| 1. |
- Kanai, M, et al.
(författare)
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- 2023
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swepub:Mat__t
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| 2. |
- Niemi, MEK, et al.
(författare)
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- 2021
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swepub:Mat__t
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| 3. |
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| 4. |
- Walker, Anthony P, et al.
(författare)
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Horizon 2020 EuPRAXIA design study
- 2017
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Ingår i: Journal of Physics: Conference Series. - : IOP Publishing. - 1742-6588 .- 1742-6596. ; 874:1
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Tidskriftsartikel (refereegranskat)abstract
- The Horizon 2020 Project EuPRAXIA ("European Plasma Research Accelerator with eXcellence In Applications") is preparing a conceptual design report of a highly compact and cost-effective European facility with multi-GeV electron beams using plasma as the acceleration medium. The accelerator facility will be based on a laser and/or a beam driven plasma acceleration approach and will be used for photon science, high-energy physics (HEP) detector tests, and other applications such as compact X-ray sources for medical imaging or material processing. EuPRAXIA started in November 2015 and will deliver the design report in October 2019. EuPRAXIA aims to be included on the ESFRI roadmap in 2020.
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| 5. |
- Drake, Thomas M., et al.
(författare)
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Outcomes following small bowel obstruction due to malignancy in the national audit of small bowel obstruction
- 2019
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Ingår i: European Journal of Surgical Oncology. - : Elsevier BV. - 0748-7983 .- 1532-2157. ; 45:12, s. 2319-2324
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Tidskriftsartikel (refereegranskat)abstract
- © 2019 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology Introduction: Patients with cancer who develop small bowel obstruction are at high risk of malnutrition and morbidity following compromise of gastrointestinal tract continuity. This study aimed to characterise current management and outcomes following malignant small bowel obstruction. Methods: A prospective, multicentre cohort study of patients with small bowel obstruction who presented to UK hospitals between 16th January and 13th March 2017. Patients who presented with small bowel obstruction due to primary tumours of the intestine (excluding left-sided colonic tumours) or disseminated intra-abdominal malignancy were included. Outcomes included 30-day mortality and in-hospital complications. Cox-proportional hazards models were used to generate adjusted effects estimates, which are presented as hazard ratios (HR) alongside the corresponding 95% confidence interval (95% CI). The threshold for statistical significance was set at the level of P ≤ 0.05 a-priori. Results: 205 patients with malignant small bowel obstruction presented to emergency surgery services during the study period. Of these patients, 50 had obstruction due to right sided colon cancer, 143 due to disseminated intraabdominal malignancy, 10 had primary tumours of the small bowel and 2 patients had gastrointestinal stromal tumours. In total 100 out of 205 patients underwent a surgical intervention for obstruction. 30-day in-hospital mortality rate was 11.3% for those with primary tumours and 19.6% for those with disseminated malignancy. Severe risk of malnutrition was an independent predictor for poor mortality in this cohort (adjusted HR 16.18, 95% CI 1.86 to 140.84, p = 0.012). Patients with right-sided colon cancer had high rates of morbidity. Conclusions: Mortality rates were high in patients with disseminated malignancy and in those with right sided colon cancer. Further research should identify optimal management strategy to reduce morbidity for these patient groups.
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| 6. |
- Filippi, F., et al.
(författare)
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Plasma density profile reconstruction of a gas cell for Ionization Induced Laser Wakefield Acceleration
- 2023
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Ingår i: Journal of Instrumentation. - 1748-0221. ; 18:5
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Tidskriftsartikel (refereegranskat)abstract
- Laser-driven plasma wakefields can provide hundreds of MeV electron beam in mm-range distances potentially shrinking the dimension of the actual particle accelerators. The plasma density plays a fundamental role in the control and stability of the acceleration process, which is a key development for the future electron injector proposed by EuPRAXIA. A gas cell was designed by LPGP and LIDYL teams, with variable length and backing pressure, to confine the gas and tailor the gas density profile before the arrival of the laser. This cell was used during an experimental campaign with the multi TW-class laser at the Lund Laser Centre. Ionization assisted injection in a tailored density profile is used to tune the electron beam properties. During the experiment, we filled the gas cell with hydrogen mixed with different concentration of nitrogen. We also varied the backing pressure of the gas and the geometrical length of the gas cell. We used a transverse probe to acquire shadowgraphic images of the plasma and to measure the plasma electron density. Methods and results of the analysis with comparisons between shadowgraphic and interferometric images will be discussed.
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| 7. |
- Dickson, L. T., et al.
