| 1. |
- Axelsson, Birger
(author)
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Byggherrekostnadernas utveckling 2015-2020
- 2020
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Reports (other academic/artistic)abstract
- Bakgrunden till denna rapport är de höga priserna och höga hyrorna i nyproducerade bostäder. Debatten fokuserar ofta på markpriser och de direkta byggkostnaderna, men i denna rapport behandlas (delar av) det som kallas byggherrekostnader.Begreppet har ingen enhetlig definition och i denna rapport fokuseras på kommunala planoch bygglovsavgifter som anslutningsavgifter för vatten och avlopp samt el. I byggherrekostnader kan man även räkna in olika skatter och kostnaderna för det egna arbete som byggherren lägger ner, men de behandlas inte här.Data har samlats in från kommuner geografiskt spridda över landet och med olika storlek, rörande avgifterna år 2015 och 2020. Det rör avgifter för styckebyggda småhus i en viss antagen storlek, densamma vid båda tidpunkterna (tomtarea 800 kvm och boyta 160 kvm). Därutöver har kompletterande intervjuer med kommunala tjänstemän och en enklare litteraturstudie genomförts i försök att besvara vad som kan förklara byggherrekostnadernas utveckling.Att jämföra prisutvecklingen med Konsumentprisindex (KPI) kan vara orättvist eftersom fallande importpriser påverkat den senare. Tjänsteprisindex (TPI) bedömdes därför som lämpligare och TPI steg under den aktuella perioden med 7%.I de studerade kommunerna har plan- och bygglovsavgifter ökat med 10% under perioden, från i genomsnitt ca 110 000 kr till ca 120 000 kr. VA-anslutningsavgifter har ökat med 20%, från drygt 140 000 kr till drygt 170 000 kr. Elanslutningsavgifterna har utvecklats på liknande sätt, från knappt 25 000 kr till drygt 35 000 kr. Rapporten visar att byggherrekostnadernas utveckling har varit kraftigt negativ i vissa utvalda kommuner, och på motsatt sätt, kraftigt positiv i andra kommuner. Ett exempel är Sundbybergs kommun, vars plan- och bygglovsavgifter har minskat med 31%. Samtidigt har t.ex. Haninge kommun ökat motsvarande avgifter med 40%. Dessa procentsatser indikerar att avgifterna påverkas av förd politik i den aktuella kommunen.Rapporten visar att det finns flera möjliga rationella skäl bakom ökningen, men att det samtidigt inte går att försumma att ökningarna i kommunernas avgifter skulle kunna bero på ineffektivitet och missbruk av dominerande ställning. Det är tydligt att utformningen av kommunala taxor är komplex till sin natur, där en mängd faktorer behöver tas i beaktning för att motivera taxans storlek. Arbetet med de kommunala taxorna har visat sig vara en kontinuerligt pågående process. Till syvende och sist så ska dock taxans storlek utformas utifrån hur kostnaderna ser ut för kommunen. Det är bevisligen så att flera kommuner uppfattar prissättningen som komplex. Aktörer som SKR bär därför ett stort ansvar för att kunna bistå kommuner i att räkna ut rätt taxa. Av denna anledning så påpekas det i rapporten att själva prissättningsprocessen bör utredas närmare.Därutöver föreslås det i rapporten att SKR, t.ex. genom webbtjänsten Kolada, bör samla och presentera kommunala PBL-taxor över tid. En av anledningarna till varför SKR bör göra detta är de bevisliga svårigheterna i att hämta information om PBL-taxor från kommuner över tid.
