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1.	Aniander, Magnus, et al. (author) Industriell Ekonomi : Faktabok 1998 Book (other academic/artistic)
2.	Brusselaers, Nele, et al. (author) Education level and survival after esophageal cancer surgery : a prospective population-based cohort study 2013 In: BMJ Open. - Stockholm : Karolinska Institutet, Dept of Molecular Medicine and Surgery. - 2044-6055. Journal article (peer-reviewed)abstract Objectives: This study aimed to investigate whether a higher education level is associated with an improved long-term survival after oesophagectomy for cancer. Design: A prospective, population-based cohort study. Setting: Sweden—nationwide. Participants: 90% of all patients with oesophageal and cardia cancer who underwent a resection in Sweden in 2001–2005 were enrolled in this study (N=600; 80.3% male) and followed up until death or the end of the study period (2012). The study exposure was level of education, defined as compulsory (≤9 years), moderate (10–12 years) or high (≥13 years). Outcome measures The main outcome measure was overall 5-year survival after oesophagectomy. Cox regression was used to estimate the associations between education level and mortality, expressed as HRs with 95% CIs, with adjustment for sex, age, tumour stage, histological type, complications, comorbidities and annual surgeon volume. The patient group with highest education was used as the reference category. Results: Among the 600 included patients, 281 (46.8%) had compulsory education, 238 (39.7%) had moderate education and 81 (13.5%) had high education. The overall 5-year survival rate was 23.1%, 24.4% and 32.1% among patients with compulsory, moderate and high education, respectively. After adjustment for confounders, a slightly higher, yet not statistically significantly increased point HR was found among the compulsory educated patients (HR 1.08, 95% CI 0.80 to 1.47). In patients with tumour stage IV, increased adjusted HRs were found for compulsory (HR 2.88, 95% CI 1.07 to 7.73) and moderately (HR 2.83, 95% CI 1.15 to 6.95) educated patients. No statistically significant associations were found for the other tumour stages. Conclusions: This study provides limited evidence of an association between lower education and worse long-term survival after oesophagectomy for cancer.
3.	Brusselaers, Nele, et al. (author) Education level influences long-term survival after esophageal cancer surgery in a nationwide Swedish cohort study 2013 In: BMJ Open. - Stockholm : Karolinska Institutet, Dept of Molecular Medicine and Surgery. - 2044-6055. Journal article (peer-reviewed)abstract Objectives: This study aimed to investigate whether a higher education level is associated with an improved long-term survival after oesophagectomy for cancer. Design: A prospective, population-based cohort study. Setting: Sweden—nationwide. Participants: 90% of all patients with oesophageal and cardia cancer who underwent a resection in Sweden in 2001–2005 were enrolled in this study (N=600; 80.3% male) and followed up until death or the end of the study period (2012). The study exposure was level of education, defined as compulsory (≤9 years), moderate (10–12 years) or high (≥13 years). Outcome measures: The main outcome measure was overall 5-year survival after oesophagectomy. Cox regression was used to estimate the associations between education level and mortality, expressed as HRs with 95% CIs, with adjustment for sex, age, tumour stage, histological type, complications, comorbidities and annual surgeon volume. The patient group with highest education was used as the reference category. Results: Among the 600 included patients, 281 (46.8%) had compulsory education, 238 (39.7%) had moderate education and 81 (13.5%) had high education. The overall 5-year survival rate was 23.1%, 24.4% and 32.1% among patients with compulsory, moderate and high education, respectively. After adjustment for confounders, a slightly higher, yet not statistically significantly increased point HR was found among the compulsory educated patients (HR 1.08, 95% CI 0.80 to 1.47). In patients with tumour stage IV, increased adjusted HRs were found for compulsory (HR 2.88, 95% CI 1.07 to 7.73) and moderately (HR 2.83, 95% CI 1.15 to 6.95) educated patients. No statistically significant associations were found for the other tumour stages. Conclusions: This study provides limited evidence of an association between lower education and worse longterm survival after oesophagectomy for cancer.
4.	Brusselaers, Nele, et al. (author) Marital status and survival after oesophageal cancer surgery : a population-based nationwide cohort study in Sweden 2014 In: BMJ Open. - Stockholm : Karolinska Institutet, Dept of Molecular Medicine and Surgery. - 2044-6055. Journal article (peer-reviewed)abstract Objectives A beneficial effect of being married on survival has been shown for several cancer types, but is unclear for oesophageal cancer. The objective of this study was to clarify the potential influence of the marital status on the overall and disease-specific survival after curatively intended treatment of oesophageal cancer using a nationwide population-based design, taking into account the known major prognostic variables. Design Prospective, population-based cohort. Setting All Swedish hospitals performing surgery for oesophageal cancer during 2001–2005. Participants This study included 90% of all patients with oesophageal or junctional cancer who underwent surgical resection in Sweden in 2001–2005, with follow-up until death or the end of the study period (2012). Primary and secondary outcome measures Cox regression was used to estimate associations between the marital status and the 5-year overall and disease-specific mortality, expressed as HRs with 95% CIs, with adjustment for sex, age, tumour stage, histological type, complications, comorbidities and annual surgeon volume. Results Of all 606 included patients (80.4% men), 55.1% were married, 9.2% were remarried, 22.6% were previously married and 13% were never married. Compared with the married patients, the never married (HR 1.02, 95% CI 0.77 to 1.35), previously married (HR 0.90, 95% CI 0.71 to 1.15) and remarried patients (HR 0.79, 95% CI 0.55 to 1.13) had no increased overall 5-year mortality. The corresponding HRs for disease-specific survival, and after excluding the initial 90 days of surgery, were similar to the HRs for the overall survival. Conclusions This study showed no evidence of a better 5-year survival in married patients compared with non-married patients undergoing surgery for oesophageal cancer.
5.	Flament, Maxime, et al. (author) An Approach to Fourth Generation Wireless Infrastructures - Scenarios and Key Research Issues 1999 In: Vehicular Technology Conference, 1999 IEEE 49th. - : IEEE. - 0780355652 ; , s. 1742-1746, s. 1742-1746 Conference paper (peer-reviewed)abstract Studying the feasibility and viability of various future infrastructure architectures and potential road-maps of their deployment is the focus of the 4th Generation Wireless Infrastructures (4GW) project within the strategic Personal Computing and Communication (PCC) program (Molin 1998). In attempting to realize the PCC vision “mobile multimedia to all at today's prices for fixed telephony”, a difficult problem arises. In contrast to the process of solving engineering and business problems in current or imminent wireless systems, where system concepts, requirements and markets are reasonably well known, very little is known about these things over a 10 year horizon. The approach used in the project to tackle this problem, is to use various scenario techniques. Plausible scenarios which describe the telecommunication scene in 2010 and which are used to determine potential technological and other bottlenecks in order to find key areas for research in this field are a very important element in these studies. Some of these scenarios are presented in this paper, together with some implications regarding bottlenecks and key research issues. The results are presented in terms of working assumptions (WAs) used with the project. The WAs are also proposed to provide a framework for interrelating different research activities within PCC.
6.	Flament, Maxime, et al. (author) Key Research Issues in 4th Generation Wireless Infrastructures 1998 Conference paper (peer-reviewed)abstract The world of communication is now developing faster than ever. Telecommunication infrastructure deployment in contrast is a slow and costly process demanding along-range strategic perspective in decision making. As aconsequence, R&D efforts are concerned with problems on a time horizon of 10 years or more. Studying the feasibility and viability of various future infrastructure architectures and potential road-maps of their deployment is the focus for the 4th Generation WirelessInfrastructures project within PCC. Determining technological and other bottlenecks to find key areas forr esearch in this area is a very important element in these studies.The methods used for this purpose are various scenario techniques. Plausible scenarios, describing the telecommunication scene in 2010, have been designed based on a number of global trends in technology,economy and politics. The scenario trends have also been verified by using a Delphi survey among leading industrials and scientists in Sweden. Based on these trends, three vivid scenarios are built which implicitly describe the different trends that have been created, for instance, the Big Brother, the Anything Goes, and thePocket Computing. At the end of the paper, the implications of the scenarios to the infrastructure research areas are discussed. In particular, the working assumptions and key research problems in each PCC/4GW work package are revisited and prioritized according to the scenarios. The scenarios are also proposed to provide a framework for inter-relating different research activities within PCC.
