| 1. |
- Israelsson, Johan, et al.
(author)
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Health status and psychological distress among in-hospital cardiac arrest survivors in relation to gender
- 2017
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In: Resuscitation. - : Elsevier. - 0300-9572 .- 1873-1570. ; 114, s. 27-33
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Journal article (peer-reviewed)abstract
- AIM: To describe health status and psychological distress among in-hospital cardiac arrest (IHCA) survivors in relation to gender.METHODS: This national register study consists of data from follow-up registration of IHCA survivors 3-6 months post cardiac arrest (CA) in Sweden. A questionnaire was sent to the survivors, including measurements of health status (EQ-5D-5L) and psychological distress (HADS).RESULTS: Between 2013 and 2015, 594 IHCA survivors were included in the study. The median values for EQ-5D-5L index and EQ VAS among survivors were 0.78 (q1-q3=0.67-0.86) and 70 (q1-q3=50-80) respectively. The values were significantly lower (p<0.001) in women compared to men. In addition, women reported more problems than men in all dimensions of EQ-5D-5L, except self-care. A majority of the respondents reported no problems with anxiety (85.4%) and/or symptoms of depression (87.0%). Women reported significantly more problems with anxiety (p<0.001) and symptoms of depression (p<0.001) compared to men. Gender was significantly associated with poorer health status and more psychological distress. No interaction effects for gender and age were found.CONCLUSIONS: Although the majority of survivors reported acceptable health status and no psychological distress, a substantial proportion reported severe problems. Women reported worse health status and more psychological distress compared to men. Therefore, a higher proportion of women may be in need of support. Health care professionals should make efforts to identify health problems among survivors and offer individualised support when needed.
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| 2. |
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| 3. |
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| 4. |
- Andersson, Johan Vium
(author)
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Undifferenced GPS for Deformation Monitoring
- 2006
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Licentiate thesis (other academic/artistic)abstract
- This thesis contains the development of a deformation monitoring software based on undifferenced GPS observations. Software like this can be used in alarm systems placed in areas where the earth is unstable. Systems like this can be used in areas where people are in risk of getting hurt, like in earthquake zones or in land slide areas, but they can also be useful when monitoring the movements in buildings, bridges and other artefacts. The main hypotheses that are tested are whether it is possible to detect deformations with undifferenced observations and if it is possible to reach the same accuracy in this mode as when working in a traditional mode where the observations are differenced. The development of a deformation monitoring software based on undifferenced GPS observations is presented. A complete mathematical model is given as well as implementation details. The software is developed in Matlab together with a GPS observation simulator. The simulator is mainly used for debugging purposes. The developed software is tested with both simulated and real observations. Results from tests with simulated observations show that it is possible to detect deformations in the order of a few millimetres with the software. Calculations with real observations give the same results. Further, the result from calculations in static mode indicates that the commercial software and the undifferenced software diverge a few millimetres, which probably depends on different implementations of the tropospheric corrections. In kinematic mode the standard deviation is about 1 millimetre larger in the undifferenced mode than in the double differenced mode. An initial test with different observation weighting procedures indicates that there is a lot of potential to improve the result by applying correct weights to the observations. This is one of the aims in the future work within this project. This thesis are sponsored by the Swedish Research Council for Enviroment, Agricultural Sciences and Spatial Planning, FORMAS within the framework “Monitoring of construction and detection of movements by GPS ref no. 2002-1257"
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| 5. |
- Arslan, Alan A, et al.
(author)
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Circulating vitamin d and risk of epithelial ovarian cancer
- 2009
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In: Journal of oncology. - : Hindawi Limited. - 1687-8450 .- 1687-8469. ; 2009, s. 672492-672500
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Journal article (peer-reviewed)abstract
- We conducted a nested case-control study within two prospective cohorts, the New York University Women's Health Study and the Northern Sweden Health and Disease Study, to examine the association between prediagnostic circulating levels of 25-hydroxy vitamin D (25(OH)D) and the risk of subsequent invasive epithelial ovarian cancer (EOC). The 25(OH)D levels were measured in serum or plasma from 170 incident cases of EOC and 373 matched controls. Overall, circulating 25(OH)D levels were not associated with the risk of EOC in combined cohort analysis: adjusted OR for the top tertile versus the reference tertile, 1.09 (95% CI, 0.59-2.01). In addition, there was no evidence of an interaction effect between VDR SNP genotype or haplotype and circulating 25(OH)D levels in relation to ovarian cancer risk, although more complex gene-environment interactions may exist.
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| 6. |
- Arwehed, Sofia, et al.
(author)
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Nordic survey showed wide variation in discharge practices for very preterm infants
- 2023
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In: Acta Paediatrica. - : John Wiley & Sons. - 0803-5253 .- 1651-2227.
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Journal article (peer-reviewed)abstract
- AimWe aimed to describe clinical practices and criteria for discharge of very preterm infants in Nordic neonatal units.MethodsMedical directors of all 89 level-2 and level-3 units in Denmark, Finland, Iceland, Norway and Sweden were invited by e-mail to complete a web-based multiple-choice survey with the option to make additional free-text comments.ResultsWe received responses from 83/89 units (93%). In all responding units, discharge readiness was based mainly on clinical assessment with varying criteria. In addition, 36% used formal tests of cardiorespiratory stability and 59% used criteria related to infant weight or growth. For discharge with feeding tube, parental ability to speak the national language or English was mandatory in 45% of units, with large variation among countries. Post-discharge home visits and video-consultations were provided by 59% and 51%, respectively. In 54% of units, parental preparation for discharge were not initiated until the last two weeks of hospital stay.ConclusionDischarge readiness was based mainly on clinical assessment, with criteria varying among units despite similar population characteristics and care structures. This variation indicates a lack of evidence base and may unnecessarily delay discharge; further studies of this matter are needed. Earlier parental preparation and use of interpreters might facilitate earlier discharge.
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| 7. |
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| 8. |
- Backes, Carl, et al.
(author)
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Outcomes Following a Comprehensive versus a Selective Approach for Infants Born at 22 Weeks of Gestation.
- 2019
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In: Journal of Perinatology. - : Springer Science and Business Media LLC. - 0743-8346 .- 1476-5543. ; 39:1, s. 39-47
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Journal article (peer-reviewed)abstract
- Objective: To examine outcomes at two institutions with different approaches to care among infants born at 22 weeks of gestation.Study design: Retrospective, cohort study (2006–2015). Enrollment was limited to mother–infant dyads at 22 weeks of gestation. Proactive care was defined as provision of antenatal corticosteroids and neonatal resuscitation and intensive care. One center (Uppsala, Sweden; UUCH) provided proactive care to all mother–infant dyads (comprehensive center); the other center (Nationwide Children’s Hospital, USA; NCH) initiated or withheld treatment based on physician and family preferences (selective center). Differences in outcomes between the two centers were evaluated.Result: Among 112 live-born infants at 22 weeks of gestation, those treated at UUCH had in-hospital survival rates higher than those at NCH (21/40, 53% vs. 6/72, 8%; P < 0.01). Among the subgroup of infants receiving proactive care (UUCH: 40/40, 100%; NCH: 16/72, 22%) survival was higher at UUCH than at NCH (21/40, 53% vs. 3/16, 19%; P < 0.05).Conclusion: Even when mother–infant dyads were provided proactive care at NCH (selective center), survival was lower than infants provided proactive care at UUCH (comprehensive center). Differences between the approaches to care at the two centers at 22 weeks of gestation merits further investigation.
