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| 4. |
- Bath, Jonathan, et al.
(författare)
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Contemporary outcomes after treatment of aberrant subclavian artery and Kommerell's diverticulum
- 2023
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Ingår i: Journal of Vascular Surgery. - : Elsevier BV. - 0741-5214 .- 1097-6809. ; 77:5, s. 1339-1348.e6
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Aberrant subclavian artery (ASA) and Kommerell's diverticulum (KD) are rare vascular anomalies that may be associated with lifestyle-limiting and life-threatening complications. The aim of this study is to report contemporary outcomes after invasive treatment of ASA/KD using a large international dataset.Methods: Patients who underwent treatment for ASA/KD (2000-2020) were identified through the Vascular Low Frequency Disease Consortium, a multi-institutional collaboration to investigate uncommon vascular disorders. We report the early and mid-term clinical outcomes including stroke and mortality, technical success, and other operative outcomes including reintervention rates, patency, and endoleak.Results: Overall, 285 patients were identified during the study period. The mean patient age was 57 years; 47% were female and 68% presented with symptoms. A right-sided arch was present in 23%. The mean KD diameter was 47.4 mm (range, 13.0-108.0 mm). The most common indication for treatment was symptoms (59%), followed by aneurysm size (38%). The most common symptom reported was dysphagia (44%). A ruptured KD was treated in 4.2% of cases, with a mean diameter of 43.9 mm (range, 18.0-100.0 mm). An open procedure was performed in 101 cases (36%); the most common approach was ASA ligation with subclavian transposition. An endovascular or hybrid approach was performed in 184 patients (64%); the most common approach was thoracic endograft and carotid-subclavian bypass. A staged operative strategy was employed more often than single setting repair (55% vs 45%). Compared with endovascular or hybrid approach, those in the open procedure group were more likely to be younger (49 years vs 61 years; P < .0001), female (64% vs 36%; P < .0001), and symptomatic (85% vs 59%; P < .0001). Complete or partial symptomatic relief at 1 year after intervention was 82.6%. There was no association between modality of treatment and symptom relief (open 87.2% vs endovascular or hybrid approach 78.9%; P = .13). After the intervention, 11 subclavian occlusions (4.5%) occurred; 3 were successfully thrombectomized resulting in a primary and secondary patency of 95% and 96%, respectively, at a median follow-up of 39 months. Among the 33 reinterventions (12%), the majority were performed for endoleak (36%), and more reinterventions occurred in the endovascular or hybrid approach than open procedure group (15% vs 6%; P = .02). The overall survival rate was 87.3% at a median follow-up of 41 months. The 30-day stroke and death rates were 4.2% and 4.9%, respectively. Urgent or emergent presentation was independently associated with increased risk of 30-day mortality (odds ratio [OR], 19.8; 95% confidence interval [CI], 3.3-116.6), overall mortality (OR, 3.6; 95% CI, 1.2-11.2) and intraoperative complications (OR, 8.3; 95% CI, 2.8-25.1). Females had a higher risk of reintervention (OR, 2.6; 95% CI, 1.0-6.5). At an aneurysm size of 44.4 mm, receiver operator characteristic curve analysis suggested that 60% of patients would have symptoms.Conclusions: Treatment of ASA/KD can be performed safely with low rates of mortality, stroke and reintervention and high rates of symptomatic relief, regardless of the repair strategy. Symptomatic and urgent operations were associated with worse outcomes in general, and female gender was associated with a higher likelihood of reintervention. Given the worse overall outcomes when symptomatic and the inherent risk of rupture, consideration of repair at 40 mm is reasonable in most patients. ASA/KD can be repaired in asymptomatic patients with excellent outcomes and young healthy patients may be considered better candidates for open approaches versus endovascular or hybrid modalities, given the lower likelihood of reintervention and lower early mortality rate.
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| 5. |
- Moffatt, Clare, et al.
