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| 5. |
- Pantazis, N, et al.
(författare)
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Determining the likely place of HIV acquisition for migrants in Europe combining subject-specific information and biomarkers data
- 2019
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Ingår i: Statistical methods in medical research. - : SAGE Publications. - 1477-0334 .- 0962-2802. ; 28:7, s. 1979-1997
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Tidskriftsartikel (refereegranskat)abstract
- In most HIV-positive individuals, infection time is only known to lie between the time an individual started being at risk for HIV and diagnosis time. However, a more accurate estimate of infection time is very important in certain cases. For example, one of the objectives of the Advancing Migrant Access to Health Services in Europe (aMASE) study was to determine if HIV-positive migrants, diagnosed in Europe, were infected pre- or post-migration. We propose a method to derive subject-specific estimates of unknown infection times using information from HIV biomarkers’ measurements, demographic, clinical, and behavioral data. We assume that CD4 cell count (CD4) and HIV-RNA viral load trends after HIV infection follow a bivariate linear mixed model. Using post-diagnosis CD4 and viral load measurements and applying the Bayes’ rule, we derived the posterior distribution of the HIV infection time, whereas the prior distribution was informed by AIDS status at diagnosis and behavioral data. Parameters of the CD4–viral load and time-to-AIDS models were estimated using data from a large study of individuals with known HIV infection times (CASCADE). Simulations showed substantial predictive ability (e.g. 84% of the infections were correctly classified as pre- or post-migration). Application to the aMASE study ( n = 2009) showed that 47% of African migrants and 67% to 72% of migrants from other regions were most likely infected post-migration. Applying a Bayesian method based on bivariate modeling of CD4 and viral load, and subject-specific information, we found that the majority of HIV-positive migrants in aMASE were most likely infected after their migration to Europe.
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| 6. |
- Henkel, C., et al.
(författare)
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Molecular line emission in NGC 4945, imaged with ALMA
- 2018
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Ingår i: Astronomy and Astrophysics. - : EDP Sciences. - 0004-6361 .- 1432-0746. ; 615
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Tidskriftsartikel (refereegranskat)abstract
- NGC 4945 is one of the nearest (D ≈ 3.8 Mpc; 1 00 ≈ 19 pc) starburst galaxies. To investigate the structure, dynamics, and composition of the dense nuclear gas of this galaxy, ALMA band 3 (λ ≈ 3−4 mm) observations were carried out with ≈2 00 resolution. Three HCN and two HC + isotopologues, CS, C 3 H 2 , SiO, HCO, and CH 3 C 2 H were measured. Spectral line imaging demonstrates the presence of a rotating nuclear disk of projected size 10 00 × 2 00 reaching out to a galactocentric radius of r ≈ 100 pc with position angle PA = 45 ◦ ± 2 ◦ , inclination i = 75 ◦ ± 2 ◦ and an unresolved bright central core of size <∼ 2 00 . The continuum source, representing mostly free-free radiation from star forming regions, is more compact than the nuclear disk by a linear factor of two but shows the same position angle and is centered 0 00 . 39 ± 0 00 . 14 northeast of the nuclear accretion disk defined by H 2 O maser emission. Near the systemic velocity but outside the nuclear disk, both HCN J = 1 → 0 and CS J = 2 → 1 delineate molecular arms of length >∼ 15 00 ( >∼ 285 pc) on opposite sides of the dynamical center. These are connected by a (deprojected) ≈ 0.6 kpc sized molecular bridge, likely a dense gaseous bar seen almost ends-on, shifting gas from the front and back side into the nuclear disk. Modeling this nuclear disk located farther inside (r <∼ 100 pc) with tilted rings provides a good fit by inferring a coplanar outflow reaching a characteristic deprojected velocity of ≈50 km s −1 . All our molecular lines, with the notable exception of CH 3 C 2 H, show significant absorption near the systemic velocity (≈571 km s −1 ), within the range ≈500-660 km s −1 . Apparently, only molecular transitions with low critical H 2 density (n crit<∼ 10 4 cm −3 ) do not show absorption. The velocity field of the nuclear disk, derived from CH 3 C 2 H, provides evidence for rigid rotation in the inner few arcseconds and a dynamical mass of M tot = (2.1 ± 0.2) × 10 8 M inside a galactocentric radius of 2 00 . 45 (≈45 pc), with a significantly flattened rotation curve farther out. Velocity integrated line intensity maps with most pronounced absorption show molecular peak positions up to ≈1 00 . 5 (≈30 pc) southwest of the continuum peak, presumably due to absorption, which appears to be most severe slightly northeast of the nuclear maser disk. A nitrogen isotope ratio of 14 N/ 15 N ≈ 200-450 is estimated. This range of values is much higher then previously reported on a tentative basis. Therefore, because 15 N is less abundant than expected, the question for strong 15 N enrichment by massive star ejecta in starbursts still remains to be settled.
