| 1. |
- Abrahamsson, Jonas, 1954, et al.
(författare)
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Improved outcome after relapse in children with acute myeloid leukaemia.
- 2007
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Ingår i: British journal of haematology. - : Wiley. - 0007-1048 .- 1365-2141. ; 136:2, s. 229-236
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Tidskriftsartikel (refereegranskat)abstract
- In the Nordic Society for Paediatric Haematology and Oncology paediatric study acute myeloid leukaemia (AML) 93, event-free survival was 50% and overall survival was 66%, indicating that many patients were cured following relapse. Factors influencing outcome in children with relapsed AML were investigated. The study included all 146 children in the Nordic countries diagnosed with AML between 1988 and 2003, who relapsed. Data on disease characteristics and relapse treatment were related to outcome. Sixty-six percentage achieved remission with survival after relapse (5 years) 34 +/- 4%. Of 122 patients who received re-induction therapy, 77% entered remission with 40 +/- 5% survival. Remission rates were similar for different re-induction regimens but fludarabine, cytarabine, granulocyte colony-stimulating factor-based therapy had low treatment-related mortality. Prognostic factors for survival were duration of first complete remission (CR1) and stem cell transplantation (SCT) in CR1. In early relapse (<1 year in CR1), survival was 21 +/- 5% compared with 48 +/- 6% in late relapse. For children receiving re-induction therapy, survival in early relapse was 29 +/- 6% and 51 +/- 6% in late. Patients treated in CR1 with SCT, autologous SCT or chemotherapy had a survival of 18 +/- 9, 5 +/- 5 and 41 +/- 5%, respectively. Survival was 62 +/- 6% in 64 children given SCT as part of their relapse therapy. A significant proportion of children with relapsed AML can be cured, even those with early relapse. Children who receive re-induction therapy, enter remission and proceed to SCT can achieve a cure rate of 60%.
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| 2. |
- Clausen, Jonas, et al.
(författare)
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Generalizing the Safety Factor Approach
- 2006
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Ingår i: Reliability Engineering & System Safety. - : Elsevier BV. - 0951-8320 .- 1879-0836. ; 91:8, s. 964-973
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Tidskriftsartikel (refereegranskat)abstract
- Safety factors (uncertainty factors) are used to avoid failure in a wide variety of practices and disciplines, in particular engineering design and toxicology. Although these two areas have similar problems in their use of safety factors, there are no signs of previous communication between the two disciplines. The present contribution aims at initiating such communications by pointing out parallel practices and joint issues between the two disciplines. These include the distinction between probabilistic variability and epistemic uncertainty, the importance of distribution tails, and the problem of countervailing risks. In conclusion, it is proposed that future research in this area should be interdisciplinary and make use of experiences from the various areas in which safety factors are used.
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| 3. |
- Clausen Mork, Jonas, et al.
(författare)
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Eurocodes and REACH - differences and similarities
- 2007
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Ingår i: Risk Management. - : Springer Science and Business Media LLC. - 1460-3799 .- 1743-4637. ; :19, s. 19-35
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Tidskriftsartikel (refereegranskat)abstract
- The developments of the new European construction standard (Eurocodes) and the new European chemical legislation (REACH) have taken place in parallel, and they are now both in their final stages. Both consist in European harmonization of safety regulations that concern major industries. In this paper, we compare Eurocodes and REACH in terms of purpose, intended level of harmonization, the science-policy interface and controversies about the costs of the regulations. We have found that the science-policy interface of REACH is characterized by public controversy and by attempts to keep risk assessment and risk management apart while the science-policy interface of Eurocodes is characterized by trust in experts, limited public involvement and organizational confluence of risk assessment and risk management. Furthermore, the costs of REACH have been a major issue in discussions between the Commission and the chemical industry while, in contrast, the costs of Eurocodes have not even been calculated either by the Commission or by the construction industry. A major reason for this is that construction industry does not seem to regard possible cost increases due to Eurocodes as a threat to their business interests. Regulators seem to have treated the cost issue as a business interest, not as an aspect of the decision that they should be concerned with even in the absence of external pressure.
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| 4. |
- Clausen Mork, Jonas, 1975-
(författare)
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Is it safe? safety factor reasoning in policy-making under uncertainty
- 2006
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis examines the practice of using safety factors in decision-making under uncertainty, in particular in the areas of toxicology and civil engineering. The aim is to expose and clarify some of the philosophical issues surrounding the practice. Paper I (co-written with Sven Ove Hansson and Fred Nilsson) gives an historical background to the practice of formal safety factor and safety margin use. The notion of an uncertainty function is presented as a more general concept covering safety margins, safety factors and the related uncertainty factors. Three categories of uncertainty functions are identified: explicit, implicit and natural safety reserves. Finally, the problems of countervailing risks and distribution arbitrariness are discussed. Paper II (co-written with John Cantwell) discusses the relation between decision-making with safety factor rules and the ideal of formal normative decision theory. The role of safety factor rules in practical and theoretical reasoning is also examined and certain difficulties regarding normative evaluation of safety factor rules are pointed out. Paper III (co-written with Sven Ove Hansson) looks at two current regulatory systems under development: Eurocodes for construction and REACH for chemicals. The two regulations have many similarities but reactions to them have been highly divergent. The differences are discussed and some hypotheses as to their explanation are suggested.
