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Sökning: WFRF:(Ekman C. J.)

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51.
  • Fjalldal, S., et al. (författare)
  • Microstructural white matter alterations and hippocampal volumes are associated with cognitive deficits in craniopharyngioma
  • 2018
  • Ingår i: European Journal of Endocrinology. - : BIOSCIENTIFICA LTD. - 0804-4643 .- 1479-683X. ; 178:6, s. 577-587
  • Tidskriftsartikel (refereegranskat)abstract
    • Context: Patients with craniopharyngioma (CP) and hypothalamic lesions (HL) have cognitive deficits. Which neural pathways are affected is unknown. Objective: To determine whether there is a relationship between microstructural white matter (WM) alterations detected with diffusion tensor imaging (DTI) and cognition in adults with childhood-onset CP. Design: A cross-sectional study with a median follow-up time of 22 (6-49) years after operation. Setting: The South Medical Region of Sweden (2.5 million inhabitants). Participants: Included were 41 patients (24 women, amp;gt;= 17 years) surgically treated for childhood-onset CP between 1958-2010 and 32 controls with similar age and gender distributions. HI was found in 23 patients. Main outcome measures: Subjects performed cognitive tests and magnetic resonance imaging, and images were analyzed using DTI of uncinate fasciculus, fornix, cingulum, hippocampus and hypothalamus as well as hippocampal volumetry. Results: Right uncinate fasciculus was significantly altered (P amp;lt;= 0.01) Microstructural WM alterations in left ventral cingulum were significantly associated with worse performance in visual episodic memory, explaining approximately 50% of the variation. Alterations in dorsal cingulum were associated with worse performance in immediate, delayed recall and recognition, explaining 26-38% of the variation, and with visuospatial ability and executive function, explaining 19-29%. Patients who had smaller hippocampal volume had worse general knowledge (P = 0.028), and microstructural WM alterations in hippocampus were associated with a decline in general knowledge and episodic visual memory. Conclusions: A structure to function relationship is suggested between microstructural WM alterations in cingulum and in hippocampus with cognitive deficits in CP.
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52.
  • Gellanki, Jnaneswari, et al. (författare)
  • Extensive Gamma-ray Spectroscopy of Band Structures in 62Zn
  • 2012
  • Ingår i: Physical Review C (Nuclear Physics). - 0556-2813. ; 86:3
  • Tidskriftsartikel (refereegranskat)abstract
    • An experimental study of the Zn-62 nucleus has been performed by combining the data sets from four fusion-evaporation reaction experiments. Apart from the previously published data, the present results include ten new rotational band structures and two more superdeformed bands. The Gammasphere Ge-detector array in conjunction with the 4 pi charged-particle detector array Microball allowed for the detection of gamma rays in coincidence with evaporated light particles. The deduced level scheme includes some 260 excited states, which are connected with more than 450 gamma-ray transitions. Spins and parities of the excited states have been determined via directional correlations of. rays emitted from oriented states. The experimental characteristics of the rotational bands are analyzed and compared with results from cranked Nilsson-Strutinsky calculations. The present analysis, combined with available experimental results in the A similar to 60 mass region, can be used to improve the current set of Nilsson parameters in the N = 3 and N = 4 oscillator shells.
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53.
  • Gladnishki, KA, et al. (författare)
  • Angular Momentum Population in the Projectile Fragmentation of 238U at 750 MeV/nucleon
  • 2004
  • Ingår i: Physical Review C (Nuclear Physics). - 0556-2813. ; 69:2
  • Tidskriftsartikel (refereegranskat)abstract
    • A systematic study of the population probabilities of nanosecond and microsecond isomers produced following the projectile fragmentation of U-238 at 750 MeV/nucleon has been undertaken at the SIS/FRS facility at GSI. Approximately 15 isomeric states in neutron-deficient nuclei around A similar to 190 were identified and the corresponding. isomeric ratios determined. The results are compared with a model based on the statistical abrasion-ablation description of relativistic fragmentation and simple assumptions concerning gamma cascades in the final nucleus (sharp cutoff). This model represents an upper limit for the population of isomeric states in relativistic projectile fragmentation. When the decay properties of the states above the isomer are taken into account, as opposed to the sharp cutoff approximation, a good agreement between the experimental and calculated angular momentum population is obtained.
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54.