(författare)
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International Multi-Institutional Experience with Presentation and Management of Aortic Arch Laterality in Aberrant Subclavian Artery and Kommerell's Diverticulum
- 2023
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Ingår i: Annals of Vascular Surgery. - : Elsevier. - 0890-5096 .- 1615-5947. ; 95, s. 23-31
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Aberrant subclavian artery (ASA) with or without Kommerell's diverticulum (KD) is a rare anatomic aortic arch anomaly that can cause dysphagia and/or life-threatening rupture. The objective of this study is to compare outcomes of ASA/KD repair in patients with a left versus right aortic arch.METHODS: Using the Vascular Low Frequency Disease Consortium methodology, a retrospective review was performed of patients ≥18 years old with surgical treatment of ASA/KD from 2000 to 2020 at 20 institutions.RESULTS: 288 patients with ASA with or without KD were identified; 222 left-sided aortic arch (LAA), and 66 right-sided aortic arch (RAA). Mean age at repair was younger in LAA 54 vs. 58 years (P = 0.06). Patients in RAA were more likely to undergo repair due to symptoms (72.7% vs. 55.9%, P = 0.01), and more likely to present with dysphagia (57.6% vs. 39.1%, P < 0.01). The hybrid open/endovascular approach was the most common repair type in both groups. Rates of intraoperative complications, death within 30 days, return to the operating room, symptom relief and endoleaks were not significantly different. For patients with symptom status follow-up data, in LAA, 61.7% had complete relief, 34.0% had partial relief and 4.3% had no change. In RAA, 60.7% had complete relief, 34.4% had partial relief and 4.9% had no change.CONCLUSIONS: In patients with ASA/KD, RAA patients were less common than LAA, presented more frequently with dysphagia, had symptoms as an indication for intervention, and underwent treatment at a younger age. Open, endovascular and hybrid repair approaches appear equally effective, regardless of arch laterality.
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| 7. |
- Amani, Navid, 1985, et al.
(författare)
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Array Configuration Effect on the Spatial Correlation of MU-MIMO Channels in NLoS Environments
- 2020
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Ingår i: 14th European Conference on Antennas and Propagation, EuCAP 2020. ; 2020:March
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Konferensbidrag (refereegranskat)abstract
- In this paper, three different base-station antenna (BSA) configurations are compared in terms of inter-user spatial correlation in a two dimensional (2D) non-line-of-sight (NLoS) environment. The three configurations are: (i) a regular uniform linear array (ULA); (ii) a periodic sparse array; and (iii) an aperiodic sparse array. Electromagnetic modeling of the NLoS channel is proposed where scatterers are considered as resonant dipoles confined in clusters of scatterers (CoSs). While the probability of facing highly correlated user-equipments (UEs) in a multi-user multiple-input multiple-output (MU-MIMO) system is decreasing as the richness of mutipath increases, the sparsity (increased inter-element spacing) is seen to be capable of reducing this probability as well. This is due to the larger spatial variations experienced by the sparse array. Moreover, the results show that further improvement can be achieved by deploying an aperiodic distribution of antenna elements into the sparse antenna aperture.
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| 8. |
- Cooper, Declan L.M., et al.
(författare)
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Consistent patterns of common species across tropical tree communities
- 2024
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Ingår i: Nature. - 0028-0836 .- 1476-4687. ; 625:7996, s. 728-734
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Tidskriftsartikel (refereegranskat)abstract
- Trees structure the Earth’s most biodiverse ecosystem, tropical forests. The vast number of tree species presents a formidable challenge to understanding these forests, including their response to environmental change, as very little is known about most tropical tree species. A focus on the common species may circumvent this challenge. Here we investigate abundance patterns of common tree species using inventory data on 1,003,805 trees with trunk diameters of at least 10 cm across 1,568 locations 1–6 in closed-canopy, structurally intact old-growth tropical forests in Africa, Amazonia and Southeast Asia. We estimate that 2.2%, 2.2% and 2.3% of species comprise 50% of the tropical trees in these regions, respectively. Extrapolating across all closed-canopy tropical forests, we estimate that just 1,053 species comprise half of Earth’s 800 billion tropical trees with trunk diameters of at least 10 cm. Despite differing biogeographic, climatic and anthropogenic histories 7, we find notably consistent patterns of common species and species abundance distributions across the continents. This suggests that fundamental mechanisms of tree community assembly may apply to all tropical forests. Resampling analyses show that the most common species are likely to belong to a manageable list of known species, enabling targeted efforts to understand their ecology. Although they do not detract from the importance of rare species, our results open new opportunities to understand the world’s most diverse forests, including modelling their response to environmental change, by focusing on the common species that constitute the majority of their trees.
