| 1. |
- Arlien-Soborg, Mai C., et al.
(författare)
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Acromegaly management in the Nordic countries: A Delphi consensus survey
- 2024
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Ingår i: Clinical Endocrinology. - : WILEY. - 0300-0664 .- 1365-2265.
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveAcromegaly is associated with increased morbidity and mortality if left untreated. The therapeutic options include surgery, medical treatment, and radiotherapy. Several guidelines and recommendations on treatment algorithms and follow-up exist. However, not all recommendations are strictly evidence-based. To evaluate consensus on the treatment and follow-up of patients with acromegaly in the Nordic countries.MethodsA Delphi process was used to map the landscape of acromegaly management in Denmark, Sweden, Norway, Finland, and Iceland. An expert panel developed 37 statements on the treatment and follow-up of patients with acromegaly. Dedicated endocrinologists (n = 47) from the Nordic countries were invited to rate their extent of agreement with the statements, using a Likert-type scale (1-7). Consensus was defined as >= 80% of panelists rating their agreement as >= 5 or <= 3 on the Likert-type scale.ResultsConsensus was reached in 41% (15/37) of the statements. Panelists agreed that pituitary surgery remains first line treatment. There was general agreement to recommend first-generation somatostatin analog (SSA) treatment after failed surgery and to consider repeat surgery. In addition, there was agreement to recommend combination therapy with first-generation SSA and pegvisomant as second- or third-line treatment. In more than 50% of the statements, consensus was not achieved. Considerable disagreement existed regarding pegvisomant monotherapy, and treatment with pasireotide and dopamine agonists.ConclusionThis consensus exploration study on the management of patients with acromegaly in the Nordic countries revealed a relatively large degree of disagreement among experts, which mirrors the complexity of the disease and the shortage of evidence-based data.
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| 2. |
- Arlien-Soborg, Mai C., et al.
(författare)
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Acromegaly management in the Nordic countries: A Delphi consensus survey
- 2024
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Ingår i: CLINICAL ENDOCRINOLOGY. - : WILEY. - 0300-0664 .- 1365-2265.
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveAcromegaly is associated with increased morbidity and mortality if left untreated. The therapeutic options include surgery, medical treatment, and radiotherapy. Several guidelines and recommendations on treatment algorithms and follow-up exist. However, not all recommendations are strictly evidence-based. To evaluate consensus on the treatment and follow-up of patients with acromegaly in the Nordic countries.MethodsA Delphi process was used to map the landscape of acromegaly management in Denmark, Sweden, Norway, Finland, and Iceland. An expert panel developed 37 statements on the treatment and follow-up of patients with acromegaly. Dedicated endocrinologists (n = 47) from the Nordic countries were invited to rate their extent of agreement with the statements, using a Likert-type scale (1-7). Consensus was defined as >= 80% of panelists rating their agreement as >= 5 or <= 3 on the Likert-type scale.ResultsConsensus was reached in 41% (15/37) of the statements. Panelists agreed that pituitary surgery remains first line treatment. There was general agreement to recommend first-generation somatostatin analog (SSA) treatment after failed surgery and to consider repeat surgery. In addition, there was agreement to recommend combination therapy with first-generation SSA and pegvisomant as second- or third-line treatment. In more than 50% of the statements, consensus was not achieved. Considerable disagreement existed regarding pegvisomant monotherapy, and treatment with pasireotide and dopamine agonists.ConclusionThis consensus exploration study on the management of patients with acromegaly in the Nordic countries revealed a relatively large degree of disagreement among experts, which mirrors the complexity of the disease and the shortage of evidence-based data.
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| 3. |
- Arlien-Søborg, Mai C., et al.
(författare)
-
Acromegaly management in the nordic countries : a Delphi consensus survey
- 2024
-
Ingår i: Clinical Endocrinology. - : John Wiley & Sons. - 0300-0664 .- 1365-2265.
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: Acromegaly is associated with increased morbidity and mortality if left untreated. The therapeutic options include surgery, medical treatment, and radiotherapy. Several guidelines and recommendations on treatment algorithms and follow-up exist. However, not all recommendations are strictly evidence-based. To evaluate consensus on the treatment and follow-up of patients with acromegaly in the Nordic countries.Methods: A Delphi process was used to map the landscape of acromegaly management in Denmark, Sweden, Norway, Finland, and Iceland. An expert panel developed 37 statements on the treatment and follow-up of patients with acromegaly. Dedicated endocrinologists (n = 47) from the Nordic countries were invited to rate their extent of agreement with the statements, using a Likert-type scale (1−7). Consensus was defined as ≥80% of panelists rating their agreement as ≥5 or ≤3 on the Likert-type scale.Results: Consensus was reached in 41% (15/37) of the statements. Panelists agreed that pituitary surgery remains first line treatment. There was general agreement to recommend first-generation somatostatin analog (SSA) treatment after failed surgery and to consider repeat surgery. In addition, there was agreement to recommend combination therapy with first-generation SSA and pegvisomant as second- or third-line treatment. In more than 50% of the statements, consensus was not achieved. Considerable disagreement existed regarding pegvisomant monotherapy, and treatment with pasireotide and dopamine agonists.Conclusion: This consensus exploration study on the management of patients with acromegaly in the Nordic countries revealed a relatively large degree of disagreement among experts, which mirrors the complexity of the disease and the shortage of evidence-based data.
