set aside forest stands, and evaluate how much remains in terms of additional forest protection, conservation management and habitat restoration to achieve forest and environmental policy objectives in the long-term. Third, a case study in central Sweden was made to estimate the functionality of old Scots pine, Norway spruce and deciduous forest habitats, as well as cultural woodland, in different forest regions. Finally, we assess operational biodiversity conservation planning processes. We conclude that Swedish policy pronouncements capture the contemporary knowledge about biodiversity and conservation planning well. However, the existing area of protected and set-aside forests is presently too small and with too poor connectivity. To bridge this gap, spatial planning, management and restoration of habitat, as well as collaboration among forest and conservation planners need to be improved.
|
|
| 12. |
- Appelros, Peter, et al.
(författare)
-
Trends in baseline patient characteristics during the years 1995-2008 : observations from Riks-Stroke, the Swedish Stroke Register.
- 2010
-
Ingår i: Cerebrovascular Diseases. - : S. Karger AG. - 1015-9770 .- 1421-9786. ; 30:2, s. 114-119
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Reported improvements in outcome in stroke patients treated in hospital are often attributed to advances in stroke care. However, secular trends in patient characteristics that are present already on admission to hospital may also contribute to improved outcome. METHODS: Time trends for baseline data (289,854 stroke admittances) in Riks-Stroke, the Swedish national quality register for stroke care, were analyzed for the years 1995 through 2008. The following data were included: number of strokes for each year, age, sex, risk factors, stroke subtype, stroke severity, functional status and need of external home service before the stroke. RESULTS: The number of annually reported strokes increased until 2005. The proportion of recurrent strokes decreased from 28.0 to 25.9%. The mean age at first-ever stroke increased in women, but not in men. The proportion of smokers dropped, and the proportion of patients who had treated hypertension increased. The stroke severity decreased in men. The prestroke functional status (walking, dressing, toileting) improved in both sexes over these years. More patients lived alone in 2008 than in 1995, and more had home help service. CONCLUSIONS: Many baseline parameters in Riks-Stroke have changed over the years. This has consequences for the interpretation of outcome data. Some changes may be due to inclusion bias, others due to alterations in general health, evolution of vascular risk factors or demographics.
|
|
| 13. |
- Appelros, Peter, 1953-, et al.
(författare)
-
Trends in Stroke Treatment and Outcome between 1995 and 2010 : Observations from Riks-Stroke, the Swedish Stroke Register
- 2014
-
Ingår i: Cerebrovascular Diseases. - : S. Karger AG. - 1015-9770 .- 1421-9786. ; 37:1, s. 22-29
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Continuous changes in stroke treatment and care, as well as changes in stroke characteristics, may alter stroke outcome over time. The aim of this paper is to describe time trends for treatment and outcome data, and to discuss if any such changes could be attributed to quality changes in stroke care. Methods: Data from Riks-Stroke, the Swedish stroke register, were analyzed for the time period of 1995 through 2010. The total number of patients included was 320,181. The following parameters were included: use of computed tomography (CT), stroke unit care, thrombolysis, medication before and after the stroke, length of stay in hospital, and discharge destination. Three months after stroke, data regarding walking, toileting and dressing ability, as well social situation, were gathered. Survival status after 7, 27 and 90 days was registered. Results: In 1995, 53.9% of stroke patients were treated in stroke units. In 2010 this proportion had increased to 87.5%. Fewer patients were discharged to geriatric or rehabilitation departments in later years (23.6% in 2001 compared with 13.4% in 2010), but more were discharged directly home (44.2 vs. 52.4%) or home with home rehabilitation (0 vs. 10.7%). The need for home help service increased from 18.2% in 1995 to 22.1% in 2010. Regarding prevention, more patients were on warfarin, antihypertensives and statins both before and after the stroke. The functional outcome measures after 3 months did improve from 2001 to 2010. In 2001, 83.8% of patients were walking independently, while 85.6% were independent in 2010. For toileting, independence increased from 81.2 to 84.1%, and for dressing from 78.0 to 80.4%. Case fatality (CF) rates after 3 months increased from 18.7% (2001) to 20.0% (2010). This trend is driven by patients with severe strokes. Conclusions: Stroke outcomes may change over a relatively short time period. In some ways, the quality of care has improved. More stroke patients have CT, more patients are treated in stroke units and more have secondary prevention. Patients with milder strokes may have benefited more from these measures than patients with severe strokes. Increased CF rates for patients with severe stroke may be caused by shorter hospital stays, shorter in-hospital rehabilitation periods and lack of suitable care after discharge from hospital.
|
|
| 14. |
- Asplund, Kjell, et al.
(författare)
-
Hemikraniektomi är livräddande, visar Riks-Stroke : erfarenheter av ingreppet vid malign hjärninfarkt och intracerebral blödning
- 2014
-
Ingår i: Läkartidningen. - : Sveriges läkarförbund. - 0023-7205 .- 1652-7518. ; 111:3-4
-
Tidskriftsartikel (refereegranskat)abstract
- From 2009 to mid-2013, 229 hemicraniectomies were reported in Riks-Stroke, of which 43 were performed in patients with intracerebral hemorrhage. In patients with brain infarction, it was performed in 0.19% (all ages) and 1.07% (below 60 years), higher than reported from the US. Of the hemicraniectomies, 45% were performed in patients above 60 years. Survival was 83% at 3 months and 81% at 12 months, similar to survival reported in the literature. Three months after hemicraniectomy, 69% of survivors responded to a follow-up questionnaire. Of these, 31% were independent in personal ADL and 46% were living at home. Case fatality was higher but functional outcome in survivors was similar in patients above 60 years compared to below 60. In conclusion, outcomes are similar in Sweden to those reported in randomized trials and international observational studies. With proper patient selection, it seems that hemicraniectomy may also benefit patients above 60 years.
|
|
| 15. |
- Asplund, Kjell, et al.
