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| 5. |
- Linder, J, et al.
(author)
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Long-term sick-leavers with fibromyalgia : Comparing their multidisciplinarily assessed characteristics with those of others with chronic pain conditions and depression
- 2009
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In: Journal of Multidisciplinary Healthcare. - 1178-2390. ; 2, s. 23-37
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Journal article (peer-reviewed)abstract
- Objective: The aim was to gain knowledge of fibromyalgia (FM) patients on long-term sick leave and with particular difficulties in resuming work, and to compare them with patients with myalgia, back or joint diagnoses, and depression.Methods: Patients were identified by and referred from social insurance offices and were multidisciplinarily examined by three board-certified specialists in psychiatry, orthopedic surgery and rehabilitation medicine. Ninety-two women were diagnosed with FM only. Three female comparison groups were chosen: depression, back/joint diagnoses, and myalgia.Results and conclusions: Ceaseless pain was reported by 73% of FM patients, 54% of back/joint diagnoses patients, 43% of myalgia patients, and 35% of depression patients. The distribution of pain (>50%) in FM patients was to almost all regions of the body, and in depression patients to the lower dorsal neck, upper shoulders and lumbosacral back but not in the anterior body. Reduced sleep was more evident in FM patients. FM patients did not meet more criteria for personality disorder than patients with the other somatic pain conditions. The most common dimension of “personality traits” of somatic pain conditions was the “obsessive compulsive” but at a level clearly below that indicating a personality disorder. More FM patients experienced disabilities, the most common being in the mobility and domestic-life areas.
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| 8. |
- Razis, E., et al.
(author)
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Assessment of the management of carcinomatous meningitis from breast cancer globally: a study by the Breast International Group Brain Metastasis Task Force
- 2022
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In: ESMO Open. - : Elsevier BV. - 2059-7029. ; 7:3
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Journal article (peer-reviewed)abstract
- Background: Carcinomatous meningitis (CM) is a severe complication of breast cancer. The Breast International Group (BIG) carried out a survey to describe the approach to CM internationally. Patients and methods: A questionnaire on the management of CM was developed by the Brain Metastases Task Force of BIG and distributed to its groups, requesting one answer per group site. Results: A total of 241 sites responded, 119 from Europe, 9 from North America, 39 from Central/South America, 58 from Asia, and 16 in Australia/New Zealand, with 24.5% being general hospitals with oncology units, 44.4% university hospitals, 22.4% oncology centers, and 8.7% private hospitals. About 56.0% of sites reported seeing <5 cases annually with 60.6% reporting no increase in the number of cases of CM recently. Nearly 63.1% of sites investigate for CM when a patient has symptoms or radiological evidence, while 33.2% investigate only for symptoms. For diagnosis, 71.8% of sites required a positive cerebrospinal fluid cytology, while magnetic resonance imaging findings were sufficient in 23.7% of sites. Roughly 97.1% of sites treat CM and 51.9% also refer patients to palliative care. Intrathecal therapy is used in 41.9% of sites, mainly with methotrexate (74.3%). As many as 20 centers have a national registry for patients with breast cancer with central nervous system metastases and of those 5 have one for CM. Most (90.9%) centers would be interested in participating in a registry as well as in studies for CM, the latter preferably (62.1%) breast cancer subtype specific. Conclusions: This is the first study to map out the approach to CM from breast cancer globally. Although guidelines with level 1 evidence are lacking, there is a high degree of homogeneity in the approach to CM globally and great interest for conducting studies in this area.
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| 11. |
- Chamberlain, M A, et al.
(author)
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Vocational rehabilitation : An educational review
- 2009
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In: Journal of rehabilitation. - : Medical Journals Sweden AB. - 0022-4154 .- 1650-1977 .- 1651-2081. ; 41:11, s. 856-869
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Research review (peer-reviewed)abstract
- The aim of this review is to describe aspects of vocational rehabilitation relevant for a physician aiming to become a specialist in physical and rehabilitation medicine (PRM). The review discusses the epidemiology of incapacity for work, the major patient groups in vocational rehabilitation (musculoskeletal and psychiatric diagnoses comprise approximately 50-70% of the patients), the influence of different kinds of environmental and individual risk factors on work resumption (such as the legal framework, application of the law, resources for rehabilitation and its effectiveness, the degree of co-operation between vocational rehabilitation agencies, economic factors/labour market situation, medical and personal factors). The review describes different models of vocational rehabilitation, the effectiveness of various vocational rehabilitation programmes on work resumption or sick leave (where strong evidence is reported for multimodal rehabilitation programmes for patients with long-lasting musculoskeletal pain). Finally, there are sections about the PRM physician's history-taking in vocational rehabilitation (using the International Classification of Functioning, Disability and Health (ICF)), and report writing with a Structure where ICF body functions and activity limitations are reported separately.
