| 1. |
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| 2. |
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| 3. |
- Bahnan, Wael, et al.
(författare)
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Spike-Dependent Opsonization Indicates Both Dose-Dependent Inhibition of Phagocytosis and That Non-Neutralizing Antibodies Can Confer Protection to SARS-CoV-2
- 2022
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Ingår i: Frontiers in Immunology. - : Frontiers Media SA. - 1664-3224. ; 12
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Tidskriftsartikel (refereegranskat)abstract
- Spike-specific antibodies are central to effective COVID19 immunity. Research efforts have focused on antibodies that neutralize the ACE2-Spike interaction but not on non-neutralizing antibodies. Antibody-dependent phagocytosis is an immune mechanism enhanced by opsonization, where typically, more bound antibodies trigger a stronger phagocyte response. Here, we show that Spike-specific antibodies, dependent on concentration, can either enhance or reduce Spike-bead phagocytosis by monocytes independently of the antibody neutralization potential. Surprisingly, we find that both convalescent patient plasma and patient-derived monoclonal antibodies lead to maximum opsonization already at low levels of bound antibodies and is reduced as antibody binding to Spike protein increases. Moreover, we show that this Spike-dependent modulation of opsonization correlate with the outcome in an experimental SARS-CoV-2 infection model. These results suggest that the levels of anti-Spike antibodies could influence monocyte-mediated immune functions and propose that non-neutralizing antibodies could confer protection to SARS-CoV-2 infection by mediating phagocytosis.
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| 4. |
- Beal, Jacob, et al.
(författare)
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Robust estimation of bacterial cell count from optical density
- 2020
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Ingår i: Communications Biology. - : Springer Science and Business Media LLC. - 2399-3642. ; 3:1
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Tidskriftsartikel (refereegranskat)abstract
- Optical density (OD) is widely used to estimate the density of cells in liquid culture, but cannot be compared between instruments without a standardized calibration protocol and is challenging to relate to actual cell count. We address this with an interlaboratory study comparing three simple, low-cost, and highly accessible OD calibration protocols across 244 laboratories, applied to eight strains of constitutive GFP-expressing E. coli. Based on our results, we recommend calibrating OD to estimated cell count using serial dilution of silica microspheres, which produces highly precise calibration (95.5% of residuals <1.2-fold), is easily assessed for quality control, also assesses instrument effective linear range, and can be combined with fluorescence calibration to obtain units of Molecules of Equivalent Fluorescein (MEFL) per cell, allowing direct comparison and data fusion with flow cytometry measurements: in our study, fluorescence per cell measurements showed only a 1.07-fold mean difference between plate reader and flow cytometry data.
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| 5. |
- Beaumont, Robin N, et al.
(författare)
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Genome-wide association study of placental weight identifies distinct and shared genetic influences between placental and fetal growth.
- 2023
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Ingår i: Nature genetics. - 1546-1718 .- 1061-4036. ; 55:11, s. 1807-19
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Tidskriftsartikel (refereegranskat)abstract
- A well-functioning placenta is essential for fetal and maternal health throughout pregnancy. Using placental weight as a proxy for placental growth, we report genome-wide association analyses in the fetal (n=65,405), maternal (n=61,228) and paternal (n=52,392) genomes, yielding 40 independent association signals. Twenty-six signals are classified as fetal, four maternal and three fetal and maternal. A maternal parent-of-origin effect is seen near KCNQ1. Genetic correlation and colocalization analyses reveal overlap with birth weight genetics, but 12 loci are classified as predominantly or only affecting placental weight, with connections to placental development and morphology, and transport of antibodies and amino acids. Mendelian randomization analyses indicate that fetal genetically mediated higher placental weight is causally associated with preeclampsia risk and shorter gestational duration. Moreover, these analyses support the role of fetal insulin in regulating placental weight, providing a key link between fetal and placental growth.
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| 6. |
- Broström (red), Tor, et al.
(författare)
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Brandsäkerhet för byggnader med kulturvärden: En kunskapsöversikt
- 2021
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Bok (övrigt vetenskapligt/konstnärligt)abstract
- Abstract [sv] Arbetet med brandsäkerhet för byggnader med kulturvärden kräver anpassade lösningar som också kan tillgodose ett bevarande av byggnaderna och deras kulturvärden. Det finns, utspritt, mycket kunskap och erfarenhet inom det här området både i Sverige och internationellt. För att tillgodose ett behov av samlad kunskap inom detta område initierade Brandforsk en kunskapsöversikt tillsammans med Akademiska hus, Fortifikationsverket, Kammarkollegiet, Kyrkans försäkring, Riksantikvarieämbetet och Statens fastighetsverk. Den här kunskapsöversikten syftar till att sammanställa och presentera den kunskap som finns. Ett kompletterande syfte är att definiera områden där kunskap saknas. Kunskapsöversikten är indelad i sex områden: 2. Skydd mot brands uppkomst 3. Spridning av brand inom byggnad 4. Spridning av brand till byggnad 5. Brandens påverkan på byggnadens stomme 6. Utrymning 7. Räddningstjänstens insats Med utgångspunkt från workshops har en sammanställning av behovsbilden gjorts. Kunskapsöversikten och behovsbilden ligger till grund för en gap-analys vilken pekar på behov av fortsatt forskning och utveckling. Abstract [en] Working with fire safety in historic buildings requires adapted solutions that can also satisfy the preservation of the buildings and their cultural values. There is a lot of knowledge and experience in this area both in Sweden and internationally. In order to make this available to end users, Brandforsk initiated a literature review together with a group of national sponsors. This literature review aims to compile and present the documented knowledge in the field. A complementary purpose is to define knowledge gaps. The review is divided into six areas: 2. Fire prevention 3. Fire spread within buildings 4. Fire spread between structures 5. Structural fire resistance 6. Evacuation 7. Fire and rescue service activities Based on workshops the needs of end users have been compiled. A comparison of the outcome of the review and the end user needs defines a knowledge gap pointing to the need for continued research and development.
