| 1. |
- Breugem, Corstiaan, et al.
(författare)
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Prioritizing Cleft/Craniofacial Surgical Care after the COVID-19 Pandemic
- 2020
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Ingår i: PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN. - 2169-7574. ; 8:9
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Tidskriftsartikel (refereegranskat)abstract
- Background: It is anticipated that in due course the burden of emergency care due to COVID-19 infected patients will reduce sufficiently to permit elective surgical procedures to recommence. Prioritizing cleft/craniofacial surgery in the already overloaded medical system will then become an issue. The European Cleft Palate Craniofacial Association, together with the European Cleft and Craniofacial Initiative for Equality in Care, performed a brief survey to capture a current snapshot during a rapidly evolving pandemic. Methods: A questionnaire was sent to the 2242 participants who attended 1 of 3 recent international cleft/craniofacial meetings. Results: The respondents indicated that children with Robin sequence who were not responding to nonsurgical options should be treated as emergency cases. Over 70% of the respondents indicated that palate repair should be performed before the age of 15 months, an additional 22% stating the same be performed by 18 months. Placement of middle ear tubes, primary cleft lip surgery, alveolar bone grafting, and velopharyngeal insufficiency surgery also need prioritization. Children with craniofacial conditions such as craniosynostosis and increased intracranial pressure need immediate care, whilst children with craniosynostosis and associated obstructive sleep apnea syndrome or proptosis need surgical care within 3 months of the typical timing. Craniosynostosis without signs of increased intracranial pressure needs correction before the age of 18 months. Conclusions: This survey indicates several areas of cleft and craniofacial conditions that need prioritization, but also certain areas where intervention is less urgent. We acknowledge that there will be differences in the post COVID-19 response according to circumstances and policies in individual countries.
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| 2. |
- Breugem, Corstiaan, et al.
(författare)
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Prioritizing Cleft/Craniofacial Surgical Care after the COVID-19 Pandemic
- 2020
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Ingår i: PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN. - 2169-7574. ; 8:9
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Tidskriftsartikel (refereegranskat)abstract
- Background: It is anticipated that in due course the burden of emergency care due to COVID-19 infected patients will reduce sufficiently to permit elective surgical procedures to recommence. Prioritizing cleft/craniofacial surgery in the already overloaded medical system will then become an issue. The European Cleft Palate Craniofacial Association, together with the European Cleft and Craniofacial Initiative for Equality in Care, performed a brief survey to capture a current snapshot during a rapidly evolving pandemic. Methods: A questionnaire was sent to the 2242 participants who attended 1 of 3 recent international cleft/craniofacial meetings. Results: The respondents indicated that children with Robin sequence who were not responding to nonsurgical options should be treated as emergency cases. Over 70% of the respondents indicated that palate repair should be performed before the age of 15 months, an additional 22% stating the same be performed by 18 months. Placement of middle ear tubes, primary cleft lipsurgery, alveolar bone grafting, and velopharyngeal insufficiency surgery also need prioritization. Children with craniofacial conditions such as craniosynostosis and increased intracranial pressure need immediate care, whilst children with craniosynostosis and associated obstructive sleep apnea syndrome or proptosis need surgical care within 3 months of the typical timing. Craniosynostosis without signs of increased intracranial pressure needs correction before the age of 18 months. Conclusions: This survey indicates several areas of cleft and craniofacial conditions that need prioritization, but also certain areas where intervention is less urgent. We acknowledge that there will be differences in the post COVID-19 response according to circumstances and policies in individual countries.
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| 3. |
- Cabrera, Carin C., et al.
(författare)
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Increased iron absorption in patients with chronic heart failure and iron deficiency
- 2020
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Ingår i: Journal of Cardiac Failure. - : Elsevier BV. - 1071-9164 .- 1532-8414. ; 26:5, s. 440-443
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Tidskriftsartikel (refereegranskat)abstract
- Background: Iron deficiency (ID) is common in patients with chronic heart failure (CHF), but the underlying causes are not fully understood. We investigated whether ID is associated with decreased iron absorption in patients with CHF.Methods and Results: We performed an oral iron-absorption test in 30 patients and 12 controls. The patients had CHF with reduced (n = 15) or preserved (n = 15) ejection fraction and ID, defined as s- ferritin < 100 mu g/L, or s-ferritin 100-299 mu g/L and transferrin saturation < 20%. The controls had no HF or ID and were of similar age and gender. Blood samples were taken before and 2 hours after ingestion of 100 mg ferroglycin sulphate. The primary endpoint was the delta plasma iron at 2 hours. The delta plasma iron was higher in the group with HF than in the control group (median increase 83.8 [61.5;128.5] mu g/dL in HF vs 47.5 [ 30.7;61.5] mu g/dL in controls, P = 0.001), indicating increased iron absorption. There was no significant difference between the groups with preserved or reduced ejection fraction (P = 0.46).Conclusion: We found increased iron absorption in patients with CHF and ID compared to controls without ID and HF, indicating that reduced iron absorption is not a primary cause of the high prevalence of ID in patients with CHF.