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| 9. |
- Baev, A., et al.
(author)
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A quantum mechanical - Electrodynamical approach to nonlinear properties : Application to optical power limiting with platinum-organic compounds
- 2007
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In: Journal of nonlinear optical physics and materials. - 0218-8635. ; 16:2, s. 157-169
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Journal article (peer-reviewed)abstract
- Light propagation in a medium is sensitively dependent on the shape and intensity of the optical pulse as well as on the electronic and vibrational structure of the basic molecular units. We review in this paper the results of systematic studies of this problem for isotropic media. Our theoretical approach - the quantum mechanical-electrodynamical (QMED) approach - is based on a quantum mechanical account of the many-level electron-nuclear medium coupled to a numerical solution of the density matrix and Maxwell's equations. This allows us to accommodate a variety of nonlinear effects which accomplish the propagation of strong light pulses. Particular attention is paid to the understanding of the role of coherent and sequential excitations of electron-nuclear degrees of freedom. The QMED combination of quantum chemistry with classical pulse propagation enables us to estimate the optical transmission from cross sections of multi-photon absorption processes and from considerations of propagation effects, saturation and pulse effects. Results of the theory suggest that in the nonlinear regime, it is often necessary to simultaneously account for coherent one-step and incoherent step-wise multi-photon absorption, as well as for off-resonant excitations even when resonance conditions prevail. The dynamic theory of nonlinear propagation of a few interacting intense light pulses is highlighted here in a study of the optical power limiting with platinum-organic molecular compounds. © World Scientific Publishing Company.
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| 10. |
- Baev, Alexander, et al.
(author)
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Theoretical Simulations of clamping levels in optical power limiting
- 2006
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In: Journal of Physical Chemistry B. - : American Chemical Society (ACS). - 1520-6106 .- 1520-5207 .- 1520-5215. ; 110:42, s. 20912-20916
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Journal article (peer-reviewed)abstract
- Multiphysics modeling, combining quantum mechanical and classical wave mechanical theories, of clamping levels has been performed for a platinum(II) organic compound in a sol-gel glass matrix. A clamping level of 2.5 mu J is found for a pulse duration of 10 ns. The excited-state absorption in the triplet manifold is shown to be crucial for clamping to occur.
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| 11. |
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| 12. |
- Biskop, Emilia, et al.
(author)
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Parental participation during therapeutic hypothermia for neonatal hypoxicischemic encephalopathy
- 2019
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In: Sexual & Reproductive HealthCare. - : ELSEVIER IRELAND LTD. - 1877-5756 .- 1877-5764. ; 20, s. 77-80
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Journal article (peer-reviewed)abstract
- Objectives: To examine parental participation in the care of newborn infants receiving therapeutic hypothermia, and to explore the possible impact of in-born vs out-born status, and location of hospital accommodation. Study design: Retrospective, quantitative and descriptive design. Main outcome measures: Infants medical charts were reviewed for defined aspects of parental participation (infant holding, tube feeding, and diaper change), and related to their in-born vs out-born status, and whether the parents were accommodated in the NICU or elsewhere. All infants have been cared for at the University Hospital Neonatal Intensive Care Unit, serving as a regional referral center for hypothermia treatment. This study is a part of a population-based regional cohort of asphyxiated newborn infants (n = 112) that received therapeutic hypothermia in 2007-2015. Results: Parents engaged in holding (60/112, 54%) or tube feeding (59/112, 53%) their infant. Parents of inborn infants (24/112, 21%) were more likely to check the placement of the feeding tube (11/24, 46% vs 15/88, 17%; p < 0.01) and change diapers (9/24, 38% vs 14/88, 16%; p < 0.05) than parents of out-born infants (88/112, 79%). A similar pattern of more extensive involvement was observed for both mothers and fathers who stayed at the neonatal intensive care compared to those accommodated elsewhere (p < 0.05). Conclusions: Active parental participation is feasible at the NICU even during therapeutic hypothermia. Timely postnatal transfer of parents of out-born/transported infants, and the provision of on-site accommodation may influence the quality of parental involvement.
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| 13. |
- Björklund, Patrik, et al.
(author)
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Västerås slott : Slott och borgar
- 2000
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Reports (pop. science, debate, etc.)abstract
- En majoritet av dagens byggnadsuppgifter gäller att hantera det redan byggda. När vi står inför situationen att restaurera en befintlig byggnad är det viktigt att förstå olika tidsperioders stilideal liksom byggnadsteknik och material. Först då kan vi göra en väl avvägd analys, som tar tillvara och utvecklar de kvaliteter som byggnaderna själva besitter. Därför är utbildningen upplagd som ett växelspel mellan föreläsningar, seminarier, exkursioner och en för året vald studieuppgift.Slott och borgar har varit läsårets tema. Vi har valt att arbeta med Västerås och Örebro slott - två ganska bortglömda Vasaslott som är väl värda att lyfta fram. Särskilt har vi studerat de senaste 300 årens förändringar, som inte tidigare ägnats lika stora forskarmöda som medelitden och Vasatiden. I dessa två exempel finns en provkarta på estetiska, praktiska och tekniska ingrepp från Carl Hårlemans tid och fram till idag.Studierna har således omfattat både gestaltning, funktion och byggnadsteknik. Avsikten är att visa på kvaliteter i de omvandlingar och restaureringar som skett, men också att peka på problem och analysera olika möjligheter inför framtiden. Arbetet har skett i samarbete med Statens fastighetsverk och är tänkt att utgöra ett underlag till vårdprogram och framtida restaureringsinsatser.
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| 14. |
- Bratberg, Johan, et al.
(author)
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Diffusion simulations of MC and M7C3 carbide coarsening in bcc and fcc matrix utilising new thermodynamic and kinetic description
- 2008
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In: Materials Science and Technology. - : Informa UK Limited. - 0267-0836 .- 1743-2847. ; 24:6, s. 695-704
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Journal article (peer-reviewed)abstract
- A new thermodynamic database has been combined with an existing kinetic database to perform coarsening simulations in ternary systems including MC and M7C3 carbides in an fcc matrix. The kinetic database was revised taking into consideration the new experimental information on the Fe-Cr-V-C system obtained in the present work, and available experiments on the ternary Fe-Cr-C and Fe-V-C systems. After revision the agreement between experimental results and simulations was satisfactory. It was found that the interfacial energy of M7C3 was twice as large as that of the MC carbide. The calculations for commercial steels with 6 alloy elements gave results in satisfactory agreement with new experimental measurements. The present coarsening simulations use the calculated equilibrium state and the observed particle sizes as the state for the start of the simulations. All the simulations were performed with the DICTRA software.
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| 15. |
- Bratberg, Johan, et al.
(author)
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Diffusion simulations of MC and M7C3 carbide coarsening in bcc and fee matrix utilising new thermodynamic and kinetic description
- 2008
-
In: Materials Science and Technology. - 0267-0836 .- 1743-2847. ; 24:6, s. 695-704
-
Journal article (peer-reviewed)abstract
- A new thermodynamic database has been combined with an existing kinetic database to perform coarsening simulations in ternary systems including MC and M7C3 carbides in an fee matrix. The kinetic database was revised taking into consideration the new experimental information on the Fe-Cr-V-C system obtained in the present work, and available experiments on the ternary Fe-Cr-C and Fe-V-C systems. After revision the agreement between experimental results and simulations was satisfactory. It was found that the interfacial energy of M7C3 was twice as large as that of the MC carbide. The calculations for commercial steels with 6 alloy elements gave results in satisfactory agreement with new experimental measurements. The present coarsening simulations use the calculated equilibrium state and the observed particle sizes as the state for the start of the simulations. All the simulations were performed with the DICTRA software. © 2008 Institute of Materials, Minerals and Mining.