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| 7. |
- Deiaco, Hanna
(författare)
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Rethinking Civil-Military Collaboration : A Relational Practice Approach to Total Defense in Sweden
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis stems from the research problem that, despite extolling the validity of relational dependencies for understanding civil-military collaboration, the interdisciplinary scholarship is notably lacking in empirical depth regarding the underlying relational dynamics in actual activities. The aim of the monograph is therefore to explore the underlying relational dynamics of civil-military collaboration. Drawing on Pierre Bourdieu’s relational approach to practice – and more specifically his thinking tools of field, capital and habitus – the thesis provides an empirically rich analysis of how Sweden’s total defense is practiced. By interviewing and observing various practitioners, I analyze how the development and organization of total defense as a field and various sub-fields, the distribution of symbolic, cultural and economic capital, and officials’ (un)shared dispositions, or habitus, reveal various seldom studied underlying relational dynamics of civil-military collaboration. The results indicate that struggles between military and civil crisis management officials organized around the stake of how total defense should be practiced are grounded in two competing logics of practice: one military and one civil crisis management. The study concludes that these logics of practice constitute particular relational dynamics at play, and struggles that shape civil-military collaboration beyond previous research that lists certain established well-known prerequisites for civil-military collaboration. This conclusion can help researchers and practitioners avoid treating the prerequisites for collaboration as merely instrumentalist, while they inherently embody underlying relational dynamics.
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| 8. |
- Ejnefjäll, Thomas, 1974-
(författare)
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Routinizing Workarounds : The Case of a Mandated PDMS in Critical Care
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Workarounds are an emerging area within information systems (IS) research where contributions are increasing but there seem to be different views on what constitutes a workaround. While some aspects of workarounds have attracted considerable research attention and show a high degree of consensus, other aspects contain scarce or conflicting findings. This thesis aims to investigate what constitutes a workaround and how routine dynamics can contribute to our understanding of workarounds in mandatory contexts.I first performed a concept-centric literature review based on literature that has influenced or been published in the former Association for Information Systems (AIS) Senior Scholars’ basket of eight journals and official AIS conferences. I also developed a conceptualization of workarounds from described workaround behaviour in the previous research.With that backdrop, I studied workarounds during the implementation of a Patient Data Management System (PDMS) in two critical care units at a Swedish hospital. A PDMS is a health information system designed to automatically retrieve data from bedside equipment at critical care units and present these in a structured format to improve documentation, manipulation, and interpretation. Usage of the PDMS was truly mandatory where the staff were required to use the system to keep and perform their jobs. Using observations and interviews, I collected data which were analysed using reflexive thematic coding.My research contributes to IS literature in several ways. I develop a conceptualization and definition for workarounds inductively derived from empirical accounts of workaround behaviour that make it possible to distinguish workarounds from other similar phenomena. Then I show how routine dynamics helps us to better understand the internal dynamics of workarounds and the role of artefacts, power, and resistance, and provides us with tools to, for instance, remove redundant workarounds. I also provide thick empirical descriptions that make it possible for researchers to engage with, and question, my assumptions and the applied theoretical framework.
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| 9. |
- Fjellstrom, Sanna, et al.
(författare)
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Web-based training intervention to increase physical activity level and improve health for adults with intellectual disability
- 2022
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Ingår i: Journal of Intellectual Disability Research. - : John Wiley & Sons. - 0964-2633 .- 1365-2788. ; 66:12, s. 967-977
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Tidskriftsartikel (refereegranskat)abstract
- Background: Individuals with intellectual disability (ID) are less physically active, have a higher body mass index (BMI) and are at greater risk for cardiovascular diseases (CVDs) than people without ID. The purpose of the study was to explore the effectiveness of a web-based training programme, consisting of 150 min of activity per week, on the health of people with ID.Method: Participants with ID living in supported accommodation (n = 28, 48% female, age = 36.4 ± 9.56 years) participated in a web-based training programme, consisting of a combination of exercises (endurance, strength balance and flexibility) of moderate intensity, 50 min, three times per week for 12 weeks. The body composition and waist circumference (WC) were measured, and questionnaires were used to assess enjoyment, quality of life (QoL) and physical activity (PA) level. Descriptive statistics and pairwise comparison pre and post intervention were carried out.Results: A total of 22 out of 28 participants completed the 12-week training intervention with 83% mean attendance of training sessions. The intensity of the PA level increased and a decrease in fat mass of 1.9 ± 2.4 kg, P < 0.001 and WC of 3 ± 5 cm, P = 0.009 were observed. Enjoyment of training sessions was 3.9 out of 5, and no differences in QoL were found.Conclusion: A web-based training programme is an effective tool for improving health parameters of people with ID and offers a new way for caregivers to enhance the PA for the target group.
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| 10. |
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| 11. |
- Gunnarsdottir, Maria J., et al.
(författare)
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Implementing risk-based approaches to improve drinking water quality in small water supplies in the Nordic region – barriers and solutions
- 2023
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Ingår i: Journal of Water and Health. - 1477-8920. ; 21:12, s. 1747-1760
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Tidskriftsartikel (refereegranskat)abstract
- Small water supplies face similar problems worldwide, regardless of ownership or management type. Non-compliance with water quality regulations is more frequent in small supplies than in large ones, as are waterborne disease outbreaks. The new EU Drinking Water Directive requires risk-based approach (RBA) to secure water safety as is recommended in the WHO's Guidelines for drinking water quality through ‘water safety plans’. This is already in regulation in the Nordic countries, although less used in small supplies. In this research, we explore the challenges, barriers and possible solutions to implementing RBA and improving compliance in small supplies. This was achieved by conducting and analysing interviews with 53 stakeholders from all 8 Nordic countries to produce recommendations for action by the different implicated actors. Our findings suggest the centrality of governmental policy, including support for continuous training, provision of simple RBA guidelines and increasing cooperation in the water sector. The Nordic experience reflects global challenges with small water supplies and the trend towards systematic preventive management epitomized in the framework for drinking water safety advocated by the World Health Organization since 2004.
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| 12. |
- Gunnarsdottir, Maria J., et al.
(författare)
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Status of risk-based approach and national framework for safe drinking water in small water supplies of the Nordic water sector
- 2020
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Ingår i: International Journal of Hygiene and Environmental Health. - : Elsevier BV. - 1438-4639. ; 230
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Tidskriftsartikel (refereegranskat)abstract
- Reliable safe water supply is a pillar of society and a key to public health. The Nordic countries have an abundance of clean fresh water as a source for drinking water supplies. They have followed developments in safeguarding water, both the recommendations of the World Health Organization framework for safe drinking water and European legislation. Worldwide, including the Nordic countries, small water supplies are less compliant with water safety regulation. The forthcoming EU directive on drinking water require risk-based approaches and improved transparency on water quality. This research looks at the Nordic frameworks for safe water supply, with emphasis on risk-based approaches and smaller systems. We analyzed the legal frameworks for safe water, the structure of the water sector across the Nordic countries and explored how prepared these countries are to meet these requirements. Our findings show that, while legal requirements are mostly in place, delivery of information to the public needs to be improved. Most Nordic countries are in the process of implementing risk-based management in large and medium size water supplies, whereas small supplies are lagging. We conclude that a key to success is increased training and support for small supplies. We suggest wider adoption of the Nordic model of cooperation with benchmarking of safe water for all to transfer knowledge between the countries. This work provides insights into challenges and opportunities for the Nordic countries and provides insights relevant to countries worldwide in their effort towards realization of SDG Target 6.1.