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| 12. |
- Connolly, Stuart J., et al.
(author)
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Andexanet for Factor Xa Inhibitor-Associated Acute Intracerebral Hemorrhage
- 2024
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In: New England Journal of Medicine. - 0028-4793. ; 390:19, s. 1745-1755
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Journal article (peer-reviewed)abstract
- Background Patients with acute intracerebral hemorrhage who are receiving factor Xa inhibitors have a risk of hematoma expansion. The effect of andexanet alfa, an agent that reverses the effects of factor Xa inhibitors, on hematoma volume expansion has not been well studied. Methods We randomly assigned, in a 1:1 ratio, patients who had taken factor Xa inhibitors within 15 hours before having an acute intracerebral hemorrhage to receive andexanet or usual care. The primary end point was hemostatic efficacy, defined by expansion of the hematoma volume by 35% or less at 12 hours after baseline, an increase in the score on the National Institutes of Health Stroke Scale of less than 7 points (scores range from 0 to 42, with higher scores indicating worse neurologic deficit) at 12 hours, and no receipt of rescue therapy between 3 hours and 12 hours. Safety end points were thrombotic events and death. Results A total of 263 patients were assigned to receive andexanet, and 267 to receive usual care. Efficacy was assessed in an interim analysis that included 452 patients, and safety was analyzed in all 530 enrolled patients. Atrial fibrillation was the most common indication for factor Xa inhibitors. Of the patients receiving usual care, 85.5% received prothrombin complex concentrate. Hemostatic efficacy was achieved in 150 of 224 patients (67.0%) receiving andexanet and in 121 of 228 (53.1%) receiving usual care (adjusted difference, 13.4 percentage points; 95% confidence interval [CI], 4.6 to 22.2; P=0.003). The median reduction from baseline to the 1-to-2-hour nadir in anti-factor Xa activity was 94.5% with andexanet and 26.9% with usual care (P<0.001). Thrombotic events occurred in 27 of 263 patients (10.3%) receiving andexanet and in 15 of 267 (5.6%) receiving usual care (difference, 4.6 percentage points; 95% CI, 0.1 to 9.2; P=0.048); ischemic stroke occurred in 17 patients (6.5%) and 4 patients (1.5%), respectively. There were no appreciable differences between the groups in the score on the modified Rankin scale or in death within 30 days. Conclusions Among patients with intracerebral hemorrhage who were receiving factor Xa inhibitors, andexanet resulted in better control of hematoma expansion than usual care but was associated with thrombotic events, including ischemic stroke. (Funded by Alexion AstraZeneca Rare Disease and others; ANNEXA-I ClinicalTrials.gov number, NCT03661528.).
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| 13. |
- Ekholm, Ella, et al.
(author)
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Characterization of beta cell and incretin function in patients with MODY1 (HNF4A MODY) and MODY3 (HNF1A MODY) in a Swedish patient collection.
- 2011
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In: Acta Diabetologica. - : Springer Science and Business Media LLC. - 1432-5233 .- 0940-5429.
