| 1. |
- Platten, Michael
(author)
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Quantitative MRI Biomarkers of Neurodegeneration in Multiple Sclerosis
- 2022
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Doctoral thesis (other academic/artistic)abstract
- Background: Multiple sclerosis (MS) is a chronic neuroinflammatory and neurodegenerative disease that targets myelin in the brain and spinal cord. The corpus callosum connects the cerebral hemispheres and is composed of heavily myelinated axons. Atrophy of the corpus callosum has been explored as a more sensitive marker of disease status and neurodegeneration relative to other neuroanatomical structures. However, development of more accurate, precise and less labor demanding tools for characterizing callosal atrophy would increase its potential as a proxy marker of MS evolution.Purpose: The primary objective of this thesis was to evaluate and develop quantitative methods for measuring neurodegeneration in MS with a focus on the corpus callosum. This was achieved through the comparison of the accuracy and precision of manual delineation, conventional volumetric methods, and machine learning approaches.Study I: In a prospective study, 9 MS patients underwent scan/re-scanning with and without repositioning to measure the precision and accuracy of manual versus volumetric cross-sectional and longitudinal FreeSurfer analyses. While the longitudinal stream of FreeSurfer revealed the highest precision, the overall limitations on accuracy warrants caution.Study II: In a prospective study, 553 MS patients with 704 2D T2-weighted MRI acquisitions were used to train and validate a machine learning algorithm for segmenting a marker of neurodegeneration. The algorithm quickly produced highly accurate segmentations of the corpus callosum and brain (Dice Coefficient: 89% and 98%, respectively). The algorithm had numerically higher correlations to neurologic disability as compared to FreeSurfer.Study III: Analogous to Study II, in a prospective study, 631 MS patients with 3D T1-weighted and T2-weighted FLAIR acquisitions were used to train and validate a machine learning algorithm for segmenting the mid-sagittal normalized corpus callosum area. The algorithm performed better with T1-weighted scans and less atrophied patients. Scanner parameters had no significant effect on the T1-weighted output. The algorithm produced segmentations in less than a minute per scan, with similar correlations to neurologic disability, as compared to FreeSurfer.Study IV: In a prospective study, 92 MS patients acquired both 3 and 7 Tesla brain MRI scans to reveal the lobe-specific lesion volumes’ association to corpus callosum atrophy, where lesion burden was found to be greatest in the frontal and parietal lobes. In addition, the posterior portions of the corpus callosum provided the strongest fit linear regression models, with a combination of white matter lesions and intracortical lesions predicting atrophy.Conclusions: Creating and evaluating novel tools for measuring neurodegeneration over time is important both for monitoring disease progression and to evaluate therapeutic responses with current drugs. As novel therapeutic strategies appear, it may also help in assessing neuroregenerative approaches.
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| 2. |
- Tolf, Andreas
(author)
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In search of lost disease : Clinical, qualitative and imaging studies to investigate long-term effects of autologous haematopoietic stem cell transplantation for multiple sclerosis
- 2023
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Doctoral thesis (other academic/artistic)abstract
- With the introduction of autologous haematopoietic stem cell transplantation (AHSCT) for the treatment of multiple sclerosis (MS), there are now individuals living without experiencing disease activity of MS. Are they cured? There is a need for terminology to describe the state of these individuals. To address this and to report the ten-year outcomes of the first ten persons treated with AHSCT for MS at our centre, we conducted tests involving six different outcome measures to encompass the inflammatory (new clinical relapses, new MRI lesions, intrathecal antibody production) and degenerative (clinical progression, elevated intrathecal levels of neurofilament light protein, presence of callosal atrophy) aspects of the disease. Half of the participants achieved ‘sustained complete remission’ (normal values in all parameters, excluding intrathecal measurements), and three ‘resolved disease’ by displaying standard values across all measures. This terminology can be used when communicating successful treatment outcomes, and ‘resolved disease’ might serve as a working definition of cure.How did one perceive oneself, one’s health, and one’s diagnosis ten years after AHSCT? In this qualitative interview study, the lived experience of the same persons was explored and analysed with qualitative content analysis. The treatment symbolised a transition from a life dominated by uncertainty to a state of health and normality. The participants shared their experience of now feeling healthy, and some even reported not having MS anymore. They expressed a desire for objective criteria to affirm their health status.Impaired cerebral blood flow has been linked to progressive MS. The third study was a case-control study examining CBF and cerebrovascular reactivity (CVR) in individuals with secondary progressive MS, healthy controls, and persons treated with AHSCT from the previous studies. CBF was measured using positron emission tomography with 15O-water. CBF was diminished in individuals with progressive MS compared to the healthy controls. In contrast, CBF in the AHSCT group did not differ significantly from healthy controls. CVR was not impaired in progressive MS patients, suggesting an opportunity for therapeutic intervention with a vasodilating agent.The fourth study was a case-control study assessing factors associated with a favourable response to COVID-19 vaccination in persons with rituximab and MS. B cells emerged as the sole factor influencing antibody production. Consequently, pre-vaccination B-cell measurement was advised to enhance the likelihood of an effective humoral immune response.