(författare)
-
Patient dissatisfaction with acute stroke care
- 2009
-
Ingår i: Stroke. - : American Heart Association, Inc.. - 0039-2499 .- 1524-4628. ; 40:12, s. 3851-3856
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE: Riks-Stroke, the Swedish Stroke Register, was used to explore patient characteristics and stroke services as determinants of patient dissatisfaction with acute in-hospital care. METHODS: All 79 hospitals in Sweden admitting acute stroke patients participate in Riks-Stroke. During 2001 to 2007, 104,876 patients (87% of survivors) responded to a follow-up questionnaire 3 months after acute stroke; this included questions on satisfaction with various aspects of stroke care. RESULTS: The majority (>90%) were satisfied with acute in-hospital stroke care. Dissatisfaction was closely associated with outcome at 3 months. Patient who were dependent regarding activities of daily living, felt depressed, or had poor self-perceived general health were more likely to be dissatisfied. Dissatisfaction with global acute stroke care was linked to dissatisfaction with other aspects of care, including rehabilitation and support by community services. Patients treated in stroke units were less often dissatisfied than patients in general wards, as were patients who had been treated in a small hospital (vs medium or large hospitals) and patient who had participated in discharge planning. In multivariate analyses, the strongest predictor of dissatisfaction with acute care was poor outcome (dependency regarding activities of daily living, depressed mood, poor self-perceived health). CONCLUSIONS: Dissatisfaction with in-hospital acute stroke care is part of a more extensive complex comprising poor functional outcome, depressive mood, poor self-perceived general health, and dissatisfaction not only with acute care but also with health care and social services at large. Several aspects of stroke care organization are associated with a lower risk of dissatisfaction.
|
|
| 16. |
|
|
| 17. |
|
|
| 18. |
- Asplund, Kjell, et al.
(författare)
-
The Riks-Stroke story : building a sustainable national register for quality assessment of stroke care
- 2011
-
Ingår i: International Journal of Stroke. - : SAGE Publications. - 1747-4930 .- 1747-4949. ; 6:2, s. 99-108
-
Tidskriftsartikel (refereegranskat)abstract
- Background Riks-Stroke, the Swedish Stroke Register, is the world's longest-running national stroke quality register (established in 1994) and includes all 76 hospitals in Sweden admitting acute stroke patients. The development and maintenance of this sustainable national register is described. Methods Riks-Stroke includes information on the quality of care during the acute phase, rehabilitation and secondary prevention of stroke, as well as data on community support. Riks-Stroke is unique among stroke quality registers in that patients are followed during the first year after stroke. The data collected describe processes, and medical and patient-reported outcome measurements. The register embraces most of the dimensions of health-care quality (evidence-based, safe, provided in time, distributed fairly and patient oriented). Result Annually, approximately 25 000 patients are included. In 2009, approximately 320 000 patients had been accumulated (mean age 76-years). The register is estimated to cover 82% of all stroke patients treated in Swedish hospitals. Among critical issues when building a national stroke quality register, the delicate balance between simplicity and comprehensiveness is emphasised. Future developments include direct transfer of data from digital medical records to Riks-Stroke and comprehensive strategies to use the information collected to rapidly implement new evidence-based techniques and to eliminate outdated methods in stroke care. Conclusions It is possible to establish a sustainable quality register for stroke at the national level covering all hospitals admitting acute stroke patients. Riks-Stroke is fulfilling its main goals to support continuous quality improvement of Swedish stroke services and serve as an instrument for following up national stroke guidelines.
|
|
| 19. |
|
|
| 20. |
- Asplund, Kjell, et al.
(författare)
-
Use of public transport by stroke survivors with persistent disability
- 2012
-
Ingår i: Scandinavian Journal of Disability Research. - : Stockholm University Press. - 1501-7419 .- 1745-3011. ; 14:4, s. 289-299
-
Tidskriftsartikel (refereegranskat)abstract
- Use of public transport (bus, train, air, ship) by persons disabled after stroke is an expression of autonomy and facilitates social interactions. Based on Riks-Stroke, the Swedish stroke register, 882 persons with persistent, moderate or severe physical disability (mean age 71 years) responded to a questionnaire 12-28 months after stroke. A minority of the respondents had travelled by bus (21%), train (9%), air (14%) or ship (12%) during the last year. Barriers perceived by persons that had abstained from travelling were dominated by physical constraints, but there were also frequent cognitive constraints. Fear of travelling was not perceived as a major constraint. The majority of persons who had actually used public transport did not report any negative experiences. Air and ship journeys were generally perceived as somewhat less troublesome than journeys by bus or train. Thus, public transport is used infrequently in people moderately or severely disabled after stroke. Anticipated cognitive constraints contribute importantly to non-use of public transport. Disabled stroke survivors who have not used public transport may overestimate the actual barriers to use of public transport.
|
|
| 21. |
- Aurell, Ylva, et al.
(författare)
-
Repeatability of sonographic measurements in clubfeet
- 2004
-
Ingår i: Acta Radiologica. - : SAGE Publications. - 1600-0455 .- 0284-1851. ; 45:6, s. 622-627
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose: To assess the intra- and interobserver agreement of ultrasound assessment of clubfoot patho-anatomy in early childhood. Material and Methods: Seventeen clubfeet in 12 children were sequentially scanned by 2 examiners and repeat assessments were carried out independently. Three well-defined imaging planes were chosen to evaluate navicular displacement: the medial malleolus-navicular (MM-N) distance, soft tissue thickness, talar deformity and the calcaneocuboid (C-C) distance. Intra- and interobserver agreement was analysed using Cohen's kappa for the discrete variables and by Bland-Altman's graphic technique for measurements. Results: Kappa values for intra-observer agreement were 0.82 for navicular displacement, 0.93 for "talar head pointing laterally", and 0.70 for medial deviation of the talar neck. The corresponding interobserver kappa values were 0.70, 0.68, and 0.36. The mean difference between the two observers for the MM-N distance was 0.42+/-3.0 mm and for the soft tissue thickness 0.35+/-2.0 mm; the C-C distance showed a mean interobserver distance of 0.0+/-2.8 mm. Conclusion: The imaging planes used to study the talo-navicular and calcaneo-cuboid relationships are reproducible and relatively easy to learn. Intra- and interobserver assessments were acceptable for MM-N distance, soft tissue thickness, navicular displacement and "talar head pointing laterally", but questionable for the C-C distance and medial deviation of the talar neck.
|
|
| 22. |
- Aurell, Y, et al.