7.	Flament, Maxime, 1974, et al. (author) Key Research Issues in the 4th Generation Wireless Infrastructures 1998 In: Proceedings PCC Workshop, Stockholm. ; , s. 1-5 Conference paper (peer-reviewed)
8.	Flament, Maxime, et al. (author) Scenarios - A tool for starting a research process 1998 In: Proceedings PCC Workshop, Stockholm. ; , s. 6-10 Conference paper (peer-reviewed)abstract Scenarios can be used as a tool for starting a research process within a group. When putting together a research group of people with different backgrounds, differentcompetencies and different preconceived ideas, special attention has to be put on the problem of integration.Many different "tools" can be used to help merging thedifferent approaches of the individuals constituting thegroup. One such tool is scenario work. Trends arecreated by analyzing and structuring the environment around the project. Combining and extrapolating the trends gives a basis for creating the scenarios. The scenarios are then used to help refining research issues. Both the process and the result are hence of importance. The process aims at revealing the different approachesand possible conflicts due to the different scientific andresearch traditions among the members of the group. Theresult forms a basis for refining and limit the researchquestion. The work within the 4th Generation Wireless Infrastructure project group of the PCC-project aims atfinding important design issues for the infrastructure of a future wireless communication system. Using the scenarios as a starting point the research questions originally put, have been successfully challenged andrefined.
9.	Flament, Maxime, 1974, et al. (author) Telecom Scenarios 2010 - a wireless infrastructure perspective 1998 In: Internal Report, Stockholm, S3, KTH. Conference paper (other academic/artistic)
10.	Flament, Maxime, et al. (author) Telecom scenarios for the 4th Generation Wireless Infrastructures 1998 In: Proceedings PCC Workshop, Stockholm. ; , s. 11-15 Conference paper (peer-reviewed)abstract Telecommunication infrastructure deployment, incontrast to the rest of the communication area, is a slowand costly process, demanding a long-range strategic perspective in decision making. Determining key issues for strategic research in this area is thus very important. This paper describes detailed work to that aim, within the PCC project. The aim was to find possible scenariosfor the 4th Generation Wireless Infrastructures (4GW)around year 2010 and to determine their implications onthe direction of research in wireless communications. In this scenario work, a number of trends were created based on the current state of technology, economy and politics. These trends are verified by using Delphi methods. Based on these trends and additional research,three vivid scenarios are built, which picture differentways the trends may develop, The scenarios are called:"Big Brother Scenario", "Anything-Goes Scenario" and"Pocket Computing Scenario". At the end, the paper discusses the implications of the scenarios on thewireless communication research areas. In particular, the working assumptions and key research problems in eachwork package in the 4th Generation Wireless Infrastructure project are verified and prioritized according to the scenarios.
11.	Gottlieb-Vedi, Eivind, et al. (author) Extent of Lymphadenectomy and Long-Term Survival in Esophageal Cancer 2023 In: Annals of Surgery. - : Wolters Kluwer. - 0003-4932 .- 1528-1140. ; 277:3, s. 429-436 Journal article (peer-reviewed)abstract Objective: To examine the hypothesis that survival in esophageal cancer increases with more removed lymph nodes during esophagectomy up to a plateau, after which it levels out or even decreases with further lymphadenectomy.Summary of Background Data: There is uncertainty regarding the ideal extent of lymphadenectomy during esophagectomy to optimize long-term survival in esophageal cancer.Methods: This population-based cohort study included almost every patient who underwent esophagectomy for esophageal cancer in Sweden or Finland in 2000-2016 with follow-up through 2019. Degree of lymphadenectomy, divided into deciles, was analyzed in relation to all-cause 5-year mortality. Multivariable Cox regression provided hazard ratios (HR) with 95% confidence intervals (95% CI) adjusted for all established prognostic factors.Results: Among 2,306 patients, the 2nd (4-8 nodes), 7th (21-24 nodes) and 8th decile (25-30 nodes) of lymphadenectomy showed the lowest all-cause 5-year mortality compared to the 1st decile (HR = 0.77, 95% CI 0.61-0.97, HR = 0.76, 95% CI 0.59-0.99, and HR = 0.73, 95% CI 0.57-0.93, respectively). In stratified analyses, the survival benefit was greatest in decile 7 for patients with pathological T-stage T3/T4 (HR = 0.56, 95% CI 0.40-0.78), although it was statistically improved in all deciles except decile 10. For patients without neoadjuvant chemotherapy, survival was greatest in decile 7 (HR = 0.60, 95% CI 0.41-0.86), although survival was also statistically significantly improved in deciles 2, 6, and 8.Conclusion: Survival in esophageal cancer was not improved by extensive lymphadenectomy, but resection of a moderate number (20-30) of nodes was prognostically beneficial for patients with advanced T-stages (T3/T4) and those not receiving neoadjuvant therapy.
12.	Jokinen, Jussi, et al. (author) Suicide attempt and future risk of cancer : a nationwide cohort study in Sweden 2015 In: Cancer Causes and Control. - : Springer Nature. - 0957-5243 .- 1573-7225. ; 44, s. 11-12 Journal article (peer-reviewed)abstract Purpose: Little is known about cancer incidence among patients with a history of suicide attempt. Suicide attempters have lower levels of oxytocin, a hormone related to lactation, stress, social functioning, and well-being, and recent research indicates influence on carcinogenesis. We hypothesized that the low oxytocin levels among suicide attempters results in an increased risk of cancer in general and in organs with oxytocin receptors in particular.Methods: A nationwide cohort study of patients aged 15 years or older with hospitalization for self-inflicted injury or attempted suicide was identified from the Swedish patient register in 1968–2011. The cancer outcomes were identified from the Swedish cancer register. Cancer risk in suicide attempters was compared with the risk in the background population of the corresponding age, sex, and calendar period by calculating standardized incidence ratios (SIRs) with 95 % confidence intervals (95 % CI).Results: The 186,627 patients (83,637 men and 102,990 women) hospitalized for self-inflicted injury or attempted suicide contributed with 2.6 million person-years at risk. The SIR for all cancer was 1.3 (95 % CI 1.27–1.33) in men and 1.25 (1.22–1.28) in women. For cancers in organs rich in oxytocin receptors (uterus, breast, and brain), the corresponding SIRs were 1.02 (0.87–1.19) and 1.13 (1.09–1.17), respectively. There was a particularly increased risk of cancers related to alcohol and tobacco in both sexes.Conclusion: Patients attempting suicide have an increased risk of cancer. However, this increase does not seem to be associated with low oxytocin levels, but rather to exposures like tobacco smoking and alcohol consumption.
13.	Lagergren, Jesper, et al. (author) Clinical implementation of a new antibiotic prophylaxis regimen for percutaneous endoscopic gastrostomy 2013 In: BMJ Open. - Stockholm : Karolinska Institutet, Dept of Molecular Medicine and Surgery. - 2044-6055. Journal article (peer-reviewed)abstract OBJECTIVES: This study was undertaken to test the extent to which a new antibiotic prophylaxis regimen for percutaneous endoscopic gastrostomy (PEG), identified as a justified and simpler alternative to conventional regimen in a randomised clinical trial, has been adopted in clinical practice. DESIGN: A Swedish nationwide implementation survey, conducted in February 2013, assessed the level of clinical implementation of a 20 ml dose of oral solution of sulfamethoxazole and trimethoprim deposited in the PEG catheter immediately after insertion. All hospitals inserting at least five PEGs annually were identified from the Swedish Patient Registry. A clinician involved in the PEG insertions at each hospital participated in a structured telephone interview addressing their routine use of antibiotic prophylaxis. SETTING: All Swedish hospitals inserting PEGs (n=60). PARTICIPANTS: Representatives of PEG insertions at each of the 60 eligible hospitals participated (100% participation). MAIN OUTCOME MEASURES: Use of routine antibiotic prophylaxis for PEG. RESULTS: A total of 32 (53%) of the 60 hospitals had adopted the new regimen. It was more frequently adopted in university hospitals (67%) than in community hospitals (41%). An annual total of 1813 (70%) of 2573 patients received the new regimen. Higher annual hospital volume was associated with a higher level of adoption of the new regimen (80% in the highest vs 31% in the lowest). CONCLUSIONS: The clinical implementation of the new antibiotic prophylaxis regimen for PEG was high and rapid (70% of all patients within 3 years), particularly in large hospitals.