(författare)
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Mechanisms to control laser-plasma coupling in laser wakefield electron acceleration
- 2022
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Ingår i: Physical Review Accelerators and Beams. - 2469-9888. ; 25:10
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Tidskriftsartikel (refereegranskat)abstract
- Experimental results, supported by precise modeling, demonstrate optimization of a plasma-based injector with intermediate laser pulse energy (<1 J), corresponding to a normalized vector potential a0=2.15, using ionization injection in a tailored plasma density profile. An increase in electron bunch quality and energy is achieved experimentally with the extension of the density downramp at the plasma exit. Optimization of the focal position of the laser pulse in the tailored plasma density profile is shown to efficiently reduce electron bunch angular deviation, leading to a better alignment of the electron bunch with the laser axis. Single peak electron spectra are produced in a previously unexplored regime by combining an early focal position and adaptive optic control of the laser wavefront by optimizing the symmetry of the prefocal laser energy distribution. Experimental results have been validated through particle-in-cell simulations using realistic laser energy, phase distribution, and temporal envelope, allowing for accurate predictions of difficult to model parameters, such as total charge and spatial properties of the electron bunches, opening the way for more accurate modeling for the design of plasma-based accelerators.
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| 8. |
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| 9. |
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| 10. |
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| 11. |
- Deming, Timothy J., et al.
(författare)
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Polymers at the Interface with Biology
- 2018
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Ingår i: Biomacromolecules. - : AMER CHEMICAL SOC. - 1525-7797 .- 1526-4602. ; 19:8, s. 3151-3162
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 12. |
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| 13. |
- Almer, Jakob, et al.
(författare)
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Ischemic QRS prolongation as a biomarker of severe myocardial ischemia.
- 2016
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Ingår i: Journal of Electrocardiology. - : Elsevier BV. - 1532-8430 .- 0022-0736. ; 49:2, s. 139-147
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Tidskriftsartikel (refereegranskat)abstract
- Previous studies have shown that QRS prolongation is a sign of depressed collateral flow and increased rate of myocardial cell death during coronary occlusion. The aims of this study were to evaluate ischemic QRS prolongation as a biomarker of severe ischemia by establishing the relationship between prolongation and collateral flow experimentally in a dog model, and test if the same pattern of ischemic QRS prolongation occurs in man.
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| 14. |
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| 15. |
- Anthony, Kenneth R. N., et al.
(författare)
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Operationalizing resilience for adaptive coral reef management under global environmental change
- 2015
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Ingår i: Global Change Biology. - : Wiley. - 1354-1013 .- 1365-2486. ; 21:1, s. 48-61
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Forskningsöversikt (refereegranskat)abstract
- Cumulative pressures from global climate and ocean change combined with multiple regional and local-scale stressors pose fundamental challenges to coral reef managers worldwide. Understanding how cumulative stressors affect coral reef vulnerability is critical for successful reef conservation now and in the future. In this review, we present the case that strategically managing for increased ecological resilience (capacity for stress resistance and recovery) can reduce coral reef vulnerability (risk of net decline) up to a point. Specifically, we propose an operational framework for identifying effective management levers to enhance resilience and support management decisions that reduce reef vulnerability. Building on a system understanding of biological and ecological processes that drive resilience of coral reefs in different environmental and socio-economic settings, we present an Adaptive Resilience-Based management (ARBM) framework and suggest a set of guidelines for how and where resilience can be enhanced via management interventions. We argue that press-type stressors (pollution, sedimentation, overfishing, ocean warming and acidification) are key threats to coral reef resilience by affecting processes underpinning resistance and recovery, while pulse-type (acute) stressors (e.g. storms, bleaching events, crown-of-thorns starfish outbreaks) increase the demand for resilience. We apply the framework to a set of example problems for Caribbean and Indo-Pacific reefs. A combined strategy of active risk reduction and resilience support is needed, informed by key management objectives, knowledge of reef ecosystem processes and consideration of environmental and social drivers. As climate change and ocean acidification erode the resilience and increase the vulnerability of coral reefs globally, successful adaptive management of coral reefs will become increasingly difficult. Given limited resources, on-the-ground solutions are likely to focus increasingly on actions that support resilience at finer spatial scales, and that are tightly linked to ecosystem goods and services.
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| 16. |
- Audet, T. L., et al.
(författare)
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Electron injector for compact staged high energy accelerator
- 2016
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Ingår i: Nuclear Instruments and Methods in Physics Research, Section A: Accelerators, Spectrometers, Detectors and Associated Equipment. - : Elsevier BV. - 0168-9002. ; 829, s. 304-308
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Tidskriftsartikel (refereegranskat)abstract
- An electron injector for multi-stage laser wakefield experiments is presented. It consists of a variable length gas cell of small longitudinal dimension (⩽10mm). The gas filling process in this cell was characterized both experimentally and with fluid simulation. Electron acceleration experiments were performed at two different laser facilities. Results show low divergence and low pointing fluctuation electron bunches suitable for transport to a second stage, and a peaked energy distribution suitable for injection into the second stage wakefield accelerator.