(författare)
-
Ultrasound anatomy in the neonatal clubfoot
- 2002
-
Ingår i: European Radiology. - : Springer Science and Business Media LLC. - 0938-7994 .- 1432-1084. ; 12:10, s. 2509-2517
-
Tidskriftsartikel (refereegranskat)abstract
- Our objective was to assess clubfoot anatomy by US in newborn babies before and in the early phase of treatment. Reproducible US projections and measurements were carried out on 30 untreated clubfeet in 22 children, consecutively included in the study. The position of the navicular in relation to the head of the talus was visualised in all feet. The mean distance between the medial malleolus and the navicular was significantly shorter in the clubfeet than in normal feet. There was a tendency to medial displacement of the cuboid. Soft tissue thickness at the medial side of the foot was increased in all deformed feet. The measurements showed an acceptable intra- and inter-observer reliability for the different variables assessed (r=0.71-0.96, Pearson's correlation coefficient). With US it is possible to obtain well-defined planes of investigation that give important information about the clubfoot deformity concerning the talo-crural, the talonavicular and the calcaneo-cuboid joints. The method is simple enough to be used in everyday clinical practice and we recommend it as a guide during the non-operative treatment and for preoperative planning.
|
|
| 23. |
- Aurell, Y, et al.
(författare)
-
Ultrasound anatomy in the normal neonatal and infant foot: an anatomic introduction to ultrasound assessment of foot deformities
- 2002
-
Ingår i: European Radiology. - : Springer Science and Business Media LLC. - 0938-7994 .- 1432-1084. ; 12:9, s. 2306-2312
-
Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to establish guidelines for US assessment of the talo-crural, the talo-navicular and the calcaneo-cuboid joints during the first year of life, which could serve as a reference while studying foot deformities. The feet of 54 healthy children were examined at birth and at the age of 4, 7 and 12 months by using three easily defined and reproducible US projections. With a medial projection the relation of the navicular in relation to the medial malleolus and the head of the talus was studied. A lateral projection revealed the calcaneo-cuboid relationship and a dorsal projection the talo-navicular alignment in the sagittal plane. Normal values for measurements of these cartilaginous relationships were established for the different age groups. Intra- and interobserver reliability was assessed and found to be acceptable (r=0.53-0.90, Pearson correlation coefficient). With US it is possible to obtain reproducible planes of investigation that give reliable information about the talo-crural, the talo-navicular and the calcaneo-cuboid relationships during the first year of life.
|
|
| 24. |
|
|
| 25. |
- Bajor, Antal, 1962, et al.
(författare)
-
Normal or increased bile acid uptake in isolated mucosa from patients with bile acid malabsorption.
- 2006
-
Ingår i: Eur J Gastroenterol Hepatol. - 0954-691X. ; 18:4, s. 397-403
-
Tidskriftsartikel (refereegranskat)abstract
- Introduction: Bile acid malabsorption as reflected by an abnormal 75Se-labelled homocholic acid-taurine (75SeHCAT) test is associated with diarrhoea, but the mechanisms and cause-and-effect relations are unclear. Objectives: Primarily, to determine whether there is a reduced active bile acid uptake in the terminal ileum in patients with bile acid malabsorption. Secondarily, to study the linkage between bile acid malabsorption and hepatic bile acid synthesis. Methods: Ileal biopsies were taken from patients with diarrhoea and from controls with normal bowel habits. Maximal active bile acid uptake was assessed in ileal biopsies using a previously validated technique based on uptake of 14C-labelled taurocholate. To monitor the hepatic synthesis, 7[alpha]-hydroxy-4-cholesten-3-one, a bile acid precursor, was assayed in blood. The 75SeHCAT-retention test was used to diagnose bile acid malabsorption. Results: The taurocholate uptake in specimens from diarrhoea patients was higher compared with the controls [median, 7.7 (n=53) vs 6.1 [mu]mol/g per min (n=17)] (P<0.01) but no difference was seen between those with bile acid malabsorption (n=18) versus diarrhoea with a normal 75SeHCAT test (n=23). The 75SeHCAT values and 7[alpha]-hydroxy-4-cholesten-3-one were inversely correlated. Conclusions: The data do not support bile acid malabsorption being due to a reduced active bile acid uptake capacity in the terminal ileum. (C) 2006 Lippincott Williams & Wilkins, Inc.
|
|
| 26. |
|
|
| 27. |
- Blom, Mathias, et al.
(författare)
-
Associations between in-hospital bed occupancy and unplanned 72-h revisits to the emergency department: a register study.
- 2014
-
Ingår i: International Journal of Emergency Medicine. - : Springer Science and Business Media LLC. - 1865-1380 .- 1865-1372. ; 7:Jun 28
-
Tidskriftsartikel (refereegranskat)abstract
- A possible downstream effect of high in-hospital bed occupancy is that patients in the emergency department (ED) who would benefit from in-hospital care are denied admission. The present study aimed at evaluating this hypothesis through investigating associations between in-hospital bed occupancy at the time of presentation in the ED and the probability for unplanned 72-hour (72-h) revisits to the ED among patients discharged at index. A second outcome was unplanned 72-h revisits resulting in admission.
|
|
| 28. |
- Blom, Mathias C., et al.
(författare)
-
Primary triage nurses do not divert patients away from the emergency department at times of high in-hospital bed occupancy - a retrospective cohort study
- 2016
-
Ingår i: BMC Emergency Medicine. - : Springer Science and Business Media LLC. - 1471-227X. ; 16:1
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Emergency department (ED) overcrowding is frequently described in terms of input- throughput and output. In order to reduce ED input, a concept called primary triage has been introduced in several Swedish EDs. In short, primary triage means that a nurse separately evaluates patients who present in the Emergency Department (ED) and either refers them to primary care or discharges them home, if their complaints are perceived as being of low acuity. The aim of the present study is to elucidate whether high levels of in-hospital bed occupancy are associated with decreased permeability in primary triage. The appropriateness of discharges from primary triage is assessed by 72-h revisits to the ED. Methods: The study is a retrospective cohort study on administrative data from the ED at a 420-bed hospital in southern Sweden from 2011-2012. In addition to crude comparisons of proportions experiencing each outcome across strata of in-hospital bed occupancy, multivariate models are constructed in order to adjust for age, sex and other factors. Results: A total of 37,129 visits to primary triage were included in the study. 53.4 % of these were admitted to the ED. Among the cases referred to another level of care, 8.8 % made an unplanned revisit to the ED within 72 h. The permeability of primary triage was not decreased at higher levels of in-hospital bed occupancy. Rather, the permeability was slightly higher at occupancy of 100-105 % compared to <95 % (OR 1.09 95 % CI 1.02-1.16). No significant association between in-hospital bed occupancy and the probability of 72-h revisits was observed. Conclusions: The absence of a decreased permeability of primary triage at times of high in-hospital bed occupancy is reassuring, as the opposite would have implied that patients might be denied entry not only to the hospital, but also to the ED, when in-hospital beds are scarce.
|
|
| 29. |
- Blom, Mathias, et al.
