| 11. |
- Friman, Ola, 1975-, et al.
(författare)
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Recognizing emphysema - A neural network approach
- 2002
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Ingår i: Pattern Recognition, 2002. Proceedings. 16th International Conference on (Volume:1). - : IEEE Computer Society. ; , s. 512-515
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Konferensbidrag (refereegranskat)abstract
- An accurate and fully automatic method for detecting and quantifying emphysema in CT-images is presented. The method is based on an image preprocessing step followed by a neural network classifier trained to separate true emphysema from artifacts. The proposed approach is shown to be superior to an established method when applied on real patient data.
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| 12. |
- Fritzell, Peter, et al.
(författare)
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Bacteria : back pain, leg pain and Modic sign—a surgical multicentre comparative study
- 2019
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Ingår i: European spine journal. - : Springer. - 0940-6719 .- 1432-0932. ; 28:12, s. 2981-2989
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To compare bacterial findings in pain-generating degenerated discs in adults operated on for lumbar disc herniation (LDH), and mostly also suffering from low back pain (LBP), with findings in adolescent patients with non-degenerated non-pain-generating discs operated on for scoliosis, and to evaluate associations with Modic signs on magnetic resonance imaging (MRI). Cutibacterium acnes (Propionibacterium acnes) has been found in painful degenerated discs, why it has been suggested treating patients with LDH/LBP with antibiotics. As multidrug-resistant bacteria are a worldwide concern, new indications for using antibiotics should be based on solid scientific evidence.Methods: Between 2015 and 2017, 40 adults with LDH/LBP (median age 43, IQR 33–49) and 20 control patients with scoliosis (median age 17, IQR 15–20) underwent surgery at seven Swedish hospitals. Samples were cultured from skin, surgical wound, discs and vertebrae. Genetic relatedness of C. acnes isolates was investigated using single-nucleotide polymorphism analysis. DNA samples collected from discs/vertebrae were analysed using 16S rRNA-based PCR sequencing. MRI findings were assessed for Modic changes.Results: No bacterial growth was found in 6/40 (15%) LDH patients, compared with 3/20 (15%) scoliosis patients. Most positive samples in both groups were isolated from the skin and then from subcutis or deep within the wound. Of the four disc and vertebral samples from each of the 60 patients, 235/240 (98%) were DNA negative by bacterial PCR. A single species, C. acnes, was found exclusively in the disc/vertebra from one patient in each group. In the LDH group, 29/40 (72%) patients had at least one sample with growth of C. acnes, compared to 14/20 (70%) in the scoliosis group. Bacterial findings and Modic changes were not associated.Conclusions: Cutibacterium acnes found in discs and vertebrae during surgery for disc herniation in adults with degenerated discs may be caused by contamination, as findings in this group were similar to findings in a control group of young patients with scoliosis and non-degenerated discs. Furthermore, such findings were almost always combined with bacterial findings on the skin and/or in the wound. There was no association between preoperative Modic changes and bacterial findings. Antibiotic treatment of lumbar disc herniation with sciatica and/or low back pain, without signs of clinical discitis/spondylitis, should be seriously questioned.
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| 13. |
- Hellström, Mikael, et al.
(författare)
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Det spelar roll hur man styr och vad man gör för kommunal hushållning.
- 2009
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Ingår i: Kommunal ekonomi. - 0282-0099. ; :2009:6, s. 26-27
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Tidskriftsartikel (populärvet., debatt m.m.)abstract
- En av de ständigt aktuella frågorna i den kommunala ekonomiska debatten är den kommunala resultatutvecklingen. Går den att påverka eller är kommuners situation allt för styrd av externa faktorer? I denna studie, som finns att hämta på www.rka.nu, närmar vi oss dessa frågor med två övergripande frågor; Vad gör kommuner för att åstadkomma en förbättrad resultatutveckling? Vilka effekter har vidtagna åtgärder för medborgare, brukare och anställda?
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| 14. |
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| 15. |
- Jeppson, Mikael, et al.
(författare)
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Hotspots för sällsynta svampar i Ölands sandstäpper och annan sandvegetation.
