| 1. |
- Hasselgren, Kristina, 1976-
(författare)
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Colorectal Liver Metastases – Different Aspects on Treatment with Associated Liver Partition and Portal Vein Ligation for Staged Hepatectomy and on Portal Vein Occlusion
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: For patients with colorectal liver metastases (CRLM), the only treatment with a possibility for long-term survival and cure is radical resection. The majority of patients are at the time of diagnosis not assessed as resectable because they have advanced disease in the liver or unresectable extrahepatic disease or are too frail to withstand liver surgery. Patients who at the time of diagnosis are not assessed as resectable may be treated with conversion chemotherapy to downsize the tumor burden and render the patient eligible for resection. One concern with chemotherapy administered preoperatively has been the potential negative effect on the future liver remnant (FLR), especially for patients with a low volume of the FLR who are undergoing techniques to increase the volume. Established techniques to increase the volume are portal vein occlusion (PVO) and two-staged hepatectomy (TSH). A more recent method is Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS). Due to the relative novelty of ALPPS, the long-term oncological results are not known. For patients with CRLM, resection of liver metastases is more favorable from a health economic perspective than palliative treatment and results in a higher quality of life than palliative chemotherapy. For patients undergoing ALPPS as well as TSH, the data are scarce. Aim: The aim of the first study was to determine whether preoperative chemotherapy has a negative impact on the volume increase for patients undergoing ALPPS. The aim of the second study was to analyze the temporal course of the volume increase in the FLR for patients undergoing PVO. The aim of the third study was to study the long-term outcome for patients randomized to ALPPS or TSH. The aim of the fourth study was to perform a health economic analysis of patients randomized to ALPPS or TSH. Methods: The first study was based on data from the ALPPS registry, which is an international registry initiated 2012. All patients included in the registry between 2012 and 2016 were included. The patients were divided into the following four groups: no preoperative chemotherapy, 1 regimen of neoadjuvant chemotherapy, more than 1 regimen, and more than 1 regimen with the addition of monoclonal antibodies. The volume increase between interventions 1 and 2 was analyzed. In the second study, a retrospective analysis was performed of patients randomized to TSH. Forty-eight patients were included. The volume increase of the FLR was analyzed as the kinetic growth rate (KGR). The KGR was calculated from PVO until radical hepatectomy or exclusion, as well as between the first and second radiological evaluations. In the third and fourth studies, patients randomized to ALPPS and TSH were included. In the third study, survival, as well as factors affecting the outcome, were analyzed. In the fourth study, a calculation of resource use was performed, as was an analysis of health-related quality of life (HRQoL) for the groups. Results: In the first study, it was found that chemotherapy had no negative impact on the volume increase for patients undergoing ALPPS. In the second study, it was found that the volume increase of the FLR was largest the first week after ALPPS. In the third study, it was found that patients randomized to ALPPS had a longer survival than those randomized to TSH. Of the factors affecting the outcome, resection of liver metastases had a significant impact. In the fourth study, no significant difference could be found in resource use or HRQoL for patients randomized to ALPPS over TSH. Conclusion: Patients with advanced CRLM undergoing ALPPS should receive preoperative chemotherapy, if indicated. For those undergoing PVO, early evaluation is crucial to evaluate the volume increase, and for those with insufficient increase, additional techniques to increase the volume should be considered. Resection of liver metastases is an important factor to improve the outcome. Further studies are warranted to conclude whether ALPPS or TSH is most effective from a health economic perspective.
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| 2. |
- Lindgren, Per, et al.
(författare)
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A Real-Time Semantics for the IEC 61499 standard
- 2015
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Ingår i: Proceedings of 2015 IEEE 20th International Conference on Emerging Technologies & Factory Automation (ETFA 2015). - Piscataway, NJ : IEEE Communications Society. - 9781467379298
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Konferensbidrag (refereegranskat)abstract
- The IEC 61499 standard provides an executable model for distributed control systems in terms of interacting function blocks. However, the current IEC 61499 standard lacks appropriate timing semantics for the specification of timing requirements, reasoning on timing properties at the model level, and for the timing verification of a specific deployment. In this paper we address this fundamental shortcoming by proposing Real-Time-4-FUN, a real-time semantics for IEC 61499. The key property is the preservation of non-determinism, allowing us to reason on (and verify) timing properties at the model level without assuming any specific scheduling policy or stipulating specific order of execution for the deployment. This provides for a clear separation of concerns, where the designer can focus on properties of the application prior to, and separately from, deployment verification. The proposed timing semantics is backwards compatible to the current standard, thus allow for reuse of existing designs. The transitional property allows timing requirements to propagate to downstream sub-systems, and can be utilized for scheduling both at device and network level. Based on a translation to RTFM-tasks and resources, IEC 61499 the models can be analyzed, compiled and executed. As a proof of concept the timing semantics has been experimentally implemented in the RTFM-core language and the accompanying (thread based) RTFM-RT run-time system.
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| 3. |
- Lindgren, Per, et al.
(författare)
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Abstract Timers and their Implementation onto the ARM Cortex-M family of MCUs
- 2016
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Ingår i: SIGBED Review. - : Association for Computing Machinery (ACM). - 1551-3688. ; 13:1
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Tidskriftsartikel (refereegranskat)abstract
- Real-Time For the Masses (RTFM) is a set of languages andtools being developed to facilitate embedded software developmentand provide highly ecient implementations gearedto static verication. The RTFM-kernel is an architecturedesigned to provide highly ecient and predicable Stack ResourcePolicy based scheduling, targeting bare metal (singlecore)platforms.We contribute by introducing a platform independent timerabstraction that relies on existing RTFM-kernel primitives.We develop two alternative implementations for the ARMCortex-M family of MCUs: a generic implementation, usingthe ARM dened SysTick/DWT hardware; and a targetspecic implementation, using the match compare/free runningtimers. While sacricing generality, the latter is moreexible and may reduce overall overhead. Invariants for correctnessare presented, and methods to static and run-timeverication are discussed. Overhead is bound and characterized.In both cases the critical section from release timeto dispatch is less than 2us on a 100MHz MCU. Queue andtimer mechanisms are directly implemented in the RTFMcorelanguage (-core in the following) and can be includedin system-wide scheduling analysis.
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| 4. |
- Lindgren, Per, et al.
(författare)
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End-to-End Response Time of 61499 Distributed Applications over Switched Ethernet
- 2017
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Ingår i: IEEE Transactions on Industrial Informatics. - : IEEE. - 1551-3203 .- 1941-0050. ; 13:1, s. 287-297
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Tidskriftsartikel (refereegranskat)abstract
- The IEC 61499 standard provides means to specify distributed control systems in terms of function blocks. For the deployment, each device may hold one or many logical resources, each consisting of a function block network with service interface blocks at the edges. The execution model is event driven (asynchronous), where triggering events may be associated with data (and seen as messages). In this paper, we propose a low complexity implementation technique allowing to assess end-to-end response times of event chains spanning over a set of networked devices. Based on a translation of IEC 61499 to RTFM1-tasks and resources, the response time for each task in the system at device-level can be derived using established scheduling techniques. In this paper, we develop a holistic method to provide safe end-to-end response times taking both intra- and inter-device delivery delays into account. The novelty of our approach is the accuracy of the system scheduling overhead characterization. While the device-level (RTFM) scheduling overhead was discussed in previous works, the network-level scheduling overhead for switched Ethernets is discussed in this paper. The approach is generally applicable to a wide range of COTS Ethernet switches without a need for expensive custom solutions to provide hard real-time performance. A behavior characterization of the utilized switch determines the guaranteed response times. As a use case, we study the implementation onto (single-core) ARMcortex based devices communicating over a switched Ethernet network. For the analysis, we define a generic switch model and an experimental setup allowing us to study the impact of network topology as well as 802.1Q quality of service in a mixed critical setting. Our results indicate that safe sub millisecond end-to-end response times can be obtained using the proposed approach.