  • Goterfelt, L., et al. (författare)
  • The Incidence of Dental Fracturing in Electroconvulsive Therapy in Sweden
  • 2020
  • Ingår i: Journal of Ect. - : Ovid Technologies (Wolters Kluwer Health). - 1095-0680 .- 1533-4112. ; 36:3, s. 168-171
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives One adverse effect of electroconvulsive therapy (ECT) is dental fracture; thus, a bite guard and muscle relaxants are used to prevent it. Earlier research reported varying rates of dental fracture, but there is no large-scale study on the incidence of dental fracture during ECT. This study aimed to examine the incidence of dental fracture during ECT and to investigate whether the incidence differs between different sexes, age groups, diagnosis groups, electrode placements, or number of treatment sessions. Methods This register-based study used data from the Swedish national quality register for ECT. All hospitals offering ECT report to this register, and the coverage ratio is about 90%. All registered patients who started an ECT series between January 2012 and January 2019 were included in this study, with the data representing 16,681 individuals, 38,862 series, and 254,906 sessions. Results Forty-six dental fractures were identified, giving an incidence of dental fracture of 0.2% per series, 0.02% per session, and 0.3% per individual. We did not find any significant associations between dental fracture rates and male or female populations, age, or different diagnosis groups, nor was there any significant difference between dental fracture rates and electrode placement. The mean number of treatments was significantly higher in the dental fracture group than in patients without dental fracture. Conclusions There is a minimal risk of dental fracture during ECT. Our findings, together with those of other studies, provide further motivation for the use of a bite guard and muscle relaxant.
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55.
  • Granger, B. B., et al. (författare)
  • Adherence to candesartan and placebo and outcomes in chronic heart failure in the CHARM programme: double-blind, randomised, controlled clinical trial
  • 2005
  • Ingår i: Lancet. - 1474-547X. ; 366:9502, s. 2005-11
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Chronic heart failure (CHF) is an important cause of hospital admission and death. Poor adherence to medication is common in some chronic illnesses and might reduce the population effectiveness of proven treatments. Because little is known about adherence in patients with CHF and about the consequences of non-adherence, we assessed the association between adherence and clinical outcome in the CHARM (Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity) programme. METHODS: CHARM was a double-blind, randomised, controlled clinical trial, comparing the effects of the angiotensin receptor blocker candesartan with placebo in 7599 patients with CHF. Median follow-up was 38 months. The proportion of time patients took more than 80% of their study medication was defined as good adherence and 80% or less as poor adherence. We used a Cox proportional hazards regression model, with adherence as a time-dependent covariate in the model, to examine the association between adherence and mortality in the candesartan and placebo groups. FINDINGS: We excluded 187 patients because of missing information on adherence. In the time-dependent Cox regression model, after adjustment for predictive factors (demographics, physiological and severity-of-illness variables, smoking history, and number of concomitant medications), good adherence was associated with lower all-cause mortality in all patients (hazard ratio [HR] 0.65, 95% CI 0.57-0.75, p<0.0001). The adjusted HR for good adherence was similar in the candesartan (0.66, 0.55-0.81, p<0.0001) and placebo (0.64, 0.53-0.78, p<0.0001) groups. INTERPRETATION: Good adherence to medication is associated with a lower risk of death than poor adherence in patients with CHF, irrespective of assigned treatment. This finding suggests that adherence is a marker for adherence to effective treatments other than study medications, or to other adherence behaviours that affect outcome. Understanding these factors could provide an opportunity for new interventions, including those aimed at improving adherence.
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56.