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| 16. |
- Bratberg, Johan, 1975-
(author)
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Phase equilibria and thermodynamic properties of high-alloy tool steels : theoretical and experimental approach
- 2005
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Doctoral thesis (other academic/artistic)abstract
- The recent development of tool steels and high-speed steels has led to a significant increase in alloy additions, such as Co, Cr, Mo, N, V, and W. Knowledge about the phase relations in these multicomponent alloys, that is, the relative stability between different carbides or the solubility of different elements in the carbides and in the matrix phase, is essential for understanding the behaviour of these alloys in heat treatments. This information is also the basis for improving the properties or designing new alloys by controlling the amount of alloying elements. Thermodynamic calculations together with a thermodynamic database is a very powerful and important tool for alloy development of new tool steels and high-speed steels. By thermodynamic calculations one can easily predict how different amounts of alloying elements influence on the stability of different phases. Phase fractions of the individual phases and the solubility of different elements in the phases can be predicted quickly. Thermodynamic calculations can also be used to find optimised processing temperatures, e.g. for different heat treatments. Combining thermodynamic calculations with kinetic modelling one can also predict the microstructure evolution in different processes such as solidification, dissolution heat treatments, carbide coarsening, and the important tempering step producing secondary carbides. The quality of predictions based on thermodynamic calculations directly depends on the accuracy of the thermodynamic database used. In the present work new experimental phase equilibria information, both in model alloys containing few elements and in commercial alloys, has been determined and was used to evaluate and improve the thermodynamic description. This new experimental investigation was necessary because important information concerning the different carbide systems in tool steels and high-speed steels were lacking. A new thermodynamic database for tool steels and high-speed steels, TOOL05, has been developed within this thesis. With the new database it is possible to calculate thermodynamic properties and phase equilibria with high accuracy and good reliability. Compared with the previous thermodynamic description the improvements are significant. In addition the composition range of different alloying elements, where reliable results are obtained with the new thermodynamic database, have been widened significantly. As the available kinetic data did not always predict results in agreement with new experiments the database was modified in the present work. By coupling the new thermodynamic description with the new kinetic description accurate diffusion simulations can be performed for carbide coarsening, carbide dissolution and micro segregation during solidification.
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| 17. |
- Bäcke, Pyrola, et al.
(author)
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When all I wanted was to hold my baby-The experiences of parents of infants who received therapeutic hypothermia
- 2021
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In: Acta Paediatrica. - : John Wiley & Sons. - 0803-5253 .- 1651-2227. ; 110:2, s. 480-486
-
Journal article (peer-reviewed)abstract
- Aim The knowledge is limited about how parents experience the time when their infant is receiving therapeutic hypothermia (TH) after severe perinatal asphyxia. The aim of this study was to explore parents' experience of closeness and involvement in their infant's care while in the neonatal intensive care unit (NICU) with their newborn undergoing TH. Methods Face-to-face, semi-structured interviews were conducted with parents (n = 11) whose infants (n = 8, aged 3-5 years at the time of the study) underwent TH at a level III Swedish NICU during 2013-2016. The interviews were analysed using qualitative content analysis. Results All the parents shared the trauma of being both physically and psychologically separated from their infant. They all described a need for information and emotional support, and reported that the NICU staff had influenced the extent to which they as parents had been able to be near and actively participate in the care. Parents described the wish to be closer to their infant and to be more actively involved in their infant's care. Conclusion Strategies to enable parent-infant closeness and active guidance from staff might help alleviate the emotional stress of parents and promote their participation during TH.
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| 18. |
- Chen, Q., et al.
(author)
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Analytical treatment of diffusion during precipitate growth in multicomponent systems
- 2008
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In: Acta Materialia. - : Elsevier BV. - 1359-6454 .- 1873-2453. ; 56:8, s. 1890-1896
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Journal article (peer-reviewed)abstract
- We propose an approximate growth rate equation that takes into account both cross-diffusion and high supersaturations for modeling precipitation in multicomponent systems. We then apply it to an Fe-alloy in which interstitial C atoms diffuse much faster than substitutional solutes, and predict a spontaneous transition from slow growth under ortho-equilibrium to fast growth under the non-partitioning local equilibrium condition. The transition is caused by the decrease in the Gibbs-Thomson effect as the growing particle becomes larger. The results agree with DICTRA simulations where full diffusion fields are calculated.
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| 19. |
- Couto, Rafael Carvalho, et al.
(author)
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Breaking inversion symmetry by protonation : Experimental and theoretical NEXAFS study of the diazynium ion, N2H
- 2021
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In: Physical Chemistry, Chemical Physics - PCCP. - : Royal Society of Chemistry (RSC). - 1463-9076 .- 1463-9084. ; 23:32, s. 17166-17176
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Journal article (peer-reviewed)abstract
- As an example of symmetry breaking in NEXAFS spectra of protonated species we present a high resolution NEXAFS spectrum of protonated dinitrogen, the diazynium ion N2H+. By ab initio calculations we show that the spectrum consists of a superposition of two nitrogen 1s absorption spectra, each including a π∗ band, and a nitrogen 1s to H+ charge transfer band followed by a weak irregular progression of high energy excitations. Calculations also show that, as an effect of symmetry breaking by protonation, the π∗ transitions are separated by 0.23 eV, only slightly exceeding the difference in the corresponding dark (symmetry forbidden) and bright (symmetry allowed) core excitations of neutral N2. By DFT and calculations and vibrational analysis, the complex π∗ excitation band of N2H+ is understood as due to the superposition of the significantly different vibrational progressions of excitations from terminal and central nitrogen atoms, both leading to bent final state geometries. We also show computationally that the electronic structure of the charge transfer excitation smoothly depends on the nitrogen-proton distance and that there is a clear extension of the spectra going from infinity to close nitrogen-proton distance where fine structures show some, although not fully detailed, similarities. An interesting feature of partial localization of the nitrogen core orbitals, with a strong, non-monotonous, variation with nitrogen-proton distance could be highlighted. Specific effects could be unraveled when comparing molecular cation NEXAFS spectra, as represented by recently recorded spectra of N2+ and CO+, and spectra of protonated molecules as represented here by the N2H+ ion. Both types containing rich physical effects not represented in NEXAFS of neutral molecules because of the positive charge, whereas protonation also breaks the symmetry. The effect of the protonation on dinitrogen can be separated in charge, which extends the high-energy part of the spectrum, and symmetry-breaking, which is most clearly seen in the low-energy π∗ transition.
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| 20. |
- Couto, Rafael Carvalho, et al.
