| 1. |
- Kronenberg, Jakub, et al.
(författare)
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The thorny path toward greening : unintended consequences, trade-offs, and constraints in green and blue infrastructure planning, implementation, and management
- 2021
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Ingår i: Ecology & Society. - : Resilience Alliance, Inc.. - 1708-3087. ; 26:2
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Tidskriftsartikel (refereegranskat)abstract
- Urban green and blue space interventions may bring about unintended consequences, involving trade-offs between the different land uses, and indeed, between the needs of different urban inhabitants, land users, and owners. Such trade-offs include choices between green/blue and non-green/blue projects, between broader land sparing vs. land sharing patterns, between satisfying the needs of the different inhabitants, but also between different ways of arranging the green and blue spaces. We analyze investment and planning initiatives in six case-study cities related to green and blue infrastructure (GBI) through the lens of a predefined set of questions an analytical framework based on the assumption that the flows of benefits from GBI to urban inhabitants and other stakeholders are mediated by three filters: infrastructures, institutions, and perceptions. The paper builds on the authors' own knowledge and experience with the analyzed case-study cities and beyond, a literature overview, a review of the relevant city documents, and interviews with key informants. The case studies indicate examples of initiatives that were intended to make GBI benefits available and accessible to urban inhabitants, in recognition of GBI as spaces with diverse functionality. Some case studies provide examples of trade-offs in trying to plan and design a green space for multiple private and public interests in densely built-up areas. The unintended consequences most typically resulted from the underappreciation of the complexity of social-ecological systems and more specifically the complexity of the involved infrastructures, institutions, and perceptions. The most important challenges addressed in the paper include trade-offs between the different ways of satisfying the residents' different needs related to the benefits from ecosystem services, ensuring proper recognition of the inhabitants' needs and perceptions, ecogentrification, caveats related to the formalization of informal spaces, and the need to consider temporal dynamics and cross-scale approaches that compromise different goals at different geographical scales.
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| 2. |
- Adli, Erik, et al.
(författare)
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Progress Of The Ess Proton Beam Imaging Systems
- 2022
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Ingår i: LINAC2022. - : ACoW Publishing. ; , s. 395-398
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Konferensbidrag (refereegranskat)abstract
- The ESS Target Proton Beam Imaging Systems has the objective to image the 5 MW ESS proton beam as it entersthe spallation target. The imaging systems has to operate in a harsh radiation environment, leading to a number of challenges : development of radiation hard photon sources, long and aperture-restricted optical paths and fast electronics required to provide rapid information in case of beam anomalies. This paper outlines how main challenges of the imaging systems have been addressed, and the status of deployment as ESS gets closer to beam.
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| 3. |
- Andersson, Erik, 1984-, et al.
(författare)
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Anaerobic Capacity in Running : The Effect of Computational Method
- 2021
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Ingår i: Frontiers in Physiology. - : Frontiers Media S.A.. - 1664-042X. ; 12:August, s. 1-13
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: To date, no study has compared anaerobic capacity (AnC) estimates computed with the maximal accumulated oxygen deficit (MAOD) method and the gross energy cost (GEC) method applied to treadmill running exercise.Purpose: Four different models for estimating anaerobic energy supply during treadmill running exercise were compared.Methods: Fifteen endurance-trained recreational athletes performed, after a 10-min warm-up, five 4-min stages at ∼55–80% of peak oxygen uptake, and a 4-min time trial (TT). Two linear speed-metabolic rate (MR) regression models were used to estimate the instantaneous required MR during the TT (MRTT_req), either including (5+YLIN) or excluding (5-YLIN) a measured Y-intercept. Also, the average GEC (GECAVG) based on all five submaximal stages, or the GEC based on the last submaximal stage (GECLAST), were used as models to estimate the instantaneous MRTT_req. The AnC was computed as the difference between the MRTT_req and the aerobic MR integrated over time.Results: The GEC remained constant at ∼4.39 ± 0.29 J⋅kg–1⋅m–1 across the five submaximal stages and the TT was performed at a speed of 4.7 ± 0.4 m⋅s–1. Compared with the 5-YLIN, GECAVG, and GECLAST models, the 5+YLIN model generated a MRTT_req that was ∼3.9% lower, with corresponding anaerobic capacities from the four models of 0.72 ± 0.20, 0.74 ± 0.16, 0.74 ± 0.15, and 0.54 ± 0.14 kJ⋅kg–1, respectively (F1.07,42 = 13.9, P = 0.002). The GEC values associated with the TT were 4.22 ± 0.27 and 4.37 ± 0.30 J⋅kg–1⋅m–1 for 5+YLIN and 5-YLIN, respectively (calculated from the regression equation), and 4.39 ± 0.28 and 4.38 ± 0.27 J⋅kg–1⋅m–1 for GECAVG and GECLAST, respectively (F1.08,42 = 14.6, P < 0.001). The absolute typical errors in AnC ranged between 0.03 and 0.16 kJ⋅kg–1 for the six pair-wise comparisons and the overall standard error of measurement (SEM) was 0.16 kJ⋅kg–1.Conclusion: These findings demonstrate a generally high disagreement in estimated anaerobic capacities between models and show that the inclusion of a measured Y-intercept in the linear regression (i.e., 5+YLIN) is likely to underestimate the MRTT_req and the GEC associated with the TT, and hence the AnC during maximal 4-min treadmill running.
