1. |
- Allard, Christina, et al.
(author)
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Rasbiologiskt språkbruk i statens rättsprocess mot sameby : DN Debatt 2015-06-11
- 2015
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Other publication (pop. science, debate, etc.)abstract
- Statens hantering av forskningsresultat i rättsprocessen med Girjas sameby utgör ett hot mot Sverige som rättsstat och kunskapsnation. Åratal av svensk och internationell forskning underkänns och man använder ett språkbruk som skulle kunna vara hämtat från rasbiologins tid. Nu måste staten ta sitt ansvar och börja agera som en demokratisk rättsstat, skriver 59 forskare.
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2. |
- Bäckman, Karin, et al.
(author)
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Vårdens alltför svåra val? : kartläggning av prioriteringsarbete och analys av riksdagens principer och riktlinjer för prioriteringar i hälso- och sjukvården
- 2007
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Reports (other academic/artistic)abstract
- PrioriteringsCentrum har på uppdrag av Socialstyrelsen genomfört en kartläggning av på vilket sätt hälso- och sjukvårdens huvudmän och andra centrala aktörer arbetar med prioriteringar och har utvärderat hur detta arbete överensstämmer med intentionerna i riksdagens beslut om prioriteringar. Vi har även analyserat innehållet i och tillämpningen av riksdagens riktlinjer för prioriteringar i hälso- och sjukvården. Det har skett genom en etisk analys och mot bakgrund av ett stort antal intervjuer i landsting och kommuner samt med representanter för statliga myndigheter och yrkesorganisationer och med ledning av vad som framkommit i tidigare uppföljningar. Vi föreslår i rapporten ett anta förändringar och förtydliganden av riktlinjerna.Vi kan konstatera att sättet att arbeta med prioriteringar i landsting och kommuner inte är helt olikt det som gällde när Prioriteringsdelegationen redovisade en motsvarande uppföljning år 2001. Fortfarande finns knappast några öppna beslut om fördelning och prioritering av resurser om man med öppenhet avser att beslutsfattaren medvetet överväger flera alternativ och att grunderna för besluten är kända för dem som önskar ta del av dem.I situationer då tillgängliga resurser inte befinner sig i paritet med önskvärda ambitioner får sjukvårdspersonalen ta det största ansvaret för att besluta om och genomföra ransonering av vården. Förutom på chefsnivå tycks dock sjukvårdpersonal fortfarande i liten utsträckning vara medveten om de etiska principer som enligt riksdagsbeslutet ska styra prioriteringar i vården. Få känner till den etiska plattformen med de tre etiska principerna. Lokala mallar eller styrdokument för prioriteringar är ovanliga. Det saknas nödvändiga förutsättningar för att tillämpa riksdagens prioriteringsbeslut och det finns inte heller några tydliga strategier för hur man vill skapa sådana förutsättningar inom landstingen.Den kommunala vård- och omsorgsverksamheten upplever sig fortfarande i ringa utsträckning berörd av den etiska plattformen och prioriteringsprinciperna. Någon gemensam prioritering mellan huvudmännen sker knappast alls.Medborgarna är i mycket liten utsträckning involverade i prioriteringsarbetet. Den ökade öppenheten gentemot brukare innebär oftast att viss information om prioriteringar sker genom traditionella kanaler som patientorganisationer, pensionärsråd och handikappråd och synpunkter inhämtas via allmänna patientenkäter medan klagomål hanteras genom patientnämnder.Vi har också funnit tydliga skillnader när det gäller hur arbetet med prioriteringar bedrivs idag jämfört med för sex år sedan. Genom Socialstyrelsen och Läkemedelsförmånsnämnden har staten tagit ledningen när det gäller att visa hur prioriteringar kan göras på ett systematiskt och öppet sätt. Detta arbete har resulterat i en tydlig metodutveckling. Idag finns det dessutom flera exempel på konkret utvecklingsarbete och samverkan mellan huvudmän kring det vidare begreppet kunskapsstyrd vård till vilket systematiska prioriteringar är starkt relaterat. Vi kan också notera olika initiativ till vertikala prioriteringar i verksamheten där det framförallt är läkarkåren som engagerat sig; men också enstaka försök med systematiska politiska prioriteringar. Det finns dessutom flera lovande utvecklingsprojekt rörande prioriteringar som initierats av och drivs av sjukvårdspersonal både lokalt och nationellt. Yrkesförbunden är också mer aktiva idag när det gäller att sprida kunskap om prioriteringar....
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3. |
- Carlsson, Per, 1951-, et al.