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| 13. |
- Haldrup, Jakob, et al.
(författare)
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FRMD6 has tumor suppressor functions in prostate cancer
- 2020
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Ingår i: Oncogene. - : Springer Science and Business Media LLC. - 1476-5594 .- 0950-9232.
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Tidskriftsartikel (refereegranskat)abstract
- Available tools for prostate cancer (PC) prognosis are suboptimal but may be improved by better knowledge about genes driving tumor aggressiveness. Here, we identified FRMD6 (FERM domain-containing protein 6) as an aberrantly hypermethylated and significantly downregulated gene in PC. Low FRMD6 expression was associated with postoperative biochemical recurrence in two large PC patient cohorts. In overexpression and CRISPR/Cas9 knockout experiments in PC cell lines, FRMD6 inhibited viability, proliferation, cell cycle progression, colony formation, 3D spheroid growth, and tumor xenograft growth in mice. Transcriptomic, proteomic, and phospho-proteomic profiling revealed enrichment of Hippo/YAP and c-MYC signaling upon FRMD6 knockout. Connectivity Map analysis and drug repurposing experiments identified pyroxamide as a new potential therapy for FRMD6 deficient PC cells. Finally, we established orthotropic Frmd6 and Pten, or Pten only (control) knockout in the ROSA26 mouse prostate. After 12 weeks, Frmd6/Pten double knockouts presented high-grade prostatic intraepithelial neoplasia (HG-PIN) and hyperproliferation, while Pten single-knockouts developed only regular PIN lesions and displayed lower proliferation. In conclusion, FRMD6 was identified as a novel tumor suppressor gene and prognostic biomarker candidate in PC.
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| 14. |
- Hansen, Matilde Bøgelund, et al.
(författare)
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Antibiotic-prescribing and antibiotic-resistance patterns among elderly citizens residing in two Nordic regions
- 2020
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Ingår i: Infectious Diseases. - : Informa UK Limited. - 2374-4235 .- 2374-4243. ; 52:4, s. 257-265
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The objective of this study was to compare antibiotic-prescribing rates in 2016 and antibiotic-resistance rates in 2017 among citizens aged ≥85 years between the Capital Region in Denmark and the Skåne Region in Sweden, with regards to overall antibiotic use and antibiotics of choice for urinary tract infections (UTIs) and skin and soft tissue infections (SSTIs). Methods: Inhabitants ≥85 year old on the date of prescription during 2016 and residing in the Capital Region or the Skåne Region were included for antibiotic-prescription analyses. Samples from 2017 from residents of the same regions who were ≥85 years old were included for antibiotic-resistance analyses. Antimicrobial use was determined according to the drugs of choice for UTIs and SSTIs in Denmark and Sweden. Students t-tests were used to compare antibiotic prescribing while a Chi-Squared test was performed to compare antibiotic resistance. Results: There was a significantly higher overall prescription rate among citizens ≥85 years in the Capital Region than in the Skåne Region. The same pattern was evident for the antibiotics of choice for UTIs and SSTIs except for clindamycin. Antibiotic resistance against all antibiotics included was more prominent in the Capital Region than in the Skåne Region. Conclusion: Considerable variation in antibiotic prescribing and resistance exists among elderly citizens between these two adjacent Nordic regions. Information and reflection on current practices and resistance patterns may direct attention towards antimicrobial stewardship as a higher priority and may help inform and motivate prescribing behaviours.
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| 15. |
- Hansen, Matilde Bøgelund, et al.
(författare)
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Antibiotic use in pre-school children and the correlation with adult educational levels in two Nordic counties : a replication of a 20-year-old study
- 2021
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Ingår i: Infectious Diseases. - : Informa UK Limited. - 2374-4235 .- 2374-4243. ; 53:4, s. 281-290
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of this study was to describe the change of antibiotic prescribing in pre-school children in the municipalities of the former Copenhagen County in Denmark and Skåne County in Sweden after 20 years of antibiotic stewardship effort. Furthermore, the variation in the prescribing of antibiotics between the municipalities and the correlation between municipal adult educational level and antibiotic prescribing in pre-school children was assessed. Methods: In this ecological study, information on antibiotic prescribing in pre-school children was obtained from a central pharmacy settlement system in each Region. The antibiotic prescribing rate was expressed in defined daily doses per 1,000 inhabitants per day (DDD/TID) and number of prescriptions/1000 inhabitants. Information on municipal adult educational levels was obtained from Statistics Denmark and Statistics Sweden. Results: The antibiotic prescribing rate during 2017 was higher in the municipalities of Copenhagen County (5.6–7.9 DDD/TID) compared to the municipalities of Skåne County (4.2–6.6 DDD/TID). In 1998 a higher rate was found in Skåne County (9.6–17.7 DDD/TID) compared to Copenhagen County (8.0–12.9 DDD/TID). A non-significant negative correlation between adult educational levels and antibiotic prescribing was observed in the municipalities of Copenhagen County (r= −0.233, p =.352) while the correlation was positive in the municipalities of Skåne County (r= +0.410, p =.018). The same correlations were observed in 1998. Conclusion: We found higher antibiotic prescribing in pre-school children in the municipalities of Copenhagen County compared to Skåne County in 2017, suggesting a possible overuse of antibiotics in Denmark. Further research should try to elucidate the reasons for the observed variation.
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| 16. |
- Hellström, Ann, 1959, et al.