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| 5. |
- Lindgren, Per, et al.
(författare)
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Real-Time Execution of Function Blocks for Internet of Things using the RTFM-kernel
- 2014
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Ingår i: Proceedings of 2014 IEEE 19th International Conference on Emerging Technologies & Factory Automation (ETFA 2014). - Piscataway, NJ : IEEE Communications Society. - 9781612849690 ; , s. 1-6
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Konferensbidrag (refereegranskat)abstract
- Function Blocks provides a means to model andprogram industrial control systems. The recently acclaimed IEC61499 standard allows such system models to be partitioned andexecuted in a distributed fashion. At device level, such models aretraditionally implemented onto programmable logic controllersthat underneath have an operating system and a softwarerun-time environment which implies high resource demands.However, there is a current trend to involve small embeddedsystems (so called Internet of Things devices) integrated into suchdistributed control systems. To this end, we seek to address theoutsets for real-time execution of Function Block based designsonto light-weight controllers (MCUs) with limited resources(memory and CPU). Furthermore, we propose a mapping ofthe Function Block execution semantics onto the RTFM-kernel,and discuss opportunities for off-line (design time) analysis withrespect to response time, overall schedulability and memoryrequirements.
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| 6. |
- Lindgren, Per, et al.
(författare)
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Response Time for IEC 61499 over Ethernet
- 2015
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Ingår i: IEEE International Conference on Industrial Informatics. - Piscataway, NJ : IEEE Communications Society. - 9781479966493 ; , s. 1206-1212
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Konferensbidrag (refereegranskat)abstract
- The IEC 61499 standard provides means to specify distributed control systems in terms of function blocks. For the deployment, each device may hold one or many logical resources, each consisting of a function block network with service interface blocks at the edges. The execution model is event driven (asynchronous), where triggering events may be associated with data (and seen as a message). In this paper we propose a low complexity implementation technique allowing to asses end-to-end response time of event chains spanning a networked devices. Based on a translation of IEC 61499 to RTFM-tasks and resources, the response time for each task in the system can be derived using established scheduling techniques. In this paper we develop a method to provide safe end-to-end response time taking both intra- and inter-device delivery delays into account. As a use case we study the implementation onto (single-core) ARMcortex based devices communicating over a switched Ethernet network. For the analysis we define a generic switch model, and an experimental setup allowing us to study the impact of network topology as well as 802.1Q quality of service in a mixed critical setting. Our results indicate that safe sub milli-second end-to-end response times can be obtained using the proposed approach.
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| 7. |
- Lindgren, Per, et al.
(författare)
-
RTFM-4-FUN
- 2014
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Ingår i: 2014 9th IEEE International Symposium on Industrial Embedded Systems (SIES 2014). - Piscataway, NJ : IEEE Communications Society.
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Konferensbidrag (refereegranskat)abstract
- Function Blocks provides a means to model andprogram industrial control systems. The recently acclaimed IEC61499 standard allows such system models to be partitioned andexecuted in a distributed fashion. At device level, such models aretraditionally implemented onto programmable logic controllersand industrial PCs. In this paper, we discuss work in progresson developing a mapping allowing to implement a subset of IEC61499 models onto light-weight embedded devices (MCUs). Wepropose and detail an event semantics, and its mapping to thenotions of tasks and resources for Stack Resource Policy basedanalysis and scheduling. Moreover, we show how the proposedmapping can be efficiently implemented under the RTFM-kernel.Finally we outline a prototype tool-chain and discuss related,ongoing and future work.
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| 8. |
- Lindgren, Per, et al.
(författare)
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RTFM-core : Language and Implementation
- 2015
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Ingår i: 2015 IEEE 10th Conference on Industrial Electronics and Applications (ICIEA). - Piscataway, NJ : IEEE Communications Society. - 9781479983896 ; , s. 990-995
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Konferensbidrag (refereegranskat)abstract
- Robustness, real-time properties and resource efficiency are key properties to embedded devices of the CPS/IoT era. In this paper we propose a language approach RTFMcore, and show its potential to facilitate the development process and provide highly efficient and statically verifiable implementations. Our programming model is reactive, based on the familiar notions of concurrent tasks and (single-unit) resources. The language is kept minimalistic, capturing the static task, communication and resource structure of the system. Whereas C-source can be arbitrarily embedded in the model, and/or externally referenced, the instep to mainstream development is minimal, and a smooth transition of legacy code is possible. A prototype compiler implementation for RTFM-core is presented. The compiler generates C-code output that compiled together withtheRTFM-kernelprimitivesrunsonbaremetal.TheRTFMkernel guarantees deadlock-lock free execution and efficiently exploits the underlying interrupt hardware for static priority scheduling and resource management under the Stack Resource Policy. This allows a plethora of well-known methods to static verification (response time analysis, stack memory analysis, etc.) to be readily applied. The proposed language and supporting tool-chain is demonstrated by showing the complete process from RTFM-core source code into bare metal executables for a lightweight ARM-Cortex M3 target.
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| 9. |
- Lindgren, Per, et al.
(författare)
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Well formed Control-flow for Critical Sections in RTFM-core
- 2015
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Ingår i: IEEE International Conference on Industrial Informatics. - Piscataway, NJ : IEEE Communications Society. - 9781479966493 ; , s. 1438-1445
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Konferensbidrag (refereegranskat)abstract
- The mainstream of embedded software development as of today is dominated by C programming. To aid the development, hardware abstractions, libraries, kernels and lightweight operating systems are commonplace. Such kernels and operating systems typically impose a thread based abstraction to concurrency. However, in general thread based programming is hard, plagued by hazards of race conditions and dead-locks. For this paper we take an alternative outset in terms of a language abstraction, RTFM-core, where the system is modelled directly in terms of tasks and resources. In compliance to the Stack Resource Policy (SRP) model, the language enforces (well formed) LIFO nesting of claimed resources, thus SRP based analysis and scheduling can be readily applied. For the execution onto bare-metal single core architectures, the rtfm-core compiler performs SRP analysis on the model, and render an executable that is deadlock free and (through RTFM-kernel primitives) exploits the underlying interrupt hardware for efficient scheduling. The RTFM-core language embeds C-code and links to C-object files and libraries, and is thus applicable to the mainstream of embedded development. However, while the language enforces well formed resource management, control flow in the embedded C-code may violate the LIFO nesting requirement, thus correctness is left with the programmer to ensure well formed nesting (through restricted control flow). In this paper we address this issue by lifting a subset of C into the RTFM-core language allowing arbitrary control flow at the model level. In this way well formed LIFO nesting can be enforced, and models ensured to be correct by construction. We demonstrate the feasibility trough a prototype implementation in the rtfm-core compiler. Additionally, we develop a set of running examples, and show in detail how control flow is handled at compile time and during run-time execution.
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| 10. |
- Lindner, Andreas, et al.