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| 17. |
- Audet, T. L., et al.
(författare)
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Investigation of ionization-induced electron injection in a wakefield driven by laser inside a gas cell
- 2016
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Ingår i: Physics of Plasmas. - : AIP Publishing. - 1070-664X .- 1089-7674. ; 23:2
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Tidskriftsartikel (refereegranskat)abstract
- Ionization-induced electron injection was investigated experimentally by focusing a driving laser pulse with a maximum normalized potential of 1.2 at different positions along the plasma density profile inside a gas cell, filled with a gas mixture composed of 99%H2+1%N2. Changing the laser focus position relative to the gas cell entrance controls the accelerated electron bunch properties, such as the spectrum width, maximum energy, and accelerated charge. Simulations performed using the 3D particle-in-cell code WARP with a realistic density profile give results that are in good agreement with the experimental ones. The interest of this regime for optimizing the bunch charge in a selected energy window is discussed.
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| 18. |
- Billgren, T, et al.
(författare)
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Detailed definition and interobserver agreement for the electrocardiographic Sclarovsky-Birnbaum ischemia grading system
- 2002
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Ingår i: Journal of Electrocardiology. - : Elsevier BV. - 1532-8430 .- 0022-0736. ; 35, s. 201-202
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Tidskriftsartikel (refereegranskat)abstract
- A generally implementable method for predicting salvageability on the presenting electrocardiogram (ECG) in patients with acute myocardial infarction (AMI) would be of great clinical importance. ECG-derived Grades of Ischemia (1) have been proven useful in predicting the extent and severity of left ventricular dysfunction after anterior MI, estimating short and long-term prognosis, final infarct size, and salvageability by reperfusion therapy (2).
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| 19. |
- Billgren, Therese, et al.
(författare)
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Grade 3 ischemia on the admission electrocardiogram predicts rapid progression of necrosis over time and less myocardial salvage by primary angioplasty
- 2005
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Ingår i: Journal of Electrocardiology. - : Elsevier BV. - 1532-8430 .- 0022-0736. ; 38:3, s. 187-194
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Tidskriftsartikel (refereegranskat)abstract
- Background: Among patients with ST-elevation acute myocardial infarction, those with terminal QRS distortion (grade 3 ischemia) have higher mortality and larger infarct size (IS) than patients without QRS distortion (grade 2 ischemia). Methods: We assessed the relation of baseline electrocardiographic ischemia grades to area at risk (AR) and myocardial salvage [100 (AR - IS)/AR] in 79 patients who underwent primary angioplasty for first ST-elevation acute myocardial infarction and had technetium Tc 99m sestamibi single-photon emission computed tomography before angioplasty (AR) and at predischarge (IS). Patients were classified as having grade 2 ischemia (ST elevation without terminal QRS distortion in any of the leads, n = 48), grade 2.5 ischemia (ST elevation with terminal QRS distortion in 1 lead, n = 16), or grade 3 ischemia (ST elevation with terminal QRS distortion in > 2 adjacent leads, n = 15). Results: Time to treatment was comparable among groups. AR was comparable among groups (38% +/- 20%, 33% +/- 23%, and 34% +/- 23%, respectively; P = .70). There were no differences among groups in residual myocardial perfusion (severity index 0.28 +/- 0.12, 0.29 +/- 0.16, and 0.30 +/- 0.15 in grades 2, 2.5, and 3 ischemia, respectively; P = .97). In contrast, there was a trend toward lower myocardial salvage (45% +/- 32%) in the grade 3 group than in the grade 2 (65% +/- 33%) and grade 2.5 (65% +/- 40%) groups (P = .16). Salvage was dependent on time only in the grade 3 group. Spearman rank correlation coefficients between time to treatment and percentage salvage were 0.003 (P = .99), -0.24 (P = .38), and -0.63 (P = .022) for grades 2, 2.5, and 3, respectively. Conclusions: Patients with grade 3 ischemia have rapid progression of necrosis over time and less myocardial salvage. This admission pattern is a predictor of myocardial salvage by primary angioplasty.
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| 20. |
- Billgren, T, et al.
