| 1. |
- Butler, Simon, et al.
(författare)
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An Exploration of Openness in Hardware and Software Through Implementation of a RISC-V Based Desktop Computer
- 2022
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Ingår i: OpenSym '22. - New York, NY, USA : Association for Computing Machinery (ACM). - 9781450398459 - 9781450398466
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Konferensbidrag (refereegranskat)abstract
- Open hardware and open source software platforms bring benefits to both implementers and users in the form of system adaptability and maintainability, and through the avoidance of lock-in, for example. Development of the \riscv\ Instruction Set Architecture and processors during the last ten years has made the implementation of a desktop computer using open hardware, including open processors, and open source software an approaching possibility. We use the SiFive Unmatched development board and Ubuntu Linux, and the recorded experiences of system builders using the Unmatched board to explore the extent to which it is possible to create an open desktop computer. The work identifies current limitations to implementing an open computer system, which lie mainly at the interface between the operating system and hardware components. Potential solutions to the challenges uncovered are proposed, including greater consideration of openness during the early stages of product design. A further contribution is made by an account of the synergies arising from open collaboration in a private-collective innovation process.
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| 2. |
- Gamalielsson, Jonas, et al.
(författare)
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On availability of Open Source Software reference implementations for standards issued by different standards setting organisations
- 2023
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Ingår i: Joint Proceedings EURAS & SIIT 2023. - Aachen : Verlag Mainz. - 9783958864917 - 3958864910 ; , s. 97-116
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Konferensbidrag (refereegranskat)abstract
- Software reference implementations of ICT standards have an important role for verifying that a standard is implementable, supporting interoperability testing among other implementations, and providing feedback to the standard development process. Providing reference implementations and widely used implementations of a standard as Open Source Software also promotes wide deployment in software systems, avoidance of different lock-in effects, interoperability, and longevity of systems and associated digital assets. In this paper results are reported on the availability of reference implementations and widely deployed implementations provided as Open Source Software for standards issued by different standards setting organisations. Specifically, findings draw from observations and analyses related to software implementations for identified standards issued by ETSI, IEC, IEEE, IETF, ISO, ITU-T, OASIS, and W3C.
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| 3. |
- Gamalielsson, Jonas, et al.
(författare)
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On engagement with ICT standards and their implementations in open source software projects : the case of WebRTC
- 2022
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Ingår i: Proceedings 26th EURAS Annual Standardisation Conference. - Aachen : Verlag Mainz. - 9783958864467 ; , s. 143-162
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Konferensbidrag (refereegranskat)abstract
- Real-time communication (RTC) technologies for the web provide opportunities for individuals and organisations to work and collaborate remotely, and the need for such technologies has recently increased. Use of RTC technologies and tools for the web involves a number of challenges concerning data privacy and lock-in effects, such as dependency to specific suppliers and proprietary technologies. Use of open standards for RTC and open source software (OSS) implementing such standards can create conditions for avoiding issues related to data privacy and lock-in, and thereby provides opportunities for long-term sustainable solutions. The paper characterises how engagement with standardisation of WebRTC in the context of IETF and W3C is related to engagement with the WebRTC OSS project.
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| 4. |
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| 5. |
- Gamalielsson, Jonas, et al.
(författare)
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Open Source Software reference implementations for standards issued by different standards setting organisations : availability, perceptions and practices
- 2024
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Ingår i: Journal of Standardisation. - : TU Delft Open. - 2772-9249. ; 3:2
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Tidskriftsartikel (refereegranskat)abstract
- Software reference implementations of ICT standards have an important role for verifying that a standard is implementable, supporting interoperability testing among other implementations, and providing feedback to the standard development process. Providing reference implementations and widely used implementations of a standard as Open Source Software promotes wide deployment in software systems, interoperability, longevity of systems and associated digital assets, and avoidance of different lock-in effects. In this paper results are reported on the availability of, and perceptions and practices concerning, reference implementations and widely deployed implementations provided as Open Source Software for standards issued by different standards setting organisations. Specifically, findings draw from observations and analyses related to software implementations for identified standards and policy statements, issued by ETSI, IEC, IEEE, IETF, ISO, ITU-T, OASIS, and W3C.
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| 6. |
- Gamalielsson, Jonas, et al.
(författare)
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Towards open government through open source software for web analytics : The case of Matomo
- 2021
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Ingår i: eJournal of eDemocracy & Open Government. - Krems : Department for E-Governance and Administration, Danube University Krems. - 2075-9517. ; 13:2, s. 133-153
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Tidskriftsartikel (refereegranskat)abstract
- Web analytics technologies provide opportunities for organisations to obtain information about users visiting their websites in order to understand and optimise web usage. Use of such technologies often leads to issues related to data privacy and potential lock-in to specific suppliers and proprietary technologies. Use of open source software (OSS) for web analytics can create conditions for avoiding issues related to data privacy and lock-in, and thereby provides opportunities for a long-term sustainable solution for organisations both in the public and private sectors. This paper characterises use of and engagement with OSS projects for web analytics. Specifically, we contribute a characterisation of use of OSS licensed web analytics technologies in Swedish government authorities, and a characterisation of organisational engagement with the Matomo OSS project for web analytics.
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| 7. |
- Lundell, Björn, et al.
(författare)
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Enabling OSS usage through procurement projects : How can lock-in effects be avoided?
- 2021
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Ingår i: Open Source Systems. - Cham : Springer. - 9783030752507 - 9783030752538 - 9783030752514 ; , s. 16-27
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Konferensbidrag (refereegranskat)abstract
- Formulation of mandatory requirements in procurement projects has significant influence on opportunities for development and deployment of Open Source Software (OSS). The paper contributes insights on a widespread practice amongst public procurement projects which causes problematic lock-in effects and thereby inhibits opportunities for use of OSS solutions. Through a systematic investigation of 30 randomly selected procurement projects in the software domain the paper highlights illustrative examples of mandatory requirements which cause lock-in and presents five recommendations for how requirements instead should be formulated in order to avoid causing lock-in. Findings show significant lock-in caused by current procurement practices with a stark preference for proprietary software and SaaS solutions amongst procuring organisations.
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| 8. |
- Lundell, Björn, et al.
(författare)
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Half a step behind – bulk disclosure of confidential data in third-party GenAI solutions under the Swedish Public Access to Information and Secrecy Act
- 2024
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Ingår i: Digital Government: Research and Practice. - : ACM Digital Library. - 2691-199X .- 2639-0175.