(författare)
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RTFM-RT: a threaded runtime for RTFM-core towards execution of IEC 61499
- 2015
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Ingår i: Proceedings of 2015 IEEE 20th International Conference on Emerging Technologies & Factory Automation (ETFA 2015). - Piscataway, NJ : IEEE Communications Society. - 9781467379298
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Konferensbidrag (refereegranskat)abstract
- The IEC 61449 standard provides an outset for designing and deploying distributed control systems. Recently, a mapping from IEC 61499 to the RTFM-kernel API has been presented. This allows predictable real-time execution of IEC 61499 applications on light-weight single-core platforms. However, integrating the RTFM-kernel (bare-metal runtime) into potential deployments requires developing device drivers, protocol stacks, and the like. For this presentation, we apply the mapping from IEC 61499 to the RTFM-MoC task and resource modelimplementedbytheRTFM-corelanguage.Thecompilation from RTFM-core can be targeted to both, RTFM-kernel and the introduced runtime system RTFM-RT. In this paper, we detail thegenericRTFM-RTruntimearchitecture,whichallowsRTFMcore programs to be executed on top of thread based environments. Furthermore, we discuss our implementation regarding scheduling specifics of Win32 threads (Windows) and Pthreads (Linux and Mac OS X). Using our RTFM-RT implementation for deployment,predictableIEC61499executiontogetherwithaccess to abovementioned operating system functions are achieved. For further developments, we discuss the needed scheduling options to achieve hard real-time and analysis required to eliminate deadlocks.
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| 11. |
- Lindner, Marcus, et al.
(författare)
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RTFM-core : Course in Compiler Construction
- 2014
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Ingår i: Proceedings of the WESE'14. - New York : ACM Digital Library. - 9781450330909
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Konferensbidrag (refereegranskat)abstract
- The course in Compiler Construction is part of the ComputerScience second cycle curriculum at Lulea Universityof Technology (LTU). Starting this year, the course is nowto be given by the Embedded Systems group at LTU. Thispaper outlines the course syllabus, and its relation to CPS/IoT and embedded systems in general. In particular, thecourse will now introduce domain specic language designwith the outset from the RTFM-core language. Studentswill be exposed to design choices for the language, spanningfrom programming model, compiler design issues, backendtools and even run-time environments. The intention is togive a holistic perspective, and motivate the use of compilationtechniques towards robust, ecient and veriable (embedded)software. Of course, developing basic skills will notbe overlooked, and as part of the laboratory assignments,students will extend the minimalistic Object Oriented languageRTFM-cOOre and develop the compiler accordinglytargeting the RTFM-core language as an intermediate representation.As the RTFM-core/-cOOre compilers are implementedunder OCaml/Menhir, the students will be exposedto the advantages of functional languages in the contextof compiler construction. However, for their own developmentthey may choose alternative design tools and languages(such as ANTLR/Java). This will give us the opportunityto review and correlate achievements and eciencyto the choice of tools and languages and be an outset forfuture course development.
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| 12. |
- Lindner, Marcus, et al.
(författare)
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RTFM-core : course in compiler construction
- 2016
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Ingår i: The SIGBED Review. - : Association for Computing Machinery (ACM). - 1551-3688. ; 14:1, s. 29-36
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Tidskriftsartikel (refereegranskat)abstract
- The course in Compiler Construction is part of the Computer Science masters program at Luleå University of Technology (LTU). Since the fall of 2014, the course is given by the Embedded Systems group. This paper outlines the course syllabus and its relation to CPS/IoT and embedded systems in general. In particular, the course introduces domain specific language design with the outset from the imperative RTFM-core language. Students are exposed to design choices for the language, spanning from programming model, compiler design issues, back-end tools, and even runtime environments. The intention is to give a holistic perspective and motivate the use of compilation techniques towards robust, efficient, and verifiable (embedded) software. Of course, developing basic skills is not overlooked and as part of the laboratory assignments, students extend the min-imalistic Object Oriented language RTFM-cOOre and develop the compiler accordingly targeting the RTFM-core language as an intermediate representation. As the RTFM-core/-cOOre compilers are implemented using OCaml/Men-hir, the students are also exposed to functional languages and to their advantages in the context of compiler construction. However, for their own development they may choose alternative design tools and languages. This gives us the opportunity to review and correlate achievements and efficiency to the choice of tools and languages and it is an outset for future course development.
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| 13. |
- Lindner, Marcus, et al.
(författare)
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Safe tasks : run time verification of the RTFM-lang model of computation
- 2016
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Ingår i: 2016 IEEE 21st International Conference on Emerging Technologies and Factory Automation (ETFA). - Piscataway, NJ : IEEE conference proceedings. - 9781509013142 - 9781509013135
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Konferensbidrag (refereegranskat)abstract
- Embedded systems for critical applications are typicallyspecified with requirements on predictable timing andsafety. While ensuring predictable timing, the RTFM-lang (Real-Time For the Masses) model of computation (MoC) currentlylacks memory access protection among real-time tasks. In thispaper, we discuss how to safely verify task execution given aspecification using the RTFM-MoC. Furthermore, an extensionto the RTFM-core infrastructure is outlined and tested with usecases of embedded development. We propose a method for runtime verification exploiting memory protection hardware. Forthis purpose, we introduce memory resources to the declarativelanguage RTFM-core allowing compliance checks. As a proofof concept, compiler support for model analysis and automaticgeneration of run time verification code is implemented togetherwith an isolation layer for the RTFM-kernel. With this verificationfoundation, functional run time checks as well as furtheroverhead assessments are future research questions.
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| 14. |
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| 15. |
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| 16. |
- Aparicio Rivera, Jorge, et al.
(författare)
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Heapless : Dynamic Data Structures without Dynamic Heap Allocator for Rust
- 2018
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Ingår i: 2018 IEEE 16TH INTERNATIONAL CONFERENCE ON INDUSTRIAL INFORMATICS (INDIN). - Piscataway, NJ : IEEE. - 9781538648292 ; , s. 87-94
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Konferensbidrag (refereegranskat)abstract
- Dynamic memory management is typically implemented using a global memory allocator, which may negatively impact the performance, reliability, and predictability of a program; in effect standards around safety-critical applications often discourage or even disallow dynamic memory management. This paper presents heapless, a collection of dynamic data structures (for vectors, strings, and circular buffers) that can be either stack or statically allocated, thus free of global allocator dependencies. The proposed data structures for vectors and strings closely mimic the Rust standard library implementations while adding support to gracefully handling cases of capacity exceedance. Our circular buffers act as queues and allowing channel like usage (by splitting). The Rust memory model together with the ability of local reasoning on memory requirements (brought by heapless) facilitates establishing robustness/safety guarantees and minimize attack surfaces of (industrial) IoT systems. We show that the heapless data structures are highly efficient and have predictable performance, thus suitable for hard real-time applications. Moreover, in our implementation heapless data structures are non-relocatable allowing mapping to hardware, useful, e.g., to DMA transfers. The feasibility, performance, and advantages of heapless are demonstrated by implementing a JSON serialization and de-serialization library for an ARM Cortex-M based IoT platform.
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| 17. |
- Axelsson, Matthias, et al.
(författare)
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Long and Short-Term Effects of Hypothermic Machine Perfusion vs. Cold Storage on Transplanted Kidneys from Expanded Criteria Donors-A Matched Comparison Study
- 2023
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Ingår i: JOURNAL OF CLINICAL MEDICINE. - 2077-0383. ; 12:17
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Tidskriftsartikel (refereegranskat)abstract
- Hypothermic machine perfusion (HMP) has been shown to reduce delayed graft function (DGF)-rates in kidneys from expanded criteria donors (ECD) and may increase graft survival compared with static cold storage (SCS). This single-center, retrospective observational study aimed to evaluate this effect. The primary endpoint was the DGF-rate, defined as the use of dialysis in the first postoperative week, excluding the first 24 h. The main secondary endpoint was graft survival at 5 years. Recipients of ECD-kidneys between 2013 and 2021 with =2 grafts were included (n = 438). The SCS-kidneys were marginal-matched by propensity score to the HMP-group for donor age, cold ischemia time, and graft number. Multivariable adjusted analysis for confounders in the unmatched cohort and caliper-based ID-matching constituted sensitivity analyses. HMP showed a trend to lower DGF-rate in the marginal-matched comparison (9.2% vs. 16.1%, p = 0.063). This was strengthened by a significant benefit observed for HMP in both the sensitivity analyses: an adjusted OR of 0.45 (95% CI: 0.24; 0.84; p = 0.012) in the multivariable analysis and DGF-rate of 8.7% vs. 17.4% (p = 0.024) after ID-matching. The 5-year graft survival rate was >90% in both groups, with no benefit using HMP (HR = 0.79; 95% CI:0.39-1.16; p = 0.52). Our results suggest that HMP may be effective in decreasing DGF-rates, however, without any significant benefit in graft survival.