(författare)
-
Patients presenting at the emergency department with acute abdominal pain are less likely to be admitted to inpatient wards at times of access block: a registry study.
- 2015
-
Ingår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. - : Springer Science and Business Media LLC. - 1757-7241. ; 23
-
Tidskriftsartikel (refereegranskat)abstract
- Also known as access block, shortage of inpatient beds is a common cause of emergency department (ED) boarding and overcrowding, which are both associated with impaired quality of care. Recent studies have suggested that access block not simply causes boarding in EDs, but may also result in that patients are less likely to be admitted to the hospital from the ED. The present study's aim was to investigate whether this effect remained for patients with acute abdominal pain, for which different management strategies have emerged. Access block was defined in terms of hospital occupancy and the appropriateness of ED discharges addressed as 72 h revisits to the ED.
|
|
| 30. |
- Blom, Mathias, et al.
(författare)
-
The probability of patients being admitted from the emergency department is negatively correlated to in-hospital bed occupancy - a registry study.
- 2014
-
Ingår i: International Journal of Emergency Medicine. - : Springer Science and Business Media LLC. - 1865-1380 .- 1865-1372. ; 7:8
-
Tidskriftsartikel (refereegranskat)abstract
- The association between emergency department (ED) overcrowding and poor patient outcomes is well described, with recent work suggesting that the phenomenon causes delays in time-sensitive interventions, such as resuscitation. Even though most researchers agree on the fact that admitted patients boarding in the ED is a major contributing factor to ED overcrowding, little work explicitly addresses whether in-hospital occupancy is associated to the probability of patients being admitted from the ED. The objective of the present study is to investigate whether such an association exists.
|
|
| 31. |
- Blom, Mathias, et al.
(författare)
-
The probability of readmission within 30 days of hospital discharge is positively associated with inpatient bed occupancy at discharge - a retrospective cohort study.
- 2015
-
Ingår i: BMC Emergency Medicine. - : Springer Science and Business Media LLC. - 1471-227X. ; 15:1
-
Tidskriftsartikel (refereegranskat)abstract
- Previous work has suggested that given a hospital's need to admit more patients from the emergency department (ED), high inpatient bed occupancy may encourage premature hospital discharges that favor the hospital's need for beds over patients' medical interests. We argue that the effects of such action would be measurable as a greater proportion of unplanned hospital readmissions among patients discharged when the hospital was full than when not. In response, the present study tested this hypothesis by investigating the association between inpatient bed occupancy at the time of hospital discharge and the 30-day readmission rate.
|
|
| 32. |
- Boegard, TL, et al.
(författare)
-
Distribution of MR-detected cartilage defects of the patellofemoral joint in chronic knee pain
- 2003
-
Ingår i: Osteoarthritis and Cartilage. - 1063-4584. ; 11:7, s. 494-498
-
Tidskriftsartikel (refereegranskat)abstract
- Objectives: The aim of the study was to detect cartilage defects and determine the center of these defects in MR imaging of the patellofemoral joint (PFJ) in middle-aged people with chronic knee pain. Design: In the format of a prospective study of early osteoarthritis (OA), this cross-sectional study of the signal knee (the most painful one at inclusion in the study in 1990) in 59 individuals, 30 women and 29 men (aged 41-58 years, mean 50 years) with chronic knee pain, with or without radiographically determined knee OA, was examined using MR imaging on a 1.0 T imager. Cartilage defects and the center of these defects in the PFJ were recorded. Results: Cartilage defects were found more often in the patella (40 knees) than in the femoral trochlea (23 knees) (P<0.001) and were unevenly distributed in the patella (P<0.001), with most cartilage defects in the mid-patella. Conclusions: Since cartilage defects occur more commonly in the mid-patella, radiographs obtained with a knee flexion of approximately 45 may be more accurate to show cartilage defects of early OA of the PFJ than views with another knee flexion. Crown Copyright (C) 2003 Published by Elsevier Science Ltd on behalf of OsteoArthritis Research Society International. All rights reserved.
|
|
| 33. |
- Boegard, TL, et al.
(författare)
-
Joint space width of the tibiofemoral and of the patellofemoral joint in chronic knee pain with or without radiographic osteoarthritis: a 2-year follow-up
- 2003
-
Ingår i: Osteoarthritis and Cartilage. - 1063-4584. ; 11:5, s. 370-376
-
Tidskriftsartikel (refereegranskat)abstract
- Objectives: To assess the interval change of the minimal joint space width (MJS) in radiographs of the tibiofemoral (TF) joint and of the patellofemoral (PF) joint with a 2-year follow-up in middle-aged people with longstanding knee pain with or without radiographic osteoarthritis (OA) and to study the precision of the MJS measurements. Design: In the format of a prospective study of early OA the signal knee in 55 people, 28 men and 27 women (aged 41-57 years, median 50), with chronic knee pain at inclusion was examined with a 2-year interval (median 25 months, range 21-30). The MJS of the TF joint was measured using a flexed PA view in weightbearing and the MJS of the PF joint using an axial view in standing. Results: The MJS of the TF joint decreased medially by 0.056+/-0.44 mm (n.s.) and increased laterally by 0.080+/-0.51 mm (n.s.) during the time of observation. In knees with an MJS medially that was less or the same as compared with the lateral compartment, the MJS decreased by 0.14+/-0.38 mm (p=0.038) and in a subgroup of these knees, without osteophytes, the MJS decreased by 0.14+/-0.27 mm (p=0.01 8). The MJS of the PF joint decreased by 0.019 mm (n.s.) during the time of observation. The coefficient of variation for intra- and interobserver MJS measurements of the TF joint was 1.0 and 1.1% medially and 2.3 and 2.7% laterally, and for measurement error 6.9% medially and 4.8% laterally, respectively. The coefficient of variation for intra- and interobserver MJS measurements of the PF joint was 8.1 and 5.8% medially and 7.5 and 10.1% laterally and for the measurement error it was 8.1% medially and 8.5% laterally, respectively. Conclusions: A statistically significant reduction of the. MJS was only demonstrated in the medial compartment of the TF joint in those individuals who had an MJS in this compartment which was less or the same as compared with the lateral compartment as well as in a subgroup of these knees without osteophytes. The radiographic examinations and the MJS measurements were reproducible. (C) 2003 OsteoArthritis Research Society International. Published by Elsevier Science Ltd. All rights reserved.
