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- Papakokkinou, Eleni, et al.
(author)
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Excess Morbidity Persists in Patients With Cushing’s Disease During Long-term Remission : A Swedish Nationwide Study
- 2020
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In: Journal of Clinical Endocrinology and Metabolism. - Washington : Oxford University Press. - 0021-972X .- 1945-7197. ; 105:8, s. 2616-2624
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Journal article (peer-reviewed)abstract
- Context: Whether multisystem morbidity in Cushing's disease (CD) remains elevated during long-term remission is still undetermined.Objective: To investigate comorbidities in patients with CD.Design, setting, and patients: A retrospective, nationwide study of patients with CD identified in the Swedish National Patient Register between 1987 and 2013. Individual medical records were reviewed to verify diagnosis and remission status.Main outcomes: Standardized incidence ratios (SIRs) with 95% confidence intervals (CIs) were calculated by using the Swedish general population as reference. Comorbidities were investigated during three different time periods: (i) during the 3 years before diagnosis, (ii) from diagnosis to 1 year after remission, and (iii) during long-term remission.Results: We included 502 patients with confirmed CD, of whom 419 were in remission for a median of 10 (interquartile range 4 to 21) years. SIRs (95% CI) for myocardial infarction (4.4; 1.2 to 11.4), fractures (4.9; 2.7 to 8.3), and deep vein thrombosis (13.8; 3.8 to 35.3) were increased during the 3-year period before diagnosis. From diagnosis until 1 year after remission, SIRs (95% CI were increased for thromboembolism (18.3; 7.9 to 36.0), stroke (4.9; 1.3 to 12.5), and sepsis (13.6; 3.7 to 34.8). SIRs for thromboembolism (4.9; 2.6 to 8.4), stroke (3.1; 1.8 to 4.9), and sepsis (6.0; 3.1 to 10.6) remained increased during long-term remission.Conclusion: Patients with CD have an increased incidence of stroke, thromboembolism, and sepsis even after remission, emphasizing the importance of early identification and management of risk factors for these comorbidities during long-term follow-up.
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- Ragnarsson, Oskar, 1971, et al.
(author)
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Overall and Disease-Specific Mortality in Patients With Cushing Disease: A Swedish Nationwide Study
- 2019
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In: Journal of Clinical Endocrinology and Metabolism. - : ENDOCRINE SOC. - 0021-972X .- 1945-7197. ; 104:6, s. 2375-2384
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Journal article (peer-reviewed)abstract
- Context: Whether patients with Cushing disease (CD) in remission have increased mortality is still debatable. Objective: To study overall and disease-specific mortality and predictive factors in an unselected nationwide cohort of patients with CD. Design, Patients, and Methods: A retrospective study of patients diagnosed with CD, identified in the Swedish National Patient Registry between 1987 and 2013. Medical records were systematically reviewed to verify the diagnosis. Standardized mortality ratios (SMRs) with 95% CIs were calculated and Cox regression models were used to identify predictors of mortality. Results: Of 502 identified patients with CD (n = 387 women; 77%), 419 (83%) were confirmed to be in remission. Mean age at diagnosis was 43 (SD, 16) years and median follow-up was 13 (interquartile range, 6 to 23) years. The observed number of deaths was 133 vs 54 expected, resulting in an overall SMR of 2.5 (95% CI, 2.1 to 2.9). The commonest cause of death was cardiovascular diseases (SMR, 3.3; 95% CI, 2.6 to 4.3). Excess mortality was also found associated with infections and suicide. For patients in remission, the SMR was 1.9 (95% CI, 1.5 to 2.3); bilateral adrenalectomy and glucocorticoid replacement therapy were independently associated with increased mortality, whereas GH replacement was associated with improved outcome. Conclusion: Findings from this large nationwide study indicate that patients with CD have excess mortality. The findings illustrate the importance of achieving remission and continued active surveillance, along with adequate hormone replacement and evaluation of cardiovascular risk and mental health.
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- Ragnarsson, Oskar, 1971, et al.