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| 3. |
- Andersson Granberg, Tobias, 1973-, et al.
(author)
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Sensor Requirements for Logistics Analysis of Emergency Incident Sites
- 2020
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In: Proceedings of the 17th ISCRAM Conference. - : Information Systems for Crisis Response and Management. - 9781949373271 ; , s. 952-960
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Conference paper (peer-reviewed)abstract
- Using sensors to collect data at emergency incident sites can facilitate analysis of the logistic operations. This can be used to improve planning and preparedness for new operations. Furthermore, real-time information from the sensors can serve as operational decision support. In this work in progress, we investigate the requirements on the sensors, and on the sensor data, to facilitate such an analysis. Through observations of exercises, the potential of using sensors for data collection is explored, and the requirements are considered. The results show that the potential benefits are significant, especially for tracking patients, and understanding the interaction between the response actors. However, the sensors need to be quite advanced in order to capture the necessary data.
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| 4. |
- Norrblom, Petter, et al.
(author)
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Vad motiverar frivilliga att fortsätta vara frivilliga?
- 2023
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In: Framtidens Skadeplats 2023. - Linköping : Linköping University Electronic Press.
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Conference paper (other academic/artistic)abstract
- Organiserade frivilliga är en allt viktigare del av samhällets beredskap. Initiativ som Sms-livräddare och Civila Insatspersoner (CIP) kan stötta professionella responsorganisationer och möjliggöra snabbare respons till händelser som hjärtstopp eller mindre bränder. Att få personer att ställa upp som frivilliga och sedan fortsätta vara frivilliga är väsentligt för att dessa initiativ ska ha en samhällsnytta. Tidigare studier har visat att det finns många faktorer som motiverar personer att bli frivilliga. Det saknas dock forskning på vilka faktorer som är mest avgörande för att personer ska fortsätta vara engagerade som frivilliga.Därför genomfördes våren 2022 en enkätstudie av forskare inom Centrum för Forskning i Respons- och Räddningssystem (CARER), där 5 300 personer som var engagerade antingen som Sms-livräddare eller CIP:ar svarade på frågor om vad som motiverade dem att vara frivilliga och om de hade för avsikt att fortsätta vara frivilliga i framtiden. En explorativ faktor-analys genomfördes för att visa på de underliggande faktorer som var gemensamma i svaren. I denna faktoranalys upptäcktes totalt 12 underliggande faktorer baserat på de 48 frågorna i enkäten. Dessa faktorer analyserades därefter med en regressionsanalys för att undersöka vilka av dessa som är mest avgörande i frivilligas motivation att fortsätta vara frivilliga.Resultatet visade att de faktorer som hade störst positiv inverkan på motivationen att fortsätta vara frivillig var Socialt sammanhang, Självbild, och Kompetens. De faktorer som hade störst negativ inverkan var Larmtrötthet och Negativa upplevelser. Resultaten från studien kan användas för att genomföra interventioner för att öka frivilligas motivation, genom att till exempel motverka larmtrötthet genom smartare utlarmningsalgoritmer eller utbildningsinsatser som ökar de frivilligas kompetens, och då förhoppningsvis även behålla fler frivilliga över tid.
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| 5. |
- Prytz, Erik, 1985-, et al.
