| 1. |
- Strand, Robin, 1978-, et al.
(författare)
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A concept for holistic whole body MRI data analysis, Imiomics
- 2017
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 12:2
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To present and evaluate a whole-body image analysis concept, Imiomics (imaging omics) and an image registration method that enables Imiomics analyses by deforming all image data to a common coordinate system, so that the information in each voxel can be compared between persons or within a person over time and integrated with non-imaging data.Methods: The presented image registration method utilizes relative elasticity constraints of different tissue obtained from whole-body water-fat MRI. The registration method is evaluated by inverse consistency and Dice coefficients and the Imiomics concept is evaluated by example analyses of importance for metabolic research using non-imaging parameters where we know what to expect. The example analyses include whole body imaging atlas creation, anomaly detection, and cross-sectional and longitudinal analysis.Results: The image registration method evaluation on 128 subjects shows low inverse consistency errors and high Dice coefficients. Also, the statistical atlas with fat content intensity values shows low standard deviation values, indicating successful deformations to the common coordinate system. The example analyses show expected associations and correlations which agree with explicit measurements, and thereby illustrate the usefulness of the proposed Imiomics concept.Conclusions: The registration method is well-suited for Imiomics analyses, which enable analyses of relationships to non-imaging data, e.g. clinical data, in new types of holistic targeted and untargeted big-data analysis.
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| 2. |
- Strand, Robin, 1978-, et al.
(författare)
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Holistic whole-body MRI image analysis
- 2016
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Ingår i: Symposium of the Swedish Society for Automated Image Analysis, Uppsala, Sweden, (SSBA).
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)
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| 3. |
- Bengtsson, Caroline, et al.
(författare)
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Chronic rhinosinusitis impairs sleep quality : results of the GA(2)LEN study
- 2017
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Ingår i: Sleep. - : Oxford University Press. - 0161-8105 .- 1550-9109. ; 40:1
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Tidskriftsartikel (refereegranskat)abstract
- STUDY OBJECTIVES: To analyse the prevalence of sleep problems in subjects with CRS and to determine whether the disease severity of CRS affects sleep quality.METHODS: Questionnaires were sent to a random sample of 45 000 adults in four Swedish cities. Questions on CRS, asthma, allergic rhinitis, co-morbidities, tobacco use, educational level and physical activity were included. CRS was defined according to the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) epidemiological criteria. The disease severity of CRS was defined by the number of reported CRS symptoms. Sleep quality was assessed using the Basic Nordic Sleep Questionnaire.RESULTS: Of the 26 647 subjects, 2249 (8.4%) had CRS. Reported sleep problems were 50-90% more common among subjects with CRS compared with those without or the total population. The prevalence of reported sleep problems increased in conjunction with the severity of CRS. After adjusting for gender, BMI, age, tobacco use, asthma, somatic diseases, physical activity level and educational level, participants with four symptoms of CRS (compared with subjects without CRS symptoms) displayed a higher risk of snoring (adj. OR (95% CI): 3.13 (2.22-4.41)), difficulties inducing sleep (3.98 (2.94-5.40)), difficulties maintaining sleep (3.44 (2.55-4.64)), early morning awakening (4.71 (3.47-6.38)) and excessive daytime sleepiness (4.56 (3.36-6.18)). The addition of persistent allergic rhinitis to CRS further increased the risk of sleep problems.CONCLUSIONS: Sleep problems are highly prevalent among subjects with CRS. The disease severity of CRS negatively affects sleep quality.
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| 4. |
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| 5. |
- Duffy, Stephen W., et al.
(författare)
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Mammography screening reduces rates of advanced and fatal breast cancers : Results in 549,091 women
- 2020
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Ingår i: Cancer. - : John Wiley & Sons. - 0008-543X .- 1097-0142. ; 126:13, s. 2971-2979
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Tidskriftsartikel (refereegranskat)abstract
- Background: It is of paramount importance to evaluate the impact of participation in organized mammography service screening independently from changes in breast cancer treatment. This can be done by measuring the incidence of fatal breast cancer, which is based on the date of diagnosis and not on the date of death.Methods: Among 549,091 women, covering approximately 30% of the Swedish screening‐eligible population, the authors calculated the incidence rates of 2473 breast cancers that were fatal within 10 years after diagnosis and the incidence rates of 9737 advanced breast cancers. Data regarding each breast cancer diagnosis and the cause and date of death of each breast cancer case were gathered from national Swedish registries. Tumor characteristics were collected from regional cancer centers. Aggregated data concerning invitation and participation were provided by Sectra Medical Systems AB. Incidence rates were analyzed using Poisson regression.Results: Women who participated in mammography screening had a statistically significant 41% reduction in their risk of dying of breast cancer within 10 years (relative risk, 0.59; 95% CI, 0.51‐0.68 [P < .001]) and a 25% reduction in the rate of advanced breast cancers (relative risk, 0.75; 95% CI, 0.66‐0.84 [P < .001]).Conclusions: Substantial reductions in the incidence rate of breast cancers that were fatal within 10 years after diagnosis and in the advanced breast cancer rate were found in this contemporaneous comparison of women participating versus those not participating in screening. These benefits appeared to be independent of recent changes in treatment regimens.
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| 6. |
- Engström, Björn E., et al.