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Journal article (peer-reviewed)abstract
- The aim of this study was to evaluate the beta cell and incretin function in patients with HNF4A and HNF1A MODY during a test meal. Clinical characteristics and biochemical data (glucose, proinsulin, insulin, C-peptide, GLP-1 and GIP) during a test meal were compared between MODY patients from eight different families. BMI-matched T2D and healthy subjects were used as two separate control groups. The early phase of insulin secretion was attenuated in HNF4A, HNF1A MODY and T2D (AUC0-30 controls: 558.2 ± 101.2, HNF4A MODY: 93.8 ± 57.0, HNF1A MODY: 170.2 ± 64.5, T2D: 211.2 ± 65.3, P < 0.01). Markedly reduced levels of proinsulin were found in HNF4A MODY compared to T2D and that tended to be so also in HNF1A MODY (HNF4A MODY: 3.7 ± 1.2, HNF1A MODY: 8.3 ± 3.8 vs. T2D: 26.6 ± 14.3). Patients with HNF4A MODY had similar total GLP-1 and GIP responses as controls (GLP-1 AUC: (control: 823.9 ± 703.8, T2D: 556.4 ± 698.2, HNF4A MODY: 1,257.0 ± 999.3, HNF1A MODY: 697.1 ± 818.4) but with a different secretion pattern. The AUC insulin during the test meal was strongly correlated with the GIP secretion (Correlation coefficient 1.0, P < 0.001). No such correlation was seen for insulin and GLP-1. Patients with HNF4A and HNF1A MODY showed an attenuated early phase of insulin secretion similar to T2Ds. AUC insulin during the test meal was strongly correlated with GIP secretion, whereas no such correlation was seen for insulin and GLP-1. Thus, GIP may be a more important factor for insulin secretion than GLP-1 in MODY patients.
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| 14. |
- Ekholm, J, et al.
(author)
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Vocational rehabilitation
- 2009
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In: Journal of rehabilitation medicine. - : Medical Journals Sweden AB. - 1651-2081 .- 1650-1977. ; 41:3, s. 113-114
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Journal article (other academic/artistic)
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| 20. |
- Gebhardt, T., et al.
(author)
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The influence of additions of Al and Si on the lattice stability of fcc and hcp Fe-Mn random alloys
- 2011
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In: Journal of Physics. - : IOP Publishing. - 0953-8984 .- 1361-648X. ; 23:24, s. 246003-
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Journal article (peer-reviewed)abstract
- We have studied the influence of additions of Al and Si on the lattice stability of face-centred-cubic (fcc) versus hexagonal-closed-packed (hcp) Fe-Mn random alloys, considering the influence of magnetism below and above the fcc Neel temperature. Employing two different ab initio approaches with respect to basis sets and treatment of magnetic and chemical disorder, we are able to quantify the predictive power of the ab initio methods. We find that the addition of Al strongly stabilizes the fcc lattice independent of the regarded magnetic states. For Si a much stronger dependence on magnetism is observed. Compared to Al, almost no volume change is observed as Si is added to Fe-Mn, indicating that the electronic contributions are responsible for stabilization/destabilization of the fcc phase.
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| 21. |
- Harms-Ringdahl, K, et al.
(author)
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Assessment of jet pilots' upper trapezius load calibrated to maximal voluntary contraction and a standardized load.
- 1996
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In: Journal of Electromyography & Kinesiology. - : Elsevier BV. - 1050-6411 .- 1873-5711. ; 6:1, s. 67-72
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Journal article (peer-reviewed)abstract
- Electromyographic (EMG) recording of the myoelectrical activity level in the trapezius muscle is often used as one method of assessing neck and shoulder muscle workload. To analyse how the normalization value influences interpretation of upper trapezius load during a work task, two different reference values for normalization were applied - one obtained during a maximum voluntary contraction (MVE) and the other during a standardized muscular load (RVE). Nine jet pilots (ages 30-48 yr) flew two sorties in a 37 Viggen aircraft using either of two types of head garment while 3-D acceleration and muscular activity were recorded. In each sortie twice in the programme a steep left turn at 5-6 +G(Z) was performed. The highest activity level (MVE) obtained during shoulder elevation combined with an isometric heavy resistance (maximum) against arm flexion/abduction was used as one normalization value. Before, between, and after the two flights, 15 s EMG recordings (RVE) during a dumbbell test in the same arm position were also taken. The muscular activity in the upper trapezius during a given task varied a great deal between individuals, but the reliability of the amplitude levels on different occasions during a work day was good, given the same electrode location and application. If muscular activity during a standardized loading force (e.g. dumbbell test) is used to normalize the recordings for workload assessments related to utilized muscular capacity, a subject with high muscular strength and comparatively low workload might in some situations be assessed as having the same workload as, or a higher load than a subject with less strength and a comparatively high workload. While normalization using a standardized force can be used to assess changes in workload, for assessing workload related to the individual's capacity recording the myoelectrical activity during maximal contraction is preferable.