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| 4. |
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| 5. |
- Baranowska, Julia, et al.
(författare)
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Associations between medical therapy after surgical aortic valve replacement for aortic stenosis and long-term mortality: a report from the SWEDEHEART registry.
- 2022
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Ingår i: European heart journal. Cardiovascular pharmacotherapy. - : Oxford University Press (OUP). - 2055-6837 .- 2055-6845. ; 8:8, s. 837-846
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Tidskriftsartikel (refereegranskat)abstract
- The association between use of statins, renin-angiotensin system (RAS) inhibitors and/or β-blockers and long-term mortality in patients with aortic stenosis who underwent surgical aortic valve replacement (SAVR) is unknown.All patients with aortic stenosis who underwent isolated first time SAVR in Sweden from 2006 to 2017 and survived six months after discharge were included. Individual patient data from four mandatory nationwide registries were merged. Cox proportional hazards models, with time-updated data on medication status and adjusted for age, sex, comorbidities, type of prosthesis, and year of surgery, were used to investigate associations between dispensed statins, RAS inhibitors, and β-blockers, and all-cause mortality. In total, 9553 patients were included, and median follow-up time was 4.9 years (range 0-11); 1738 patients (18.2%) died during follow-up. Statins were dispensed to 49.1% and 49.0% of the patients within six months of discharge from hospital and after ten years, respectively. Corresponding figures were 51.4% and 53.9% for RAS inhibitors, and 79.3% and 60.7% for β-blockers. Ongoing treatment was associated with lower mortality risk for statins [adjusted hazard ratio (aHR) 0.67 (95% confidence interval 0.60-0.74), p<0.001] and RAS inhibitors [aHR 0.84 (0.76-0.93), p<0.001] but not for β-blockers [aHR 1.17 (1.05-1.30), p=0.004]. The associations were robust in subgroups based on age, sex, and comorbidities (p for interactions>0.05).The results of this large population-based real-world study support the use of statins and RAS inhibitors for patients who underwent SAVR due to aortic stenosis.
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| 6. |
- Björklund, Erik, et al.
(författare)
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Comparison of Midterm Outcomes Associated With Aspirin and Ticagrelor vs Aspirin Monotherapy After Coronary Artery Bypass Grafting for Acute Coronary Syndrome.
- 2021
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Ingår i: JAMA network open. - : American Medical Association (AMA). - 2574-3805. ; 4:8
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Tidskriftsartikel (refereegranskat)abstract
- Guidelines recommend dual antiplatelet therapy after coronary artery bypass grafting (CABG) for patients with acute coronary syndrome (ACS). However, the evidence for these recommendations is weak.To compare midterm outcomes after CABG in patients with ACS treated postoperatively with acetylsalicylic acid (ASA) and ticagrelor or with ASA monotherapy.This cohort study used merged data from several national registries of Swedish patients who were diagnosed with ACS and subsequently underwent CABG. All included patients underwent isolated CABG in Sweden between 2012 and 2017 with an ACS diagnosis less than 6 weeks before the procedure, survived 14 days after discharge from hospital, and were treated postoperatively with ASA plus ticagrelor or ASA monotherapy. A multivariable Cox regression model was used for the main analysis, and propensity score-matched models were performed as sensitivity analysis. Data were analyzed between May and September 2020.Postoperative antiplatelet treatment, defined as filled prescriptions, with either ASA and ticagrelor or ASA only.Major adverse cardiovascular events (MACE), defined as all-cause mortality, myocardial infarction, and stroke, and major bleeding, at 12 months and at the end of follow-up.A total of 6558 patients (5281 [80.5%] men; mean [SD] age at surgery, 67.6 [9.3] years) were included; 1813 (27.6%) were treated with ASA plus ticagrelor and 4745 (72.4%) were treated with ASA monotherapy. Crude MACE rate was 3.0 per 100 person years (95% CI, 2.5-3.6 per 100 person years) in the ASA plus ticagrelor group and 3.8 per 100 person years (95% CI, 3.5-4.1 per 100 person years) in the ASA group. After adjustment, there was no significant difference in MACE risk between ASA plus ticagrelor vs ASA only, neither during the first 12 months (adjusted hazard ratio [aHR], 0.84; 95% CI, 0.58-1.21; P=.34) or during total follow-up (aHR, 0.89; 95% CI, 0.71-1.11; P=.29). The use of ASA plus ticagrelor was associated with a significantly increased risk for major bleeding during the first 12 months (aHR, 1.90; 95% CI, 1.16-3.13; P=.011). Sensitivity analyses confirmed the results.In patients with ACS who survived 2 weeks after CABG, no significant difference in the risk of death or ischemic events could be demonstrated between ASA plus ticagrelor and patients treated with ASA only, while the risk for major bleeding was higher in patients treated with ASA plus ticagrelor. Sufficiently powered prospective randomized trials comparing different antiplatelet therapy strategies after CABG are warranted.