(författare)
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Meal suppression of circulating ghrelin is normalized in obese individuals following gastric bypass surgery
- 2007
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Ingår i: International Journal of Obesity. - : Springer Science and Business Media LLC. - 0307-0565 .- 1476-5497. ; 31:3, s. 476-480
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: It has been proposed that the success of maintained weight loss in morbidly obese subjects following Roux-en-Y gastric bypass (RYGBP) surgery depends on inappropriately low circulating concentrations of the appetite-stimulating peptide ghrelin, being unresponsive to food intake. In this study, this hypothesis was examined. DESIGN: Cross-sectional study with repeated blood samples in 40 subjects after 14 h of prolonged overnight fasting followed by a standardized mixed meal (770 kcal). SUBJECTS: Twenty men and 20 women were included: 10 middle-aged morbidly obese (body mass index (BMI) 43.9+/-3.3 kg/m(2)), 10 middle-aged subjects who had undergone RYGBP at the Uppsala University Hospital (BMI 34.7+/-5.8 kg/m(2)), 10 middle-aged non-obese (BMI 23.5+/-2.2 kg/m(2)) and 10 young non-obese (BMI 22.7+/-1.8 kg/m(2)). MEASUREMENTS: Ghrelin, glucose and insulin levels were analysed pre- and postprandially. RESULTS: In the morbidly obese, ghrelin concentrations were lower in the morning than in the RYGBP group and did not change following the meal. In the RYGBP group, fasting ghrelin levels fell after meal intake and showed similar suppression as both age-matched and young non-obese controls. The RYGBP surgery resulted in an increased meal-induced insulin secretion, which was related to the degree of postprandial ghrelin suppression. CONCLUSION: The present study demonstrates low circulating concentrations of ghrelin and blunted responses to fast and feeding in morbidly obese subjects. Marked weight reduction after RYGBP at our hospital is followed by a normalization of ghrelin secretion, illustrated by increased fasting levels compared to the preoperative obese state and regain of meal-induced ghrelin suppression.
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| 7. |
- Eriksson, Håkan, et al.
(författare)
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Det är obalansen som är problemet
- 2004
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Ingår i: KommunAktuellt. ; :16, 6 maj
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Tidskriftsartikel (populärvet., debatt m.m.)abstract
- Debatten har länge rasat om sjukskrivningarnas kostnader, men sett över en längretid är det arbetslöshetens kostnader som ökat. Det visar en forskarstudie om bruk av offentliga försörjningssystem som tagits fram på initiativ av de samverkande myndigheterna i Västmanland. Den redovisar hur de offentliga försörjningsinkomsterna har utvecklats efter 1990 och hur de är sammansatta och fördelade i befolkningen.
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| 8. |
- Eriksson, Lars-Gunnar, et al.
(författare)
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Endoscopic marking with metallic clip facilitates transcatheter arterial embolization in upper peptic ulcer bleeding.
- 2006
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Ingår i: Journal of Vascular and Interventional Radiology. - 1051-0443 .- 1535-7732. ; 17:6, s. 959-964
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To enable accurate transcatheter arterial embolization (TAE) of the target vessel, a new technique to localize the exact position of a bleeding ulcer was tested that involves endoscopic marking of the ulcer with a metallic clip. MATERIALS AND METHODS: In 13 patients (mean age, 75 years) with acute bleeding ulcers (11 duodenal ulcers, two malignant ulcers), a metallic clip was placed at gastroscopy followed or preceded by routine endoscopic treatment. The metallic clip was placed in the fibrous edge of the ulcer adjacent to the bleeding point. In 10 patients, TAE was indicated as a result of continued or recurrent bleeding. The artery was embolized with microcoils as close as possible to the clip. In three patients, there was no indication for TAE, so plain abdominal radiography was performed to determine whether the marking clip was still in place. RESULTS: In 11 patients, the clip was still in place on radiography; in two, it had disappeared. Hemostasis was achieved in eight of 10 patients after TAE. In six patients, the clip was essential to identify the bleeding vessel. CONCLUSION: Marking of the bleeding ulcer with a clip before TAE enhances the possibility that the correct vessel is embolized. This will most likely minimize the risk of recurrent bleeding after embolization, especially in patients who do not show contrast medium extravasation.
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| 9. |
- Eriksson, Lars-Gunnar, 1956-, et al.
(författare)
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Transcatheter arterial embolization versus surgery in the treatment of upper gastrointestinal bleeding after therapeutic endoscopy failure
- 2008
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Ingår i: Journal of Vascular and Interventional Radiology. - : Elsevier BV. - 1051-0443 .- 1535-7732. ; 19:10, s. 1413-8
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To retrospectively compare the outcome of transcatheter arterial embolization (TAE) and surgery as salvage therapy of upper gastrointestinal bleeding after failed endoscopic treatment. MATERIALS AND METHODS: From January 1998 to December 2005, 658 patients were referred to diagnostic/therapeutic emergency endoscopy and diagnosed with upper gastrointestinal bleeding. Ninety-one of these 658 patients (14%) had repeat bleeding or continued to bleed. Forty of those 91 patients were treated with TAE and 51 were treated with surgery. From the medical records, the following variables were recorded: demographic data, endoscopic diagnoses, comorbidities, lowest hemoglobin levels, total transfusion requirements, lengths of hospitalization stays, postprocedure complications, and mortality rates. The relative survival rate was calculated, and survival probability was calculated with the Kaplan-Meier technique. RESULTS: Patients treated with TAE were older (mean age, 76 years; age range, 40-94 years) and had slightly more comorbidities compared to patients who underwent surgery (mean age, 71 years; age range, 45-89 years). The 30-day mortality rate in patients treated with TAE was one of 40 (3%) compared to seven of 51 (14%) in patients treated with surgery (P < .07). Most repeat bleeding could be effectively treated with TAE, both in the surgical and TAE groups. CONCLUSIONS: The results of this study suggest that, after failure of therapeutic endoscopy for upper gastrointestinal bleeding, TAE should be the treatment of choice before surgery and that TAE can also be used to effectively control bleeding after failed surgery or TAE. There was a clear trend to lower 30-day mortality with use of TAE instead of surgery.
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| 10. |
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| 11. |
- Granath, Robert, et al.
(författare)
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Sjuksiffror starkt överdrivna
- 2004
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Ingår i: Svenska Dagbladet: Brännpunkt. ; :18 oktober
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Tidskriftsartikel (populärvet., debatt m.m.)abstract
- FRISKARE SVERIGE. Siffran en miljon bidragsförsörjda svenskar är inte korrekt. Den baseras på en statistisk konstruktion som leder fel i den heta debatten om det sjuka Sverige, skriver två höga chefer vid Försäkringskassan och Länsarbetsnämnden samt två forskare vid Mälardalens högskola.
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| 12. |
- Guimarães, Jean R.D., et al.