(författare)
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Effect of Enteral Lipid Supplement on Severe Retinopathy of Prematurity A Randomized Clinical Trial
- 2021
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Ingår i: JAMA Pediatrics. - : American Medical Association (AMA). - 2168-6203 .- 2168-6211. ; 175:4, s. 359-367
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Tidskriftsartikel (refereegranskat)abstract
- IMPORTANCE Lack of arachidonic acid (AA) and docosahexaenoic acid (DHA) after extremely preterm birth may contribute to preterm morbidity, including retinopathy of prematurity (ROP). OBJECTIVE To determine whether enteral supplementation with fatty acids from birth to 40 weeks' postmenstrual age reduces ROP in extremely preterm infants. DESIGN, SETTING, AND PARTICIPANTS The Mega Donna Mega trial, a randomized clinical trial, was a multicenter study performed at 3 university hospitals in Sweden from December 15, 2016, to December 15, 2019. The screening pediatric ophthalmologists were masked to patient groupings. A total of 209 infants born at less than 27 weeks' gestation were tested for eligibility, and 206 infants were included. Efficacy analyses were performed on as-randomized groups on the intention-to-treat population and on the per-protocol population using as-treated groups. Statistical analyses were performed from February to April 2020. INTERVENTIONS Infants received either supplementation with an enteral oil providing AA (100mg/kg/d) and DHA (50mg/kg/d) (AA:DHA group) or no supplementation within 3 days after birth until 40 weeks' postmenstrual age. MAIN OUTCOMES AND MEASURES The primary outcomewas severe ROP (stage 3 and/or type 1). The secondary outcomes were AA and DHA serum levels and rates of other complications of preterm birth. RESULTS A total of 101 infants (58 boys [57.4%]; mean [SD] gestational age, 25.5 [1.5] weeks) were included in the AA:DHA group, and 105 infants (59 boys [56.2%]; mean [SD] gestational age, 25.5 [1.4] weeks) were included in the control group. Treatment with AA and DHA reduced severe ROP compared with the standard of care (16 of 101 [15.8%] in the AA:DHA group vs 35 of 105 [33.3%] in the control group; adjusted relative risk, 0.50 [95% CI, 0.28-0.91]; P =.02). The AA:DHA group had significantly higher fractions of AA and DHA in serum phospholipids compared with controls (overall mean difference in AA:DHA group, 0.82 mol% [95% CI, 0.46-1.18 mol%]; P <.001; overall mean difference in control group, 0.13 mol% [95% CI, 0.01-0.24 mol%]; P =.03). There were no significant differences between the AA:DHA group and the control group in the rates of bronchopulmonary dysplasia (48 of 101 [47.5%] vs 48 of 105 [45.7%]) and of any grade of intraventricular hemorrhage (43 of 101 [42.6%] vs 42 of 105 [40.0%]). In the AA:DHA group and control group, respectively, sepsis occurred in 42 of 101 infants (41.6%) and 53 of 105 infants (50.5%), serious adverse events occurred in 26 of 101 infants (25.7%) and 26 of 105 infants (24.8%), and 16 of 101 infants (15.8%) and 13 of 106 infants (12.3%) died. CONCLUSIONS AND RELEVANCE This study found that, compared with standard of care, enteral AA:DHA supplementation lowered the risk of severe ROP by 50% and showed overall higher serum levels of both AA and DHA. Enteral lipid supplementation with AA:DHA is a novel preventive strategy to decrease severe ROP in extremely preterm infants.
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| 17. |
- Hofherr, Alexis, et al.
(författare)
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Targeting inflammation for the treatment of Diabetic Kidney Disease: a five-compartment mechanistic model.
- 2022
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Ingår i: BMC nephrology. - : Springer Science and Business Media LLC. - 1471-2369. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- Diabetic kidney disease (DKD) is the leading cause of kidney failure worldwide. Mortality and morbidity associated with DKD are increasing with the global prevalence of type 2 diabetes. Chronic, sub-clinical, non-resolving inflammation contributes to the pathophysiology of renal and cardiovascular disease associated with diabetes. Inflammatory biomarkers correlate with poor renal outcomes and mortality in patients with DKD. Targeting chronic inflammation may therefore offer a route to novel therapeutics for DKD. However, the DKD patient population is highly heterogeneous, with varying etiology, presentation and disease progression. This heterogeneity is a challenge for clinical trials of novel anti-inflammatory therapies. Here, we present a conceptual model of how chronic inflammation affects kidney function in five compartments: immune cell recruitment and activation; filtration; resorption and secretion; extracellular matrix regulation; and perfusion. We believe that the rigorous alignment of pathophysiological insights, appropriate animal models and pathology-specific biomarkers may facilitate a mechanism-based shift from recruiting 'all comers' with DKD to stratification of patients based on the principal compartments of inflammatory disease activity.
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| 18. |
- Howe, LJ, et al.
(författare)
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Within-sibship genome-wide association analyses decrease bias in estimates of direct genetic effects
- 2022
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Ingår i: Nature genetics. - : Springer Science and Business Media LLC. - 1546-1718 .- 1061-4036. ; 54:65, s. 581-
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Tidskriftsartikel (refereegranskat)abstract
- Estimates from genome-wide association studies (GWAS) of unrelated individuals capture effects of inherited variation (direct effects), demography (population stratification, assortative mating) and relatives (indirect genetic effects). Family-based GWAS designs can control for demographic and indirect genetic effects, but large-scale family datasets have been lacking. We combined data from 178,086 siblings from 19 cohorts to generate population (between-family) and within-sibship (within-family) GWAS estimates for 25 phenotypes. Within-sibship GWAS estimates were smaller than population estimates for height, educational attainment, age at first birth, number of children, cognitive ability, depressive symptoms and smoking. Some differences were observed in downstream SNP heritability, genetic correlations and Mendelian randomization analyses. For example, the within-sibship genetic correlation between educational attainment and body mass index attenuated towards zero. In contrast, analyses of most molecular phenotypes (for example, low-density lipoprotein-cholesterol) were generally consistent. We also found within-sibship evidence of polygenic adaptation on taller height. Here, we illustrate the importance of family-based GWAS data for phenotypes influenced by demographic and indirect genetic effects.
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| 19. |
- Iivari, Juhani, et al.
(författare)
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A proposal for minimum reusability evaluation of design principles
- 2021
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Ingår i: European Journal of Information Systems. - 0960-085X .- 1476-9344. ; 30:3, s. 286-303
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Tidskriftsartikel (refereegranskat)abstract
- Many Design Science Research (DSR) papers in Information Systems (IS) suggest sets of design principles (DPs) that provide knowledge for creating instances, in different contexts, of IT artefacts that belong to the same class. However, despite frameworks for evaluating DSR contributions, the evaluation of DP reusability to, with and for practitioners has been largely neglected. We suggest that in order to maintain the practical relevance of DSR, papers with DPs as their key outcomes should contain a reusability evaluation of the proposed principles. We propose a framework of minimum reusability evaluation of DPs by members of the target community of practitioners. The framework comprises five criteria: (1) accessibility, (2) importance, (3) novelty and insightfulness, (4) actability and guidance, and (5) effectiveness.
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| 20. |
- Jorgensen, A. A., et al.