(author)
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The carbon and oxygen K-edge NEXAFS spectra of CO
- 2020
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In: Physical Chemistry, Chemical Physics - PCCP. - : Royal Society of Chemistry (RSC). - 1463-9076 .- 1463-9084. ; 22:28, s. 16215-16223
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Journal article (peer-reviewed)abstract
- We present and analyze high resolution near edge X-ray absorption fine structure (NEXAFS) spectra of CO+ at the carbon and oxygen K-edges. The spectra show a wealth of features that appear very differently at the two K-edges. The analysis of these features can be divided into three parts; (i) repopulation transition to the open shell orbital – here the C(1s) or O(1s) to 5σ transition, where the normal core hole state is reached from a different initial state and different interaction than in X-ray photoelectron spectroscopy; (ii) spin coupled split valence bands corresponding to C(1s) or O(1s) to π* transitions; (iii) remainder weak and long progressions towards the double ionization potentials containing a manifold of peaks. These parts, none of which has correspondence in NEXAFS spectra of neutral molecules, are dictated by the localization of the singly occupied 5σ orbital, adding a dimension of chemistry to the ionic NEXAFS technique.
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| 21. |
- Dickmark, Malin, et al.
(author)
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Risk factors for seizures in the vigorous term neonate : A population-based register study of singleton births in Sweden
- 2022
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In: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 17:2
-
Journal article (peer-reviewed)abstract
- Background Neonatal seizures have been associated with increased mortality and impaired neurodevelopment and, knowledge about risk factors may be useful for prevention. Clear associations have been established between labor-related risk factors and seizures in asphyxiated neonates. However, there is limited information about why some vigorous term-born infants experience seizures. Objectives Our aim was to assess antepartum and intrapartum risk factors for seizures in vigorous term-born neonates. Methods This was a national cohort study of singleton infants born at term in Sweden from 2009-2015. Vigorous was defined as an Apgar score of at least 7 at 5 and 10 minutes. Data on the mothers and infants were obtained from the Swedish Medical Birth Register and the Swedish Neonatal Quality Register. A diagnosis of neonatal seizures was the main outcome measure and the exposures were pregnancy and labor variables. Logistic regression analysis was used and the results are expressed as adjusted odds ratios (aOR) with 95% confidence intervals (CI). Results The incidence of neonatal seizures was 0.81/1,000 for 656 088 births. Seizures were strongly associated with obstetric emergencies (aOR 4.0, 95% CI 2.2-7.4), intrapartum fever and/or chorioamnionitis (aOR 3.4, 95% CI 2.1-5.3), and intrapartum fetal distress (aOR 3.0, 95% CI 2.4-3.7). Other associated intrapartum factors were: labor dystocia, occiput posterior position, operative vaginal delivery, and Cesarean delivery. Some maternal factors more than doubled the risk: a body mass of more than 40 (aOR 2.6, 95% CI 1.4-4.8), hypertensive disorders (aOR 2.3, 95% CI 1.7-3.1) and diabetes mellitus (aOR 2.6, 95% CI 1.7-4.1). Conclusion A number of intrapartum factors were associated with an increased risk of seizures in vigorous term-born neonates. Obstetric emergencies, intrapartum fever and/or chorioamnionitis and fetal distress were the strongest associated risks. The presence of such factors, despite a reassuring Apgar score could prompt close surveillance.
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| 22. |
- Diderholm, Barbro, 1965-, et al.
(author)
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The Impact of Restricted versus Liberal Early Fluid Volumes on Plasma Sodium, Weight Change, and Short-Term Outcomes in Extremely Preterm Infants
- 2022
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In: Nutrients. - : MDPI AG. - 2072-6643. ; 14:4
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Journal article (peer-reviewed)abstract
- The optimal fluid requirements for extremely preterm infants are not fully known. We examined retrospectively the fluid intakes during the first week of life in two cohorts of extremely preterm infants born at 22-26 weeks of gestation before (n = 63) and after a change from a restrictive to a more liberal (n = 112) fluid volume allowance to improve nutrient provision. The cohorts were similar in gestational age and birth weight, but antenatal steroid exposure was more frequent in the second era. Although fluid management resulted in a cumulative difference in the total fluid intake over the first week of 87 mL/kg (p < 0.001), this was not reflected in a mean weight loss (14 +/- 5% at a postnatal age of 4 days in both groups) or mean peak plasma sodium (142 +/- 5 and 143 +/- 5 mmol/L in the restrictive and liberal groups, respectively). The incidences of hypernatremia (>145 and >150 mmol/L), PDA ligation, bronchopulmonary dysplasia, and IVH were also similar. We conclude that in this cohort of extremely preterm infants a more liberal vs. a restricted fluid allowance during the first week had no clinically important influence on early changes in body weight, sodium homeostasis, or hospital morbidities.
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| 23. |
- Du, Zhixue, et al.
(author)
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Imaging Fluorescence Blinking of a Mitochondrial Localization Probe : Cellular Localization Probes Turned into Multifunctional Sensors br
- 2022
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In: Journal of Physical Chemistry B. - : American Chemical Society (ACS). - 1520-6106 .- 1520-5207. ; 126:16, s. 3048-3058
-
Journal article (peer-reviewed)abstract
- Mitochondrial membranes and their microenviron-ments directly influence and reflect cellular metabolic states but aredifficult to probe on site in live cells. Here, we demonstrate astrategy, showing how the widely used mitochondrial membranelocalizationfluorophore 10-nonyl acridine orange (NAO) can betransformed into a multifunctional probe of membrane micro-environments by monitoring its blinking kinetics. By transient state(TRAST) studies of NAO in small unilamellar vesicles (SUVs),together with computational simulations, we found that NAOexhibits prominent reversible singlet-triplet state transitions andcan act as a light-induced Lewis acid forming a red-emissivedoublet radical. The resulting blinking kinetics are highlyenvironment-sensitive, specifically reflecting local membrane oxy-gen concentrations, redox conditions, membrane charge,fluidity, and lipid compositions. Here, not only cardiolipin concentrationbut also the cardiolipin acyl chain composition was found to strongly influence the NAO blinking kinetics. The blinking kinetics alsoreflect hydroxyl ion-dependent transitions to and from thefluorophore doublet radical, closely coupled to the proton-transfer eventsin the membranes, local pH, and two- and three-dimensional buffering properties on and above the membranes. Following the SUVstudies, we show by TRAST imaging that thefluorescence blinking properties of NAO can be imaged in live cells in a spatiallyresolved manner. Generally, the demonstrated blinking imaging strategy can transform existingfluorophore markers intomultiparametric sensors reflecting conditions of large biological relevance, which are difficult to retrieve by other means. This opensadditional possibilities for fundamental membrane studies in lipid vesicles and live cells
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| 24. |
- Ehrlén, Johan, et al.
(author)
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Pollen limitation, seed predation and scape length in Primula farinosa
- 2002
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In: Oikos. - : Wiley. - 0030-1299 .- 1600-0706. ; 97:1, s. 45-51
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Journal article (peer-reviewed)abstract
- Floral display and reward production may affect the attractiveness of a plant to a range of interacting animals including pollinators, herbivores, and vectors of pathogenic fungi. The optimal floral phenotype should therefore depend on the relative importance of selection exerted by both mutualistic and antagonistic animals. The perennial, rosette herb Primula farinosa is polymorphic for scape length. Natural populations may include both plants with flowers displayed well above the ground (the long-scaped morph) and those with flowers positioned very close to the ground (the short-scaped morph). In this study, we conducted a field experiment to examine how the relative fitness of the two scape morphs is affected by interactions with pollinators and fruit predators in two different microhabitats (high and low vegetation). As predicted based on the difference in floral display, supplemental hand-pollination showed that fruit initiation was more strongly pollen-limited in the short-scaped than in the long-scaped morph, and that this difference was significantly larger in high than in low vegetation. Moreover, plants with a short scape experienced lower levels of fruit predation than plants with a long scape. Among open-pollinated controls, there was no significant difference in seed output between the two scape morphs. However, among plants receiving supplemental hand-pollination, short-scaped plants produced significantly more seeds than long-scaped plants. The results suggest that the positive and negative effects of a prominent floral display (increased pollination and seed predation, respectively) balance in the study population, but also that the short-scaped morph would have an advantage at higher pollination intensities. Spatial and temporal variation in pollinator activity and seed predation should result in associated variation in the relative fecundity of the two scape morphs.
