| 1. |
- Andersson, Henrik, et al.
(författare)
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Using optimization to provide decision support for strategic emergency medical service planning - Three case studies
- 2020
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Ingår i: International Journal of Medical Informatics. - : ELSEVIER IRELAND LTD. - 1386-5056 .- 1872-8243. ; 133
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Tidskriftsartikel (refereegranskat)abstract
- To achieve high performing emergency medical services (EMS), planning is of vital importance. EMS planners face several challenges when managing ambulance stations and the fleet of ambulances. In this paper, three strategic cases for EMS planners are presented together with potential solutions. In the first case, the effects of closing down a local emergency room (ER) are analyzed together with how adding an ambulance station and an ambulance to the area affected by the closing of the ER can be used to mitigate the negative consequences from the closing. The second case investigates a change in the organization of EMS. Currently, many non-urgent transport assignments are performed by ambulances which make them unavailable for more urgent calls. The potential for a more effective utilization of the ambulances is explored through transferring these assignments to designated transport vehicles. The third case is more technical and challenges the common practice regarding how time dependent demand is handled. Looking at the busiest hour or the average daily demand, is compared with taking time varying demand into account. The cases and solutions are studied using a recently developed strategic ambulance station location and ambulance allocation model for the Maximum Expected Performance Location Problem with Heterogeneous Regions (MEPLP-HR). The model has been extended to also include multiple time periods. This article demonstrates an innovative use of the model and how it can be applied to find and evaluate solutions to real cases within the field of strategic planning of EMS. The model is found to be a useful decision support tool when analyzing the cases and the expected performance of potential solutions.
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| 2. |
- Bauden, Monika, et al.
(författare)
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Circulating nucleosomes as epigenetic biomarkers in pancreatic cancer.
- 2015
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Ingår i: Clinical Epigenetics. - : Springer Science and Business Media LLC. - 1868-7075 .- 1868-7083. ; 7
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Tidskriftsartikel (refereegranskat)abstract
- To improve the prognosis of patients with pancreatic cancer, new biomarkers are required for earlier, pre-symptomatic diagnosis. Epigenetic mutations take place at the earliest stages of tumorigenesis and therefore offer new approaches for detecting and diagnosing disease. Nucleosomes are the repeating subunits of DNA and histone proteins that constitute human chromatin. Because of their release into the circulation, intact nucleosome levels in serum or plasma can serve as diagnostic disease biomarkers, and elevated levels have been reported in various cancers. However, quantifying nucleosomes in the circulation for cancer detection has been challenging due to nonspecific elevation in sera of patients with benign diseases. Here, we report for the first time differential, disease-associated epigenetic profiles of intact cell-free nucleosomes (cfnucleosomes) containing specific DNA and histone modifications as well as histone variants circulating in the blood. The study comprised serum samples from 59 individuals, including 25 patients with resectable pancreatic cancer, 10 patients with benign pancreatic disease, and 24 healthy individuals using Nucleosomics(®), a novel ELISA method.
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| 3. |
- Leknes, Hakon, et al.
(författare)
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Strategic ambulance location for heterogeneous regions
- 2017
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Ingår i: European Journal of Operational Research. - : ELSEVIER SCIENCE BV. - 0377-2217 .- 1872-6860. ; 260:1, s. 122-133
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Tidskriftsartikel (refereegranskat)abstract
- Providing Emergency Medical Services (EMS) is a key function of society. To achieve high quality EMS, planning is of vital importance. An important strategic and tactical problem is the location of ambulance stations and the allocation of ambulances to these stations. This paper presents a new mixed integer model for this problem especially suitable for regions with heterogeneous demand and multiple performance measures. The model decides on the location/allocation of stations/ambulances, calculates the service and arrival rates for each station and the probabilities that a call is served by a particular station. The model is tested on a combined urban and rural area in Norway with multiple performance measures. Compared with the current solution for the area, the best solution from the model has a higher expected performance on each of the performance measures used. (C) 2016 Elsevier B.V. All rights reserved.
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| 4. |
- Persson, Josefine, 1980, et al.
(författare)
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Stratification of COVID-19 patients based on quantitative immune-related gene expression in whole blood.