(författare)
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Petabit-per-second data transmission using a chip-scale microcomb ring resonator source
- 2022
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Ingår i: Nature Photonics. - : Springer Science and Business Media LLC. - 1749-4885 .- 1749-4893. ; 16:11, s. 798-802
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Tidskriftsartikel (refereegranskat)abstract
- Optical fibre communication is the backbone of the internet. As essential core technologies are approaching their limits of size, speed and energy-efficiency, there is a need for new technologies that offer further scaling of data transmission capacity. Here we show that a single optical frequency-comb source based on a silicon nitride ring resonator supports data capacities in the petabit-per-second regime. We experimentally demonstrate transmission of 1.84 Pbit s–1 over a 37-core, 7.9-km-long fibre using 223 wavelength channels derived from a single microcomb ring resonator producing a stabilized dark-pulse Kerr frequency comb. We also present a theoretical analysis that indicates that a single, chip-scale light source should be able to support 100 Pbit s–1 in massively parallel space-and-wavelength multiplexed data transmission systems. Our findings could mark a shift in the design of future communication systems, targeting device-efficient transmitters and receivers.
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| 21. |
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| 22. |
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| 23. |
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| 24. |
- Kong, D., et al.
(författare)
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Single Dark-Pulse Kerr Comb Supporting 1.84 Pbit/s Transmission over 37-Core Fiber
- 2020
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Ingår i: Conference Proceedings - Lasers and Electro-Optics Society Annual Meeting-LEOS. - 1092-8081. ; 2020-May
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Konferensbidrag (refereegranskat)abstract
- We show that a single dark-pulse Kerr comb can generate high enough OSNR to carry 1.84 Pbit/s data, achieved by 223 WDM spectral lines modulated with 32-Gbaud, SNR-adapted probabilistically shaped DP-QAM, over a 37-core fiber.
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| 25. |
- Kyvsgaard Hansen, Poul, et al.
(författare)
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Benefits of Modularity Strategies - Implications of Decisions and Timing
- 2022
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Ingår i: Lecture Notes in Mechanical Engineering. - Cham : Springer International Publishing. - 2195-4356 .- 2195-4364. ; , s. 879-886
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Konferensbidrag (refereegranskat)abstract
- Many companies are managing the complexity of customized products, such as product variants, by implementing product modularity strategy. The modular product structure supports in realizing the potential benefits if it is exploited in relation to customer needs (Market Dimension), configuring to process capabilities and thereby cost and quality (Process Dimension), and configuring to supply chain architecture and thereby speed and predictability in supply and delivery (Supply Chain Dimension). This paper introduces interactive training and learning methods that can reveal and exemplify the complex relationships between efforts and benefits when implementing modular strategies. This approach is comprised of a combination of two parts: a serious play and simulation. The resulting setup based on a real but simple industrial product, the LEGO Collectable Minifigure Series, has demonstrated that the potential qualitative benefits of a modular strategy can be hold up against a synchronized quantitative financial impact assessment. It has been possible to demonstrate the complexity of realizing potential benefits from a modular strategy. In particular, it has been visualized how short-term benefits can differ significant from long-term benefits.
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| 26. |
- Lund, Anna My, et al.
(författare)
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Mother's Own Milk and Its Relationship to Growth and Morbidity in a Population-based Cohort of Extremely Preterm Infants
- 2022
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Ingår i: Journal of Pediatric Gastroenterology and Nutrition. - : Wolters Kluwer. - 0277-2116 .- 1536-4801. ; 74:2, s. 292-300
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Tidskriftsartikel (refereegranskat)abstract
- Objectives:The aim of the study was to evaluate the relationships between intake of mother's own milk (MOM), compared with intake of pasteurized donor milk (DM), and postnatal growth, incidence of retinopathy of prematurity (ROP) and bronchopulmonary dysplasia (BPD), in extremely preterm infants.Methods:Swedish population-based cohort of surviving extremely preterm infants born 2004 to 2007. Exposure to MOM and DM was investigated from birth until 32 weeks postmenstrual age (PMA) in 453 infants. Primary outcome variables were change in z-score (Δ) from birth to 32 weeks PMA for weight, length, and head circumference (HC). Secondary outcomes were incidence of ROP and BPD. Mixed models adjusting for confounders were used to investigate the association between exposures and outcomes.Results:Infants' mean gestational age (GA) was 25.4 weeks. Unadjusted, MOM (per 10 mL · kg-1 · day-1) was associated with Δweight and ΔHC with beta estimates of 0.03 z-score units (95% CI, 0.02-0.04, P < 0.001) and 0.03 z-score units (95% CI, 0.01-0.05, P = 0.003), respectively. After adjustment for predefined confounders, the association remained significant for Δweight and ΔHC. A similar pattern was found between Δweight and each 10% increase of MOM. Unadjusted, a higher intake of MOM (mL · kg-1 · day-1) was significantly associated to a lower probability of any ROP and severe ROP; however, these associations did not remain in the adjusted analyses. No associations were found between MOM (mL · kg-1 · day-1) and BPD. Moreover, no associations were found between DM and growth or morbidity outcomes.Conclusions:An increased intake of MOM, as opposed to DM (and not formula feeding), was associated with improved postnatal weight gain and HC growth from birth until 32 weeks PMA in extremely preterm infants. Interventions aiming at increasing early intake of unpasteurized MOM for extremely preterm infants should be encouraged.
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| 27. |
- Magnus, MC, et al.
(författare)
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Fetal death after the introduction of COVID-19 mitigation measures in Sweden, Denmark and Norway: a registry-based study
- 2022
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Ingår i: Scientific reports. - : Springer Science and Business Media LLC. - 2045-2322. ; 12:1, s. 20625-
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Tidskriftsartikel (refereegranskat)abstract
- It remains unclear whether the rate of fetal death has changed during the COVID-19 pandemic. We assessed the impact of COVID-19 mitigation measures on fetal death in Sweden (449,347 births), Denmark (290,857 pregnancies) and Norway (261,057 pregnancies) using robust population-based registry data. We used Cox regression to assess the impact of the implementation of pandemic mitigation measures on March 12th, 2020, on miscarriage (fetal loss before gestational week 22) and stillbirth (fetal loss after gestational week 22). A total of 11% of 551,914 pregnancies in Denmark and Norway ended in miscarriage, while the proportion of stillbirths among 937,174 births across the three countries was 0.3%. There was no difference in the risk of fetal death during the year following pandemic mitigation measures. For miscarriage, the combined hazard ratio (HR) for Norway and Denmark was 1.01 (95% CI 0.98, 1.03), and for stillbirth, the combined HR for all three countries was 0.99 (95% CI 0.89, 1.09). We observed a slightly decreased risk of miscarriage during the first 4 months, with an HR of 0.94 (95% CI 0.90, 0.99) after lockdown. In conclusion, the risk of fetal death did not change after the implementation of COVID-19 pandemic mitigation measures in the three Scandinavian countries.