(författare)
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Refinement and interobserver agreement for the electrocardiographic Sclarovsky-Birnbaum Ischemia Grading System
- 2004
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Ingår i: Journal of Electrocardiology. - : Elsevier BV. - 1532-8430 .- 0022-0736. ; 37:3, s. 149-156
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Tidskriftsartikel (refereegranskat)abstract
- Background: Electrocardiogram-derived grades of ischemia at the time of patient presentation with acute myocardial infarction have proved useful in predicting the salvageability by reperfusion therapy, final infarct size, severity of left ventricular dysfunction, and short- and long-term prognosis. Subjects and Methods: The Sclarovsky-Birnbaum Ischemia Grading System based on the relation between the acute appearances of the T wave, the ST segment, and the QRS complex was considered as a means of enhanced ECG analysis in this group of patients. The evaluation of a training population (n = 46) resulted in refinement of the published description of the Sclarovsky-Birnbaum Ischemia Grading System, and a test population (n = 50) was utilized for investigating the interobserver agreement among 5 observers in determining the grade of ischemia. Results: The agreement among the observers applying the "refined" Sclarovsky-Birnbaum Ischemia Grading System was 0.89. Complete agreement was found for the ECGs of 80% of the patients, and the most common reason for disagreement was the application of the terminal T-negativity criterion. Conclusions: The refined Sclarovsky-Birnbaum Ischemia Grading System can be performed manually with low interobserver variability. It has potential for support of the acute myocardial infarction triage decision as an electrocardiographic method for evaluating the level of ischemic protection at the time of either pre-hospital or emergency-department presentation.
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| 21. |
- Bradley, KA, et al.
(författare)
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Alcohol Screening and Risk of Postoperative Complications on Male VA Patients Undergoing Major Non-cardiac Surgery
- 2011
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Ingår i: Journal of General Internal Medicine. - : Springer Science and Business Media LLC. - 0884-8734 .- 1525-1497. ; 26:2, s. 162-169
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Patients who misuse alcohol are at increased risk for surgical complications. Four weeks of preoperative abstinence decreases the risk of complications, but practical approaches for early preoperative identification of alcohol misuse are needed. OBJECTIVE: To evaluate whether results of alcohol screening with the Alcohol Use Disorders Identification Test - Consumption (AUDIT-C) questionnaire—up to a year before surgery—were associated with the risk of postoperative complications. DESIGN: This is a cohort study. SETTING AND PARTICIPANTS: Male Veterans Affairs (VA) patients were eligible if they had major noncardiac surgery assessed by the VA’s Surgical Quality Improvement Program (VASQIP) in fiscal years 2004-2006, and completed the AUDIT-C alcohol screening questionnaire (0-12 points) on a mailed survey within 1 year before surgery. MAIN OUTCOME MEASURE: One or more postoperative complication(s) within 30 days of surgery based on VASQIP nurse medical record reviews. RESULTS Among 9,176 eligible men, 16.3% screened positive for alcohol misuse with AUDIT-C scores ≥ 5, and 7.8% had postoperative complications. Patients with AUDIT-C scores ≥ 5 were at significantly increased risk for postoperative complications, compared to patients who drank less. In analyses adjusted for age, smoking, and days from screening to surgery, the estimated prevalence of postoperative complications increased from 5.6% (95% CI 4.8–6.6%) in patients with AUDIT-C scores 1–4, to 7.9% (6.3–9.7%) in patients with AUDIT-Cs 5–8, 9.7% (6.6–14.1%) in patients with AUDIT-Cs 9–10 and 14.0% (8.9–21.3%) in patients with AUDIT-Cs 11–12. In fully-adjusted analyses that included preoperative covariates potentially in the causal pathway between alcohol misuse and complications, the estimated prevalence of postoperative complications increased significantly from 4.8% (4.1–5.7%) in patients with AUDIT-C scores 1–4, to 6.9% (5.5–8.7%) in patients with AUDIT-Cs 5-8 and 7.5% (5.0–11.3%) among those with AUDIT-Cs 9–10. CONCLUSIONS: AUDIT-C scores of 5 or more up to a year before surgery were associated with increased postoperative complications.
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| 22. |
- Davis, TH, et al.
