| 1. |
- Bastos Lima, Mairon G., et al.
(författare)
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Large-scale collective action to avoid an Amazon tipping point - key actors and interventions
- 2021
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Ingår i: Current Research in Environmental Sustainability. - : Elsevier BV. - 2666-0490. ; 3
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Tidskriftsartikel (refereegranskat)abstract
- The destruction of the Amazon is a major global environmental issue, not only because of greenhouse gas emissions or direct impacts on biodiversity and livelihoods, but also due to the forest's role as a tipping element in the Earth System. With nearly a fifth of the Amazon already lost, there are already signs of an imminent forest dieback process that risks transforming much of the rainforest into a drier ecosystem, with climatic implications across the globe. There is a large body of literature on the underlying drivers of Amazon deforestation. However, insufficient attention has been paid to the behavioral and institutional microfoundations of change. Fundamental issues concerning cooperation, as well as the mechanisms facilitating or hampering such actions, can play a much more central role in attempts to unravel and address Amazon deforestation. We thus present the issue of preventing the Amazon biome from crossing a biophysical tipping point as a large-scale collective action problem. Drawing from collective action theory, we apply a novel analytical framework on Amazon conservation, identifying six variables that synthesize relevant collective action stressors and facilitators: information, accountability, harmony of interests, horizontal trust, knowledge about consequences, and sense of responsibility. Drawing upon literature and data, we assess Amazon deforestation and conservation through our heuristic lens, showing that while growing transparency has made information availability a collective action facilitator, lack of accountability, distrust among actors, and little sense of responsibility for halting deforestation remain key stressors. We finalize by discussing interventions that can help break the gridlock.
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| 2. |
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| 3. |
- Jagers, Sverker C., 1967, et al.
(författare)
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On the preconditions for large-scale collective action
- 2020
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Ingår i: Ambio. - : Springer Science and Business Media LLC. - 0044-7447 .- 1654-7209. ; 49:7, s. 1282-1296
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Tidskriftsartikel (refereegranskat)abstract
- The phenomenon of collective action and the origin of collective action problems have been extensively and systematically studied in the social sciences. Yet, while we have substantial knowledge about the factors promoting collective action at the local level, we know far less about how these insights travel to large-scale collective action problems. Such problems, however, are at the heart of humanity's most pressing challenges, including climate change, large-scale natural resource depletion, biodiversity loss, nuclear proliferation, antibiotic resistance due to overconsumption of antibiotics, and pollution. In this paper, we suggest an analytical framework that captures the theoretical understanding of preconditions for large-scale collective action. This analytical framework aims at supporting future empirical analyses of how to cope with and overcome larger-scale collective action problems. More specifically, we (i) define and describe the main characteristics of a large-scale collective action problem and (ii) explain why voluntary and, in particular, spontaneous large-scale collective action among individual actors becomes more improbable as the collective action problem becomes larger, thus demanding interventions by an external authority (a third party) for such action to be generated. Based on this, we (iii) outline an analytical framework that illustrates the connection between third-party interventions and large-scale collective action. We conclude by suggesting avenues for future research.
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| 4. |
- Fischer, Carolyn, et al.
(författare)
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The Legal and Economic Case for an Auction Reserve Price in the EU Emissions Trading System
- 2020
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Ingår i: The Columbia journal of European law. - 1076-6715. ; 26:2, s. 1-28
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Tidskriftsartikel (refereegranskat)abstract
- When it first launched in 2005, the European Union emissions trading system (EU ETS) expected to see carbon dioxide prices of around €30/ton and be a cornerstone of the EU's climate policy. The reality was a cascade of falling prices, a ballooning privately held emissions bank, and a decade of muted incentives for investment in the technology and innovation necessary to achieve long-term climate goals. The European Commission responded with various administrative measures, including postponing the introduction of allowances (“backloading”) and using a quantity-based criterion for regulating future allowance sales (“the market stability reserve”). While prices have now begun to recover, it is far from clear whether these measures are sufficient to adequately support the price of carbon dioxide into the future. In the meantime, governments outside the EU ETS have begun turning away from carbon pricing and adopting overlapping regulatory measures that reinforce low prices. Unfortunately, however, this further undermines confidence in market-based mechanisms for reducing greenhouse gas emissions. Other carbon markets have responded to such by introducing an auction reserve price that sets a minimum price in allowance auctions, thus avoiding the unexpectedly low price outcomes experienced in the EU ETS. Opponents of instituting such an auction reserve price in the EU ETS express two main concerns. First, they fear that a minimum auction price would interfere with the quantity-based nature of the market. Second, they argue that a reserve price would be tantamount to a tax, thus triggering a burdensome decision rule requiring unanimity among EU Member States that would be difficult to overcome. This Article reviews the economic and legal arguments for and against an auction reserve price. Our economic analysis concludes that an auction reserve price is necessary to accommodate overlapping policies and for the allowance market to operate efficiently. Our legal analysis concludes that, inasmuch as an auction reserve price is not a “provision primarily of a fiscal nature,” nor would it “significantly affect a Member State's choice between different energy sources,” no legal barriers stand in the way of the introduction of an auction reserve price into the EU ETS. We then describe two ways by which a reserve price could be introduced into this system.