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- Tavakol, M, et al.
(författare)
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Diagnostic Approach to the Patients with Suspected Primary Immunodeficiency
- 2020
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Ingår i: Endocrine, metabolic & immune disorders drug targets. - : Bentham Science Publishers Ltd.. - 2212-3873 .- 1871-5303. ; 20:2, s. 157-171
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Tidskriftsartikel (refereegranskat)abstract
- Primary immunodeficiency diseases (PIDs) are a group of more than 350 disorders affecting distinct components of the innate and adaptive immune systems. In this review, the classic and advanced stepwise approach towards the diagnosis of PIDs are simplified and explained in detail.Results:Susceptibility to recurrent infections is the main hallmark of almost all PIDs. However, noninfectious complications attributable to immune dysregulation presenting with lymphoproliferative and/or autoimmune disorders are not uncommon. Moreover, PIDs could be associated with misleading presentations including allergic manifestations, enteropathies, and malignancies.Conclusion:Timely diagnosis is the most essential element in improving outcome and reducing the morbidity and mortality in PIDs. This wouldn’t be possible unless the physicians keep the diagnosis of PID in mind and be sufficiently aware of the approach to these patients.
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| 14. |
- Alipour, F, et al.
(författare)
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Social issues and post-disaster recovery: A qualitative study in an Iranian context
- 2015
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Ingår i: INTERNATIONAL SOCIAL WORK. - : SAGE Publications. - 0020-8728 .- 1461-7234. ; 58:5, s. 689-703
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- The physical impacts of a disaster are usually the most obvious impacts, and they are easily measured. However, there is not sufficient in-depth understanding of social issues arising after disasters. This qualitative study explored three main concepts regarding social issues after an earthquake in an Iranian context: social vulnerability, social uncertainty and confusion, and ignorance of local social capital. Negligence of social issues after disasters leads to delays in returning back to normal life. Policymakers are encouraged to take a comprehensive plan into account which considers these issues and facilitates the process of returning to normal life after earthquakes.
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| 15. |
- Avery, P. J., et al.
(författare)
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A Proposal for an Individualized Pharmacogenetics-Based Warfarin Initiation Dose Regimen for Patients Commencing Anticoagulation Therapy
- 2011
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Ingår i: Clinical Pharmacology and Therapeutics. - : Springer Science and Business Media LLC. - 0009-9236 .- 1532-6535. ; 90:5, s. 701-706
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Tidskriftsartikel (refereegranskat)abstract
- A significant proportion of the interindividual variability in warfarin dose requirements can be explained on the basis of CYP2C9 and VKORC1 genotypes. We report the development of a novel pharmacogenetics-based 3-day warfarin initiation dose (ID) algorithm based on the International Warfarin Pharmacogenetics Consortium (IWPC) maintenance dose algorithm and the CYP2C9 genotype-based variance in warfarin half-life. The predictive value of the pharmacogenetics-based ID was assessed in a large cohort of 671 newly diagnosed patients with thromboembolic disorders who were about to commence anticoagulation therapy in accordance with standard induction regimens. In patients with mean international normalized ratio (INR)(days 4-7)>4.0 (n = 63) after warfarin initiation, the pharmacogenetics-based ID algorithm predicted a markedly lower dose requirement (median reduction = 4.2 mg), whereas in those with mean INR(days 4-7) < 2.0 (n = 145), the predicted dose requirement was very similar to that in the standard regimen. The use of a pharmacogenetics-based ID may avoid overshooting of INR in warfarin-sensitive patients without unduly affecting the time taken to reach target range in the majority of patients.