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| 22. |
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| 23. |
- Hu, Yannan, et al.
(author)
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Trends in socioeconomic inequalities in self-assessed health in 17 European countries between 1990 and 2010
- 2016
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In: Journal of Epidemiology and Community Health. - : BMJ. - 0143-005X .- 1470-2738. ; 70:7, s. 644-652
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Journal article (peer-reviewed)abstract
- BACKGROUND: Between the 1990s and 2000s, relative inequalities in all-cause mortality increased, whereas absolute inequalities decreased in many European countries. Whether similar trends can be observed for inequalities in other health outcomes is unknown. This paper aims to provide a comprehensive overview of trends in socioeconomic inequalities in self-assessed health (SAH) in Europe between 1990 and 2010.METHODS: Data were obtained from nationally representative surveys from 17 European countries for the various years between 1990 and 2010. The age-standardised prevalence of less-than-good SAH was analysed by education and occupation among men and women aged 30-79 years. Socioeconomic inequalities were measured by means of absolute rate differences and relative rate ratios. Meta-analysis with random-effects models was used to examine the trends of inequalities.RESULTS: We observed declining trends in the prevalence of less-than-good SAH in many countries, particularly in Southern and Eastern Europe and the Baltic states. In all countries, less-than-good SAH was more prevalent in lower educational and manual groups. For all countries together, absolute inequalities in SAH were mostly constant, whereas relative inequalities increased. Almost no country consistently experienced a significant decline in either absolute or relative inequalities.CONCLUSIONS: Trends in inequalities in SAH in Europe were generally less favourable than those found for inequalities in mortality, and there was generally no correspondence between the two when we compared the trends within countries. In order to develop policies or interventions that effectively reduce inequalities in SAH, a better understanding of the causes of these inequalities is needed.
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| 26. |
- John Mukkattukavil, D., et al.
(author)
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Resonant inelastic soft x-ray scattering on LaPt 2 Si 2
- 2022
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In: Journal of physics. Condensed matter : an Institute of Physics journal. - 1361-648X .- 0953-8984. ; 34:32
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Journal article (peer-reviewed)abstract
- X-ray absorption and resonant inelastic x-ray scattering spectra of LaPt2Si2single crystal at the Si 2pand La 4dedges are presented. The data are interpreted in terms of density functional theory, showing that the Si spectra can be described in terms of Sisanddlocal partial density of states (LPDOS), and the La spectra are due to quasi-atomic local 4fexcitations. Calculations show that Ptd-LPDOS dominates the occupied states, and a sharp localized Lafstate is found in the unoccupied states, in line with the observations.
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| 30. |
- Kärrholm, Johan, 1951, et al.
(author)
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Effects on work resumption of a co-operation project in vocational rehabilitation. Systematic, multi-professional, client-centred and solution-oriented co-operation
- 2006
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In: Disabil Rehabil. - : Informa UK Limited. - 0963-8288 .- 1464-5165. ; 28:7, s. 457-67
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Journal article (peer-reviewed)abstract
- PURPOSE: The present aim was to evaluate the effect of systematic multi-professional co-ordinated rehabilitation (the Stockholm Co-operation Project) on the number of days' sick leave during the first and second half-years after the rehabilitation co-ordination period, compared to the year before. Another aim was to evaluate the economic effects at national level. METHOD: A matched-pairs design was used. The study group was based on 64 rehabilitees employed by a public employer in Stockholm, who took part in a systematic multi-professional co-operation project. To obtain pairs, the 64 individuals were individually matched with 64 people who received conventionally organised rehabilitation. Thus, there were 128 subjects altogether. RESULTS: The study group had substantially less sick leave days per month than the comparison group during the second half-year after the rehabilitation co-ordination period. The effect was even greater in a subgroup with more previous sick leave. During the first half-year after the intervention the comparison group had relatively more sick leave. No effect was found for a subgroup with less previous sick leave. The economic benefit of the intervention was estimated to 1,278 euros per month and person based on the whole group, and to 2,405 euros per month and person based on those with more sick leave. CONCLUSIONS: People who undergo co-ordinated rehabilitation have more working days after the intervention period than those with conventional rehabilitation. This way for rehabilitation actors to co-operate gives better outcomes for rehabilitation cases with long previous sick leave, but not for cases with less previous sick leave. It also generates economic gains at several levels.