(författare)
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Problem-based learning of research skills
- 2006
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Ingår i: Journal of Electrocardiology. - : Elsevier BV. - 1532-8430 .- 0022-0736. ; 39:1, s. 120-128
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To determine whether a short-term, problem-based educational intervention leads to increased research activity among health care practitioners. Subjects and Methods: Participant's success was evaluated as a composite of 2 outcomes. These were (1) reporting results for the project designed during the practicum and (2) conducting subsequent research activities. The study population included 36 clinical research outcomes projects developed by clinical practitioners, postgraduate trainees, and medical students during 6 separate practicums. All project teams received the same educational intervention, an "outcomes research practicum" that was divided into 4 primary learning modules administered over a I to 4 month period. Each module included a preparatory videotape lecture, supplemental readings, and a 90-minute interactive laboratory session during which faculty members worked with participants to develop answers to a series of predefined questions relating to the design of clinical outcomes research projects. Follow-up continued for a minimum of 12 months and a maximum of 36 months. Results: Eighty-three percent of project teams completed all 4 practicum modules, and 69% completed one of the study outcomes (50% completed their research project and 47% completing a subsequent research activity). Practitioners were more likely to complete subsequent research activities, whereas trainees were more likely to complete their study project. Discussion: This short-term, problem-based educational intervention was successful in increasing the collective research activities of participants. Further, more rigorous structured research is needed to determine the ultimate impact on practice change and patient outcomes. (c) 2006 Elsevier Inc. All rights reserved.
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| 23. |
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| 24. |
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| 25. |
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| 26. |
- Harvey, P, et al.
(författare)
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The electric field instrument on the Polar satellite
- 1995
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Ingår i: Space Science Reviews. - 0038-6308 .- 1572-9672. ; 71, s. 583-596
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Tidskriftsartikel (refereegranskat)abstract
- The Polar satellite carries a system of four wire booms in the spacecraft spin plane and two rigid booms along the spin axis. Each of the booms has a spherical sensor at its tip along with nearby guard and stub surfaces whose potentials relative to that of their sphere are controlled by associated electronics. The potential differences between opposite sphere pairs are measured to yield the three components of the DC to >1 MHz electric field. Spheres can also be operated in a mode in which their collected current is measured to give information on the plasma density and its fluctuations. The scientific studies to be performed by this experiment as well as the mechanical and electrical properties of the detector system are described.
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| 27. |
- Hedén, Bo, et al.
(författare)
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A modified Anderson-Wilkins electrocardiographic acuteness score for anterior or inferior myocardial infarction.
- 2003
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Ingår i: American Heart Journal. - 1097-6744. ; 146:5, s. 797-803
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Tidskriftsartikel (refereegranskat)abstract
- Background Optimal treatment of acute myocardial infarction (AMI) depends on the duration of the ischemia. The Anderson Wilkins (AW) electrocardiographic acuteness score has been shown to complement the historical timing in estimating the time interval from acute thrombotic coronary occlusion in patients presenting with chest pain and evolving myocardial infarction. The purposes of this study were to (1) compare the distributions of the previously developed AW acuteness score in a training population with either anterior or inferior AMI and (2) propose modifications to the formula to achieve distributions similar to the observed distributions of historical times from onset of pain. Methods Two hundred three and 177 patients were included as training and testing population, respectively. All patients had an anterior or an inferior AMI and were without confounding factors on the electrocardiogram. Results The training population had similar distributions of historical times from onset of pain, but differences in distributions of AW acuteness scores, between patients with anterior and inferior AMI (P<.0001). Eighty percent of the inferior AMI group had the highest possible AW acuteness score. Modification of a Q-wave criterion from &GE;30 to &GE;20 ms resulted in similar distributions in patients with anterior and inferior AMI both in the training and an independent testing population. Conclusions These results suggest that a modified AW acuteness score using a lower Q-wave duration criterion provides similar AMI timing information in patients with anterior and inferior locations. Clinical use of the AW acuteness score will only be practical if the calculation is automated
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| 28. |
- Horejs, CM, et al.
(författare)
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Preventing tissue fibrosis by local biomaterials interfacing of specific cryptic extracellular matrix information
- 2017
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Ingår i: Nature communications. - : Springer Science and Business Media LLC. - 2041-1723. ; 8, s. 15509-
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Tidskriftsartikel (refereegranskat)abstract
- Matrix metalloproteinases (MMPs) contribute to the breakdown of tissue structures such as the basement membrane, promoting tissue fibrosis. Here we developed an electrospun membrane biofunctionalized with a fragment of the laminin β1-chain to modulate the expression of MMP2 in this context. We demonstrate that interfacing of the β1-fragment with the mesothelium of the peritoneal membrane via a biomaterial abrogates the release of active MMP2 in response to transforming growth factor β1 and rescues tissue integrity ex vivo and in vivo in a mouse model of peritoneal fibrosis. Importantly, our data demonstrate that the membrane inhibits MMP2 expression. Changes in the expression of epithelial-to-mesenchymal transition (EMT)-related molecules further point towards a contribution of the modulation of EMT. Biomaterial-based presentation of regulatory basement membrane signals directly addresses limitations of current therapeutic approaches by enabling a localized and specific method to counteract MMP2 release applicable to a broad range of therapeutic targets.
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| 29. |
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| 30. |
- Lipton, J. A., et al.