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| 18. |
- Carpenter, Lucy M, et al.
(författare)
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Independent effects of reported sexually transmitted infections and sexual behavior on HIV-1 prevalence among adult women, men, and teenagers in rural Uganda
- 2002
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Ingår i: Journal of Acquired Immune Deficiency Syndromes. - 1525-4135 .- 1944-7884. ; 29:2, s. 174-180
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To assess whether sexually transmitted infections (STIs) and sexual behavior are independently associated with HIV-1 among adult women, men, and teenagers in rural Uganda. DESIGN: Cross-sectional survey. METHODS: All adults (13 years and older) residing in 18 communities were invited to participate. HIV status was determined from serum samples and data collected during confidential interview. Independent effects of risk factors for HIV were estimated using adjusted odds ratios (ORs) with 95% confidence intervals (CIs) from logistic regression. RESULTS: Women reporting genital ulcers in the last 12 months were over twice as likely to be HIV positive after adjustment for sociodemographic factors and number of lifetime sexual partners (OR, 2.5; 95% CI, 1.9-3.4). Equivalent associations were stronger for men (OR, 3.2; 95% CI, 2.2-4.7) but weaker for teenagers (OR, 2.0, 95% CI, 0.5-8.7). Number of lifetime sexual partners was associated ( p <.05) with HIV status for women, men, and teenagers independently of reported genital ulcers. Teenagers reporting casual partners were over four times ( p <.001), and men reporting condom use almost twice ( p <.001), as likely to be HIV positive. Neither history of genital discharge nor other measures of sexual behavior were independently related to HIV status. CONCLUSION: Reported STIs and sexual behavior are independently associated with HIV in rural Uganda. Community-based interventions to reduce HIV should target both and should include teenagers.
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| 19. |
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Dynamic Positioning based on Voronoi Cells (DPVC)
- 2006. - 1
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Samlingsverk (redaktörskap) (refereegranskat)abstract
- In this paper we are proposing an approach for flexible positioning of players in Soccer Simulation in a Multi-Agent environment. We introduce Dynamic Positioning based on Voronoi Cells (DPVC) as a new method for players' positioning which uses Voronoi Diagram for distributing agents in the field. This method also uses Attraction Vectors that indicate agents' tendency to specific objects in the field with regard to the game situation and players' roles. Finally DPVC is compared with SBSP as the conventional method of positioning.
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| 22. |
- Kamali, Anatoli, et al.