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| 4. |
- Forslund, Sofia K., et al.
(författare)
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Combinatorial, additive and dose-dependent drug–microbiome associations
- 2021
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Ingår i: Nature. - : Springer Science and Business Media LLC. - 0028-0836 .- 1476-4687. ; 600:7889, s. 500-505
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Tidskriftsartikel (refereegranskat)abstract
- During the transition from a healthy state to cardiometabolic disease, patients become heavily medicated, which leads to an increasingly aberrant gut microbiome and serum metabolome, and complicates biomarker discovery1–5. Here, through integrated multi-omics analyses of 2,173 European residents from the MetaCardis cohort, we show that the explanatory power of drugs for the variability in both host and gut microbiome features exceeds that of disease. We quantify inferred effects of single medications, their combinations as well as additive effects, and show that the latter shift the metabolome and microbiome towards a healthier state, exemplified in synergistic reduction in serum atherogenic lipoproteins by statins combined with aspirin, or enrichment of intestinal Roseburia by diuretic agents combined with beta-blockers. Several antibiotics exhibit a quantitative relationship between the number of courses prescribed and progression towards a microbiome state that is associated with the severity of cardiometabolic disease. We also report a relationship between cardiometabolic drug dosage, improvement in clinical markers and microbiome composition, supporting direct drug effects. Taken together, our computational framework and resulting resources enable the disentanglement of the effects of drugs and disease on host and microbiome features in multimedicated individuals. Furthermore, the robust signatures identified using our framework provide new hypotheses for drug–host–microbiome interactions in cardiometabolic disease.
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| 5. |
- Kehoe, Laura, et al.
(författare)
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Make EU trade with Brazil sustainable
- 2019
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Ingår i: Science. - : American Association for the Advancement of Science (AAAS). - 0036-8075 .- 1095-9203. ; 364:6438, s. 341-
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 6. |
- Adiels, Emil, 1989, et al.
(författare)
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The use of virtual work for the formfinding of fabric, shell and gridshell structures
- 2018
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Ingår i: Proceedings of the Advances in Architectural Geometry conference 2018. - 9783903015135 ; , s. 286-315
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Konferensbidrag (refereegranskat)abstract
- The use of the virtual work theorem enables one to derive the equations of static equilibrium of fabric, shell and gridshell structures from the compatibility equations linking the rate of deformation of a surface to variations in its velocity. If the structure is treated as a continuum there is no need to consider its micro-structure provided that the grid is fine compared to the overall geometry. Thus we can include fabrics, ribbed shells, corrugated shells and gridshells with a fine grid, such as the Mannheim Multihalle. The equilibrium equations are almost identical to those obtained by assuming that a shell is thin and of uniform thickness, but are more general in their application. Our formulation introduces the concept of geodesic bending moments which are relevant to gridshell structures with continuous laths. The virtual work theorem is more general than the energy theorems, which it in- cludes as a special case. Hence it can be applied to surfaces which admit some form of potential, including minimal surfaces and hanging fabrics. We can then use the calculus of variations for the minimization of a surface integral to define the form of a structure. Many existing formfinding techniques can be rewritten in this way, but we concen- trate on surfaces which minimize the surface integral of the mean curvature subject to a constraint on the enclosed volume, producing a surface of constant Gaussian curvature. This naturally leads to the more general study of conjugate stress and curvature directions, and hence to quadrilateral mesh gridshells with flat cladding panels and no bending moments in the structural members under own weight.
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| 7. |
- Anderson, Helén, et al.
(författare)
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Skapa kundnärvaro i innovationsprocessen
- 2008
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Ingår i: Innovationsförmåga. - Malmö : Holmbergs i Malmö AB. - 9789197785204 ; , s. 40-59
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Bokkapitel (populärvet., debatt m.m.)
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| 8. |
- Bosch, Jan, et al.
