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| 2. |
- Bosshard, G, et al.
(author)
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Forgoing treatment at the end of life in 6 European countries
- 2005
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In: Archives of Internal Medicine. - 0003-9926. ; 165:4, s. 401-407
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Journal article (peer-reviewed)abstract
- Background: Modern medicine provides unprecedented opportunities in diagnostics and treatment. However, in some situations at the end of a patient's life, many physicians refrain from using all possible measures to prolong life. We studied the incidence of different types of treatment withheld or withdrawn in 6 European countries and analyzed the main background characteristics. Methods: Between June 2001 and February 2002, samples were obtained from deaths reported to registries in Belgium, Denmark, Italy, the Netherlands, Sweden, and Switzerland. The reporting physician was then sent a questionnaire about the medical decision-making process that preceded the patient's death. Results: The incidence of nontreatment decisions, whether or not combined with other end-of-life decisions, varied widely from 6% of all deaths studied in Italy to 41% in Switzerland. Most frequently forgone in every country were hydration or nutrition and medication, together representing between 62% (Belgium) and 71% (Italy) of all treatments withheld or withdrawn. Forgoing treatment estimated to prolong life for more than I month was more common in the Netherlands (10%), Belgium (9%), and Switzerland (8%) than in Denmark (5%), Italy (3%), and Sweden (2%). Relevant determinants of treatment being withheld rather than withdrawn were older age (odds ratio [OR], 1.53; 95% confidence interval [CI], 1.31-1.79), death outside the hospital (death in hospital: OR, 0.80; 95% CI, 0.68-0.93), and greater lifeshortening effect (OR, 1.75; 95% Cl, 1.27-2.39). Conclusions: In all of the participating countries, life prolonging treatment is withheld or withdrawn at the end of life. Frequencies vary greatly among countries. Low technology interventions, such as medication or hydration or nutrition, are most frequently forgone. in older patients and outside the hospital, physicians prefer not to initiate life-prolonging treatment at all rather than stop it later.
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| 3. |
- Van Alstine, JM, et al.
(author)
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Polymer coatings for improved protein crystal growth
- 1999
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In: Colloids and Surfaces B. - 0927-7765 .- 1873-4367. ; 14, s. 197-211
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Journal article (peer-reviewed)abstract
- The ability to grow quality protein crystals is necessary to analyze protein structure by X-ray diffraction and related techniques. As such it plays a key role in enzymology, structure-based drug design, molecular biology, and other biomedical areas. It is also required for macromolecule purification by crystallization. Protein crystal growth (PCG) may be negatively influenced by various factors related to nonspecific adsorption and adherence at growth chamber surfaces. Such factors include nucleation and growth of flawed crystals at chamber walls, or wall growth blockage of optical monitoring paths. Surface localized poly(ethylene glycol) (PEG) and other neutral, hydrophilic polymers are known to significantly reduce nonspecific adsorption of biological macromolecules and particles. Preliminary studies, involving various PCG methods (temperature induction, vapor diffusion), apparatii (test tubes, cuvettes, and specialized PCG hardware), growth chamber materials (glass, polystyrene, polysulfone), chamber volumes (0.1-10 mi) and protein samples (lysozyme, thaumatin, insulin) indicate the potential of PEG coatings to significantly reduce problems related to adsorption in PCG. The results, which match the ability of such coatings to reduce protein adsorption as evaluated by both ellipsometry and enzyme linked immunoassay, are discussed in relation to colloidal stabilization theory and properties of PEG coated surfaces.