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| 4. |
- Gyldenkerne, Christine, et al.
(författare)
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Coronary Artery Lesion Lipid Content and Plaque Burden in Diabetic and Nondiabetic Patients : PROSPECT II
- 2023
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Ingår i: Circulation. - : Lippincott Williams & Wilkins. - 0009-7322 .- 1524-4539. ; 147:6, s. 469-481
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Patients with diabetes have increased rates of major adverse cardiac events (MACEs). We hypothesized that this is explained by diabetes-associated differences in coronary plaque morphology and lipid content.METHODS: In PROSPECT II (Providing Regional Observations to Study Predictors of Events in the Coronary Tree), 898 patients with acute myocardial infarction with or without ST-segment elevation underwent 3-vessel quantitative coronary angiography and coregistered near-infrared spectroscopy and intravascular ultrasound imaging after successful percutaneous coronary intervention. Subsequent MACEs were adjudicated to either treated culprit lesions or untreated nonculprit lesions. This substudy stratified patients by diabetes status and assessed baseline culprit and nonculprit prevalence of high-risk plaque characteristics defined as maximum plaque burden ≥70% and maximum lipid core burden index ≥324.7. Separate covariate-adjusted multivariable models were performed to identify whether diabetes was associated with nonculprit lesion-related MACEs and high-risk plaque characteristics.RESULTS: Diabetes was present in 109 of 898 patients (12.1%). During a median 3.7-year follow-up, MACEs occurred more frequently in patients with versus without diabetes (20.1% versus 13.5% [odds ratio (OR), 1.94 (95% CI, 1.14-3.30)]), primarily attributable to increased risk of myocardial infarction related to culprit lesion restenosis (4.3% versus 1.1% [OR, 3.78 (95% CI, 1.12-12.77)]) and nonculprit lesion-related spontaneous myocardial infarction (9.3% versus 3.8% [OR, 2.74 (95% CI, 1.25-6.04)]). However, baseline prevalence of high-risk plaque characteristics was similar for patients with versus without diabetes concerning culprit (maximum plaque burden ≥70%: 90% versus 93%, P=0.34; maximum lipid core burden index ≥324.7: 66% versus 70%, P=0.49) and nonculprit lesions (maximum plaque burden ≥70%: 23% versus 22%, P=0.37; maximum lipid core burden index ≥324.7: 26% versus 24%, P=0.47). In multivariable models, diabetes was associated with MACEs in nonculprit lesions (adjusted OR, 2.47 [95% CI, 1.21-5.04]) but not with prevalence of high-risk plaque characteristics (adjusted OR, 1.21 [95% CI, 0.86-1.69]).CONCLUSIONS: Among patients with recent myocardial infarction, both treated and untreated lesions contributed to the diabetes-associated ≈2-fold increased MACE rate during the 3.7-year follow-up. Diabetes-related plaque characteristics that might underlie this increased risk were not identified by multimodality imaging.
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| 5. |
- Hage, Camilla, et al.