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| 31. |
- Landstad, Bodil J, et al.
(author)
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Women at work despite ill health : Diagnoses and pain before and after personnel support - A prospective study of hospital cleaners/home-help personnel with comparison groups
- 2001
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In: Journal of Rehabilitation Medicine. - 1650-1977 .- 1651-2081. ; 33, s. 216-224
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Journal article (peer-reviewed)abstract
- The present study sought to elicit the diagnoses behind the pain conditions causing complaints by female hospital cleaners and home-help personnel who were working despite their symptoms. We also wished to describe the prevalence of musculoskeletal diagnoses and the intensity, frequency and location of pain, and changes in the clinical picture and pain after personnel supporting interventions. A prospective study was carried out with intervention groups and non-randomized comparison groups. The hospital cleaners intervention programme comprised occupational organizational measures, competence development, physical and psychosocial working environmental measures and individual and rehabilitation measures on both an individual and a group basis. The home-help programme comprised a 2-week stay at an orthopaedic rehabilitation unit, training of supervisors, comrade massage, purchase of training equipment and stress management. Myalgia/tendinitis occurred in 61% of shoulder girdle elevators, 18% of rotator cuffs, 16% of dorsal neck muscles and 29% of hip muscles. There was musculoskeletal pain in the lower back in 28% of cases. Referred pain from a musculoskeletal focus occurred in about one-sixth to one-third of individuals with the diagnosis in question. Neurogenic pain occurred in 6% of cases. No fibromyalgia syndrome was found. One-third of individuals felt pain all the time or almost all the time. The mean rated perceived “worst pain” was 70 mm on a visual analogue scale of 1-100 mm. Comparisons between intervention and reference groups indicated that some improvement in the clinical picture can be attained using this kind of general support programme for employees.
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| 32. |
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| 33. |
- Marnetoft, SU, et al.
(author)
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The unemployed sick-listed and their vocational rehabilitation
- 1997
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In: International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation. - : Ovid Technologies (Wolters Kluwer Health). - 0342-5282. ; 20:3, s. 245-253
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Journal article (peer-reviewed)
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| 34. |
- Marnetoft, Sven-Uno, et al.
(author)
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Factors associated with successful vocational rehabilitation in a Swedish rural area
- 2001
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In: Journal of Rehabilitation Medicine. - 1650-1977 .- 1651-2081. ; 33, s. 71-78
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Journal article (peer-reviewed)abstract
- The objective of this study was to identify factors associated with a positive outcome of vocational rehabilitation, and to identify groups that have been successfully rehabilitated in a Swedish rural area. In this study vocational rehabilitation is defined as medical multidisciplinary, psychological, social and occupational activities aiming to re-establish, among sick or injured people with previous work history, their working capacity and prerequisites for returning to the labour market. The study was based on 732 people on registered long-term sick-leave who, in a rural area in northern Sweden during 1992-94, became objects for vocational rehabilitation. Bivariate and stepwise logistic regression analysis was used to identify factors associated with the outcome. By successful vocational rehabilitation is meant reporting well (no economical benefit) at all three Lime-points 6, 12 and 24 months after termination of rehabilitation, or lowered benefit levels. The results indicate that younger, male, employed persons, with an early start on rehabilitation, in a programme entailing education, and partly sick-listed before the start of this programme, had the greatest chance of successful rehabilitation. In contrast, older, female, unemployed people, with a delayed start on rehabilitation, without education, and fully sick-listed before the start, greatly risked being unsuccessful with vocational rehabilitation. The results indicate how to improve the rehabilitation process: several process-related factors shown to be connected with successful vocational rehabilitation include time before the start of rehabilitation, partial instead of full sickness benefit, and education programmes.
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| 42. |
- Tigerstedt, C, et al.
