| 1. |
- Ulmert, David, et al.
(författare)
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A novel automated platform for quantifying the extent of skeletal tumour involvement in prostate cancer patients using the bone scan index
- 2012
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Ingår i: European Urology. - : Elsevier BV. - 0302-2838 .- 1873-7560. ; 62:1, s. 78-84
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Tidskriftsartikel (refereegranskat)abstract
- Background: There is little consensus on a standard approach to analysing bone scan images. The Bone Scan Index (BSI) is predictive of survival in patients with progressive prostate cancer (PCa), but the popularity of this metric is hampered by the tedium of the manual calculation. Objective: Develop a fully automated method of quantifying the BSI and determining the clinical value of automated BSI measurements beyond conventional clinical and pathologic features. Design, setting, and participants: We conditioned a computer-assisted diagnosis system identifying metastatic lesions on a bone scan to automatically compute BSI measurements. A training group of 795 bone scans was used in the conditioning process. Independent validation of the method used bone scans obtained ≤3 mo from diagnosis of 384 PCa cases in two large population-based cohorts. An experienced analyser (blinded to case identity, prior BSI, and outcome) scored the BSI measurements twice. We measured prediction of outcome using pretreatment Gleason score, clinical stage, and prostate-specific antigen with models that also incorporated either manual or automated BSI measurements. Measurements: The agreement between methods was evaluated using Pearson's correlation coefficient. Discrimination between prognostic models was assessed using the concordance index (C-index). Results and limitations: Manual and automated BSI measurements were strongly correlated (ρ = 0.80), correlated more closely (ρ = 0.93) when excluding cases with BSI scores ≥10 (1.8%), and were independently associated with PCa death (p < 0.0001 for each) when added to the prediction model. Predictive accuracy of the base model (C-index: 0.768; 95% confidence interval [CI], 0.702-0.837) increased to 0.794 (95% CI, 0.727-0.860) by adding manual BSI scoring, and increased to 0.825 (95% CI, 0.754-0.881) by adding automated BSI scoring to the base model. Conclusions: Automated BSI scoring, with its 100% reproducibility, reduces turnaround time, eliminates operator-dependent subjectivity, and provides important clinical information comparable to that of manual BSI scoring. © 2012 European Association of Urology.
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| 2. |
- Vickers, Andrew J., et al.
(författare)
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Prostate specific antigen concentration at age 60 and death or metastasis from prostate cancer : Case-control study
- 2010
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Ingår i: BMJ (Online). - : BMJ. - 1756-1833 .- 0959-8138 .- 1468-5833. ; 341:7773
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To determine the relation between concentrations of prostate specific antigen at age 60 and subsequent diagnosis of clinically relevant prostate cancer in an unscreened population to evaluate whether screening for prostate cancer and chemoprevention could be stratified by risk. Design: Case-control study with 1:3 matching nested within a highly representative population based cohort study. Setting: General population of Sweden taking part in the Malmo Preventive Project. Cancer registry at the National Board of Health and Welfare. Participants: 1167 men aged 60 who provided blood samples in 1981 and were followed up to age 85. Main outcome measures: Metastasis or death from prostate cancer. Results: The rate of screening during the course of the study was low. There were 43 cases of metastasis and 35 deaths from prostate cancer. Concentration of prostate specific antigen at age 60 was associated with prostate cancer metastasis (area under the curve 0.86, 95% confidence interval 0.79 to 0.92; P<0.001) and death from prostate cancer (0.90, 0.84 to 0.96; P<0.001). The greater the number for the area under the curve (values from 0 to 1) the better the test. Although only a minority of the men with concentrations in the top quarter (>2 ng/ml) develop fatal prostate cancer, 90% (78% to 100%) of deaths from prostate cancer occurred in these men. Conversely, men aged 60 with concentrations at the median or lower (≤1 ng/ml) were unlikely to have clinically relevant prostate cancer (0.5% risk of metastasis by age 85 and 0.2% risk of death from prostate cancer). Conclusions: The concentration of prostate specific antigen at age 60 predicts lifetime risk of metastasis and death from prostate cancer. Though men aged 60 with concentrations below the median (≤1 ng/ml) might harbour prostate cancer, it is unlikely to become life threatening. Such men could be exempted from further screening, which should instead focus on men with higher concentrations.
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| 3. |
- Vickers, Andrew J., et al.