(author)
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National Model for Transparent Vertical Prioritisation in Swedish Health Care
- 2007
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Reports (other academic/artistic)abstract
- The proposed national model described in this report has been developed by a working group comprised of staff from the National Board of Health and Welfare, the National Centre for Priority Setting in Health Care, and other organisations involved in vertical prioritisation – including the Östergötland County Council, Stockholm County Council, Västra Götaland, the Health Services Region of Southern Sweden, the Swedish Society of Medicine, the Swedish Society of Nursing, and the Swedish Association of Health Professionals. Throughout the process of designing the model, the Swedish Federation of Occupational Therapists and the Swedish Association of Registered Physiotherapists were regularly informed and given opportunities to review and comment on the proposal. Furthermore, the report was reviewed and discussed at a meeting with invited representatives from the other county councils, the Pharmaceutical Benefits Board, and several professional interest groups. Viewpoints were also obtained at a seminar arranged by PrioNet, a network of individuals interested in prioritisation.Potentially, the working model described in Chapter 4 could be used in any context where vertical prioritisation takes place, e.g. activities arranged by the state, county councils, municipalities, hospital departments, and professional groups.This report is designed to be a useful tool for those working on development projects in priority setting. We believe that the contents must be adapted, with the help of relevant examples and some simplifications; to fit the specific needs of different projects or groups. The text must also be adapted to a target group’s knowledge and previous experience in dealing with transparent priority setting. It must be the responsibility of each provider and other affected organisation to adapt the material to the given situation and project. The National Centre for Priority Setting in Health Care, the National Board of Health and Welfare, and others who have participated actively in this effort can be helpful to various target groups in adapting this report.When and how to engage in practically implementing vertical prioritisation are questions that need to be answered at the local level. Primarily, it is the duty of the local authorities/providers to take responsibility for implementation. Professional organisations also play an important role. Public agencies, universities, and knowledge centres should be sources of support for the local authorities/providers.The Riksdag’s resolution on prioritisation served as the foundation for developing the model.Where there are areas of uncertainty in how to translate these guidelines in practice, or where practical implementation might conflict with the principles, we have pointed this out.Our conclusions and proposals are the following:When facing a choice – regardless of whether it involves allocating new resources for different purposes, or to implement cutbacks – it can be advantageous to rank the possible choices in order of priority. In our model, only the relevant options can be ranked by priority. The consequences of this ranking are not obvious at the outset, but can serve as a basis either to allocate more resources or ration by some means.In vertical prioritisation, it is advantageous to organise the prioritization process starting from a general categorisation of health problems/disease groups. As a rule, these categories cover many organisational units/clinical departments, specialties, or professional groups, thus providing a more multidimensional view of the problem. Furthermore, this allows the process to start from a patient/population perspective, which appears to be more goal-oriented than an organisational/staff perspective.That which is ranked, i.e. one of the choices, we refer to as a prioritization object. We suggest that prioritisation objects consist of different combinations of health conditions and interventions.1 When deciding on the appropriate level of detail, the decision must be based on the context in which prioritisation is carried out. A starting point would be to focus on typical cases, large-volumes services, and controversial care.All forms of vertical prioritisation should be based on the ethical principles that the Riksdag decided should apply in prioritising health services. However, these ethical principles must be made known, clarified, and perhaps complemented before they can be applied to practical priority setting. Furthermore, we believe that the Riksdag’s four so-called priority groups should not be part of the model.The human dignity principle, i.e. that all people should have equal value and equal rights to care irrespective of their personal characteristics and function in society, is the undisputed cornerstone in priority setting. When personal characteristics such as age, gender, lifestyle, or function of a group are expressions of the presence of special needs, so that benefits of the interventions are different, these personal characteristics could be addressed in a priority at the group level. Further discussion is needed regarding the question of how external effects (i.e. the effects of an intervention on families and groups other than the individual directly affected by the intervention) should be valued in priority setting.The concept of need in health care includes both the severity level of the condition and the expected benefits of intervention. As a patient, one needs only those interventions that can be expected to yield benefits. Based on this definition of need, a person does not need an intervention that does not improve health and quality of life, i.e. an intervention with no benefit. In such cases, health services have a responsibility to refer people who seek care for some type of problem, to other appropriate services.The Riksdag’s guidelines regarding the cost-effectiveness principle (applied to individual patients) are too limited to provide guidance for vertical prioritisation at the group level. From the outset, the Government’s bill (Priority Setting in Health Care) highlighted the importance of differentiating a cost-effectiveness principle that applied to choices among various interventions for the individual patient (where the principle can be applied as the Commission of Inquiry proposed) and the aim of health services to achieve high cost-effectiveness in health care generally. Here we also refer to the Riksdag’s directive to the Pharmaceutical Benefits Board. In its decisions on subsidising (prioritising) a drug, the Board should determine, e.g. whether the drug is cost effective from a societal perspective, which requires comparing the patient benefits of the drug to its cost. In such decisions, the cost effectiveness should be considered along with the needs and solidarity principle and the human dignity principle.The proposed working model essentially concurs with the working model used by the National Board of Health and Welfare in developing national guidelines. In describing a national working model, it is not possible to include every aspect that might be considered. Hence, one must start from the model and decide which other relevant aspects should be included. For instance, the International Classification on Functioning, Disability, and Health (ICF) can be used as guidance to describe the severity of health conditions.Due to the wealth of variety in outcome measures for different activities, and the limited experience in working with explicit threshold values, we believe would be premature to recommend standardised categories, e.g. risk levels. However, it is important that those working with prioritization describe their reasoning. Primarily, the categories applied by the Swedish Council on Technology Assessment in Health Care (SBU) to grade the scientific evidence of an intervention’s effects should be used. Local prioritisation projects with limited resources at their disposal should describe (text) their appraisal of the scientific evidence and reference the scientific sources used. The strength of evidence should be expressed in numbers only when supporting a conclusion of a systematic review by SBU, or other literature reviews of good quality.Prioritisation projects having access to health economic evaluation should, until further notice, adhere to the approach used by the National Board of Health and Welfare and present cost-effectiveness on a scale from low to very high cost per life-year gained or cost per quality-adjusted life-year. Economic evidence should be presented according to the principles applied by the National Board of Health and Welfare. In local projects with limited resources, or problems in consistently acquiring information on cost effectiveness, we recommend that the authors at least discuss cost effectiveness in cases where the priority ranking would be decisively affected when costs are weighed in.A 10-level ranking list should be used. The ranking list should be complemented by a “don’t do” list for methods that should not be used at all, or not used routinely, and a research and development (R&D) list for methods where the evidence still insufficient to motivate their use in standard practice. In the absence of an objective quantitative/mathematical method, a qualitative method should be used in the appraisal. Here too, we believe that it is not yet possible to establish standard criteria to determine within which ranking level a prioritisation object should fall.Results should be presented as a ranking list. The parameters used as a basis for prioritisation should also be presented in a uniform manner in ranking lists that are shared with other parties. For pedagogic reasons, details concerning language and format need to be adapted to the respective target groups.Thresholds for what constitutes an acceptable coverage of need (care quality, volume, and percentage of the patient group with access to services) a
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4. |
- Carlsson, Per, 1951-, et al.