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| 25. |
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| 26. |
- Fahlman, Åsa, et al.
(author)
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Wild boar behaviour during live-trap capture in a corral-style trap : implications for animal welfare
- 2020
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In: Acta Veterinaria Scandinavica. - : Springer Science and Business Media LLC. - 0044-605X .- 1751-0147. ; 62:1
-
Journal article (peer-reviewed)abstract
- BackgroundWildlife traps are used in many countries without evaluation of their effect on animal welfare. Trap-capture of wild animals should minimise negative effects on animal welfare, irrespective of whether the animals are trapped for hunting, research, or management purposes. Live-trap capture of wild boar (Sus scrofa) followed by killing inside the trap by gunshot is a recently introduced but disputed hunting method in Sweden. Approval of trap constructions is based on gross necropsy findings of 20 trapped and shot wild boars. For improved animal welfare evaluation, our aim was to study wild boar behaviour during live-trapping in a 16 m2 square corral-style trap. Behavioural assessments were conducted after filming 12 capture events of in total 38 wild boars (five adults, 20 subadults, 13 piglets). Selected behavioural traits were compared with pathological changes (trap-related lesions) found at necropsy of the 20 subadults, to determine if these variables were useful proxies of capture-induced stress in wild boar.ResultsThe wild boars spent less time resting in the evening than in the night and morning. Using Friedman’s ANOVA, there was an overall difference in the time spent foraging. However, we only found a difference between the evening and morning in the Wilcoxon matched pairs test after the Sequential Bonferroni correction, where the wild boars spent more time foraging in the evening than in the morning. Single captured individuals showed more escape behaviours and reacted more strongly to external stimuli than individuals captured in a group. It was more common for animals to charge against the mesh walls of the trap upon human approach compared to upon initial capture when the trap door closed. Trap-related pathological findings due to trauma were documented in 13 of the 20 subadults that were necropsied. Behavioural alterations indicative of capture-induced stress (e.g. charging into the trap walls) were documented in trapped wild boars with no or minor physical injuries (e.g. skin abrasions, subcutaneous haemorrhage).ConclusionsBehavioural assessment provided valuable information for determination of capture-induced stress in wild boar when evaluating live-trapping in a corral-style trap, whereas pathological evaluation through necropsy did not fully reflect the animal welfare aspects of live-trapping. We emphasize the inclusion of species-specific behavioural data assessment for evaluation of capture-related stress during live-trapping and for testing of new trap constructions before approval.
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| 27. |
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| 28. |
- Fogelqvist, Johan, et al.
(author)
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Cryptic population genetic structure : the number of inferred clusters depends on sample size
- 2010
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In: Molecular Ecology Resources. - : Wiley. - 1755-098X .- 1755-0998. ; 10:2, s. 314-323
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Journal article (peer-reviewed)abstract
- Clustering methods have been used extensively to unravel cryptic population genetic structure. We investigated the effect of the number of individuals sampled in each location on the resulting number of clusters. Our study was motivated by recent results in Arabidopsis thaliana: studies in which more than one individual was sampled per location apparently have led to a much higher number of clusters than studies where only one individual was sampled in each location, as is generally done in this species. We show, using computer simulations and microsatellite data in A. thaliana, that the number of sampled individuals indeed has a strong impact on the number of resulting clusters. This effect is smaller if the sampled populations have a hierarchical structure. In most cases, sampling 5-10 individuals per population should be enough. The results argue for abandoning the concept of 'accessions' in partially selfing organisms.
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| 29. |
- Frid, Ingrid, et al.
(author)
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Critically ill neonates displayed stable vital parameters and reduced metabolic acidosis during neonatal emergency airborne transport in Sweden
- 2018
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In: Acta Paediatrica. - : WILEY. - 0803-5253 .- 1651-2227. ; 107:8, s. 1357-1361
-
Journal article (peer-reviewed)abstract
- Aim: This study evaluated the medical quality of acute airborne transports carried out by a neonatal emergency transport service in a Swedish healthcare region from 2012 to 2015. Methods: The transport charts and patient records of all infants transported to the regional centre were reviewed for transport indications and vital parameters and outcomes. Results: We identified 187 acute airborne transports and the main indications for referral were therapeutic hypothermia after perinatal asphyxia, extremely preterm birth and respiratory failure. There were 37 deaths, but none of these occurred during transport and none of the deaths that occurred within 24 hours after transport were found to be related to the transport per se. No differences were found in vital parameters or ventilator settings before and after transport, except for an improvement in blood pH (7.22 +/- 0.13 versus 7.27 +/- 0.13, mean +/- SD, p < 0.01), due to a decrease in base deficit (-8.0 +/- 6.8 versus -5.4 +/- 6.3 mmol, p < 0.001), while the partial pressure of carbon dioxide remained unchanged. Conclusion: During air transport, critically ill neonates displayed stable vital parameters and reduced metabolic acidosis. No transport-related mortality was found, but the high number of extremely preterm infants transported indicates the potential for improving in-utero transport.
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| 30. |
- Grönhagen, Klara, et al.
(author)
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Grain-boundary segregation and dynamic solute drag theory : A phase-field approach
- 2007
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In: Acta Materialia. - : Elsevier BV. - 1359-6454 .- 1873-2453. ; 55, s. 955-960
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Journal article (peer-reviewed)abstract
- We propose a model based on a phase-field approach to study grain-boundary segregation and solute drag. We will show that it is possible to model the dynamics of grain-boundary segregation to a stationary boundary as well as solute drag on a moving boundary with the same phase-field model. We shall achieve this by introducing a concentration dependency in the height of the double-well potential in the Gibbs-energy expression. As the model then will be able to treat the build-up of a concentration spike in the boundary as well as its disappearance we shall term this treatment dynamic solute-drag theory.
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| 31. |
- Gärdenäs, Annemieke, et al.
(author)
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Knowledge gaps in soil carbon and nitrogen interactions - From molecular to global scale
- 2011
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In: Soil Biology and Biochemistry. - : Elsevier BV. - 0038-0717 .- 1879-3428. ; 43, s. 702-717
-
Journal article (peer-reviewed)abstract
- The objective of this review was to identify, address and rank knowledge gaps in our understanding of five major soil C and N interactions across a range of scales – from molecular to global. The studied five soil C and N interactions are: i) N controls on the soil emissions of greenhouse gases, ii) plant utilisation of organic N, iii) impact of rhizosphere priming on C and N cycling, iv) impact of black N on the stabilisation of soil organic matter (SOM) and v) representation of fractions of SOM in simulation models. We ranked the identified knowledge gaps according to the importance we attached to them for functional descriptions of soil–climate interactions at the global scale, for instance in general circulation models (GCMs). Both the direct and indirect influences on soil–climate interactions were included. We found that the level of understanding declined as the scale increased from molecular to global for four of the five topics. By contrast, the knowledge level for SOM simulation models appeared to be highest when considered at the ecosystem scale. The largest discrepancy between knowledge level and importance was found at the global modelling scale. We concluded that a reliable quantification of greenhouse gas emissions at the ecosystem scale is of utmost importance for improving soil–climate representation in GCMs. We see as key questions the identification of the role of different N species for the temperature sensitivity of SOM decomposition rates and its consequences for plant available N
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| 32. |
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| 33. |
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| 34. |
- Hellström, Sara, et al.