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| 5. |
- Jakola, Asgeir Store, et al.
(författare)
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Disulfiram repurposing combined with nutritional copper supplement as add-on to chemotherapy in recurrent glioblastoma (DIRECT) : Study protocol for a randomized controlled trial
- 2018
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Ingår i: F1000 Research. - : F1000Research. - 2046-1402. ; 7
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Tidskriftsartikel (refereegranskat)abstract
- Background: Disulfiram (DSF) is a well-tolerated, inexpensive, generic drug that has been in use to treat alcoholism since the 1950s. There is now independent preclinical data that supports DSF as an anticancer agent, and experimental data suggest that copper may increase its anti-neoplastic properties. There is also some clinical evidence that DSF is a promising anticancer agent in extracranial cancers. In glioblastoma, DSF induced O 6-methylguanine methyltransferase (MGMT) inhibition may increase response to alkylating chemotherapy. A recent phase I study demonstrated the safety of DSF in glioblastoma patients when DSF was administered at doses below 500 mg/day together with chemotherapy. We plan to assess the effects of DSF combined with nutritional copper supplement (DSF-Cu) as an adjuvant to alkylating chemotherapy in glioblastoma treatment.Methods: In an academic, industry independent, multicenter, open label randomized controlled phase II/III trial with parallel group design (1:1) we will assess the efficacy and safety of DSF-Cu in glioblastoma treatment. The study will include 142 patients at the time of first recurrence of glioblastoma where salvage therapy with alkylating chemotherapy is planned. Patients will be randomized to treatment with or without DSF-Cu. Primary end-point is survival at 6 months. Secondary end-points are overall survival, progression free survival, quality of life, contrast enhancing tumor volume and safety.Discussion: There is a need to improve the treatment of recurrent glioblastoma. Results from this randomized controlled trial with DSF-Cu in glioblastoma will serve as preliminary evidence of the future role of DSF-Cu in glioblastoma treatment and a basis for design and power estimations of future studies. In this publication we provide rationale for our choices and discuss methodological issues.Trial registration: The study underwent registration in EudraCT 2016-000167-16 (Date: 30.03.2016,) and Clinicaltrials.gov NCT02678975 (Date: 31.01.2016) before initiating the study.
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| 6. |
- Johansson, Markus, 1985, et al.
(författare)
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A risk framework for optimising policies for deep decarbonisation technologies
- 2021
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Ingår i: Energy Research and Social Science. - : Elsevier BV. - 2214-6296 .- 2214-6326. ; 82
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Tidskriftsartikel (refereegranskat)abstract
- Massive resource infusion and coordination between state and market actors are needed to develop and diffuse deep decarbonisation technologies. This makes wise policy design imperative. Policy-makers are confronted with a plethora of diverging views on which policies are preferable for a low carbon transition, and which interventions, such as R&D funding, information, environmental taxes, or bans, should be employed to achieve necessary and sufficient technological transformation. Focusing on market and technological investment risks, we offer a conceptual framework that explains why no silver bullet policy or single theoretical approach exists in regard to decarbonisation. Our framework highlights that policies need to be designed with these risks in mind and aids in the key task of matching problems and policies, thereby also facilitating judicious use of resources to optimise climate benefits from resources spent.
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| 7. |
- Kinhult, Sara, et al.