(author)
-
Nationell modell för öppna vertikala prioriteringar inom svensk hälso- och sjukvård
- 2007
-
Reports (other academic/artistic)abstract
- En arbetsgrupp med personer från Socialstyrelsen och PrioriteringsCentrum, andra organisationer som arbetat med vertikala prioriteringar såsom Landstinget i Östergötland, Stockholms läns landsting, Västra Götaland, Södra sjukvårdsregionen, Svenska Läkaresällskapet, Svensk sjuksköterskeförening och Vårdförbundet har tagit fram detta förslag. Förslaget har fortlöpande förankrats hos Förbundet Sveriges Arbetsterapeuter och Legitimerade Sjukgymnasters Riksförbund som kunnat lämna synpunkter på utformningen av odellen.Dessutom har rapporten varit föremål för granskning och diskussion vid ett möte med inbjudna representanter från övriga landsting, Läkemedelsförmånsnämnden och flera yrkesorganisationer. Synpunkter har också inkommit från ett seminarium som arrangerades av PrioNet, ett nätverk av personer med intresse för prioriteringar.Den arbetsmodell som beskrivs i kapitel 4 ska kunna användas i alla sammanhang där vertikala prioriteringar sker såsom aktiviteter som arrangeras av staten, landsting, kommuner, kliniker, professionella grupper eller motsvarande.Rapporten är skriven på ett sådant sätt att den ska kunna användas i första hand som ett stöd till dem som bedriver utvecklingsarbete rörande prioriteringar. Vi tror att innehållet måste anpassas till olika verksamheter eller personalgruppers specifika behov med hjälp av kompletterande exempel och vissa förenklingar. Texten måste givetvis också anpassas till de kunskaper och tidigare erfarenheter som den aktuella målgruppen har när det gäller arbete med öppna prioriteringar. Sådana situations- och verksamhetsanpassade versioner måste det åligga varje sjukvårdshuvudman och andra berörda organisationer att utarbeta. PrioriteringsCentrum, Socialstyrelsen och andra parter som deltagit aktivt i detta arbete kan givetvis vara behjälpliga i arbetet med att bearbeta denna rapport för olika målgrupper.Frågan om när och hur arbetet med vertikala prioriteringar ska bedrivas i praktiken kan också endast besvaras lokalt. Det är i första hand ett nsvar för huvudmännen att ta ansvar för implementeringen. Professionella organisationer har också en viktig roll. Myndigheter, universitet och kunskapscentra ska vara ett stöd till huvudmännen.Utgångspunkten i modellutvecklingen är Riksdagens beslut om prioriteringar. När det finns oklarheter om hur dessa riktlinjer ska omsättas i praktiken eller att praktiken kan förefalla i konflikt med principerna har vi påpekat detta.När man står inför ett val - oavsett om det handlar om att fördela nya resurser till olika ändamål eller att genomföra besparingar - kan det vara en fördel att kunna rangordna tänkbara valmöjligheter i enprioriteringsordning. I vår modell innebär prioritering enbart att de relevanta alternativen rangordnas. Konsekvenserna av denna rangordning är inte på förhand given utan kan ligga till grund såväl för tillskott av resurser som för ransonering av något slag.Vid en vertikal prioritering är det en fördel att organisera prioriteringsarbetet så att det utgår från en grov uppdelning i hälsoproblem/sjukdomsgrupper. En sådan uppdelning innebär i regel att flera organisationsenheter/kliniker, specialiteter eller yrkesgrupper berörs och man får en mer allsidig belysning av problemet. Dessutom utgår man från ett patient/befolkningsperspektiv vilket förefaller mer ändamålsenligt än ett organisatoriskt/personalperspektiv.Det som rangordnas och som någon väljer mellan benämner vi prioriteringsobjekt. Vi föreslår att prioriteringsobjektet utgörs av olika kombinationer av hälsotillstånd och åtgärder1. När det gäller att bestämma en lämplig detaljeringsgrad måste det avgöras utifrån sammanhanget prioriteringar ska göras i. En utgångspunkt är att fokusera på typfall, vård som representerar stor volym och kontroversiell vård.Alla former av vertikala prioriteringar ska baseras på de etiska principer som riksdagen beslutat ska gälla vid prioriteringar inom hälso- och sjukvården. De etiska principerna behöver dock göras kända, förtydligas och eventuellt kompletteras för att kunna omsättas i praktiska prioriteringar. Vidare anser vi att riksdagens fyra så kallade prioriteringsgrupper inte ska ingå i modellen.Människovärdesprincipen, som innebär att alla människor bör ha lika värde och samma rätt till vård oberoende av personliga egenskaper och funktioner i samhället, är den självklara utgångspunkten vid prioriteringar. När personliga egenskaper såsom ålder, kön, livsstil eller funktion hos en grupp är ett uttryck för att speciella behov föreligger så att nytta med insatserna blir olika ska de personliga egenskaperna kunna beaktas i en prioritering på gruppnivå. Frågan om hur externa