(author)
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Comparing older people's drinking habits in four Nordic countries: Summary of the thematic issue
- 2020
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In: Nordisk alkohol- & narkotikatidskrift : NAT. - : SAGE Publications. - 1458-6126. ; 37:5, s. 434-443
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Journal article (peer-reviewed)abstract
- The present article summarises status and trends in the 21st century in older people’s (60–79 years) drinking behaviour in Denmark, Finland, Norway and Sweden and concludes this thematic issue. Each country provided a detailed report analysing four indicators of alcohol use: the prevalence of alcohol consumers, the prevalence of frequent use, typical amounts of use, and the prevalence of heavy episodic drinking (HED). The specific aim of this article is to compare the results of the country reports.Findings:Older people’s drinking became more common first in Denmark in the 1970s and then in the other countries by the 1980s. Since 2000 the picture is mixed. Denmark showed decreases in drinking frequency, typically consumed amounts and HED, while in Sweden upward trends were dominant regarding prevalence of consumers and frequency of drinking as well as HED. Finland and Norway displayed both stable indicators except for drinking frequency and proportion of women consumers where trends increased. In all four countries, the gender gap diminished with regard to prevalence and frequency of drinking, but remained stable in regard to consuming large amounts. In Norway the share of alcohol consumers among women aged 60–69 years exceeded the share among men. During the late 2010s, Denmark had the highest prevalence of alcohol consumers as well as the highest proportion drinking at a higher frequency. Next in ranking was Finland, followed by Sweden and Norway. This overall rank ordering was observed for both men and women.Conclusion:As the populations aged 60 years and older in the Nordic countries continue to grow, explanations for the drivers and consequences of changes in older people’s drinking will become an increasingly relevant topic for future research. Importantly, people aged 80 years and older should also be included as an integral part of that research.
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| 43. |
- Werner, Josephina, et al.
(author)
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Surface Partitioning in Organic-Inorganic Mixtures Contributes to the Size-Dependence of the Phase-State of Atmospheric Nanoparticles
- 2016
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In: Environmental Science and Technology. - : American Chemical Society (ACS). - 0013-936X .- 1520-5851. ; 50:14, s. 7434-7442
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Journal article (peer-reviewed)abstract
- Atmospheric particulate matter is one of the main factors governing the Earth's radiative budget, but its exact effects on the global climate are still uncertain. Knowledge on the molecular-scale surface phenomena as well as interactions between atmospheric organic and inorganic compounds is necessary for understanding the role of airborne nanoparticles in the Earth system. In this work, surface composition of aqueous model systems containing succinic acid and sodium chloride or ammonium sulfate is determined using a novel approach combining X-ray photoelectron spectroscopy, surface tension measurements and thermodynamic modeling. It is shown that succinic acid molecules are accumulated in the surface, yielding a 10-fold surface concentration as compared with the bulk for saturated succinic acid solutions. Inorganic salts further enhance this enrichment due to competition for hydration in the bulk. The surface compositions for various mixtures are parametrized to yield generalizable results and used to explain changes in surface tension. The enhanced surface partitioning implies an increased maximum solubility of organic compounds in atmospheric nanoparticles. The results can explain observations of size-dependent phase-state of atmospheric nanoparticles, suggesting that these particles can display drastically different behavior than predicted by bulk properties only.
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| 44. |
- Beecken, Jörg, 1982, et al.
(author)
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Airborne emission measurements of SO2, NOx and particles from individual ships using a sniffer technique
- 2014
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In: Atmospheric Measurement Techniques. - : Copernicus GmbH. - 1867-1381 .- 1867-8548. ; 7:7, s. 1957-1968
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Journal article (peer-reviewed)abstract
- A dedicated system for airborne ship emission measurements of SO2, NOx and particles has been developed and used from several small aircraft. The system has been adapted for fast response measurements at 1 Hz, and the use of several of the instruments is unique. The uncertainty of the given data is about 20% for SO2 and 24% for NOx emission factors. The mean values with one standard deviation for multiple measurements of 158 ships measured from the air on the Baltic and North Sea during 2011 and 2012 show emission factors of 18.8+/-6.5 g kg(fuel)(-1), 66.6+/-23.4 g kg(fuel)(-1) and 1.8+/-1.3 1016 particles kg(fuel)(-1) for SO2, NOx and particle number, respectively. The particle size distributions were measured for particle diameters between 15 and 560 nm. The mean sizes of the particles are between 45 and 54 nm dependent on the distance to the source, and the number size distribution is monomodal. Concerning the sulfur fuel content, around 85% of the monitored ships comply with the International Maritime Organization (IMO) limits. The reduction of the sulfur emission control area (SECA) limit from 1.5 to 1% in 2010 appears to have contributed to reduction of sulfur emissions that were measured in earlier studies from 2007 to 2009. The presented method can be implemented for regular ship compliance monitoring.