(författare)
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High frequency QRS electrocardiogram analysis during exercise stress testing for detecting ischemia
- 2008
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Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273. ; 124:2, s. 198-203
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Tidskriftsartikel (refereegranskat)abstract
- Introduction ECG stress testing is an inexpensive and non-invasive detector of myocardial ischemia; addition of high-frequency QRS analysis (HFQRS) may improve accuracy. This study compared HFQRS during exercise in patients with and without ischemia as defined by multiple criteria. Material and methods High-resolution ECGs were recorded for 139 patients undergoing T99-sestamibi/T201-thallium stress testing. Twenty-three were positive by at least two and 37 were negative for ischemia by all three of the following criteria: nuclear scan, ST-segment analysis and typical angina. Sixty-four not meeting criteria for positive or negative, six with adenosine test and nine patients with ECG recording artifacts were excluded. Mean age of the study group was 62 ± 10 years, 83% were male. Ischemic patients had a higher incidence of previous myocardial infarction and coronary intervention than non-ischemic patients (74% vs. 46%; P = 0.03 and 70% vs. 43%; P = 0.05, respectively), but had a lower body mass index (28.7 ± 5 vs. 33.0 ± 8; P = 0.015). HFQRS analysis consisting of signal averaging (150–250 Hz) and calculation of root mean squared values for each lead at different time points was performed and was similar between the groups. The relative change in HFQRS (RCQ) was calculated for each lead: {(maxHFQRS − minHFQRS) / maxHFQRS}. For each patient an RCQ index was calculated by averaging the two leads with the greatest RCQ value. The RCQ index was greater in ischemic vs. non-ischemic patients (45% vs. 34%; P = 0.0069). Conclusion Maximum decrease in HFQRS, as quantified by RCQ index, was greater in ischemic vs. non-ischemic patients. Use of the RCQ index may improve the diagnosis of ischemia during exercise stress testing.
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| 31. |
- Low, Donald E., et al.
(författare)
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Guidelines for Perioperative Care in Esophagectomy : Enhanced Recovery After Surgery (ERAS®) Society Recommendations
- 2019
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Ingår i: World Journal of Surgery. - : Springer. - 0364-2313 .- 1432-2323. ; 43:2, s. 299-330
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Forskningsöversikt (refereegranskat)abstract
- INTRODUCTION: Enhanced recovery after surgery (ERAS) programs provide a format for multidisciplinary care and has been shown to predictably improve short term outcomes associated with surgical procedures. Esophagectomy has historically been associated with significant levels of morbidity and mortality and as a result routine application and audit of ERAS guidelines specifically designed for esophageal resection has significant potential to improve outcomes associated with this complex procedure.METHODS: A team of international experts in the surgical management of esophageal cancer was assembled and the existing literature was identified and reviewed prior to the production of the guidelines. Well established procedure specific components of ERAS were reviewed and updated with changes relevant to esophagectomy. Procedure specific, operative and technical sections were produced utilizing the best current level of evidence. All sections were rated regarding the level of evidence and overall recommendation according to the evaluation (GRADE) system.RESULTS: Thirty-nine sections were ultimately produced and assessed for quality of evidence and recommendations. Some sections were completely new to ERAS programs due to the fact that esophagectomy is the first guideline with a thoracic component to the procedure.CONCLUSIONS: The current ERAS society guidelines should be reviewed and applied in all centers looking to improve outcomes and quality associated with esophageal resection.
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| 32. |
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| 33. |
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| 34. |
- Pahlm, Ulrika, et al.
(författare)
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Comparison of teaching the basic electrocardiographic concept of frontal plane QRS axis using the classical versus the orderly electrocardiogram limb lead displays
- 1997
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Ingår i: American Heart Journal. - 1097-6744. ; 134:6, s. 1014-1018
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Tidskriftsartikel (refereegranskat)abstract
- This study compares the effectiveness of teaching the calculation of frontal plane QRS axis with the use of the classical versus the orderly electrocardiographic limb lead display. Eighty-three students from two environments were randomized into two groups and were taught to determine frontal plane axis with one of the methods. The accuracy and time to determine the axis were tested on 10 electrocardiograms. In the United States the group using the classical display achieved 4.2 (+/-2.7) correct answers, whereas those using the orderly method achieved 6.8 (+/-3.0) (p = 0.0006). The classical group used 9.2 (+/-2.8) minutes to complete the test, whereas the orderly group needed 7.2 (+/-2.0) minutes (p = 0.015). The results achieved in Sweden were similar. The use of the orderly electrocardiographic limb lead display results in greater diagnostic accuracy in less time than the classical display when determining the frontal plane QRS axis.
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| 35. |
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| 36. |
- Ripa, R S, et al.