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| 18. |
- Ben-Shabat, Ilan, et al.
(författare)
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Isolated hepatic perfusion as a treatment for liver metastases of uveal melanoma.
- 2015
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Ingår i: Journal of visualized experiments : JoVE. - : MyJove Corporation. - 1940-087X. ; :95
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Tidskriftsartikel (refereegranskat)abstract
- Isolated hepatic perfusion (IHP) is a procedure where the liver is surgically isolated and perfused with a high concentration of the chemotherapeutic agent melphalan. Briefly, the procedure starts with the setup of a percutaneous veno-venous bypass from the femoral vein to the external jugular vein. Via a laparotomy, catheters are then inserted into the proper hepatic artery and the caval vein. The portal vein and the caval vein, both supra- and infrahepatically, are then clamped. The arterial and venous catheters are connected to a heart lung machine and the liver is perfused with melphalan (1 mg/kg body weight) for 60 min. This way it is possible to locally perfuse the liver with a high dose of a chemotherapeutic agent, without leakage to the systemic circulation. In previous studies including patients with isolated liver metastases of uveal melanoma, an overall response rate of 33-100% and a median survival between 9 and 13 months, have been reported. The aim of this protocol is to give a clear description of how to perform the procedure and to discuss IHP as a treatment option for liver metastases of uveal melanoma.
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| 19. |
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| 20. |
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| 21. |
- Carlbring, Per, et al.
(författare)
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Behavioral Activation vs. Physical Exercise in the Treatment of Mild to Moderate Depression
- 2015
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Despite their potential as low-threshold, low-cost and high-flexibility treatments of depression, behavioral activation and physical exercise have not yet been directly compared. This study has examined the effects of these interventions, administered via the Internet. In this randomized controlled trial a total of 312 participants meeting the diagnostic criteria for mild to moderate major depression, recruited in multiple cycles and randomized to either a waiting list control group with delayed treatment, or one of the four active treatment groups: (1) physical exercise without a clear psychological treatment rationale; (2) physical exercise with a psychological treatment rationale; (3) behavioral activation a la Lewinsohn; or (4) behavioral activation a la Martel. A total of 72% were women and the average age of the participants were M=42.3 years (SD=13,5). More than half (53,9%) had a history of previous psychological treatment. Primary outcome measure was the 9-item Patient Health Questionnaire. Assessments were made on a weekly basis for the full duration of the acute treatment which was 12 weeks. The preliminary results are in line with previous online studies showing that all active treatment groups were superior to the waitlist (large effect sizes) and that only minor differences could be identified between the four active groups (large within effect sizes). At the time of the conference 6-month follow-up data will be available in addition to the already collected post-assessment data (analyzed according to the intention-to-treat principle).
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| 22. |
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| 23. |
- Carlbring, Per, et al.
(författare)
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In session virtual reality use for public speaking anxiety : A randomized controlled trial
- 2017
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Konferensbidrag (refereegranskat)abstract
- Fear of public speaking is common and for some individuals this interferes significantly with the person's life and causes marked distress. We wanted to test a newly developed virtual reality assisted 1-session in-person treatment (3 hours). The therapist guided session consisted of a series of behavioral experiments based on the expectancy violation principle. This was followed by a 4-week booster intervention delivered via the internet. Following a diagnostic interview a total of 50 individuals with a score of ≥ 60 on the Personal Report of Public Speaking Anxiety questionnaire were randomized to a treatment or a control condition. A total of 78% also met criteria for social anxiety disorder. Considering only having had one treatment session in-person the preliminary results were promising with a between group effect size on the primary outcome (Public Speaking Anxiety Scale) of Cohen’s d=1.32 before commencing the internet-based booster program. Four weeks later the between-group effect size was d=1.90. However, on the secondary outcome measures the effect sizes were more often moderate than large. At the time of the conference 6-month follow-up data will be available in addition to the already collected post-assessment data (analyzed according to the intention-to-treat principle).
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| 24. |
- Carlbring, Per, et al.
(författare)
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ITSY : A Gamified One-Session Virtual Reality App With 12-Month Follow-Up Data
- 2017
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Ingår i: Program Book. ; , s. 396-396
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Konferensbidrag (refereegranskat)abstract
- Introduction: This is the first large randomized-controlled trial to evaluate whether commercially available VR hardware and software can be used for exposure therapy. The aim of this study was to compare gold-standard One Session Therapy (OST) for reduction of spider phobia symptoms and avoidance behavior using in vivo spiders and a human therapist, to a newly developed single-session gamified Virtual Reality Exposure Therapy (VRET) application with modern, consumer-available VR hardware, virtual spiders, and a virtual therapist.Method: Subjects (N=100) with spider phobia, diagnosed, and meeting inclusion criteria were recruited from the general population and randomized to 2 treatment arms. In 1-week intervals, pre-measurement, 3-hr treatment and post-measurement were completed with an in-vivo behavioral approach test (BAT) serving as the primary outcome measure for both groups. This study was powered to detect a non-inferiority margin of a 2-point between-group difference on the BAT, with a standard deviation of 4 (at 80% power).Results: 98 patients commenced treatment and 97 patients completed post-measurement. Per protocol analysis indicated VR was not non-inferior to OST. Repeated-measures ANOVA identified a significant main effect of time (p < .001) and time x group effect (p < .05). Both OST and VR participants experienced large BAT within-group effect sizes (d=2.28 and d=1.45, respectively). By the time of the conference there will be 12-month follow-up data including prediction analysis and the effect of treatment credibility and working alliance (with the virtual therapist).Conclusion: OST is the superior treatment option for spider phobia. VRET is an effective alternative if OST cannot be provided, as pure self-help, as the initial intervention in a stepped-care model, or as a possible post-OST booster.
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| 25. |
- Carlbring, Per, et al.
(författare)
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The effects of a 12-week relapse prevention program following acute depression treatment : A randomised controlled trial
- 2019
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Konferensbidrag (refereegranskat)abstract
- Context: Depression can be effectively treated using internet interventions. However, the relapse rate is non-ignorable. Methods: 286 participants were randomized to an additional relapse prevention program or a control group. Monthly telephone calls using the MINI diagnostic interview as well as online assessments were carried out for 24 months. Intervention: Standard cognitive behaviour therapy via the internet without guidance. Results: Relapse rates of 27.1% and 22.0% were reported in the relapse prevention program group and the control group respectively. A log-rank test of the Kaplan-Meier model did not show any significant difference between the prevention program group and the control group (χ2(1) = 0.87; p = .352) in terms of relapse rates. At the one-year follow-up, 79.2% in the prevention program group and 82.9% of the participants in the control group had PHQ-9 scores indicating them to be in remission. By the second-year follow-up the rate of remission was 75.8% in the relapse prevention program group and 81.2% in the control group. No significant differences could be seen neither at the one-year follow-up (χ2(1) = 0.36; p = .552) nor the two-year follow-up (χ2(1) = 0.53; p = .467). Conclusions: Don’t do it!
