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- 2019
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Tidskriftsartikel (refereegranskat)
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| 2. |
- Ederle, Joerg, et al.
(författare)
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Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial
- 2010
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Ingår i: The Lancet. - 1474-547X. ; 375:9719, s. 985-997
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Tidskriftsartikel (refereegranskat)abstract
- Background Stents are an alternative treatment to carotid endarterectomy for symptomatic carotid stenosis, but previous trials have not established equivalent safety and efficacy. We compared the safety of carotid artery stenting with that of carotid endarterectomy. Methods The International Carotid Stenting Study (ICSS) is a multicentre, international, randomised controlled trial with blinded adjudication of outcomes. Patients with recently symptomatic carotid artery stenosis were randomly assigned in a 1:1 ratio to receive carotid artery stenting or carotid endarterectomy. Randomisation was by telephone call or fax to a central computerised service and was stratified by centre with minimisation for sex, age, contralateral occlusion, and side of the randomised artery. Patients and investigators were not masked to treatment assignment. Patients were followed up by independent clinicians not directly involved in delivering the randomised treatment. The primary outcome measure of the trial is the 3-year rate of fatal or disabling stroke in any territory, which has not been analysed yet. The main outcome measure for the interim safety analysis was the 120-day rate of stroke, death, or procedural myocardial infarction. Analysis was by intention to treat (ITT). This study is registered, number ISRCTN25337470. Findings The trial enrolled 1713 patients (stenting group, n=855; endarterectomy group, n=858). Two patients in the stenting group and one in the endarterectomy group withdrew immediately after randomisation, and were not included in the ITT analysis. Between randomisation and 120 days, there were 34 (Kaplan-Meier estimate 4.0%) events of disabling stroke or death in the stenting group compared with 27 (3.2%) events in the endarterectomy group (hazard ratio [HR] 1.28, 95% CI 0.77-2.11). The incidence of stroke, death, or procedural myocardial infarction was 8.5% in the stenting group compared with 5.2% in the endarterectomy group (72 vs 44 events; HR 1.69, 1.16-2.45, p=0.006), Risks of any stroke (65 vs 35 events; HR 1.92, 1.27-2.89) and all-cause death (19 vs seven events; HR 2.76, 1.16-6.56) were higher in the stenting group than in the endarterectomy group. Three procedural myocardial infarctions were recorded in the stenting group, all of which were fatal, compared with four, all non-fatal, in the endarterectomy group. There was one event of cranial nerve palsy in the stenting group compared with 45 in the endarterectomy group. There were also fewer haematomas of any severity in the stenting group than in the endarterectomy group (31 vs 50 events; p=0.0197). Interpretation Completion of long-term follow-up is needed to establish the efficacy of carotid artery stenting compared with endarterectomy. In the meantime, carotid endarterectomy should remain the treatment of choice for patients suitable for surgery.
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| 3. |
- Olsson, MIT, et al.
(författare)
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Gender Gap in Parental Leave Intentions : Evidence from 37 Countries
- 2023
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Ingår i: Political Psychology. - : Wiley-Blackwell Publishing Ltd. - 0162-895X .- 1467-9221. ; 44:6, s. 1163-1192
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Tidskriftsartikel (refereegranskat)abstract
- Despite global commitments and efforts, a gender-based division of paid and unpaid work persists. To identify how psychological factors, national policies, and the broader sociocultural context contribute to this inequality, we assessed parental-leave intentions in young adults (18–30 years old) planning to have children (N = 13,942; 8,880 identified as women; 5,062 identified as men) across 37 countries that varied in parental-leave policies and societal gender equality. In all countries, women intended to take longer leave than men. National parental-leave policies and women's political representation partially explained cross-national variations in the gender gap. Gender gaps in leave intentions were paradoxically larger in countries with more gender-egalitarian parental-leave policies (i.e., longer leave available to both fathers and mothers). Interestingly, this cross-national variation in the gender gap was driven by cross-national variations in women's (rather than men's) leave intentions. Financially generous leave and gender-egalitarian policies (linked to men's higher uptake in prior research) were not associated with leave intentions in men. Rather, men's leave intentions were related to their individual gender attitudes. Leave intentions were inversely related to career ambitions. The potential for existing policies to foster gender equality in paid and unpaid work is discussed.
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| 5. |
- Devos, Y., et al.