effekter, d v s effekten av en insats för närstående och andra grupper än den individ som är direkt berörd av insatsen, ska värderas vid en prioritering behöver diskuteras ytterligare.Med behov av hälso- och sjukvård menas både tillståndets svårighetsgrad och den förväntade nyttan av en åtgärd. Som patient har man endast behov av sådana vårdåtgärder som man förväntas ha nytta av. Motsatt gäller att en människa enligt detta sätt att definiera behov inte behöver åtgärder som inte förbättrar hälsan och livskvaliteten, sådana som hon inte har nytta av. Här har givetvis hälso- och sjukvården ett ansvar att lotsa människor de kommer i kontakt med, och som far illa på något sätt, till andra lämpliga aktörer.Riksdagens riktlinjer, när det gäller kostnadseffektivitetsprincipen (tillämpad för enskilda patienter), är för begränsad för att vägleda vid vertikala prioriteringar som gäller prioritering på gruppnivå. Regeringen konstaterade redan i prioriteringspropositionen att det är angeläget att skilja på en kostnadseffektivitetsprincip som gäller val mellan olika åtgärder för den enskilde patienten (där principen kan tillämpas som utredningen föreslår) och på hälso- och sjukvårdens strävan efter en hög kostnadseffektivitet när det gäller vårdens verksamhet i allmänhet. Här stödjer vi oss på Riksdagens direktiv till Läkemedelsförmånsnämnden. Nämnden ska vid beslut om subvention (prioriteringar) av ett läkemedel bl a bedöma om det är kostnadseffektivt i ett samhälleligt perspektiv, vilket innebär att man ställer patientnyttan av läkemedlet mot kostnaden. I bedömningen ska kostnadseffektiviteten vägas samman med behovs- och solidaritetsprincipen och människovärdesprincipen.Den föreslagna arbetsmodellen överensstämmer i allt väsentligt med den arbetsmodell som används av Socialstyrelsens vid framtagning av nationella riktlinjer. Det är inte möjligt att rymma alla aspekter som kan vara aktuella att beakta vid beskrivning av en nationell arbetsmodell. Man måste därför utgå från modellen och fundera på vilka andra relevanta aspekter som dessutom bör vägas in. T ex kan den internationella klassifikationen för funktionsförmåga (ICF) användas som vägledning.På grund av den stora variationsrikedomen av effektmått i olika verksamheter och de begränsade erfarenheter som finns att arbeta med sådana explicita gränsvärden anser vi att det är för tidigt att rekommendera en enhetlig indelning i t ex risknivåer. Det är dock viktigt att de som arbetar med prioriteringar redovisar hur de har resonerat.SBU:s klassifikation för att gradera den vetenskapliga evidensen för en åtgärds effekt bör användas i första hand. Lokala prioriteringsprojekt med begränsade resurser till sitt förfogande föreslås redovisa bedömningen av det vetenskapliga underlaget med ord och referera till det kunskapsunderlag som använts. Evidensstyrkan bör endast uttryckas med siffror då man stöder en slutsats på en systematisk kunskapsöversikt från SBU eller en annan översikt av god kvalitet.Prioriteringsarbeten där hälsoekonomiska data finns tillgängliga bör tills vidare ansluta till Socialstyrelsens arbetssätt och ange kostnadseffektivitet i en skala från låg till mycket hög kostnad per vunnet levnadsår eller kostnad per kvalitetsjusterat levnadsår. Den hälsoekonomiska evidensen bör redovisas i enlighet med de principer som Socialstyrelsen tillämpar. I lokala projekt med små resurser eller svårigheter att konsekvent få fram uppgifter om kostnadseffektivitet rekommenderar vi att man åtminstone resonerar om kostnadseffektivitet i de fall prioriteringsordningen på ett avgörande sätt påverkas när kostnaderna vägs in.Tio nivåer bör användas för rangordning samt att rangordningslistan kompletteras med en ”icke-göra-lista” för metoder som inte bör utföras alls eller rutinmässigt samt en FoU-lista för metoder där det fortfarande saknas tillräcklig evidens för att kunna motivera ett införande i rutinsjukvården. Sammanvägningen sker företrädesvis med en kvalitativ metod i avsaknad av en invändningsfri kvantitativ/matematisk metod. Likaså tror vi att det för närvarade inte är möjligt att fastställa entydiga kriterier som avgör inom vilken rangordningsnivå ett prioriteringsobjekt ska hamna.Resultatet bör presenteras i form av en rangordningslista. De parametrar som ligger till grund för prioriteringen bör också på ett enhetligt sätt redovisas i sådana rangordningslistor som visas för andra. I detalj kan språket och utseendet av pedagogiska skäl behöva anpassas för respektive målgrupp.Gränser för vad som är acceptabel behovstäckning (vårdkvalitet, mängd liksom andel av de i patientgrupp som får tillgång till insatsen) är en regional och lokal fråga och ingår därför inte i den nationella modellen.
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6. |
- Artman, Henrik, 1968-, et al.