(författare)
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Simultaneous radioassays of bacterial production and mercury methylation in the periphyton of a tropical and a temperate wetland
- 2006
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Ingår i: Journal of Environmental Management. - : Elsevier BV. - 0301-4797 .- 1095-8630. ; 81:2, s. 95-100
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Tidskriftsartikel (refereegranskat)abstract
- Laboratory radioassays were made to study mercury (Hg) methylation together with bacterial production in the periphyton of two aquatic macrophytes, the submerged Myriophyllum spicatum, from a constructed wetland in Sweden and the floating Eichhornia crassipes, from a eutrophied tropical lake in Brazil. Time course incubations were made by addition of 203HgCl2 and the methylmercury formed was extracted at pre-defined time intervals. Bacterial production (14C-leucine incorporation) was measured at the same time intervals, with plants removed from parallel incubations made with and without addition of cold HgCl2. For E. crassipes, higher methylmercury production was observed at elevated bacterial production, whereas for M. spicatum, the bacterial production was significantly lower, and Hg methylation was below the detection limit. The combined results confirm the importance of microbial processes for Hg methylation, although other factors are known to influence this process in complex ways. The addition of Hg did not significantly influence bacterial production, while the incubation temperatures used (25 and 35 1C) resulted in different methylation rates. Radiotracer techniques for measurements of bacterial production such as 14C-leucine uptake can provide useful insights into the Hg cycle in aquatic environments, and our data suggest that they may be used as a proxy of mercury methylation potentials.
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| 13. |
- Hedberg, Jakob, et al.
(författare)
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Preoperative Slow-Release Morphine Reduces Need of Postoperative Analgesics and Shortens Hospital Stay in Laparoscopic Gastric Bypass
- 2016
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Ingår i: Obesity Surgery. - : Springer Science and Business Media LLC. - 0960-8923 .- 1708-0428. ; 26:4, s. 757-761
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: As most bariatric procedures are performed by laparoscopy, hospital stay is exceptionally short, despite the habitus of patients and the rather extensive intra-abdominal surgery. To facilitate postoperative mobilization, most patients are given repeated single doses of morphine, a drug with several side effects. We aimed to evaluate the effect of preoperative treatment with a tablet of slow-release morphine (SRM) on postoperative analgesic consumption and length of stay (LOS) in laparoscopic gastric bypass (LGBP).METHODS: The SRM group (244 patients) was retrospectively compared to a control group (197 patients) concerning postoperative pain management and hospital stay by studying medical charts and data from Scandinavian Obesity Surgery Registry (SOReg).RESULTS: Patients in the SRM group needed significantly less analgesics during days 0, 1, and 2 postoperatively, morphine 10.7 vs. 13.6 mg, 10.2 vs. 13.9 mg, and 1.1 vs. 3.6 mg, respectively, p < 0.05, as well as acetaminophen, p < 0.05. According to a subgroup analysis, 20 mg of SRM was needed to obtain these effects. In addition, SRM patients had shorter hospital stay (2.3 vs. 3.5 days, p < 0.05) than the control group. No negative side effects were seen.CONCLUSIONS: Preoperatively administered slow-release morphine significantly reduced the need for postoperative analgesics and shortened hospital stay, without side effects or other complications. At our department, the studied regime is now routinely used in all bariatric surgery and we have started to use the concept in other groups of surgical patients.
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| 14. |
- Hedberg, Jakob, et al.
(författare)
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Randomized controlled trial of nasogastric tube use after esophagectomy : study protocol for the kinetic trial
- 2024
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Ingår i: Diseases of the esophagus. - : John Wiley & Sons. - 1120-8694 .- 1442-2050. ; 37:6
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Tidskriftsartikel (refereegranskat)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.
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| 15. |
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| 16. |
- Holdstock, Camilla, et al.
(författare)
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CRP reduction following gastric bypass surgery is most pronounced in insulin-sensitive subjects
- 2005
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Ingår i: International Journal of Obesity. - : Springer Science and Business Media LLC. - 0307-0565 .- 1476-5497. ; 29:10, s. 1275-1280
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Obesity is frequently associated with insulin resistance, dyslipidemia, hypertension and an increased risk ofcardiovascular disease, reflected in elevated markers of inflammation, in particular C-reactive protein (CRP). To what extent theinsulin resistance or the obesity per se contributes to increased CRP levels is unclear. In morbidly obese patients, gastric bypasssurgery causes marked changes in body weight and improves metabolism, thereby providing informative material for studies onthe regulation of inflammatory markers.DESIGN: Prospective, surgical intervention study of inflammatory markers in morbidly obese subjects.SUBJECTS: In total, 66 obese subjects with mean age 39 y and mean body mass index (BMI) 45 kg/m2 were studied prior to and6 and 12 months following Roux-en-Y gastric bypass (RYGBP) surgery.MEASUREMENTS: Serum concentrations of high sensitivity CRP, serum amyloid A (SAA) and interleukin-6 (IL-6), as well asmarkers of glucose and lipid metabolism.RESULTS: Prior to surgery, CRP levels were elevated compared to the reference range of healthy, normal-weight subjects. CRPcorrelated with insulin sensitivity, as reflected by the homeostatic model assessment (HOMA) index, but not BMI, whencorrected for age and gender. Surgery reduced BMI from 45 to 31 kg/m2 and lowered CRP, SAA and IL-6 levels by 82, 57 and50%, respectively, at 12 months. The reduction in CRP was inversely related to HOMA at baseline independently of the changein body weight (r=-0.36, P=0.005). At 12 months, 140 and 40% reductions in CRP were seen in subjects with HOMA o 4(insulin sensitive) and HOMA49 (insulin resistant) despite similar reductions in BMI. Reductions in SAA and IL-6 tended toparallel the changes in CRP, but were less informative.CONCLUSION: In morbidly obese subjects, gastric bypass surgery lowers energy intake, reduces inflammatory markers andimproves insulin sensitivity. Despite a marked reduction in body weight, only a small effect on CRP levels was seen in insulinresistantpatients, indicating that flexibility of circulating CRP levels is primarily dependent upon insulin sensitivity rather thanenergy supply.