(author)
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A follow up on the feasibility after national implementation of magnesium sulfate for neuroprotection prior to preterm birth.
- 2023
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In: Acta obstetricia et gynecologica Scandinavica. - : John Wiley & Sons. - 1600-0412 .- 0001-6349. ; 102:12, s. 1741-1748
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Journal article (peer-reviewed)abstract
- The risk for brain injury manifested as cerebral palsy is higher in very preterm born children than in term. Prenatal administration of magnesium sulfate (MgSO4 ) has been shown to be neuroprotective and reduces the proportion of very preterm born children later diagnosed with cerebral palsy. A Swedish national clinical practice guideline was implemented in March 2020, stipulating the administration of a single intravenous dose of 6g MgSO4 1-24h prior to delivery before gestational age 32+0, aiming for 90% treatment coverage. The aim of this study was to evaluate the feasibility of this new clinical practice guideline in the first year of its implementation.Data on MgSO4 treatment were collected by reviewing the medical charts of women who gave birth to live born children in gestational age 22+0-31+6 during the period of March 1, 2020 to February 28, 2021, at five Swedish university hospitals. Women with pre-eclampsia, eclampsia, or high elevated liver enzymes low platelets (HELLP) were excluded.A total of 388 women were eligible and 79% received treatment with MgSO4 . Of the 21% not receiving treatment, 9% did not receive treatment due to lack of knowledge about the clinical practice guideline, 9% were not possible to treat and 3% had missing data. The proportion treated increased from 72% to 87% from the first to the last 3months. Of those treated, 81% received the drug within the stipulated timeframe (mean 8.7h, median 3.4h).There was a positive trend over time in the proportion of women receiving MgSO4 treatment, but the a priori target of 90% was not reached during the first year of implementation. Our findings indicate that this target could be reached with additional information to clinicians.
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| 35. |
- Hellström-Westas, Lena, 1954-, et al.
(author)
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Systematic review of neonatal seizure management strategies provides guidance on anti-epileptic treatment
- 2015
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In: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 104:2
-
Research review (peer-reviewed)abstract
- There is a lack of scientific evidence to support the best management of neonatal seizures. Current strategies for neonatal seizure management were investigated by analysis of all surveys published during the time period 2000-2012. Methods for seizure diagnosis and availability of electroencephalogram (EEG), including monitoring, varied. Phenobarbital was the drug of first choice, and the use of off-label drugs and treatment times varied. We conclude that there is an urgent need for more evidence-based studies to guide neonatal seizure management.
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| 36. |
- Hällstig, Emil, et al.
(author)
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Retrocommunication utilizing electroabsorption modulators and non-mechanical beam steering
- 2005
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In: Optical Engineering. - : SPIE-Intl Soc Optical Eng. - 0091-3286 .- 1560-2303. ; 44:4, s. 045001-
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Journal article (peer-reviewed)abstract
- A novel retrocommunication link utilizing reflective multiplequantum well (MQW) optical modulators and nonmechanical beamsteering and tracking is demonstrated. Large aperture reflective MQWmodulators using AlGaAs/GaAs are optimized and manufactured. Themodulators exhibit a contrast ratio larger than 4:1 and a modulationbandwidth of 10 MHz. Nonmechanical beam steering and tracking arestudied using nematic liquid crystal (NLC) spatial light modulators(SLMs). The communication link is comprised of a retromodulating arraywith four MQW modulators and a transceiver using a NLC SLM for beamsteering and tracking. Transfer of audio, real-time image data and pseudorandombit sequences over 100-m range while tracking the movingretromodulator is shown. The link is capable of transferring data at approximately8 Mbps.
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| 37. |
- Israelsson, Johan, 1970-, et al.
(author)
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Post cardiac arrest care and follow-up in Sweden – a national survey
- 2016
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In: BMC Nursing. - : Springer Science and Business Media LLC. - 1472-6955. ; 15:1
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Journal article (peer-reviewed)abstract
- BackgroundRecent decades have shown major improvements in survival rates after cardiac arrest. However, few interventions have been tested in order to improve the care for survivors and their family members. In many countries, including Sweden, national guidelines for post cardiac arrest care and follow-up programs are not available and current practice has not previously been investigated. The aim of this survey was therefore to describe current post cardiac arrest care and follow-up in Sweden.MethodsAn internet based questionnaire was sent to the resuscitation coordinators at all Swedish emergency hospitals (n = 74) and 59 answers were received. Quantitative data were analysed with descriptive statistics and free text responses were analysed using manifest content analysis.ResultsAlmost half of the hospitals in Sweden (n = 27, 46 %) have local guidelines for post cardiac arrest care and follow-up. However, 39 % of them reported that these guidelines were not always applied. The most common routine is a follow-up visit at a cardiac reception unit. If the need for neurological or psychological support are discovered the routines are not explicit. In addition, family members are not always included in the follow-up.ConclusionsAlthough efforts are already made to improve post cardiac arrest care and follow-up, many hospitals need to focus more on this part of cardiac arrest treatment. In addition, evidence-based national guidelines will have to be developed and implemented in order to achieve a more uniform care and follow-up for survivors and their family members. This national survey highlights this need, and might be helpful in the implementation of such guidelines.
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| 38. |
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| 39. |
- Jeppsson, Johan, et al.
(author)
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Inverse Saltykov analysis for particle-size distributions and their time evolution
- 2011
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In: Acta Materialia. - : Elsevier BV. - 1359-6454 .- 1873-2453. ; 59:3, s. 874-882
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Journal article (peer-reviewed)abstract
- In this work a new method for transforming 2-D to 3-D size distributions is proposed. A representation of the 2-D size distributions is constructed from the data of measured radii with a statistical method called the kernel density estimator. The method yields a smooth density estimation that is more accurate than the classic histogram. The 3-D distribution is optimized from the 2-D density estimate in an iterative manner. (C) 2010 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.
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| 40. |
- Jeppsson, Johan, et al.
(author)
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Modeling of dispersoid precipitation in multicomponent alloys
-
In: Acta Materialia. - 1359-6454 .- 1873-2453.
-
Journal article (other academic/artistic)abstract
- A model for nucleation, growth and coarsening of precipitates in multicomponent, multiphase systems is presented. High supersaturation and volume fraction of theprecipitate phase are considered. Deviation from local equilibrium at the phaseinterface is treated by means of a model based on trans-interface diffusion. Anexample simulation predict a sudden transition from diffusion-controlled to massivegrowth during continues cooling of an Fe-5%Ni alloy. The precipitation model iscompared with experiments in the Al-Sc-Mg system. To calculate the equilibriumphases, the chemical driving forces, equilibrium concentrations and diffusivities, thecommercial softwares Thermo-Calc and Dictra were used. The main advantage ofthis strategy is that there is nearly no restriction on a special alloy system.