  • Jendle, Johan, 1963-, et al. (författare)
  • Real-world cost-effectiveness of insulin degludec in type 1 and type 2 diabetes in a Swedish setting
  • 2019
  • Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
    • Background and aims: Randomised controlled trials and observational studies have shown lower risk of hypoglycemia in patients with type 1-diabetes (T1D) and type 2-diabetes (T2D) on treatment with insulinde gludec (IDeg) vs insulin glargine 100 units/mL (IGlar). This study assessed cost-effectiveness (C/E) of IDeg vs insulin treatment before switch to IDeg in a Swedish real-world setting in people with T1D and T2D.Materials and methods: ReFLeCT is a prospective, observational study in T1D (n=566) and T2D (n=611) in seven European countries and comprised a four-week baseline period (pre-switch basal insulin) and a 12-month follow-up period (IDeg). Data from ReFLeCT was used to assess C/E of IDeg compared with basal insulin treatment prior to switching to IDeg. Basal insulin unit costs were weighted to represent the basal insulin present at baseline (T1D: IGlar 63.8%, Insulin detemir (IDet) 22.7%, other/missing 13.5%. T2D: IGlar 59.1%, IDet 20.8%, other/missing 20.1%). The Swedish original IGlar price was used as base case. IGlar biosimilar price was used in a sensitivity analysis. Where information on basal insulin at baseline was missing, the lowest basal insulin price (insulin NPH) was used as a conservative approach. C/E was analysed over a 1-year time horizon from a Swedish societal perspective (price level 2019). Only differences with p<0.05 were included in the analysis.Results: Basal and bolus insulin doses at baseline were 25.0 IU and 27.3 IU (T1D) and 37.5 IU and 24.4 IU (T2D). At 12 months estimated basal and bolus insulin dose ratios were 0.91 (95% C.I. 0.83-0.91) and 0.87 (0.83-0.91) for T1D and 0.98 (0.95-1.01) and 0.96 (0.94-1.01) for T2D. For T1D riskratios (RR) for non-severe daytime hypoglycaemia was 0.85 (0.78-0.93), non-severe nocturnal hypoglycaemia 0.63 (0.52-0.76) and severe hypoglycaemia 0.28 (0.14-0.56). Corresponding RR for T2D were 0.56 (0.46-0.69), 0.38 (0.22-0.64) and 2.87 (0.33-24.65). In T1D IDeg was cost-saving compared to previous basal therapy (Table 1). In T2D, IDeg was highly cost-effective, with a cost per quality-adjusted life-year (QALY) of SEK 15,000-24,000 (Table 1). A treatment is considered cost-effective in Sweden if cost/QALY is below SEK 500,000. Sensitivity analyses showed that the results were robust to changes in efficacy and cost parameters in both T1D and T2D.Conclusion: In this C/E-analysis, treatment with IDeg was cost-saving (T1D) or highly cost-effective (T2D) relative to the treatment used before switch in a Swedish setting after one year. C/E of IDeg in clinical practice is driven by lower insulin doses (T1D) and reduced risk of hypoglycaemia (T1D and T2D).
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57.
  • Jendle, Johan, 1963-, et al. (författare)
  • Switching to insulin degludec is a cost-saving therapy for patients with type 1 and type 2 diabetes in the Swedish setting based on real world data
  • 2019
  • Ingår i: Value in Health. - : Elsevier. - 1098-3015 .- 1524-4733. ; 22:Suppl. 3, s. 575-576
  • Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
    • Objectives: The Europe-based, prospective, observational ReFLeCT study recently showed that switching to the ultralong-acting basal insulin analogue degludec (IDeg) was associated with improved glycemic control and reductions in hypoglycemic events versus previous basal insulin therapies in patients with type 1 (T1D) or type 2 diabetes (T2D). The present analysis aimed to assess the impact of thesefindings on long-term cost-effectiveness outcomes in the Swedish setting.Methods: Cost-effectiveness was evaluated separately in patients with T1D and T2D over a 50-year time horizon using the IQVIA CORE Diabetes Model (version 9.0). Patients were assumed to receive IDeg or continue previous insulin therapy (with or without bolus insulin) for 5 years, before all patients intensified to insulin degludec plus bolus insulin for the remainder of their lifetimes. Baseline cohort characteristics were sourced from ReFLeCT where possible. Treatment effects on initiation of IDeg were based on data from ReFLeCT. Costs were estimated from a Swedish societal perspective and expressed in 2018 Swedish krona (SEK).Results: IDeg was associated with improvements in quality-adjusted life expectancy of 0.14 and 0.07 quality-adjusted life years versus continuation of previous insulin therapy in patients with T1D and T2D, respectively, resulting from improved glycemic control and fewer hypoglycemic events. Combined direct and indirect costs were estimated to be SEK 137,020 and SEK 2,009 lower for insulin degludec versus previous insulin therapy in patients with T1D and T2D, respectively, with higher treatment costs offset by cos tsavings from avoidance of diabetes-related complications. IDeg was therefore considered dominant versus continuation of previous insulin therapies for the treatment of both T1D and T2D.Conclusions: Based on real-world evidence, IDeg represents an effective and cost-saving treatment option versus other basal insulin therapies for patients with T1D and T2D in Sweden.
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58.