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| 17. |
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| 18. |
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| 19. |
- Johansson, Lars, et al.
(författare)
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Lipid Mobilization Following Roux-en-Y Gastric Bypass Examined by Magnetic Resonance Imaging and Spectroscopy
- 2008
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Ingår i: Obesity Surgery. - : Springer Science and Business Media LLC. - 0960-8923 .- 1708-0428. ; 18:10, s. 1297-1304
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Recent developments of magnetic resonance imaging (MRI) and spectroscopy have made it possible to quantify lipid deposited in different tissues. To what extent an improvement of glucose tolerance shortly after Roux-en-Y gastric bypass surgery (RYGBP) is reflected in lipid levels in liver and skeletal muscle, markers of insulin resistance, has not been clarified. METHODS: Whole-body MRI and MR spectroscopy (MRS) of liver and muscle and measurements of biochemical markers of glucose and lipid metabolism were performed at baseline and 1, 6, and 12 months following surgery in seven morbidly obese women. Volumes of adipose tissue depots and liver and muscle lipids were assessed from the MRI/MRS data. RESULTS: At 1 month postoperatively, body mass index and visceral and subcutaneous adipose tissues were reduced by 9%, 26%, and 10%, respectively, whereas no reductions in intrahepatocellular or skeletal intramyocellular lipid concentrations were found. Free fatty acid and beta-hydroxybutyrate levels were elevated two- and sixfold, respectively; glucose and insulin levels were lowered, indicating increased insulin sensitivity. Further weight loss up to 1 year was associated with reductions in all investigated lipid depots investigated, with the exception of the intramyocellular compartment. CONCLUSION: RYGBP causes rapid lipid mobilization from visceral and subcutaneous adipose depots and enhanced free fatty acid flux to the liver. An exceptional disconnection between liver fat and insulin sensitivity occurs in the early dynamic phase after surgery. However, in the late phase, the energy restriction imposed by the surgical procedure also reduces the liver lipids, but not the intramyocellular lipids.
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| 20. |
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| 21. |
- Kullberg, Joel, et al.
(författare)
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Gastric bypass promotes more lipid mobilization than a similar weight loss induced by low-calorie diet
- 2011
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Ingår i: Journal of Obesity. - : Hindawi Limited. - 2090-0708 .- 2090-0716. ; 2011, s. 959601-
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Tidskriftsartikel (refereegranskat)abstract
- Background.Recently, we found large reductions in visceral and subcutaneous fat one month after gastric bypass (GBP), without any change in liver fat content.Purpose.Firstly to characterize weight loss-induced lipid mobilization after one month with preoperative low-calorie diet (LCD) and a subsequent month following GBP, and secondly, to discuss the observations with reference to our previous published findings after GBP intervention alone.Methods.15 morbidly obese women were studied prior to LCD, at GBP, and one month after GBP. Effects on metabolism were measured by magnetic resonance techniques and blood tests.Results.Body weight was similarly reduced after both months (mean: -8.0 kg, n = 13). Relative body fat changes were smaller after LCD than after GBP (-7.1 ± 3.6% versus -10 ± 3.2%, P = .029, n = 13). Liver fat fell during the LCD month (-41%, P = .001, n = 13) but was unaltered one month after GBP (+12%).Conclusion.Gastric bypass seems to cause a greater lipid mobilization than a comparable LCD-induced weight loss. One may speculate that GBP-altered gastrointestinal signalling sensitizes adipose tissue to lipolysis, promoting the changes observed.
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| 22. |
- Lind, Lars, et al.
(författare)
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Vasoreactivity is rapidly improved in obese subjects after gastric bypass surgery
- 2009
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Ingår i: International Journal of Obesity. - : Springer Science and Business Media LLC. - 0307-0565 .- 1476-5497. ; 33:12, s. 1390-5
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Obesity is associated with increased risk of cardiovascular disease. We investigated vasoreactivity in conduit and resistance arteries in morbidly obese subjects, and the effect of weight loss after gastric bypass surgery. METHODS: A total of 19 obese subjects (body mass index (BMI): 43.8+/-3.1 kg m(-2), 75% female, mean age 41 years) were investigated before surgery and after 1 and 12 months of surgery. Nineteen non-obese controls matched for age and gender were examined. Vasoreactivity was evaluated by ultrasound to measure flow-mediated dilation (FMD, evaluating a conduit vessel) and pulse-wave analysis with terbutaline provocation (change in reflectance index (RI), evaluating resistance vessels). RESULTS: Before surgery, the obese showed a low change in RI (18+/-12 vs 37+/-15% in controls, P=0.0001), but not significantly regarding FMD (7.9+/-6.4 vs 8.9+/-5.4% in controls). Surgery resulted in a weight loss of 9% at 1 month and 30% at 1 year. Change in RI markedly improved to 36+/-12% at 1 month (P=0.0001 vs baseline) and further to 44+/-11% at 1 year (P=0.014 vs 1 month). FMD did not change significantly. Heart rate and brachial artery diameter were reduced, with no significant change in blood pressure. The improvement in resistance vessel vasodilation, estimated as change in RI, was not correlated to changes in weight or measures of glucose and lipid metabolism. CONCLUSIONS: Obese patients showed impaired vasoreactivity in resistance arteries that was normalized already 1 month after gastric bypass surgery. The basis for this remarkable outcome, not significantly related to changes in body weight and metabolic variables, remains to be clarified.
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| 23. |
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| 24. |
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| 25. |
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| 26. |
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| 27. |
- Persson, Jan, 1962, et al.
(författare)
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Fully covered stents are similar to semi-covered stents with regard to migration in palliative treatment of malignant strictures of the esophagus and gastric cardia : results of a randomized controlled trial.