(author)
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Effektiv miljötillsyn : slutrapport
- 2013
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Reports (other academic/artistic)abstract
- Målsättningen har varit att ta fram ny kunskap inom miljötillsynen och därigenom uppnå en effektivare miljötillsyn samt att få in nya vetenskapliga perspektiv på miljötillsyn.I rapporten studeras metoder för inspektioner och det kommunikativa samspelet mellan inspektören och företrädare för den verksamhet som inspekteras, hur den institutionella ramen för inspektionsprocessen fungerar samt visar på möjligheter att mäta effekterna av inspektioner och tillsyn.Naturvårdsverket kommer att ha resultatet som ett kunskapsunderlag i fortsatt arbete med tillsynsvägledning och utveckling av hur tillsyn och tillsynsvägledning kan följas upp och utvärderas.
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7. |
- Björgvinsson, Erling, et al.
(author)
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Prototyping Futures
- 2012
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Reports (other academic/artistic)abstract
- Prototyping Futures gives you a glimpse of what collaborating with academia might look like. Medea and its co-partners share their stories about activities happening at the research centre – projects, methods, tools, and approaches – what challenges lie ahead, and how these can be tackled. Examples of highlighted topics include: What is a living lab and how does it work? What are the visions behind the Connectivity Lab at Medea? And, how can prototyping-methods be used when sketching scenarios for sustainable futures? Other topics are: What is the role of the body when designing technology? What is collaborative media and how can this concept help us understand contemporary media practices? Prototyping Futures also discusses the open-hardware platform Arduino, and the concepts of open data and the Internet of Things, raising questions on how digital media and connected devices can contribute to more sustainable lifestyles, and a better world.
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8. |
- Gryback, Per, et al.
(author)
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Gastroparesis versus dyspepsia by intragastric meal distribution : new diagnostics and definitions ahead
- 2020
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In: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 0036-5521 .- 1502-7708. ; 55:2, s. 251-255
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Journal article (peer-reviewed)abstract
- Gastroparesis often presents a challenge to the practicing gastroenterologist. Postprandial symptoms with nausea and vomiting may not only lead to nutritional and metabolic consequences, but also significant disruption of social activities that often center around food. The treatment options that affect gastric function are limited and often disappointing. The female predominance, the mostly idiopathic and idiosyncratic nature of the illness, often with some common psychiatric co-morbidity, parallels other functional disorders of the gastrointestinal tract. These parallels have provided the rationale for studies investigating alternative diagnostic features of the gastric emptying test as employed in the clinical setting. Hence, not only the regular cut-offs of 60% or 10% gastric retention of a meal at 2 and 4 h, but also a new concept, the intragastric meal distribution at time 0 (IMD0) is now introduced as a plausible diagnostic feature that should be more aligned with the patients' symptoms as they appear in close connection with the meal. Impaired gastric accommodation with absence of fundic relaxation followed by dumping of the meal into antrum is suggested to be diagnostic for functional dyspepsia and gastroparesis. The diagnostic cut-off is considered when more than 57% of the meal is distributed to the distal part of the stomach immediately on food intake. This new diagnostic feature of the gastric emptying profile lend support to better understanding of the patients' symptoms and provides a new basis for pharmacological treatment options in gastroparesis that may provide an improved quality of life in affected individuals.
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9. |
- Leidermark, Erik, 1981, et al.
(author)
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Estimating the risk for secondary cancer following targeted alpha therapy with astatine-211 intraperitoneal radioimmunotherapy.
- 2022
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In: Journal of nuclear medicine : official publication, Society of Nuclear Medicine. - : Society of Nuclear Medicine. - 1535-5667. ; 64:1, s. 165-172
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Journal article (peer-reviewed)abstract
- Intraperitoneal 211At-based targeted alpha therapy (TAT) may hold most promise as an adjuvant therapy following surgery and chemotherapy in epithelial ovarian cancer to eradicate any remaining undetectable disease. This implies it will also be delivered to patients possibly already cured by the primary treatment. An estimate of long-term risks is therefore sought whether to justify the treatment. Methods: Baseline data for risk estimates of alpha-particle irradiation were collected from published studies on excess cancer induction and mortality for subjects exposed to either 224Ra treatments or Thorotrast contrast agent (25% ThO2 colloid, containing 232Th). Organ dosimetry for 224Ra and Thorotrast irradiation were taken from the literature. These organ-specific risks were then applied for our previously reported dosimetry for intraperitoneal (i.p.) 211At-TAT patients. Results: Risk could be estimated for 10 different organ or organ groups. The calculated excess relative risk per Gray (ERR/Gy) could be sorted into two groups. In the lower ERR/Gy group, up to approx. 5, were: Trachea, bronchus and lung 0.52 (CI 95% 0.21-0.82), Stomach 1.4 (CI 95% -5.0-7.9), Lymphoid and hematopoietic system 2.17 (CI 95% 1.7-2.7), Bone and articular cartilage 2.6 (CI 95% 2.0-3.3), Breast 3.45 (CI 95% -10-17) and Colon 4.5 (CI 95% -3.5-13). In the higher ERR/Gy group, ranging from approx. 10 to 15 were: Urinary bladder 10.1 (CI 95% 1.4-23), Liver 14.2 (CI 95% 13-16), Kidney 14.9 (CI 95% 3.9-26) and Lip, oral cavity and pharynx 15.20 (CI 95% 2.73-27.63). Applying a typical candidate patient (female, age 65 years) and correcting for reference population mortality rate, a total estimated excess mortality of an i.p. 211At-mAb treatment amounted to 1.13 per 100 treated. More than half of this excess originated from urinary bladder and kidney, 0.29 and 0.34 respectively. Depending on various adjustments in calculation and assumptions on competing risks excess mortality could range from 0.11 - 1.84 per 100 treated. Conclusion: Published epidemiological data on life-long detriment following alpha-particle irradiation and its dosimetry allowed calculations to estimate the risk for secondary cancer following 211At-based i.p. TAT. Measures to reduce dose to the urinary organs may further decrease the estimated relative low risk for secondary cancer from 211At-mAb based i.p. TAT.