(författare)
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Metabolomic Profile in HFpEF vs HFrEF Patients
- 2020
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Ingår i: Journal of Cardiac Failure. - : Elsevier BV. - 1071-9164 .- 1532-8414. ; 26:12, s. 1050-1059
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Tidskriftsartikel (refereegranskat)abstract
- Background: Heart failure with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF) are associated with metabolic derangements, which may have different pathophysiological implications.Methods and Results: In new-onset HFpEF (EF of >= 50%, n = 46) and HFrEF (EF of <40%, n = 75) patients, 109 endogenous plasma metabolites including amino acids, phospholipids and acylcarnitines were assessed using targeted metabolomics. Differentially altered metabolites and associations with clinical characteristics were explored. Patients with HFpEF were older, more often female with hypertension, atrial fibrillation, and diabetes compared with patients with HFrEF. Patients with HFpEF displayed higher levels of hydroxyproline and symmetric dimethyl arginine, alanine, cystine, and kynurenine reflecting fibrosis, inflammation and oxidative stress. Serine, cGMP, cAMP, L-carnitine, lysophophatidylcholine (18:2), lactate, and arginine were lower compared with patients with HFrEF. In patients with HFpEF with diabetes, kynurenine was higher (P = .014) and arginine lower (P = .014) vs patients with no diabetes, but did not differ with diabetes status in HFrEF. Decreasing kynurenine was associated with higher eGFR only in HFpEF (P-interaction = .020).Conclusions: Patients with new-onset HFpEF compared with patients with new-onset HFrEF display a different metabolic profile associated with comorbidities, such as diabetes and kidney dysfunction. HFpEF is associated with indices of increased inflammation and oxidative stress, impaired lipid metabolism, increased collagen synthesis, and downregulated nitric oxide signaling. Together, these findings suggest a more predominant systemic microvascular endothelial dysfunction and inflammation linked to increased fibrosis in HFpEF compared with HFrEF.
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| 6. |
- Linde, Cecilia, et al.
(författare)
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Baseline characteristics of 547 new onset heart failure patients in the PREFERS heart failure study
- 2022
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Ingår i: ESC Heart Failure. - : John Wiley & Sons. - 2055-5822. ; 9:4, s. 2125-2138
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Tidskriftsartikel (refereegranskat)abstract
- Aim We present the baseline characteristics of the PREFERS Stockholm epidemiological study on the natural history and course of new onset heart failure (HF) aiming to improve phenotyping focusing on HF with preserved left ventricular ejection fraction (HFpEF) pathophysiology.Methods and results New onset HF patients diagnosed in hospital or at outpatient HF clinics were included at five Stockholm hospitals 2015-2018 and characterized by N-terminal pro brain natriuretic peptide (NT-proBNP), biomarkers, echocardiography, and cardiac magnetic resonance imaging (subset). HFpEF [left ventricular ejection fraction (LVEF) >= 50%) was compared with HF with mildly reduced LVEF (HFmrEF; LVEF 41-49%) and with HF with reduced LVEF (HFrEF; LVEF <= 40%). We included 547 patients whereof HFpEF (n = 137; 25%), HFmrEF (n = 61; 11%), and HFrEF (n = 349; 64%). HFpEF patients were older (76; 70-81 years; median; interquartile range) than HFrEF (67; 58-74; P < 0.001), more often women (49% vs. 30%; P < 0.001), and had significantly higher comorbidity burden. They more often had atrial fibrillation, hypertension, and renal dysfunction. NT-proBNP was lower in HFpEF (896; 462-1645 ng/L) than in HFrEF (1160; 563-2370; P = 0.005). In HFpEF, left ventricular (LV) diameters and volumes were smaller (P < 0.001) and septa! and posterior wall thickness and relative wall thickness higher (P < 0.001). E/e >= 14 was present in 26% of HFpEF vs. 32% of HFrEF (P = 0.017) and left atrial volume index > 34 mL/m(2) in 57% vs. 61% (P = 0.040). HFmrEF patients were intermediary between HFpEF and HFrEF for LV mass, LV volumes, and RV volumes but had the highest proportion of left ventricular hypertrophy and the lowest proportion of elevated E/e.Conclusions Phenotype data in new onset HF patients recruited in a broad clinical setting showed that 25% had HFpEF, were older, more often women, and had greater comorbidity burden. PREFERS is well suited to further explore biomarker and imaging components of HFpEF pathophysiology and may contribute to the emerging knowledge of HF epidemiology.
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| 7. |
- Matan, Dmitri, et al.