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Tidskriftsartikel (refereegranskat)abstract
- Technological progress poses unique challenges for the public sector. New technology should be adopted, but it must always be done within the framework of good administration. It follows laws governing public administration must be continuously adapted. Sweden recently amended its secrecy legislation to facilitate the use of third-party cloud solutions by public authorities. When the amendment was enacted, most public sector organisations had already been using external cloud solutions for a long time. Today, there is as much pressure on authorities to implement AI technology as there ever was to move administration into the cloud. This paper uses traditional legal methodology to investigate if the Swedish secrecy legislation adequately enables the use of cloud-based GenAI solutions. Findings indicate that the recent amendment is likely insufficient and that there are significant practical hurdles for the application of the law, particularly with services from global cloud providers. The paper contributes to the understanding of Swedish law, and of the difficulties that can occur anywhere when policy makers and legislators do not move in tandem.
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| 9. |
- Butler, Simon, et al.
(författare)
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Considerations and challenges for the adoption of open source components in software-intensive businesses
- 2022
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Ingår i: Journal of Systems and Software. - : Elsevier. - 0164-1212 .- 1873-1228. ; 186
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Tidskriftsartikel (refereegranskat)abstract
- Component-Based Software Development is a conventional way of working for software-intensive businesses and OpenSource Software (OSS) components are frequently considered by businesses for adoption and inclusion in softwareproducts. Previous research has found a variety of practices used to support the adoption of OSS components, in-cluding formally specified processes and less formal, developer-led approaches, and that the practices used continue todevelop. Evolutionary pressures identified include the proliferation of available OSS components and increases in thepace of software development as businesses move towards continuous integration and delivery. We investigate workpractices used in six software-intensive businesses in the primary and secondary software sectors to understand currentapproaches to OSS component adoption and the challenges businesses face establishing effective work practices to eval-uate OSS components. We find businesses have established processes for evaluating OSS components and communitiesthat support more complex and nuanced considerations of the cost and risks of component adoption alongside matterssuch as licence compliance and functional requirements. We also found that the increasing pace and volume of softwaredevelopment within some businesses provides pressure to continue to evolve software evaluation processes.
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| 10. |
- Butler, Simon, et al.
(författare)
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Maintaining interoperability in open source software : A case study of the Apache PDFBox project
- 2020
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Ingår i: Journal of Systems and Software. - : Elsevier. - 0164-1212 .- 1873-1228. ; 159
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Tidskriftsartikel (refereegranskat)abstract
- Software interoperability is commonly achieved through the implementation of standards for communication protocols or data representation formats. Standards documents are often complex, difficult to interpret, and may contain errors and inconsistencies, which can lead to differing interpretations and implementations that inhibit interoperability. Through a case study of two years of activity in the Apache PDFBox project we examine day-to-day decisions made concerning implementation of the PDF specifications and standards in a community open source software (OSS) project. Thematic analysis is used to identify semantic themes describing the context of observed decisions concerning interoperability. Fundamental decision types are identified including emulation of the behaviour of dominant implementations and the extent to which to implement the PDF standards. Many factors influencing the decisions are related to the sustainability of the project itself, while other influences result from decisions made by external actors, including the developers of dependencies of PDFBox. This article contributes a fine grained perspective of decision-making about software interoperability by contributors to a community OSS project. The study identifies how decisions made support the continuing technical relevance of the software, and factors that motivate and constrain project activity.
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| 11. |
- Butler, Simon, et al.
(författare)
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On business adoption and use of reproducible builds for open and closed source software
- 2023
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Ingår i: Software quality journal. - : Springer Nature Switzerland AG. - 0963-9314 .- 1573-1367. ; 31:3, s. 687-719
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Tidskriftsartikel (refereegranskat)abstract
- Reproducible builds (R-Bs) are software engineering practices that reliably create bit-for-bit identical binary executable files from specified source code. R-Bs are applied in someopen source software (OSS) projects and distributions to allow verification that the distrib-uted binary has been built from the released source code. The use of R-Bs has been advo-cated in software maintenance and R-Bs are applied in the development of some OSS secu-rity applications. Nonetheless, industry application of R-Bs appears limited, and we seekto understand whether awareness is low or if significant technical and business reasonsprevent wider adoption. Through interviews with software practitioners and business man-agers, this study explores the utility of applying R-Bs in businesses in the primary and sec-ondary software sectors and the business and technical reasons supporting their adoption.We find businesses use R-Bs in the safety-critical and security domains, and R-Bs are valu-able for traceability and support collaborative software development. We also found thatR-Bs are valued as engineering processes and are seen as a badge of software quality, butwithout a tangible value proposition. There are good engineering reasons to use R-Bs inindustrial software development, and the principle of establishing correspondence betweensource code and binary offers opportunities for the development of further applications.
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| 12. |
- Ekerstad, Niklas, et al.
(författare)
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Clinical Frailty Scale classes are independently associated with 6-month mortality for patients after acute myocardial infarction
- 2022
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Ingår i: European Heart Journal. - : Oxford University Press. - 2048-8726 .- 2048-8734. ; 11:2, s. 89-98
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Tidskriftsartikel (refereegranskat)abstract
- Aims: Data on the prognostic value of frailty to guide clinical decision-making for patients with myocardial infarction (MI) are scarce. To analyse the association between frailty classification, treatment patterns, in-hospital outcomes, and 6-month mortality in a large population of patients with MI.Methods and results: An observational, multicentre study with a retrospective analysis of prospectively collected data using the SWEDEHEART registry. In total, 3381 MI patients with a level of frailty assessed using the Clinical Frailty Scale (CFS-9) were included. Of these patients, 2509 (74.2%) were classified as non-vulnerable non-frail (CFS 1–3), 446 (13.2%) were vulnerable non-frail (CFS 4), and 426 (12.6%) were frail (CFS 5–9). Frailty and non-frail vulnerability were associated with worse in-hospital outcomes compared with non-frailty, i.e. higher rates of mortality (13.4% vs. 4.0% vs. 1.8%), cardiogenic shock (4.7% vs. 2.5% vs. 1.9%), and major bleeding (4.5% vs. 2.7% vs. 1.1%) (allP < 0.001), and less frequent use of evidence-based therapies. In Cox regression analyses, frailty was strongly and independently associated with 6-month mortality compared with non-frailty, after adjustment for age, sex, the GRACE risk score components, and other potential risk factors [hazard ratio (HR) 3.32, 95% confidence interval (CI) 2.30–4.79]. A similar pattern was seen for vulnerable non-frail patients (fully adjusted HR 2.07, 95% CI1.41–3.02).Conclusion: Frailty assessed with the CFS was independently and strongly associated with all-cause 6-month mortality, also after comprehensive adjustment for baseline differences in other risk factors. Similarly, non-frail vulnerability was independently associated with higher mortality compared with those with preserved functional ability.
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| 13. |
- Garman, Ian, et al.