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| 26. |
- Carlbring, Per, et al.
(författare)
-
The effects on depression of Internet-administered behavioral activation vs. physical exercise
- 2015
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Despite their potential as low-threshold, low-cost and high-flexibility treatments of depression, behavioral activation and physical exercise have not yet been directly compared. This study has examined the effects of these interventions, administered via the Internet. In this randomized controlled trial a total of 312 participants meeting the diagnostic criteria for mild to moderate major depression, recruited in multiple cycles and randomized to either a waiting list control group with delayed treatment, or one of the four active treatment groups: (1) physical exercise without a clear psychological treatment rationale; (2) physical exercise with a psychological treatment rationale; (3)behavioral activation a la Lewinsohn; or (4) behavioral activation a la Martel. A total of 72% were women and the average age of the participants were M=42.3 years (SD=13,5). More than half (53,9%) had a history of previous psychological treatment. Primary outcome measure was the 9-item Patient Health Questionnaire. Assessments were made on a weekly basis for the full duration of the acute treatment which was 12 weeks. The preliminary results are in line with previous online studies showing that all active treatment groups were superior to the waitlist (large effect sizes) and that only minor differences could be identified between the four active groups (large within effect sizes). At the time of the conference 6-month follow-up data will be available in addition to the already collected post-assessment data (analyzed according to the intention-to-treat principle).
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| 27. |
- Carlbring, Per, et al.
(författare)
-
The effects on depression of Internet-administered behavioural activation and physical exercise with treatment rationale and relapse prevention : study protocol for a randomised controlled trial
- 2013
-
Ingår i: Trials. - : Springer Science and Business Media LLC. - 1745-6215. ; 14, s. 35-
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Despite their potential as low-threshold, low-cost and high-flexibility treatments of depression, behavioural activation and physical exercise have not yet been directly compared. This study will examine the effects of these interventions, administered via the Internet. The added effect of providing a treatment rationale will also be studied, as well as a relapse prevention program featuring cognitive behavioural therapy components.Methods/Design: This randomised controlled trial will include 500 participants meeting the diagnostic criteria for major depression, recruited in multiple cycles and randomised to either a waiting list control group with delayed treatment, or one of the four treatment groups: (1) physical exercise without a clear treatment rationale; (2) physical exercise with treatment rationale; (3) behavioural activation with treatment rationale; or (4) behavioural activation without a clear treatment rationale. Post treatment, half of the participants will be offered a relapse prevention program. Primary outcome measure will be the Patient Health Questionnaire 9-item. Secondary measures include diagnostic criteria for depression, as well as self-reported anxiety, physical activity and quality of life. Measurements - done via telephone and the Internet - will be collected pre-treatment, weekly during treatment period, immediately post treatment and then monthly during a 24-month follow-up period.Discussion: The results of this study will constitute an important contribution to the body of knowledge of the respective interventions. Limitations are discussed.
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| 28. |
- Carlbring, Per, et al.
(författare)
-
The efficacy of internet-based virtual reality exposure therapy for public speaking anxiety : A randomized controlled trial
- 2017
-
Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Fear of public speaking is common and for some individuals this interferes significantly with the person's life and causes marked distress. We wanted to test a newly developed virtual reality assisted 1-session in-person treatment (3 hours). The therapist guided session consisted of a series of behavioral experiments based on the expectancy violation principle. This was followed by a 4-week booster intervention delivered via the internet. Following a diagnostic interview a total of 50 individuals with a score of ≥ 60 on the Personal Report of Public Speaking Anxiety questionnaire were randomized to a treatment or a control condition. A total of 78% also met criteria for social anxiety disorder. Considering only having had one treatment session in-person the preliminary results were promising with a between group effect size on the primary outcome (Public Speaking Anxiety Scale) of Cohen’s d=1.32 before commencing the internet-based booster program. Four weeks later the between-group effect size was d=1.90. However, on the secondary outcome measures the effect sizes were more often moderate than large. At the time of the conference 6-month follow-up data will be available in addition to the already collected post-assessment data (analyzed according to the intention-to-treat principle).
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| 29. |
- Carlbring, Per, et al.
(författare)
-
The relative effects of behavioral activation vs. physical exercise in the treatment of mild to moderate depression
- 2016
-
Konferensbidrag (refereegranskat)abstract
- Aim: Despite their potential as low-threshold, low-cost and high-flexibility treatments of depression, behavioral activation and physical exercise have not yet been directly compared. This study has examined the effects of these interventions, administered via the Internet.Method: In this randomized controlled trial a total of 312 participants meeting the diagnostic criteria for mild to moderate major depression, recruited in multiple cycles and randomized to either a waiting list control group with delayed treatment, or one of the four active treatment groups: (1) physical exercise without a clear psychological treatment rationale; (2) physical exercise with a psychological treatment rationale; (3) behavioral activation a la Lewinsohn; or (4) behavioral activation a la Martel.Results: A total of 72% were women and the average age of the participants were M=42.3 years (SD=13,5). More than half (53,9%) had a history of previous psychological treatment. Primary outcome measure was the 9-item Patient Health Questionnaire. Assessments were made on a weekly basis for the full duration of the acute treatment which was 12 weeks.Conclusion: The preliminary results are in line with previous online studies showing that all active treatment groups were superior to the waitlist (large effect sizes) and that only minor differences could be identified between the four active groups (large within effect sizes). At the time of the conference 6-month follow-up data will be available in addition to the already collected post- assessment data (analyzed according to the intention-to-treat principle).
|
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| 30. |
- Carlbring, Per, et al.
(författare)
-
Therapist and Internet Administered One-Session Virtual Reality Exposure Therapy for Public Speaking Anxiety : A Randomized Controlled Trial
- 2018
-
Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Fear of public speaking is common and for some individuals this interferes significantly with the person's life and causes marked distress. We wanted to test a newly developed virtual reality assisted 1-session in-person treatment (3 hours). The therapist guided session consisted of a series of behavioral experiments based on the expectancy violation principle. This was followed by a 4-week booster intervention delivered via the internet. Following a diagnostic interview a total of 50 individuals with a score of ≥ 60 on the Personal Report of Public Speaking Anxiety questionnaire were randomized to a treatment or a control condition. A total of 78% also met criteria for social anxiety disorder. Considering only having had one treatment session in-person the preliminary results were promising with a between group effect size on the primary outcome (Public Speaking Anxiety Scale) of Cohen’s d=1.32 before commencing the internet-based booster program. Four weeks later the between-group effect size was d=1.90. However, on the secondary outcome measures the effect sizes were more often moderate than large. At the time of the conference 6-month follow-up data will be available in addition to the already collected post-assessment data (analyzed according to the intention-to-treat principle).
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| 31. |
- Carlbring, Per, et al.
(författare)
-
Unified protocol vs. diagnostic specific treatment of social anxiety : a randomized treatment study with a factorial design
- 2018
-
Ingår i: Scientific Programme.
-
Konferensbidrag (refereegranskat)abstract
- Traditionally, Cognitive Behavior Therapy researchers have developed and tested diagnostic specific treatment manuals. Most of which are efficacious. However, since comorbidity between anxiety and mood disorders is common and as the choice of the best suited treatment manual for each patient can be hard when delivering the treatment via the internet, transdiagnostic interventions have been put forward.The purpose of this study was to compare the effect of unified protocol vs. diagnostic specific treatment in a group of 147 individuals with social anxiety. The score on Liebowitz Social Anxiety Scale at pre-treatment was M=52.7.The interventions were both delivered via the internet during 9 weeks. In addition, the relative effect of no guidance vs. guidance on demand was investigated in a factorial design with 25 % of the patients randomized into each of the four groups. The preliminary results at week 9 show large within group effects (average Cohen’s d = 1,03), but no significant between-group differences as measured with the self-report MINI-SPIN-R and OASIS/ODSIS.At the time of the conference 6-month follow-up data will be available in addition to the already collected post-assessment data (analyzed according to the intention-to-treat principle).