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| 28. |
- Magnus, MC, et al.
(författare)
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Fetal death after the introduction of COVID-19 mitigation measures in Sweden, Denmark and Norway: a registry-based study
- 2022
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Ingår i: Scientific reports. - : Springer Science and Business Media LLC. - 2045-2322. ; 12:1, s. 20625-
-
Tidskriftsartikel (refereegranskat)abstract
- It remains unclear whether the rate of fetal death has changed during the COVID-19 pandemic. We assessed the impact of COVID-19 mitigation measures on fetal death in Sweden (449,347 births), Denmark (290,857 pregnancies) and Norway (261,057 pregnancies) using robust population-based registry data. We used Cox regression to assess the impact of the implementation of pandemic mitigation measures on March 12th, 2020, on miscarriage (fetal loss before gestational week 22) and stillbirth (fetal loss after gestational week 22). A total of 11% of 551,914 pregnancies in Denmark and Norway ended in miscarriage, while the proportion of stillbirths among 937,174 births across the three countries was 0.3%. There was no difference in the risk of fetal death during the year following pandemic mitigation measures. For miscarriage, the combined hazard ratio (HR) for Norway and Denmark was 1.01 (95% CI 0.98, 1.03), and for stillbirth, the combined HR for all three countries was 0.99 (95% CI 0.89, 1.09). We observed a slightly decreased risk of miscarriage during the first 4 months, with an HR of 0.94 (95% CI 0.90, 0.99) after lockdown. In conclusion, the risk of fetal death did not change after the implementation of COVID-19 pandemic mitigation measures in the three Scandinavian countries.
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| 29. |
- Måseide, Ragnhild J., et al.
(författare)
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Haemophilia early arthropathy detection with ultrasound and haemophilia joint health score in the moderate haemophilia (MoHem) study
- 2021
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Ingår i: Haemophilia. - : Wiley. - 1351-8216 .- 1365-2516. ; 27:2
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Detection of early arthropathy is crucial for the management of haemophilia, but data on moderate haemophilia are limited. Therefore, we evaluated joint health and treatment modalities in Nordic patients with moderate haemophilia A (MHA) and B (MHB). Aim: To explore and compare the Haemophilia Early Arthropathy Detection with Ultrasound (HEAD-US) and Haemophilia Joint Health Score (HJHS) to detect early arthropathy in moderate haemophilia. Methods: A cross-sectional, multicentre study covering Nordic patients with MHA and MHB. Arthropathy was evaluated by HEAD-US and HJHS 2.1. Results: We assessed 693 joints in 118 patients. HEAD-US scores (medians [interquartile ranges]) were as follows: elbows 0 points (0–0), knees 0 (0–0) and ankles 0 (0–1). Respectively, by HJHS: elbows 0 (0–1), knees 0 (0–1) and ankles 0 (0–1). Cartilage (14%) and bone (13%) were most commonly affected by HEAD-US. Frequent HJHS findings were crepitus on motion in knees (39%), and loss of flexion (23%) and extension (13%) in ankles. HEAD-US correlated strongly with HJHS (elbows r =.70, knees r =.60 and ankles r =.65), but 24% had discordant scores. Joints with HJHS zero points, 5% captured HEAD-US ≥1 point. Moreover, 26% had HJHS findings without HEAD-US pathology. Notably, 31% of knees had crepitus on motion and normal HEAD-US. Conclusion: Overall, the joints attained low scores implying good joint health. HEAD-US correlated strongly with HJHS. In 5%, HEAD-US detected subclinical pathology. Crepitus on motion was frequently reported despite normal HEAD-US, thus not necessarily reflecting arthropathy. HEAD-US therefore improves the joint assessment in moderate haemophilia.
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| 30. |
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| 31. |
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| 32. |
- Persson, Magnus, 1975, et al.
(författare)
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Improving decision making in product modularization by game-based management training
- 2021
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Ingår i: Proceedings of the Design Society. - : Cambridge University Press (CUP). - 2732-527X. ; 1, s. 1837-1846
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Konferensbidrag (refereegranskat)abstract
- To deal with the complexity caused by a constantly increasing need for product customization many companies have adopted a product modularization strategy. Product modularization has the potential to give benefits both in the design of products, in manufacturing as well as in the supply chain. But, it poses great challenges in its implementation, which includes complex decision-making that will affect the whole value-chain. The purpose of this paper is to describe how a game-based approach can be used for academic education, and management training, with the aim of improving decision-making in product modularization. This by visualizing, and practice, the complex interplay between product, manufacturing and supply chain architecture. The paper describes the development of the LEGO Exploratorium game set up, based on the LEGO minifigures, and how it has been used for both teaching engineering students and in company workshop. Using this game set up will increase companies’ possibilities to develop modularized products that are designed for both efficient manufacturing and supply chain management.
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| 33. |
- (red.) Broström, Tor, 1955-, et al.
(författare)
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Brandsäkerhet för byggnader med kulturvärden : En kunskapsöversikt
- 2021
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Bok (refereegranskat)abstract
- Arbetet med brandsäkerhet för byggnader med kulturvärden kräver anpassade lösningar som också kan tillgodose ett bevarande av byggnaderna och deras kulturvärden. Det finns, utspritt, mycket kunskap och erfarenhet inom det här området både i Sverige och internationellt. För att tillgodose ett behov av samlad kunskap inom detta område initierade Brandforsk en kunskapsöversikt tillsammans med Akademiska hus, Fortifikationsverket, Kammarkollegiet, Kyrkans försäkring, Riksantikvarieämbetet och Statens fastighetsverk. Den här kunskapsöversikten syftar till att sammanställa och presentera den kunskap som finns. Ett kompletterande syfte är att definiera områden där kunskap saknas. Kunskapsöversikten är indelad i sex områden:2. Skydd mot brands uppkomst3. Spridning av brand inom byggnad4. Spridning av brand till byggnad5. Brandens påverkan på byggnadens stomme6. Utrymning7. Räddningstjänstens insatsMed utgångspunkt från workshops har en sammanställning av behovsbilden gjorts. Kunskapsöversikten och behovsbilden ligger till grund för en gap-analys vilken pekar på behov av fortsatt forskning och utveckling.
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| 34. |
- Rosengren, Anna, et al.