(författare)
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Demand control and constant flow ventilation compared in an exhaust ventilated bedroom in a cold-climate single-family house
- 2024
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Ingår i: Intelligent Buildings International. - : Elsevier. - 1750-8975 .- 1756-6932. ; 15:4, s. 175-188
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Tidskriftsartikel (refereegranskat)abstract
- A convertible, zoned ventilation system was field-tested in a modern, airtight Swedish home when occupied either by an experimental team or by a family. Indoor air quality in the master bedroom was monitored under four ventilation strategies. Relative to constant air volume strategies (CAV), demand-controlled ventilation (DCV) that was responding to CO2 concentration extracted more air when people were present, but less in total over 24 h. This elevated the indoor air humidity, beneficial in climates with dry winter air. Multiple monitors within the bedroom indicated that vertical CO2 stratification occurred routinely, presumably due to low mixing of supply air from a wall-mounted diffuse vent, spreading the air radially over the wall. This seemingly improved air quality in the breathing zone under local (ceiling) extract ventilation but worsened it during more typical, centralised extract ventilation, where air escapes the room via an inner doorway. The local extract arrangement thus seemed to yield both improved ventilation efficiency and reduced contaminant spread to other rooms. The noted air quality variations within the room highlight the importance of sensor placement in demand-control ventilated spaces, even in small rooms such as bedrooms.
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| 14. |
- Garman, Ian, et al.
(författare)
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Ventilation alone fails to prevent overheating in a Nordic home field study
- 2022
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Ingår i: 17th International Conference on Indoor Air Quality and Climate, INDOOR AIR 2022, Kuopio, 12 June 2022 through 16 June 2022. - : International Society of Indoor Air Quality and Climate.
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Konferensbidrag (refereegranskat)abstract
- A field study conducted in a modern Nordic single-family house with high airtightness and insulation levels, attempted to control summer indoor overheating using night-time cooling strategies. Exhaust air flow rates were manually scheduled by the researchers (based on weather forecasts), analogous to what an engaged occupant - or a predictive system - might do. Air temperatures at a nearby meteorological station peaked at 30 °C during 6 days in June that saw only 44 hours below 18 °C. Temperatures recorded indoors at the test house reached 32 °C, due also to very large solar gains, and never fell below 26 °C over 8 continuous days. It appears that under extended heat conditions that are exceptional now, but foreseen to become more frequent, some modern Nordic homes cannot be temperature controlled by ambient ventilation alone. © 2022 17th International Conference on Indoor Air Quality and Climate, INDOOR AIR 2022. All rights reserved.
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| 15. |
- Lassesson, Henric, et al.
(författare)
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Kemisk återvinning av plast : Teknik, flöden och miljöaspekter
- 2021
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Denna rapport är resultatet av ett projekt utfört av konsortiet SMED, tillsammans med underkonsulter, på uppdrag av Naturvårdsverket.SyfteDet övergripande syftet med uppdraget var att göra en analys av följande aspekter för kemisk återvinning: Vilka resurs-, miljö- och klimateffekter skulle en svensk anläggning kunna innebära, särskilt med avseende på aspekterna farliga ämnen, klimatpåverkan och resurseffektivitet, för olika kemiska återvinningstekniker, flöden och plastsorter?För vilka flöden och plastsorter kan kemisk återvinning vara aktuellt och för vilka plastsorter kan det göra mest nytta? Behövs reglering för att styra det?Vilka problem och hinder i plastflödet kan avhjälpas med kemisk återvinning? Vilka hinder och möjligheter finns med införandet av kemisk återvinning?MetodProjektet genomfördes huvudsakligen under perioden augusti till december 2020. De huvudsakliga momenten i genomförandet av projektet var attGå igenom litteratur, både vetenskaplig litteratur, andra rapporter och utredningar samt även mer marknadsorienterad information, såsom websidor, för att kartlägga olika tekniker, pilotstudier och anläggningar, och extrahera relevant information.Identifiera och intervjua relevanta aktörer inom forskning, myndigheter och näringsliv med särskild kompetens och insyn i området och sammanställa samt bearbeta informationen från dessa.Hålla ett seminarium med brett urval av deltagare inklusive intervjuade personer för att få ytterligare synpunkter, inte minst inspel till analysen av hinder och möjligheterBearbeta och sammanställa underlag och resultat samt författa och uppdatera rapport inklusive granskningar och återkopplingar från beställaren.Tekniker för kemisk återvinningKemisk återvinning av plast är idag under stark utveckling och många anläggningar byggs eller är under projektering, främst på kontinenten. Kemisk återvinning innebär att plasterna genomgår en process eller följd av processer där polymerkedjorna bryts upp till mindre molekyler. Det finns många olika tekniker och varianter av kemisk återvinning, vilket delvis också beror på att det finns många olika plastsorter, och olika tekniker har utvecklats för att passa för olika plasttyper. Vi har här gjort en indelning i sex kategorier av tekniker, där ordningen ungefär motsvarar graden av nedbrytning av polymererna, så att ju längre ner på listan, desto högre grad av nedbrytning.De kategorier av tekniker som beskrivs i rapporten ärUpplösning/utfällningDepolymeriseringSolvolysPyrolysFörgasningCCU – koldioxidinfångning och nyttiggörande (Carbon Capture and Utilization)Inom varje kategori finns oftast ett stort antal specifika teknikspår, och kategoriseringen är inte helt enkel. Det finns många olika begrepp som används inom området och terminologin är i dagsläget inte standardiserad.Upplösning/utfällning innebär som benämningen antyder att polymeren löses upp i något lösningsmedium, med avsikt att sedan fällas ut igen efter avlägsnande av oönskade komponenter. Tanken är att separera polymerkedjor, men inte ha sönder dem, vilket dock inte helt undviks. Metoden