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10. |
- Persson, Per-Axel, et al.
(author)
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Enhanced thermal dissociation of optically excited C60 chains.
- 2000
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In: Europhysics letters. - : EDP Sciences. - 0295-5075 .- 1286-4854. ; 49:5, s. 631-636
-
Journal article (peer-reviewed)abstract
- The thermal dissociation of C60 polymers has been studied using Raman scattering. The measured dissociation rate depends on the intensity of the 1064 nm NIR excitation, showing that i) the band gap is smaller than 1.17 eV and ii) a radiation-enhanced thermal breakdown path exists in addition to the "normal'' thermal breakdown mechanism. Quantum chemical calculations show that the energy barrier Ea for thermal breakdown is about 40% lower in the first (optically) excited state than in the ground state. This agrees well with the ratio between our radiation-enhanced value $E_{a} = (1.1 \pm 0.02)\,eV$ and values near 1.9 eV measured by purely thermal methods.
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11. |
- Persson, Per-Axel, et al.
(author)
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High-pressure polymerized C60
- 1996
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In: Extended Abstracts of Carbon´96, European Carbon Conference, Newcastle-upon-Tyne 1996, volume 2. - : The British Carbon Group. ; , s. 746-747, s. 746-747
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Conference paper (other academic/artistic)
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12. |
- Persson, Per-Axel, et al.
(author)
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NMR and Raman characterization of pressure polymerized C-60
- 1996
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In: Chemical Physics Letters. - : Elsevier BV. - 0009-2614 .- 1873-4448. ; 258:5-6, s. 540-546
-
Journal article (peer-reviewed)abstract
- Bulk C60 has been treated at 1.1 GPa and 550–585 K, producing a dense insoluble material which on heating to above 600 K reverts to normal C60. Raman and IR studies on modified material show a large number of new lines, and the Raman pentagon pinch mode shifts from 1469 to 1458 cm−1 as on photopolymerization. MAS NMR shows one broadened line at the original C60 shift 144 ppm and a small peak at about 77 ppm due to the bridging carbons. None of the new resonances observed for C60 polymerized by other methods were observed. The results verify previously suggested polymeric structures where the fullerence cages are connected by four-membered rings.
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13. |
- Persson, Per-Axel, et al.
(author)
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Physical properties of pressure polymerized C60
- 1996
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In: High Pressure Science and Technology. - Singapore : World Scientific. - 9810225474 ; , s. 716-718
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Conference paper (peer-reviewed)abstract
- The properties of C60 have been studied after treatment at high temperature and high pressure (1.1 GPa and 565 K for 2 h). The treated material is insoluble in organic solvents. We present results obtained in NMR and Raman studies and measured data for the specific heat and the thermal expansion. Our results show clearly that there are no covalent bonds and no molecular rotation, but suggest that the molecules are slightly deformed and held together by weak pi-type bonds.
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14. |
- Persson, Per-Axel, et al.
(author)
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The physical properties of high-pressure polymerized C60
- 1997
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In: Journal of Physics and Chemistry of Solids, volume 58, issue 11. - : Elsevier B.V.. ; 58:11, s. 1881-1885
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Conference paper (peer-reviewed)abstract
- We have studied the structural, thermophysical, and spectroscopic properties of polymeric C60 obtained by high pressure treatment at pressures and temperatures near 1 GPa and 600 K. We present here a brief overview of our results for the structural and thermophysical properties and a more detailed report on recent results obtained by Raman spectroscopy on both thin films, polycrystalline, and single crystal material. The results presented include a comparison between Raman results for photopolymerized and pressure polymerized thin films and a preliminary estimate of the binding energy of polymeric C60.
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15. |
- Soldatov, Alexander, et al.
(author)
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Pressure polymerized C60 : Raman and NMR studies
- 1996
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In: Fullerenes and Fullerene Nanostructures. - Singapore : World Scientific. - 9810228538 ; , s. 344-348
-
Conference paper (peer-reviewed)abstract
- The properties of bulk C60 have been studied after treatment at 1.1 GPa and 550-585 K. The treated material is insoluble in both toluene and 1,2-dichlorobenzene. Raman spectroscopy on modified aterial shows a large number of new lines, and the Raman pentagon pinch mode (Ag2) shifts from 1469 to 1458 /cm as on photopolymerization. MAS NMR shows one broadened line at the original C60 shift 144 ppm and a small peak at about 77 ppm due to the bridging carbons. The results verify previous suggested polymeric structures where the fullerene cages are connected by four-membered rings.
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16. |
- Sundqvist, Bertil, et al.
(author)
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Physical properties of pressure polymerized C60
- 1996
-
In: Fullerenes: Recent Advances in the Chemistry and Physics of Fullerenes and Related Materials, volume 3. - Pennington, NJ : The Electrochemical Society. - 1566771625 ; , s. 1014-1028
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Conference paper (peer-reviewed)abstract
- We present in this paper an overview of the physical properties of the high pressure polymerized C60 phase commonly known as "soft fcc". This phase has been studied by several methods over wide ranges in temperature T and/or pressure, p. We present here experimental information about the specific heat capacity, the thermal expansion coefficient, the lattice structure, and the thermal conductivity, and we also show results obtained by NMR and Raman spectroscopy. All data presented agree with the accepted model that the individual molecules in this phase are covalently bound to form linear molecular chains. In particular, the NMR data show clearly the presence of covalent bonds, and the Raman data exhibit several new lines at very low energies connected with chain vibrations. Thermal conductivity data obtained during polymerization show both the time dependence of the process and that polymerization occurs at lower p and T than observed previously for this phase.