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| 9. |
- Coscieme, Luca, et al.
(författare)
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Multiple conceptualizations of nature are key to inclusivity and legitimacy in global environmental governance
- 2020
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Ingår i: Environmental Science and Policy. - : Elsevier BV. - 1462-9011 .- 1873-6416. ; 104, s. 36-42
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Tidskriftsartikel (refereegranskat)abstract
- Despite increasing scientific understanding of the global environmental crisis, we struggle to adopt the policies science suggests would be effective. One of the reasons for that is the lack of inclusive engagement and dialogue among a wide range of different actors. Furthermore, there is a lack of consideration of differences between languages, worldviews and cultures. In this paper, we propose that engagement across the science-policy interface can be strengthened by being mindful of the breadth and depth of the diverse human-nature relations found around the globe. By examining diverse conceptualizations of nature in more than 60 languages, we identify three clusters: inclusive conceptualizations where humans are viewed as an integral component of nature; non-inclusive conceptualizations where humans are separate from nature; and deifying conceptualizations where nature is understood and experienced within a spiritual dimension. Considering and respecting this rich repertoire of ways of describing, thinking about and relating to nature can help us communicate in ways that resonate across cultures and worldviews. This repertoire also provides a resource we can draw on when defining policies and sustainability scenarios for the future, offering opportunities for finding solutions to global environmental challenges.
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| 10. |
- Farsaei, Amirashkan, et al.
(författare)
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Uniform Linear Arrays With Optimized Inter-Element Spacing for LOS Massive MIMO
- 2021
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Ingår i: IEEE Communications Letters. - 1558-2558 .- 1089-7798. ; 25:2, s. 613-616
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Tidskriftsartikel (refereegranskat)abstract
- In this letter, a uniform linear array (ULA) is proposed for line-of-sight massive multiple-input-multiple-output (MIMO). It is assumed that the number of antennas is fixed. For a given ULA with an arbitrary inter-element spacing, the probability that the correlation among the channel vectors of two users being above a threshold value is derived. The inter-element spacing of the proposed ULA is the one for which the aforementioned probability is minimized. To show the effectiveness of the proposed ULA, simulation results for two scenarios are given for a 64-antenna ULA that serves 6 single-antenna users. By using the proposed ULA instead of conventional half-wavelength ULA, 5th percentile sum-rate for zero-forcing precoder is improved by 9.90 bits/channel use in first scenario without dropping, and by 1.43 bits/channel use in second scenario with dropping 1 user.
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| 11. |
- Franic, Iva, et al.
(författare)
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Climate, host and geography shape insect and fungal communities of trees
- 2023
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Ingår i: Scientific Reports. - : Nature Publishing Group. - 2045-2322. ; 13:1
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Tidskriftsartikel (refereegranskat)abstract
- Non-native pests, climate change, and their interactions are likely to alter relationships between trees and tree-associated organisms with consequences for forest health. To understand and predict such changes, factors structuring tree-associated communities need to be determined. Here, we analysed the data consisting of records of insects and fungi collected from dormant twigs from 155 tree species at 51 botanical gardens or arboreta in 32 countries. Generalized dissimilarity models revealed similar relative importance of studied climatic, host-related and geographic factors on differences in tree-associated communities. Mean annual temperature, phylogenetic distance between hosts and geographic distance between locations were the major drivers of dissimilarities. The increasing importance of high temperatures on differences in studied communities indicate that climate change could affect tree-associated organisms directly and indirectly through host range shifts. Insect and fungal communities were more similar between closely related vs. distant hosts suggesting that host range shifts may facilitate the emergence of new pests. Moreover, dissimilarities among tree-associated communities increased with geographic distance indicating that human-mediated transport may serve as a pathway of the introductions of new pests. The results of this study highlight the need to limit the establishment of tree pests and increase the resilience of forest ecosystems to changes in climate.