- 2008
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Buksvampar (Gatseromyceter) såsom jordstjärnor, stjälkröksvampar, diskröksvampar är svampar väl anpassade till torra och på andra sätt ekologiskt krävande naturtyper. Genom sin speciella morfologi och ekologi utgör de ett mycket viktigt inslag i mer eller mindre stäppliknande miljöer. Påfallande många har sina växtplatser i kalkrika områden med sandmarker utsatta för speciella klimatförhållanden såsom långvarig torka, oregelbunden nederbörd och höga sommartemperaturer. De olika vegetationstyperna på sandmarker beskrivs i rapporten liksom dess karakteristik och mångfald av svampar och kärlväxter. Viss utblick görs även internationellt. Skillnaderna mellan vegetationen i olika sandrika områden är stor bl.a. tack vare olika hög grad av påverkan av kalkrik sand resp. urlakning. Dessa pH-förhållanden har även stor inverkan på den funga som kan påträffas i olika områden. Erfarenheter från svamparna bidrar i hög grad till ett utvidgat synsätt på ”stäpp-” resp. ”hedserien” i sandmarksvegetationen. Bland annat så förekommer ett antal ”stäppsvampar” ofta i vegetationstyper även utan samband med en av dess ledarter tofsäxing (Koeleria glauca). Dessa insikter bör bidra till ett vidare synsätt på termen ”sandstäpp” till att omfatta vegetationstyper på kalkrik sandmark, även om tofsäxing saknas. De i rapporten behandlade svamparterna presenteras vad gäller öländsk, nationell och internationell status samt något om deras hot och ekologi. Många av dem presenteras i bild. Sammanlagt har 33 olika arter röksvampar (i vid bemärkelse) påträffats i de öländska sandmarkerna varav 19 bedömdes som naturvårdsintressanta i den bemärkelse att de visar på skyddsvärda och/eller hotade biotoper. Av de funna arterna är 16 rödlistade (3 CR, 7 EN, 2 VU och 4 NT). För många av arterna utgör de öländska förekomsterna betydande andelar av de svenska och i vissa fall även europeiska populationerna. Fältbesök gjordes på ett 50-tal lokaler för de utvalda svamparna 2006-2008 och i rapporten presenteras de 39 mest värdefulla lokalerna på Öland för rödlistade och naturvårdsintressanta buksvampar (Gasteromyceter) växande i sandrika habitat på Öland. Lokalerna avgränsas, deras naturvärden och dagens markanvändning beskrivs översiktligt. Vidare ges ett tidsfönster med bedömningar av graden av hot mot lokalen och i de flesta fall specificeras åtgärdsbehov och rekommendationer ges för framtida skötsel. Av de 39 värdefullaste lokalerna ansågs 24 (62 %) tillhöra den högsta naturvärdesklassen medan nio (23 %) resp. sex (15 %) bedömdes ha något lägre prioritet för naturvården. Åtgärdsbehovet ansågs akut på sju av lokalerna (18 %) men nästa lika angelägna (”snarast”) på 13 lokaler (33 %). Nitton av lokalerna (49%) har ett utseende och markanvändning som idag upprätthåller bra förutsättningar för sandsvamparna. Rapporten är framtagen för att underlätta urval och prioriteringar av naturvårdsåtgärder de närmast kommande åren. De öländska sandmarkslokaler som ur mykologisk synpunkt hyser högsta naturvärde och samtidigt är i akut behov av skötselåtgärder om inte naturvärdena ska försvinna är: • Gåtebo sandstäpp, Bredsättra • Gårdby sandhed, Gårdby • Triberga-Alby mosse, Hulterstad • Sandby kyrkvägskäl, Sandby
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| 16. |
- Johansson, Lotta, 1965, et al.
(författare)
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Evaluation of a sound environment intervention in an ICU : A feasibility study
- 2018
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Ingår i: Australian Critical Care. - Amsterdam : Elsevier. - 1036-7314 .- 1878-1721. ; 31:2, s. 59-70
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Tidskriftsartikel (refereegranskat)abstract
- Background: Currently, it is well known that the sound environment in intensive care units (ICU) is substandard. Therefore, there is a need of interventions investigating possible improvements. Unfortunately, there are many challenges to consider in the design and performance of clinical intervention studies including sound measurements and clinical outcomes.Objectives: (1) explore whether it is possible to implement a full-scale intervention study in the ICU concerning sound levels and their impact on the development of ICU delirium; (2) discuss methodological challenges and solutions for the forthcoming study; (3) conduct an analysis of the presence of ICU delirium in the study group; and (4) describe the sound pattern in the intervention rooms.Methods: A quasi-randomized clinical trial design was chosen. The intervention consisted of a refurbished two-bed ICU patient room (experimental) with a new suspended wall-to-wall ceiling and a low frequency absorber. An identical two-bed room (control) remained unchanged.Inclusion criteria: Patients >18 years old with ICU lengths of stay (LoS) >48. h. The final study group consisted of 31 patients: six from the rebuilt experimental room and 25 from the control room. Methodological problems and possible solutions were continuously identified and documented.Results: Undertaking a full-scale intervention study with continuous measurements of acoustic data in an ICU is possible. However, this feasibility study demonstrated some aspects to consider before start. The randomization process and the sound measurement procedure must be developed. Furthermore, proper education and training are needed for determining ICU delirium.Conclusion: This study raises a number of points that may be helpful for future complex interventions in an ICU. For a full-scale study to be completed a continuously updated cost calculation is necessary. Furthermore, representatives from the clinic need to be involved in all stages during the project.