(författare)
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Comparison between human and automated electrocardiographic waveform measurements for calculating the Anderson-Wilkins acuteness score in patients with acute myocardial infarction
- 2005
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Ingår i: Journal of Electrocardiology. - : Elsevier BV. - 1532-8430 .- 0022-0736. ; 38:2, s. 96-99
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Tidskriftsartikel (refereegranskat)abstract
- The Anderson-Wilkins (AW) electrocardiographic (ECG) acuteness score complements time from pain onset in prognostic stratification of patients with acute myocardial infarction (AMI). However, for the AW acuteness score to be of practical use in the acute situation, it must be an integral component of a commercial automated ECG analysis program. The objective of this study was to determine the concordance between human and computer measurements and calculation of the AW acuteness score. The mean difference in AW acuteness score was 0.11 +/- 0.66 for anterior and -0.07 +/- 1.24 for inferior AMI. Ninety-nine percent of the differences were found to be 1.0 or less for the anterior AMI group, and 91.7% were 1.0 or less in the inferior AMI group. The differences were primarily caused by minor disagreements in measurements. In conclusion, the AW acuteness score established using manual ECG waveform measurements can be implemented into commercial automated ECG analysis programs to achieve practical use in clinical decision support for patients with AMI.
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| 37. |
- Rubinsky, AD, et al.
(författare)
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AUDIT-C Alcohol Screening Results and Postoperative Inpatient Health Care Use.
- 2012
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Ingår i: Journal of the American College of Surgeons. - : Ovid Technologies (Wolters Kluwer Health). - 1879-1190 .- 1072-7515. ; 214:3, s. 296-305
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Alcohol screening scores 5 on the Alcohol Use Disorders Identification Test–Consumption (AUDIT-C) up to a year before surgery have been associated with postoperative complications, but the association with postoperative health care use is unknown. This study evaluated whether AUDIT-C scores in the year before surgery were associated with postoperative hospital length of stay, total ICU days, return to the operating room, and hospital readmission. STUDY DESIGN: This cohort study included male Veterans Affairs patients who completed the AUDIT-C on mailed surveys (October 2003 through September 2006) and were hospitalized for nonemergent noncardiac major operations in the following year. Postoperative health care use was evaluated across 4 AUDIT-C risk groups (scores 0, 1 to 4, 5 to 8, and 9 to 12) using linear or logistic regression models adjusted for sociodemographics, smoking status, surgical category, relative value unit, and time from AUDIT-C to surgery. Patients with AUDIT-C scores indicating low-risk drinking (scores 1 to 4) were the referent group. RESULTS: Adjusted analyses revealed that among eligible surgical patients (n 5,171), those with the highest AUDIT-C scores (ie, 9 to 12) had longer postoperative hospital length of stay (5.8 [95% CI, 5.06.7] vs 5.0 [95% CI, 4.75.3] days), more ICU days (4.5 [95% CI, 3.25.8] vs 2.8 [95% CI, 2.63.1] days), and increased probability of return to the operating room (10% [95% CI, 613%] vs 5% [95% CI, 46%]) in the 30 days after surgery, but not increased hospital readmission within 30 days postdischarge, relative to the low-risk group. CONCLUSIONS: AUDIT-C screening results could be used to identify patients at risk for increased postoperative health care use who might benefit from preoperative alcohol interventions.
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| 38. |
- Sejersten, M, et al.
(författare)
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Comparison of EASI-derived 12-lead electrocardiograms versus paramedic-acquired 12-lead electrocardiograms using Mason-Likar limb lead configuration in patients with chest pain
- 2006
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Ingår i: Journal of Electrocardiology. - : Elsevier BV. - 1532-8430 .- 0022-0736. ; 39:1, s. 13-21
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Monitoring of serial 12-lead electrocardiogram (ECG) recordings is the accepted requirement for prehospital data acquisition in patients with chest pain. The purpose of this study was to determine whether waveforms and clinical triage decisions are similar for EASI-derived ECGs and paramedic-acquired 12-lead ECGs using Mason-Likar limb lead configuration when compared with standard 12-lead ECGs (stdECG). Method: Twenty patients with chest pain had a prehospital 12-lead ECG recorded in the ambulance, and paramedic-applied electrodes retained in place at hospital arrival. An ECG technician applied standard precordial and EASI electrodes in their Correct positions. Twelve-lead ECGs were obtained from the paramedic-applied electrodes using their Mason-Likar limb lead configuration, and derived from the EASI leads for comparison with the stdECG. Three computer-measured QRS-T waveform parameters were considered, and differences in waveform measurement between EASI and stdECG (EASI Delta stdECG) versus differences in waveform measurements between paramedic Mason-Likar and stdECG (PML Delta stdECG) were calculated. Two emergency physicians determined whether the EASI-derived or the paramedic Mason-Likar ECG contained information that would change their clinical triage decision from that indicated by the stdECG. Results: EASI Delta stdECG and PML Delta stdECG were identical in 28%, whereas EASI Delta stdECG was more than PML Delta stdECG in 35%, and PML Delta stdECG was accurate (both times) than EASI Delta stdECG in 37% (P = .62). The physicians were more likely to change the level of patient care based on the EASI-derived ECGs compared with the paramedic ECGs; however, this difference was not statistically significant (P = .27), but this may only be caused by the small study population. Conclusions: There are similar differences from stdECG waveforms in EASI-derived ECGs and those acquired via paramedic-applied precordial electrodes using Mason-Likar limb lead configuration. Either method can be used as a substitute for monitoring, but neither should be considered equivalent to the stdECG for diagnostic purposes. (c) 2006 Elsevier Inc. All rights reserved.