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| 41. |
- Jeppsson, Johan, et al.
(author)
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Modified mean field models of normal grain growth
- 2008
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In: Acta Materialia. - : Elsevier BV. - 1359-6454 .- 1873-2453. ; 56:18, s. 5188-5201
-
Journal article (peer-reviewed)abstract
- Models of normal grain growth can either start from a postulated kinetic law for individual grains and yield a distribution of grain sizes or they can start from a postulated distribution and the kinetic law may be derived. Both methods are studied and a whole family of distributions based on new kinetic laws are derived using the first method. Both methods have recently been applied using Onsager's extremum principle but it is now shown that more classical procedures are sufficient. Kinetic laws give an indication of what physical factors govern the growth or shrinkage of individual grains. A Rayleigh's distribution seems to indicate that large grains are surrounded by grains smaller than the critical size and small grains are surrounded by grains larger than the critical size. The effects of the new family of kinetic laws on the development of grain size distributions are studied by numerical simulations.
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| 42. |
- Jeppsson, Johan
(author)
-
Simulation of Phase Transformations and coarsening : Computational tools for alloy development
- 2011
-
Doctoral thesis (other academic/artistic)abstract
- The final properties of an alloy are highly interlaced with its microstructure. It is therefore essential to control the evolution of the microstructure of the material during the fabrication process. Nowadays, materials design involves an increasing part of computational design to complement the traditional experimental trial and error approach. Such simulations of the process can decrease the number of material prototypes and shorten the development time for new alloys. In this thesis several microstructure models, aimed for process design, have been suggested. The ambition has been to develop physically based models that are capable to represent the evolution of hundreds of grain or particle sizes, where the models should be possible to run on a standard computer with simulation times less than one day. To achieve this goal, simplified approaches have been suggested, which are accurate enough for the growth rate of grains and particles. The microstructure models have all in common that size distributions of grains or particles are simulated with mean-field approaches. Several of the models also utilize composition and temperature dependent thermodynamic and kinetic properties continually throughout the simulations. These properties have been calculated with programming interfaces to Thermo-Calc and DICTRA together with appropriate thermodynamic and kinetic databases. The materials that have been considered in the present thesis are low alloyed steels, aluminium alloys and cemented carbides. The models are however generic in the sense that all materials can be handled if appropriate thermodynamic, kinetic and property databases exist for the alloy.
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| 43. |
- Jonsson, Maria, 1966-, et al.
(author)
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Neonatal encephalopathy and the association to asphyxia in labor
- 2014
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In: American Journal of Obstetrics and Gynecology. - : Elsevier. - 0002-9378 .- 1097-6868. ; 211:6, s. 667.e1-667.e8
-
Journal article (peer-reviewed)abstract
- OBJECTIVE: In cases with moderate and severe neonatal encephalopathy, we aimed to determine the proportion that was attributable to asphyxia during labor and to investigate the association between cardiotocographic (CTG) patterns and neonatal outcome.STUDY DESIGN: In a study population of 71,189 births from 2 Swedish university hospitals, 80 cases of neonatal encephalopathy were identified. Cases were categorized by admission CTG patterns (normal or abnormal) and by the presence of asphyxia (cord pH, <7.00; base deficit, ≥12 mmol/L). Cases with normal admission CTG patterns and asphyxia at birth were considered to experience asphyxia related to labor. CTG patterns were assessed for the 2 hours preceding delivery.RESULTS: Admission CTG patterns were normal in 51 cases (64%) and abnormal in 29 cases (36%). The rate of cases attributable to asphyxia (ie, hypoxic ischemic encephalopathy) was 48 of 80 cases (60%), most of which evolved during labor (43/80 cases; 54%). Both severe neonatal encephalopathy and neonatal death were more frequent with an abnormal, rather than with a normal, admission CTG pattern (13 [45%] vs 11 [22%]; P = .03), and 6 [21%] vs 3 [6%]; P = .04), respectively. Comparison of cases with an abnormal and a normal admission CTG pattern also revealed more frequently observed decreased variability (12 [60%] and 8 [22%], respectively) and more late decelerations (8 [40%] and 1 [3%], respectively).CONCLUSION: Moderate and severe encephalopathy is attributable to asphyxia in 60% of cases, most of which evolve during labor. An abnormal admission CTG pattern indicates a poorer neonatal outcome and more often is associated with pathologic CTG patterns preceding delivery.
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| 44. |
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| 45. |
- Jonsson, Maria, et al.
(author)
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Suboptimal care and metabolic acidemia is associated with neonatal encephalopathy but not with neonatal seizures alone : a population-based clinical audit
- 2014
-
In: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley-Blackwell. - 0001-6349 .- 1600-0412. ; 93:5, s. 477-482
-
Journal article (peer-reviewed)abstract
- Objective: To determine the incidence of moderate to severe neonatal encephalopathy (NE) and neonatal seizures without encephalopathy, and the association with metabolic acidemia. Secondly, to investigate the occurrence of suboptimal intrapartum care and its impact on neonatal outcome.Design: Clinical audit.Setting: Two university hospitals in Sweden.Population: Neonates 34weeks with moderate or severe NE and neonatal seizures alone, i.e. without encephalopathy, from a population of 71189 births, where umbilical blood gases were routinely analyzed.Methods: Neonates were categorized depending on the presence of metabolic acidemia at birth by umbilical artery pH<7.00, base deficit 12mmol/L. Records were audited for suboptimal care and a decision was made on whether management was assessed to have impacted neonatal outcome.Main outcome measures: Encephalopathy and seizures alone.Results: We identified 80 neonates with NE and 30 with seizures alone, of which 48 (60%) and none, respectively, had metabolic acidemia. Suboptimal care could be assessed in 77 and occurred in 28 (36%) NE cases and in one neonate with seizures alone (p<0.001). In 47 NE cases with metabolic acidemia, suboptimal care occurred in 22 (47%) vs. 6/30 (20%) without metabolic acidemia (p=0.02). Suboptimal care had an impact on outcome in 18/77 (23%) NE cases but in no cases with seizures alone.Conclusion: Suboptimal care was commonly seen with NE, particularly in neonates with metabolic acidemia, and also affected neonatal outcome. No such associations were found in neonates with seizures alone.
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| 46. |
- Karlsson, Victoria, 1968-
(author)
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Aspects of neonatal intensive care and anesthesia : Thermal balance and respiratory management
- 2018
-
Doctoral thesis (other academic/artistic)abstract
- This thesis is based on four articles originating from three studies conducted in the neonatal intensive care unit and the children’s operating deparment at Uppsala University Hospital, Sweden.The overall aim was to obtain new knowledge about thermal balance and care environment in extremely preterm infants during skin-to-skin care (SSC), evaluate different methods of intraoperative monitoring of carbon dioxide (CO2), and to investigate how different levels of inhaled oxygen affect infants’ oxygenation during anesthesia and surgery. Study I investigated infant thermal balance and the physical environment for extremely preterm infants during SSC. Study II formed part of a prospective study to assess the performance of non-invasive transcutaneous and end-tidal technique to continuously monitor CO2 levels in the infants blood during anesthesia. Study III was a prospective randomized trial to investigate oxygenation during induction of anesthesia with room air versus high fraction (80%) of oxygen in healthy newborn infants.The infants maintained normal body temperature during SSC. In comparison to care in an incubator, during SSC ambient humidity was lower and insensible water loss through the skin was higher. Compared to blood gas Pco2, transcutaneous carbon dioxide monitoring yielded a bias of 0.3 ± 0.7 kPa, and end-tidal technique a bias of -1.9 ± 0.9 kPa. After intubation, saturation measured by pulse oximetry was lower (p < .05) in the group breathing room air than in the group with high oxygen (93% ± 6.7 and 99% ± 1.5). None of the infants spent time below the pre-specified safety oxygen saturation targets to mandate supplemental oxygen.This thesis provides new knowledge about early initiation of SSC after birth for extremely preterm infants, the results will be useful to guide safe routines for implementation of early SSC. These results suggest that during anesthesia would transcutaneous monitoring of carbon dioxide be beneficial, end-tidal monitoring correlated poorly to blood gas and induction of general anesthesia in newborn infants can be safely performed without the use of high levels of supplemental oxygen. Taken together, this new knowledge has the potential to improve intraoperative respiratory management.