|
|
| 34. |
- Boegard, T.L., et al.
(författare)
-
Magnetic resonance imaging of the knee in chronic knee pain. A 2-year follow-up
- 2001
-
Ingår i: Osteoarthritis and Cartilage. - : Elsevier BV. - 1063-4584. ; 9:5, s. 473-480
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of the study was to evaluate the change over time of cartilage defects, subchondral lesions and meniscal abnormalities of the knee using magnetic resonance (MR) imaging with a 2-year interval in patients with chronic knee pain. Design: In the format of a prospective study of early osteoarthritis (OA), the signal knee (most painful at the inclusion in the study 1990) in 47 individuals, 25 women and 22 men (aged 41-57 years, median 50), with chronic knee pain, with or without radiographically determined knee OA, were examined using MR imaging on a 1.0 T imager with a 2-year interval (median 25 months, range 21-30). Cartilage defects, subchondral lesions and meniscal abnormalities were recorded and compared in blind between the examinations. Results: Five new cartilage defects and eight subchondral lesions appeared during the 2-year interval. Seven defects and seven subchondral lesions disappeared during the same time. Thirty-two out of 93 cartilage defects (34%) and 19 out of 32 subchondral lesions (59%) displayed an increase or a decrease in size over time. A meniscal abnormality appeared in three locations, and disappeared in none. In 14 out of 54 locations (26%) with a meniscal abnormality an increase or a decrease of the abnormality was recorded over time and no abnormality decreased. Conclusions: After the 2 years of observation it was possible to register, using MR imaging, the appearance, increase, decrease and disappearance of cartilage defects, subchondral lesions and meniscal abnormalities in middle-aged people with chronic knee pain. This has to be considered in studies of the natural course of knee CA as well as in studies of the intraarticular effect of pharmacological treatment aiming at cartilage repair or protection.
|
|
| 35. |
|
|
| 36. |
- Boegård, Torsten, et al.
(författare)
-
Postero-anterior radiogram of the knee in weightbearing and semiflexion. Comparison with MR imaging
- 1997
-
Ingår i: Acta Radiologica. - : SAGE Publications. - 0001-6926 .- 0284-1851 .- 1600-0455. ; 38:6, s. 1063-1070
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose: the purpose was four-fold: to assess the reproducibility of p.a. weight-bearing radiograms of the knee and the minimal joint-space (MJS) width measurements in these radiograms; to compare the MJS with MR-detected cartilage defects; to evaluate the location of these cartilage defects; and to estimate the relation between meniscal abnormalities and joint-space narrowing Material and Methods: Fifty-nine individuals, aged 41–58 years (mean 50), with chronic knee pain were examined by means of p.a. weight-bearing radiograms in semi-flexion with fluoroscopic guidance of the knee joint. the MJS was measured with a standard ruler. on the same day MR imaging was performed with proton-density- and T2-weighted turbo spin-echo on a 1.0 T imager. Meniscal abnormalities and cartilage defects in the tibiofemoral joint (TFJ) were noted Results and Conclusion: the p.a. view of the knee and the MJS measurements were reproducible. MJS of 3 mm is a limit in diagnosing joint-space narrowing in knees with MR-detected cartilage defects. There was a high proportion <p<0.001) of meniscal abnormality within the narrowed compartments in comparison with those that were not narrowed. A larger number of the cartilage defects (p<0.05) was found in the medial femoral condyle than in any of the other condyles of the TFJ. the defects had a dorsal location <p<0.001) as shown in the weight-bearing radiograms of the knee in semiflexion
|
|
| 37. |
- Chroinin, Danielle Ni, et al.
(författare)
-
Statin Therapy and Outcome After Ischemic Stroke : Systematic Review and Meta-Analysis of Observational Studies and Randomized Trials
- 2013
-
Ingår i: Stroke. - 0039-2499 .- 1524-4628. ; 44:2, s. 448-456
-
Forskningsöversikt (refereegranskat)abstract
- Background and Purpose-Although experimental data suggest that statin therapy may improve neurological outcome after acute cerebral ischemia, the results from clinical studies are conflicting. We performed a systematic review and meta-analysis investigating the relationship between statin therapy and outcome after ischemic stroke. Methods-The primary analysis investigated statin therapy at stroke onset (prestroke statin use) and good functional outcome (modified Rankin score 0 to 2) and death. Secondary analyses included the following: (1) acute poststroke statin therapy (<= 72 hours after stroke), and (2) thrombolysis-treated patients. Results-The primary analysis included 113 148 subjects (27 studies). Among observational studies, statin treatment at stroke onset was associated with good functional outcome at 90 days (pooled odds ratio [OR], 1.41; 95% confidence interval [CI], 1.29-1.56; P<0.001), but not 1 year (OR, 1.12; 95% CI, 0.9-1.4; P=0.31), and with reduced fatality at 90 days (pooled OR, 0.71; 95% CI, 0.62-0.82; P<0.001) and 1 year (OR, 0.80;95% CI, 0.67-0.95; P=0.01). In the single randomized controlled trial reporting 90-day functional outcome, statin treatment was associated with good outcome (OR, 1.5; 95% CI, 1.0-2.24; P=0.05). No reduction in fatality was observed on meta-analysis of data from 3 randomized controlled trials (P=0.9). In studies restricted to of thrombolysis-treated patients, an association between statins and increased fatality at 90 days was observed (pooled OR, 1.25; 95% CI, 1.02-1.52; P=0.03, 3 studies, 4339 patients). However, this association was no longer present after adjusting for age and stroke severity in the largest study (adjusted OR, 1.14; 95% CI, 0.90-1.44; 4012 patients). Conclusion-In the largest meta-analysis to date, statin therapy at stroke onset was associated with improved outcome, a finding not observed in studies restricted to thrombolysis-treated patients. Randomized trials of statin therapy in acute ischemic stroke are needed.
|
|
| 38. |
- Daniel, Jonsson, 1991, et al.