(författare)
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A community randomized controlled trial to investigate impact of improved STD management and behavioural interventions on HIV incidence in rural Masaka, Uganda : trial design, methods and baseline findings
- 2002
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Ingår i: Tropical medicine & international health. - : Wiley. - 1360-2276 .- 1365-3156. ; 7:12, s. 1053-1063
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To describe study design, methods and baseline findings of a behavioural intervention alone and in combination with improved management of sexually transmitted diseases (STDs) aimed at reducing HIV incidence and other STDs. DESIGN: A three-arm community randomized controlled trial (RCT) of 18 rural communities (approximately 96 000 adults) in SW Uganda. A standardized behavioural intervention was implemented in 12 communities (arms A and B) through community-based education, meetings and information leaflets. Six of these communities in addition received improved STD management through government and private health units (arm B). Arm C communities received routine government health services. Impact assessment was through three questionnaire and serological surveys of 750-1000 adults in each community at 18-24-month intervals. The primary outcome measure was HIV incidence and secondary measures were syphilis and herpes simplex virus type 2 incidence, prevalence of Neisseria gonorrhoea and Chlamydia trachomatis and sexual behaviour changes. RESULTS: Approximately 15 000 adults (72% of eligible population) were enrolled at baseline. HIV baseline prevalence rates were 9-10% in all arms and demographic and behavioural characteristics and STD prevalence were also similar. In intervention communities, there were 391 995 attendance at 81 502 activities (6.1 per target adult), 164 063 leaflets distributed (2.6 per person) and 1 586 270 condoms (16.5 condoms per adult). In the STD communities a total of 12 239 STD cases (65% women) were seen over a 5-year period (7.7 per 100 adults/year). CONCLUSION: This is the first community RCT of its type with a behavioural component. There is fair baseline comparability between study arms and process data suggest that interventions were adequately implemented.
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| 23. |
- Lindblom, Rickard P F, 1981-, et al.
(författare)
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Protein Profiling in Serum and Cerebrospinal Fluid Following Complex Surgery on the Thoracic Aorta Identifies Biological Markers of Neurologic Injury.
- 2018
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Ingår i: Journal of Cardiovascular Translational Research. - : Springer Science and Business Media LLC. - 1937-5387 .- 1937-5395. ; 11:6, s. 503-516
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Tidskriftsartikel (refereegranskat)abstract
- Surgery on the arch or descending aorta is associated with significant risk of neurological complications. As a consequence of intubation and sedation, early neurologic injury may remain unnoticed. Biomarkers to aid in the initial diagnostics could prove of great value as immediate intervention is critical. Twenty-three patients operated in the thoracic aorta with significant risk of perioperative neurological injury were included. Cerebrospinal fluid (CSF) and serum were obtained preoperatively and in the first and second postoperative days and assessed with a panel of 92 neurological-related proteins. Three patients suffered spinal cord injury (SCI), eight delirium, and nine hallucinations. There were markers in both serum and CSF that differed between the affected and non-affected patients (SCI; IL6, GFAP, CSPG4, delirium; TR4, EZH2, hallucinations; NF1). The study identifies markers in serum and CSF that reflect the occurrence of neurologic insults following aortic surgery, which may aid in the care of these patients.
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| 25. |
- Quigley, Maria A, et al.
(författare)
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The impact of attending a behavioural intervention on HIV incidence in Masaka, Uganda
- 2004
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Ingår i: AIDS. - : Ovid Technologies (Wolters Kluwer Health). - 0269-9370 .- 1473-5571. ; 18:15, s. 2055-2063
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Changing behaviour is an important method for preventing HIV infection. We examined why a community randomized trial of a behavioural intervention found no significant effect of this on HIV incidence in rural Uganda.DESIGN: An individual-level analysis of a community randomized trial.METHODS: All sexually active, initially HIV-seronegative individuals with data on sexual behaviour were included (1558 men and 1836 women). Uptake of the intervention was measured using self-reported attendance at meetings, videos, dramas, and interactions with community educators in the past year. Sexual behaviour was assessed using self-reported condom use and the number of sexual partners in the past year.RESULTS: Overall, 81% of individuals in the intervention communities and 9% in the comparison communities reported attending at least one of the intervention activities in the past year. Attendance was lower in women, in those aged 55 years or older, and in the widowed. There was a lower HIV incidence in those who reported attending at least one intervention activity compared with those who attended none, and in women this effect was statistically significant (in women, adjusted rate ratio 0.41, 95% CI 0.19-0.89, P = 0.024; in men, adjusted rate ratio 0.66, 95% CI 0.25-1.79, P = 0.42). Reported behaviour change did not differ markedly between those who did and did not report attending any intervention activities.CONCLUSION: Although the intervention had no significant benefit in the communities as a whole, it resulted in a reduced risk of HIV acquisition in women who attended it. The methodological implications for future trials are discussed.