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| 7. |
- Björklund, Erik
(författare)
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Platelet inhibition and secondary prevention in cardiac surgery patients
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- ABSTRACT Background and objective Coronary artery bypass grafting (CABG) is the most common cardiac surgery procedure. Dual antiplatelet therapy (DAPT) reduces the risk for ischaemic events in patients with acute coronary syndrome (ACS) but increases the bleeding risk, both for spontaneous bleedings and procedure-related bleedings for the subset of ACS patients undergoing urgent CABG. Statins, beta-blockers, and renin-angiotensin-system (RAS) inhibitors are commonly prescribed after CABG but the scientific evidence for their use after CABG is scarce. The objective of this thesis is to investigate how different aspects of pharmacotherapy are associated with short- and long-term risk for adverse events after CABG. Methods Study I: Platelet function before and after cardiac surgery was analysed using impedance aggregometry in patients treated with acetylsalicylic acid and the P2Y12-inhibitor ticagrelor. Associations between pre- and postoperative platelet function and risk for severe postoperative bleeding were investigated. Study II-IV: Individual patient data from the Swedish Cardiac Surgery Registry, the National Patient Register, the Swedish Prescribed Drug Register, LISA register and the Cause of Death Register was merged to obtain data on procedural aspects, baseline comorbidities, adverse events and mortality after CABG. Study II investigated associations between use of statins, beta-blockers, RAS-inhibitors and platelet inhibitors and mortality risk. Study III investigated if the combination of ASA and ticagrelor was associated with improved clinical outcome compared to ASA monotherapy in patients with acute coronary syndrome undergoing CABG. Study IV investigated the associations between post-discharge major bleeding and myocardial infarction respectively with subsequent mortality risk. Results Study I: Postoperative platelet aggregation induced by adenosin diphosphate (ADP) had an area under curve (AUC) of 0.75 (95% CI 0.62-0.87) in predicting severe bleeding. The corresponding value for preoperative testing was AUC of 0.77 (95% CI 0.65-0.89). Study II: Utilization of secondary prevention medication was high early after CABG but decreased significantly over time. Ongoing use of statins, RAS inhibitors and platelet inhibitors were associated with reduced mortality risk after CABG. Use of beta-blockers was not associated with lower mortality risk. Study III: The combination of acetylsalicylic acid (ASA) and ticagrelor was not associated with lower risk for ischaemic events but increased the bleeding risk compared with ASA monotherapy. Study IV: Post-discharge major bleeding was associated with increased mortality risk, comparable to the increase in mortality risk associated with post-discharge myocardial infarction. Conclusions Adding a postoperative test of platelet aggregation did not improve accuracy in predicting severe bleeding. Improving long-term utilization of statins, RAS inhibitors and platelet inhibitors poses an opportunity to improve long-term survival after CABG. Prospective, randomized controlled trials are warranted to establish the clinical outcome of DAPT with ticagrelor after CABG in ACS patients, especially considering the increased mortality risk associated with post-discharge major bleeding events.
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| 8. |
- Björklund, Erik, et al.
(författare)
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Postdischarge major bleeding, myocardial infarction, and mortality risk after coronary artery bypass grafting
- 2023
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Ingår i: HEART. - 1355-6037 .- 1468-201X.