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| 39. |
- Sejersten, M, et al.
(författare)
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The relative accuracies of ECG precordial lead waveforms derived from EASI leads and those acquired from paramedic applied standard leads
- 2003
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Ingår i: Journal of Electrocardiology. - 1532-8430. ; 36:3, s. 179-185
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Tidskriftsartikel (refereegranskat)abstract
- Accurate precordial electrode placement can be difficult in emergency situations leading either to loss of time or diminished accuracy. A possible solution is the quasi-orthogonal EASI lead system, with only five electrodes and easily defined landmarks to provide a derived 12-lead electrocardiogram (ECG). The purpose of this study was to test the hypothesis that precordial waveforms in EASI-derived ECGs have no greater deviation from those in gold standard ECGs, than do the precordial waveforms in paramedic acquired standard ECGs. Twenty paramedics applied the standard precordial electrodes employing the routine procedure. A certified ECG technician applied the 6 standard precordial electrodes in their correct gold standard positions, and the EASI electrodes. 12-lead ECGs were obtained from the paramedics' standard leads, and derived from the EASI leads, for comparison with the gold standard ECG. In each precordial lead recording, 6 computer-measured QRS-T waveform parameters were considered. Differences between DeltaEASI-gold standard versus Deltaparamedic-gold standard were calculated for every waveform in every lead resulting in 720 comparisons. EASI and paramedic results were "equally accurate" in 47%, the paramedic was more accurate in 31%, and EASI was more accurate in the remaining 22%. The differences from gold standard recording of precordial waveforms in ECGs derived from the EASI leads and those acquired via paramedic-applied standard electrodes are similar. The results suggest that the EASI lead system may provide an alternative,to the standard ECG precordial leads to facilitate data acquisition and possibly save valuable time in emergency situations.
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| 40. |
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| 44. |
- Weston, P., et al.
(författare)
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The value of both ST-segment and QRS complex changes during acute coronary occlusion for prediction of reperfusion-induced myocardial salvage in a canine model
- 2007
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Ingår i: J Electrocardiol. - 1532-8430. ; 40:1, s. 18-25
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Analysis of ST-segment elevation for assessment of patients with suspected acute coronary occlusion is in widespread use for diagnostic and prognostic purposes. In this study, changes in the QRS complex also were analyzed to determine if these changes that are seldom used clinically can provide additional prognostic information. An acute coronary occlusion canine model, in which direct measurements of myocardial salvage were made, was used to assess whether ST-segment and QRS complex changes during coronary occlusion yielded independent estimates of the amount of salvage provided by reperfusion with arterial blood. METHODS AND RESULTS: Continuous electrocardiographic recordings were obtained from 14 study dogs undergoing a 90-minute period of coronary artery occlusion in which the severity of the ischemia during the occlusion was estimated at 10 and 45 minutes by microsphere injections. After 3 hours of reperfusion, the myocardium at risk and postmortem infarct size was measured. Myocardial salvage correlated inversely with both ST-segment elevation (r = -0.85; P < .0001), and QRS complex prolongation (r = -0.72; P = .003). When dogs were paired so that they had equal amounts of ST elevation but differed with respect to the presence of QRS prolongation, less myocardial salvage was found in those with QRS prolongation. The independent value of QRS prolongation was supported further by the observation that presence of QRS prolongation resulted in a loss of the highly significant correlation between ST elevation and salvage (r = -0.60; P = .2). CONCLUSIONS: High magnitudes of ST elevation are correlated significantly with less myocardial salvage. Moreover, for a given magnitude of ST elevation, the presence of concurrent QRS prolongation is associated with even less myocardial salvage.
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