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| 2. |
- Axelsson, Birger
(author)
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US Equity REIT Returns and Digitalization
- 2023
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Licentiate thesis (other academic/artistic)abstract
- This licentiate thesis is a collection of two essays that utilize time-series econometric methods in real estate finance. The first essay applies econometric modelling on Real Estate Investment Trust (REIT) index returns, focusing on estimating the effect of the quantitative easing (QE) and quantitative tightening (QT) programmes on U.S. equity REIT index returns, while controlling for several other important macro-financial factors. The second essay instead focuses on forecasting U.S. equity REIT index returns empirically, where the performance of a traditional econometric model (ARIMA) is compared to a modern state-of-the-art deep learning-based model (LSTM).Digitalization, which encompasses a broad range of technological advancements, is the main factor that we study for its impact on REIT investments. One perspective on the impact of digitalization on REITs is its effect on inflation. Digitalization has the potential to increase productivity and reduce costs, which could help to keep inflation low. This, in turn, has in the recent decades provided a supportive environment for REIT investments through lower interest rates, which we partly investigate in the first essay.Another perspective is that digitalization has not only led, but is also expected to lead, to significant innovations in the field of artificial intelligence (AI) and machine learning (ML), including deep learning (DL), which is a subset of ML. Many researchers and market practitioners are currently working to develop models that can use large amounts of data to make better forecasts and investment decisions. If successful, these models could significantly improve the performance of REIT investments. Can DL models be trained to make better forecasts for making investments? This is a question we ask ourselves in the second essay.The study of digitalization and its effects on inflation has been a growing area of interest in recent years, with researchers exploring the potential impact of technological advancements on macroeconomic trends, which founded the base to our studies. However, recent developments in the global economy have shifted the focus of this research, as inflation levels have unexpectedly risen from what was previously believed to be a low and stable environment. As a result, the setting and framework for our research on digitalization and inflation have been significantly altered, as we have tried to adapt to this changing landscape.
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| 3. |
- Dogan, Emanuel M., 1984-
(author)
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Endovascular occlusion methods in non-traumatic cardiac arrest
- 2021
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Doctoral thesis (other academic/artistic)abstract
- Approximately 10% of out-of-hospital cardiac arrest patients survive to hospital discharge. An important factor for survival is perfusion to the coronary and cerebral circulations during cardiopulmonary resuscitation (CPR). Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an endovascular method used to centralize the circulation and augment blood flow to the heart and brain. REBOA is mostly used in trauma patients but its use in non-traumatic cardiac arrest (NTCA) is evolving. The effects and optimal location of REBOA during CPR are, however, not well-known. Intra-aortic balloon pump (IABP) is another endovascular method which, unlike REBOA, inflates and deflates in correlation with the heart’s contraction and relaxation cycles. IABP is mostly used in patients with cardiogenic shock and its usage has been sparsely studied in NTCA. In addition, there are no studies evaluating if an intra-caval balloon pump (ICBP) could increase venous return during CPR. The aim of this thesis was to investigate endovascular occlusion methods in NTCA and how they influence the hemodynamic parameters during CPR. All studies were experimental where a total of 133 pigs were included.In Study I, REBOA increased systemic blood pressures while causing an ischemic insult to organs distal to the occlusion, already at 30 min of occlusion.Study II showed that a REBOA placed below the heart and outside of the compression field increased arterial blood pressures more than if the REBOA was placed behind the heart during NTCA and CPR.Study III compared REBOA in zone I (thoracic) with REBOA in zone III (infrarenal) during experimental CPR. Zone III REBOA did not yield the same favorable circulatory response as zone I REBOA.Study IV showed that IABP increased hemodynamic values if it was inflated before the chest compression. An ICBP did not improve hemodynamic values.Conclusion: REBOA caused a time-dependent ischemic insult, a maximum total occlusion time of 15-30 min is suggested. When an optimally placed REBOA and an optimally synchronized IABP are used in NTCA and CPR, they improve hemodynamic variables.
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| 4. |
- Dogan, Emanuel M., 1984-, et al.