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| 45. |
- Beecken, Jörg, 1982, et al.
(author)
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Emission factors of SO2, NOx and particles from ships in Neva Bay from ground-based and helicopter-borne measurements and AIS-based modeling
- 2015
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In: Atmospheric Chemistry and Physics. - : Copernicus GmbH. - 1680-7316 .- 1680-7324. ; 15:9, s. 5229-5241
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Journal article (peer-reviewed)abstract
- Emission factors of SO2, NOx and size-distributed particle numbers were measured for approximately 300 different ships in the Gulf of Finland and Neva Bay area during two campaigns in August/September 2011 and June/July 2012. The measurements were carried out from a harbor vessel and from an Mi-8 helicopter downwind of passing ships. Other measurements were carried out from shore sites near the island of Kronstadt and along the Neva River in the urban area of Saint Petersburg. Most ships were running at reduced speed (10 kn), i.e., not at their optimal load. Vessels for domestic and international shipping were monitored. It was seen that the distribution of the SO2 emission factors is bi-modal, with averages of 4.6 and 18.2 gSO(2) kg(fuel)(-1) for the lower and the higher mode, respectively. The emission factors show compliance with the 1% fuel sulfur content Sulfur Emission Control Areas (SECA) limit for 90% of the vessels in 2011 and 97% in 2012. The distribution of the NOx emission factor is mono-modal, with an average of 58 gNO(x) kg(fuel)(-1). The corresponding emission related to the generated power yields an average of 12.1 gNO(x) kWh(-1). The distribution of the emission factors for particulate number shows that nearly 90% of all particles in the 5.6 nm to 10 mu m size range were below 70 nm in diameter. The distribution of the corresponding emission factors for the mass indicates two separated main modes, one for particles between 30 and 300 nm and the other for above 2 mu m. The average particle emission factors were found to be in the range from 0.7 to 2.7 x 10(16) particles kg(fuel)(-1) and 0.2 to 3.4 gPM kg(fuel)(-1), respectively. The NOx and particulate emissions are comparable with other studies. The measured emission factors were compared, for individual ships, to modeled ones using the Ship Traffic Emission Assessment Model (STEAM) of the Finnish Meteorological Institute. A reasonably good agreement for gaseous sulfur and nitrogen emissions can be seen for ships in international traffic, but significant deviations are found for inland vessels. Regarding particulate mass, the values of the modeled data are about 2-3 times higher than the measured results, which probably reflects the assumptions made in the modeled fuel sulfur content. The sulfur contents in the fuel retrieved from the measurements were lower than the previously used assumptions by the City of Saint Petersburg when carrying out atmospheric modeling, and using these measurements it was possible to better assess the impact of shipping on air quality.
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| 47. |
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| 48. |
- Bojan, Alicja J., 1980, et al.
(author)
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Critical factors in cut-out complication after gamma nail treatment of proximal femoral fractures.
- 2013
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In: BMC musculoskeletal disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 14:1
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Journal article (peer-reviewed)abstract
- BACKGROUND: The most common mechanical failure in the internal fixation of trochanteric hip fractures is the cut-out of the sliding screw through the femoral head. Several factors that influence this complication have been suggested, but there is no consensus as to the relative importance of each factor.The purpose of this study was to analyse the cut-out complication with respect to the following variables: patients' age, fracture type, fracture reduction, implant positioning and implant design. METHODS: 3066 consecutive patients were treated for trochanteric fractures with Gamma Nails between 1990 and 2002 at the Centre de Traumatologie et de l`Orthopedie (CTO), Strasbourg, France. Cut-out complications were identified by reviewing all available case notes and radiographs. Subsequently, the data were analysed by a single reviewer (AJB) with focus on the studied factors. RESULTS: Seventy-one cut-out complications were found (2.3%) of the 3066 trochanteric fractures. Cut-out failure associated with avascular head necrosis, pathologic fracture, deep infection or secondary to prior failure of other implants were excluded from the study (14 cases). The remaining 57 cases (1.85 %, median age 82.6, 79% females) were believed to have a biomechanical explanation for the cut-out failure. 41 patients had a basicervical or complex fracture type. A majority of cut-outs (43 hips, 75%) had a combination of the critical factors studied; non-anatomical reduction, non-optimal lag screw position and the characteristic fracture pattern found. CONCLUSIONS: The primary cut-out rate of 1.85% was low compared with the literature. A typical cut-out complication in our study is represented by an unstable fracture involving the trochanteric and cervical regions or the combination of both, non-anatomical reduction and non-optimal screw position. Surgeons confronted with proximal femoral fractures should carefully scrutinize preoperative radiographs to assess the primary fracture geometry and fracture classification. To reduce the risk of a cut-out it is important to achieve both anatomical reduction and optimal lag screw position as these are the only two factors that can be controlled by the surgeon.