(författare)
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Collegial learning during the pandemic : Realized activities and lessons learnt
- 2022
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Ingår i: Proceedings of the 18th International CDIO Conference. - Reykjavík : Reykjavík University. - 9789935965561 ; , s. 385-395
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Konferensbidrag (refereegranskat)abstract
- The pandemic has forced teaching as well as as the Software Development industry, to be performed remotely. The educational institutions are therefore facing the situation of training and steering the students in, not only complex work, but also in remote-based work and it processes. Specific challenges here relate to project work with larger groups of developers, with testing, and integration of technical components for complete solutions, but the psychosocial factors come into play as well. This paper considers the situation that has arisen as a consequence of the pandemic and regards how project-based courses should be adapted to ‘The New Normal’. In focus is a course in Software Engineering, where a large-scaled project shall be developed remotely. Representatives from IT-companies act at the course remote, and at specific occurrences. The course is observed by the teachers to see its outcome, as well as different aspects on attitudes towards future remote work. Interviews and surveys regarding attitudes of students, as well as involved company representatives are presented, where the focus is on process, productivity, work environment, interest in remote work, as well as social aspects. The main findings, based on the surveys, motivates hybrid solutions for university courses, to meet the corresponding companies’ way of future working style.
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| 35. |
- Sartelli, Massimo, et al.
(författare)
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Ten golden rules for optimal antibiotic use in hospital settings: the WARNING call to action
- 2023
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Ingår i: WORLD JOURNAL OF EMERGENCY SURGERY. - 1749-7922. ; 18:1
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Forskningsöversikt (refereegranskat)abstract
- Antibiotics are recognized widely for their benefits when used appropriately. However, they are often used inappropriately despite the importance of responsible use within good clinical practice. Effective antibiotic treatment is an essential component of universal healthcare, and it is a global responsibility to ensure appropriate use. Currently, pharmaceutical companies have little incentive to develop new antibiotics due to scientific, regulatory, and financial barriers, further emphasizing the importance of appropriate antibiotic use. To address this issue, the Global Alliance for Infections in Surgery established an international multidisciplinary task force of 295 experts from 115 countries with different backgrounds. The task force developed a position statement called WARNING (Worldwide Antimicrobial Resistance National/International Network Group) aimed at raising awareness of antimicrobial resistance and improving antibiotic prescribing practices worldwide. The statement outlined is 10 axioms, or "golden rules," for the appropriate use of antibiotics that all healthcare workers should consistently adhere in clinical practice.
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| 36. |
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| 37. |
- Sverrild, Asger, et al.
(författare)
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The effect of tezepelumab on airway hyperresponsiveness to mannitol in asthma (UPSTREAM)
- 2022
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Ingår i: The European respiratory journal. - : European Respiratory Society (ERS). - 1399-3003 .- 0903-1936. ; 59:1
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Tidskriftsartikel (refereegranskat)abstract
- RATIONALE AND OBJECTIVES: Thymic stromal lymphopoietin (TSLP), an epithelial upstream cytokine, initiates production of type-2 (T2) cytokines with eosinophilia and possibly airway hyperresponsiveness (AHR) in asthma.This study aimed to determine whether tezepelumab (a human monoclonal antibody targeting TSLP) decreases AHR and airway inflammation in patients with symptomatic asthma on maintenance treatment with inhaled corticosteroids.METHODS AND MEASUREMENTS: In this double-blind, placebo-controlled randomised trial adult patients with asthma and AHR to mannitol received either 700 mg tezepelumab or placebo intravenously at 4-week intervals for 12 weeks. AHR to mannitol was assessed, and a bronchoscopy was performed at baseline and after 12 weeks. The primary outcome was the change in AHR from baseline to week-12 and secondary outcomes were changes in airway inflammation.RESULTS: Forty patients were randomised to receive either tezepelumab (n=20) or placebo (n=20). The mean change in PD15 with tezepelumab was 1.9 DD (95% CI 1.2 to 2.5) versus 1·0 (95% CI 0.3 to 1.6) with placebo; p=0.06. Nine (45%) tezepelumab and three (16%) placebo patients had a negative PD15 test at week-12, p=0.04. Airway tissue and BAL eosinophils decreased by 74% (95% CI -53 to -86) and 75% (95% CI -53 to -86) respectively with tezepelumab compared with an increase of 28% (95% CI -39 to 270) and a decrease of 7% (95% CI -49 to 72) respectively with placebo, p=0.004 and p=0.01.CONCLUSIONS: Inhibiting TSLP-signalling with tezepelumab reduced the proportion of patients with AHR and decreased eosinophilic inflammation in BAL and airway tissue.
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| 38. |
- Unemo, Magnus, 1970-, et al.
(författare)
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Sensitivity, specificity, inclusivity and exclusivity of the updated Aptima Combo 2 assay, which provides detection coverage of the new diagnostic-escape Chlamydia trachomatis variants
- 2020
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Ingår i: BMC Infectious Diseases. - : BioMed Central. - 1471-2334. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Four new variants of Chlamydia trachomatis (nvCTs), detected in several countries, cause false-negative or equivocal results using the Aptima Combo 2 assay (AC2; Hologic). We evaluated the clinical sensitivity and specificity, as well as the analytical inclusivity and exclusivity of the updated AC2 for the detection of CT and Neisseria gonorrhoeae (NG) on the automated Panther system (Hologic).Methods: We examined 1004 clinical AC2 samples and 225 analytical samples spiked with phenotypically and/or genetically diverse NG and CT strains, and other potentially cross-reacting microbial species. The clinical AC2 samples included CT wild type (WT)-positive (n = 488), all four described AC2 diagnostic-escape nvCTs (n = 170), NG-positive (n = 214), and CT/NG-negative (n = 202) specimens.Results: All nvCT-positive samples (100%) and 486 (99.6%) of the CT WT-positive samples were positive in the updated AC2. All NG-positive, CT/NG-negative, Trichomonas vaginalis (TV)-positive, bacterial vaginosis-positive, andCandida-positive AC2 specimens gave correct results. The clinical sensitivity and specificity of the updated AC2 for CT detection was 99.7 and 100%, respectively, and for NG detection was 100% for both. Examining spiked samples, the analytical inclusivity and exclusivity were 100%, i.e., in clinically relevant concentrations of spiked microbe.Conclusions: The updated AC2, including two CT targets and one NG target, showed a high sensitivity, specificity, inclusivity and exclusivity for the detection of CT WT, nvCTs, and NG. The updated AC2 on the fully automated Panther system offers a simple, rapid, high-throughput, sensitive, and specific diagnosis of CT and NG, which can easily be combined with detection of Mycoplasma genitalium and TV.