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| 4. |
- Christiansen, Mats, 1972-
(author)
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Patient experiences and the influence on health literacy and self-care using mHealth to manage symptoms during radiotherapy for prostate cancer
- 2019
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Licentiate thesis (other academic/artistic)abstract
- Introduction: Prostate cancer is a diagnosis that can affect the men’s quality of life both due to the symptoms related to the disease and the treatment the men receive. Treatment with radiotherapy for prostate cancer in Sweden takes place at outpatient clinics, where the patient visits daily for radiotherapy and then returns home. Most of the time the patient is experiencing the symptoms and side-effects at home without health-care professionals easily accessible. To facilitate person-centered care and improve clinical management when hospital care is moving to outpatient care, the app (Interaktor) for smartphones and tablets was developed. Using patient-reported outcomes (PRO), the app was intended to identify symptoms early, assess them in real time, and provide symptom-management support during radiotherapy for prostate cancer. Aims: The overall objective of the intervention described in this thesis, was to facilitate symptom management for patients with prostate cancer assisted with an interactive app during radiotherapy treatment.Methods: The two studies included in this thesis come from one trial. A descriptive investigation evaluated the intervention group’s use and perception of the using the app, and a quasi-experimental investigation compared those using the app with a historical control group not using the app to evaluate the effect on health literacy and self-care agency. The patients (n=130) were recruited consecutively from two university hospitals in Sweden between April 2012 and October 2013. The intervention group (n=66) had access to the app during 5-7 weeks of radiotherapy and three additional weeks. The intervention group’s use of the app was logged. Health literacy was measured using the Swedish Functional Health Literacy Scale (FHL) and the Swedish Communicative and Critical Health Literacy Scale (CCHL), and the Appraisal of Self-care Agency scale, version A (patient’s assessment) (ASA-A) for self-care agency. Transcribed notes from phone or face-to-face interviews about participants’ experiences of using and reporting in the app were analyzed.Results: In the intervention group using the app, adherence to daily reports was 87% (Md 92%, 16-100%), and generated 3,536 reports. All listed symptoms were used, where the most common being: urinary urgency, fatigue, hot flushes, and difficulties in urinating. A total of 1,566 alerts were generated, with 1/3 being severe (red alert). The app was reported in the interviews as easy to use, the reporting became routine; to report facilitated reflection over symptoms, the symptoms were relevant although some found that nuancing severity was hard. Using the app was reported as providing a sense of security. Substantial portions of the participants showed inadequate FHL and CCHL at baseline for both groups. CCHL changed significantly for the intervention group from baseline to three months after ended treatment (p = 0.050). Functional health literacy and self-care agency did not reveal any statistically significant differences over time for either group. Conclusions: The conclusions to draw from this thesis are that an mHealth intervention, the app Interaktor, served as a supportive tool for the patients to assess and manage symptoms during the radiotherapy for prostate cancer. The intervention provided the patients with a sense of safety, increased awareness of own well-being and a significant improvement in communicative and critical health literacy was found. The portions of inadequate levels of health literacy reported leave substantial groups of patients more vulnerable in assessing and managing symptoms when treated with radiotherapy for prostate cancer. Although health literacy levels include notable portions of patients in this study that have inadequate levels of both functional and communicative and critical health literacy, the adherence of using the app was high.
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| 5. |
- Lenaers, Peter, et al.
(author)
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Negative streamwise velocities and other rare events near the wall in turbulent flows
- 2011
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In: 13th European Turbulence Conference (ETC13). - : Institute of Physics Publishing (IOPP). ; , s. 022013-
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Conference paper (peer-reviewed)abstract
- Negative streamwise velocities, extreme wall-normal velocites and high flatness values for the wall-normal fluctuations near the wall are investigated for turbulent channel flow simulations at a series of Reynolds numbers up to Reτ = 1000 in this paper. Probability density functions of the wall-shear stress and velocity components are presented, as well as joint probability density functions of the velocity components and the pressure. Backflow occurs more often (0.06% at Reτ = 1000) and further away from the wall into the buffer layer for rising Reynolds number. An oblique vortex outside the viscous sublayer is found to cause this backflow. Extreme v events occur also more often for rising Rey nolds number. Positive and negative velocity spikes appear in pairs, located on the two edges of a strong streamwise vortex: the negative spike occurring in a high speed streak indicating a sweeping motion, while the positive spike is located between a high and low speed streak. These extreme v events cause high flatness values near the wall (F(v) = 43 at Reτ = 1000).
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| 6. |
- Lenaers, Peter, et al.