(author)
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Intra-aortic and Intra-caval Balloon Pump Devices in Experimental Non-traumatic Cardiac Arrest and Cardiopulmonary Resuscitation
- 2023
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In: Journal of Cardiovascular Translational Research. - : Springer-Verlag New York. - 1937-5387 .- 1937-5395. ; 16:4, s. 948-955
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Journal article (peer-reviewed)abstract
- Intra-aortic balloon pump (IABP) use during CPR has been scarcely studied. Intra-caval balloon pump (ICBP) may decrease backward venous flow during CPR. Mechanical chest compressions (MCC) were initiated after 10 min of cardiac arrest in anesthetized pigs. After 5 min of MCC, IABP (n = 6) or ICBP (n = 6) was initiated. The MCC device and the IABP/ICBP had slightly different frequencies, inducing a progressive peak pressure phase shift. IABP inflation 0.15 s before MCC significantly increased mean arterial pressure (MAP) and carotid blood flow (CBF) compared to inflation 0.10 s after MCC and to MCC only. Coronary perfusion pressure significantly increased with IABP inflation 0.25 s before MCC compared to inflation at MCC. ICBP inflation before MCC significantly increased MAP and CBF compared to inflation after MCC but not compared to MCC only. This shows the potential of IABP in CPR when optimally synchronized with MCC. The effect of timing of intra-aortic balloon pump (IABP) inflation during mechanical chest compressions (MCC) on hemodynamics. Data from12 anesthetized pigs.
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| 5. |
- Dogan, Emanuel M., 1984-, et al.
(author)
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Resuscitative endovascular balloon occlusion of the aorta in zone I versus zone III in a porcine model of non-traumatic cardiac arrest and cardiopulmonary resuscitation : A randomized study
- 2020
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In: Resuscitation. - : Elsevier. - 0300-9572 .- 1873-1570. ; 151, s. 150-156
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Journal article (peer-reviewed)abstract
- INTRODUCTION: Resuscitative endovascular balloon occlusion of the aorta (REBOA) in zone I increases systemic blood pressure during cardiopulmonary resuscitation (CPR), while also obstructing the blood flow to distal organs. The aim of the study was to compare the effects on systemic blood pressure and visceral blood flow of REBOA-III (zone III, infrarenal) and REBOA-I (zone I, supraceliac) during non-traumatic cardiac arrest and CPR.METHODS: Cardiac arrest was induced in 61 anesthetized pigs. Thirty-two pigs were allocated to a hemodynamic study group where the primary outcomes were systemic arterial pressures and 29 pigs were allocated to a blood flow study group where the primary outcomes were superior mesenteric arterial (SMA) and internal carotid arterial (ICA) blood flow. After 7-8minutes of CPR with a mechanical compression device, REBOA-I, REBOA-III or no aortic occlusion (control group) were initiated after randomization.RESULTS: Systemic mean and diastolic arterial pressures were statistically higher during CPR with REBOA-I compared to REBOA-III (50mmHg and 16mmHg in REBOA-I vs 38mmHg and 1mmHg in REBOA-III). Systemic systolic, mean and diastolic arterial pressures were statistically elevated during CPR in the REBOA-I group compared to the controls. The SMA blood flow increased by 49% in REBOA-III but dropped to the levels of the controls within minutes. The ICA blood flow increased the most in REBOA-I compared to REBOA-III and the control group (54%, 19% and 0%, respectively).CONCLUSION: In experimental non-traumatic cardiac arrest and CPR, REBOA-I increased systemic blood pressures more than REBOA-III, and the potential enhancement of visceral organ blood flow by REBOA-III was short-lived.
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| 6. |
- Grafver, Isabelle, 1991-, et al.