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| 49. |
- Bojan, Alicja J., 1980, et al.
(author)
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Three-dimensional bone-implant movements in trochanteric hip fractures. Precision and accuracy of radiostereometric analysis in a phantom model.
- 2015
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In: Journal of orthopaedic research : official publication of the Orthopaedic Research Society. - : Wiley. - 1554-527X. ; 33:5, s. 705-11
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Journal article (peer-reviewed)abstract
- The accuracy and precision of RSA was evaluated in the experimental study of screw cut-out complication after fixation of trochanteric fractures. A plastic bone model of a two-part trochanteric fracture was constructed with a Gamma nail implant incorporating RSA markers. The femoral head fragment was attached to a separate rotational table and the femoral shaft was mounted on the micrometer. Three main motions were simulated: femoral head translation and rotation along the axis of the lag screw and fracture fragment translation along anatomical axes. Accuracy and precision were determined according to ISO 16087 and ASTM standard F2385-04. Translations along the lag screw axis were measured with a precision within±0.14mm and an accuracy within±0.03mm. With simultaneous translations along all three anatomical axes, lowest precision was measured for the x-axis (±0.29mm, 0.07mm respectively), but improved when analyzed as a vector (±0.08mm, 0.03mm). The precision and accuracy of femoral head rotations were within 0.5° and 0.18°, respectively. The resolution of the RSA method tested in this model was high, though it varied depending on the type of analyzed motion. This information is valuable when selecting and interpreting outcome parameters evaluating implant migration and osteosynthesis stability in future clinical RSA studies. This article is protected by copyright. All rights reserved.
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| 50. |
- Bojan, Alicja J., 1980, et al.
(author)
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Trochanteric fracture-implant motion during healing - A radiostereometry (RSA) study
- 2018
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In: Injury-International Journal of the Care of the Injured. - : Elsevier BV. - 0020-1383. ; 49:3, s. 673-679
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Journal article (peer-reviewed)abstract
- Cut-out complication remains a major unsolved problem in the treatment of trochanteric hip fractures. A better understanding of the three-dimensional fracture-implant motions is needed to enable further development of clinical strategies and countermeasures. The aim of this clinical study was to characterise and quantify three-dimensional motions between the implant and the bone and between the lag screw and nail of the Gamma nail. Radiostereometry Analysis (RSA) analysis was applied in 20 patients with trochanteric hip fractures treated with an intramedullary nail. The following three-dimensional motions were measured postoperatively, at 1 week, 3, 6 and 12 months: translations of the tip of the lag screw in the femoral head, motions of the lag screw in the nail, femoral head motions relative to the nail and nail movements in the femoral shaft. Cranial migration of the tip of the lag screw dominated over the other two translation components in the femoral head. In all fractures the lag screw slid laterally in the nail and the femoral head moved both laterally and inferiorly towards the nail. All femoral heads translated posteriorly relative to the nail, and rotations occurred in both directions with median values close to zero. The nail tended to retrovert in the femoral shaft. Adverse fracture-implant motions were detected in stable trochanteric hip fractures treated with intramedullary nails with high resolution. Therefore, RSA method can be used to evaluate new implant designs and clinical strategies, which aim to reduce cut-out complications. Future RSA studies should aim at more unstable fractures as these are more likely to fail with cut-out. (C) 2018 Elsevier Ltd. All rights reserved.
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