14.	Lagergren, Jesper, et al. (author) Extent of lymphadenectomy and prognosis after esophageal cancer surgery 2015 In: JAMA Surgery. - Stockholm : Karolinska Institutet, Dept of Molecular Medicine and Surgery. - 2168-6254 .- 2168-6262. Journal article (peer-reviewed)abstract Importance: The prognostic role of the extent of lymphadenectomy during surgery for esophageal cancer is uncertain and requires clarification. Objective: To clarify whether the number of removed lymph nodes influences mortality following surgery for esophageal cancer. Design, Setting, and Participants: Conducted from January 1, 2000, to January 31, 2014, this was a cohort study of patients who underwent esophagectomy for cancer in 2000-2012 at a high-volume hospital for esophageal cancer surgery, with follow-up until 2014. Exposures: The main exposure was the number of resected lymph nodes. Secondary exposures were the number of metastatic lymph nodes and positive to negative lymph node ratio. Main Outcomes and Measures: The independent role of the extent of lymphadenectomy in relation to all-cause and disease-specific 5-year mortality was analyzed using Cox proportional hazard regression models, providing hazard ratios (HRs) with 95% CIs. The HRs were adjusted for age, pathological T category, tumor differentiation, margin status, calendar period of surgery, and response to preoperative chemotherapy. Results: Among 606 included patients, 506 (83.5%) had adenocarcinoma of the esophagus, 323 (53%) died within 5 years of surgery, and 235 (39%) died of tumor recurrence. The extent of lymphadenectomy was not statistically significantly associated with all-cause or disease-specific mortality, independent of the categorization of lymphadenectomy or stratification for T category, calendar period, or chemotherapy. Patients in the fourth quartile of the number of removed nodes (21-52 nodes) did not demonstrate a statistically significant reduction in all-cause 5-year mortality compared with those in the lowest quartile (0-10 nodes) (HR, 0.86; 95% CI, 0.63-1.17), particularly not in the most recent calendar period (HR, 0.98; 95% CI, 0.57-1.66 for years 2007-2012). A greater number of metastatic nodes and a higher positive to negative node ratio was associated with increased mortality rates, and these associations showed dose-response associations. Conclusions and Relevance: This study indicated that the extent of lymphadenectomy during surgery for esophageal cancer might not influence 5-year all-cause or disease-specific survival. These results challenge current clinical guidelines. This cohort study indicates that the extent of lymphadenectomy during surgery for esophageal cancer might not influence the 5-year all-cause or disease-specific survival. These results challenge current clinical guidelines.
15.	Lagergren, Jesper, et al. (author) Prognosis following cancer surgery during holiday periods 2017 In: International Journal of Cancer. - Stockholm : Karolinska Institutet, Dept of Molecular Medicine and Surgery. - 0020-7136 .- 1097-0215. Journal article (peer-reviewed)abstract Surgery is the mainstay curative treatment in most cancer. We aimed to test the new hypothesis that cancer surgery performed during holiday periods is associated with worse long-term prognosis than for non-holiday periods. This nationwide Swedish population- based cohort study included 228,927 patients during 1997-2014 who underwent elective resectional surgery for a cancer where the annual number of resections was over 100. The 16 eligible cancer sites were grouped into 10 cancer groups. The exposure, holiday periods, was classified as wide (14-weeks) or narrow (7-weeks). Surgery conducted inside versus outside holiday periods was compared regarding overall disease-specific (main outcome) and overall all-cause (secondary outcome) mortality. Cox regression provided hazard ratios (HR) with 95% confidence intervals (CI) adjusted for age, sex, comorbidity, hospital volume, calendar period, and tumor stage. Surgery conducted during wide and narrow holiday periods were associated with increased HRs of disease-specific mortality for cancer of the breast (HR 1.08, 95% CI 1.03-1.13 and HR 1.06, 95% CI 1.01-1.12) and possibly of cancer of the liver-pancreas-bile ducts (HR 1.09, 95% CI 0.99-1.20 and HR 1.12, 95% CI 0.99-1.26). Sub- groups with cancer of the colon-rectum, head-and-neck, prostate, kidney-urine bladder, and thyroid also experienced statistically significantly worse prognosis following surgery conducted during holiday periods. No influence of surgery during holiday was detected for cancer of the esophagus-stomach, lung, or ovary-uterus. All-cause HRs were similar to the disease-specific HRs. The prognosis following cancer surgery might not be fully maintained during holiday periods for all cancer sites.
16.	Lagergren, Jesper, et al. (author) Weekday of cancer surgery in relation to prognosis 2017 In: British Journal of Surgery. - Stockholm : Karolinska Institutet, Dept of Molecular Medicine and Surgery. - 0007-1323 .- 1365-2168. Journal article (peer-reviewed)abstract BACKGROUND: Later weekday of surgery seems to affect the prognosis adversely in oesophageal cancer, whereas any such influence on other cancer sites is unknown. This study aimed to test whether weekday of surgery influenced prognosis following commonly performed cancer operations. METHODS: This nationwide Swedish population-based cohort study from 1997 to 2014 analysed weekday of elective surgery for ten major cancers in relation to disease-specific and all-cause mortality. Cox regression provided hazard ratios with 95 per cent confidence intervals, adjusted for the co-variables age, sex, co-morbidity, hospital volume, calendar year and tumour stage. RESULTS: A total of 228 927 patients were included. Later weekday of surgery (Thursdays and, even more so, Fridays) was associated with increased mortality rates for gastrointestinal cancers. Adjusted hazard ratios for disease-specific mortality, comparing surgery on Friday with that on Monday, were 1·57 (95 per cent c.i. 1·31 to 1·88) for oesophagogastric cancer, 1·49 (1·17 to 1·88) for liver/pancreatic/biliary cancer and 1·53 (1·44 to 1·63) for colorectal cancer. Excluding mortality during the initial 90 days of surgery made little difference to these findings, and all-cause mortality was similar to disease-specific mortality. The associations were similar in analyses stratified for co-variables. No consistent associations were found between weekday of surgery and prognosis for cancer of the head and neck, lung, thyroid, breast, kidney/bladder, prostate or ovary/uterus.
17.	Lagergren, Jesper, et al. (author) Weekday of esophageal cancer surgery and its relation to prognosis 2015 In: Annals of Surgery. - Stockholm : Karolinska Institutet, Dept of Molecular Medicine and Surgery. - 0003-4932. ; 263:6, s. 1133-1137 Journal article (peer-reviewed)abstract In this nationwide Swedish study, later weekday of esophageal cancer surgery entailed increased long-term mortality, particularly for earlier tumor stages. The increase in 5-year mortality for each later weekday was 7% for all tumor stages, 24% for stages 0-I, 13% for stage II, but was not increased for stages III-IV. Objective: To assess whether weekday of surgery influences long-term survival in esophageal cancer. Summary Background Data: Increased 30-day mortality rates have been reported in patients undergoing elective surgery later compared to earlier in the week Methods: This population-based cohort study included 98% of all esophageal cancer patients who underwent elective surgery in Sweden in 1987-2010, with follow-up until 2014. The association between weekday of surgery and 5-year all-cause and disease-specific mortality was analyzed using a multivariable Cox proportional hazards model, providing hazard ratios (HRs) with 95% confidence intervals (CIs), adjusted for age, co-morbidity, tumor stage, histology, neoadjuvant therapy, and surgeon volume. Results: Among 1,748 included patients, surgery conducted Wednesday-Friday entailed 13% increased all-cause 5-year mortality compared to surgery Monday-Tuesday (HR=1.13, 95% CI 1.01-1.26). The corresponding association was strong for early tumor stages (0-I) (HR=1.59, 95% CI 1.17-2.16), moderate for intermediate tumor stage (II) (HR=1.28, 95% CI 1.07-1.53), and absent in advanced tumor stages (III-IV) (HR=0.93, 95%CI 0.79-1.09). The increase in 5-year mortality for each later weekday (discrete variable) was 7% for all tumor stages (HR=1.07, 95% CI 1.02-1.12), 24% for early tumor stages (HR=1.24, 95% CI 1.09-1.41), 13% for intermediate stage (HR=1.13, 95% CI 1.05-1.22), while no increase was found for advanced stages (HR=0.98, 95% CI 0.92-1.05). The disease-specific 5-year mortality was similar to the all-cause mortality. Conclusions: The increased 5-year mortality of potentially curable esophageal cancer following surgery later in the week suggests that this surgery is better performed earlier in the week.
18.	Lagergren, Jesper, et al. (author) Weekday of oesophageal cancer surgery in relation to early postoperative outcomes in a nationwide Swedish cohort study 2016 In: BMJ Open. - Stockholm : Karolinska Institutet, Dept of Molecular Medicine and Surgery. - 2044-6055. Journal article (peer-reviewed)abstract Objectives: Later weekday of surgery for oesophageal cancer seems to increase 5-year mortality, but the mechanisms are unclear. We hypothesised that early postoperative reoperations and mortality might explain this association, since reoperation after oesophagectomy decreases long-term prognosis, and later weekday of elective surgery increases 30-day mortality. Design: This was a population-based cohort study during the study period 1987–2014. Setting: All Swedish hospitals conducting elective surgery for oesophageal cancer in Sweden. Participants: Included were 1748 patients, representing almost all (98%) patients who underwent elective surgery for oesophageal cancer in Sweden during 1987–2010, with follow-up until 2014. Primary and secondary outcome measures: The risk of reoperation or mortality within 30 days of oesophageal cancer surgery was assessed in relation to weekday of surgery by calculating ORs with 95% CIs using multivariable logistic regression. ORs were adjusted for age, comorbidity, tumour stage, histology, neoadjuvant therapy and surgeon volume. Results: Surgery Wednesday to Friday did not increase the risk of reoperation or mortality compared with surgery Monday to Tuesday (OR=0.99, 95% CI 0.75 to 1.31). A decreased point estimate of reoperation (OR=0.88, 95% CI 0.64 to 1.21) was counteracted by an increased point estimate of mortality (OR=1.28, 95% CI 0.83 to 1.99). ORs did not increase from Monday to Friday when each weekday was analysed separately. There was no association between weekday of surgery and reoperation specifically for anastomotic leak, laparotomy or wound infection. Stratification for surgeon volume did not reveal any clear associations between weekday of surgery and risk of 30-day reoperation or mortality. Conclusions: Weekday of oesophageal cancer surgery does not seem to influence the risk of reoperation or mortality within 30 days of surgery, and thus cannot explain the association between weekday of surgery and long-term prognosis.
