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- Arlien-Soborg, Mai C., et al.
(author)
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Acromegaly management in the Nordic countries: A Delphi consensus survey
- 2024
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In: CLINICAL ENDOCRINOLOGY. - : WILEY. - 0300-0664 .- 1365-2265.
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Journal article (peer-reviewed)abstract
- ObjectiveAcromegaly is associated with increased morbidity and mortality if left untreated. The therapeutic options include surgery, medical treatment, and radiotherapy. Several guidelines and recommendations on treatment algorithms and follow-up exist. However, not all recommendations are strictly evidence-based. To evaluate consensus on the treatment and follow-up of patients with acromegaly in the Nordic countries.MethodsA Delphi process was used to map the landscape of acromegaly management in Denmark, Sweden, Norway, Finland, and Iceland. An expert panel developed 37 statements on the treatment and follow-up of patients with acromegaly. Dedicated endocrinologists (n = 47) from the Nordic countries were invited to rate their extent of agreement with the statements, using a Likert-type scale (1-7). Consensus was defined as >= 80% of panelists rating their agreement as >= 5 or <= 3 on the Likert-type scale.ResultsConsensus was reached in 41% (15/37) of the statements. Panelists agreed that pituitary surgery remains first line treatment. There was general agreement to recommend first-generation somatostatin analog (SSA) treatment after failed surgery and to consider repeat surgery. In addition, there was agreement to recommend combination therapy with first-generation SSA and pegvisomant as second- or third-line treatment. In more than 50% of the statements, consensus was not achieved. Considerable disagreement existed regarding pegvisomant monotherapy, and treatment with pasireotide and dopamine agonists.ConclusionThis consensus exploration study on the management of patients with acromegaly in the Nordic countries revealed a relatively large degree of disagreement among experts, which mirrors the complexity of the disease and the shortage of evidence-based data.
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- Lingegård, Sofia, et al.
(author)
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Sustainable public procurement in large infrastructure projects—policy implementation for carbon emission reductions
- 2021
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In: Sustainability. - : MDPI AG. - 2071-1050. ; 13:20
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Journal article (peer-reviewed)abstract
- The infrastructure construction sector is a significant source of carbon emissions, and more stringent procurement requirements are central to meeting reduction targets in this demand-led and project-based industry. This paper aims to analyze the implementation of international policies for reducing carbon emissions in infrastructure construction, focusing on the interaction between policy ambitions and procurement practices. Based on case studies of large projects and their contexts in five countries worldwide: Australia, the Netherlands, Sweden, the UK, and the US, a cross-country comparison is performed of how policies and practices for carbon reduction develop across multiple implementation levels. Three levels are included in the analysis: policy, industry, and project level. We identify the projects as either drivers of policy goals, frontrunners in industry-level development processes, or translators of national policy. These roles, and the associated pathways for carbon emission reduction, are context-specific and depend on the policy ambitions at the national or regional level, the maturity of the supplier market, and, often, on the strategies of individual champions at the project level. Long-term learning processes, both within and between the various levels, are essential for advancing carbon reduction.
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- Alström, Per, Professor, et al.
(author)
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Morphology, vocalizations, and mitochondrial DNA suggest that the Graceful Prinia is two species
- 2021
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In: Ornithology. - : Oxford University Press (OUP). - 0004-8038 .- 2732-4613 .- 1938-4254. ; 138:2
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Journal article (peer-reviewed)abstract
- Prinias (Cisticolidae:Prinia) are resident warblers of open areas across Africa and Asia and include many polytypic species whose species limits have not been seriously reevaluated recently. Based on an integrative taxonomic analysis of morphology, song, and mitochondrial DNA (mtDNA), we suggest that 2 species should be recognized in the Graceful Prinia (Prinia gracilis) complex. In addition, our morphological analyses show the existence of a well-marked undescribed form in southeastern Somalia, which we name herein as a new subspecies. Prinia gracilisis a small, drab, long-tailed species with streaking above and plain pale underparts that has been suggested to fall into 2 groups: the southwestern nominate group (from Egypt to Oman) and the northeastern lepida group (from Turkey through India). However, the characters presented to justify this grouping are variable and show a mosaic pattern, and whether genetic and vocal differences exist is unknown. We found consistent between-group song differences, with the nominate group giving consistently longer inter-phrase intervals, whereas the members of the lepida group sing an essentially continuous reel. An mtDNA tree suggests a deep split between the nominate and lepida groups, with a coalescence time between these clades of similar to 2.2 million years ago. Vocal and mtDNA analyses provided evidence that the northeastern Arabian Peninsula taxon carpenteri belongs to the lepida group. We found that, of all the morphological characters proposed, only proportions and tail barring and spotting relatively consistently distinguish the 2 groups. However, these characters strongly suggest that the eastern Arabian Peninsula is populated by taxa of both the gracilis and lepida groups, in different areas, but we lack genetic and bioacoustic data to corroborate this. Although further study is needed in potential contact zones, we suggest that 2 species should be recognized in the P. gracilis complex, and we propose the retention of the English name Graceful Prinia for P. gracilis sensu stricto, while we suggest that P. lepida be known as Delicate Prinia.