(författare)
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Regional variation i användningen av TTF vid glioblastombehandling : [Regional variation in usage of TTF (Optune)]
- 2023
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Ingår i: Läkartidningen. - : Läkartidningen Förlag AB. - 0023-7205 .- 1652-7518. ; 120:120
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Tidskriftsartikel (refereegranskat)abstract
- The standard treatment of glioblastoma, an aggressive brain tumour, includes radiotherapy combined with temozolomide. Based on a randomised trial, showing five months increased survival, TTF has been introduced in the management of patients with good performance status. Data from the Swedish national quality registry for CNS tumours have been analysed for TTF usage. The results demonstrate that 65 percent of the patients accepted treatment with TTF. More than half of the treated patients interrupted treatment due to low compliance or their own wish. Median treatment time was 164 days, with a range from 0 to 774 days. There was a large variation between different regions in how many patients were offered TTF treatment. A non-significant trend to better survival was seen for the group of TTF-treated patients compared to individually matched controls. In summary, TTF is a new treatment for glioblastoma, with potential to prolong survival also in real world patients. Today, the treatment is not offered equally to all patients, despite national guidelines.
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| 8. |
- Löfgren, David, 1977-, et al.
(författare)
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Older meningioma patients : a retrospective population-based study of risk factors for morbidity and mortality after neurosurgery.
- 2022
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Ingår i: Acta Neurochirurgica. - : Springer. - 0001-6268 .- 0942-0940. ; 164, s. 2987-2997
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Meningioma is the most common primary CNS tumour. Most meningiomas are benign, and most patients are 65 years or older. Surgery is usually the primary treatment option. Most prior studies on early surgical outcomes in older patients with meningioma are small, and there is a lack of larger population-based studies to guide clinical decision-making. We aimed to explore the risks for perioperative mortality and morbidity in older patients with meningioma and to investigate changes in surgical incidence over time.METHODS: In this retrospective population-based study on patients in Sweden, 65 years or older with surgery 1999-2017 for meningioma, we used data from the Swedish Brain Tumour Registry. We analysed factors contributing to perioperative mortality and morbidity and used official demographic data to calculate yearly incidence of surgical procedures for meningioma.RESULTS: The final study cohort included 1676 patients with a 3.1% perioperative mortality and a 37.6% perioperative morbidity. In multivariate analysis, higher age showed a statistically significant association with higher perioperative mortality, whereas larger tumour size and having preoperative symptoms were associated with higher perioperative morbidity. A numerical increased rate of surgical interventions after 2012 was observed, without evidence of worsening short-term surgical outcomes.CONCLUSIONS: Higher mortality with increased age and higher morbidity risk in larger and/or symptomatic tumours imply a possible benefit from considering surgery in selected older patients with a growing meningioma before the development of tumour-related symptoms. This study further underlines the need for a standardized method of reporting and classifying complications from neurosurgery.
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| 9. |
- Löfgren, David, 1977-, et al.
(författare)
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P01.078 Glioma surgery in the elderly, a retrospective population based registry study
- 2018
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Ingår i: Neuro-Oncology. - : Oxford University Press. - 1522-8517 .- 1523-5866. ; 20:Suppl. 3, s. iii247-iii248
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Tidskriftsartikel (refereegranskat)abstract
- Background: There is a trend in brain tumor treatments over time to treat patients at a higher age and to perform more advanced and radical surgery. Despite this little is known about the perioperative morbidity and mortality after intracranial tumor surgery, especially regarding the elderly. The Swedish brain tumor registry has collected data since 1999 with good coverage and is considered population based. Among the parameters registered are perioperative complications such as postoperative hematoma and thromboembolism as well as newly diagnosed epilepsy, new focal neurologic deficit and date of death.Methods: Data from the registry has been collected and analyzed in this retrospective population based study. This study includes patients in the registry at age 65 or older, with high grade glioma (GBM, astrocytoma grIII), low grade glioma (astrocytoma grI-II, oligodendroglioma grII-III and gangliogliomas) registered from 1999 to 2015. Formation of diagnose groups are in conjunction with suggestions from the Swedish National Brain Tumor Trialist Group. From this data we have excluded patients that have not undergone surgery, where surgery (or not) cannot be determined and where data on complications is unavailable. Only the national regions with a high enough coverage are included.Results: The material contains 1467 evaluable patients. High grade gliomas were 1277 (male 59%, female 41%), median age at surgery 71 (range 65 to 86), women not older (72 VS 71; NS). 17,5% (male 16,4%, female 20,0%; NS) had WHO/ECOG-PS >2. Perioperative mortality was 7,8% (male 9,2%, female 5,9%; p=0,03), associated with WHO/ECOG-PS >2 (p<0,0001). 15,7% (male 17,3%, female 13,5%; NS) had perioperative complications. The most common complication was worsening of neurologic function (7,6%, male 8,4%, female 6,5%; NS) and most patients (10,8%, male 12,8%, female 8,0%; NS) had one recorded complication. The mortality and morbidity remains consistent regardless of year of surgery. Low grade gliomas were 190 (male 55% VS female 45%), median age 70 (65 to 83), men not significantly older (71 VS 69; NS). 16,8% (male 15,7%, female 19,5%; NS) had WHO/ECOG-PS >2. Perioperative mortality was 5,3% (male 6,7%, female 3,5%; NS). 20,0% (male 21%, female 18,8%; NS) had perioperative complications. As with high grade gliomas the most common complication was worsening of neurologic function (13,7%, male 15,2%, female 11,8%; NS) and the mortality and morbidity remains without significant changes regardless of year of surgery.Conclusion: In this material we can conclude that the perioperative mortality as well as morbidity is higher than in published younger patient materials for gliomas. We cannot see an increase in perioperative mortality or morbidity with higher age within the material but this could be from lack of power and we hope to be able to get a clearer view in a later comparison with the younger patients in the registry.