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| 12. |
- Franic, Iva, et al.
(författare)
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Worldwide diversity of endophytic fungi and insects associated with dormant tree twigs
- 2022
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Ingår i: Scientific Data. - : Nature Publishing Group. - 2052-4463. ; 9:1
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Tidskriftsartikel (refereegranskat)abstract
- International trade in plants and climate change are two of the main factors causing damaging tree pests (i.e. fungi and insects) to spread into new areas. To mitigate these risks, a large-scale assessment of tree-associated fungi and insects is needed. We present records of endophytic fungi and insects in twigs of 17 angiosperm and gymnosperm genera, from 51 locations in 32 countries worldwide. Endophytic fungi were characterized by high-throughput sequencing of 352 samples from 145 tree species in 28 countries. Insects were reared from 227 samples of 109 tree species in 18 countries and sorted into taxonomic orders and feeding guilds. Herbivorous insects were grouped into morphospecies and were identified using molecular and morphological approaches. This dataset reveals the diversity of tree-associated taxa, as it contains 12,721 fungal Amplicon Sequence Variants and 208 herbivorous insect morphospecies, sampled across broad geographic and climatic gradients and for many tree species. This dataset will facilitate applied and fundamental studies on the distribution of fungal endophytes and insects in trees.
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| 13. |
- Lavefjord, Amani, et al.
(författare)
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Assessment methods in single case design studies of psychological treatments for chronic pain : A scoping review
- 2021
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Ingår i: Journal of Contextual Behavioral Science. - : Elsevier. - 2212-1447. ; 21, s. 121-135
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Forskningsöversikt (refereegranskat)abstract
- Single case designs (SCDs) represent an excellent approach for developing and testing treatments, and for generating general knowledge of treatment mechanisms and outcomes. Their ability to generate knowledge, however, will depend on their methods being reliable, valid, clearly described, and replicable. This scoping review aims to map assessment methods in SCD studies of psychological treatments for chronic pain. The particular aims were to review the specific measures used, their modes of administration, their adequacy as measures, and opportunities for improvement. PubMed, PsycINFO, CINAHL and OpenGrey were searched for SCD studies of psychological treatments for chronic pain in adults. Two reviewers independently assessed eligibility, with input from two additional reviewers, and then extracted relevant data from the 55 included studies. The most common outcome domains were “pain”, “physical functioning” and “psychological processes.” Non-behavioral measures were more common than behavioral or physiological measures. Measures were often standardized. Measures in each domain were highly varied, and administration information was lacking. Evi dence for adequacy of measures was based on psychometric analyses of aggregated group data for nonbehavioral measures and agreement for behavioral and physiological measures, but was frequently not re ported. Non-behavioral idiographic measures were often inadequate in that adapted measures were often used but validation was reported for original versions. Outcome domains did not correspond with currently available guidelines for measures employed in clinical trials in pain. A new set of guidelines, that is more suited to psy chological treatments and to SCDs, is needed. Researchers should consider following an idiographic framework by using individualized measures more often. When measures are individually applied, it is recommended that their adequacy is not based on nomothetic psychometric approaches. Rather, behavioral assessment principles should be employed. Overall, adequacy reporting, usage of SCD consistent terminology, and information on how measures are administered need improvement.
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| 14. |
- Lavefjord, Amani, et al.