(author)
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Evaluating the Effect of Bleeding Control Kit Locations for a Mass Casualty Incident Using Discrete Event Simulation
- 2020
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In: Proceedings of the 17th ISCRAM Conference. - : Information Systems for Crisis Response and Management. - 9781949373271 ; , s. 167-178
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Conference paper (peer-reviewed)abstract
- The purpose of this study was to develop a simulation model to evaluate bleeding control kit location strategies for a mass casualty incident scenario. Specifically, the event simulated was an explosion at a large sports arena. The model included a representation of the arena itself, simulated crowd movements following the detonation of an improvised explosive device, injuries and treatments, and different ways for immediate responders to help injured patients using tourniquets. The simulation model gave logically consistent results in the validation scenarios and the simulation outcomes were in line with the expected outcomes. The results of the different tourniquet location scenarios indicated that decentralized placement (more than one location) is better, easy access is important (between rather than at emergency exits) and that an increased number of available tourniquets will result in an increased number of survivors.
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| 6. |
- Prytz, Erik, 1985-, et al.
(author)
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Tillbaka till Framtidens Skadeplats : Scenarier och resultat
- 2021
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Reports (other academic/artistic)abstract
- Denna rapport presenterar ett nytt kunskapsläge om framtidens skadeplats utifrån de resultat som kommit från forskningsprogrammet Effektiva räddningsinsatser på Framtidens Skadeplats 2015–2020. Rapporten är en omarbetad version baserad på rapporten Att hantera framtidens skadeplatser: scenarier och utgångspunkter för kunskapsutveckling runt räddningsinsatser och skadeplatsarbete som gavs ut av Centrum för forskning inom respons- och räddningssystem (CARER) 2016. I den rapporten presenterades ett underlag för de kommande aktiviteterna som var planerade att genomföras inom forskningsprogrammet. Rapporten beskrev också åtta olika skadeplatsscenarier som togs fram i linje med Myndigheten för samhällsskydd och beredskaps (MSB:s) dåvarande framtidsanalyser samt en analys av då tillgänglig litteratur om olyckor och katastrofer. Dessa scenarier beskrev på ett strukturerat och detaljerat sätt möjliga framtida skadeplatser av särskilt intresse ur ett praktiker- och forskningsperspektiv. I denna rapport har dessa åtta scenarier arbetats om och uppdaterats utifrån rådande läge i samhället i dag. De har också utökats med en beskrivning av en möjlig respons så som den kan se ut i framtiden inom tidsramen 10 till 15 år. Denna rapport innehåller också en övergripande beskrivning av de resultat som framkommit från de sex arbetspaketen (AP) i programmet. Inom AP2 redovisas teman om a) frivilliga och civila insatspersoner, b) semi-professionella som första insatsaktörer, c) genus, etnicitet och utsatthet, samt d) efterforskning av försvunna personer. AP3 redovisar teman om a) effektiv utlarmning av frivilliga och semiprofessionella resurser, b) prediktering, c) skadeplatslogistik, samt d) alarmering och effektivare räddningstjänst. AP4 går igenom a) IT-plattformen OP-SENS och b) lägesbilder, medan AP5 redovisar teman om a) utvärdering av ny teknik, b) utvärdering av utbildning och övning, samt c) utvärdering av ny metodik. Slutligen har AP6 redovisat teman om a) nya metoders och resurser effekt på systemnivå, samt b) värdering av frivilliga och semiprofessionella. Dessa forskningsresultat återkommer i scenarierna för att exemplifiera hur de kan omsättas i praktiskt skadeplatsarbete innan, under och efter en insats.
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| 7. |
- Prytz, Erik, 1985-, et al.
(author)
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What motivates and demotivates emergency response volunteers? A survey-based factor analysis study
- 2023
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In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. - : BMC. - 1757-7241. ; 31:1
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Journal article (peer-reviewed)abstract
- BackgroundOrganized volunteer initiatives can reduce response times and improve outcomes in emergencies such as cardiac arrests or fires. Retention of volunteers is important to maintain good coverage and capabilities. The current study explores factors underlying volunteers motivation to continue as volunteers.MethodsData from 5347 active volunteers were collected through an online survey. An exploratory factor analysis was used to identify underlying factors that were then used in a regression analysis to predict intention to continue as a volunteer. Group differences based on, among others, number of alarms and prior professional experience in emergency response were explored.ResultsThe results showed that the factors community, self-image, and competence were the strongest positive predictors for the motivation to continue, whereas alarm fatigue and negative experience were the strongest negative predictors. Volunteers with professional background had higher competence and lower Alarm fatigue. Volunteers from rural areas and small cities had higher community than those in large cities.ConclusionsAlarm fatigue can make it hard to retain volunteers, which could be addressed using improved dispatch algorithms. Support after dispatch is important to prevent negative experiences. Finally, increased competence, e.g. through education and training, can improve volunteers motivation to continue.
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