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17. |
- Sundqvist, Bertil, et al.
(author)
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Structural and physical properties of pressure polymerized C60
- 1998
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In: Carbon, vol. 36 issue 5-6. - : Elsevier B.V.. ; 36:5-6, s. 657-660
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Conference paper (peer-reviewed)abstract
- We discuss the structural and dynamic properties of C60 polymerized under low-P, low-T conditions, and suggest that the disordered mixed orthorhombic-tetragonal-rhombohedral phases produced under these conditions arise from nucleation of molecular chains in random directions because of the quasi-free molecular rotation under standard reaction conditions in the fcc phase of C60. Polymerization in He gives results qualitatively different from those obtained in other media.
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18. |
- Sundqvist, Bertil, et al.
(author)
-
Structure and stability of pressure polymerized C60
- 2000
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In: Molecular Materials: Molecular Crystals and Liquid Crystals Section C, vol. 13. - : Overseas Publishers Association N.V.. ; 13:1-4, s. 117-122
-
Conference paper (peer-reviewed)abstract
- We discuss the bond energy of the orthorhombic C60 polymer and the structure of the two-dimensional C60 polymers. For the orthorhombic polymer, measurements of the dissociation energy by different methods give results that differ by a factor of two. We show that optical excitations lead to a temporary weakening of the intermolecular bonds and optical measurements thus show a low apparent bond energy. We have also polymerized a single crystal of C60 into two-dimensional phases. X-ray diffraction studies of this crystal have enabled us to determine the stacking sequences of both the tetragonal and the rhombohedral structures.
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19. |
- Winter, Johannes, et al.
(author)
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Charge transfer in alkali-metal-doped polymeric fullerenes
- 1996
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In: Physical Review B. Condensed Matter and Materials Physics. - 1098-0121 .- 1550-235X. ; 54, s. 17486-17492
-
Journal article (peer-reviewed)abstract
- We present room-temperature Raman measurements of pressure-polymerized C60 and compare them with the spectra of RbC60 in the orthorhombic phase. Although both materials were prepared according to two completely different routes the spectra show a surprising similarity with respect to mode positions and line splitting. We concluded from this that both materials, the uncharged pressure-polymerized C60 and the rubidium-doped orthorhombic compound, have the same overall structure and the AC60 compounds can be considered as the doped species of the C60, polymerized using moderate low pressure and high temperatures. From a detailed comparison between both spectra mode shifting and line broadening as a consequence of the charge transfer was determined and electron-phonon coupling constants were estimated for the high-frequency Hg(7) and Hg(8) modes. The low values for the coupling constants compared to the ones in the K3C60 can explain the lack of superconductivity in the AC60 compounds.
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20. |
- Witte, Anne-Barbara, et al.
(author)
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Involvement of endogenous glucagon-like peptide-1 in regulation of gastric motility and pancreatic endocrine secretion
- 2011
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In: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 0036-5521 .- 1502-7708. ; 46:4, s. 428-435
-
Journal article (peer-reviewed)abstract
- Objective. To study the role of endogenous glucagon-like peptide-1 (GLP-1) on gastric emptying rates of a solid meal as well as postprandial hormone secretion and glucose disposal. Material and methods. In nine healthy subjects, gastric emptying of a 310-kcal radio-labelled solid meal and plasma concentrations of insulin, glucagon and glucose were measured during infusion of saline or the GLP-1 receptor antagonist exendin(9-39)amide (Ex(9-39)) at 300 pmol·kg−1·min−1. Results. Ex(9-39) infusion had no effect on the total gastric emptying curve, but changed the intra-gastric distribution of the meal. During infusion of Ex(9-39), more content stayed in the upper stomach (79.1 ± 2.5% of total during Ex(9-39) compared to 66.6 ± 5.7% during saline at 5 min). During Ex(9-39) infusion, higher concentrations of plasma glucagon were measured both before (after 40 min of Ex(9-39) infusion the glucagon level was 15.1 ± 0.7 pmol·L−1 compared to 5.4 ± 1.4 during saline) and after the meal, and postprandial GLP-1 levels increased. Basal insulin and glucose levels were not affected by Ex(9-39), but the postprandial rise of insulin and glucose enhanced during Ex(9-39). Conclusions. Endogenous GLP-1 is involved in the regulation of gastric motility in relation to meal intake and also in the regulation of postprandial insulin and glucose levels. Furthermore, endogenous GLP-1 seems to tonically restrain glucagon secretion.
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21. |
- Wågberg, Thomas, et al.
(author)
-
A Raman study of polymerised C60
- 1997
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In: Applied Physics A. - : Springer Science and Business Media LLC. - 0947-8396 .- 1432-0630. ; 64:3, s. 223-226
-
Journal article (peer-reviewed)abstract
- Results of Raman scattering studies on high pressure polymerized and photo polymerized C60 are reported. Although prepared according to different routes the Raman spectra of the two polymeric phases of C60 show a quantitative agreement with respect to mode positions and intensity. We conclude from this that both materials have the same structure at least in the short range order, i.e. the same type of bonding and co-ordination between neighbouring C60 molecules. An investigation of the time dependence of the thermal decomposition of high pressure polymerised C60 is also presented. The rate of decomposition of the polymeric phase is found to be multi-exponential at all temperatures investigated. From an Arrhenius-type analysis of the short time data and the long time data, respectively, the activation energy for thermal dissociation of polymeric bonds was found to increase with time.