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| 32. |
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| 33. |
- De Angelis, A., et al.
(författare)
-
Science with e-ASTROGAM A space mission for MeV-GeV gamma-ray astrophysics
- 2018
-
Ingår i: Journal of High Energy Astrophysics. - : Elsevier. - 2214-4048 .- 2214-4056. ; 19, s. 1-106
-
Tidskriftsartikel (refereegranskat)abstract
- e-ASTROGAM ('enhanced ASTROGAM') is a breakthrough Observatory space mission, with a detector composed by a Silicon tracker, a calorimeter, and an anticoincidence system, dedicated to the study of the non-thermal Universe in the photon energy range from 0.3 MeV to 3 GeV - the lower energy limit can be pushed to energies as low as 150 keV for the tracker, and to 30 keV for calorimetric detection. The mission is based on an advanced space-proven detector technology, with unprecedented sensitivity, angular and energy resolution, combined with polarimetric capability. Thanks to its performance in the MeV-GeV domain, substantially improving its predecessors, e-ASTROGAM will open a new window on the non-thermal Universe, making pioneering observations of the most powerful Galactic and extragalactic sources, elucidating the nature of their relativistic outflows and their effects on the surroundings. With a line sensitivity in the MeV energy range one to two orders of magnitude better than previous generation instruments, e-ASTROGAM will determine the origin of key isotopes fundamental for the understanding of supernova explosion and the chemical evolution of our Galaxy. The mission will provide unique data of significant interest to a broad astronomical community, complementary to powerful observatories such as LIGO-Virgo-GEO600-KAGRA, SKA, ALMA, E-ELT, TMT, LSST, JWST, Athena, CTA, IceCube, KM3NeT, and LISA.
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| 34. |
- Ekberg, Jana, 1964, et al.
(författare)
-
A Randomized Controlled Trial on Safety of Steroid Avoidance in Immunologically Low-Risk Kidney Transplant Recipients
- 2022
-
Ingår i: Kidney International Reports. - : Elsevier BV. - 2468-0249. ; 7:2, s. 259-269
-
Tidskriftsartikel (refereegranskat)abstract
- Introduction: Steroid-based immunosuppression after transplantation increases the risk of post-transplant diabetes mellitus (PTDM), with adverse effects on patient and graft survival. In the SAILOR study, we investigated the safety and efficacy of complete steroid avoidance in immunologically low-risk kidney recipients without diabetes on the current standard-of-care maintenance regimen with tacrolimus/mycophenolate mofetil (MMF). Methods: In this 2-year, multicenter, open-label trial, a total of 222 patients were randomized to receive either steroid avoidance protocol (tacrolimus/MMF/antithymocyte globulin [ATG] induction [n = 113]) or steroid maintenance protocol (tacrolimus/MMF/prednisolone/basiliximab-induction [n = 109]). Results: At 1 year, no significant differences were found between steroid avoidance and steroid maintenance arms in the incidence of PTDM, the primary end point (12.4% vs. 18.3%, respectively, P = 0.30, CI: 16.3–4.4), or in overall biopsy-proven rejections (15% vs. 13.8%, respectively, P = 0.85). At 2 years, the composite end point of freedom from acute rejection, graft loss, and death (81% vs. 85%, respectively, P = 0.4), kidney function, or adverse events was comparable between the 2 arms. Moreover, 63.9% of the patients in the steroid avoidance arm remained free from steroids at 2 years. Conclusion: The SAILOR study provides further evidence for the feasibility, safety, and efficacy of early steroid-free treatment at 2 years in immunologically low-risk kidney recipients with tacrolimus/MMF maintenance regimen. © 2021 International Society of Nephrology
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| 35. |
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| 36. |
- Ekman, Jonas, et al.
(författare)
-
Projekt: Frekvensomriktares funktion i beredskapskritiska system
- 2014
-
Annan publikation (populärvet., debatt m.m.)abstract
- Vid dödnätstart av produktionsanläggningar och drift av svaga nät eller ö-drift är frekvensomriktare som driver pumpar och fläktar kritiska komponenter. Om frekvensomriktare påverkas av störningar i nätet kan elproduktion kopplas bort och det svaga nätet eller ö-driften kollapsa. Projektet ska studera frekvensomriktare ur ett antal aspekter såsom uppbyggnad, styrning och implementering i syfte att utveckla mer robusta frekvensomriktare och implementering av dessa för att säkerställa drift av svaga nät och ö-drift och minimera ytterligare driftstörningar vid svåra påfrestningar på elnätet.
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| 37. |
- Eldh, Maria, 1980, et al.
(författare)
-
MicroRNA in exosomes isolated directly from the liver circulation in patients with metastatic uveal melanoma
- 2014
-
Ingår i: BMC Cancer. - London : Springer Science and Business Media LLC. - 1471-2407. ; 14
-
Tidskriftsartikel (refereegranskat)abstract
- Uveal melanoma is a tumour arising from melanocytes of the eye, and 30 per cent of these patients develop liver metastases. Exosomes are small RNA containing nano-vesicles released by most cells, including malignant melanoma cells. This clinical translational study included patients undergoing isolated hepatic perfusion (IHP) for metastatic uveal melanoma, from whom exosomes were isolated directly from liver perfusates. The objective was to determine whether exosomes are present in the liver circulation, and to ascertain whether these may originate from melanoma cells.
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| 38. |
- Erlandsson, H., et al.
(författare)
-
Observational study of risk factors associated with clinical outcome among elderly kidney transplant recipients in Sweden - a decade of follow-up
- 2021
-
Ingår i: Transplant International. - : Frontiers Media SA. - 0934-0874 .- 1432-2277. ; 34:11, s. 2363-2370
-
Tidskriftsartikel (refereegranskat)abstract
- Kidney transplantation (Ktx) in elderly has become increasingly accepted worldwide despite their higher burden of comorbidities. We investigated important risk factors affecting long-term patient and graft survival. We included all (n = 747) Ktx patients >60 years from 2000 to 2012 in Sweden. Patients were age-stratified, 60-64, 65-69 and >70 years. Follow-up time was up to 10 years (median 7.9 years, 75% percentile >10 years). Primary outcome was 10-year patient survival in age-stratified groups. Secondary outcomes were 5-year patient and graft survival in age-stratified groups and the impact of risk factors including Charlson comorbidity index (CCI) on patient and graft survival. Mortality was higher in patients >70 years, after 10 years (HR 1.94; 95% CI 1.24-3.04; P = 0.004). Males had a higher 10-year risk of death (HR 1.39; CI 95% 1.04-1.86; P = 0.024). Five-year patient survival did not differ between age groups. In multivariate Cox analysis (n = 500), hazard ratio for 10-year mortality was 4.6 in patients with CCI >= 7 vs. <4 (95% CI 2.42-8.62; P = 0.0001). Higher CCI identified ESKD patients with 4.6 times higher risk of death after Ktx. We suggest that this index should be used as a part of the preoperative evaluation in elderly.
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| 39. |
- Fagernäs, Simon, et al.