19.	Lagergren, Katarina, et al. (author) Abdominal fat and male excess of esophageal adenocarcinoma 2013 In: Epidemiology. - Stockholm : Karolinska Institutet, Dept of Molecular Medicine and Surgery. - 1531-5487. Journal article (peer-reviewed)abstract The 7-to-1 male-to-female ratio in esophageal and gastroesophageal junctional adenocarcinoma (EAC) might be explained by abdominal adiposity, typical for males. If true, a stronger male predominance in higher BMI categories is expected. We conducted a nationwide Swedish population-based case-control study in 1995-1997 and collected data on BMI and other variables at face-to-face interviews. Age-adjusted relative risk (RR) and 95% confidence intervals (CI) levels were calculated using Poisson regression. Among 451 EAC cases and 820 controls, RR of EAC in males compared to females did not increase with higher BMI as assessed 20 years before interview, at 20 years of age, or at maximum or minimum adult BMI. For BMI 20 years before interview, RR in males compared to females were 7.4 (95%CI:3.9-14.1), 5.3 (95%CI:3.5-8.1), and 5.8 (95%CI:3.9-8.8) in the BMI categories <22, 22-<25, and ≥25, respectively. Conclusions: Abdominal adiposity might not explain the male predominance in esophageal adenocarcinoma.
20.	André, Karin, et al. (author) Klimatanpassat skogsbruk : drivkrafter, risker och möjligheter : Mistra-SWECIA syntesrapport 2015 Reports (other academic/artistic)
21.	Bergh, Johan, et al. (author) Är anpassning av skogsskötseln nödvändigt i dagsläget för att minska skogsskador i ett förändrat klimat? : Del 2 –analyser på regional nivå 2012 Reports (other academic/artistic)
22.	Bergh, Johan, et al. (author) Är anpassning av skogsskötseln nödvändigt i dagsläget för att minska skogsskador i ett förändrat klimat? Del 2 –analyser på regional nivå 2012 Reports (other academic/artistic)
23.	Bergkvist, John, et al. (author) Modelling managed forest ecosystems in Sweden : An evaluation from the stand to the regional scale 2023 In: Ecological Modelling. - : Elsevier BV. - 0304-3800. ; 477 Journal article (peer-reviewed)abstract Incorporation of a forest management module in the dynamic vegetation model LPJ-GUESS has allowed the study and predictions of management treatment effects on the carbon cycle and on forest ecosystem structure. In this study, LPJ-GUESS is evaluated at the regional scale against observational data from the Swedish National Forest Inventory. Simulated standing volume is compared against observations for the four most common forest types in the country. Furthermore, eddy-covariance flux measurements from the Integrated Carbon Observation System (ICOS) are used to evaluate model predictions of net ecosystem exchange (NEE), gross primary productivity (GPP) and ecosystem respiration (Reco) at the site scale. The model results suggest an adequate representation of standing volume in monocultures of Norway spruce and Scots pine for regional simulations in southern and central Sweden, after an updated parameterization of the species. For northern Sweden, the standing volume in Norway spruce monocultures was overestimated with the updated parameter values. At the stand scale, the model produced mixed results for carbon fluxes when evaluated against eddy-covariance data for two sites, one in central and one in southern Sweden. The interannual variation of GPP was well captured for the central Swedish site, but the modelled average GPP for the period 2015–2019 was overestimated by 9%. For the southern Swedish site, GPP was underestimated by 15% for the corresponding period and the simulated interannual variation was half of the observed. The seasonal estimates of modelled net ecosystem exchange (NEE) deviated from observations and the simulated standing volume was underestimated by 25% for both sites. The results highlight further potential to perform species-specific calibration to capture latitudinal gradients in key ecosystem properties, and to incorporate additional characteristics of site quality which could benefit model accuracy at the scale of individual forest stands, both regarding simulated carbon fluxes and forest stand variables.
24.	Bergkvist, John, et al. (author) Modelling managed forest ecosystems in Sweden : Poster presentation 2022 Conference paper (other academic/artistic)abstract In this work, the forestry-enabled dynamic vegetation model LPJ-GUESS was used to simulate forest standing volume for the three main regions of Sweden. At the regional scale, the model results were evaluated against observational data from the Swedish National Forest Inventory. Carbon fluxes of net ecosystem exchange (NEE), gross primary productivity (GPP), and ecosystem respiration (Reco) were simulated at the local scale on a daily time step for two sites in Sweden and results were evaluated against data from the Integrated Carbon Observation System (ICOS). The model produced adequate results of standing volume in monocultures of Norway spruce and Scots pine for southern and central Sweden, after an updated parameterization of the species. Stand-scale simulations of carbon fluxes produced mixed results after an evaluation against EC data from ICOS.
25.	Berglund, Emelie, et al. (author) Spatial maps of prostate cancer transcriptomes reveal an unexplored landscape of heterogeneity 2018 In: Nature Communications. - : Springer Science and Business Media LLC. - 2041-1723. ; 9 Journal article (peer-reviewed)abstract Intra-tumor heterogeneity is one of the biggest challenges in cancer treatment today. Here we investigate tissue-wide gene expression heterogeneity throughout a multifocal prostate cancer using the spatial transcriptomics (ST) technology. Utilizing a novel approach for deconvolution, we analyze the transcriptomes of nearly 6750 tissue regions and extract distinct expression profiles for the different tissue components, such as stroma, normal and PIN glands, immune cells and cancer. We distinguish healthy and diseased areas and thereby provide insight into gene expression changes during the progression of prostate cancer. Compared to pathologist annotations, we delineate the extent of cancer foci more accurately, interestingly without link to histological changes. We identify gene expression gradients in stroma adjacent to tumor regions that allow for re-stratification of the tumor microenvironment. The establishment of these profiles is the first step towards an unbiased view of prostate cancer and can serve as a dictionary for future studies.
26.	Blanco, Victor, et al. (author) The effect of forest owner decision-making, climatic change and societal demands on land-use change and ecosystem service provision in Sweden 2017 In: Ecosystem Services. - : Elsevier BV. - 2212-0416. ; 23, s. 174-208 Journal article (peer-reviewed)abstract The uncertain effects of climatic change and changing demands for ecosystem services on the distribution of forests and their levels of service provision require assessments of future land-use change, ecosystem service provision, and how ecosystem service demands may be met. We present CRAFTY-Sweden, an agent-based, land-use model that incorporates land owner behaviour and decision-making in modelling future ecosystem service provision in the Swedish forestry sector. Future changes were simulated under scenarios of socio-economic and climatic change between 2010 and 2100. The simulations indicate that the influence of climatic change (on land productivities) may be less important than that of socio-economic change or behavioural differences. Simulations further demonstrate that the variability in land owner and societal behaviour has a substantial role in determining the direction and impact of land-use change. The results indicate a sizeable increase in timber harvesting in coming decades, which together with a substantial decoupling between supply and demand for forest ecosystem services highlights the challenge of continuously meeting demands for ecosystem services over long periods of time. There is a clear need for model applications of this kind to better understand the variation in ecosystem service provision in the forestry sector, and other associated land-use changes.
27.	Blennow, Kristina, et al. (author) Implementing storm damage in a dynamic vegetation model for regional applications in Sweden 2012 In: Ecological Modelling. - : Elsevier BV. - 0304-3800 .- 1872-7026. ; 247, s. 71-82 Journal article (peer-reviewed)abstract Wind is the dominant agent of damage in forests in Western Europe. Traditional wind-damage models calculate a probability for damage or a critical wind speed at which damage occurs. However, in a dynamic vegetation model actual damage to stands and individual trees is needed to get a dynamical progression of the vegetation. We present a prototype for a new approach to modelling forest wind damage at the regional scale, which we incorporate within a dynamic vegetation model. The approach is based on knowledge from both empirical and mechanical models and calculates the damaged fraction of a cohort based on wind load and a sensitivity that depends on the current physical state and history of the cohort in relation to the ecosystem. The modelling concept has been developed, calibrated and evaluated for Swedish conditions but can be applicable to other similar areas with minor modification. Because of the stochastic nature of local wind load and the difficulty of describing the stand-level exposure, the ability to explain observed damage at stand level was low. Regional level variation in damage, which more depends on the wind load, was however explained reasonably well (R-2 = 0.43). We suggest that this is a useful concept for evaluating alternatives of forest management under different climate scenarios in the process of adaptation to future storm-damage risks. (C) 2012 Elsevier B.V. All rights reserved.