- 2022
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Ingår i: Molecular immunology. - : Elsevier BV. - 1872-9142 .- 0161-5890. ; 145, s. 17-26
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Tidskriftsartikel (refereegranskat)abstract
- The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes mild symptoms in the majority of infected individuals, yet in some cases it leads to a life-threatening condition. Determination of early predictive biomarkers enabling risk stratification for coronavirus disease 2019 (COVID-19) patients can inform treatment and intervention strategies. Herein, we analyzed whole blood samples obtained from individuals infected with SARS-CoV-2, varying from mild to critical symptoms, approximately one week after symptom onset. In order to identify blood-specific markers of disease severity status, a targeted expression analysis of 143 immune-related genes was carried out by dual-color reverse transcriptase multiplex ligation-dependent probe amplification (dcRT-MLPA). The clinically well-defined subgroups of COVID-19 patients were compared with healthy controls. The transcriptional profile of the critically ill patients clearly separated from that of healthy individuals. Moreover, the number of differentially expressed genes increased by severity of COVID-19. It was also found that critically ill patients can be distinguished by reduced peripheral blood expression of several genes, which most likely reflects the lower lymphocyte counts. There was a notable predominance of IFN-associated gene expression in all subgroups of COVID-19, which was most profound in critically ill patients. Interestingly, the gene encoding one of the main TNF-receptors, TNFRS1A, had selectively lower expression in mild COVID-19 cases. This report provides added value in understanding COVID-19 disease, and shows potential of determining early immune transcript signatures in the blood of patients with different disease severity. These results can guide further explorations to uncover mechanisms underlying immunity and immunopathology in COVID-19.
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| 5. |
- Vianello, Eleonora, et al.
(författare)
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Global blood miRNA profiling unravels early signatures of immunogenicity of Ebola vaccine rVSVΔG-ZEBOV-GP
- 2023
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Ingår i: iScience. - 2589-0042. ; 26:12
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Tidskriftsartikel (refereegranskat)abstract
- The vectored Ebola vaccine rVSVΔG-ZEBOV-GP elicits protection against Ebola Virus Disease (EVD). In a study of forty-eight healthy adult volunteers who received either the rVSVΔG-ZEBOV-GP vaccine or placebo, we profiled intracellular microRNAs (miRNAs) from whole blood cells (WB) and circulating miRNAs from serum-derived extracellular vesicles (EV) at baseline and longitudinally following vaccination. Further, we identified early miRNA signatures associated with ZEBOV-specific IgG antibody responses at baseline and up to one year post-vaccination, and pinpointed target mRNA transcripts and pathways correlated to miRNAs whose expression was altered after vaccination by using systems biology approaches. Several miRNAs were differentially expressed (DE) and miRNA signatures predicted high or low IgG ZEBOV-specific antibody levels with high classification performance. The top miRNA discriminators were WB-miR-6810, EV-miR-7151-3p, and EV-miR-4426. An eight-miRNA antibody predictive signature was associated with immune-related target mRNAs and pathways. These findings provide valuable insights into early blood biomarkers associated with rVSVΔG-ZEBOV-GP vaccine-induced IgG antibody responses.
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| 6. |
- Andersson, Bodil, et al.
(författare)
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Combining Keystroke Logging with Eye Tracking
- 2006
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Ingår i: Writing and Digital Media. - 1572-6304. - 0080448631 ; 17, s. 166-172
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Bokkapitel (refereegranskat)abstract
- This chapter describes the successful development of a new methodology for studying on-line writing. The text-logging tool ScriptLog has been combined with the eyetracking technology iView X HED HT, in order to enhance the study of the interplay between writing, monitoring and revision. Data on the distribution of visual attention during writing help determining to what extent pauses are used for monitoring. The complexity of the experimental settings, and the expertise needed for interpreting the eye-tracking data make this a method suitable mainly for laboratory settings. The chapter also introduces an analysis tool that merges data from ScriptLog and iView and thus helps the researcher to organise and analyse the vast amount of data produced.