kan kategoriseras som en fysikaliskkemisk process.Depolymerisering avser i denna studie en kategori av teknologier som innebär att polymerer genomgår en process där de specifikt delas sönder i sina byggstenar, monomerer, som därmed återskapas. Även processer som ospecifikt sönderdelar polymerer till mindre delar kan anses vara depolymerisering. Men enligt praxis avser depolymerisering just processer där återskapande av monomerer avses.Solvolys avser i denna studie en process som utförs i ett vätskeformigt medium vid hög temperatur och högt tryck bryter ned polymerer till en oljeprodukt. Då mediet är vatten kallas det också hydrotermisk förvätskning eller HTL (hydrothermal liquefaction) och sker vid 200-400 grader och 50-250 bar.Pyrolys innebär en process som sker i en syrefri eller syrefattig miljö, där plasterna upphettas och bryts sönder till mindre beståndsdelar, och där man vanligtvis eftersträvar en vätskeformig produkt. Därför används ibland även begreppet termisk förvätskning inom denna kategori.Förgasning innebär att plasterna upphettas och bryts ned, med viss tillförsel av syre, till i huvudsak gasformiga ämnen, däribland kolmonoxid.CCU - Koldioxidinfångning och -nyttiggörande innebär som namnet antyder att koldioxid fångas in och nyttiggörs. I kombination med förbränning av plast skulle CCU vara en form av kemisk plaståtervinning.Egenskaperna hos de olika teknikkategorierna 1–6 har sammanfattats i tabell S1. De huvudsakliga för- och nackdelarna med olika tekniker har sammanställts i tabell S2.Resurs-, miljö- och klimataspekterResurs- och KlimataspekterResurs- energi- och klimataspekter är nära sammankopplade då man studerar plaståtervinning. Kemisk återvinning som teknikfamilj intar ett resurs-, energi- och klimatmässigt mellanläge mellan mekanisk återvinning och förbränning. Lokala förutsättningar i det enskilda fallet, såsom tillgång på klimatsnål processenergi, påverkar hur utfallet blir. Utsläppen från mekanisk återvinning är generellt mycket små. Det finns en viss miljöpåverkan, bland annat från produktionen av den elektricitet eller andra energibärare, som behövs för separation och tvättprocesser. Utsläpp från kemisk återvinning för de olika teknikerna är sinsemellan i samma storleksordning, större än de från mekanisk återvinning, då kemisk återvinning kräver mer energi, men mindre än utsläppen från avfallsförbränning. Indirekta effekter, i detta fall främst mängd elektricitet och produktionssätt för denna, samt förhållanden i och kring avfallsförbränningsanläggningar (som är ett alternativt sätt att behandla plastavfall som inte kan återvinnas mekaniskt) kommer att ha stor inverkan på systemets prestanda. Om processen använder energi från koldioxidsnåla källor så kommer den ha en högre klimatnytta än om processen använder fossila energi- och råvarukällor. En del av det gasflödet skulle också kunna återvinnas som produkt, i en storskaligare, mer optimerad anläggning, och där energin istället tillförs från annan källa, som då kan vara en klimatsnål energikälla, till exempel grön el.Farliga ämnenEftersom det handlar om kemiska processer kan man egentligen aldrig fullständigt garantera frihet från potentiellt riskabla ämnen. Det har varit ganska svårt att få helt klarlagd och likvärdig information för de olika teknikerna och för de olika varianterna av olika teknik, hur de hanterar tillsatser och eventuellt bildade farliga ämnen, delvis för att flertalet tekniker är ganska nya och inte helt utredda. Tillsatsämnen kan delas in i fyra huvudgrupper i form av funktionella tillsatser, färgämnen, fyllmedel och förstärkningar. I dessa grupper finns bland annat flamskyddsmedel, mjukgörare, biocider, färgpigment, talk och glasfiber. Dessa ämnen kan bete sig olika under processer för kemisk återvinning beroende på kemisk struktur, mängd, processegenskaper samt om additiven är inbundna i polymeren. De olika teknikerna har olika karakteristik avseende detta. Genom att kontrollera och eventuellt förbehandla ingående plastavfallsström kan man styra den kemiska nedbrytningsprocessen och minska bildandet av farliga och oönskade ämnen.För processer som sker under lägre temperatur på upp till 250°C, till exempel upplösning/utfällning och depolymerisering, kommer tillsatsämnets kemiska och termiska stabilitet bestämma hur ämnet påverkas. Detta medför att tillsatsämnena kan vara helt eller delvis nedbrutna, eller helt opåverkade. Därför behöver föroreningsprofil och reaktivitet undersökas för att optimera renhet på slutprodukten. Biprodukten i form av urlakade tillsatsämnen behöver också hanteras, exempelvis via destruktion eller återcirkulering. Om tillsatsämnet är klassat som farligt ämne enligt REACH kan detta ge problem i hantering och utökade krav på tillstånd för återvinningsaktörerna.Under högre temperaturer på 300–1000°C, såsom i solvolys, pyrolys, förgasning och förbränning, kommer organiska molekyler påverkas via termisk eller kemisk nedbrytning. En viss bildning av aromatiska strukturer sker i dessa processer, och återfinns typiskt i fraktionerna tjära eller koks. Sådana ämnen kan därmed hittas i produkter från metoder för kemisk återvinning liksom vid förbränning. Tillsatser i form av färgämnen och flamskyddsmedel kan bilda nedbrytningsprodukter som kan störa processen eller bilda nya farliga ämnen. Förenklat kan man säga att allt som följer med in i dessa processer kan också till någon del komma att ingå i reaktionsprodukter. Så om syre, kväve, svavel, klor eller brom följer med in i processen, så kan nya ämnen bildas där dessa ingår, och detta behöver man beakta om man vill undvika sådana ämnen, antingen genom noggrann förseparering, eller lämpliga reningssteg. Variationerna i hur dessa ämnen hanteras är stora, beroende på specifik teknik och processbetingelser.Användarna av produkter från kemisk återvinning vill inte ha med föroreningar av olika slag i sitt råvaruinflöde. Det talar för att man kommer vara tvungen att säkerställa att oönskade farliga ämnen i vid mening undviks i kemiskt återvunna produktflöden. Kemiska återvinningsanläggningar kommer generellt att lyda under liknande miljölagstiftning som kemiindustri. Det talar för att man kan via tillståndsprocesser och miljörelaterad övervakning bevaka potentiella flöden av farliga ämnen. Rätt utförd kemisk återvinning kan därmed ge en ny möjlighet att hantera kontaminerade plastavfallsströmmar vilket skulle minska miljöpåverkan av dessa farliga ämnen.Särskilt intressanta flödenOlika tekniker passar bättre för olika plastsorter. I tabell
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| 16. |
- Leuzy, Antoine, et al.