(author)
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Intestinal fatty acid-binding protein as a potential biomarker for gastrointestinal complications after complex endovascular aortic surgery
- 2024
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In: Annals of Vascular Surgery. - : Springer. - 0890-5096 .- 1615-5947. ; 106, s. 176-183
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Journal article (peer-reviewed)abstract
- OBJECTIVE: This study aimed to investigate the association between intestinal fatty acid-binding protein, acute gastrointestinal injury grade, and gastrointestinal complications after fenestrated or branched endovascular aortic aneurysm repair.METHODS: A total of 17 patients undergoing endovascular aortic repair for thoracoabdominal, juxtarenal, suprarenal or pararenal aneurysm between May 2017 and September 2018 were enrolled. Blood samples were collected preoperatively and during postoperative intensive care. The blood samples were analyzed for intestinal fatty acid-binding protein with enzyme-linked immunosorbent assay. Gastrointestinal function was assessed according to the acute gastrointestinal injury grade every day during postoperative intensive care.RESULTS: Higher concentrations of intestinal fatty acid-binding protein at 24 h and 48 h correlated to higher acute gastrointestinal injury grade on postoperative days 1, 2 and 3 (p=0.032 and p=0.048, p=0.040 and p=0.018, and p=0.012 and p=0.016, respectively). Patients who developed a gastrointestinal complication within 90 days postoperatively had a higher overall acute gastrointestinal injury grade than those who did not develop a gastrointestinal complication (p<0.001), as well as higher concentrations of intestinal fatty acid-binding protein at 48 h (p=0.019). Patients developing gastrointestinal dysfunction (acute gastrointestinal injury grade ≥2) had a higher frequency of complications (p=0.009) and longer length of stay in the intensive care unit (p=0.008).CONCLUSIONS: In patients undergoing endovascular aortic repair for complex aneurysm increased postoperative plasma intestinal fatty acid-binding protein concentrations and postoperative gastrointestinal dysfunction, evaluated using the acute gastrointestinal injury grade, were associated with gastrointestinal complications, indicating that these measures may be useful in the postoperative management of these patients.
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| 7. |
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| 8. |
- Seilitz, Jenny, 1978-, et al.
(author)
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A Randomized Porcine Study in Low Cardiac Output of Vasoactive and Inotropic Drug Effects on the Gastrointestinal Tract
- 2021
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In: Shock. - : Lippincott Williams & Wilkins. - 1073-2322 .- 1540-0514. ; 56:2, s. 308-317
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Journal article (peer-reviewed)abstract
- BACKGROUND: Splanchnic vasodilation by inodilators is an argument for their use in critical cardiac dysfunction. To isolate peripheral vasoactivity from inotropy, such drugs were investigated, and contrasted to vasopressors, in a fixed low cardiac output (CO) model resembling acute cardiac dysfunction effects on the gastrointestinal tract. We hypothesized that inodilators would vasodilate and preserve the aerobic metabolism in the splanchnic circulation in low CO.METHODS: In anaesthetized pigs, CO was lowered to 60% of baseline by partial inferior caval vein balloon inflation. The animals were randomized to placebo (n = 8), levosimendan (24 μg kg-1 bolus, 0.2 μg kg-1 min-1, n = 7), milrinone (50 μg kg-1 bolus, 0.5 μg kg-1 min-1, n = 7), vasopressin (0.001, 0.002 and 0.006 U kg-1 min-1, one hour each, n = 7) or norepinephrine (0.04, 0.12 and 0.36 μg kg-1 min-1, one hour each, n = 7). Hemodynamic variables including mesenteric blood flow were collected. Systemic, mixed-venous, mesenteric-venous and intraperitoneal metabolites were analyzed.RESULTS: Cardiac output was stable at 60% in all groups, which resulted in systemic hypotension, low superior mesenteric artery blood flow, lactic acidosis, and increased intraperitoneal concentrations of lactate. Levosimendan and milrinone did not change any circulatory variables, but levosimendan increased blood lactate concentrations. Vasopressin and norepinephrine increased systemic and mesenteric vascular resistances at the highest dose. Vasopressin increased mesenteric resistance more than systemic, and the intraperitoneal lactate concentration and lactate/pyruvate ratio.CONCLUSION: Splanchnic vasodilation by levosimendan and milrinone may be negligible in low CO, thus rejecting the hypothesis. High dose vasopressors may have side effects in the splanchnic circulation.
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| 9. |
- Seilitz, Jenny, 1978-, et al.