28.	Blomgren, Henrik, 1964-, et al. (author) Getting back to scenario planning : Strategic action in the future of Energy Europe 2011 Conference paper (peer-reviewed)abstract Scenario planning is a commonly used method in order to analyse complex aspects of the energy system. Historically it has been an important tool to prepare for long-term action. Today however, due to the deregulated market, it could be assumed that scenario analysis is abandoned. Maybe more (the only) attention is on short-term action.This paper presents a review over the time period of 1970 to 2010 on scenario-planning articles. The overall purpose is to evaluate how historical scenario studies stand in a situation of today’s deregulated energy markets.Articles surveyed are published in well-respected and internationally well-spread peer-reviewed journals. Focus is put on 1, when, and by whom, articles have been published 2, for what reasons projects have been taken and with what method 3, what aspect that have been in focus. The articles are also analysed in terms of possible use in today’s deregulated situation.Three conclusions are drawn. Firstly, the main use of scenario planning still tends to be a support to political processes. Secondly, three major issues and drivers for change dominate when different aspects of the energy system are analysed in scenario projects: climate change, security in terms of demand/supply and economic development. Thirdly, it is concluded that scenario planning still tend to be of value when analysing the future of the deregulated energy sector in Europe.However, in order to be fully utilized for the future scenario methodology must take into account that energy industry actors are not being controlled by politics as they where during the regulated period.
29.	Blomgren, Henrik, 1964-, et al. (author) Wheeling & Dealing : Scenarios for understanding the European energy future 2010 Conference paper (peer-reviewed)abstract The deregulation of energy industries in combination with internationalization and a changing Europe requires strategic efforts to be undertaken in a different way than earlier. Policy activitites do not control this sector to the same extent as before – corporate strategies and activities have also become important to understand. During 2002 the Royal Swedish Academy of Engineering Sciences engaged more than one hundred experts from industry, government and academia to analyze energy within the project “Energy Foresight – Sweden in Europe”. One part of the project, the structure foresight panel, sketched out four different scenarios that each describes a possible European setting for the energy industries - meaning: corporate action was in the center. In this article the aim is to evaluate the result from that scenario project in hindsight and to compare it with other similar scenario projects in this field.
30.	Bodén, Robert, et al. (author) Antidopaminergic drugs and acute pancreatitis : a population-based study 2012 In: BMJ Open. - : BMJ. - 2044-6055. ; 2:3, s. e000914- Journal article (peer-reviewed)abstract OBJECTIVES: To evaluate the suggested association between antidopaminergic drugs and acute pancreatitis.DESIGN: A large population-based nested case-control study.SETTING: Swedish nationwide study from 2006 to 2008.PARTICIPANTS: The Patient Register was used to identify 6161 cases of acute pancreatitis. The 61 637 control subjects were randomly selected from the Register of the Total Population by frequency-based density sampling, matched for age, sex and calendar year.EXPOSURE: Exposure data were extracted from the Prescribed Drug Register. Antidopaminergic drugs were grouped into antiemetic/anxiolytic and other antipsychotics. Current use of antidopaminergic drugs was defined as filling a prescription 1-114 days before index date, while previous use was 115 days to 3.5 years before index date.MAIN OUTCOME MEASURES: Cases were defined as being diagnosed as having acute pancreatitis. ORs and 95% CIs were calculated using unconditional logistic regression.RESULTS: The unadjusted OR indicated an increased risk of acute pancreatitis among current users of antiemetic/anxiolytics (OR 1.9, 95% CI 1.4 to 2.6), but not in the multivariable model adjusting for alcohol-related comorbidity, chronic obstructive lung disease, ischaemic heart disease, obesity, diabetes, opioid use, gallstone disease, educational level, marital status and number of concomitant medications (OR 0.9, 95% CI 0.6 to 1.2). Similarly, among current users of other antipsychotics, the unadjusted OR was 1.4 (95% CI 1.1 to 1.6), while the adjusted OR was 0.8 (95% CI 0.6 to 0.9). Results regarding previous use of antidopaminergic drugs followed a similar risk pattern as for current use.CONCLUSIONS: The lack of association between antidopaminergic drugs and acute pancreatitis after adjustment for confounding factors in this study suggests that the previously reported positive associations might be explained by confounding.
31.	Braunerhjelm, Pontus, 1953-, et al. (author) Entreprenörskap och innovation för hållbar utveckling 2009 Book (other academic/artistic)
32.	Brusselaers, Nele, et al. (author) Hospital and surgical volume in relation to long-term survival after oesophagectomy : systematic review and meta-analysis 2014 In: Gut. - Stockholm : Karolinska Institutet, Dept of Molecular Medicine and Surgery. - 1468-3288 .- 0017-5749. Journal article (peer-reviewed)abstract BACKGROUND: Centralisation of healthcare, especially for advanced cancer surgery, has been a matter of debate. Clear short-term mortality benefits have been described for oesophageal cancer surgery conducted at high-volume hospitals and by high-volume surgeons. OBJECTIVE: To clarify the association between hospital volume, surgeon volume and hospital type in relation to long-term survival after oesophagectomy for cancer, by a meta-analysis. DESIGN: The systematic literature search included PubMed, Web of Science, Cochrane library, EMBASE and Science Citation Index, for the period 1990-2013. Eligible articles were those which reported survival (time to death) as HRs after oesophagectomy for cancer by hospital volume, surgeon volume or hospital type. Fully adjusted HRs for the longest follow-up were the main outcomes. Results were pooled by a meta-analysis, and reported as HRs and 95% CIs. RESULTS: Sixteen studies from seven countries met the inclusion criteria. These studies reported hospital volume (N=13), surgeon volume (N=4) or hospital type (N=4). A survival benefit was found for high-volume hospitals (HR=0.82, 95% CI 0.75 to 0.90), and possibly also, for high-volume surgeons (HR=0.87, 95% CI 0.74 to 1.02) compared with their low-volume counterparts. No association with survival remained for hospital volume after adjustment for surgeon volume (HR=1.01, 95% CI 0.97 to 1.06; N=2), while a survival benefit was found in favour of high-volume surgeons after adjustment for hospital volume (HR=0.91, 95% CI 0.85 to 0.98; N=2). CONCLUSIONS: This meta-analysis demonstrated better long-term survival (even after excluding early deaths) after oesophagectomy with high-volume surgery, and surgeon volume might be more important than hospital volume. These findings support centralisation with fewer surgeons working at large centres. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
33.	Brusselaers, Nele, et al. (author) Tumour staging of oesophageal cancer in the Swedish Cancer Registry : a nationwide validation study 2015 In: Acta Oncologica. - Stockholm : Karolinska Institutet, Dept of Molecular Medicine and Surgery. - 1651-226X. Journal article (peer-reviewed)abstract Background: Tumour stage was introduced to the Swedish Cancer Registry in 2004, but this key variable for prognostic research has not yet been validated. We validated the tumour stage data in surgically treated oesophageal cancer patients. Material and Methods: Completeness and accuracy of tumour stage according to the TNM system (“Tumour Node Metastasis”) in the Cancer Registry were compared with a cohort study including comprehensive tumour stage data based on the pathological TNM of almost all patients operated for oesophageal cancer in 2006-2010 in Sweden. Results: Of the 397 patients with pathological TNM data in the comparison cohort, the Cancer Registry reported an overall TNM stage in 390 patients (98.2%), which was based on the pathological TNM of 104 patients (26.2%), the clinical TNM of 183 patients (46.1%), and the pathological or clinical TNM (undefined) of 110 patients (27.7%). The completeness for the separate T, N, and M components was 89.4%, 90.9%, and 85.1%, respectively. The concordance with tumour stage was 98.2%, while it was 51.1%, 70.5%, and 80.4% for the separate T, N, and M components, respectively. While the concordance with tumour stage was high for all TNM assessment groups (98.1-98.4%), the concordance of the T and N components was highest when using pathological TNM (82.7% and 95.2%, respectively), and the concordance of the M component was highest when using clinical TNM (88.5%). Conclusion: Although the overall completeness of tumour stage is high, the recording of pathological TNM stage and individual components could be improved within the Swedish Cancer Registry.