(författare)
-
Biomarker-Based Prediction of Longitudinal Tau Positron Emission Tomography in Alzheimer Disease
- 2022
-
Ingår i: JAMA Neurology. - : American Medical Association (AMA). - 2168-6149. ; 79:2, s. 149-158
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Tidskriftsartikel (refereegranskat)abstract
- Importance: There is currently no consensus as to which biomarkers best predict longitudinal tau accumulation at different clinical stages of Alzheimer disease (AD). Objective: To describe longitudinal [18F]RO948 tau positron emission tomography (PET) findings across the clinical continuum of AD and determine which biomarker combinations showed the strongest associations with longitudinal tau PET and best optimized clinical trial enrichment. Design, Setting, and Participants: This longitudinal cohort study consecutively enrolled amyloid-β (Aβ)-negative cognitively unimpaired (CU) participants, Aβ-positive CU individuals, Aβ-positive individuals with mild cognitive impairment (MCI), and individuals with AD dementia between September 2017 and November 2020 from the Swedish BioFINDER-2 (discovery cohort) and BioFINDER-1 (validation cohort) studies. Exposures: Baseline plasma and cerebrospinal fluid Aβ42/Aβ40, tau phosphorylated at threonine-217 (p-tau217), p-tau181 and neurofilament light, magnetic resonance imaging, amyloid PET ([18F]flutemetamol), and tau PET ([18F]RO948 in the BioFINDER-2 study; [18F]flortaucipir in the BioFINDER-1 study). Main Outcomes and Measures: Baseline tau PET standardized uptake value ratio (SUVR) and annual percent change in tau PET SUVR across regions of interest derived using a data-driven approach combining clustering and event-based modeling. Regression models were used to examine associations between individual biomarkers and longitudinal tau PET and to identify which combinations best predicted longitudinal tau PET. These combinations were then entered in a power analysis to examine how their use as an enrichment strategy would affect sample size in a simulated clinical trial. Results: Of 343 participants, the mean (SD) age was 72.56 (7.24) years, and 157 (51.1%) were female. The clustering/event-based modeling-based approach identified 5 regions of interest (stages). In Aβ-positive CU individuals, the largest annual increase in tau PET SUVR was seen in stage I (entorhinal cortex, hippocampus, and amygdala; 4.04% [95% CI, 2.67%-5.32%]). In Aβ-positive individuals with MCI and with AD dementia, the greatest increases were seen in stages II (temporal cortical regions; 4.45% [95% CI, 3.41%-5.49%]) and IV (certain frontal regions; 5.22% [95% CI, 3.95%-6.49%]), respectively. In Aβ-negative CU individuals and those with MCI, modest change was seen in stage I (1.38% [95% CI, 0.78%-1.99%] and 1.80% [95% CI, 0.76%-2.84%], respectively). When looking at individual predictors and longitudinal tau PET in the stages that showed most change, plasma p-tau217 (R2= 0.27, P <.005), tau PET (stage I baseline SUVR; R2= 0.13, P <.05) and amyloid PET (R2= 0.10, P <.05) were significantly associated with longitudinal tau PET in stage I in Aβ-positive CU individuals. In Aβ-positive individuals with MCI, plasma p-tau217 (R2= 0.24, P <.005) and tau PET (stage II baseline SUVR; R2= 0.44, P <.001) were significantly associated with longitudinal tau PET in stage II. Findings were replicated in BioFINDER-1 using longitudinal [18F]flortaucipir. For the power analysis component, plasma p-tau217 with tau PET resulted in sample size reductions of 43% (95% CI, 34%-46%; P <.005) in Aβ-positive CU individuals and of 68% (95% CI, 61%-73%; P <.001) in Aβ-positive individuals with MCI. Conclusions and Relevance: In trials using tau PET as the outcome, plasma p-tau217 with tau PET may prove optimal for enrichment in preclinical and prodromal AD. However, plasma p-tau217 was most important in preclinical AD, while tau PET was more important in prodromal AD..
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| 17. |
- Leuzy, Antoine, et al.
(författare)
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Diagnostic Performance of RO948 F 18 Tau Positron Emission Tomography in the Differentiation of Alzheimer Disease from Other Neurodegenerative Disorders
- 2020
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Ingår i: JAMA Neurology. - : American Medical Association (AMA). - 2168-6149. ; 77:8, s. 955-965
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Tidskriftsartikel (refereegranskat)abstract
- Importance: The diagnostic performance of second-generation tau positron emission tomographic (PET) tracers is not yet known. Objective: To examine the novel tau PET tracer RO948 F 18 ([18F]RO948) performance in discriminating Alzheimer disease (AD) from non-AD neurodegenerative disorders. Design, Setting, and Participants: In this diagnostic study, 613 participants in the Swedish BioFINDER-2 study were consecutively enrolled in a prospective cross-sectional study from September 4, 2017, to August 28, 2019. Participants included 257 cognitively unimpaired controls, 154 patients with mild cognitive impairment, 100 patients with AD dementia, and 102 with non-AD neurodegenerative disorders. Evaluation included a comparison of tau PET tracer [18F]RO948 with magnetic resonance imaging (MRI) and cerebrospinal fluid and a head-to-head comparison between [18F]RO948 and flortaucipir F 18 ([18F]flortaucipir) in patients with semantic variant primary progressive aphasia (svPPA). Exposures: [18F]RO948 (all patients) and [18F]flortaucipir (3 patients with svPPA) tau PET; MRI (hippocampal volume, composite temporal lobe cortical thickness, whole-brain cortical thickness) and cerebrospinal fluid measures (p-tau181 and amyloid Aβ42 and Aβ40 ratio[Aβ42/Aβ40], and Aβ42/p-tau181 ratio). Main Outcomes and Measures: Standard uptake value ratios (SUVRs) in 4 predefined regions of interest (ROIs) reflecting Braak staging scheme for tau pathology and encompass I-II (entorhinal cortex), III-IV (inferior/middle temporal, fusiform gyrus, parahippocampal cortex, and amygdala), I-IV, and V-VI (widespread neocortical areas), area under the receiver operating characteristic curve (AUC) values, and subtraction images between [18F]RO948 and [18F]flortaucipir. Results: Diagnostic groups among the 613 participants included cognitively unimpaired (mean [SD] age, 65.8 [12.1] years; 117 men [46%]), mild cognitive impairment (age, 70.8 [8.3] years; 82 men [53%]), AD dementia (age, 73.5 [6.7] years; 57 men [57%]), and non-AD disorders (age, 70.5 [8.6] years; 41 men [40%]). Retention of [18F]RO948 was higher in AD dementia compared with all other diagnostic groups. [18F]RO948 could distinguish patients with AD dementia from individuals without cognitive impairment and those with non-AD disorders, and the highest AUC was obtained using the I-IV ROI (AUC = 0.98; 95% CI, 0.96-0.99 for AD vs no cognitive impairment and AUC = 0.97; 95% CI, 0.95-0.99 for AD vs non-AD disorders), which outperformed MRI (highest AUC = 0.91 for AD vs no cognitive impairment using whole-brain thickness, and AUC = 0.80 for AD vs non-AD disorders using temporal lobe thickness) and cerebrospinal fluid measures (highest AUC = 0.94 for AD vs no cognitive impairment using Aβ42/p-tau181, and AUC = 0.93 for AD vs non-AD disorders using Aβ42/Aβ40). Generally, tau PET positivity using [18F]RO948 was observed only in Aβ-positive cases or in MAPT R406W mutation carriers. Retention of [18F]RO948 was not pronounced in patients with svPPA, and head-to-head comparison revealed lower temporal lobe uptake than with [18F]flortaucipir. Conclusions and Relevance: In this study, elevated [18F]RO948 SUVRs were most often seen among Aβ-positive cases, which suggests that [18F]RO948 has high specificity for AD-type tau and highlights its potential as a diagnostic marker in the differential diagnosis of AD.
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| 18. |
- Lewin, Marcus, et al.