(author)
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The incidence of Cushing’s disease : a nationwide Swedish study
- 2019
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In: Pituitary. - : Springer. - 1386-341X .- 1573-7403. ; 22:2, s. 179-186
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Journal article (peer-reviewed)abstract
- Background: Studies on the incidence of Cushing’s disease (CD) are few and usually limited by a small number of patients. The aim of this study was to assess the annual incidence in a nationwide cohort of patients with presumed CD in Sweden.Methods: Patients registered with a diagnostic code for Cushing’s syndrome (CS) or CD, between 1987 and 2013 were identified in the Swedish National Patient Registry. The CD diagnosis was validated by reviewing clinical, biochemical, imaging, and histopathological data.Results: Of 1317 patients identified, 534 (41%) had confirmed CD. One-hundred-and-fifty-six (12%) patients had other forms of CS, 41 (3%) had probable but unconfirmed CD, and 334 (25%) had diagnoses unrelated to CS. The mean (95% confidence interval) annual incidence between 1987 and 2013 of confirmed CD was 1.6 (1.4–1.8) cases per million. 1987–1995, 1996–2004, and 2005–2013, the mean annual incidence was 1.5 (1.1–1.8), 1.4 (1.0–1.7) and 2.0 (1.7–2.3) cases per million, respectively. During the last time period the incidence was higher than during the first and second time periods (P < 0.05).Conclusion: The incidence of CD in Sweden (1.6 cases per million) is in agreement with most previous reports. A higher incidence between 2005 and 2013 compared to 1987–2004 was noticed. Whether this reflects a truly increased incidence of the disease, or simply an increased awareness, earlier recognition, and earlier diagnosis can, however, not be answered. This study also illustrates the importance of validation of the diagnosis of CD in epidemiological research.
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- Toijer, Elin, et al.
(author)
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Ab initio investigation of effects of solute segregation onintergranular fracture in nickel: Importance of fracture path andstructural modification
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Other publication (other academic/artistic)abstract
- In the present work, the impact of chromium and silicon impurities on thegrain boundary strength of nickel has been investigated by means of densityfunctional theory (DFT) modelling. The excess-energy approach has beenused to model the impact of the solutes, and a quantitative comparison of their corresponding impact in combination with the impact of phosphorus, self-interstitial Ni is here presented. The results of main importance are inreference to the Cr: It is shown that the common assumption that interstitial Cr segregates to the center of a GB gives decisively erroneous resultsregarding the impact of the solute in this context. The solute will instead remain at the GB surface, and consequently self interstitial Ni will migrateto the GB center. This configuration will give an important weakening tothe structure, in clear contrast to previous studies were Cr has been shown to promote strengthening of the same structure. However, the results in the current work further show that this weakening is in fact not due to the presence of Cr, but to the enrichment of self-interstitial atoms in the GB center.
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- Toijer, Elin, et al.
(author)
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Ab initio modelling of intergranular fracture of nickel containing phosphorus : Interfacial excess properties
- 2021
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In: Nuclear Materials and Energy. - : Elsevier BV. - 2352-1791. ; 28
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Journal article (peer-reviewed)abstract
- In the present work, the impact of phosphorus impurities on the grain boundary strength of nickel has been investigated by means of density functional theory (DFT) modelling. Owing to different outcomes and trends previously reported in the literature, it is unclear whether P is strengthening or weakening the Ni grain boundary. To address this issue, we utilize three different DFT based methods: the excess-energy approach, rigid grain separation, and Rice-Wang's thermodynamic approach. The results show that the commonly used rigid model predicts P to have an increasing effect on the peak stress of Ni of up to 14%, as opposed to a reduction, which is indicated by the excess-energy approach. Employment of the Rice-Wang approach, on the other hand, displays a slight reduction in work of separation. The results show that the discrepancies between previous works can be attributed not so much to the physics of the system, but to the applied model, the partition scheme and the interpretation of the outcomes. This underlines the importance of a proper description of the fracture process, and shows that common simplifications can have a decisive impact on the observed trends.
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- Vinblad, Elin, et al.
(author)
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Children and young people’s experiences of participation in pediatric rehabilitation : a qualitative study
- 2019
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In: Developmental Medicine & Child Neurology. - Chichester : Wiley-Blackwell. - 0012-1622 .- 1469-8749. ; 61:S2
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Journal article (peer-reviewed)abstract
- Introduction: Creating a healthcare system of justice requires a child-centered care where children and young people, regardless of disability, are allowed to participate in their own rehabilitation. The aim of this study was to explore children and young people’s experiences of participation in pediatric rehabilitation.Patients and methods: The study had a descriptive design with a qualitative content analysis approach. Interviews were conducted with 20 children (6-17 years old, 9 girls and 11 boys) and 8 young people (18-30 years old, 6 women and 2 men) with intellectual disabilities, physical disabilities or autism spectrum disorders.Results: Three categories emerged that reflected children and young people’s experiences of participation in pediatric rehabilitation: to be included; to be empowered; and to feel supported. To be included meant that children and young people are respected, listened to and involved in shared decision-making. To be empowered comprised autonomy, responsibility and understanding as essential aspects for participation. To feel supported meant that children and young people described their parents as facilitators for enabling participation by supporting communication and being a bridge between child and professionals.Conclusion: To increase participation, children need support in communication with the healthcare professionals in a way that they feel respected, empowered and able to be included in decisions concerning their own pediatric rehabilitation. This result constitutes an important step in the development of a forthcoming digital communication and decision tool, with the main objective to increase participation, for children with disabilities.