(författare)
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Strategy for detection of prostate cancer based on relation between prostate specific antigen at age 40-55 and long term risk of metastasis: case-control study
- 2013
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Ingår i: BMJ: British Medical Journal. - : BMJ. - 1756-1833. ; 346, s. 2023-2023
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Tidskriftsartikel (refereegranskat)abstract
- Objective To determine the association between concentration of prostate specific antigen (PSA) at age 40-55 and subsequent risk of prostate cancer metastasis and mortality in an unscreened population to evaluate when to start screening for prostate cancer and whether rescreening could be risk stratified. Design Case-control study with 1: 3 matching nested within a highly representative population based cohort study. Setting Malmo Preventive Project, Sweden. Participants 21 277 Swedish men aged 27-52 (74% of the eligible population) who provided blood at baseline in 1974-84, and 4922 men invited to provide a second sample six years later. Rates of PSA testing remained extremely low during median follow-up of 27 years. Main outcome measures Metastasis or death from prostate cancer ascertained by review of case notes. Results Risk of death from prostate cancer was associated with baseline PSA: 44% (95% confidence interval 34% to 53%) of deaths occurred in men with a PSA concentration in the highest 10th of the distribution of concentrations at age 45-49 (>= 1.6 mu g/L), with a similar proportion for the highest 10th at age 51-55 (>= 2.4 mu g/L: 44%, 32% to 56%). Although a 25-30 year risk of prostate cancer metastasis could not be ruled out by concentrations below the median at age 45-49 (0.68 mu g/L) or 51-55 (0.85 mu g/L), the 15 year risk remained low at 0.09% (0.03% to 0.23%) at age 45-49 and 0.28% (0.11% to 0.66%) at age 51-55, suggesting that longer intervals between screening would be appropriate in this group. Conclusion Measurement of PSA concentration in early midlife can identify a small group of men at increased risk of prostate cancer metastasis several decades later. Careful surveillance is warranted in these men. Given existing data on the risk of death by PSA concentration at age 60, these results suggest that three lifetime PSA tests (mid to late 40s, early 50s, and 60) are probably sufficient for at least half of men.
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| 4. |
- Anderson, Leif G, 1951, et al.
(författare)
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Source and formation of the upper halocline of the Arctic Ocean
- 2013
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Ingår i: Journal of Geophysical Research - Oceans. - 0148-0227 .- 2156-2202. ; 118:1, s. 410-421
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Tidskriftsartikel (refereegranskat)abstract
- The upper halocline of the Arctic Ocean has a distinct chemical signature with high nutrient concentrations as well as low oxygen and pH values. This signature is formed in the Chukchi and East Siberian Seas, by a combination of mineralization of organic matter and release of decay products to the sea ice brine enriched bottom water. Salinity and total alkalinity data show that the fraction of sea ice brine in the nutrient enriched upper halocline water in the central Arctic Ocean is up to 4%. In the East Siberian Sea the bottom waters with exceptional high nutrient concentration and low pH have typically between 5 and 10% of sea ice brine as computed from salinity and oxygen-18 values. On the continental slope, over bottom depths of 15-200 m, the brine contribution was 6% at the nutrient maximum depth (50-100 m). At the same location as well as over the deeper basin the silicate maximum was found over a wider salinity range than traditionally found in the Canada Basin, in agreement with earlier observations east of the Chukchi Plateau. A detailed evaluation of the chemical and the temperature-salinity properties suggests at least two different areas for the formation of the nutrient rich halocline within the East Siberian Sea. This has not been observed before 2004 and it could be a sign of a changing marine climate in the East Siberian Sea, caused by more open water in the summer season followed by more sea ice formation and brine production in the fall/winter.
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| 5. |
- Annerstedt, Matilda, et al.
(författare)
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Green qualities in the neighbourhood and mental health - results from a longitudinal cohort study in Southern Sweden
- 2012
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Ingår i: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 12
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Tidskriftsartikel (refereegranskat)abstract
- Background: Poor mental health is a major issue worldwide and causality is complex. For diseases with multifactorial background synergistic effects of person-and place-factors can potentially be preventive. Nature is suggested as one such positive place-factor. In this cohort study we tested the effect of defined green qualities (Serene, Space, Wild, Culture, Lush) in the environment at baseline on mental health at follow-up. We also studied interaction effects on mental health of those place factors and varied person factors (financial stress, living conditions, and physical activity). Methods: Data on person factors were extracted from a longitudinal (years 1999/2000 and 2005) population health survey (n = 24945). The participants were geocoded and linked to data on green qualities from landscape assessments, and stored in the Geographical Information System (GIS). Crude odds ratios (OR) and 95% confidence intervals (CI) were calculated, and multivariate logistic analyses were performed. Results: Mental health was not affected by access to the chosen green qualities, neither in terms of amount nor in terms of any specific quality. However, we found a reduced risk for poor mental health at follow-up among women, through a significant interaction effect between physical activity and access to the qualities Serene or Space. For men the tendencies were similar, though not significant. Regarding the other three green qualities, as well as amount of qualities, no statistically certain synergistic effects were found. Likewise, no significant synergies were detected between green qualities and the other person-factors. Only advanced exercise significantly reduced the risk for poor mental health among women, but not for men, compared to physical inactivity. Conclusions: The results do not directly support the hypothesis of a preventive mental health effect by access to the green qualities. However, the additive effect of serene nature to physical activity contributed to better mental health at follow-up. This tendency was equal for both sexes, but statistically significant only for women. Objective landscape assessments may be important in detangling geographic determinants of health. This study stresses the importance of considering interaction effects when dealing with disorders of multifactorial background.