(författare)
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The Early Stage Software Startup Development Model : A Framework for Supporting Lean Principles in Software Startups
- 2013
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Ingår i: Lean Enterprise Software and Systems. LESS 2013.. - Berlin, Heidelberg : Springer. ; , s. 1-15
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Konferensbidrag (refereegranskat)abstract
- Software startups are more popular than ever and growing in numbers. They operate under conditions of extreme uncertainty and face many challenges. Often, agile development practices and lean principles are suggested as ways to increase the odds of succeeding as a startup, as they both advocate close customer collaboration and short feedback cycles focusing on delivering direct customer value. However, based on an interview study we see that despite guidance and support in terms of well-known and documented development methods, practitioners find it difficult to implement and apply these in practice. To explore this further, and to propose operational support for software startup companies, this study aims at investigating (1) what are the typical challenges when finding a product idea worth scaling, and (2) what solution would serve to address these challenges. To this end, we propose the ‘Early Stage Software Startup Development Model’ (ESSSDM). The model extends already existing lean principles, but offers novel support for practitioners for investigating multiple product ideas in parallel, for determining when to move forward with a product idea, and for deciding when to abandon a product idea. The model was evaluated in a software startup project, as well as with industry professionals within the software startup domain.
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| 9. |
- Bosch, Jan, 1967, et al.
(författare)
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The Early Stage Software Startup Development Model: A Framework for Operationalizing Lean Principles in Software Startups
- 2013
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Ingår i: Lecture Notes in Business Information Processing. - Berlin, Heidelberg : Springer Berlin Heidelberg. - 1865-1356 .- 1865-1348. ; 167, s. 1-15
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Konferensbidrag (refereegranskat)abstract
- Software startups are more popular than ever and growing in numbers. They operate under conditions of extreme uncertainty and face many challenges. Often, agile development practices and lean principles are suggested as ways to increase the odds of succeeding as a startup, as they both advocate close customer collaboration and short feedback cycles focusing on delivering direct customer value. However, based on an interview study we see that despite guidance and support in terms of well-known and documented development methods, practitioners find it difficult to implement and apply these in practice. To explore this further, and to propose operational support for software startup companies, this study aims at investigating (1) what are the typical challenges when finding a product idea worth scaling, and (2) what solution would serve to address these challenges. To this end, we propose the ‘Early Stage Software Startup Development Model’ (ESSSDM). The model extends already existing lean principles, but offers novel support for practitioners for investigating multiple product ideas in parallel, for determining when to move forward with a product idea, and for deciding when to abandon a product idea. The model was evaluated in a software startup project, as well as with industry professionals within the software startup domain.
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| 10. |
- Christiansen, Evald H, et al.
(författare)
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Instantaneous Wave-free Ratio versus Fractional Flow Reserve to Guide PCI.
- 2017
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Ingår i: The New England journal of medicine. - : Massachussetts Medical Society. - 1533-4406 .- 0028-4793. ; 376:19, s. 1813-1823
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Tidskriftsartikel (refereegranskat)abstract
- The instantaneous wave-free ratio (iFR) is an index used to assess the severity of coronary-artery stenosis. The index has been tested against fractional flow reserve (FFR) in small trials, and the two measures have been found to have similar diagnostic accuracy. However, studies of clinical outcomes associated with the use of iFR are lacking. We aimed to evaluate whether iFR is noninferior to FFR with respect to the rate of subsequent major adverse cardiac events.We conducted a multicenter, randomized, controlled, open-label clinical trial using the Swedish Coronary Angiography and Angioplasty Registry for enrollment. A total of 2037 participants with stable angina or an acute coronary syndrome who had an indication for physiologically guided assessment of coronary-artery stenosis were randomly assigned to undergo revascularization guided by either iFR or FFR. The primary end point was the rate of a composite of death from any cause, nonfatal myocardial infarction, or unplanned revascularization within 12 months after the procedure.A primary end-point event occurred in 68 of 1012 patients (6.7%) in the iFR group and in 61 of 1007 (6.1%) in the FFR group (difference in event rates, 0.7 percentage points; 95% confidence interval [CI], -1.5 to 2.8; P=0.007 for noninferiority; hazard ratio, 1.12; 95% CI, 0.79 to 1.58; P=0.53); the upper limit of the 95% confidence interval for the difference in event rates fell within the prespecified noninferiority margin of 3.2 percentage points. The results were similar among major subgroups. The rates of myocardial infarction, target-lesion revascularization, restenosis, and stent thrombosis did not differ significantly between the two groups. A significantly higher proportion of patients in the FFR group than in the iFR group reported chest discomfort during the procedure.Among patients with stable angina or an acute coronary syndrome, an iFR-guided revascularization strategy was noninferior to an FFR-guided revascularization strategy with respect to the rate of major adverse cardiac events at 12 months. (Funded by Philips Volcano; iFR SWEDEHEART ClinicalTrials.gov number, NCT02166736 .).
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