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| 17. |
- Johnston, S. Claiborne, et al.
(författare)
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Ischemic Benefit and Hemorrhage Risk of Ticagrelor-Aspirin Versus Aspirin in Patients With Acute Ischemic Stroke or Transient Ischemic Attack
- 2021
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Ingår i: Stroke. - : Wolters Kluwer. - 0039-2499 .- 1524-4628. ; 52:11, s. 3482-3489
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Tidskriftsartikel (refereegranskat)abstract
- Background and Purpose: In patients with acute mild-moderate ischemic stroke or high-risk transient ischemic attack, the THALES trial (Acute Stroke or Transient Ischemic Attack Treated With Ticagrelor and Aspirin for Prevention of Stroke and Death) demonstrated that when added to aspirin, ticagrelor reduced stroke or death but increased risk of severe hemorrhage compared with placebo. The primary efficacy outcome of THALES included hemorrhagic stroke and death, events also counted in the primary safety outcome. We sought to disentangle risk and benefit, assess their relative impact, and attempt to identify subgroups with disproportionate risk or benefit. Methods: In a randomized, placebo-controlled, double-blind trial of patients with mild-to-moderate acute noncardioembolic ischemic stroke or high-risk transient ischemic attack, patients were randomized within 24 hours after symptom onset to a 30-day regimen of either ticagrelor plus aspirin or matching placebo plus aspirin. For the present analyses, we defined the efficacy outcome, major ischemic events, as the composite of ischemic stroke or nonhemorrhagic death, and defined the safety outcome, major hemorrhage, as intracranial hemorrhage or hemorrhagic death. Net clinical impact was defined as the combination of these 2 end points. Results: In 11 016 patients (5523 ticagrelor-aspirin and 5493 aspirin), a major ischemic event occurred in 294 patients (5.3%) in the ticagrelor-aspirin group and in 359 patients (6.5%) in the aspirin group (absolute risk reduction 1.19% [95% CI, 0.31%-2.07%]). Major hemorrhage occurred in 22 patients (0.4%) in the ticagrelor-aspirin group and 6 patients (0.1%) in the aspirin group (absolute risk increase 0.29% [95% CI, 0.10%-0.48%]). Net clinical impact favored ticagrelor-aspirin (absolute risk reduction 0.97% [95% CI, 0.08%-1.87%]). Findings were similar when different thresholds for disability were applied and over a range of predefined subgroups. Conclusions: In patients with mild-moderate ischemic stroke or high-risk transient ischemic attack, ischemic benefits of 30-day treatment with ticagrelor-aspirin outweigh risks of hemorrhage. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03354429.
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| 18. |
- Johnston, S. Claiborne, et al.
(författare)
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The Acute Stroke or Transient Ischemic Attack Treated with Ticagrelor and Aspirin for Prevention of Stroke and Death (THALES) trial : Rationale and design
- 2019
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Ingår i: International Journal of Stroke. - : SAGE Publications. - 1747-4930 .- 1747-4949. ; 14:7, s. 745-751
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Tidskriftsartikel (refereegranskat)abstract
- RationaleIn patients with acute cerebral ischemia, the rate of stroke, myocardial infarction, or death during 90 days was reported to be non-significantly lower with ticagrelor compared with aspirin, with no increase in major hemorrhage. Dual antiplatelet therapy may be more effective in this setting.AimTo investigate whether ticagrelor combined with aspirin are superior to aspirin alone in preventing stroke or death in patients with non-severe, non-cardioembolic ischemic stroke or high-risk transient ischemic attack.DesignThe Acute Stroke or Transient Ischemic Attack Treated with Ticagrelor and Aspirin for Prevention of Stroke and Death (THALES) trial is a randomized, placebo-controlled, double-blind, event-driven study. Patients will be randomized within 24 h of onset of acute ischemic symptoms. THALES is expected to randomize 13,000 at ∼450 sites worldwide, to collect 764 primary outcome events. Study treatments are ticagrelor 180 mg loading dose on day 1, then 90 mg twice daily on days 2–30, or matching placebo. All patients will also receive open-label aspirin 300–325 mg on day 1, then 75–100 mg once daily on days 2–30.Study outcomesThe primary efficacy outcome is time to the composite endpoint of stroke or death through 30-day follow-up. The primary safety outcome is time to first severe bleeding event.DiscussionThe THALES trial will provide important information about the benefits and risks of dual antiplatelet therapy with ticagrelor and aspirin in patients with acute cerebral ischemia in a global setting (funding: AstraZeneca)
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| 19. |
- Johnston, S. Claiborne, et al.