(författare)
-
Moderating effects of presence and adherence in internetbased CBT with virtual reality exposure therapy for public speaking anxiety
- 2017
-
Konferensbidrag (refereegranskat)abstract
- Introduction: Previous research has revealed that Virtual Reality Exposure Therapy (VRET) is an effective method for reducing symptoms of public speaking anxiety (PSA). Research about presence in the virtual environment indicates a moderating effect on physiological arousal, but more ambiguous effect on treatment effects where some research indicates a small effect while other indicate no effect. Furthermore, previous research has found adherence to home work assignments to moderate treatment outcome. In this treatment study which aimed for treating public speaking anxiety with VRET and a internetbased CBT-program, we investigated whether presence in the virtual environment and adherence to home work moderated treatment effects.Methods: N=25 adult participants from the general public with clinically significant PSA were recruited to a wait-list to another study. After five weeks on waitlist, they started the treatment with a self-guided in virtuo exposure session followed by a four week online maintenance promoting in-vivo exposure. Participants got a simple VR headset by post. The three-hour exposure session included psychoeducation in text, and the participants conducted speech exercises, framed as behavioral experiments targeting idiosyncratic catastrophic beliefs, in front of virtual audiences, and listening to audio recording afterwards. Primary outcome measure was self-reported PSA. To measure moderating effects of presence on the primary outcome measure a self-reported validated scale with subscales for presence (iGroup Presence Questionnaire, IPQ) were used, and for adherence a score were manually calculated based on the number of completed home-work assignments in both a linear model and a binary model dividing participants in two groups: one with at least one completed home work assignment and one with no completed home work assignment. The analysis on presence included both the effects of the VRET-session alone and in combination with the internetbased CBT-program. Data were analyzed using mixed effects modeling.Results: No significant results were found in moderating effects of presence with its subscales on the primary outcome measure for either the VRET-session (p = .375-.616) nor in combination with the internetbased CBT-program (p = .454 - .877). Moderating effects of adherence on primary outcome measure neither revealed no significant results in the linear model (p = .368) nor the binary model (p = .113).Conclusions: The findings of this study indicate, in line with some previous research, that presence in the virtual environment has no significant moderating effect on treatment outcome. Furthermore, in contrast to previous research, this study found no significant moderating effect on adherence to home work assignments on primary treatment outcome. Internal- and external validity and other potential explanations are discussed in detail in the poster.
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| 40. |
- Fagernäs, Simon, et al.
(författare)
-
What do users think about Virtual Reality relaxation applications? A mixed methods study of online user reviews using natural language processing
- 2021
-
Ingår i: Internet Interventions. - : Elsevier BV. - 2214-7829. ; 24
-
Tidskriftsartikel (refereegranskat)abstract
- The advent of affordable Virtual Reality (VR) technology has spurred consumer and commercial interest in VR relaxation applications, which has quickly grown into a popular non-gaming genre on digital marketplaces. While laboratory studies have demonstrated efficacy of VR relaxation for mental health purposes, little is known about how users experience this type of intervention and no study has examined the reception of consumer versions among regular users in everyday life. Studying published user reviews offers a unique window into naturalistic user experiences that complements traditional qualitative methods by circumventing the sampling bias of interview studies, and allowing analyses on full samples, unconstrained by coding resources. Using an innovative, semi-automated Natural Language Processing technique, the current study analyzed 1379 published reviews (including star ratings) of 30 different VR relaxation applications available for the Oculus Go and Gear VR. The uncovered topic structure and sentiment analysis thereof suggests that users have an overall positive view of VR relaxation applications, describing them as successful in inducing immersion and relaxation, and having appreciated gamification elements. However, perceived quality varied substantially between applications that explained more variance in star ratings than specific features. Critical issues raised were both technical (e.g. “overheating”) in nature and related to specific design elements and use. Implications for the design of consumer VR applications and future research are discussed.
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| 41. |
- Forsström, David, et al.
(författare)
-
Gamblers' Perception of the Playscan Risk Assessment : A Mixed-Methods Study
- 2022
-
Ingår i: Journal of Gambling Studies. - : Springer Science and Business Media LLC. - 1050-5350 .- 1573-3602. ; 38:2, s. 591-606
-
Tidskriftsartikel (refereegranskat)abstract
- Responsible gambling (RG) tools are globally widespread; they aim to prevent or decrease the harm caused by gambling. However, existing research suggests that several included features do not decrease gambling or significantly reduce the subsequent harm. Most of the previous studies have used gambling data to understand the changes in gambling behavior. However, the literature lacks research regarding gamblers' experience and perception of RG tools, which may provide insight into increasing the usage and effectiveness of RG tools. This mixed-methods study aimed to explore gamblers' perception of their risk assessment in the RG tool Playscan regarding developing harmful gambling problems. Overall, 757 participants rated the perceived accuracy of their risk assessment and their perception of the overall RG tool that conducted the assessment. Participants were also allowed to leave a comment providing feedback, which was analyzed using thematic analysis. Quantitative data was analyzed using logistic regression and structural equation modeling. Qualitative analyses revealed that most of the participants were pleased with the risk assessment and found it helpful. Moderated mediation analysis showed that participants' assessment agreement partially mediated the association between expressing a negative view and their general view of Playscan. These results highlight the need to decrease the level of disagreement for promoting a better general view of RG tools to potentially increase their usage and effectiveness.
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| 42. |
- Forsström, David, et al.
(författare)
-
GamTest : Psychometric Evaluation in a Low-Gambling General Population
- 2020
-
Ingår i: Journal of Gambling Issues. - Toronto : Concurrent Disorders Society Press. - 1910-7595. ; 44, s. 77-102
-
Tidskriftsartikel (refereegranskat)abstract
- Instruments that investigate different aspects of gambling activities are needed to distinguish negative consequences. Because gambling is a complex activity that occurs both offline and online, different questionnaires are necessary for screening and risk classification. GamTest, an instrument used by several gambling companies, was designed to cover different aspects of gambling: money and time spent, as well as social, financial, and emotional consequences. This study explores GamTest’s psychometric properties in a general population. A total of 2,234 Swedish respondents completed an online survey containing demographic questions, the questionnaire (GamTest), and the Problem Gambling Severity Index (PGSI). A confirmatory factor analysis was performed and GamTest’s reliability and validity tested. The confirmatory factor analysis yielded an inclusive fit. The internal consistency (omega) for the five factors was high (.79–.91), indicating good reliability, and a high positive correlation with the PGSI supported the validity of the GamTest. The inclusive fit of the confirmatory factor analysis can be explained by the low endorsement of negative consequences of gambling in the sample. However, GamTest seems to have good reliability and validity. The utility of GamTest is discussed in relation to its psychometric properties and its use in the responsible gambling tool Playscan.
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| 43. |
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| 44. |
- Forsström, David, 1981-, et al.
(författare)
-
Psychometric properties of the Jonsson-Abbott Scale : Rasch and confirmatory factor analyses
- 2022
-
Ingår i: Frontiers in Psychology. - : Frontiers Media SA. - 1664-1078. ; 13
-
Tidskriftsartikel (refereegranskat)abstract
- Measuring and assessing the different aspects of gambling behavior and its consequences is crucial for planning prevention, treatment, and understanding the development of at-risk and problem gambling. Studies indicate that instruments measuring problem gambling produce different results based on the characteristics of the population assessed. To accurately measure at-risk and problem gambling behavior, especially in a low-risk population, measures must cover a wider set of dimensions than the negative consequences already manifest. The Jonsson-Abbott Scale (JAS) includes items that cover overconsumption, actions that reinforce gambling behavior, and belief in gambling fallacies, based on a three-factor structure and has previously demonstrated good psychometric properties. However, there is a need to investigate how the instrument also functions in low-risk populations. This study aims to do so using both confirmatory factor and Rasch analysis; this research included 1,413 Swedish participants who endorsed at least one JAS item. The results replicated the previous three-factor solution and indicated that the instrument had good reliability. In addition, the results demonstrated that the three factors are independent, and the overall score per factor needs to be analyzed. In summary, the JAS appears suitable for use in low-risk populations to measure various aspects of gambling behavior.