(författare)
-
Experimental Disc Herniation in the Rat Causes Downregulation of Serotonin Receptor 2c in a TNF-dependent Manner.
- 2015
-
Ingår i: Clinical Orthopaedics and Related Research. - : Ovid Technologies (Wolters Kluwer Health). - 0009-921X .- 1528-1132. ; 473:6, s. 1913-1919
-
Tidskriftsartikel (refereegranskat)abstract
- Background During recent decades, the knowledge of the pathophysiology of disc herniation and sciatica has drastically improved. What previously was considered a strict biomechanical process is now considered a more complex interaction between leaked nucleus pulposus and the tissue in the spinal canal. An inflammatory reaction, with tumor necrosis factor (TNF) playing an essential role, has been demonstrated. However, the exact mechanisms of the pathophysiology of disc herniation remain unknown. Questions/purposes In this study we use an animal model to investigate (1) if and/or how experimental disc herniation affects gene expression in the early phase (24 hours postsurgery) in the dorsal root ganglion; and (2) if TNF inhibition can reduce any observed changes. Methods A rat model of disc herniation was used. Twenty rats were evenly divided into four groups: naïve, sham, disc herniation, and disc herniation with TNF inhibition. The dorsal root ganglion of the affected nerve root was harvested 24 hours after surgery and analyzed with a TaqMan Low Density Array® quantitative polymerase chain reaction assay. Gene expression levels in sham were compared with disc herniation to assess question 1 and disc herniation to disc herniation with TNF inhibition to assess question 2. Results Experimental disc herniation caused a decrease in the expression of the serotonin receptor 2c gene (p = 0.022). TNF inhibition was found to reduce the observed decrease in expression of serotonin receptor 2c (p = 0.037). Conclusions Our results suggest that a decrease in the expression of the serotonin receptor 2c gene may contribute to the pathophysiology of disc herniation. Further research on its involvement is warranted. Clinical Relevance This pilot study gives a brief insight into cellular changes that may contribute to the pathophysiology of disc herniation. This knowledge may contribute to the development of more and better treatment options for patients with disc herniation and sciatica.
|
|
| 39. |
|
|
| 40. |
- Domanski, Henryk A, et al.
(författare)
-
Core-needle biopsy performed by the cytopathologist : a technique to complement fine-needle aspiration of soft tissue and bone lesions
- 2005
-
Ingår i: Cancer. - : Wiley. - 1097-0142 .- 0008-543X. ; 105:4, s. 229-239
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Fine-needle aspiration cytology (FNAC) is gaining increased popularity in the diagnosis of musculoskeletal lesions; and, in many patients, a definitive diagnosis can be rendered from aspiration smears alone. The main limitation of FNAC of soft tissue and bone neoplasms is in the evaluation of tissue architecture. In addition cytologic specimens are not always adequate for ancillary studies.METHODS: A consecutive series of 130 patients with soft tissue and bone lesions was examined by core-needle biopsy (CNB) performed by a cytopathologist in conjunction with FNAC. The findings of this combined diagnostic approach were compared with histologic diagnoses made on surgical biopsies and resected specimens from 86 patients. Adequate follow-up was available in all patients.RESULTS: FNAC combined with CNB correctly could identify 77 of 78 malignant lesions and 50 of 52 benign lesions. Only seven patients underwent incisional biopsy. The tumor subtype was determined correctly in 30 of 39 patients (77%) and the malignancy grade was determined in 35 of 39 patients (90%) with primary soft tissue and bone sarcomas compared with the biopsy or operative specimens.CONCLUSIONS: FNAC of musculoskeletal tumors/lesions complemented with CNB combined cytomorphology with tissue architecture and ancillary procedures. In the current study, obtaining FNAC as well as CNB at the same clinic visit and by the cytopathologist made preliminary diagnosis on the day of referral possible. This speeded diagnosis increased the number of correct diagnoses and usually enabled correct subtyping and malignancy grading of sarcomas.
|
|
| 41. |
- Domanski, Henryk, et al.
(författare)
-
Distinct cytologic features of spindle cell lipoma - A cytologic-histologic study with clinical, radiologic, electron microscopic, and cytogenetic correlations
- 2001
-
Ingår i: Cancer. - : Wiley. - 1097-0142 .- 0008-543X. ; 93:6, s. 381-389
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND. Spindle cell lipoma (SCL) is a relatively uncommon, benign tumor that usually presents in the subcutaneous fat of adult men. Although some studies have addressed the histologic findings of SCL, only a few descriptions of aspiration cytology findings have been published. The cytologic features are poorly defined, and aspirates from SCL may cause diagnostic problems, because SCL shares some features with other fatty/spindle cell or myxoid lesions, benign as well as malignant. METHODS. Twelve patients underwent fine-needle aspiration (FNA) cytology as the primary diagnostic modality before surgery. FNA findings were evaluated and correlated with histologic features, In addition, radiologic, electron microscopic, and cytogenetic findings were analyzed. The objective of this study was to determine cytologic criteria of SCL by reviewing cytologic specimens in 12 patients with SCL who underwent FNA cytology. RESULTS. All of the motors arose in adults, and to tumors developed in the subcutaneous tissue of the neck, back, or shoulder girdle. Two patients presented with tumors in atypical locations; one in the tongue and one in the check. Cytologically, all 12 tumors were characterized by a mixture of mature adipocytes, uniform spindle cells, and collagen bundles and/or fibers in varying proportions. The presence of a myxoid matrix and of mast cells was less specific and occurred in six aspirates. CONCLUSIONS. SCL has a characteristic cytologic appearance that, together with clinical data, helps to exclude low-grade liposarcoma as well as other spindle cell and myxoid lesions.
|
|
| 42. |
- Drevhammar, Thomas, et al.