- 2017
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Ingår i: Surgical Endoscopy. - : Springer Science and Business Media LLC. - 0930-2794 .- 1432-2218. ; 31:10, s. 4025-4033
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Stent migration is a significant clinical problem in palliation of malignant strictures in the esophagus and gastro-esophageal junction (GEJ). We have compared a newer design of a fully-covered stent to a widely used semi-covered stent using migration >20 mm as the primary outcome variable. Effects on dysphagia, quality of life (QoL) and re-intervention frequency were also investigated.METHODS: Patients with dysphagia due to non-curable esophagus/GEJ cancer were randomized to receive either a more recent design of a fully-covered stent (n = 48) or a conventional semi-covered stent (n = 47). Chest x-ray, dysphagia and QoL were studied at baseline, one week, four weeks and three months thereafter.RESULTS: There were no significant differences either in stent migration distance or in the migration frequency. Stent migration during the total study period occurred in 37.2 % in the semi-covered group compared to 20.0 % for the fully-covered group. Dysphagia was measured with Watson and Ogilvie scores and with the dysphagia module in the QoL scale (QLQ-OG25). On average, there was a tendency to better dysphagia relief for the fully-covered design as scored with the two latter dysphagia instruments (p= 0.081 and p= 0.067) at three months and towards more re-interventions in the semi-covered group (p= 0.083).CONCLUSION: In spite of its somewhat lower intrinsic radial force, the fully-covered stent was comparable to the conventional semi-covered stent with regard to stent migration. The data further suggest a potential benefit of the fully-covered stent in improving dysphagia in patients with longer life expectancy.
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| 28. |
- Pess, Gary M., et al.
(författare)
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A post hoc analysis of Dupuytren contracture treated with collagenase Clostridium histolyticum across disease stages
- 2018
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Ingår i: Journal of Plastic Surgery and Hand Surgery. - 2000-656X. ; 52:5, s. 301-306
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Tidskriftsartikel (refereegranskat)abstract
- This post hoc analysis from a multicenter study (NCT01674634) was designed to evaluate the efficacy of collagenase Clostridium histolyticum (CCH) treatment in patients with different stages of Dupuytren contracture. Previously untreated patients who received two concurrent injections of CCH in two affected joints in the same finger were assessed by disease severity (Tubiana stage). The mean (SD) improvement in total fixed flexion contraction (FFC) 31 days post-CCH treatment in 181 patients was: 71.1 (36.5)% for Tubiana I, 77.0 (21.0)% for Tubiana II, 72.0 (20.4)% for Tubiana III and 66.4 (22.2)% for Tubiana IV. Treatment of metacarpophalangeal and proximal interphalangeal joints in the same finger resulted in a mean (SD) improvement of 82.5 (24.8)% and 66.4 (27.9)%, respectively. In conclusion, CCH is an effective treatment alternative for all stages of Dupuytren contracture and it provides a less invasive treatment alternative to surgery with similar short-term efficacy in patients with more severe disease.
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| 29. |
- Sidebäck, Göran, et al.
(författare)
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Arbetslösa större problem än sjuka
- 2004
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Ingår i: Dagens Nyheter. ; :1 april
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Tidskriftsartikel (populärvet., debatt m.m.)abstract
- Debatten har länge rasat om sjukskrivningarna, men arbetslösheten kostar mera. Sjukskrivningarna kostar fortfarande 25 procent mindre än 1990, medan arbetslösheten är 130 procent dyrare. Det visar en ny studie i Västmanland, men utvecklingen är densamma för hela riket. I Västmanland har de årliga utgifterna för a-kassa, sjukpeng, förtidspension och socialbidrag länge legat på oförändrade 4 miljarder kronor, oavsett om tiderna varit goda eller dåliga. Om ansträngningarna att få ned kostnaderna skall lyckas måste i första hand arbetslösheten angripas, skriver bland andra forskarna Göran Sidebäck och Lars Sundbom vid Mälardalens högskola.
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| 30. |
- Sidebäck, Göran, 1943-, et al.
(författare)
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Arbetslöshet och sysselsättning bland invandrare : Analyser av situationen i Mälardalen och i Sverige baserad på registerdata
- 2000
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Fram till mitten av 1970-talet hade invandrarna i Sverige lika god förankring på arbetsmarknaden som den inhemska befolkningen. Därefter har deras situation blivit betydligt sämre. Hög arbetslöshet och låg sysselsättningsgrad är idag en realitet för många invandrare. Det är denna problematik som utgör rapportens utgångspunkt. Genom en redovisning där olika invandrargrupper jämförs med varandra, och med den inhemska befolkningen, när det gäller ställningen på arbetsmarknaden, framkommer intressanta och oroväckande fakta. Rapporten består av fyra huvuddelar: • En inledning om invandring, arbetsmarknad och migrationspolitik, som avslutas med en forskningsbaserad problemöversikt. • En regional studie av arbetslöshet bland invandrarna i Mälardalen under perioden 1995–1997. • En nationell studie av invandrarnas situation på arbetsmarknaden i Sverige under motsvarande period. • Några avslutande reflektioner och perspektiv, där studiens resultat diskuteras och förslag till nya studier på området läggs fram.
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| 31. |
- Sidebäck, Göran, 1943-, et al.
(författare)
-
Bruk av offentliga försörjningssystem : En analys av förhållandena i Västmanland efter 1990
- 2004
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- UNDER 1900-talets sista decennium hamnade svensk ekonomi i den djupaste ekonomiska krisen sedan 1930-talet. Decenniet inleddes med att BNP sjönk under tre år i följd, parat med mycket kraftigt stigande arbetslöshet, vikande sysselsättning, sjunkande reallöner och växande underskott i statens finanser. De offentliga trygghetssystemen blev hårt ansatta då många tvingades vända sig till dem för att klara sin försörjning. ÄVEN OM den ekonomiska tillväxten tog fart mot slutet av decenniet, med ökad sysselsättning och statliga finanser som bringats under kontroll var inte alla problem ur världen. De offentliga försörjningsutgifterna sjönk visserligen under åren närmast efter krisens kulmen, men sedan upphörde nedgången och utgifterna låg envist kvar på en hög nivå. Vad är det som har hänt? Är det bara fråga om den ökning i sjukskrivningar som det talas så högt om idag, eller finns det andra faktorer som förklarar de fortsatt höga utgifterna för de offentliga välfärdssystemen? OM DETTA HANDLAR denna rapport om BRUK AV OFFENTLIGA FÖRSÖRJNINGSSYSTEM, som utifrån individbaserade inkomstuppgifter analyserar utvecklingen efter 1990 med fokus på Västmanlands län och dess kommuner. Jämförelser görs även med utvecklingen i övriga riket.