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Tidskriftsartikel (refereegranskat)abstract
- Objective To investigate the incidence and mortality risk associated with postdischarge major bleeding after coronary artery bypass grafting (CABG), and relate this to the incidence of, and mortality risk from, postdischarge myocardial infarction.Methods All patients undergoing first-time isolated CABG in Sweden in 2006-2017 and surviving 14 days after hospital discharge were included in a cohort study. Individual patient data from the SWEDEHEART Registry and five other mandatory nationwide registries were merged. Piecewise Cox proportional hazards models were used to investigate associations between major bleeding, defined as hospitalisation for bleeding, with subsequent mortality risk. Similar Cox proportional hazards models were used to investigate the association between postdischarge myocardial infarction and mortality risk.Results Among 36 633 patients, 2429 (6.6%) had a major bleeding event and 2231 (6.1%) had a myocardial infarction. Median follow-up was 6.0 (range 0-11) years. Major bleeding was associated with higher mortality risk <30 days (adjusted HR (aHR)=20.2 (95% CI 17.3 to 23.5)), 30-365 days (aHR=3.8 (95% CI 3.4 to 4.3)) and >365 days (aHR=1.8 (95% CI 1.7 to 2.0)) after the event. Myocardial infarction was associated with higher mortality risk <30 days (aHR=20.0 (95% CI 16.7 to 23.8)), 30-365 days (aHR=4.1 (95% CI 3.6 to 4.8)) and >365 days (aHR=1.8 (95% CI 1.7 to 2.0)) after the event.Conclusions The increase in mortality risk associated with a postdischarge major bleeding after CABG is substantial and is similar to the mortality risk associated with a postdischarge myocardial infarction.
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| 9. |
- Björklund, Erik, et al.
(författare)
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Sulfolane-Based Ethylene Carbonate-Free Electrolytes for LiNi0.6Mn0.2Co0.2O2-Li4Ti5O12 Batteries
- 2020
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Ingår i: Batteries & Supercaps. - : Wiley. - 2566-6223. ; 3:2, s. 201-207
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Tidskriftsartikel (refereegranskat)abstract
- Most electrolytes in today's lithium-ion batteries contain a large proportion of ethylene carbonate (EC) mixed with other alkyl carbonate-based solvents. EC has, however, been shown to be unstable at the high potentials at which several novel cathode materials are electrochemically active. Here, different mixtures of sulfolane and DMC are investigated in this context. The electrochemical stability is explored in addition to galvanostatic cycling of LiNi0.6Mn0.2Co0.2O2-Li4Ti5O12 (NMC-LTO) cells. The measurement of the ionic conductivity showed that mixing 25 % sulfolane into DMC improved the electrolyte properties as compared to pure DMC, making the conductivity similar to EC:DEC electrolytes and therefore fully functional. Moreover, the addition of sulfolane slightly enhanced the capacity retention, likely caused by formation of thinner and more stable surface layers on the LTO electrodes as determined by X-ray photoelectron spectroscopy (XPS). The cycling performance is especially improved for sulfolane-based electrolytes during cycling at sub-zero temperatures.
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| 10. |
- Björklund, Johan, et al.
(författare)
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The 90-day cause-specific mortality after radical prostatectomy : a nationwide population-based study.
- 2022
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Ingår i: BJU International. - : John Wiley & Sons. - 1464-4096 .- 1464-410X. ; 129:3, s. 318-324
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To investigate the cause-specific mortality in the postoperative period after radical prostatectomy (RP) for prostate cancer (PCa).METHODS: In the National Prostate Cancer Register of Sweden (NPCR), we identified all men who died within 90 days after RP performed 1998-2018 and we assessed cause of death in a chart review. We compared the adjudications of death from our medical record review with those in in the Swedish Cause of Death Registry (CDR).RESULTS: Out of 44 635, 58 (0.13%) men who had undergone RP from 1998 through 2018 died within 90 days after RP. Per medical record review the most common causes of death were cardiac disease (30%) and venous thromboembolic events (VTE; 21%). No men died of metastatic PCa as was first indicated in the CDR. After robot-assisted RP (RARP) or open retropubic RP (RRP), the postoperative mortality was 0.09% (19/21 520) and 0.19% (37/19 635), respectively. The effect off modality was confounded mainly by year of surgery, age at surgery, Charlson Comorbidity Index score and the concomitant pelvic lymph node dissection.CONCLUSION: The validated absolute 90-day mortality after RP was 1.3/1000 during the 21-year study period. Cardiovascular diseases were the most common causes of death after RP. Our validation of the CDR refuted the occurrence of postoperative deaths from metastatic PCa. There were differences in rates and type of mortality between RRP and RARP, but the RARP cohort was more recent than the RRP cohort, which likely explain the differences.
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