34.	Buker, P., et al. (author) DO3SE modelling of soil moisture to determine ozone flux to forest trees 2012 In: Atmospheric Chemistry and Physics. - : Copernicus GmbH. - 1680-7316 .- 1680-7324. ; 12:12, s. 5537-5562 Journal article (peer-reviewed)abstract The DO3SE (Deposition of O-3 for Stomatal Exchange) model is an established tool for estimating ozone (O-3) deposition, stomatal flux and impacts to a variety of vegetation types across Europe. It has been embedded within the EMEP (European Monitoring and Evaluation Programme) photochemical model to provide a policy tool capable of relating the flux-based risk of vegetation damage to O-3 precursor emission scenarios for use in policy formulation. A key limitation of regional flux-based risk assessments has been the assumption that soil water deficits are not limiting O-3 flux due to the unavailability of evaluated methods for modelling soil water deficits and their influence on stomatal conductance (g(sto)), and subsequent O-3 flux. This paper describes the development and evaluation of a method to estimate soil moisture status and its influence on g(sto) for a variety of forest tree species. This DO3SE soil moisture module uses the Penman-Monteith energy balance method to drive water cycling through the soil-plant-atmosphere system and empirical data describing g(sto) relationships with pre-dawn leaf water status to estimate the biological control of transpiration. We trial four different methods to estimate this biological control of the transpiration stream, which vary from simple methods that relate soil water content or potential directly to g(sto), to more complex methods that incorporate hydraulic resistance and plant capacitance that control water flow through the plant system. These methods are evaluated against field data describing a variety of soil water variables, g(sto) and transpiration data for Norway spruce (Picea abies), Scots pine (Pinus sylvestris), birch (Betula pendula), aspen (Populus tremuloides), beech (Fagus sylvatica) and holm oak (Quercus ilex) collected from ten sites across Europe and North America. Modelled estimates of these variables show consistency with observed data when applying the simple empirical methods, with the timing and magnitude of soil drying events being captured well across all sites and reductions in transpiration with the onset of drought being predicted with reasonable accuracy. The more complex methods, which incorporate hydraulic resistance and plant capacitance, perform less well, with predicted drying cycles consistently underestimating the rate and magnitude of water loss from the soil. A sensitivity analysis showed that model performance was strongly dependent upon the local parameterisation of key model drivers such as the maximum g(sto), soil texture, root depth and leaf area index. The results suggest that the simple modelling methods that relate g(sto) directly to soil water content and potential provide adequate estimates of soil moisture and influence on g(sto) such that they are suitable to be used to assess the potential risk posed by O-3 to forest trees across Europe.
35.	Börjesson, Sofia, et al. (author) Innovating Executive Management in Self-Managed Organizations : A Radical Swedish Experience 2024 In: European perspectives on innovation management. - Cham : Springer. - 9783031417955 - 9783031417986 - 9783031417962 ; , s. 67-91 Book chapter (peer-reviewed)abstract This chapter explores how new logic replaces power that associates with executive work in a managerial hierarchy. Following a collaborative research tradition, we conducted a case study of a Swedish company, Qamcom Research Technology, a 20-year-old firm within the Qamcom Group, which has a record of continuous growth through innovation. Results suggest that executive management itself can be innovated to enhance creativity and innovativeness of the firm. We explore the company’s organizational model based on roles and self-organization, finding a novel logic that operates across four concepts—willingness to share power, a dynamic steering model, natural hierarchies, and true transparency. These concepts jointly extend innovation capability research and encourage rethinking the role that organizational democracy and hierarchy play in self-managed organizations to explain far-reaching self-management of executive work.
36.	Doorakkers, Eva, et al. (author) Early complications following oesophagectomy for cancer in relation to long-term healthcare utilisation: a prospective population-based cohort study 2015 In: Plos One. - Stockholm : Karolinska Institutet, Dept of Molecular Medicine and Surgery. - 1932-6203. Journal article (peer-reviewed)abstract BACKGROUND: Little is known about how early postoperative complications after oesophagectomy for cancer influence healthcare utilisation in the long-term. We hypothesised that these complications also increase healthcare utilisation long after the recovery period. METHODS: This was a prospective, nationwide Swedish population-based cohort study of patients who underwent curatively intended oesophagectomy for cancer in 2001-2005 and survived at least 1 year postoperatively (n = 390). Total days of in-hospitalisation, number of hospitalisations and number of visits to the outpatient clinic within 5 years of surgery were analysed using quasi-Poisson models with adjustment for patient, tumour and treatment characteristics and are expressed as incidence rate ratios (IRR) and 95% confidence intervals (CI). RESULTS: There was an increased in-hospitalisation period 1-5 years after surgery in patients with more than 1 complication (IRR 1.5, 95% CI 1.0-2.4). The IRR for the number of hospitalisations by number of complications was 1.1 (95% CI 0.7-1.6), and 1.2 (95% CI 0.9-1.6) for number of outpatient visits in patients with more than 1 complication. The IRR for in-hospitalisation period 1-5 years following oesophagectomy was 1.8 (95% CI 1.0-3.0) for patients with anastomotic insufficiency and 1.5 (95% CI 0.9-2.5) for patients with cardiovascular or cerebrovascular complications. We found no association with number of hospitalisations (IRR 1.2, 95% CI 0.7-2.0) or number of outpatient visits (IRR 1.3, 95% CI 0.9-1.7) after anastomotic insufficiency, or after cardiovascular or cerebrovascular complications (IRR 1.2, 95% CI 0.7-1.9) and (IRR 1.1, 95% CI 0.8-1.5) respectively. CONCLUSION: This study showed an increased total in-hospitalisation period 1-5 years after oesophagectomy for cancer in patients with postoperative complications, particularly following anastomotic insufficiency.
37.	Dubber, Wilhelm, et al. (author) Comparing field inventory with mechanistic modelling and light-use efficiency modelling based approaches for estimating forest net primary productivity at a regional level 2017 In: Boreal Environment Research. - 1239-6095. ; 22, s. 337-352 Journal article (peer-reviewed)abstract Monitoring of forest carbon fluxes for the purpose of national greenhouse-gas inventorying and reporting are commonly based on repeated large-scale field measurements. Alternate approaches based on modelling of forest growth offers potential benefits such as cost savings and detailed assessments of involved carbon fluxes. We calculated the net primary productivity (NPP) of Swedish forests using two methods based on mechanistic and light use efficiency (LUE) modelling. The results were evaluated using data from traditional field inventories, and showed large variations in calculated NPP for the two methods. The national mean NPP for each method ranged between 0.35 and 0.59 kg C m- 2 year- 1, with an average regional difference of ±50%. Despite the large differences in calculated NPP, mechanistic modelling was promising for estimating the spatial distribution with an r2 value of 0.92 for predicting NPP of mainland Sweden.
38.	Elliott, Jessie A, et al. (author) An International Multicenter Study Exploring Whether Surveillance After Esophageal Cancer Surgery Impacts Oncological and Quality of Life Outcomes (ENSURE). 2022 In: Annals of Surgery. - 0003-4932 .- 1528-1140. Journal article (peer-reviewed)abstract OBJECTIVE: To determine the impact of surveillance on recurrence pattern, treatment, survival and health-related quality-of-life (HRQL) following curative-intent resection for esophageal cancer.SUMMARY BACKGROUND DATA: Although therapies for recurrent esophageal cancer may impact survival and HRQL, surveillance protocols after primary curative treatment are varied and inconsistent, reflecting a lack of evidence.METHODS: European iNvestigation of SUrveillance after Resection for Esophageal cancer was an international multicenter study of consecutive patients undergoing surgery for esophageal and esophagogastric junction cancers (2009-2015) across 20 centers (NCT03461341). Intensive surveillance (IS) was defined as annual computed tomography for 3 years postoperatively. The primary outcome measure was overall survival (OS), secondary outcomes included treatment, disease-specific survival, recurrence pattern, and HRQL. Multivariable linear, logistic, and Cox proportional hazards regression analyses were performed.RESULTS: Four thousand six hundred eighty-two patients were studied (72.6% adenocarcinoma, 69.1% neoadjuvant therapy, 45.5% IS). At median followup 60 months, 47.5% developed recurrence, oligometastatic in 39%. IS was associated with reduced symptomatic recurrence (OR 0.17 [0.12-0.25]) and increased tumor-directed therapy (OR 2.09 [1.58-2.77]). After adjusting for confounders, no OS benefit was observed among all patients (HR 1.01 [0.89-1.13]), but OS was improved following IS for those who underwent surgery alone (HR 0.60 [0.47-0.78]) and those with lower pathological (y)pT stages (Tis-2, HR 0.72 [0.58-0.89]). IS was associated with greater anxiety ( P =0.016), but similar overall HRQL.CONCLUSIONS: IS was associated with improved oncologic outcome in select cohorts, specifically patients with early-stage disease at presentation or favorable pathological stage post neoadjuvant therapy. This may inform guideline development, and enhance shared decision-making, at a time when therapeutic options for recurrence are expanding.