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| 7. |
- Andersson, Henrik, 1974-
(författare)
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Coordinated Routing : applications in location and inventory management
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Almost everywhere, routing plays an important role in everyday life. This thesis consists of three parts, each studying different applications where routing decisions are coordinated with other decisions. A common denominator in all applications is that an intelligent utilization of a fleet of vehicles is crucial for the performance of the system. In the first part, routing and inventorymanagement decisions are coordinated, in the second part, routing decisions concerning different modes of transportation are coordinated with inventory management, and in the third part, location decision and routing are coordinated.In the first part, an application concerning waste management is presented. Many industries generate garbage, and instead of handling the waste disposal themselves, other companies, specialized in garbage collection, handle the disposal. Each industry rents containers from a company to be used for waste, and the garbage collection companies handle the collection. The industries buy a service including one or more containers at the industry and the garbage collection companies are obliged to make sure that the containers never become overfull. The idea is that the industries buy this service and in return, the garbage collection company can plan the collection so that the overall cost and the number of overfull containers is minimized. Two models for the problem facing the garbage collection company are proposed. The first is solved using a Lagrangean relaxation approach on a flow based model, and the second is solved using Benders decomposition on a column based model.The second part investigates a distribution chain management problem taken from the Swedish pulp industry. Given fixed production plans at the mills, and fixed customer demands, the problem is to minimize the distribution cost. Unlike many other models for marine distribution chains, the customers are not located at the harbors. This means that the model proposed also incorporates the distribution planning from the harbors to the customers. All customers are not served from the harbors; some are served directly from the mills using trucks and trains to distribute the pulp, and these decisions are also included. The problem is modeled as a mixed integer linear program and solved using a branch and price scheme. Due to the complexity of the problem, the solution strategy is divided into two phases, where the first emphasizes the generation of schedules for the vessels operated by the company, while the second deals with the chartering of vessels on the spot market.In the third part, routing is combined with location decisions in the location-routing problem. Special emphasis is given to strategic management where decision makers must make location, capacity and routing decisions over a long planning period. The studied application comes fromstrategic schoolmanagement, where the location and capacity of the schools as well as their catchment areas are under consideration. The problem is modeled as a mixed integer linear program. The computational study shows the importance of incorporatinga routing component allowing multiple visits, as well as the danger of having a too short planning period.
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| 8. |
- Bhatt, Deepak L., et al.
(författare)
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Rationale, design and baseline characteristics of the effect of ticagrelor on health outcomes in diabetes mellitus patients Intervention study
- 2019
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Ingår i: Clinical Cardiology. - : Wiley. - 0160-9289 .- 1932-8737. ; 42:5, s. 498-505
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Tidskriftsartikel (refereegranskat)abstract
- In the setting of prior myocardial infarction, the oral antiplatelet ticagrelor added to aspirin reduced the risk of recurrent ischemic events, especially, in those with diabetes mellitus. Patients with stable coronary disease and diabetes are also at elevated risk and might benefit from dual antiplatelet therapy. The Effect of Ticagrelor on Health Outcomes in diabEtes Mellitus patients Intervention Study (THEMIS, NCT01991795) is a Phase 3b randomized, double-blinded, placebo-controlled trial of ticagrelor vs placebo, on top of low dose aspirin. Patients >= 50 years with type 2 diabetes receiving anti-diabetic medications for at least 6 months with stable coronary artery disease as determined by a history of previous percutaneous coronary intervention, bypass grafting, or angiographic stenosis of >= 50% of at least one coronary artery were enrolled. Patients with known prior myocardial infarction (MI) or stroke were excluded. The primary efficacy endpoint is a composite of cardiovascular death, myocardial infarction, or stroke. The primary safety endpoint is Thrombolysis in Myocardial Infarction major bleeding. A total of 19 220 patients worldwide have been randomized and at least 1385 adjudicated primary efficacy endpoint events are expected to be available for analysis, with an expected average follow-up of 40 months (maximum 58 months). Most of the exposure is on a 60 mg twice daily dose, as the dose was lowered from 90 mg twice daily partway into the study. The results may revise the boundaries of efficacy for dual antiplatelet therapy and whether it has a role outside acute coronary syndromes, prior myocardial infarction, or percutaneous coronary intervention.
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| 9. |
- Bhatt, Deepak L., et al.