(författare)
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Extracellular vesicles in heart failure : A study in patients with heart failure with preserved ejection fraction or heart failure with reduced ejection fraction characteristics undergoing elective coronary artery bypass grafting
- 2022
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Ingår i: Frontiers in Cardiovascular Medicine. - : Frontiers Media S.A.. - 2297-055X. ; 9
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Tidskriftsartikel (refereegranskat)abstract
- AimsExtracellular vesicles (EVs) were investigated as potential biomarkers associated with heart failure (HF) pathophysiology in patients undergoing elective coronary artery bypass surgery characterized by HF phenotype. Materials and methodsPatients with preoperative proxy-diagnoses of HF types i.e., preserved (HFpEF; n = 19) or reduced ejection fraction (HFrEF; n = 20) were studied and compared to patients with normal left ventricular function (n = 42). EVs in plasma samples collected from the coronary sinus, an arterial line, and from the right atrium were analyzed by flow cytometry. We studied EVs of presumed cardiomyocyte origin [EVs exposing Connexin-43 + Caveolin-3 (Con43 + Cav3) and Connexin-43 + Troponin T (Con43 + TnT)], of endothelial origin [EVs exposing VE-Cadherin (VE-Cad)] and EVs exposing inflammatory markers [myeloperoxidase (MPO) or pentraxin3 (PTX3)]. ResultsMedian concentrations of EVs exposing Con43 + TnT and Con43 + Cav3 were approximately five to six times higher in coronary sinus compared to radial artery indicative of cardiac release. Patients with HFrEF had high trans-coronary gradients of both Con43 + TnT and Con43 + Cav3 EVs, whereas HFpEF had elevated gradients of Con43 + Cav3 EVs but lower gradients of Con43 + TnT. Coronary sinus concentrations of both Con43 + TnT and Con43 + Cav3 correlated significantly with echocardiographic and laboratory measures of HF. MPO-EV concentrations were around two times higher in the right atrium compared to the coronary sinus, and slightly higher in HFpEF than in HFrEF. EV concentrations of endothelial origin (VE-Cad) were similar in all three patient groups. ConclusionCon43 + TnT and Con43 + Cav3 EVs are released over the heart indicating cardiomyocyte origin. In HFrEF the EV release profile is indicative of myocardial injury and myocardial stress with elevated trans-coronary gradients of both Con43 + TnT and Con43 + Cav3 EVs, whereas in HFpEF the profile indicates myocardial stress with less myocardial injury.
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| 8. |
- Papamichail, A., et al.
(författare)
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Compositionally graded channel HEMTs towards improved linearity for low-noise RF amplifiers
- 2022
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Ingår i: 2022 Compound Semiconductor Week, CSW 2022.
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Konferensbidrag (refereegranskat)abstract
- Although AlGaN/GaN HEMTs with high power and current gain have been demonstrated in RF device applications, at high signal operation they show an inherent non-linear behavior which leads to gain compression and signal distortion. Polarization-doped AlGaN/GaN HEMTs, with a compositionally graded channel enables a linear response improvement through formation of a 3-D electron gas. In this work, we develop the growth process for graded channel HEMTs in a hot-wall MOCVD reactor. Control of the grading profile is established through growth parameter tuning. Afterwards, analysis by EDS allows for precise determination of Al composition across the channel. Conventional and graded channel HEMT structures were fabricated and characterized. Furthermore, the sheet resistance, carrier density and mobility in HEMT structures with different grading profiles are compared and discussed. The conventional (non-graded) structure revealed the highest electron mobility of ~2350 cm2/V.s, which is among the highest values reported.
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| 9. |
- Persson, P. O.Å., et al.
(författare)
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Tuning composition in graded AlGaN channel HEMTs toward improved linearity for low-noise radio-frequency amplifiers
- 2023
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Ingår i: Applied Physics Letters. - : AIP Publishing. - 0003-6951 .- 1077-3118. ; 122:15
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Tidskriftsartikel (refereegranskat)abstract
- Compositionally graded channel AlGaN/GaN high electron mobility transistors (HEMTs) offer a promising route to improve device linearity, which is necessary for low-noise radio-frequency amplifiers. In this work, we demonstrate different grading profiles of a 10-nm-thick AlxGa1-xN channel from x = 0 to x = 0.1 using hot-wall metal-organic chemical vapor deposition (MOCVD). The growth process is developed by optimizing the channel grading and the channel-to-barrier transition. For this purpose, the Al-profiles and the interface sharpness, as determined from scanning transmission electron microscopy combined with energy-dispersive x-ray spectroscopy, are correlated with specific MOCVD process parameters. The results are linked to the channel properties (electron density, electron mobility, and sheet resistance) obtained by contactless Hall and terahertz optical Hall effect measurements coupled with simulations from solving self-consistently Poisson and Schrödinger equations. The impact of incorporating a thin AlN interlayer between the graded channel and the barrier layer on the HEMT properties is investigated and discussed. The optimized graded channel HEMT structure is found to have similarly high electron density (∼9 × 10 12 cm-2) as the non-graded conventional structure, though the mobility drops from ∼ 2360 cm2/V s in the conventional to ∼ 960 cm2/V s in the graded structure. The transconductance gm of the linearly graded channel HEMTs is shown to be flatter with smaller g m ′ and g m ″ as compared to the conventional non-graded channel HEMT implying improved device linearity.