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| 32. |
- Sidebäck, Göran, et al.
(författare)
-
Bruk av offentliga försörjningssystem. : En analys av förhållandena i Västmanland efter 1990. (Sammanfattning).
- 2004
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- UNDER1900-talets sista decennium hamnade svensk ekonomi i den djupaste ekonomiska krisen sedan 1930-talet. Decenniet inleddes med att BNP sjönk under tre år i följd, parat med mycket kraftigt stigande arbetslöshet, vikande sysselsättning, sjunkande reallöner och växande underskott i statens finanser. De offentliga trygghetssystemen blev hårt ansatta då många tvingades vända sig till dem för att klara sin försörjning. ÄVEN OM den ekonomiska tillväxten tog fart mot slutet av decenniet, med ökad sysselsättning och statliga finanser som bringats under kontroll var inte alla problem ur världen. De offentliga försörjningsutgifterna sjönk visserligen under åren närmast efter krisens kulmen, men sedan upphörde nedgången och utgifterna låg envist kvar på en hög nivå. Vad är det som har hänt? Är det bara fråga om den ökning i sjukskrivningar som det talas så högt om idag, eller finns det andra faktorer som förklarar de fortsatt höga utgifterna för de offentliga välfärdssystemen? OM DETTA HANDLAR denna rapport om BRUK AV OFFENTLIGA FÖRSÖRJNINGSSYSTEM, som utifrån individbaserade inkomstuppgifter analyserar utvecklingen efter 1990 med fokus på Västmanlands län och dess kommuner. Jämförelser görs även med utvecklingen i övriga riket.
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| 33. |
- Sidebäck, Göran, et al.
(författare)
-
Kunskap för mångfald och utveckling - en förstudie. : Ett av EU delfinansierat mål 2-projekt.
- 2002
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Högskolans betydelse för tillväxt och utveckling, både lokalt och regionalt, betonas alltmer av alltfler. Utveckling idag är kunskapsdriven utveckling. Utan kunskap och förmå¨gan att tillgodogöra sig den blir regionen akterseglad i en föränderlig värld. Detta är en utgångspunkt för projektet Kunskap för mångfald och utveckling. I denna förstudie till projektet föreslås en ny samverkansmodell mellan högskolan och offentliga och privata aktörer, för att ta fram och dra nytta av samhällsrelevant kunskap om och för regionen. Modellen har följande inslag: Ett praktikbaserat kunskaps- och erfarenhetsutbyte: Genom regelbundet återkommande arbetsseminarier diskuteras och ventileras olika regionala problem och utvecklingsstrategier Studenterna - en regional resurs: Genom nya samarbetsformer utvecklas studenternas examensarbeten så att de bättre svarar mot regionala problem och kunskapsbehov. Strategisk satsning på regional välfärdsforskning: Med Datakällan, en socialstatistisk databas, kan utveckling och fördelning av välfärd (och ofärd) i regionen beskrivas, analyseras och utvärderas. Nätverk för kunskapsdriven utveckling: Ett brett kontaktnät med akademiker och praktiker skapar möjligheter för utbyte av erfarenheter och en effektivare användning av resurser och kompetenser.
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| 34. |
- Sidebäck, Göran, et al.
(författare)
-
Projektarbete i lokala samverkansgrupper : Dokumentation från et utvärderingscirkel för projektledare och projektmedarbetare i lokala samverkansprojekt
- 2002
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Under 2001 deltog ett antal tjänstemän, som arbetar med lokala samverkansprojekt i Södermanlands län, i en cirkel som anordnades av Centrum för välfärdsforskning vid Mälardalens högskola. Syftet var att de skulle få stöd och handledning i sina pågående projektarbeten, genom att projekten togs upp till gemensam diskussion och granskning vid cirkelsammankomsterna, där också forskare från högskolan medverkade. I denna rapport, som bygger på cirkeldeltagarnas och cirkelledarnas gemensamma arbete, redovisas hur cirkelarbetet organiserats och genomförts, samt hur cirkeldeltagarna själva värderar utbytet av sitt deltagande. Cirkeln kan ses som ett försök att utveckla nya former för samarbete mellan högskolan och regionen på kompetensutvecklingsområdet. Rapporten kan därmed vara ett underlag i en fortstatt diskussion om hur samverkan mellan regionen och högskolan kan förbättras och utvecklas på detta område.
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| 35. |
- Stenberg, Erik, 1979-, et al.
(författare)
-
Early complications after laparoscopic gastric bypass surgery : results from the Scandinavian Obesity Surgery Registry
- 2014
-
Ingår i: Annals of Surgery. - : Lippincott Williams & Wilkins. - 0003-4932 .- 1528-1140. ; 260:6, s. 1040-1047
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To identify risk factors for serious and specific early complications of laparoscopic gastric bypass surgery using a large national cohort of patients.BACKGROUND: Bariatric procedures are among the most common surgical procedures today. There is, however, still a need to identify preoperative and intraoperative risk factors for serious complications.METHODS: From the Scandinavian Obesity Surgery Registry database, we identified 26,173 patients undergoing primary laparoscopic gastric bypass operation for morbid obesity between May 1, 2007, and September 30, 2012. Follow-up on day 30 was 95.7%. Preoperative data and data from the operation were analyzed against serious postoperative complications and specific complications.RESULTS: The overall risk of serious postoperative complications was 3.4%. Age (adjusted P = 0.028), other additional operation [odds ratio (OR) = 1.50; confidence interval (CI): 1.04-2.18], intraoperative adverse event (OR = 2.63; 1.89-3.66), and conversion to open surgery (OR = 4.12; CI: 2.47-6.89) were all risk factors for serious postoperative complications. Annual hospital volume affected the rate of serious postoperative complications. If the hospital was in a learning curve at the time of the operation, the risk for serious postoperative complications was higher (OR = 1.45; CI: 1.22-1.71). The 90-day mortality rate was 0.04%.CONCLUSIONS: Intraoperative adverse events and conversion to open surgery are the strongest risk factors for serious complications after laparoscopic gastric bypass surgery. Annual operative volume and total institutional experience are important for the outcome. Patient related factors, in particular age, also increased the risk but to a lesser extent.