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| 39. |
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| 40. |
- Vikberg, Sanna, et al.
(författare)
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Adapted internet-based training program improves exercise accessibility for people with intellectual disabilities
- 2021
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Konferensbidrag (refereegranskat)abstract
- Introduction and objective Individuals with intellectual disability (ID) are less physically active than people without ID, and rarely or never reach the recommended daily dose of physical activity level. People with ID have a higher BMI than their peers and therefore a higher risk of obesity causing cardiovascular diseases. The overall objective was to determine the effectiveness on health and user experience of a 12-week, internet-based training program, customized for people with ID. Methods Participants with ID living in communal settings (n=27, 48% female, age = 36.4±9.56 years) were recruited for a training study including 50 minutes training 3 times a week in 12 weeks. Staff working with these participants (n=7, 57% female) were recruited for interviews. Questionnaires were used to evaluate enjoyment, quality of life and physical activity level, along with interviews. Body composition was measured as well as waist circumference. Results This study showed that 85% of the participants completed the web-based training. The level of physical activity (PA) increased during this period and positive changes in health outcomes were observed, for example a significant decrease in fat mass by a mean of 1.9kg ±2.4. The study also high-lighted barriers and facilitators for people with ID to use web-based training, along with perspectives and experiences on health and exercise among the staff within the supported housings. Conclusion A web-based training program is a new way to increase level of PA for people with ID. This study showed that web-based training program is an effective tool to improve health parameters, reduces hinders such as transport. Moreover, it is an easy way for staff to enhance PA in their work. This study present how web-based training was appreciated by many but not all participants ID which would probably be the same for people in general. The study was performed during the Covid-19 pandemic, which might have influenced the interest of the study in a positive manner. Individuals with ID can be difficult to reach in health care. Barriers such as transport, less knowledge in health literacy and difficulties in seeking care are examples why. A web based exercise program is one of many parameters that can help to improve health and an effective way for health care to reach this target group in a cost effective manner.
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| 41. |
- Wackernagel, Dirk, et al.
(författare)
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Swedish national guideline for prevention and treatment of neonatal hypoglycaemia in newborn infants with gestational age ≥ 35 weeks
- 2020
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Ingår i: Acta Paediatrica. - : John Wiley & Sons. - 0803-5253 .- 1651-2227. ; 109:1, s. 31-44
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Forskningsöversikt (refereegranskat)abstract
- Aim: Postnatal hypoglycaemia in newborn infants remains an important clinical problem where prolonged periods of hypoglycaemia are associated with poor neurodevelopmental outcome. The aim was to develop an evidence-based national guideline with the purpose to optimise prevention, diagnosis and treatment of hypoglycaemia in newborn infants with a gestational age >= 35 + 0 weeks.Methods: A PubMed search-based literature review was used to find actual and applicable evidence for all incorporated recommendations. The GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach was used for grading the evidence of the recommendations.Results: Recommendations for the prevention of neonatal hypoglycaemia were extended and updated, focusing on promotion of breastfeeding as one prevention strategy. Oral dextrose gel as a novel supplemental therapy was incorporated in the treatment protocol. A new threshold-based screening and treatment protocol presented as a flow chart was developed.Conclusion: An updated and evidence-based national guideline for screening and treatment of neonatal hypoglycaemia will support standardised regimes, which may prevent hypoglycaemia and the risk for hypoglycaemia-related long-term sequelae.
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| 42. |
- Westergaard, David, et al.
(författare)
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Genome-wide association meta-analysis identifies five loci associated with postpartum hemorrhage.
- 2024
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Ingår i: Nature genetics. - 1546-1718.
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Tidskriftsartikel (refereegranskat)abstract
- Bleeding in early pregnancy and postpartum hemorrhage (PPH) bear substantial risks, with the former closely associated with pregnancy loss and the latter being the foremost cause of maternal death, underscoring the severe impact on maternal-fetal health. We identified five genetic loci linked to PPH in a meta-analysis. Functional annotation analysis indicated candidate genes HAND2, TBX3 and RAP2C/FRMD7 at three loci and showed that at each locus, associated variants were located within binding sites for progesterone receptors. There were strong genetic correlations with birth weight, gestational duration and uterine fibroids. Bleeding in early pregnancy yielded no genome-wide association signals but showed strong genetic correlation with various human traits, suggesting a potentially complex, polygenic etiology. Our results suggest that PPH is related to progesterone signaling dysregulation, whereas early bleeding is a complex trait associated with underlying health and possibly socioeconomic status and may include genetic factors that have not yet been identified.
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| 43. |
- Zamir, Itay, et al.
(författare)
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Neonatal hyperglycaemia is associated with worse neurodevelopmental outcomes in extremely preterm infants
- 2021
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Ingår i: Archives of Disease in Childhood. - : BMJ Publishing Group Ltd. - 1359-2998 .- 1468-2052. ; 106:5, s. F460-F466
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To assess the associations between neonatal hyperglycaemia and insulin treatment, versus long-Term neurodevelopmental outcomes in children born extremely preterm.Design and setting: Observational national cohort study (Extremely Preterm Infants in Sweden Study) using prospectively and retrospectively collected data. Neurodevelopmental assessment was performed at 6.5 years of age.Patients: 533 infants born <27 gestational weeks during 2004-2007; 436 survivors were assessed at 6.5 years.Outcome measures: Neurodevelopmental disability (NDD), survival without moderate to severe NDD, Wechsler Intelligence Scale for Children IV Full scale intelligence quotient (WISC-IV FSIQ) and Movement Assessment Battery for Children 2 (MABC-2) total score.Results: Duration of neonatal hyperglycaemia >8 mmol/L was associated with WISC-IV scores-for each day with hyperglycaemia there was a decrease of 0.33 points (95% CI 0.03 to 0.62) in FSIQ. Neonatal hyperglycaemia >8 mmol/L occurring on 3 consecutive days was associated with lower MABC-2 scores (adjusted mean difference:-4.90; 95% CI-8.90 to-0.89). For each day with hyperglycaemia >8 mmol/L, there was a decrease of 0.55 points (95% CI 0.17 to 0.93) in MABC-2 total score. Insulin treatment was not associated with any of the outcome measures.Conclusion: Neonatal hyperglycaemia >8 mmol/L was associated with lower intelligence scores and worse motor outcomes at 6.5 years of age. Insulin treatment was not associated with either worsened or improved neurodevelopmental outcomes. Randomised controlled trials are needed to clarify the role of insulin in treating hyperglycaemia in extremely preterm infants.
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