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| 10. |
- Andersson, Irene, et al.
(författare)
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Kunskapsområdet sexualitet och samlevnad i lärarutbildningen : En kartläggning av kursplaner och resonemang kring innehåll
- 2020
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Denna rapport har som syfte att kartlägga kunskapsområdet sexualitet och samlevnad i svensk lärarutbildning 2016 med särskilt fokus på hiv, STI och SRHR. Resultatet visar att det finns skillnader mellan olika lärosäten, såväl i antal förekomster av indikatorer för kunskapsområdet i olika kurser som på olika utbildningsprogram och stadier. Flera lärosäten har kursplaner som skriver fram ett omfattande innehåll som rör kunskapsområdet sexualitet och samlevnad, medan andra lärosäten presenterar kursplaner med ett betydligt mer begränsat innehåll.I resultatdiagram synliggörs tydligt två kluster av indikatorer med höga antal förekomster i kursplanerna. Det ena klustret av indikatorer är etik, genus, demokrati, normer, normkritik, det andra värdegrund, barnkonventionen, mänskliga rättigheter, diskriminering och kränkande behandling. Dessa indikatorer förekommer vanligtvis i utbildningsvetenskapliga kurser på alla nivåer samt i olika samhällsorienterande kurser och i akademiska ämneskurser som historia, religionsvetenskap och samhällsvetenskap. Indikatorer som hivprevention, STI, graviditet och preventivmedel saknas helt i de undersökta kursplanerna, i både grundlärarutbildning och ämneslärarutbildning. De förekommer inte heller i biologi, naturkunskap eller i de naturorienterande ämnena för grundlärare i årskurserna 4-6.Utifrån kartläggningens resultat 2016 föreslås följande:1. Kunskapsområdet sex och samlevnad behöver ringas in så att åtminstone en slags baskurs innehållande moment som rör stora delar av indikatorerna i denna kartläggning kan konstrueras. Denna bör vara obligatorisk för alla blivande lärare.2. I enlighet med januariöverenskommelsen om att sex- och samlevnadsundervisning ska bli obligatorisk på alla lärarutbildningsprogram bör UKÄ lägga till ett examensmål, som behandlar kunskapsområdet sexualitet och samlevnad i examensordningen för lärarutbildningar för alla olika stadier inom den svenska skolan. Examensmålen bör omfatta såväl kunskap om och förståelse av sexualitet och forskningsbaserad undervisning, som färdighet och förmåga att undervisa om kunskapsområdet. (Ett examensmål om kunskapsområdet lades till i september 2020.)3. För att tillgodose god kvalitet och gedigen kompetens hos såväl lärarutbildare som lärarstudenter behövs kontinuerliga och fördjupade utbildningsinsatser.4. Ett nationellt centrum för kunskapsområdet sexualitet och relationer föreslås. Detta centrum bör vara ämnesövergripande och tvärvetenskapligt samt också fokusera på didaktik. Ett sådant centrum skulle kunna utgöra ett kunskapsstöd för lärarutbildningarna, särskilt under den inledande fasen, när sexualitet och relationer ska bli obligatoriskt och etableras på alla lärarutbildningar. Ett sådant centrum skulle öka möjligheten att alla lärarutbildningarna bygger upp och har tillräckligt hög kompetens inom kunskapsområdet. Ett nationellt centrum skulle dessutom vara ett stöd för verksamma lärare och skulle även kunna erbjuda fortbildning.5. För att utveckla kunskapsområdet sexualitet och samlevnad behövs ny och aktuell forskning som också kopplas till internationell pågående forskning. Denna forskning kan vara både ämnesinriktad och skolinriktad och av både kvantitativ och kvalitativ art.6. Den osäkerhet som lärare enligt Skolinspektionens rapport har när det gäller att undervisa om normer och om hbtq-frågor visar att lärarutbildningarna måste ha tydliga inslag som ger kunskaper om hur olika normer kan påverka och begränsa eleverna och även deras lärande.Avslutningsvis visar resultatet av kartläggningen från 2016 en bild av att kunskapsområdet sexualitet och samlevnad förekommer i alla programutbildningar för blivande lärare. Dessutom visar kartläggningen hur kunskapsområdet uttrycks i kursplaners olika delar genom förekomsten av antalet indikatorer enligt konstruktiv länkning. Tillsammans med de sex förslagen på åtgärder ovan kan därmed kartläggningens syften anses vara uppnådda.
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