(författare)
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Hybrids between Rubus caesius and Rubus sect. Corylifolii (Rosaceae) and their relation to R. cyclomorphus, R. tiliaster, R. glauciformis, R. slesvicensis and R. firmus
- 2022
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Ingår i: Nordic Journal of Botany. - : Wiley. - 0107-055X .- 1756-1051. ; 2022:12
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Tidskriftsartikel (refereegranskat)abstract
- Using flow cytometry and microsatellite DNA analysis (MSDA), we studied hybrids between Rubus caesius and various other Rubus species, with an emphasis on Sweden. We show that hybrids between Rubus caesius and Rubus sect. Corylifolii arise easily. They show a large variation in morphology, but can normally be recognised by a number of characters. They are typically hexaploids, but ~13% of the hybrids are pentaploids and ~8% tetraploids. With MSDA, they are harder to identify than hybrids with R. idaeus, partly because all Corylifolii species have themselves arisen from R. caesius hybrids and therefore share many alleles with R. caesius, partly because hybridisation with R. caesius seems to give rise to some variation in microsatellite regions. Hybrids with species of R. sect. Rubus are much rarer in Sweden and we have only identified one such case. We show that R. cyclomorphus and R. tiliaster are not proper apomictic species, at least not in Sweden, but rather a collection of genetically unrelated hybrids between R. caesius and R. raduloides or R. camptostachys. MSDA analysis of R. slesvicensis and R. firmus shows that these species are problematic. We identify two distinct taxa, one from Skåne in Sweden, which we describe as a new species, R. ruboculus and another from the neighbourhood of Viborg and Schleswig, although the latter is probably not identical with R. slesvicensis s.s. All the other samples form a diverse group of putative R. caesius hybrids at three different ploidy levels. Rubus glauciformis is uniform in Småland, Öland and Blekinge, but becomes harder to distinguish from various hybrids in Skåne. We conclude that once R. caesius and R. idaeus hybrids are properly identified, along with a small number of new apomictic species (often with a local distribution), the genus Rubus does not pose any serious taxonomical problems in Sweden.
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| 19. |
- Lundell, Björn, et al.
(författare)
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Effective Strategies for Using Open Source Software and Open Standards in Organizational Contexts : Experiences From the Primary and Secondary Software Sectors
- 2022
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Ingår i: IEEE Software. - : IEEE. - 0740-7459 .- 1937-4194. ; 39:1, s. 84-92
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Tidskriftsartikel (refereegranskat)abstract
- Open source software (OSS) and open standards have become increasingly important for addressing challenges related to lock-in, interoperability and long-term maintenance of systems and associated digital assets. OSS projects operate under different conditions and many projects and organisations consider successful governance and strategic involvement with projects to constitute major challenges. Today, many companies seek to establish work practices which facilitate strategic engagement with OSS projects. Based on findings from collaborative research which draws from rich insights and extensive experiences from practice, the paper presents seven actionable strategies for organisations that seek to leverage long-term involvement with OSS projects.
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| 20. |
- Mattsson, Brady J., et al.
(författare)
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Enhancing monitoring and transboundary collaboration for conserving migratory species under global change : The priority case of the red kite
- 2022
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Ingår i: Journal of Environmental Management. - : Elsevier BV. - 0301-4797. ; 317
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Forskningsöversikt (refereegranskat)abstract
- Calls for urgent action to conserve biodiversity under global change are increasing, and conservation of migratory species in this context poses special challenges. In the last two decades the Convention on the Conservation of Migratory Species of Wild Animals (CMS) has provided a framework for several subsidiary instruments including action plans for migratory bird species, but the effectiveness and transferability of these plans remain unclear. Such laws and policies have been credited with positive outcomes for the conservation of migratory species, but the lack of international coordination and on-ground implementation pose major challenges. While research on migratory populations has received growing attention, considerably less emphasis has been given to integrating ecological information throughout the annual cycle for examining strategies to conserve migratory species at multiple scales in the face of global change. We fill this gap through a case study examining the ecological status and conservation of a migratory raptor and facultative scavenger, the red kite (Milvus milvus), whose current breeding range is limited to Europe and is associated with agricultural landscapes and restricted to the temperate zone. Based on our review, conservation actions have been successful at recovering red kite populations within certain regions. Populations however remain depleted along the southern-most edge of the geographic range where many migratory red kites from northern strongholds overwinter. This led us to a forward-looking and integrated strategy that emphasizes international coordination involving researchers and conservation practitioners to enhance the science-policy-action interface. We identify and explore key issues for conserving the red kite under global change, including enhancing conservation actions within and outside protected areas, recovering depleted populations, accounting for climate change, and transboundary coordination in adaptive conservation and management actions. The integrated conservation strategy is sufficiently general such that it can be adapted to inform conservation of other highly mobile species subject to global change.
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| 21. |
- Mattsson, Jens, et al.
(författare)
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Modeller för att leda och styra mot social hållbarhet. : lärdomar från ett innovationspartnerskap
- 2023
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Mellan 2020-11-01 och 2023-09-30 har RISE varit medskapande i ett innovationspartnerskap med Kungälv och Mölndals kommun för att gynna det lokala arbetet och bidra till den bredare kunskapsutvecklingen för att stödja kommuners omställning mot ökad social hållbarhet. Denna slutrapport innehåller en beskrivning av innovationspartnerskapet och är ett kunskapsunderlag för fortsatt utvecklingsarbete.Projektet har syftat till att skapa effektiv ledning och styrning mot social hållbarhet genom att utveckla och testa en uppföljningsmodell. Modellen kallas SMASH, vilket står för Systematisk Mätning och Analays av Social Hållbarhet. Modellen utvecklades utifrån de behov kommunerna hade, och innefattar tre delar: en ekonomisk modell för att beräkna vinster av insatser inom socialt arbete och sociala investeringar, en uppföljningsstruktur gällande indikatorer och mål samt ett batteri av verktyg för systematisk verksamhetsutveckling. Både Mölndal och Kungälv valde att arbeta inom arbetsmarknad-/ vuxenutbildningsområdet eftersom det var aktuella processer i båda kommunerna. Modellen kan dock användas inom fler områden.Modellen som utvecklats i projektet ger en bättre förståelse av vad som ska följas upp och hur, bland både politik och verksamhet. Modellen har använts som verktyg för att följa upp och utvärdera insatser och projekt inom ramen för socialt arbete. Modellen kan hjälpa till att följa och styra mot sociala hållbarhetsmål, främst genom att koppla politiska mål till aktiviteter och utfall.De främsta organisatoriska förflyttningarna som skett som en följd av SMASH och Innovationspartnerskapet handlar om ett större fokus på att mäta utfall, inte bara mål, samt en förbättrad samarbetskultur mellan chefer och medarbetare och mellan olika verksamheter och sektorer. SMASH har också lett till en gemensam förståelse och ett gemensamt språk kring uppföljning, en ökad politisk medvetenhet om vikten av realistiska mål och en bättre struktur för uppföljning.En central del i innovationspartnerskapet har varit att involvera parter från olika nivåer i kommunerna och genom dialoger skapa en gemensam förståelse av ägandeskap, ansvar och mandat kring uppföljning av social hållbarhet. Det är i dialogen som det främsta lärandet har skett.Innovationspartnerskapet har skapat utrymme för analys och utveckling kopplat till uppföljning av social hållbarhet. RISE ser att både Kungälv och Mölndal har gjort stora förflyttningar inom ramen för SMASH. Det handlar främst om stärkt helhetstänk och utvecklad systematisk kvalitetsutveckling som i sin tur har flyttat fram kommunernas arbete och fokus på social hållbarhet.