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| 36. |
- Sundbom, Elisabet, et al.
(författare)
-
Personality and defenses : a cross-cultural study of psychiatric patients and healthy individuals in Nicaragua and Sweden.
- 1998
-
Ingår i: Psychological Reports. - 0033-2941 .- 1558-691X. ; 83:3 Pt 2, s. 1331-47
-
Tidskriftsartikel (refereegranskat)abstract
- This study examined cross-cultural variability in personality and defenses among Nicaraguan and Swedish healthy individuals, patients with borderline personality disorder and schizophrenic disorders by means of the projective perceptual Defense Mechanism Test. The over-all aim was to test the hypothesis proposed by Anthony Marsella of 'severity related cross-cultural variability' suggesting that differences in symptom profile or personality patterns between cultures are most pronounced among healthy individuals and less so among individuals with severe mental disorders as they are perceived as more universal and less culturally determined. The over-all results showed that cross-cultural differences were in accordance with the proposed hypothesis. In addition, there were significant intracultural differences between the different diagnostic groups in both countries. The conclusion is that the Defense Mechanism Test and Partial Least Squares analysis seem to be powerful methods for personality assessment and potentially for cross-cultural research, and culture-specific norms in the Defense Mechanism Test must be employed.
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| 37. |
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| 38. |
- Sundbom, E, et al.
(författare)
-
Phytoluminography - imaging plants by delayed light-emission
- 1977
-
Ingår i: Physiologia Plantarum. - : Wiley. - 0031-9317 .- 1399-3054. ; 40:1, s. 39-41
-
Tidskriftsartikel (refereegranskat)abstract
- It is demonstrated that photographic images of plants can be produced in the absence of external illumination using an image intensifier. The image is produced by the weak delayed light emission (afterglow) from photosynthetically active chloroplasts. The use of such phytoluminographs is proposed for the study and diagnosis at an early stage of disturbances due to parasites, mineral deficiency, herbicides, frost, etc.
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| 39. |
- Sundbom, Lars, et al.
(författare)
-
Högskoleutbildades inträde på arbetsmarknaden : En studie av hur de högskoleutbildades etableringsprocess kan mätas och beskrivas
- 2010
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Allt fler ungdomar studerar vid högskola innan de går ut i arbetslivet. För många sker utträdet på arbetsmarknaden utan större problem, men detta gäller inte alla.I denna rapport betonas vikten av kunskap om villkoren och förutsättningarna för dem som går ut på arbetsmarknaden efter högskolestudier. En utförlig diskussion förs om de begränsningar och möjligheter som finns att med registerdataanalysen som metod få fram sådan kunskap.I jämförelse med andra länder har Sverige mycket goda förutsättningar att utnyttja registerdata för forsknings- och utredningsarbete. Och när det gäller etableringen på arbetsmarknaden kan befintliga registerdata användas för att belysa både strukturella och individbaserade aspekter.Metodutveckling och fördjupade studier på detta område kan leda fram till mer nyanserade sätt att mäta och beskriva etableringsprocessen. Och ytterst kanske till en säkrare kunskap om hur det går för de studenter som lämnat högskolan, vilket bör vara av värde för många intressenter – alltifrån presumtiva och aktiva högskolestuderande till utbildningsanordnare inom högskolesektorn samt olika myndigheter, organisationer och företag.
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| 40. |
- Sundbom, Lars, 1944-, et al.
(författare)
-
Utbildningssamhällets underklass? : En registerstudie om unga vuxna med låg utbildning
- 2008
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Utbildningssamhällets underklass? Dagens ungdomar förväntas skaffa sig en betydligt högre utbildning än den som den obligatoriska nioåriga grundskolan ger för att kunna klara sig bra i livet. Hur skall de annars kunna få ett intressant och utvecklande arbete, som också ger en någorlunda hygglig inkomst, ja, ett arbete överhuvudtaget? Vi lever ju i ett samhälle där kunskap och utbildning sägs vara nyckeln till framgång. Men vi lever också i ett samhälle där många ungdomar i varje årskull misslyckas med att erövra denna nyckel. Som lågutbildade unga vuxna har de att möta utbildningssamhällets utmaningar med enbart en mer eller mindre skral grundskoleutbildning i bagaget. Vilka är de? Vad har de för bakgrund? Vad gör de? Hur går det för dem? I Utbildningssamhällets underklass? presenteras en analys av de lågutbildade unga vuxnas situation baserad på riksomfattande longitudinella registerdata. Den ger en ingående bild av omfattningen och konsekvenserna av den ”utslagning” från utbildningssystemet som pågått i många år och som berör många tusen ungdomar i varje årskull.
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| 41. |
- Sundbom, Magnus, et al.
(författare)
-
Substantial Decrease in Comorbidity 5 Years After Gastric Bypass: A Population-based Study From the Scandinavian Obesity Surgery Registry.