(författare)
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Ticagrelor and Aspirin or Aspirin Alone in Acute Ischemic Stroke or TIA
- 2020
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Ingår i: New England Journal of Medicine. - : Massachusetts Medical Society. - 0028-4793 .- 1533-4406. ; 383:3, s. 207-217
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundTrials have evaluated the use of clopidogrel and aspirin to prevent stroke after an ischemic stroke or transient ischemic attack (TIA). In a previous trial, ticagrelor was not better than aspirin in preventing vascular events or death after stroke or TIA. The effect of the combination of ticagrelor and aspirin on prevention of stroke has not been well studied.MethodsWe conducted a randomized, placebo-controlled, double-blind trial involving patients who had had a mild-to-moderate acute noncardioembolic ischemic stroke, with a National Institutes of Health Stroke Scale (NIHSS) score of 5 or less (range, 0 to 42, with higher scores indicating more severe stroke), or TIA and who were not undergoing thrombolysis or thrombectomy. The patients were assigned within 24 hours after symptom onset, in a 1:1 ratio, to receive a 30-day regimen of either ticagrelor (180-mg loading dose followed by 90 mg twice daily) plus aspirin (300 to 325 mg on the first day followed by 75 to 100 mg daily) or matching placebo plus aspirin. The primary outcome was a composite of stroke or death within 30 days. Secondary outcomes were first subsequent ischemic stroke and the incidence of disability within 30 days. The primary safety outcome was severe bleeding.ResultsA total of 11,016 patients underwent randomization (5523 in the ticagrelor–aspirin group and 5493 in the aspirin group). A primary-outcome event occurred in 303 patients (5.5%) in the ticagrelor–aspirin group and in 362 patients (6.6%) in the aspirin group (hazard ratio, 0.83; 95% confidence interval [CI], 0.71 to 0.96; P=0.02). Ischemic stroke occurred in 276 patients (5.0%) in the ticagrelor–aspirin group and in 345 patients (6.3%) in the aspirin group (hazard ratio, 0.79; 95% CI, 0.68 to 0.93; P=0.004). The incidence of disability did not differ significantly between the two groups. Severe bleeding occurred in 28 patients (0.5%) in the ticagrelor–aspirin group and in 7 patients (0.1%) in the aspirin group (P=0.001).ConclusionsAmong patients with a mild-to-moderate acute noncardioembolic ischemic stroke (NIHSS score ≤5) or TIA who were not undergoing intravenous or endovascular thrombolysis, the risk of the composite of stroke or death within 30 days was lower with ticagrelor–aspirin than with aspirin alone, but the incidence of disability did not differ significantly between the two groups. Severe bleeding was more frequent with ticagrelor.
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| 20. |
- Karlsson, Mikael, et al.
(författare)
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Prediction of the onset of sound amplification at shear layers using linear stability analysis
- 2019
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Ingår i: 25th AIAA/CEAS Aeroacoustics Conference, 2019. - Reston, Virginia : American Institute of Aeronautics and Astronautics Inc, AIAA.
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Konferensbidrag (refereegranskat)abstract
- A simple numerical technique for predicting the potentiality of sound amplification by shear layers is presented. The technique applies Howe’s energy corollary to describe the energy exchange between the vortical mode in the shear layer and the acoustic wave incident on the layer. Potential sound amplification by the vortical mode is identified when the net energy gain of the incident acoustic wave is positive. The technique only requires steady flow simulation and linear stability analysis so the computational cost is modest. Numerical results are compared with a measurement on a particle agglomeration pipe and it shows that the sound amplification can be satisfactorily predicted by the simple technique.
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