(författare)
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Ticagrelor in patients with diabetes and stable coronary artery disease with a history of previous percutaneous coronary intervention (THEMIS-PCI) : a phase 3, placebo-controlled, randomised trial
- 2019
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Ingår i: The Lancet. - 0140-6736 .- 1474-547X. ; 394:10204, s. 1169-1180
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Tidskriftsartikel (refereegranskat)abstract
- Background Patients with stable coronary artery disease and diabetes with previous percutaneous coronary intervention (PCI), particularly those with previous stenting, are at high risk of ischaemic events. These patients are generally treated with aspirin. In this trial, we aimed to investigate if these patients would benefit from treatment with aspirin plus ticagrelor.Methods The Effect of Ticagrelor on Health Outcomes in diabEtes Mellitus patients Intervention Study (THEMIS) was a phase 3 randomised, double-blinded, placebo-controlled trial, done in 1315 sites in 42 countries. Patients were eligible if 50 years or older, with type 2 diabetes, receiving anti-hyperglycaemic drugs for at least 6 months, with stable coronary artery disease, and one of three other mutually non-exclusive criteria:a history of previous PCI or of coronary artery bypass grafting, or documentation of angiographic stenosis of 50% or more in at least one coronary artery. Eligible patients were randomly assigned (1:1) to either ticagrelor or placebo, by use of an interactive voice-response or web-response system. The THEMIS-PCI trial comprised a prespecified subgroup of patients with previous PCI. The primary efficacy outcome was a composite of cardiovascular death, myocardial infarction, or stroke (measured in the intention-to-treat population).Findings Between Feb 17, 2014, and May 24, 2016, 11 154 patients (58% of the overall THEMIS trial) with a history of previous PCI were enrolled in the THEMIS-PCI trial. Median follow-up was 3.3 years (IQR 2.8-3.8). In the previous PCI group, fewer patients receiving ticagrelor had a primary efficacy outcome event than in the placebo group (404 [7.3%] of 5558 vs 480 [8.6%] of 5596; HR 0.85 [95% CI 0.74-0.97], p=0.013). The same effect was not observed in patients without PCI (p=0.76, p(interaction)=0.16). The proportion of patients with cardiovascular death was similar in both treatment groups (174 [3.1%] with ticagrelor vs 183 (3.3%) with placebo; HR 0.96 [95% CI 0.78-1.18], p=0.68), as well as all-cause death (282 [5.1%] vs 323 [5.8%]; 0.88 [0.75-1.03], p=0.11). TIMI major bleeding occurred in 111 (2.0%) of 5536 patients receiving ticagrelor and 62 (1.1%) of 5564 patients receiving placebo (HR 2.03 [95% CI 1.48-2.76], p<0.0001), and fatal bleeding in 6 (0.1%) of 5536 patients with ticagrelor and 6 (0.1%) of 5564 with placebo (1.13 [0.36-3.50], p=0.83). Intracranial haemorrhage occurred in 33 (0.6%) and 31 (0.6%) patients (1.21 [0.74-1.97], p=0.45). Ticagrelor improved net clinical benefit:519/5558 (9.3%) versus 617/5596 (11.0%), HR=0.85, 95% CI 0.75-0.95, p=0.005, in contrast to patients without PCI where it did not, p(interaction)=0.012. Benefit was present irrespective of time from most recent PCI.Interpretation In patients with diabetes, stable coronary artery disease, and previous PCI, ticagrelor added to aspirin reduced cardiovascular death, myocardial infarction, and stroke, although with increased major bleeding. In that large, easily identified population, ticagrelor provided a favourable net clinical benefit (more than in patients without history of PCI). This effect shows that long-term therapy with ticagrelor in addition to aspirin should be considered in patients with diabetes and a history of PCI who have tolerated antiplatelet therapy, have high ischaemic risk, and low bleeding risk.
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| 10. |
- Dahlin, Mats, et al.
(författare)
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Internet-delivered acceptance-based behavior therapy for generalized anxiety disorder : A pilot study
- 2016
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Ingår i: Internet Interventions. - : Elsevier. - 2214-7829. ; 6, s. 16-21
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Internet-delivered cognitive behavior therapy (ICBT) has been developed and tested for treating persons with generalized anxiety disorder (GAD). A new form of CBT focuses on acceptance (of internal experiences or difficult psychological content), mindfulness and valued actions. To date this form of CBT has not been delivered via the internet for persons with GAD. The aim of this study was to describe the functionality of a new internet-delivered acceptance-based behavior therapy for GAD, and to test the effect of the intervention in an open pilot trial. Methods: Following exclusion of two patients we included 14 patients diagnosed with GAD from two primary care clinics. At 2–3 months follow-up after treatment 10 patients completed the outcome measures. The treatment lasted for an average of 15 weeks and consisted of acceptance-based techniques, behavior therapy components and homework assignments. Results: A majority of participants completed all modules during the treatment. Findings on the Penn State Worry Questionnaire showed a within-group improvement of Cohen's d = 2.14 at posttreatment. At the follow-up results were maintained. Client satisfaction ratings were high. Conclusions: We conclude that internet-delivered acceptance-based behavior therapy potentially can be a promising new treatment for GAD. A controlled trial of the program has already been completed.
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