  • Johansson, Viktoria, et al. (författare)
  • Microscopic Particles in Two Fractions of Fresh Cerebrospinal Fluid in Twins with Schizophrenia or Bipolar Disorder and in Healthy Controls
  • 2012
  • Ingår i: Plos One. - : Public Library of Science (PLoS). - 1932-6203. ; 7:9
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Using scanning electron microscopy, microscopic structures have been identified in fresh cerebrospinal fluid (CSF) in patients with schizophrenia and bipolar disorder, but only rarely in control subjects. However, it has not been determined whether these microscopic particles represent state or trait markers, i.e. if their presence is related to clinical manifestations of the disease or if they also can be found in as yet asymptomatic individuals with a genetic liability. This question can be addressed by studying twins discordant or concordant for schizophrenia or bipolar disorder. Methodology/Principal Findings: We investigated microscopic structures in CSF in 102 individuals: 21 monozygotic and 16 dizygotic twins affected or not affected with schizophrenia, schizoaffective disorder or bipolar disorder and in 65 healthy singleton controls. A first and a second fraction of CSF was freshly applied on filters and examined by scanning electron microscopy technique. Spherical particles with lipid appearance averaging between 0.1 to 8.0 mu m in diameter were detected in the center of the filter as well as located in the margins of larger aggregates binding in a viscous state. Structures were found in 12 of 17 probands, 5 of 12 healthy co-twins and 3 of 73 healthy controls. Thus, a positive microscopic finding significantly increased the likelihood of belonging to the proband group (OR = 48, 95% CL: 8.2-550, p<0.0001) and the co-twin-group (OR = 16, 95% CL: 2.0-218, p = 0.006). Age, sex, history of alcohol abuse or anxiety syndrome, somatic disorder and markers of acute inflammatory activity did not account for group differences; nor did exposure to psychotropic medication. Conclusion: Presence of microscopic particles in CSF may possibly reflect trait dependent genetic or environmental vulnerability in patients with schizophrenia, schizoaffective disorder or bipolar disorder.
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59.
  • Kirkevag, A., et al. (författare)
  • Aerosol-climate interactions in the Norwegian Earth System Model-NorESM1-M
  • 2013
  • Ingår i: Geoscientific Model Development. - : Copernicus GmbH. - 1991-959X .- 1991-9603. ; 6:1, s. 207-244
  • Tidskriftsartikel (refereegranskat)abstract
    • The objective of this study is to document and evaluate recent changes and updates to the module for aerosols and aerosol-cloud-radiation interactions in the atmospheric module CAM4-Oslo of the core version of the Norwegian Earth System Model (NorESM), NorESM1-M. Particular attention is paid to the role of natural organics, sea salt, and mineral dust in determining the gross aerosol properties as well as the anthropogenic contribution to these properties and the associated direct and indirect radiative forcing. The aerosol module is extended from earlier versions that have been published, and includes life-cycling of sea salt, mineral dust, particulate sulphate, black carbon, and primary and secondary organics. The impacts of most of the numerous changes since previous versions are thoroughly explored by sensitivity experiments. The most important changes are: modified prognostic sea salt emissions; updated treatment of precipitation scavenging and gravitational settling; inclusion of biogenic primary organics and methane sulphonic acid (MSA) from oceans; almost doubled production of land-based biogenic secondary organic aerosols (SOA); and increased ratio of organic matter to organic carbon (OM/OC) for biomass burning aerosols from 1.4 to 2.6. Compared with in situ measurements and remotely sensed data, the new treatments of sea salt and dust aerosols give smaller biases in near-surface mass concentrations and aerosol optical depth than in the earlier model version. The model biases for mass concentrations are approximately unchanged for sulphate and BC. The enhanced levels of modeled OM yield improved overall statistics, even though OM is still underestimated in Europe and overestimated in North America. The global anthropogenic aerosol direct radiative forcing (DRF) at the top of the atmosphere has changed from a small positive value to -0.08 W m(-2) in CAM4-Oslo. The sensitivity tests suggest that this change can be attributed to the new treatment of biomass burning aerosols and gravitational settling. Although it has not been a goal in this study, the new DRF estimate is closer both to the median model estimate from the AeroCom intercomparison and the best estimate in IPCC AR4. Estimated DRF at the ground surface has increased by ca. 60 %, to -1.89 W m(-2). We show that this can be explained by new emission data and omitted mixing of constituents between updrafts and downdrafts in convective clouds. The increased abundance of natural OM and the introduction of a cloud droplet spectral dispersion formulation are the most important contributions to a considerably decreased estimate of the indirect radiative forcing (IndRF). The IndRF is also found to be sensitive to assumptions about the coating of insoluble aerosols by sulphate and OM. The IndRF of -1.2 W m(-2), which is closer to the IPCC AR4 estimates than the previous estimate of -1.9 W m(-2), has thus been obtained without imposing unrealistic artificial lower bounds on cloud droplet number concentrations.
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60.
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