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| 47. |
- Karlsson, Victoria, et al.
(author)
-
Early Skin-to-Skin Care in Extremely Preterm Infants : Thermal Balance and Care Environment
- 2012
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In: Journal of Pediatrics. - : Elsevier BV. - 0022-3476 .- 1097-6833. ; 161:3, s. 422-426
-
Journal article (peer-reviewed)abstract
- ObjectiveTo evaluate infant thermal balance and the physical environment in extremely preterm infants during skin-to-skin care (SSC).Study designMeasurements were performed in 26 extremely preterm infants (gestational age 22-26 weeks; postnatal age, 2-9 days) during pretest (in incubator), test (during SSC), and posttest (in incubator) periods. Infants' skin temperature and body temperature, ambient temperature, and relative humidity were measured. Evaporimetry was used to determine transepidermal water loss, and insensible water loss through the skin was calculated.ResultsThe infants maintained a normal body temperature during SSC. Transfer to and from SSC was associated with a drop in skin temperature, which increased during SSC. Ambient humidity and temperature were lower during SSC than during incubator care. Insensible water loss through the skin was higher during SSC.ConclusionSSC can be safely used in extremely preterminfants. SSC can be initiated during the first week of life and is feasible in infants requiring neonatal intensive care, including ventilator treatment. During SSC, the conduction of heat from parent to infant is sufficiently high to compensate for the increase in evaporative and convective heat loss. The increased water loss through the skin during SSC is small and should not affect the infant's fluid balance.
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| 48. |
- Karlsson, Victoria, et al.
(author)
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Nursing care of infants born extremely preterm
- 2022
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In: Seminars in Fetal & Neonatal Medicine. - : Elsevier. - 1744-165X .- 1878-0946. ; 27:3
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Journal article (peer-reviewed)abstract
- With improving survival at the lowest gestations an increasing number of tiny and vulnerable infants are being cared for, and optimal outcomes require an approach to care that takes their specific characteristics into account. These include immature organ function and a risk for iatrogenic injury, and parental/familial strain due to the high degree of uncertainty, infant-mother separation, and long hospital stay. While the challenges in providing nursing care to these infants are obvious it is also clear that this field has tremendous potential to influence both short and long-term outcomes of this population. This mini-review discusses aspects of the nursing care provided to infants born at the very lowest gestations and their families, with focus on doing less harm by establishing an adequate care environment, actively promoting parental closeness and care-giving, and conservative skin care.
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| 49. |
- Karlsson, Victoria, et al.
(author)
-
Poor performance of main-stream capnography in newborn infants during general anesthesia
- 2017
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In: Pediatric Anaesthesia. - : Wiley. - 1155-5645 .- 1460-9592. ; 27:12, s. 1235-1240
-
Journal article (peer-reviewed)abstract
- BackgroundEndtidal (ET) measurement of carbon dioxide is well established for intraoperative respiratory monitoring of adults and children, but the method's accuracy for intraoperative use in small newborn infants has been less extensively investigated.AimsThe aim of this study was to compare carbon dioxide from ET measurements with arterialized capillary blood samples in newborn infants during general anesthesia and surgery.MethodsEndtidal carbon dioxide was continuously measured during anesthesia and surgery and compared with simultaneous blood gas analyses obtained from capillary blood samples. Fifty-nine sample sets of ET to blood gas carbon dioxide were obtained from 23 prospectively enrolled infants with a gestational age of 23-41 weeks and a birth weight of 670-4110 g.ResultsEndtidal levels of carbon dioxide were considerably lower in all sample sets and only 4/23 individual ET-blood gas sample pairs differed <7.5 mm Hg (1 kPa). Bland-Altman analysis indicated a poor agreement with a bias of -13 7 mm Hg and a precision of +/- 14 mm Hg. The performance of ET measurements was particularly poor in infants weighing below 2.5 kg, in infants in need of respiratory support prior to anesthesia, and when the true (blood gas) carbon dioxide level was high, above 45 mm Hg.ConclusionMain-stream capnography during anesthesia and surgery correlated poorly to blood gas values in small and/or respiratory compromised infants. We conclude that caution should be exercised when relying solely on ET measurements to guide mechanical ventilation in the OR.
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| 50. |
- Karlsson, Victoria, et al.
(author)
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Randomized controlled trial of low vs high oxygen during neonatal anesthesia : Oxygenation, feasibility, and oxidative stress
- 2022
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In: Pediatric Anaesthesia. - : John Wiley & Sons. - 1155-5645 .- 1460-9592. ; 32:9, s. 1062-1069
-
Journal article (peer-reviewed)abstract
- Background To reduce risk for intermittent hypoxia a high fraction of inspired oxygen is routinely used during anesthesia induction. This differs from the cautious dosing of oxygen during neonatal resuscitation and intensive care and may result in significant hyperoxia. Aim In a randomized controlled trial, we evaluated oxygenation during general anesthesia with a low (23%) vs a high (80% during induction and recovery, and 40% during maintenance) fraction of inspired oxygen, in newborn infants undergoing surgery. Method Thirty-five newborn infants with postconceptional age of 35-44 weeks were included (17 infants in low and 18 in high oxygen group). Oxygenation was monitored by transcutaneous partial pressure of oxygen, pulse oximetry, and cerebral oxygenation. Predefined SpO2 safety targets dictated when to increase inspired oxygen. Results At start of anesthesia, oxygenation was similar in both groups. Throughout anesthesia, the high oxygen group displayed significant hyperoxia with higher (difference-20.3 kPa, 95% confidence interval (CI)-28.4 to 12.2, p < .001) transcutaneous partial pressure of oxygen values than the low oxygen group. While SpO2 in the low oxygen group was lower (difference - 5.8%, 95% CI -9.3 to -2.4, p < .001) during anesthesia, none of the infants spent enough time below SpO(2) safety targets to mandate supplemental oxygen, and cerebral oxygenation was within the normal range and not statistically different between the groups. Analysis of the oxidative stress biomarker urinary F-2-Isoprostane revealed no differences between the low and high oxygen group. Conclusion We conclude that in healthy newborn infants, use of low oxygen during general anesthesia was feasible, while the prevailing practice of using high levels of inspired oxygen resulted in significant hyperoxia. The trade-off between careful dosing of oxygen and risks of hypo- and hyperoxia in neonatal anesthesia should be further examined.
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