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| 45. |
- Gustafsson, Bengt I., 1955, et al.
(författare)
-
Retransplantation of the liver.
- 2006
-
Ingår i: Transplantation proceedings. - : Elsevier BV. - 0041-1345. ; 38:5, s. 1438-9
-
Tidskriftsartikel (refereegranskat)abstract
- Retransplantation (re-TX) is the only available therapy for irreversible liver graft dysfunction. The outcome of a second procedure depends upon several factors, some of which are not defined at the time of the decision to retransplant. This study is an analysis of all re-TX of the liver performed at our unit between January 1995 and January 2004. Among the 474 liver TX were 55 (11.6%) re-TX in 47 patients. We studied (1) diagnosis at first TX; (2) indication for re-TX and time lapse; (3) donor age and cold ischemia time (CIT); (4) duration of operation, peroperative bleeding, and complications; (5) ICU and ward periods; and (6) patient and graft survivals. Patients who underwent re-TX did not differ from those transplanted once with regard to age, gender, or diagnosis. The indications for re-TX were roughly one-third biliary tract complications/chronic rejection, one-third hepatic artery thrombosis, and one-third others, including primary nonfunction, acute rejection, portal vein thrombosis, sepsis, and B/C hepatitis. The re-TX were "urgent" in 29 and "elective" in 26 cases. Complications were common; about half of the patients were reoperated due to bleeding or biliary problems. To date (May 2004), 15 patients have died (12 "urgent" and 3 "elective"), of whom 5 had well functioning grafts. In summary, liver re-TX is a complicated procedure associated with significant mortality and morbidity, but considering that the actual patient group has a poor prognosis without re-TX, the results are nevertheless encouraging.
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| 46. |
- Hafström, Lars-Olof, 1936, et al.
(författare)
-
Isolated hyperthermic liver perfusion with chemotherapy for liver malignancy.
- 1994
-
Ingår i: Surgical oncology. - 0960-7404. ; 3:2, s. 103-8
-
Tidskriftsartikel (refereegranskat)abstract
- In an open study of unresectable liver tumours, isolated regional perfusion with hyperthermia and cytotoxic drugs has been tested in 29 patients. Four patients had primary hepatocellular cancer, 10 patients had metastases from malignant melanoma, remaining from breast cancer, colorectal cancer, midgut carcinoids and miscellaneous primaries. At laparotomy the proper hepatic artery and portal vein were canulated and connected to a pump oxygenator. The inferior vena cava was canulated with a triple lumen catheter (Perfufix) allowing for porto-caval shunting, drainage of lower body and renal veins to the heart and separate drainage of liver veins to the pump oxygenator. Liver perfusion was performed with a mean flow of 900 ml per min. Melphalan and cis-platinum 0.5 mg/kg body-weight were added to the perfusate for 1 h after liver temperature reached 40 degrees C. Four patients died within 30 days of perfusion due to multiple organ failure. These patients had more than 50% of liver volume occupied by cancer. All surviving patients developed reversible hepato- and renal toxicity. Partial tumour regression was registered in 20% of the patients. Five patients have survived more than three years. Hyperthermic liver perfusion is feasible but in patients with massive liver tumour, there is a significant risk of developing multiple organ failure.
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| 47. |
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| 48. |
- Hafström, Lars-Olof, 1936, et al.
(författare)
-
Treatment of primary liver cancer.
- 1998
-
Ingår i: The European journal of surgery = Acta chirurgica. - : Oxford University Press (OUP). - 1102-4151. ; 164:8, s. 569-74
-
Tidskriftsartikel (refereegranskat)abstract
- To evaluate treatment of patients with primary liver cancer.
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| 49. |
- Hansson, Josefin, et al.
(författare)
-
The risk of graft loss 5 years after kidney transplantation is increased if cold ischemia time exceeds 14 hours
- 2018
-
Ingår i: Clinical Transplantation. - : Wiley. - 0902-0063. ; 32:9
-
Tidskriftsartikel (refereegranskat)abstract
- Background: The state of the evidence is unclear regarding the impact of cold ischemia time (CIT) on the outcome of kidney transplantation. The aim of this study was to investigate the effect of CIT on the short- and long-term function of kidneys transplanted at the Sahlgrenska University Hospital in 2007-2009 from donors after brain death (DBDs). Methods: This study was designed as a retrospective analysis of data from local and national transplantation registers. The study endpoints were as follows: delayed graft function (DGF), primary nonfunction (PNF), biopsy-proven acute rejection (BPAR), serum creatinine (S-creatinine) level at discharge, days of hospitalization after transplantation, and graft survival at 5 years post-transplantation. Adjusted regression analyses were used to determine causal relationships with CIT. A further aim was to estimate a threshold for CIT by analyzing event rates and coordinates of the receiver-operated characteristic (ROC) curve. Results: There was a causal relationship between CIT as a continuous variable and the following endpoints: graft survival at 5 years post-transplantation, though this was not significant (hazard ratio (HR) 1.07, P = 0.057), DGF (odds ratio (OR) 1.09, P = 0.03) and S-creatinine (P = 0.003). In our material, the risk for impaired outcome was higher with longer CIT. We were therefore able to estimate a threshold value for CIT, set to 14 hours for both graft survival at 5 years post-transplantation and DGF. This was proved with significance by analyzing both event rates and the coordinates of the ROC curve. The risk of graft loss increased, with HR 2.3 (P = 0.023), when comparing a CIT cutoff of >= 14 hours with CIT < 14 hours. Delayed graft function increased, with an OR of 2.6 (P = 0.001). Conclusion: Our study confirms that, in this patient material, longer CIT was associated with increased risk for both impaired graft survival and incidence of DGF. We estimated a threshold for CIT of 14 hours.
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| 50. |
- Hellstrand, Kristoffer, 1956, et al.
(författare)
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Alleviating oxidative stress in cancer immunotherapy: a role for histamine?
- 2000
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Ingår i: Medical oncology (Northwood, London, England). - 1357-0560. ; 17:4, s. 258-69
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Tidskriftsartikel (refereegranskat)abstract
- Interleukin-2 is a remarkable activator of lymphocytes with anti-neoplastic properties such as T-cells or natural killer cells, but tumor regression only rarely occurs in interleukin-2-treated cancer patients. In this review, we focus on interactions between monocytes/macrophages and T-cells/natural killer-cells, and in particular the role of such interactions for the outcome of cancer immunotherapy with interleukin-2. We propose that interleukin-2 therapy should be supplemented with compounds that alleviate toxicity inflicted by monocyte/macrophage-derived reactive oxygen metabolites within and around tumors. The hypothesis is founded on data demonstrating that (i) functions of intratumoral lymphocytes in many human malignant tumors are inhibited by reactive oxygen metabolites, generated by neighboring monocytes/macrophages, (ii) interleukin-2 only weakly activates T-cells or natural killer cells in an environment of oxidative stress, and (iii) inhibitors of the formation of reactive oxygen metabolites or scavengers of reactive oxygen metabolites synergize with interleukin-2 to activate these lymphocyte subsets. We also review the preclinical background to the use of histamine dihydrochloride, an inhibitor of reactive oxygen metabolite formation in monocytes/macrophages, as a supplement to cancer immunotherapy with interleukin-2.
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