| 1. |
- Bjöhle, Judith, et al.
(författare)
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Post-mastectomy radiation therapy with or without implant-based reconstruction is safe in terms of clinical target volume coverage and survival : A matched cohort study
- 2019
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Ingår i: Radiotherapy and Oncology. - : Elsevier BV. - 0167-8140 .- 1879-0887. ; 131, s. 229-236
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE: Patients with breast cancer receiving mastectomy in our institution are offered immediate breast reconstruction (IBR). IBR may have an impact on the optimisation of radiation therapy (RT). Therefore, we aimed to evaluate the clinical target volume (CTV) dose coverage when disregarding the dose received by the breast implant in women treated for breast cancer. Furthermore, to investigate the safety of immediate breast reconstruction (IBR) with an implant (IBR+) in terms of recurrence and survival compared to patients without an implant (IBR-).PATIENTS AND METHODS: This matched-cohort included 128 patients with IBR+ and 252 IBR- patients (controls). The potential confounding effects of tumour stage and treatment were controlled for. For IBR+ patients, the implant volume was excluded from the CTV in the RT planning images, and the RT target coverage (V95%: CTV covered by ≥the 95% isodose) was compared between the IBR+ and IBR- groups.RESULTS: A limited under dosage was observed in patients without lymph-node irradiation; the V95% mean values for the CTV subtracting the implant were 84% and 92%, for IBR+ and IBR- groups, respectively. Median follow-up duration was 5.8 years (0.1-7.5 years). In comparing IBR+ and IBR- groups, no statistically significant differences were found in the incidence of recurrence rate ratios or recurrence free survival (log-rank p = 0.142), overall survival (log-rank p = 0.096), or breast cancer specific survival (log-rank p = 0.147).CONCLUSIONS: Post-mastectomy radiation therapy and implant-based reconstruction lead to minor under dosage of the target, due to the projection of the subcutaneous tissue in the presence of the implant. However, recurrence and survival rates were equally distributed among IBR+ and IBR- patients indicating that the overall treatment protocol used in our institution is safe.
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| 2. |
- Michielsen, Astrid, et al.
(författare)
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Predicting and communicating flood risk of transport infrastructure based on watershed characteristics
- 2016
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Ingår i: Journal of Environmental Management. - : Elsevier. - 0301-4797 .- 1095-8630. ; 182, s. 505-518
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Tidskriftsartikel (refereegranskat)abstract
- This research aims to identify and communicate water-related vulnerabilities in transport infrastructure, specifically flood risk of road/rail-stream intersections, based on watershed characteristics. This was done using flooding in Varmland and Vastra Gotaland, Sweden in August 2014 as case studies on which risk models are built. Three different statistical modelling approaches were considered: a partial least square regression, a binomial logistic regression, and artificial neural networks. Using the results of the different modelling approaches together in an ensemble makes it possible to cross-validate their results. To help visualize this and provide a tool for communication with stakeholders (e.g., the Swedish Transport Administration - Trafikverket), a flood 'thermometer' indicating the level of flooding risk at a given point was developed. This tool improved stakeholder interaction and helped highlight the need for better data collection in order to increase the accuracy and generalizability of modelling approaches.
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| 3. |
- Näslund, Olivia, et al.
(författare)
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Amino acid tracers in PET imaging of diffuse low-grade gliomas : a systematic review of preoperative applications
- 2018
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Ingår i: Acta Neurochirurgica. - : Springer Nature. - 0001-6268 .- 0942-0940. ; 160:7, s. 1451-1460
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Tidskriftsartikel (refereegranskat)abstract
- Positron emission tomography (PET) imaging using amino acid tracers has in recent years become widely used in the diagnosis and prediction of disease course in diffuse low-grade gliomas (LGG). However, implications of preoperative PET for treatment and prognosis in this patient group have not been systematically studied. The aim of this systematic review was to evaluate the preoperative diagnostic and prognostic value of amino acid PET in suspected diffuse LGG. Medline, Cochrane Library, and Embase databases were systematically searched using keywords "PET," "low-grade glioma," and "amino acids tracers" with their respective synonyms. Out of 2137 eligible studies, 28 met the inclusion criteria. Increased amino acid uptake (lesion/brain) was consistently reported among included studies; in 25-92% of subsequently histopathology-verified LGG, in 83-100% of histopathology-verified HGG, and also in some non-neoplastic lesions. No consistent results were found in studies reporting hot spot areas on PET in MRI-suspected LGG. Thus, the diagnostic value of amino acid PET imaging in suspected LGG has proven difficult to interpret, showing clear overlap and inconsistencies among reported results. Similarly, the results regarding the prognostic value of PET in suspected LGG and the correlation between uptake ratios and the molecular tumor status of LGG were conflicting. This systematic review illustrates the difficulties with prognostic studies presenting data on group-level without adjustment for established clinical prognostic factors, leading to a loss of additional prognostic information. We conclude that the prognostic value of PET is limited to analysis of histological subgroups of LGG and is probably strongest when using kinetic analysis of dynamic FET uptake parameters.