(författare)
-
Comparison of Nasal Continuous Positive Airway Pressure Delivered by Seven Ventilators Using Simulated Neonatal Breathing
- 2013
-
Ingår i: Pediatric Critical Care Medicine. - 1529-7535 .- 1947-3893. ; 14:4, s. E196-E201
-
Tidskriftsartikel (refereegranskat)abstract
- Objectives: Nasal continuous positive airway pressure (NCPAP) is an established treatment for respiratory distress in neonates. Most modern ventilators are able to provide NCPAP. There have been no large studies examining the properties of NCPAP delivered by ventilators. The aim of this study was to compare pressure stability and imposed work of breathing (iWOB) for NCPAP delivered by ventilators using simulated neonatal breathing. Design: Experimental in vitro study. Setting: Research laboratory in Sweden. Intervention: None. Measurements and Main Results: Neonatal breathing was simulated using a mechanical lung simulator. Seven ventilators were tested at different CPAP levels using two breath profiles. Pressure stability and iWOB were determined. Results from three ventilators revealed that they provided a slight pressure support. For these ventilators, iWOB could not be calculated. There were large differences in pressure stability and iWOB between the tested ventilators. For simulations using the 3.4-kg breath profile, the pressure swings around the mean pressure were more than five times greater, and iWOB more than four times higher, for the system with the highest measured values compared with the system with the lowest. Overall, the Fabian ventilator was the most pressure stable system. Evita XL and SERVO-i were found more pressure stable than Fabian in some simulations. The results for iWOB were in accordance with pressure stability for systems that allowed determination of this variable. Conclusions: Some of the tested ventilators unexpectedly provided a minor degree of pressure support. In terms of pressure stability, we have not found any advantages of ventilators as a group compared with Bubble CPAP, Neopuff, and variable flow generators that were tested in our previous study. The variation between individual systems is great within both categories. The clinical importance of these findings needs further investigation.
|
|
| 43. |
- Drevhammar, Thomas, et al.
(författare)
-
Comparison of seven infant continuous positive airway pressure systems using simulated neonatal breathing
- 2012
-
Ingår i: Pediatric Critical Care Medicine. - 1529-7535 .- 1947-3893. ; 13:2, s. E113-E119
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: Continuous positive airway pressure is an established treatment for respiratory distress in neonates. Continuous positive airway pressure has been applied to infants using an array of devices. The aim of this experimental study was to investigate the characteristics of seven continuous positive airway pressure systems using simulated breath profiles from newborns. Design: Experimental in vitro study. Setting: Research laboratory in Sweden. Intervention: None. Measurements and Main Results: In vitro simulation of spontaneous neonatal breathing was achieved with a mechanical lung model. Simulation included two breath profiles, three levels of continuous positive airway pressure with and without short binasal prongs and different levels of constant leak. Pressure stability and imposed work of breathing were determined. Seven continuous positive airway pressure systems were tested. There were large differences in pressure stability and imposed work of breathing between tested continuous positive airway pressure systems. Neopuff and Medijet had the highest pressure instability and imposed work of breathing. Benveniste, Hamilton Universal (Arabella), and Bubble continuous positive airway pressure showed intermediate results. AirLife and Infant Flow had the lowest pressure instability and imposed work of breathing. AirLife and Infant Flow showed the least decrease in delivered pressure when challenged with constant leak. Conclusion: The seven tested continuous positive airway pressure systems showed large variations in pressure stability and imposed work of breathing. They also showed large differences in how well they maintain continuous positive airway pressure when exposed to leak. For most systems, imposed work of breathing increased with increasing continuous positive airway pressure level. The clinical importance of the difference in pressure stability is uncertain. Our results may facilitate the design of clinical studies examining the effect of pressure stability on outcome.
|
|
| 44. |
- Drevhammar, Thomas, et al.
(författare)
-
Seven Ventilators Challenged With Leaks During Neonatal Nasal CPAP : An Experimental Pilot Study
- 2015
-
Ingår i: Respiratory care. - : Daedalus Enterprises. - 0020-1324 .- 1943-3654. ; 60:7, s. 1000-1006
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Nasal CPAP is the most common respiratory support for neonates. Several factors are considered important for effective treatment, including leaks at the patient interface and the delivery of pressure-stable CPAP. Investigations of pressure stability during leaks should include both the change in the mean delivered CPAP and the pressure variation during each breath. The aim of this study was to examine the response of ventilators delivering nasal CPAP when challenged with leaks at the patient interface. METHODS: Seven ventilators providing nasal CPAP at 4 cmH(2)O were challenged with leaks during simulated neonatal breathing. Leak was applied for 15 consecutive breaths at a constant level (1-4 L/min). RESULTS: The 2 aspects of pressure stability were evaluated by measuring the mean delivered CPAP and the amplitude of pressure swings before, during, and after leaks. The ability to maintain the delivered CPAP and the amplitude of pressure swings varied greatly among the 7 ventilators before, during, and after leaks. Four of the ventilators tested have built-in leak compensation. CONCLUSIONS: There was no simple relationship between maintaining delivered CPAP during leaks and providing CPAP with low pressure swing amplitude. Maintaining the delivered CPAP and providing this without pressure swings are 2 separate aspects of pressure stability, and investigations concerning the clinical importance of pressure stability should address both aspects. This study also shows that compensation for leaks does not necessarily provide pressure-stable CPAP.
|
|
| 45. |
- Eklund, K., et al.
(författare)
-
Are digital images good enough? A comparative study of conventional film-screen vs digital radiographs on printed images of total hip replacement.