(författare)
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The role of stigma in health and functioning in chronic pain : Not just catastrophizing
- 2024
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Ingår i: European Journal of Pain. - : John Wiley & Sons. - 1090-3801 .- 1532-2149. ; 28:4, s. 620-632
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundPeople with chronic pain are frequently exposed to stigma, which is typically distressing and may lead to internal stigmatizing thoughts. The thought content associated with stigma has similarities to pain catastrophizing, although these concepts differ in that stigma is arguably more social in origin. Stigma can be measured by the Stigma Scale for Chronic Illness – 8-item version (SSCI-8). In this study, we first demonstrate the validity of this measure in Swedish. We then examine the role of stigma in the health and functioning of people with chronic pain, particularly beyond the role played by pain catastrophizing.MethodsAdult participants (N = 404) with chronic pain recruited online completed measures of pain, stigma, catastrophizing, pain interference, work and social adjustment and depression on two occasions.ResultsA one-factor solution had an overall good model fit as long as residuals were allowed to covary, indicating some redundancy in the items. The SSCI-8 demonstrated good internal consistency and moderate temporal stability, and SSCI-8 scores demonstrated medium-to-large correlations with the measures of health and functioning. Furthermore, stigma was found to significantly contribute to explained variance in pain interference, work and social adjustment and depression, uniquely adding to the explained variance in these outcomes even after accounting for pain catastrophizing.ConclusionsThe SSCI-8 provides an adequate measure to capture stigma experiences. Stigma is uniquely associated with pain-related outcomes and should be further considered in pain research and clinical practice in the future.SignificanceThis study points to the importance of a social perspective on pain-related outcomes. We may need to more fully appreciate the way that people with chronic pain are treated by both health care providers and others can have an impact on their well-being. Potential negative impacts of stigmatizing responses to people with chronic pain are highlighted by the current results.
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| 15. |
- Salimzadeh, Hamideh, 1975, et al.
(författare)
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Colorectal Cancer Screening Pilot Project in Tehran- Iran, a Feasibility Study
- 2023
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Ingår i: Archives of Iranian Medicine. - 1029-2977. ; 26:3, s. 138-146
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Tidskriftsartikel (refereegranskat)abstract
- Background: Colorectal cancer (CRC) is the third most common cancer in Iran, where there is no organised CRC-screening programme. This study aimed to evaluate feasibility of CRC screening using a qualitative fecal immunochemical test (FIT) among Iranian average-risk adults.Methods: In this feasibility study, 7039 individuals aged 50-75 years were invited by community health workers (CHWs) in southern Tehran and its suburban districts between April 2018 and November 2019. The CHWs performed a qualitative FIT with cut-off level 50 ng Hb/mL buffer and referred those with positive-FIT for colonoscopy to the endoscopy center of Shariati hospital in Tehran. Outcomes included acceptance rate, FIT positivity rate, colonoscopy compliance, detection rates and positive predictive values (PPVs) with 95% confidence interval for CRC and advanced adenomas (AAs). Results: Acceptance rate at initial invitation was 71.7%. From 4974 average-risk adults (1600 males and 3374 females) who were offered FIT, 96.8% (n = 4813) provided valid samples, of whom 471 (9.8%) tested positive. Among FIT-positive participants, 150 (31.8%) underwent colonoscopy; CRC was detected in 2.0% (n = 3) and adenomas in 27.3% (n = 41). Detection rate of CRC and AAs per 1000-FIT-screened participants was 0.6 (0.1-1.8) [males: 0.7 (0.01-3.6), females: 0.6 (0.07-2.0)1 and 4.2 (2.5-6.4) [males: 5.9 (2.6-11.0), females: 3.4 (1.7-6.0)1, respectively. PPVs were 2.0% (0.4-5.7) for CRC and 13.3% (8.3-19.8) for AAs. There was no association between gender and the studied outcomes.Conclusion: Our results partially support the feasibility of scaling up organized CRC-screening through the existing healthcare system in Iran; it remains to be discussed carefully to ensure the capacity of healthcare system for adequate colonoscopy services.
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| 16. |
- Strinati, Emilio Calvanese, et al.
(författare)
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Distributed Intelligent Integrated Sensing and Communications: The 6G-DISAC Approach
- 2024
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Ingår i: 2024 Joint European Conference on Networks and Communications and 6G Summit, EuCNC/6G Summit 2024. ; , s. 392-397
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Konferensbidrag (refereegranskat)abstract
- This paper introduces the concept of Distributed Intelligent integrated Sensing and Communications (DISAC), which expands the capabilities of Integrated Sensing and Communications (ISAC) towards distributed architectures. Additionally, the DISAC framework integrates novel waveform design with new semantic and goal-oriented communication paradigms, enabling ISAC technologies to transition from traditional data fusion to the semantic composition of diverse sensed and shared information. This progress facilitates large-scale, energy-efficient support for high-precision spatial-temporal processing, optimizing ISAC resource utilization, and enabling effective multi-modal sensing performance. Addressing key challenges such as efficient data management and connect-compute resource utilization, 6G- DISAC stands to revolutionize applications in diverse sectors including transportation, healthcare, and industrial automation. Our study encapsulates the project's vision, methodologies, and potential impact, marking a significant stride towards a more connected and intelligent world.