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| 26. |
- Shahri, F., et al.
(författare)
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Effects of heat treatment on the structure and magnetic properties of Al-Ge added Fe73.5-xSi13.5B9Nb3Cu alloys
- 2007
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Ingår i: Physical Review B. Condensed Matter and Materials Physics. - 1098-0121 .- 1550-235X. ; 76:2, s. 024434-
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Tidskriftsartikel (refereegranskat)abstract
- In this work, we have studied the effects of the coaddition of Al(1.5 at. %)/Ge(1 at. %) and heat-treatment temperature on the structure and magnetic properties of rapidly quenched pure Fe73.5-xSi13.5B9Nb3Cu (FINEMET) alloys prepared by the single roller melt spinning process. Two series of as-spun and heat-treated alloys, 400, 480, 560, 640, and 730 degrees C for 1 h in vacuum (10(-6) Torr), were studied using various techniques such as x-ray diffraction (XRD), transmission electron microscopy (TEM), differential scanning calorimetry (DSC), Mossbauer spectroscopy, and B-H loop tracer. Mossbauer analysis carried out on both series of alloys heat treated at 560 degrees C revealed the presence of two phases, Fe3Si phase with D0(3) structure and a residual amorphous phase with reduced hyperfine field (16.9 T) compared to those of Al/Ge added (22.5 T) and pure FINEMET (similar to 23.4 T) alloys, in close agreement with XRD and TEM results. The highest maximum permeability, saturation magnetization, and the lowest coercivity were obtained for both series of alloys when heat treated at 560 degrees C. However, the magnitude of coercivity was lower for the Al/Ge substituted alloy (heat treated at 560 degrees C) compared to that of the pure FINEMET alloy. This is due to the substitution of Al atoms for Fe as confirmed by our XRD and Mossbauer results. Further, a higher ferromagnetic amorphous phase Curie temperature (T-C,T-am) was detected for the Al/Ge added alloy (322 degrees C) compared to that of the pure FINEMET alloy (317 degrees C), which is believed to be mainly related to the presence of Ge atoms in the amorphous matrix. Furthermore, the removal of stress and the setup of nanocrystallization for both series of alloys gave rise to a higher collinear magnetic moment angle. However, this was not the case for the samples heat treated at temperatures above 560 degrees C, for which the formation of the Fe-B hard magnetic phase was confirmed by our XRD, TEM, and Mossbauer results. Finally, the structural-magnetic properties relationship is discussed for various samples studied in this work.
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| 27. |
- van Schie, Rianne M. F., et al.
(författare)
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Genotype-guided dosing of coumarin derivatives : the European pharmacogenetics of anticoagulant therapy (EU-PACT) trial design
- 2009
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Ingår i: Pharmacogenomics (London). - : Future Medicine Ltd. - 1462-2416 .- 1744-8042. ; 10:10, s. 1687-1695
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Tidskriftsartikel (refereegranskat)abstract
- The narrow therapeutic range and wide interpatient variability in dose requirement make anticoagulation response to coumarin derivatives unpredictable. As a result, patients require frequent monitoring to avert adverse effects and maintain therapeutic efficacy. Polymorphisms in VKORC1 and CYP2C9 jointly account for about 40% of the interindividual variability in dose requirements. To date, several pharmacogenetic-guided dosing algorithms for coumarin derivatives, predominately for warfarin, have been developed. However, the potential benefit of these dosing algorithms in terms of their safety and clinical utility has not been adequately investigated in randomized settings. The European Pharmacogenetics of Anticoagulant Therapy (EU-PACT) trial will assess, in a single-blinded and randomized controlled trial with a follow-up period of 3 months, the safety and clinical utility of genotype-guided dosing in daily practice for the three main coumarin derivatives used in Europe. The primary outcome measure is the percentage time in the therapeutic range for international normalized ratio. This report describes the design and protocol for the trial.
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| 28. |
- Verhoef, Talitha I, et al.