- 2004
-
Ingår i: European Radiology. - : Springer Science and Business Media LLC. - 0938-7994 .- 1432-1084. ; 14:5, s. 865-869
-
Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to evaluate the inter- and intra-observer variability and to find differences in diagnostic safety between digital and analog technique in diagnostic zones around hip prostheses. In 80 patients who had had a total hip replacement (THR) for more than 2 years, a conventional image and a digital image were taken. Gruen's model of seven distinct regions of interest was used for evaluations. Five experienced radiologists observed the seven regions and noted in a protocol the following distances: stem-cement; cement-bone; and stem-bone. All images were printed on hard copies and were read twice. Weighted kappa, kappa(w), analyses were used. The two most frequently loosening regions, stem-cement region 1 and cement-bone region 7, were closely analyzed. In region 1 the five observers had an agreement of 86.75-97.92% between analog and digital images in stem-cement, which is a varied kappa(w) 0.29-0.71. For cement-bone region 7 an agreement of 87.21-90.45% was found, which is a varied kappa(w) of 0.48-0.58. All the kappa values differ significantly from nil. The result shows that digital technique is as good as analog radiographs for diagnosing possible loosening of hip prostheses.
|
|
| 46. |
- Eklöf, Jenny, 1973-
(författare)
-
Gene technology at stake : Swedish governmental commissions on the border of science and politics
- 2007
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis examines the Swedish political response to the challenges posed by gene technology, seen through the prism of governmental commissions. It discerns and analyses continuities and changes in the Swedish political conception of gene technology, over the course of two decades, 1980–2000. This is done by thematically following ideas of “risks” and “ethics” as they are represented in the inner workings and reception of three governmental commissions. The Gene-Ethics Commission (1981–1984), the Gene Technology Commission (1990–1992) and the Biotechnology Commission (1997–2000) form the empirical focal points of this analysis. The first two provided preparatory policy proposals that preceded the implementation of the Swedish gene technology laws of 1991 and 1994. The last one aimed at presenting a comprehensive Swedish biotechnology policy for the new millennium.The study takes into account the role of governmental commissions as arenas where science and politics intersect in Swedish political life, and illuminates how this type of “boundary organisation”, placed on the border of science and politics, impinges on the understanding of the gene technology issue. The commissions have looked into the limits, dangers, possibilities and future applications of gene technology. They have been appointed to deal with the problematic task of distinguishing between what is routine and untested practices, realistic prediction and “science fiction”, what are unique problems and what are problems substantially similar to older ones, what constitutes a responsible approach as opposed to misconduct and what it means to let things “get out of hand” in contrast to being “in control”. Throughout a period of twenty years, media reports have continued to frame the challenges posed by gene technology as a task of balancing risks and benefits, walking the fine line between “frankenfoods” and “miracle drugs”.One salient problem for the commissions to solve was that science and industry seemed to promote a technology the public opposed and resisted, at least in parts. For both politics and science to gain, or regain, public trust it needed to demonstrate that risks – be it environmental, ethical or health related ones – were under control. Under the surface, it was much more complicated than “science helping politics” to make informed and rational decisions on how to formulate a regulatory policy. Could experts be trusted to participate in policy-making in a neutral way and was it not important, in accordance with democratic norms, to involve the public?
|
|
| 47. |
- Eklöf, Mats, et al.
(författare)
-
Workplace intervention for improved risk perception and preventive activity among workers : using hand-held vibrating machines: a pilot study
- 2023
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- This article presents a pilot study of a 1-h workplace educational intervention implemented among ten construction workers who were highly exposed to hand–arm vibration. The intervention combined risk communication and normative expert advice intended to reinforce preventive behaviour related to vibration, noise, and biomechanical loads. Data for this study comprised intervention notes and interview data from interventionists, and pre- and post-intervention interview data from participating workers.The results suggested that the intervention was sensitive to disturbances and should be directed only to motivated workers possessing sufficient self-efficacy, and only in circumstances in which exposure may be controlled on the local workplace level and by locally implemented measures. Unless these conditions are present, the studied intervention may fail to influence preventive behaviour, and may instead cause cognitive dissonance and frustration among participants and interventionists.
|
|
| 48. |
- Eriksson, Marie, et al.
(författare)
-
Dissemination of thrombolysis for acute ischemic stroke across a nation : experiences from the Swedish stroke register, 2003 to 2008
- 2010
-
Ingår i: Stroke. - 0039-2499 .- 1524-4628. ; 41:6, s. 1115-1122
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE: We used Riks-Stroke, the Swedish Stroke Register, to explore how thrombolysis has been disseminated in Swedish hospitals since it was approved in 2003. METHODS: All 78 hospitals in Sweden admitting patients with acute stroke participate in Riks-Stroke. Between 2003 and 2008, 72 033 adult patients were hospitalized for acute ischemic stroke. We analyzed thrombolysis use by region, patient characteristics, and stroke service settings. RESULTS: Nationwide, the use of thrombolysis increased from 0.9% in 2003 to 6.6% in 2008. There were marked regional differences in the dissemination of thrombolysis, but these gaps narrowed over time. Nonuniversity hospitals reached treatment levels similar to university settings, although with a 2- to 3-year delay. Symptomatic intracranial hemorrhage remained at the 3% to 9% level without an apparent time trend during dissemination. Independent predictors of higher thrombolysis use included younger age, male sex, not living alone, and no history of stroke or diabetes. In 2008, patients admitted to a stroke unit were 5 times more likely to receive thrombolysis than those admitted to general wards. CONCLUSIONS: Nationwide implementation of thrombolysis has been slow but has accelerated mainly due to increased access outside university hospitals. The increased use has been achieved safely, but access has been unequal.
|
|
| 49. |
- Eriksson, Marie, et al.
(författare)
-
Trombolys som akutbehandling vid ischemisk stroke sprids över landet : Men regionala variationer är ännu stora, visar Riks-Stroke-analys
- 2011
-
Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 108:1-2, s. 21-25
-
Tidskriftsartikel (refereegranskat)abstract
- Spridningen av trombolys som akutbehandling vid ischemisk stroke har analyserats hos patienter registrerade i Riks-Stroke under 2003–2009. Implementeringen har varit långsam, även om den varit snabbare än i många andra länder. De regionala variationerna i införandet av trombolys är stora. Trombolys har införts med 2–3 års fördröjning vid icke-universitetssjukhus jämfört med universitetssjukhus. Andra oberoende prediktorer för trombolysbehandling har varit bl a låg ålder, sammanboende, intagning på strokeenhet och intagning på neurologklinik i stället för medicinklinik. Andelen trombolyslarm i målgruppen har nära samband med behandlingsfrekvensen. Spridningen till mindre sjukhus har kunnat genomföras med bevarad patientsäkerhet.
|
|
| 50. |
|
|