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| 22. |
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| 23. |
- Meaney, Paul, et al.
(författare)
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Vertebrae Transmission Probe Testing - Preliminary Bone Measurements
- 2023
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Ingår i: 2023 17th European Conference on Antennas and Propagation, EuCAP. - : IEEE. - 9788831299077 - 9781665475419
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Konferensbidrag (refereegranskat)abstract
- We are developing a new transmission-based probe for assessing vertebrae strength via the differences between the dielectric properties of normal and osteoporotic bone. The probes are simple open-ended coaxial cables that will fit easily into the pedicle canals drilled by the surgeons before implanting screws to secure the supporting instrumentation. If the screws pull because of bone weakness, it can inflict a wide range of complications. In the progression towards actual clinical trials, we have already validated the approach on different liquids with varying dielectric properties. In this study, we assess actual animal bone samples as a precursor to human investigations. We exploit the fact that the trabecular bone is considerably different on opposite sides of the growth plate of long bones such as the femur - somewhat mimicking differences between normal and osteoporotic bone. For these experiments, we show that the properties of the distal and proximal sections are considerably different and present opportunities to exploit them in a diagnostic setting
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| 24. |
- Ossenkoppele, Rik, et al.
(författare)
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Accuracy of Tau Positron Emission Tomography as a Prognostic Marker in Preclinical and Prodromal Alzheimer Disease : A Head-to-Head Comparison against Amyloid Positron Emission Tomography and Magnetic Resonance Imaging
- 2021
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Ingår i: JAMA Neurology. - : American Medical Association (AMA). - 2168-6149. ; 78:8, s. 961-971
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Tidskriftsartikel (refereegranskat)abstract
- Importance: Tau positron emission tomography (PET) tracers have proven useful for the differential diagnosis of dementia, but their utility for predicting cognitive change is unclear. Objective: To examine the prognostic accuracy of baseline fluorine 18 (18F)-flortaucipir and [18F]RO948 (tau) PET in individuals across the Alzheimer disease (AD) clinical spectrum and to perform a head-to-head comparison against established magnetic resonance imaging (MRI) and amyloid PET markers. Design, Setting, and Participants: This prognostic study collected data from 8 cohorts in South Korea, Sweden, and the US from June 1, 2014, to February 28, 2021, with a mean (SD) follow-up of 1.9 (0.8) years. A total of 1431 participants were recruited from memory clinics, clinical trials, or cohort studies; 673 were cognitively unimpaired (CU group; 253 [37.6%] positive for amyloid-β [Aβ]), 443 had mild cognitive impairment (MCI group; 271 [61.2%] positive for Aβ), and 315 had a clinical diagnosis of AD dementia (315 [100%] positive for Aβ). Exposures: [18F]Flortaucipir PET in the discovery cohort (n = 1135) or [18F]RO948 PET in the replication cohort (n = 296), T1-weighted MRI (n = 1431), and amyloid PET (n = 1329) at baseline and repeated Mini-Mental State Examination (MMSE) evaluation. Main Outcomes and Measures: Baseline [18F]flortaucipir/[18F]RO948 PET retention within a temporal region of interest, MRI-based AD-signature cortical thickness, and amyloid PET Centiloids were used to predict changes in MMSE using linear mixed-effects models adjusted for age, sex, education, and cohort. Mediation/interaction analyses tested whether associations between baseline tau PET and cognitive change were mediated by baseline MRI measures and whether age, sex, and APOE genotype modified these associations. Results: Among 1431 participants, the mean (SD) age was 71.2 (8.8) years; 751 (52.5%) were male. Findings for [18F]flortaucipir PET predicted longitudinal changes in MMSE, and effect sizes were stronger than for AD-signature cortical thickness and amyloid PET across all participants (R2, 0.35 [tau PET] vs 0.24 [MRI] vs 0.17 [amyloid PET]; P <.001, bootstrapped for difference) in the Aβ-positive MCI group (R2, 0.25 [tau PET] vs 0.15 [MRI] vs 0.07 [amyloid PET]; P <.001, bootstrapped for difference) and in the Aβ-positive CU group (R2, 0.16 [tau PET] vs 0.08 [MRI] vs 0.08 [amyloid PET]; P <.001, bootstrapped for difference). These findings were replicated in the [18F]RO948 PET cohort. MRI mediated the association between [18F]flortaucipir PET and MMSE in the groups with AD dementia (33.4% [95% CI, 15.5%-60.0%] of the total effect) and Aβ-positive MCI (13.6% [95% CI, 0.0%-28.0%] of the total effect), but not the Aβ-positive CU group (3.7% [95% CI, -17.5% to 39.0%]; P =.71). Age (t = -2.28; P =.02), but not sex (t = 0.92; P =.36) or APOE genotype (t = 1.06; P =.29) modified the association between baseline [18F]flortaucipir PET and cognitive change, such that older individuals showed faster cognitive decline at similar tau PET levels. Conclusions and Relevance: The findings of this prognostic study suggest that tau PET is a promising tool for predicting cognitive change that is superior to amyloid PET and MRI and may support the prognostic process in preclinical and prodromal stages of AD.
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| 25. |
- Ossenkoppele, Rik, et al.
(författare)
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The impact of demographic, clinical, genetic, and imaging variables on tau PET status
- 2021
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Ingår i: European Journal of Nuclear Medicine and Molecular Imaging. - : Springer Science and Business Media LLC. - 1619-7070 .- 1619-7089. ; 48:7, s. 2245-2258
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: A substantial proportion of amyloid-β (Aβ)+ patients with clinically diagnosed Alzheimer’s disease (AD) dementia and mild cognitive impairment (MCI) are tau PET–negative, while some clinically diagnosed non-AD neurodegenerative disorder (non-AD) patients or cognitively unimpaired (CU) subjects are tau PET–positive. We investigated which demographic, clinical, genetic, and imaging variables contributed to tau PET status. Methods: We included 2338 participants (430 Aβ+ AD dementia, 381 Aβ+ MCI, 370 non-AD, and 1157 CU) who underwent [18F]flortaucipir (n = 1944) or [18F]RO948 (n = 719) PET. Tau PET positivity was determined in the entorhinal cortex, temporal meta-ROI, and Braak V-VI regions using previously established cutoffs. We performed bivariate binary logistic regression models with tau PET status (positive/negative) as dependent variable and age, sex, APOEε4, Aβ status (only in CU and non-AD analyses), MMSE, global white matter hyperintensities (WMH), and AD-signature cortical thickness as predictors. Additionally, we performed multivariable binary logistic regression models to account for all other predictors in the same model. Results: Tau PET positivity in the temporal meta-ROI was 88.6% for AD dementia, 46.5% for MCI, 9.5% for non-AD, and 6.1% for CU. Among Aβ+ participants with AD dementia and MCI, lower age, MMSE score, and AD-signature cortical thickness showed the strongest associations with tau PET positivity. In non-AD and CU participants, presence of Aβ was the strongest predictor of a positive tau PET scan. Conclusion: We identified several demographic, clinical, and neurobiological factors that are important to explain the variance in tau PET retention observed across the AD pathological continuum, non-AD neurodegenerative disorders, and cognitively unimpaired persons.