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| 10. |
- Löfgren, David, 1977-, et al.
(författare)
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P05.54 Meningioma surgery in the elderly, a retrospective population based registry study
- 2018
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Ingår i: Neuro-Oncology. - : Oxford University Press. - 1522-8517 .- 1523-5866. ; 20:Suppl 3, s. iii315-iii315
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Meningioma surgery is often considered, even at a high age, and is regarded an acceptable practice in patients without severe health problems even though there is much that is not yet known about the perioperative morbidity and mortality. Since the start 1999 the Swedish brain tumor registry has collected data on a national level. It is accepted as population based and has demonstrated good coverage. In the registry perioperative parameters such as newly diagnosed epilepsy, new focal neurological deficit, thromboembolism and date of death can be found. <h4>Methods</h4> We have collected retrospective data from the registry to perform a population based study of the perioperative period. Included are patients with meningioma at age 65 and older from regions with a high enough coverage of registration and with surgery dates from 1999 to 2015. Two diagnose groups were made (grade I and grade II+III) as suggested by the Swedish National Brain Tumor Trialist Group. Excluded are patients in the registry that have not undergone surgery, where surgery (or not) cannot be determined and where data on complications is unavailable. <h4>Results</h4> 1109 patients were included (female 67,1%, male 32,9%). Median age was 72 (range 65–90) with an even gender distribution. Most patients had grade I meningioma (88,6%, female 91,0%, male 83,8%; p<0,001) with an even age distribution. 14,1% (female 15,4%, male 11,5%, NS) had WHO-PS >2, rising with age (Age>80, 28,9%, p<0,001). Perioperative mortality was 3,6% (male 4,7%, female 3,1%; NS) but clearly higher within the older age-groups (Age 65-69 1,4%; 70-74 3,3%; 75-79 4,6%; >80 7,7%; p=0,004). In the gradeII-III group mortality was significantly higher 8,7% (p<0,001) then the gradeI group and there is a statistical correlation between a WHO-PS >2 and perioperative mortality (0–2=2,8%, 3–4=7,9%; p=0,002). 28,3% (male 33,4%, female 25,8%; p=0,008) had perioperative complications (other than death), with an even age distribution. As with mortality there is a correlation with tumor grade (grI 26,8%, grII-III 40,5%; p=0,001) and there is a correlation with WHO-PS >2 (0-2 25,7%, 3-4 40,8%; p<0,001). Surgery 1999–2007 is associated with less complications (1999-2007 16,4%, 2007-2015 37,5%; p<0,001) but not with less mortality. The most common complications were hematoma and neurologic deficit (14,3% and 13,6%; NS), both evenly distributed by gender and age group. <h4>Conclusion</h4> Our data shows similar perioperative mortality with published data. The risk of perioperative death is higher with rising age and a bad performancestatus correlates with a higher risk of both perioperative death and complications. The high rate of WHO-PS >2 might be a contributing factor to the high rates of perioperative morbidity as compared with published material. This data suggests caution when operating on elderly patients, especially older than 75 and with compromised performancestatus.
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| 11. |
- Löfgren, David, 1977-, et al.