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8. |
- Alvarez, Alberto, 1992-, et al.
(author)
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Questgram [Qg] : Toward a Mixed-Initiative Quest Generation Tool
- 2021
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In: Proceedings of the 16th International Conference on the Foundations of Digital Games. - New York, NY, USA : Association for Computing Machinery (ACM). ; , s. 1-10
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Conference paper (peer-reviewed)abstract
- Quests are a core element in many games, especially role-playing and adventure games, where quests drive the gameplay and story, engage the player in the game’s narrative, and in most cases, act as a bridge between different game elements. The automatic generation of quests and objectives is an interesting challenge since this can extend the lifetime of games such as in Skyrim, or can help create unique experiences such as in AI Dungeon. This work presents Questgram [Qg], a mixed-initiative prototype tool for creating quests using grammars combined in a mixed-initiative level design tool. We evaluated our tool quantitatively by assessing the generated quests and qualitatively through a small user study. Human designers evaluated the system by creating quests manually, automatically, and through mixed-initiative. Our results show the Questgram’s potential, which creates diverse, valid, and interesting quests using quest patterns. Likewise, it helps engage designers in the quest design process, fosters their creativity by inspiring them, and enhance the level generation facet of the Evolutionary Dungeon Designer with steps towards intertwining both level and quest design.
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9. |
- Alverhed, Elin, et al.
(author)
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Autonomous last-mile delivery robots: a literature review
- 2024
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In: European Transport Research Review. - 1867-0717 .- 1866-8887. ; 16:1
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Research review (peer-reviewed)abstract
- This literature review investigates how self-driving autonomous delivery robots (ADRs) impact last-mile deliveries, add value to the logistics and transport industry, and contribute to creating competitive business models. Autonomous vehicles are still a developing technology and ADRs could possibly be one of the solutions to the last-mile problem, in particular in cities and for urban freight with an increasing number of parcels to deliver. Last-mile delivery is also changing as e-commerce and more demanding customers emerge. Such development, however, faces challenges regarding infrastructure, externalities such as CO2 emissions, and shorter delivery-time requirements. This review, focused on ADRs, reveals four major themes (operations, infrastructure, regulations, and acceptance) through which we explain the barriers and benefits of using ADRs for last-mile deliveries. The review shows that the operations of ADRs can impact last-mile deliveries by lowering costs, optimising the use of time, and reducing externalities. The review also shows that the foundation of last-mile infrastructure would have to change if ADRs are to be used to a greater extent. Regulations for ADRs are still not yet in place, which makes the market somewhat confused. The acceptance of ADRs in society is another challenge because the innovation of ADRs is still new and unfamiliar. Altogether, the use of ADRs for last-mile deliveries shows great potential, based on the promising results of the articles reviewed. However, most studies on ADRs have been theoretical in nature, such as models, which highlights the need for real-world case studies and implementations.
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10. |
- Andersson, Gerhard, Professor, 1988-, et al.
(author)
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Individually tailored Internet-delivered cognitive-behavioral therapy for survivors of intimate partner violence : A randomized controlled pilot trial
- 2021
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In: Internet Interventions. - : Elsevier BV. - 2214-7829. ; 26
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Journal article (peer-reviewed)abstract
- Intimate partner violence (IPV) is a serious public health concern worldwide and defined as behavior performed by spouses or other intimate partners that causes physical, sexual, or psychological harm. Internet-delivered cognitive-behavioral therapy (ICBT) may be particularly useful for survivors of IPV for several reasons, including barriers pertaining to limited community recourses and treatment availability, safety concerns, and issues of stigma, guilt and shame, which may prevent members of this population from seeking help via face-to-face interactions. However, Internet interventions are lacking. The primary aim of the present randomized controlled pilot trial was to explore the feasibility of ICBT as guided self-help individually tailored to the predominant symptomatology of PTSD or depression in survivors of IPV. A second aim was to conduct a preliminary evaluation exploring the short- and long-term effects of the treatment in comparison to a waitlist control condition. Results showed that the treatment was feasible. Attrition rate was low (9.4%), and participants were satisfied with treatment. However, treatment adherence was moderate in terms of completed modules (62.5%). Results of the preliminary evaluation of treatment effects showed large and statistically significant between-group effect sizes (Cohen's d = 0.86–1.08) on some measures of PTSD and depression at post assessment, favoring the treatment condition. However, there were no effects on other measures. At follow-up assessment, when the control condition had received delayed treatment, there were large and statistically significant within-group effect sizes (d = 0.96–1.48) on measures of PTSD, depression and anxiety, and small effects (d = 0.48) on a measure of quality of life. The results of the present pilot study are promising and warrant further research on ICBT for this population.
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