(författare)
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A systematic review of cost-effectiveness analyses of pharmacogenetic-guided dosing in treatment with coumarin derivatives.
- 2010
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Ingår i: Pharmacogenomics (London). - : Future Medicine Ltd. - 1462-2416 .- 1744-8042. ; 11:7, s. 989-1002
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Tidskriftsartikel (refereegranskat)abstract
- Anticoagulant therapy with coumarin derivatives is often sub- or supra-therapeutic, resulting in an increased risk of thromboembolic events or hemorrhage, respectively. Pharmacogenetic-guided dosing has been proposed as an effective way of reducing bleeding rates. Clinical trials to confirm the safety, efficacy and effectiveness of this strategy are ongoing, but in addition, it is also necessary to consider the cost-effectiveness of this strategy. This article describes the findings of a systematic review of published cost-effectiveness analyses of pharmacogenetic-guided dosing of coumarin derivatives. Similarities and differences in the approaches used were examined and the quality of the analyses was assessed. The results of the analyses are not sufficient to determine whether or not pharmacogenetic-guided dosing of coumarins is cost effective. More reliable cost-effectiveness estimates need to become available before it is possible to recommend whether or not this strategy should be applied in clinical practice.
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| 29. |
- Verhoef, T. I., et al.
(författare)
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Cost-effectiveness of pharmacogenetic-guided dosing of warfarin in the United Kingdom and Sweden
- 2016
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Ingår i: The Pharmacogenomics Journal. - : Springer Science and Business Media LLC. - 1470-269X .- 1473-1150. ; 16:5, s. 478-484
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Tidskriftsartikel (refereegranskat)abstract
- We aimed to assess the cost-effectiveness of pharmacogenetic-guided dosing of warfarin in patients with atrial fibrillation (AF) in the United Kingdom and Sweden. Data from EU-PACT, a randomized controlled trial in newly diagnosed AF patients, were used to model the incremental costs per quality-adjusted life-year (QALY) gained by pharmacogenetic-guided warfarin dosing versus standard treatment over a lifetime horizon. Incremental lifetime costs were £26 and 382 Swedish kronor (SEK) and incremental QALYs were 0.0039 and 0.0015 in the United Kingdom and Sweden, respectively. The corresponding incremental cost-effectiveness ratios (ICERs) were £6 702 and 253 848 SEK per QALY gained. The ICER was below the willingness-to-pay threshold of £20 000 per QALY gained in 93% of the simulations in the United Kingdom and below 500 000 SEK in 67% of the simulations in Sweden. Our data suggest that pharmacogenetic-guided dosing of warfarin is a cost-effective strategy to improve outcomes of patients with AF treated with warfarin in the United Kingdom and in Sweden.
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| 30. |
- Verhoef, Talitha I, et al.
(författare)
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Cost-effectiveness of pharmacogenetics in anticoagulation: international differences in healthcare systems and costs
- 2012
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Ingår i: Pharmacogenomics (London). - : Future Medicine. - 1462-2416 .- 1744-8042. ; 13:12, s. 1405-1417
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Forskningsöversikt (refereegranskat)abstract
- Genotyping patients for CYP2C9 and VKORC1 polymorphisms can improve the accuracy of dosing during the initiation of anticoagulation with vitamin K antagonists (coumarin derivatives). The anticipated degree of improvement in the safety of anticoagulation with coumarins through genotyping may vary depending on the quality of patient care, which varies both with and among countries. The management and the cost of anticoagulant care can therefore influence the cost effectiveness of genotyping within any given country. In this article, we provide an overview of the cost effectiveness of pharmacogenetics-guided dosing of coumarin derivatives. We describe the organization of anticoagulant care in the UK, Sweden, The Netherlands, Greece, Germany and Austria, where a genotype-guided dosing algorithm is currently being investigated as part of the EU-PACT trial. We also explore the costs of anticoagulant care for the treatment of atrial fibrillation in these countries.
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