(författare)
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Risk for morbidity and mortality after neurosurgery in older patients with high grade gliomas : a retrospective population based study
- 2022
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Ingår i: BMC Geriatrics. - : BioMed Central (BMC). - 1471-2318. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Although high grade gliomas largely affect older patients, current evidence on neurosurgical complications is mostly based on studies including younger study populations. We aimed to investigate the risk for postoperative complications after neurosurgery in a population-based cohort of older patients with high grade gliomas, and explore changes over time.METHODS: In this retrospective study we have used data from the Swedish Brain Tumour Registry and included patients in Sweden age 65 years or older, with surgery 1999-2017 for high grade gliomas. We analysed number of surgical procedures per year and which factors contribute to postoperative morbidity and mortality.RESULTS: The study included 1998 surgical interventions from an area representing 60% of the Swedish population. Over time, there was an increase in surgical interventions in relation to the age specific population (p < 0.001). Postoperative morbidity for 2006-2017 was 24%. Resection and not having a multifocal tumour were associated with higher risk for postoperative morbidity. Postoperative mortality for the same period was 5%. Increased age, biopsy, and poor performance status was associated with higher risk for postoperative mortality.CONCLUSIONS: This study shows an increase in surgical interventions over time, probably representing a more active treatment approach. The relatively low postoperative morbidity- and mortality-rates suggests that surgery in older patients with suspected high grade gliomas can be a feasible option. However, caution is advised in patients with poor performance status where the possible surgical intervention would be a biopsy only. Further, this study underlines the need for more standardised methods of reporting neurosurgical complications.
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| 12. |
- Werlenius, Katja, et al.
(författare)
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Effect of Disulfiram and Copper Plus Chemotherapy vs Chemotherapy Alone on Survival in Patients With Recurrent Glioblastoma: A Randomized Clinical Trial.
- 2023
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Ingår i: JAMA network open. - : American Medical Association (AMA). - 2574-3805. ; 6:3
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Tidskriftsartikel (refereegranskat)abstract
- Disulfiram has demonstrated broad antitumoral effect in several preclinical studies. One of the proposed indications is for the treatment of glioblastoma.To evaluate the efficacy and safety of disulfiram and copper as add-on to alkylating chemotherapy in patients with recurrent glioblastoma.This was a multicenter, open-label, randomized phase II/III clinical trial with parallel group design. Patients were recruited at 7 study sites in Sweden and 2 sites in Norway between January 2017 and November 2020. Eligible patients were 18 years or older, had a first recurrence of glioblastoma, and indication for treatment with alkylating chemotherapy. Patients were followed up until death or a maximum of 24 months. The date of final follow-up was January 15, 2021. Data analysis was performed from February to September 2022.Patients were randomized 1:1 to receive either standard-of-care (SOC) alkylating chemotherapy alone, or SOC with the addition of disulfiram (400 mg daily) and copper (2.5 mg daily).The primary end point was survival at 6 months. Secondary end points included overall survival, progression-free survival, adverse events, and patient-reported quality of life.Among the 88 patients randomized to either SOC (n=45) or SOC plus disulfiram and copper (n=43), 63 (72%) were male; the mean (SD) age was 55.4 (11.5) years. There was no significant difference between the study groups (SOC vs SOC plus disulfiram and copper) in 6 months survival (62% [26 of 42] vs 44% [19 of 43]; P=.10). Median overall survival was 8.2 months (95% CI, 5.4-10.2 months) with SOC and 5.5 months (95% CI, 3.9-9.3 months) with SOC plus disulfiram and copper, and median progression-free survival was 2.6 months (95% CI, 2.4-4.6 months) vs 2.3 months (95% CI, 1.7-2.6 months), respectively. More patients in the SOC plus disulfiram and copper group had adverse events grade 3 or higher (34% [14 of 41] vs 11% [5 of 44]; P=.02) and serious adverse events (41% [17 of 41] vs 16% [7 of 44]; P=.02), and 10 patients (24%) discontinued disulfiram treatment because of adverse effects.This randomized clinical trial found that among patients with recurrent glioblastoma, the addition of disulfiram and copper to chemotherapy, compared with chemotherapy alone, resulted in significantly increased toxic effects, but no significant difference in survival. These findings suggest that disulfiram and copper is without benefit in patients with recurrent glioblastoma.ClinicalTrials.gov Identifier: NCT02678975; EUDRACT Identifier: 2016-000167-16.
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