39.	Feigenwinter, Christian, et al. (author) Comparison of horizontal and vertical advective CO2 fluxes at three forest sites 2008 In: Agricultural and Forest Meteorology. - : Elsevier BV. - 1873-2240 .- 0168-1923. ; 148:1, s. 12-24 Journal article (peer-reviewed)abstract Extensive field measurements have been performed at three CarboEurope-Integrated Project forest sites with different topography (Renon/Ritten, Italian Alps, Italy; Wetzstein, Thuringia, Germany; Norunda, Uppland, Sweden) to evaluate the relevant terms of the carbon balance by measuring CO2 concentrations [CO2] and the wind field in a 3D multi-tower cube setup. The same experimental setup (geometry and instrumentation) and the same methodology were applied to all the three experiments. It is shown that all sites are affected by advection in different ways and strengths. Everywhere, vertical advection (F-VA) occurred only at night. During the day, F-VA disappeared because of turbulent mixing, leading to a uniform vertical profile of [CO2]. Mean F-VA was nearly zero at the hilly site (wetzstein) and at the flat site (Norunda). However, large, momentary positive or negative contributions occurred at the flat site, whereas vertical non-turbulent fluxes were generally very small at the hilly site. At the slope site (Renon), F-VA was always positive at night because of the permanently negative mean vertical wind component resulting from downslope winds. Horizontal advection also occurred mainly at night. It was positive at the slope site and negative at the flat site in the mean diurnal course. The size of the averaged non-turbulent advective fluxes was of the same order of magnitude as the turbulent flux measured by eddy-covariance technique, but the scatter was very high. This implies that it is not advisable to use directly measured quantities of the non-turbulent advective fluxes for the estimation of net ecosystem exchange (NEE) on e.g. an hourly basis. However, situations with and without advection were closely related to local or synoptic meteorological conditions. Thus, it is possible to separate advection affected NEE estimates from fluxes which are representative of the source term. However, the development of a robust correction scheme for advection requires a more detailed site-specific analysis of single events for the identification of the relevant processes. This paper presents mean characteristics of the advective CO2 fluxes in a first site-to-site comparison and evaluates the main problems for future research.
40.	Granier, A., et al. (author) Evidence for soil water control on carbon and water dynamics in European forests during the extremely dry year: 2003 2007 In: Agricultural and Forest Meteorology. - : Elsevier BV. - 1873-2240 .- 0168-1923. ; 143:1-2, s. 123-145 Journal article (peer-reviewed)abstract The drought of 2003 was exceptionally severe in many regions of Europe, both in duration and in intensity. In some areas, especially in Germany and France, it was the strongest drought for the last 50 years, lasting for more than 6 months. We used continuous carbon and water flux measurements at 12 European monitoring sites covering various forest ecosystem types and a large climatic range in order to characterise the consequences of this drought on ecosystems functioning. As soil water content in the root zone was only monitored in a few sites, a daily water balance model was implemented at each stand to estimate the water balance terms: trees and understorey transpiration, rainfall interception, throughfall, drainage in the different soil layers and soil water content. This model calculated the onset date, duration and intensity of the soil water shortage (called water stress) using measured climate and site properties: leaf area index and phenology that both determine tree transpiration and rainfall interception, soil characteristics and root distribution, both influencing water absorption and drainage. At sites where soil water content was measured, we observed a good agreement between measured and modelled soil water content. Our analysis showed a wide spatial distribution of drought stress over Europe, with a maximum intensity within a large band extending from Portugal to NE Germany. Vapour fluxes in all the investigated sites were reduced by drought, due to stomatal closure, when the relative extractable water in soil (REW) dropped below ca. 0.4. Rainfall events during the drought, however, typically induced rapid restoration of vapour fluxes. Similar to the water vapour fluxes, the net ecosystem production decreased with increasing water stress at all the sites. Both gross primary production (GPP) and total ecosystem respiration (TER) also decreased when REW dropped below 0.4 and 0.2, for GPP and TER, respectively. A higher sensitivity to drought was found in the beech, and surprisingly, in the broadleaved Mediterranean forests; the coniferous stands (spruce and pine) appeared to be less drought-sensitive. The effect of drought on tree growth was also large at the three sites where the annual tree growth was measured. Especially in beech, this growth reduction was more pronounced in the year following the drought (2004). Such lag effects on tree growth should be considered an important feature in forest ecosystems, which may enhance vulnerability to more frequent climate extremes.
41.	Grünig, Marc, et al. (author) A harmonized database of European forest simulations under climate change 2024 In: Data in Brief. - 2352-3409. ; 54 Journal article (peer-reviewed)abstract Process-based forest models combine biological, physical, and chemical process understanding to simulate forest dynamics as an emergent property of the system. As such, they are valuable tools to investigate the effects of climate change on forest ecosystems. Specifically, they allow testing of hypotheses regarding long-term ecosystem dynamics and provide means to assess the impacts of climate scenarios on future forest development. As a consequence, numerous local-scale simulation studies have been conducted over the past decades to assess the impacts of climate change on forests. These studies apply the best available models tailored to local conditions, parameterized and evaluated by local experts. However, this treasure trove of knowledge on climate change responses remains underexplored to date, as a consistent and harmonized dataset of local model simulations is missing. Here, our objectives were (i) to compile existing local simulations on forest development under climate change in Europe in a common database, (ii) to harmonize them to a common suite of output variables, and (iii) to provide a standardized vector of auxiliary environmental variables for each simulated location to aid subsequent investigations. Our dataset of European stand- and landscape-level forest simulations contains over 1.1 million simulation runs representing 135 million simulation years for more than 13,000 unique locations spread across Europe. The data were harmonized to consistently describe forest development in terms of stand structure (dominant height), composition (dominant species, admixed species), and functioning (leaf area index). Auxiliary variables provided include consistent daily climate information (temperature, precipitation, radiation, vapor pressure deficit) as well as information on local site conditions (soil depth, soil physical properties, soil water holding capacity, plant-available nitrogen). The present dataset facilitates analyses across models and locations, with the aim to better harness the valuable information contained in local simulations for large-scale policy support, and for fostering a deeper understanding of the effects of climate change on forest ecosystems in Europe.
42.	Hedberg, Jakob, et al. (author) Randomized controlled trial of nasogastric tube use after esophagectomy : study protocol for the kinetic trial 2024 In: Diseases of the esophagus. - : John Wiley & Sons. - 1120-8694 .- 1442-2050. ; 37:6 Journal article (peer-reviewed)abstract Esophagectomy is a complex and complication laden procedure. Despite centralization, variations in perioparative strategies reflect a paucity of evidence regarding optimal routines. The use of nasogastric (NG) tubes post esophagectomy is typically associated with significant discomfort for the patients. We hypothesize that immediate postoperative removal of the NG tube is non-inferior to current routines. All Nordic Upper Gastrointestinal Cancer centers were invited to participate in this open-label pragmatic randomized controlled trial (RCT). Inclusion criteria include resection for locally advanced esophageal cancer with gastric tube reconstruction. A pretrial survey was undertaken and was the foundation for a consensus process resulting in the Kinetic trial, an RCT allocating patients to either no use of a NG tube (intervention) or 5 days of postoperative NG tube use (control) with anastomotic leakage as primary endpoint. Secondary endpoints include pulmonary complications, overall complications, length of stay, health related quality of life. A sample size of 450 patients is planned (Kinetic trial: https://www.isrctn.com/ISRCTN39935085). Thirteen Nordic centers with a combined catchment area of 17 million inhabitants have entered the trial and ethical approval was granted in Sweden, Norway, Finland, and Denmark. All centers routinely use NG tube and all but one center use total or hybrid minimally invasive-surgical approach. Inclusion began in January 2022 and the first annual safety board assessment has deemed the trial safe and recommended continuation. We have launched the first adequately powered multi-center pragmatic controlled randomized clinical trial regarding NG tube use after esophagectomy with gastric conduit reconstruction.
43.	Holmberg, Dag, et al. (author) Aspirin or statin use in relation to survival after surgery for esophageal cancer : a population-based cohort study 2023 In: BMC Cancer. - : BioMed Central (BMC). - 1471-2407. ; 23:1 Journal article (peer-reviewed)abstract Background: Adjuvant postoperative treatment with aspirin and statins may improve survival in several solid tumors. This study aimed to assess whether these medications improve the survival after curatively intended treatment (including esophagectomy) for esophageal cancer in an unselected setting.Methods: This nationwide cohort study included nearly all patients who underwent esophagectomy for esophageal cancer in Sweden from 2006 to 2015, with complete follow-up throughout 2019. Risk of 5-year disease-specific mortality in users compared to non-users of aspirin and statins was analyzed using Cox regression, providing hazard ratios (HR) with 95% confidence intervals (CI). The HRs were adjusted for age, sex, education, calendar year, comorbidity, aspirin/statin use (mutual adjustment), tumor histology, pathological tumor stage, and neoadjuvant chemo(radio)therapy.Results: The cohort included 838 patients who survived at least 1 year after esophagectomy for esophageal cancer. Of these, 165 (19.7%) used aspirin and 187 (22.3%) used statins during the first postoperative year. Neither aspirin use (HR 0.92, 95% CI 0.67-1.28) nor statin use (HR 0.88, 95% CI 0.64-1.23) were associated with any statistically significant decreased 5-year disease-specific mortality. Analyses stratified by subgroups of age, sex, tumor stage, and tumor histology did not reveal any associations between aspirin or statin use and 5-year disease-specific mortality. Three years of preoperative use of aspirin (HR 1.26, 95% CI 0.98-1.65) or statins (HR 0.99, 95% CI 0.67-1.45) did not decrease the 5-year disease-specific mortality.Conclusions: Use of aspirin or statins might not improve the 5-year survival in surgically treated esophageal cancer patients.