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22. |
- Wågberg, Thomas, et al.
(author)
-
Polymeric phases of C60
- 1997
-
In: Fullerenes: Recent Advances in the Chemistry and Physics of Fullerenes and Related Materials, vol. 5. - Pennington, NJ : The Electrochemical Society. - 1566771927 ; , s. 674-679
-
Conference paper (peer-reviewed)abstract
- We have investigated the "low" pressure region where C60 can be transformed into polymeric chains or clusters. To learn more about the polymerization process we have treated pristine C60 at several different temperatures under hydrostatic pressures in silicone oil. We found that the reaction rate varied with temperature. Above 520 K at 1.0 GPa similar and high polymer fractions were obtained in all samples, but at 497 K the polymer fraction was only 10% after three hours, as indicated by the shift of the intensity of the pentagonal pinch mode in the Raman spectrum. Also, samples treated at the same pressure and temperature but with different thermal pre-history showed different degrees of polymerization. We have also found a correlation between the shift of the pentagonal pinch mode in the Raman spectrum to 1463 /cm and the intermolecular vibrational mode at 97 /cm. We therefore make the conclusion that the shift of the pentagonal pinch mode to 1463 /cm corresponds to the presence of dimers in the sample.
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23. |
- Abel, Marianne Hope, et al.
(author)
-
Insufficient maternal iodine intake is associated with subfecundity, reduced foetal growth, and adverse pregnancy outcomes in the Norwegian Mother, Father and Child Cohort Study.
- 2020
-
In: BMC medicine. - : Springer Science and Business Media LLC. - 1741-7015. ; 18:1
-
Journal article (peer-reviewed)abstract
- Severe iodine deficiency impacts fertility and reproductive outcomes. The potential effects of mild-to-moderate iodine deficiency are not well known. The aim of this study was to examine whether iodine intake was associated with subfecundity (i.e. >12months trying to get pregnant), foetal growth, and adverse pregnancy outcomes in a mild-to-moderately iodine-deficient population.We used the Norwegian Mother, Father and Child Cohort Study (MoBa) and included 78,318 pregnancies with data on iodine intake and pregnancy outcomes. Iodine intake was calculated using an extensive food frequency questionnaire in mid-pregnancy. In addition, urinary iodine concentration was available in a subsample of 2795 pregnancies. Associations were modelled continuously by multivariable regression controlling for a range of confounding factors.The median iodine intake from food was 121μg/day and the median urinary iodine was 69μg/L, confirming mild-to-moderate iodine deficiency. In non-users of iodine supplements (n=49,187), low iodine intake (<100-150μg/day) was associated with increased risk of preeclampsia (aOR=1.14 (95% CI 1.08, 1.22) at 75 vs. 100μg/day, p overall <0.001), preterm delivery before gestational week 37 (aOR=1.10 (1.04, 1.16) at 75 vs. 100μg/day, p overall=0.003), and reduced foetal growth (-0.08 SD (-0.10, -0.06) difference in birth weight z-score at 75 vs. 150μg/day, p overall <0.001), but not with early preterm delivery or intrauterine death. In planned pregnancies (n=56,416), having an iodine intake lower than ~100μg/day was associated with increased prevalence of subfecundity (aOR=1.05 (1.01, 1.09) at 75μg/day vs. 100μg/day, p overall=0.005). Long-term iodine supplement use (initiated before pregnancy) was associated with increased foetal growth (+0.05 SD (0.03, 0.07) on birth weight z-score, p<0.001) and reduced risk of preeclampsia (aOR 0.85 (0.74, 0.98), p=0.022), but not with the other adverse pregnancy outcomes. Urinary iodine concentration was not associated with any of the dichotomous outcomes, but positively associated with foetal growth (n=2795, p overall=0.017).This study shows that a low iodine intake was associated with restricted foetal growth and a higher prevalence of preeclampsia in these mild-to-moderately iodine-deficient women. Results also indicated increased risk of subfecundity and preterm delivery. Initiating iodine supplement use in pregnancy may be too late.
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24. |
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25. |
- Adebahr, Josefina, 1973, et al.
(author)
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Ab initio calculations, Raman and NMR investigation of the plastic crystal di-methyl pyrrolidinium iodide
- 2003
-
In: Electrochimica Acta. - 0013-4686. ; 48:14-16, s. 2283-2289
-
Journal article (peer-reviewed)abstract
- Above 110 °C the symmetric di-methyl-pyrrolidinium iodide salt forms a plastic crystal phase of interest in the area of new electrolyte materials. In this study ab initio calculations of this material has been conducted in order to assign the vibrational spectra. Raman spectroscopy measurements on the solid salt as well as on the salt dissolved in different solvents has been performed and these have been compared to the theoretical spectra. Furthermore, Raman spectra as a function of temperature have been recorded to investigate possible changes in inter-ionic interaction and/or structure through the phase transition. 1 H NMR linewidth measurements as a function of temperature showed a large decrease in linewidth above 100 °C, attributed here to an increase in mobility in agreement with a previously reported phase transition at ∼ 110 °C. © 2003 Elsevier Science Ltd. All rights reserved.
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