(author)
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Rare backflow and extreme wall-normal velocity fluctuations in near-wall turbulence
- 2012
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In: Physics of fluids. - : AIP Publishing. - 1070-6631 .- 1089-7666. ; 24:3, s. 035110-
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Journal article (peer-reviewed)abstract
- Rare negative streamwise velocities and extreme wall-normal velocity fluctuations near the wall are investigated for turbulent channel flow at a series of Reynolds numbers based on friction velocity up to Re-tau = 1000. Probability density functions of the wall-shear stress and velocity components are presented as well as joint probability density functions of the velocity components and the pressure. Backflow occurs more often (0.06% at the wall at Re-tau = 1000) and further away (up to y(+) = 8.5) from the wall for increasing Reynolds number. The regions of backflow are circular with an average diameter, based on ensemble averages, of approximately 20 viscous units independent of Reynolds number. A strong oblique vortex outside the viscous sublayer is found to cause this backflow. Extreme wall-normal velocity events occur also more often for increasing Reynolds number. These extreme fluctuations cause high flatness values near the wall (F(v) = 43 at Re-tau = 1000). Positive and negative velocity spikes appear in pairs, located on the two edges of a strong streamwise vortex as documented by Xu et al. [Phys. Fluids 8, 1938 (1996)] for Re-tau = 180. The spikes are elliptical and orientated in streamwise direction with a typical length of 25 and a typical width of 7.5 viscous units at y(+) approximate to 1. The negative spike occurs in a high-speed streak indicating a sweeping motion, while the positive spike is located in between a high and low-speed streak. The joint probability density functions of negative streamwise and extreme wall-normal velocity events show that these events are largely uncorrelated. The majority of both type of events can be found lying underneath a large-scale structure in the outer region with positive sign, which can be understood by considering the more intense velocity fluctuations due to amplitude modulation of the inner layer by the outer layer. Simulations performed at different resolutions give only minor differences. Results from experiments and recent turbulent boundary layer simulations show similar results indicating that these rare events are universal for wall-bounded flows. In order to detect these rare events in experiments, measurement techniques have to be specifically tuned.
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| 8. |
- Ormann, Linda, et al.
(author)
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Numerical analysis of curved embankment of an upstream tailings dam
- 2011
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In: Electronic Journal of Geotechnical Engineering. - : Mete Öner. - 1089-3032. ; 16:I, s. 931-944
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Journal article (peer-reviewed)abstract
- A curved embankment (corner) of an upstream tailings dam was analyzed with the finite element method to identify possible zones of low compressive stresses susceptible to hydraulic fracturing that might initiate internal erosion. The embankment was also analyzed as a straight section, with the same cross section as in the corner, in order to compare compressive stresses in the corner and the straight section. The analysis showed that in comparison to the straight section of the dam, the compressive stresses in the corner were (i) much lower above the phreatic level, in the rockfill banks and the filter zones, and (ii) fairly lower below the phreatic level. The rockfill and the filter contain coarse materials, which are not sensitive to hydraulic fracturing and internal erosion. An increase in radius of the corner is proposed to avoid too low compressive stresses that may develop due to future raisings. The slope stability analysis showed that the corner is currently stable, but an additional rock fill bank on the downstream toe is required for future raisings.
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| 9. |
- Ormann, Linda, et al.
(author)
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Numerical analysis of strengthening by rockfill embankments on an upstream tailings dam
- 2013
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In: Canadian geotechnical journal (Print). - : Canadian Science Publishing. - 0008-3674 .- 1208-6010. ; 50:4, s. 391-399
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Journal article (peer-reviewed)abstract
- The consolidation process could be slow in an upstream tailings dam; therefore, the stability can reduce due to an increase in excess pore pressures when the dam is raised. The safety of the dam can be enhanced by constructing rockfill berms on the downstream side. This paper presents a case study on the strengthening of an upstream tailings dam with rockfill berms. The finite element analyses were performed for modelling the staged construction of the dam and for optimizing the volume of the rockfill berms. The dam was raised in 11 stages; each stage consisting of a raising phase and a consolidation phase. The study shows that the slope stability of the dam reduced due to an increase of excess pore pressures during the raising phase. The stability of the dam was successfully improved by utilizing rockfill berms as supports on the downstream side. A technique has been presented to minimize the volume of the rockfill berms so that the required stability can be achieved at minimum cost. This paper shows that the finite element method can be a useful tool for modelling the consolidation behaviour of an upstream tailings dam and minimizing the volume of the rockfill berms that may be needed to maintain the stability of the dam during staged construction.
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