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| 17. |
- Sundström, Felicia T. A., et al.
(författare)
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Associations between psychological flexibility and daily functioning in endometriosis-related pain
- 2024
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Ingår i: Scandinavian Journal of Pain. - : Walter de Gruyter. - 1877-8860 .- 1877-8879. ; 24:1
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Tidskriftsartikel (refereegranskat)abstract
- ObjectivesProcesses of psychological flexibility (PF) are positively associated with health and wellbeing in several chronic pain disorders. However, these processes have not been investigated in endometriosis, a chronic pain disorder affecting 5–10 % of women worldwide. This study is a preliminary investigation of the associations between PF or psychological inflexibility (PI) and daily functioning in people with a primary diagnosis of endometriosis.MethodsThis study is based on a secondary analysis of survey data from Swedish-speaking adult participants with chronic pain recruited online. The current study included only those reporting a diagnosis of endometriosis and significant long-term pain. All participants completed the Multidimensional Psychological Flexibility Inventory (MPFI), a measure of PF and PI, as well as other measures of PF, and measures of pain and daily functioning. Correlation and multiple regression analyses were performed to examine relations of PF and PI with measures of pain and daily functioning.ResultsIn general, PF facet scores from the MPFI did not correlate with pain interference but did correlate with depression, with the exception of acceptance. The overall facets of PI appeared to perform better as correlates and in regression. Established measures of PF performed in correlation and regression analyses generally as has been observed in other chronic pain populations, with significant positive associations.ConclusionsIn this preliminary analysis of PF and PI in participants with endometriosis-related pain, these processes appear relevant, especially in understanding depression, but results varied along with the measures used. Specifically, when employing the MPFI, the PI facets emerged as stronger correlates. The findings underscore the potential benefit of incorporating assessments of PF and PI as process variables in endometriosis-research, but also that careful consideration should be given when selecting instruments.
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| 18. |
- Tungu, Malale M., et al.
(författare)
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Health, wealth, and medical expenditures among the elderly in rural Tanzania : experiences from Nzega and Igunga districts
- 2023
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Ingår i: BMC Health Services Research. - : BioMed Central (BMC). - 1472-6963. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The per capita health expenditure (HE) and share of gross domestic product (GDP) spending on elderly healthcare are expected to increase. The gap between health needs and available resources for elderly healthcare is widening in many developing countries, like Tanzania, leaving the elderly in poor health. These conditions lead to catastrophic HEs for the elderly. This study aimed to analyse the association between measures of health, wealth, and medical expenditure in rural residents aged 60 years and above in Tanzania.METHODS: The data of this study were collected through a cross-sectional household survey to residents aged 60 years and above living in Nzega and Igunga districts using a standardised World Health Organization (WHO) Study on Global Ageing and Adult Health (SAGE) and European Quality of Life Five Dimension (EQ-5D) questionnaires. The quality of life (QoL) was estimated using EQ-5D weights. The wealth index was generated from principal component analysis (PCA). The linear regression analyses (outpatient/inpatient) were performed to analyse the association between measures of health, wealth, medical expenditure, and socio-demographic variables.RESULTS: This study found a negative and statistically significant association between QoL and HE, whereby HE increases with the decrease of QoL. We could not find any significant relationship between HE and social gradients. In addition, age influences HE such that as age increases, the HE for both outpatient and inpatient care also increases.CONCLUSION: The health system in these districts allocate resources mainly according to needs, and social position is not important. We thus conclude that the elderly of lower socio-economic status (SES) was subjected to similar health expenditure as those of higher socio-economic status. Health, not wealth, determines the use of medical expenditures.
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