44.	Islam, Md Rafikul, et al. (author) Projected effects of climate change and forest management on carbon fluxes and biomass of a boreal forest 2024 In: Agricultural and Forest Meteorology. - 0168-1923. ; 349 Journal article (peer-reviewed)abstract Boreal forests are key to global carbon (C) sequestration and storage. However, the potential impacts of climate change on these forests could be profound. Nearly 70 % of the European boreal forests are intensively managed, but our understanding of the combined effects of forest management and climate change on the forest's integral role as a C sink is still limited. In this study, we aim to fill this gap with simulations of the process-based dynamic global vegetation model LPJ-GUESS. We evaluated the effects of four forest management options under two different climate scenarios (RCP 4.5 and RCP 8.5), at a southern boreal forest stand in Sweden. These options were compared against a baseline without clear-cut or management interventions. We found that the projected increase in temperatures (+2 to +4 °C) during the latter part of the 21st century will reduce the net C sink strength, particularly in the unmanaged forest. The standing biomass C for reforestations was projected to be 57–67 % lower in 2100 than in the old forest in 2022. The study also revealed that the C sequestration potential of replanted pine forests may surpass that of 200-years old forests in the far future (2076–2100). The study did not detect statistically significant differences in overall net C exchange between the clear-cut with subsequent reforestation options and the baseline, even though specific reforestation strategies, such as pine plantations, enhanced the overall net C sink by 7–20 % relative to the baseline during 2022–2100. These findings underscore the profound influence of forest management on the net C budget, surpassing that of climate change scenarios alone. By adopting pertinent reforestation strategies, C uptake could be augmented, with concurrently improved forest productivity, resulting in favourable outcomes for the forest's critical role in C sequestration and storage amidst a changing climate.
45.	Johansson, Petter, 1983-, et al. (author) Critical factors in different phases of the Swedish heat pump market development 2013 In: The Industrial. Conference paper (other academic/artistic)abstract Since the heat pump was invented in the mid 19th century it has been dependent on technological development of principally five main mechanical components as well as on economic, social and political factors to penetrate the market. It can therefore be useful to describe the heat pump as a sociotechnical system consisting of different components, or sub-systems, to understand how all components must align to achieve market acceptance. While technological and social conditions affecting the heat pump demand are currently in the process of aligning in several European emerging and growing markets, the Swedish heat pump market is slowing down due to signs of market saturation.Sweden has been a pioneering nation in the field of heat pumps and the heat pump has had a larger market impact in Sweden than anywhere else. Since the birth of the market in the 1970s it has gone through several phases: Growth from 1979, a market collapse in the mid 1980s, a strong growth once more from 1995 to 2006, and a recent decline in sales. This article studies these shifts in market demand by answering the research question: What critical factors have affected the heat pump market in Sweden during different phases of its development? These critical factors have been mapped out through interviews with researchers and industry representatives together with an extensive literature review and analysis of secondary available data such as statistical reviews and research program records.This article arguments that the market demand has correlated to the alignment of factors in the heat pump sociotechnical system, and that too much focus has previously been on subsidies when trying to explain the causes behind the heat pump market development in Sweden. Subsidies has only been one factor out of many. Understanding the market development of energy technologies such as heat pumps from a sociotechnical perspective is useful knowledge for practitioners and policy makers engaged in emerging energy markets as well as researchers in the field.
46.	Jönsson, Anna Maria, et al. (author) Effects of climate and soil conditions on the productivity and defence capacity of Picea abies in Sweden—An ecosystem model assessment 2018 In: Ecological Modelling. - 0304-3800. ; 384, s. 154-167 Journal article (peer-reviewed)abstract Climate change can lead to an increased frequency of extreme weather events, which may induce a decline in tree vitality, rendering the forest more vulnerable to other stress factors. In this study we used the ecosystem model LPJ-GUESS to compare the NPP of boreal conifers on till soil and sandy soil, simulating the growth of Norway spruce during the 21st century using climate model projections corresponding to RCP 8.5. Model runs with and without nitrogen cycling enabled, in combination with two different approaches to implement the dynamics of non-structural carbohydrates (NSC) were compared. The simulations showed that the forest productivity in Sweden is influenced by an interplay between site-specific temperature conditions and precipitation. Local differences in soil conditions can have an impact on the productivity, mediated by soil water and nutrient content. A warmer climate will lead to a longer growing season, but the productivity increase will partly be offset by a higher frequency of drought stress in summer and higher autotrophic respiration in winter. The ecosystem model runs indicated that periods with drought stress can cause low NSC levels, leading to time periods with decreased defence capacity against attacks by secondary agents such as bark beetles. The risks may however not become apparent until the forest stands are middle-aged. The model results are discussed in relation to current forestry practice, with Norway spruce (Picea abies) commonly being planted on dry soils better suited for Scots pine (Pinus sylvestris) in order to reduce moose browsing damage of seedlings, which in the longer term may create a forest landscape more sensitive to spruce bark beetle attacks.
47.	Jönsson, Anna Maria, et al. (author) Forest management facing climate change : an ecosystem model analysis of adaptation strategies 2015 In: Mitigation and Adaptation Strategies for Global Change. - : Springer Science and Business Media LLC. - 1573-1596 .- 1381-2386. ; 20:2, s. 201-220 Journal article (peer-reviewed)
48.	Jönsson, Anna Maria, et al. (author) Guess the impact of Ips typographus – An ecosystem modelling approach for simulating bark beetle outbreaks 2012 In: Agricultural and Forest Meteorology. - : Elsevier BV. - 1873-2240 .- 0168-1923. ; 166-167, s. 188-200 Journal article (peer-reviewed)abstract Spruce bark beetle outbreaks are common in Norway spruce forests following windstorm damage, due to ample availability of brood material. The realization of an outbreak depends on factors regulating the Ips typographus population dynamics, such as weather conditions and salvage cutting. In this study, we take an ecosystem modelling approach to analyse the influence of multiple environmental factors on the risk for I. typographus outbreaks. Model calculations of I. typographus phenology and population dynamics as a function of weather and brood tree availability were developed and implemented in the LPJ-GUESS ecosystem modelling framework. The model simulations were driven by gridded climate data covering Sweden with a spatial resolution of 0.5° and a daily temporal resolution. Records on storm damage and I. typographus outbreak periods in Sweden for the period of 1960–2009 were used for model evaluation, and a sensitivity analysis was performed to examine the model behaviour. The model simulations replicated the observed pattern in outbreak frequency, being more common in southern and central Sweden than in northern Sweden. A warmer climate allowing for more than one generation per year can increase the risk for attacks on living trees. The effect of countermeasures, aiming at either reduce the availability of brood material or the I. typographus population size, is dependent on a non-linear relation between I. typographus attack density and reproductive success. The sensitivity analysis indicated a major reduction in the risk of attacks on living trees by timely salvage cutting and cutting of infested trees. Knowledge uncertainties associated with attacks on standing trees, i.e. factors influencing tree defence capacity and I. typographus reproductive success, should be further addressed.
49.	Jönsson, Anna Maria, et al. (author) Klimatförändringarna och risken för skador i skog 2012 Reports (pop. science, debate, etc.)
50.	Jönsson, Anna Maria, et al. (author) Potential use of seasonal forecasts for operational planning of north European forest management 2017 In: Agricultural and Forest Meteorology. - : Elsevier BV. - 0168-1923. ; 244-245, s. 122-135 Journal article (peer-reviewed)abstract Weather and climate conditions can have large impacts on the outcome of forest management operations: Suboptimal conditions can increase the amount of driving damage to forest ground caused by the heavy machines used for harvesting, forwarding and soil scarification. Planting of tree seedlings is commonly practised after clear cutting, and drought in summer or soil frost uplifting in autumn reduces the likelihood of successful plant establishment. Weather and climate also influence the risk of forest fires and the occurrence and development of pest and pathogens, and thereby the timing suitable for surveillance and countermeasures. In this study, the potential use of seasonal forecasts to support the operational planning of forest management in northern Europe was assessed. The analysis was based on temperature and precipitation data from WFDEI System 4 with 15 ensemble members representing seasonal hindcasts (retrospective predictions) for the period of 1981–2010. The data was used directly and as input to a soil model from which monthly indices of frozen soil and plant water stress were calculated. Relatively low skills were found for most months, and in particular for longer lead times. Highest skill was found for bias corrected temperature of January to March, with one month lead time. The skill was higher for the soil model indices, in particular those related to soil frost, as they are influenced by cumulative processes and the initial model conditions contribute to the skill. Probabilistic forecasts on frozen soil can thus be valuable for planning of which areas to harvest, taking the risk of driving damage to forest soils and forest roads into account.

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