(författare)
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Applying ecosystem services for pre-market environmental risk assessments of regulated stressors
- 2019
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Ingår i: EFSA Journal. - : Wiley. - 1831-4732. ; 17
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Tidskriftsartikel (refereegranskat)abstract
- Ecosystem services (ES) are the benefits that people obtain from ecosystems. Investigating the environment through an ES framework has gained wide acceptance in the international scientific community and is applied by policymakers to protect biodiversity and safeguard the sustainability of ecosystems. This approach can enhance the ecological and societal relevance of pre-market/prospective environmental risk assessments (ERAs) of regulated stressors by: (1) informing the derivation of operational protection goals; (2) enabling the integration of environmental and human health risk assessments; (3) facilitating horizontal integration of policies and regulations; (4) leading to more comprehensive and consistent environmental protection; (5) articulating the utility of, and trade-offs involved in, environmental decisions; and (6) enhancing the transparency of risk assessment results and the decisions based upon them. Realisation of these advantages will require challenges that impede acceptance of an ES approach to be overcome. Particularly, there is concern that, if biodiversity only matters to the extent that it benefits humans, the intrinsic value of nature is ignored. Moreover, our understanding of linkages among ecological components and the processes that ultimately deliver ES is incomplete, valuing ES is complex, and there is no standard ES lexicon and limited familiarity with the approach. To help overcome these challenges, we encourage: (1) further research to establish biodiversity-ES relationships; (2) the development of approaches that (i) quantitatively translate responses to chemical stressors by organisms and groups of organisms to ES delivery across different spatial and temporal scales, (ii) measure cultural ES and ease their integration into ES valuations, and (iii) appropriately value changes in ES delivery so that trade-offs among different management options can be assessed; (3) the establishment of a standard ES lexicon; and (4) building capacity in ES science and how to apply ES to ERAs. These development needs should not prevent movement towards implementation of an ES approach in ERAs, as the advantages we perceive of using this approach render it more than worthwhile to tackle those challenges. Society and the environment stand to benefit from this shift in how we conduct the ERA of regulated stressors. (C) 2019 European Food Safety Authority. EFSA Journal published by John Wiley and Sons Ltd on behalf of European Food Safety Authority.
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| 6. |
- Fox, Anthony D., et al.
(författare)
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Recent changes in the abundance of Common Pochard Aythya ferina breeding in Europe
- 2016
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Ingår i: Wildfowl. - 0954-6324. ; 66, s. 22-40
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Forskningsöversikt (refereegranskat)abstract
- National accounts suggest that the Common Pochard Aythya ferina was an uncommon breeding bird throughout western Europe before 1850. Extensions to the breeding range in the late 19th century were potentially aided by the rapid development of managed fish-ponds in eastern Europe, which provided suitable novel habitat at that time. Expansion into western Europe followed in subsequent decades. Wetland and waterbody eutrophication throughout Europe, which likely provided food and cover for the birds, may have accelerated the rapid expansion from the 1950s until the early 1980s. Widespread declines in the last 30 years, especially in eastern Europe, where breeding numbers are highest, are possibly linked to intensification and/or abandonment of freshwater fish farming and changes in water quality. Studies show that Pochard gain fitness benefits from nesting in Black-headed Gull Chroicocephalus ridibundus colonies and hence has been affected by major losses of European gull colonies in the last 30 years. The spread of alien fish species such as the Carp Cyprinus carpio, which compete with Pochard for food resources, is a problem in the Mediterranean region. Changing predation pressures (in some cases linked to invasive alien mammals) are also implicated in some areas. Relatively modest numbers breeding in the UK, France and the Netherlands have remained stable or increased over the same recent span of years, confirming that different factors currently affect Pochard breeding abundance throughout its range. We urgently need better information relating to key factors affecting Pochard breeding success and abundance, which is currently showing an unfavourable conservation status throughout much of Europe.
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| 9. |
- Hugo, Fred, et al.
(författare)
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Innovative Applications of the MLS10 for Developing Pavement Design Systems
- 2008
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Ingår i: Third International Conference on Accelerated Pavement Testing. - Madrid.