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| 6. |
- Andersson, Johanna, et al.
(author)
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Study on reduced process temperature for energy optimisation in mesophilic digestion : A lab to full-scale study
- 2020
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In: Applied Energy. - : Elsevier BV. - 0306-2619 .- 1872-9118. ; 271
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Journal article (peer-reviewed)abstract
- This unique study combined the lab and full scales to investigate how the anaerobic digestion process of sewage sludge was affected by a temperature change within the lower mesophilic temperature range (32–37.5 °C). Both scientific methane potential experiments and dewaterability studies were made to be used in changes of the operational conditions for a full-scale wastewater treatment plant. The aim of this study was to reduce anaerobic digestions heat consumption by altering the operational mesophilic temperature in first lab-scale experiments and then in continuation to full-scale conditions. The results of the study suggest that it is possible to save approximately 13% in heat energy demand each year by reducing the temperature for anaerobic digestion by 2.5 °C. At the lab scale, the effect of temperature on biogas production was tested in a batch experiment by measuring the biochemical methane production. At 32 °C, the production of biogas decreased by 11% compared to that at 37.5 °C. No significant difference was observed between 37.5 °C and 34.5 °C. The effect of temperature on sludge dewaterability was tested by measuring the capillary suction time, and no difference was detected between various temperatures. To confirm these results, the temperature in two full-scale digesters was gradually adjusted from 37.5 °C to 35 °C. No change was observed in biogas production, process stability, or dewaterability. The amount of heat energy that can be saved for the full-scale digesters was calculated using a heat balance. This study shows that it is possible to reduce the heat demand for AD in real applications without compromising the biogas production and process stability.
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- Flygt, Hjalmar, et al.
(author)
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Long-term tolerability and efficacy after initial PegIFN-alpha addition to dasatinib in CML-CP : Five-year follow-up of the NordCML007 study
- 2021
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In: European Journal of Haematology. - : Wiley-Blackwell. - 0902-4441 .- 1600-0609. ; 107:6, s. 617-623
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Journal article (peer-reviewed)abstract
- Objectives Treatment-free remission (TFR) has emerged as a treatment goal in chronic myeloid leukemia in the chronic phase (CML-CP). Attempts to increase proportion of patients achieving TFR include combination of tyrosine kinase inhibitors (TKI) and other drugs. Interferon-alpha in addition to TKI has shown promising efficacy but with dose-dependent toxicity and discontinuations. NordCML007 was initiated to study the efficacy and safety of low dose pegylated IFN-alpha (PegIFN-alpha) in combination with dasatinib (DAS) in CML-CP. Methods Forty patients with newly diagnosed CML-CP were given DAS upfront. After month 3 (M3) 15 mu g/wk of PegIFN-alpha was added and increased to 25 mu g/wk from M7 until M15. DAS treatment was continued and adverse events and BCR-ABL1 qRT-PCR values were reported yearly after M24. Results from M1 to M18 have previously been published, and here we present long-term data. Results After 5 years of follow-up, there were no suspected unexpected serious adverse reactions, no increase in serosal effusions, no disease progressions and no CML-related deaths. Rates of MR3.0 (MMR), MR4.0 and MR4.5 were 84.6%, 64.1% and 51.3% respectively at M60, and 95% of patients reached MMR at some point during the study. Conclusion Initial addition of PegIFN-alpha to DAS shows good long-term efficacy without increased toxicity.
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| 10. |
- Flygt, Hjalmar, et al.
(author)
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Long-term tolerability and efficacy after initial PegIFN-α addition to dasatinib in CML-CP : Five-year follow-up of the NordCML007 study
- 2021
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In: European Journal of Haematology. - : John Wiley & Sons. - 0902-4441 .- 1600-0609. ; 107:6, s. 617-623
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Journal article (peer-reviewed)abstract
- ObjectivesTreatment-free remission (TFR) has emerged as a treatment goal in chronic myeloid leukemia in the chronic phase (CML-CP). Attempts to increase proportion of patients achieving TFR include combination of tyrosine kinase inhibitors (TKI) and other drugs. Interferon-α in addition to TKI has shown promising efficacy but with dose-dependent toxicity and discontinuations. NordCML007 was initiated to study the efficacy and safety of low dose pegylated IFN-α (PegIFN-α) in combination with dasatinib (DAS) in CML-CP.MethodsForty patients with newly diagnosed CML-CP were given DAS upfront. After month 3 (M3) 15 μg/wk of PegIFN-α was added and increased to 25 μg/wk from M7 until M15. DAS treatment was continued and adverse events and BCR-ABL1 qRT-PCR values were reported yearly after M24. Results from M1 to M18 have previously been published, and here we present long-term data.ResultsAfter 5 years of follow-up, there were no suspected unexpected serious adverse reactions, no increase in serosal effusions, no disease progressions and no CML-related deaths. Rates of MR3.0 (MMR), MR4.0 and MR4.5 were 84.6%, 64.1% and 51.3% respectively at M60, and 95% of patients reached MMR at some point during the study.ConclusionInitial addition of PegIFN-α to DAS shows good long-term efficacy without increased toxicity.
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