(author)
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Early Onset of Postoperative Gastrointestinal Dysfunction Is Associated With Unfavorable Outcome in Cardiac Surgery : A Prospective Observational Study
- 2021
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In: Journal of Intensive Care Medicine. - : Sage Publications. - 0885-0666 .- 1525-1489. ; 36:11, s. 1264-1271
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Journal article (peer-reviewed)abstract
- OBJECTIVE: The distribution of postoperative gastrointestinal (GI) dysfunction and its association with outcome were investigated in cardiac surgery patients. Gastrointestinal function was evaluated using the Acute Gastrointestinal Injury (AGI) grade proposed by the European Society of Intensive Care Medicine.DESIGN: Prospective observational study at a single center.SETTING: University hospital.PATIENTS: Consecutive patients presenting for elective cardiac surgery with extracorporeal circulation (ECC).INTERVENTIONS: None.RESULTS: Daily assessment using the AGI grade was performed on the first 3 postoperative days in addition to standard care. For analysis, 3 groups were formed based on the maximum AGI grade: AGI 0, AGI 1, and AGI ≥2. Five hundred and one patients completed the study; 32.7%, 65.1%, and 2.2% of the patients scored a maximum AGI 0, AGI 1, and AGI ≥2, respectively. Patients with AGI grade ≥2 had more frequently undergone thoracic aortic surgery and had longer surgery duration and time on ECC. Patients with AGI grade ≥2 had statistically significant higher frequency of GI complications within 30 days (63.6% vs 1.2% and 5.5% in patients with AGI 0 and AGI 1) and higher 30-day mortality (9.1% vs 0.0% and 1.8% in patients with AGI 0 and AGI 1).CONCLUSIONS: Early GI dysfunction following cardiac surgery was associated with an unfavorable outcome. Increased attention to GI dysfunction in cardiac surgery patients is warranted and the AGI grade could be a helpful adjunct to a structured approach.
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| 10. |
- Seilitz, Jenny, 1978-, et al.
(author)
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Intestinal fatty acid-binding protein and acute gastrointestinal injury grade in postoperative cardiac surgery patients
- 2021
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In: Journal of cardiac surgery. - : Wiley-Blackwell Publishing Inc.. - 0886-0440 .- 1540-8191. ; 36:6, s. 1850-1857
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Journal article (peer-reviewed)abstract
- BACKGROUND AND AIM: Gastrointestinal complications post cardiac surgery are infrequent but difficult to diagnose and carry a high mortality. Plasma intestinal fatty acid-binding protein (I-FABP) concentrations and the relationship between I-FABP, gastrointestinal dysfunction, and postoperative outcomes were investigated in patients who developed gastrointestinal dysfunction (acute gastrointestinal injury [AGI] grade ≥2) and those with normal gastrointestinal function.METHODS: Patients with (AGI 2 group, n = 11) and without (matched controls, AGI 0 group, n = 22) early postoperative gastrointestinal dysfunction were extracted from a larger single-center prospective observational study, including adults undergoing elective cardiac surgery with extracorporeal circulation, and investigated in this nested case-control analysis.RESULTS: Both groups displayed variations in I-FABP concentrations with higher I-FABP on postoperative Day 1 compared to baseline and postoperative Days 2 and 3 (p < .001 and p = .005, respectively). The AGI 2 group had higher I-FABP concentrations on Day 2 compared to the AGI 0 group (p = .024). I-FABP on Day 2 correlated positively with AGI grade over the first 3 days (p = .036, p = .021 and p = .018, respectively). High I-FABP (defined as fourth quartile concentrations) on Day 1 was associated with more prolonged surgical procedures (p < .05). Furthermore, fourth quartile I-FABP on Day 1 and early gastrointestinal dysfunction were associated with higher frequencies of postoperative organ dysfunction (p < .05) and gastrointestinal complications (p < .05), and higher 365-day mortality.CONCLUSION: The present study indicates an association between intraoperative gastrointestinal injury, postoperative gastrointestinal dysfunction and gastrointestinal complications. A high-powered study is needed to further explore this relationship and the interpretation of I-FABP concentrations in individual cardiac surgery patients.
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