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| 26. |
- Ryde, Ulf, et al.
(författare)
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Hybrids between Rubus idaeus and Rubus sect. Corylifolii and their relation to R. pruinosus and R. rosanthus
- 2021
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Ingår i: Nordic Journal of Botany. - : Wiley. - 0107-055X .- 1756-1051. ; 39:8
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Tidskriftsartikel (refereegranskat)abstract
- We have studied hybrids between Rubus idaeus and various members of R. sect. Corylifolii, primarily in Sweden. With the help of DNA-ploidy level determinations using flow cytometry and microsatellite DNA analysis of over 500 samples, we show that the material can be divided into four stable apomictic species (belonging to subsect. Subidaei) and a large number of primary hybrids. Stable species can be recognised by a distribution that is distinct from the Corylifolii parent, a uniform morphology and an almost invariant genetic pattern. We confirm that R. cordatiformis has arisen from the hybrid R. eluxatus × idaeus. Moreover, our study shows that R. lagerbergii has arisen from the hybrid R. dissimulans × idaeus. For R. onsalaënsis, we unexpectedly identify the Corylifolii ancestor as a previously unidentified species with a very restricted distribution in the northern part of the province of Halland, which is here described as R. antecedens. Furthermore, we show that R. pruinosus s. str. has arisen from the hybrid R. aureolus × idaeus and that it is known only from a rather restricted area in the provinces of Småland, Östergötland and Södermanland in eastern Sweden. On the other hand, the great majority of what has been called R. pruinosus is a diverse collection of primary hybrids between R. idaeus and various R. sect. Corylifolii species, which show a large variation both genetically and morphologically. The same applies to R. rosanthus, which represents R. norvegicus × idaeus hybrids: The microsatellite analysis shows that they have arisen independently and therefore should be considered as primary hybrids. We also identified primary hybrids between R. idaeus and R. gothicus (by far the most common hybrid in Sweden), R. aureolus, R. camptostachys, R. decurrentispinus, R. eluxatus, R. friesianus, R. hallandicus, R. lidforssii and R. norvegicus.
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| 27. |
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| 28. |
- Sveinsson, Olafur, et al.
(författare)
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Clinical risk factors in SUDEP : A nationwide population-based case-control study
- 2020
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Ingår i: Neurology. - 0028-3878 .- 1526-632X. ; 94:4, s. e419-e429
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: We conducted a nationwide case-control study in Sweden to test the hypothesis that specific clinical characteristics are associated with increased risk of sudden unexpected death in epilepsy (SUDEP).METHODS: The study included 255 SUDEP cases (definite and probable) and 1,148 matched controls. Clinical information was obtained from medical records and the National Patient Register. The association between SUDEP and potential risk factors was assessed by odds ratios (ORs) and 95% confidence intervals (CIs) and interaction assessed by attributable proportion due to interaction (AP).RESULTS: Experiencing generalized tonic-clonic seizures (GTCS) during the preceding year was associated with a 27-fold increased risk (OR 26.81, 95% CI 14.86-48.38), whereas no excess risk was seen in those with exclusively non-GTCS seizures (OR 1.15, 95% CI 0.54-48.38). The presence of nocturnal GTCS during the last year of observation was associated with a 15-fold risk (OR 15.31, 95% CI 9.57-24.47). Living alone was associated with a 5-fold increased risk of SUDEP (OR 5.01, 95% CI 2.93-8.57) and interaction analysis showed that the combination of not sharing a bedroom and having GTCS conferred an OR of 67.10 (95% CI 29.66-151.88), with AP estimated at 0.69 (CI 0.53-0.85). Among comorbid diseases, a previous diagnosis of substance abuse or alcohol dependence was associated with excess risk of SUDEP.CONCLUSIONS: Individuals with GTCS who sleep alone have a dramatically increased SUDEP risk. Our results indicate that 69% of SUDEP cases in patients who have GTCS and live alone could be prevented if the patients were not unattended at night or were free from GTCS.
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| 29. |
- Sveinsson, Olafur, et al.
(författare)
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Pharmacologic treatment and SUDEP risk : A nationwide, population-based, case-control study
- 2020
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Ingår i: Neurology. - 0028-3878 .- 1526-632X. ; 95:18, s. E2509-E2518
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Tidskriftsartikel (refereegranskat)abstract
- Objective We conducted a nationwide case–control study in Sweden to test the hypothesis that antiepileptic drugs (AEDs) mono- or polytherapy, adherence, antidepressants, neuroleptics, β-blockers, and statins are associated with sudden unexpected death in epilepsy (SUDEP) risk.Methods Included were 255 SUDEP cases and 1,148 matched controls. Information on clinical factors and medications came from medical records and the National Patient and Prescription Registers. The association between SUDEP and medications was assessed by odds ratios (ORs) with 95% confidence intervals (CIs) adjusted for potential risk factors including type of epilepsy, living conditions, comorbidity, and frequency of generalized tonic-clonic seizures (GTCS).Results Polytherapy, especially taking 3 or more AEDs, was associated with a substantially reduced risk of SUDEP (OR 0.31, 95% CI 0.14–0.67). Combinations including lamotrigine (OR 0.55, 95% CI 0.31–0.97), valproic acid (OR 0.53, 95% CI 0.29–0.98), and levetiracetam (OR 0.49, 95% CI 0.27–0.90) were associated with reduced risk. No specific AED was associated with increased risk. Regarding monotherapy, although numbers were limited, the lowest SUDEP risk was seen in users of levetiracetam (0.10, 95% CI 0.02–0.61). Having nonadherence mentioned in the medical record was associated with an OR of 2.75 (95% CI 1.58–4.78). Statin use was associated with a reduced SUDEP risk (OR 0.34, 95% CI 0.11–0.99) but selective serotonin reuptake inhibitor use was not.Conclusion These results provide support for the importance of medication adherence and intensified AED treatment for patients with poorly controlled GTCS in the effort to reduce SUDEP risk and suggest that comedication with statins may reduce risk.
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