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| 5. |
- Clausen Mork, Jonas, et al.
(författare)
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Reasoning with Safety Factor Rules
- 2007
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Ingår i: Techné. - 1091-8264 .- 2691-5928. ; 11:1, s. 55-70
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Tidskriftsartikel (refereegranskat)abstract
- Safety factor rules are used for drawing putatively reasonable conclusions from incomplete datasets. The paper attempts to provide answers to four questions: “How are safety factors used?”, “When are safety factors used?”, “Why are safety used?” and “How do safety factor rules relate to decision theory?”. The authors conclude that safety factor rules should be regarded as decision methods rather than as criteria of rightness and that they can be used in both practical and theoretical reasoning. Simplicity of application and inability or unwillingness to defer judgment appear to be important factors in explaining why the rules are used.
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| 7. |
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| 8. |
- Lie, S. O., et al.
(författare)
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Long-term results in children with AML: NOPHO-AML Study Group--report of three consecutive trials
- 2005
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Ingår i: Leukemia. - : Springer Science and Business Media LLC. - 0887-6924 .- 1476-5551. ; 19:12, s. 2090-100
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Tidskriftsartikel (refereegranskat)abstract
- In all, 447 children with acute myeloid leukaemia (AML) have been treated on three consecutive NOPHO studies from July 1984 to December 2001. NOPHO-AML 84 was of moderate intensity with an induction of three courses of cytarabine, 6-thioguanine and doxorubicin followed by four consolidation courses with high-dose cytarabine. The 5-year event-free survival (EFS), disease free survival (DFS) and overall survival (OS) were 29, 37 and 38%. NOPHO-AML 88 was of high intensity with the addition of etoposide and mitoxantrone in selected courses during induction and consolidation. The interval between the induction courses should be as short as possible, that is, time intensity was introduced. The 5-year EFS, DFS and OS were 41, 48 and 46%. In NOPHO-AML 93, the treatment was stratified according to response to first induction course. The protocol utilised the same induction blocks as NOPHO-AML 88, but after the first block, children with a hypoplastic, nonleukaemic bone marrow were allowed to recover before the second block. Consolidation was identical with NOPHO-AML 88. The 5-year EFS, DFS and OS in NOPHO-AML 93 were 48, 52 and 65%. The new NOPHO-AML protocol has been based on experiences from previous protocols with stratification of patients with regard to in vivo response and specific cytogenetic aberrations.
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| 9. |
- Wendtland Edslev, Pernille, et al.
(författare)
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Age and Prognosis in Pediatric AML
- 2008
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Ingår i: Blood. - 1528-0020 .- 0006-4971. ; 112:11
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Konferensbidrag (refereegranskat)
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| 10. |
- Zeller, B., et al.
(författare)
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Acute leukaemia in children with Down syndrome: a population-based Nordic study
- 2005
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Ingår i: Br J Haematol. - : Wiley. - 0007-1048 .- 1365-2141. ; 128:6, s. 797-804
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Tidskriftsartikel (refereegranskat)abstract
- To determine the epidemiology and outcome of children with Down syndrome (DS) diagnosed with acute leukaemia in the Nordic countries, data registered in the Nordic Society of Paediatric Haematology and Oncology (NOPHO) population-based leukaemia registry were analysed. Of 3494 children with acute leukaemia diagnosed between July 1984 and December 2001, 136 patients (3.9%) with DS were identified. 2.1% of the children with acute lymphoid leukaemia (ALL) and 14.0% of the children with acute myeloid leukaemia (AML) had DS. In ALL, DS patients had similar age and sex distribution and no major differences in blood counts compared with non-DS children. None of the DS patients had T cell leukaemia. Outcome was inferior to that of non-DS children and treatment results did not improve over time. In AML, DS patients showed a significant female predominance and all but one were <5 years old. DS patients with AML had significantly lower platelet and white blood cell counts and two-thirds were type M7 as according to the French-American-British classification. None of the patients <5 years of age had typical AML cytogenetic aberrations. Outcome was far better in the DS group. DS patients treated for AML after 1992 had an excellent outcome (probability of event-free survival, 83 +/- 6%). The high proportion of female DS patients with AML is unexplained. The differing treatment results in AML versus ALL need further evaluation and represent a challenge for the coming years.
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