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Konferensbidrag (refereegranskat)abstract
- This paper presents innovative applications of accelerated pavement testing (APT) to advance pavement design in 3 case studies using MLS technology. Initially the MLS10 system was used to evaluate response and performance of cement stabilized coastal sand bases (CTB) in Mozambique. The aim was development of guidelines for a mechanistic-empirical design method. Trafficking speed was varied with dual wheel loads of either 60kN or 70kN and tire pressures at 800kPa under simulated environmental conditions. Integrated, cost-effective full-scale and MMLS3 scaled laboratory tests were used. Cost would have been 16 times more if full-scale testing were used for pre-selecting test sections. In both test modes, 2 unique failure mechanisms were identified; namely, horizontal shear within the CTB layer and debonding at the interface between surfacing and CTB. PSPA stiffness monitoring enabled progressive deterioration of pavements to be evaluated and performance modeled for subsequent use. The second MLS10 application evaluated performance of an innovative, ultra-thin reinforced concrete pavement (UTCRCP). The SA Road Agency (SANRAL) is investigating UTCRCP for reconstruction or rehabilitation of heavily trafficked freeways. Trafficking differed from HVS APT that had already yielded very positive results. Limited trafficking was applied to evaluate performance of a strengthened construction joint. Trafficking was primarily channelized and unidirectional. Loading frequency was 6.9 fold higher than the HVS'. Performance under MLS10 was positive with smaller deflection and joint movement as expected. No failure occurred. However, a sharp increase in deflection of the construction joint occurred with the switch to limited laterally distributed wet trafficking. This was ascribed to a change in pore pressure patterns. This could not be investigated further due to unavoidable early termination of trafficking. Should the trend continue performance life is likely to be negatively affected. Larger deflection was detected away from the construction joint throughout the test. This could be due to a deficiency in the sub base, or the smaller quantity of reinforcing steel compared to the reinforcing at the joint where additional steel had been added. The test provided guidance for planned validation of APT performance on a specially constructed highway trial section. A third application by EMPA in Switzerland tested a 20-yr-old untrafficked, heavy duty deep structured HMA pavement with cement treated sub-base on a spur of a trafficked freeway. Trafficking was terminated after 1 million 65kN channelized half axle load applications. The performance provided a basis for comparison with the adjacent freeway that had carried ca. 6.5 million equivalent E100’s with one intervention for replacement of 50mm surfacing. Ground penetrating radar (GPR) monitoring showed progressive distress with trafficking. This correlated with decline in PSPA seismic stiffness and increased surface deflection. Pumping was experienced with wet trafficking. Diagnostic trenching ratified indications from GPR and seismic stiffness trends that indicated delamination between the 2 HMA layers. The one million E130 load applications equate to ca. 4.9 million E100 axle load applications on the test section in terms of damage. A detailed diagnostic study of the trafficked freeway should provide invaluable information for a more thorough comparison of respective performances.
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| 10. |
- Kletzel, Sandra L., et al.
(författare)
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Effectiveness of Brain Gaming in Older Adults With Cognitive Impairments : A Systematic Review and Meta-Analysis.
- 2021
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Ingår i: Journal of the American Medical Directors Association. - : Elsevier. - 1525-8610 .- 1538-9375. ; 22:11, s. 2281-2288
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: This systematic review and meta-analysis evaluates the evidence from randomized clinical trials (RCTs) that designed brain gaming interventions to improve cognitive functions of older adults with cognitive impairments, including mild cognitive impairments and dementia.DESIGN: Systematic review and meta-analysis.SETTING AND PARTICIPANTS: N/A.MEASURES: N/A.METHODS: Data sources-relevant randomized control trials (RCTs) were identified by a systematic search of databases including Medline, PubMed, PsycINFO, Embase, CINAHL, Web of Science, and Cochrane. RCTs were selected first based on title and abstract review and then on full-text review by independent reviewers using predefined eligibility criteria. Risk of bias (RoB) was assessed using the Cochrane RoB tool and funnel plots. The primary outcome variable was the composite score of global cognitive function.RESULTS: A total of 909 participants with mild cognitive impairment or dementia from 16 RCTs were included in the systematic review. The study quality was modest, and the RoB assessment showed bias in blinding the participants and personnel. Funnel plots showed no evidence of publication bias. The meta-analysis of 14 RCTs revealed no superior effect of brain gaming compared to other interventions on global cognitive function (pooled standardized mean difference = 0.08, 95% confidence interval -0.24, 0.41, P = .61, I2 = 77%). Likewise, no superior effects were found on the cognitive domains of memory, executive function, visuospatial skills, and language.CONCLUSION AND IMPLICATIONS: The findings of this meta-analysis suggest that brain gaming compared with the control intervention does not show significant improvement in standardized tests of cognitive function. Because of considerable heterogeneity in sample size, gaming platform, cognitive status, study design, assessment tools, and training prescription, we cannot confidently refute the premise that brain gaming is an effective cognitive training approach for older adults with cognitive impairments. Recommendations for future research are included.
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