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| 6. |
- Björk, Martina, et al.
(författare)
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Barbaren Medea
- 2014
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Ingår i: Civilisation : tjugoen försök. - 9789189672604 ; , s. 33-40
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Bokkapitel (populärvet., debatt m.m.)
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| 7. |
- Björk, Marcus, 1985-, et al.
(författare)
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Dynamic models with quantized output for modeling patient response to pharmacotherapy
- 2010
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Ingår i: Proc. International Conference on Control Applications. - Piscataway, NJ : IEEE. - 9781424453627 ; , s. 1029-1034
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Konferensbidrag (refereegranskat)abstract
- This article presents a way of modeling patient response to a pharmacotherapy by means of dynamic models with quantized output. The proposed modeling technique is exemplified by treatment of Parkinson's disease with Duodopa ®, where the drug is continuously administered via duodenal infusion. Titration of Duodopa ® is currently performed manually by a nurse judging the patient's motor symptoms on a quantized scale and adjusting the drug flow provided by a portable computer-controlled infusion pump. The optimal drug flow value is subject to significant inter-individual variation and the titration process might take up to two weeks for some patients. In order to expedite the titration procedure via automation, as well as to find optimal dosing strategies, a mathematical model of this system is sought. The proposed model is of Wiener type with a linear dynamic block, cascaded with a static nonlinearity in the form of a non-uniform quantizer where the quantizer levels are to be identified. An identification procedure based on the prediction error method and the Gauss-Newton algorithm is suggested. The datasets available from titration sessions are scarce so that finding a parsimonious model is essential. A few different model parameterizations and identification algorithms were initially evaluated. The results showed that models with four parameters giving accurate predictions can be identified for some of the available datasets.
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| 8. |
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| 9. |
- Björk, Marcus, et al.
(författare)
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Magnitude-constrained sequence design with application in MRI
- 2014
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Ingår i: Proc. 39th IEEE International Conference on Acoustics, Speech, and Signal Processing. - Piscataway, NJ : IEEE. - 9781479928934 ; , s. 4943-4947
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Konferensbidrag (refereegranskat)abstract
- In this paper we present an algorithm for sequence design with magnitude constraints. We formulate the design problem in a general setting, but also illustrate its relevance to parallel excitation MRI. The formulated non-convex design optimization criterion is minimized locally by means of a cyclic algorithm, consisting of two simple algebraic sub-steps. Since the algorithm truly minimizes the criterion, the obtained sequence designs are guaranteed to improve upon the estimates provided by a previous method, which is based on the heuristic principle of the Iterative Quadratic Maximum Likelihood algorithm. The performance of the proposed algorithm is illustrated in two numerical examples.
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| 10. |
- Björk, Marcus, 1985-, et al.
(författare)
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New approach to phase correction in multi-echo T2 relaxometry
- 2014
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Ingår i: Journal of magnetic resonance. - : Elsevier BV. - 1090-7807 .- 1096-0856. ; 249, s. 100-107
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Tidskriftsartikel (refereegranskat)abstract
- Estimation of the transverse relaxation time, T-2, from multi-echo spin-echo images is usually performed using the magnitude of the noisy data, and a least squares (LS) approach. The noise in these magnitude images is Rice distributed, which can lead to a considerable bias in the LS-based T-2 estimates. One way to avoid this bias problem is to estimate a real-valued and Gaussian distributed dataset from the complex data, rather than using the magnitude. In this paper, we propose two algorithms for phase correction which can be used to generate real-valued data suitable for LS-based parameter estimation approaches. The first is a Weighted Linear Phase Estimation algorithm, abbreviated as WELPE. This method provides an improvement over a previously published algorithm, while simplifying the estimation procedure and extending it to support multi-coil input. The algorithm fits a linearly parameterized function to the multi-echo phase-data in each voxel and, based on this estimated phase, projects the data onto the real axis. The second method is a maximum likelihood estimator of the true decaying signal magnitude, which can be efficiently implemented when the phase variation is linear in time. The performance of the algorithms is demonstrated via Monte Carlo simulations, by comparing the accuracy of the estimates. Furthermore, it is shown that using one of the proposed algorithms enables more accurate T-2 estimates; in particular, phase corrected data significantly reduces the estimation bias in multi-component T-2 relaxometry example, compared to when using magnitude data. WELPE is also applied to a 32-echo in vivo brain dataset, to show its practical feasibility.
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