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| 4. |
- Rydstedt Nyman, Monika, 1961-
(författare)
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Managing knowledge sharing of extreme weather induced impacts on land transport infrastructure : Case study of the Swedish Transport Administration
- 2016
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Extreme weather events and effects of climate change are threats to the transport sector’s functionality and safety. Risk management in this context implies a necessity to focus on the connection between near-term experiences and coping strategies on one hand, and long-term adaptation analyses on the other. How learning from past events and subsequent knowledge sharing can be adopted is a question that needs to be explored, discussed and tested. A systematic approach to lessons learned calls for measures of investigation, reporting, planning, implementation and evaluation. A qualitative case study approach was used in this thesis. In the first paper the practices of accident investigation in operation and maintenance were inventoried within the Swedish Transport Administration (STA). Three accident investigation methods were applied and tested on a cloudburst event, causing flooding in a railway tunnel in Sweden. In the second paper, semi-structured interviews, documents, and archival records were used as means for penetrating deeper into the attitudes and understanding of lessons learned concerning extreme weather events within a procured public-private partnership. The results of the two studies showed weak signals of feedback on lessons learned. Partly, these weak signals could be traced back to weak steering signals. Various obstacles impeded learning curves from lessons learned. The obstacles were of both hard and soft values, e.g. resources in time and equipment, systematic investigation methods, incentives for lessons learned, education and knowledge, values, norms and attitudes towards how and why identified problems should be solved. Successful knowledge sharing requires that close attention is paid to such obstacles and that an adaptive approach is adopted.
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| 5. |
- Rydstedt Nyman, Monika, 1961-
(författare)
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Organizational Lessons Learned : Natural Hazards Affecting Critical Infrastructure
- 2018
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Konstnärligt arbete (övrigt vetenskapligt/konstnärligt)abstract
- This thesis focuses on an issue often presented as a solution – albeit a debated one – namely learning, specifically lessons learned from natural hazard events. Empirically, this thesis examines flooding and avalanches in a Swedish context, centering on systematic feedback mechanisms and learning from extreme events. Opportunities to and constraints affecting learning and knowledge sharing are discussed.The thesis comprises four papers, collectively contributing a description of aspects of learning and feedback in a case study setting of the Swedish Transport Administration (STA) [Trafikverket], and providing an understanding of the present level of knowledge and awareness of climate change related natural hazards, as well as how knowledge sharing may give incentives and understanding for change. The notion of social learning is that individuals, groups, and organizations (and ultimately society) can learn from one another in a context, i.e. fostering mutual change. The goal of learning and using feedback is to create an opportunity to address changes in a thoughtful and explicit manner. At the same time, there is an implicit idea that learning occurs automatically somehow, which is problematized on the basis of the cases in the articles.An interdisciplinary approach was adopted to obtain understanding of lessons learned related to natural hazards affecting critical infrastructure in Sweden. Interdiciplinarity refers to the use of theories from different research fields to achieve synergies in the search for explanations and useful understanding. The different objectives and aims of each paper have increased understanding of mechanisms related to aspects of feedback, learning and knowledge sharing after natural hazard impacts. Each paper also provides examples of opportunities and constraints to feedback mechanisms and learning in a collective context.
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| 6. |
- Rydstedt Nyman, Monika, 1961-, et al.
(författare)
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Systematic Knowledge Sharing in a Natural Hazard Damage Context : How Organizational Borders Limit Lessons Learned
- 2017
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Ingår i: Risk, Hazards & Crisis in Public Policy. - : Wiley. - 1944-4079. ; 8:4, s. 356-380
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this paper is to increase knowledge about systematic lessons learning in a public-private partnership. Empirically, it focuses on road maintenance in Sweden where the Swedish Transport Administration (STA) is responsible for the state-owned infrastructure and tendered contractors carry out all maintenance. The tendering process stipulates that the stakeholders should enable learning and the knowledge transfer that is, by necessity, required for preventive purposes. Semi-structured interviews with project leaders from the STA and respondents from two tendering contractors of maintenance were used to investigate attitudes to and the understanding of sharing experiences and knowledge about damage caused by weather extremes and the relevance of climate change adaptation in their field. The analysis suggests that most of the respondents' experiences stay within their own organization, which creates parallel feedback loops, rather than becomes shared knowledge that could be used as lessons learned enhancing preventive work against future damage and loss. The analysis indicates imbalance in feedback of knowledge concerning weather extremes and their effects.
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| 7. |
- Thurin, Erik, et al.
(författare)
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Proton therapy for low-grade gliomas in adults : A systematic review
- 2018
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Ingår i: Clinical neurology and neurosurgery (Dutch-Flemish ed. Print). - : Elsevier BV. - 0303-8467 .- 1872-6968. ; 174, s. 233-238
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Tidskriftsartikel (refereegranskat)abstract
- For adult patients with diffuse low-grade glioma (LGG) proton therapy is an emerging radiotherapy modality. The number of proton facilities is rapidly increasing. However, there is a shortage of published data concerning the clinical effectiveness compared to photon radiotherapy and potential proton-specific toxicity. This study aimed to systematically review and summarize the relevant literature on proton therapy for adult LGG patients, including dosimetric comparisons, the type and frequency of acute and long-term toxicity and the clinical effectiveness. A systematic search was performed in several medical databases and 601 articles were screened for relevance. Nine articles were deemed eligible for in-depth analysis using a standardized data collection form by two independent researchers. Proton treatment plans compared favorably to photon-plans regarding dose to uninvolved neural tissue. Fatigue (27-100%), alopecia (37-85%), local erythema (78-85%) and headache (27-75%) were among the most common acute toxicities. One study reported no significant long-term cognitive impairments. Limited data was available on long-term survival. One study reported a 5-year overall survival of 84% and 5-year progression-free survival of 40%. We conclude that published data from clinical studies using proton therapy for adults with LGG are scarce. As the technique becomes more available, controlled clinical studies are urgently warranted to determine if the potential benefits based on comparative treatment planning translate into clinical benefits.
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