- 2017
-
Ingår i: Annals of Surgery. - Philadelphia PA, USA : Lippincott Williams & Wilkins. - 0003-4932 .- 1528-1140. ; 265:6, s. 1166-1171
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: To evaluate effect on comorbid disease and weight loss 5 years after Roux-en-Y gastric bypass (RYGB) surgery for morbid obesity in a large nationwide cohort. Background: The number patients having surgical procedures to treat obesity and obesity-related disease are increasing. Yet, population-based, long-term outcome studies are few. Methods: Data on 26,119 individuals [75.8% women, 41.0 years, and body mass index (BMI) 42.8 kg/m2] undergoing primary RYGB between May 1, 2007 and June 30, 2012, were collected from 2 Swedish quality registries: Scandinavian Obesity Surgery Registry and the Prescribed Drug Registry. Weight, remission of type 2 diabetes mellitus, hypertension, dyslipidemia, depression, and sleep apnea, and changes in corresponding laboratory data were studied. Five-year follow-up was 100% (9774 eligible individuals) for comorbid diseases. Results: BMI decreased from 42.8 ± 5.5 to 31.2 ± 5.5 kg/m2 at 5 years, corresponding to 27.7% reduction in total body weight. Prevalence of type 2 diabetes mellitus (15.5%–5.9%), hypertension (29.7%–19.5%), dyslipidemia (14.0%–6.8%), and sleep apnea (9.6%–2.6%) was reduced. Greater weight loss was a positive prognostic factor, whereas increasing age or BMI at baseline was a negative prognostic factor for remission. The use of antidepressants increased (24.1%–27.5%). Laboratory status was improved, for example, fasting glucose and glycated hemoglobin decreased from 6.1 to 5.4 mmol/mol and 41.8% to 37.7%, respectively. Conclusions: In this nationwide study, gastric bypass resulted in large improvements in obesity-related comorbid disease and sustained weight loss over a 5-year period. The increased use of antidepressants warrants further investigation. Studies with long-term results after bariatric surgery are surprisingly rare, 1–5 especially in the light of the large number of procedures performed worldwide. In most studies there is a 1 to 2-year follow-up, 6 and at such an early point in time, it is impossible to evaluate the true effect of gastric bypass, because patients have just reached their nadir in weight. Moreover, for this group of patients, the longstanding remission of obesity-related comorbidities, for example, diabetes mellitus, hypertension, dyslipidemia, and sleep apnea, are of utmost importance. The Scandinavian Obesity Surgery Registry (SOReg) was launched in 2007 as a quality registry for the expanding number of bariatric surgeries in Sweden. 7 In 2015, SOReg contained more than 50,000 bariatric procedures (>98% national coverage), with all 43 operating centers reporting to the registry. There has been an expansion of bariatric surgery, with 3300 bariatric procedures performed in 2008, 4800 in 2009, 7800 in 2010, and 8600 in 2011. There has been a slight decrease in procedures, and currently approximately 7000 performed annually, and approximately 95% of the reported procedures have been primary laparoscopic gastric bypass. 8 Perioperative complication rates (eg, 1.2% leaks) and mortality are low (0.04%), the latter validated with the Swedish Population Register. Regular audits are performed by randomly comparing data in SOReg with patient charts at the surgical centers, demonstrating a high validity with less than 2% incorrect values. 7 Furthermore, by cross-linkage with the national Prescribed Drug Registry (PDR), a 100% follow-up of the occurrence of comorbid disease (defined as medical treatment) can be achieved. The present study reports outcome in weight and obesity-related comorbid disease in a nationwide cohort of 26,119 individuals over 5 years after primary Roux-en-Y gastric bypass (RYGB) in Sweden, using the prospective SOReg database with cross-linkage with the PDR.
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| 42. |
- Tabar, Laszlo, et al.
(författare)
-
Early detection of breast cancer rectifies inequality of breast cancer outcomes
- 2020
-
Ingår i: Journal of Medical Screening. - : Sage Publications. - 0969-1413 .- 1475-5793. ; 28:1, s. 34-38
-
Tidskriftsartikel (refereegranskat)abstract
- Objectives: To explain apparent differences among mammography screening services in Sweden using individual data on participation in screening and with breast cancer-specific survival as an outcome.Methods: We analysed breast cancer survival data from the Swedish Cancer Register on breast cancer cases from nine Swedish counties diagnosed in women eligible for screening. Data were available on 38,278 breast cancers diagnosed and 4312 breast cancer deaths. Survival to death from breast cancer was estimated using the Kaplan-Meier estimate, for all cases in each county, and separately for cases of women participating and not participating in their last invitation to screening. Formal statistical comparisons of survival were made using proportional hazards regression.Results: All counties showed a reduction in the hazard of breast cancer death with participation in screening, but the reductions for individual counties varied substantially, ranging from 51% (95% confidence interval 46-55%) to 81% (95% confidence interval 74-85%). Survival rates in nonparticipating women ranged from 53% (95% confidence interval 40-65%) to 74% (95% confidence interval 72-77%), while the corresponding survival in women participating in screening varied from 80% (95% confidence interval 77-84%) to 86% (95% confidence interval 83-88%), a considerably narrower range.Conclusions: Differences among counties in the effect of screening on breast cancer outcomes were mainly due to variation in survival in women not participating in screening. Screening conferred similarly high survival rates in all counties. This indicates that the performance of screening services was similar across counties and that detection and treatment of breast cancer in early-stage reduces inequalities in breast cancer outcome.
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| 43. |
- Åkerblom, Staffan, et al.
(författare)
-
Half a century of changing mercury levels in Swedish freshwater fish
- 2014
-
Ingår i: Ambio. - : Springer Science and Business Media LLC. - 0044-7447 .- 1654-7209. ; 43, s. 91-103
-
Tidskriftsartikel (refereegranskat)abstract
- The variability of mercury (Hg) levels in Swedish freshwater fish during almost 50 years was assessed based on a compilation of 44 927 observations from 2881 waters. To obtain comparable values, individual Hg concentrations of fish from any species and of any size were normalized to correspond to a standard 1-kg pike [median: 0.69 mg kg(-1) wet weight (ww), mean +/- SD: 0.84 +/- 0.67 mg kg(-1) ww]. The EU Environmental Quality Standard of 0.02 mg kg(-1) was exceeded in all waters, while the guideline set by FAO/WHO for Hg levels in fish used for human consumption (0.5-1.0 mg kg(-1)) was exceeded in 52.5 % of Swedish waters after 2000. Different trend analysis approaches indicated an overall long-term decline of at least 20 % during 1965-2012 but trends did not follow any consistent regional pattern. During the latest decade (2003-2012), however, a spatial gradient has emerged with decreasing trends predominating in southwestern Sweden.
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