| 1. |
- Ahn, J. M., et al.
(author)
-
Microcirculatory Resistance Predicts Allograft Rejection and Cardiac Events After Heart Transplantation
- 2021
-
In: Journal of the American College of Cardiology. - : Elsevier BV. - 0735-1097. ; 78:24, s. 2425-2435
-
Journal article (peer-reviewed)abstract
- BACKGROUND: Single-center data suggest that the index of microcirculatory resistance (IMR) measured early after heart transplantation predicts subsequent acute rejection. OBJECTIVES: The goal of this study was to validate whether IMR measured early after transplantation can predict subsequent acute rejection and long-term outcome in a large multicenter cohort. METHODS: From 5 international cohorts, 237 patients who underwent IMR measurement early after transplantation were enrolled. The primary outcome was acute allograft rejection (AAR) within 1 year after transplantation. A key secondary outcome was major adverse cardiac events (MACE) (the composite of death, re-transplantation, myocardial infarction, stroke, graft dysfunction, and readmission) at 10 years. RESULTS: IMR was measured at a median of 7 weeks (interquartile range: 3-10 weeks) post-transplantation. At 1 year, the incidence of AAR was 14.4%. IMR was associated proportionally with the risk of AAR (per increase of 1-U IMR; adjusted hazard ratio [aHR]: 1.04; 95% confidence interval [CI]: 1.02-1.06; p < 0.001). The incidence of AAR in patients with an IMR >= 18 was 23.8%, whereas the incidence of AAR in those with an IMR <18 was 6.3% (aHR: 3.93; 95% CI: 1.77-8.73; P = 0.001). At 10 years, MACE occurred in 86 (36.3%) patients. IMR was significantly associated with the risk of MACE (per increase of 1-U IMR; aHR: 1.02; 95% CI: 1.01-1.04; P = 0.005). CONCLUSIONS: IMR measured early after heart transplantation is associated with subsequent AAR at 1 year and clinical events at 10 years. Early IMR measurement after transplantation identifies patients at higher risk and may guide personalized posttransplantation management. Published by Elsevier on behalf of the American College of Cardiology Foundation.
|
|
| 2. |
|
|
| 3. |
|
|
| 4. |
|
|
| 5. |
|
|
| 6. |
|
|
| 7. |
|
|
| 8. |
|
|
| 9. |
- Heltveit-Olsen, S. R., et al.
(author)
-
Experiences and management strategies of Norwegian GPs during the COVID-19 pandemic: a longitudinal interview study
- 2023
-
In: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 41:1, s. 2-12
-
Journal article (peer-reviewed)abstract
- Objective When the COVID-19 pandemic reached Norway, primary health care had to reorganize to ensure safe patient treatment and maintain infection control. General practitioners (GPs) are key health care providers in the municipalities. Our aim was to explore the experiences and management strategies of Norwegian GPs during the COVID-19 pandemic - over time, and in the context of a sudden organizational change. Design Longitudinal qualitative interview study with two interview rounds. The first round of interviews was conducted from September-December 2020, the second round from January-April 2021. In the first interview round, we performed eight semi-structured interviews with GPs from eight municipalities in Norway. In the second round, five of the GPs were re-interviewed. Consecutive interviews were performed 2-4 months apart. To analyze the data, we used thematic analysis. Results The COVID-19 pandemic required GPs to balance several concerns, such as continuity of care and their own professional efforts. Several GPs experienced challenges in the collaboration with the municipality and in relation to defining their own professional position. Guided by The Norwegian Association of General practitioners, The Norwegian College of General Practice and collegial support, they found viable solutions and ended up with a feeling of having adapted to a new normal. Conclusions Although our study demonstrates that the GPs adapted to the changing conditions, the current municipal health care models are not ideal. There is a need for clarification of responsibilities between GPs and the municipality to facilitate a more coordinated future pandemic response.
|
|
| 10. |
- Hohenschurz-Schmidt, David, et al.
(author)
-
Recommendations for the development, implementation, and reporting of control interventions in efficacy and mechanistic trials of physical, psychological, and self-management therapies : the CoPPS Statement
- 2023
-
In: BMJ. British Medical Journal. - : BMJ Publishing Group Ltd. - 0959-8146 .- 0959-535X. ; 381, s. e072108-
-
Journal article (peer-reviewed)abstract
- Control interventions (often called "sham," "placebo," or "attention controls") are essential for studying the efficacy or mechanism of physical, psychological, and self-management interventions in clinical trials. This article presents core recommendations for designing, conducting, and reporting control interventions to establish a quality standard in non-pharmacological intervention research. A framework of additional considerations supports researchers' decision making in this context. We also provide a reporting checklist for control interventions to enhance research transparency, usefulness, and rigour.
|
|
| 11. |
- Lunde Hermansson, Anna, 1987, et al.
(author)
-
Cumulative environmental risk assessment of metals and polycyclic aromatic hydrocarbons from ship activities in ports
- 2023
-
In: Marine Pollution Bulletin. - : Elsevier BV. - 0025-326X .- 1879-3363. ; 189
-
Journal article (peer-reviewed)abstract
- Marine environmental risk assessments rarely consider the cumulative risk from multiple contaminants and sources. Ships give rise to a range of contaminants, originating from different onboard sources, resulting in contaminant loads to the marine environment. Here, the Ship Traffic Emission Assessment Model (STEAM), in combination with the hydrodynamic and chemical fate model MAMPEC, was used to calculate loads and predicted environmental concentrations (PECs) of metals and polycyclic aromatic hydrocarbons, in four ports. PECs were compared to the predicted no effect concentrations (PNEC) to assess environmental risk from the different onboard sources, both separately and cumulatively. The results show that three out of four ports were subject to unacceptable risk. This study highlights the importance of accounting for multiple contaminant sources when assessing the marine environmental risks of shipping and challenges the suitability of the proposed new international guidelines on how to assess risk of scrubber water discharge.
|
|
| 12. |
- Lunde Hermansson, Anna, 1987, et al.
(author)
-
Strong economic incentives of ship scrubbers promoting pollution
- 2024
-
In: Nature Sustainability. - Göteborg : IVL Svenska Miljöinstitutet. - 2398-9629. ; 7:6, s. 812-822
-
Journal article (peer-reviewed)abstract
- In response to stricter regulations on ship air emissions, many shipowners have installed exhaust gas cleaning systems, known as scrubbers, allowing for use of cheap residual heavy fuel oil. Scrubbers produce large volumes of acidic and polluted water that is discharged to the sea. Due to environmental concerns, the use of scrubbers is being discussed within the International Maritime Organization. Real-world simulations of global scrubber-vessel activity, applying actual fuel costs and expenses related to scrubber operations, show that 51% of the global scrubber-fitted fleet reached economic break even by the end of 2022, with a surplus of €4.7 billion in 2019 euros. Within five years after installation, more than 95% of the ships with the most common scrubber systems reach break even. However, the marine ecotoxicity damage cost, from scrubber water discharge in the Baltic Sea Area 2014–2022, amounts to >€680 million in 2019 euros, showing that private economic interests come at the expense of marine environmental damage.
|
|
| 13. |
|
|
| 14. |
- Smits, P. C., et al.
(author)
-
Fractional flow reserve-guided multivessel angioplasty in myocardial infarction: three-year follow-up with cost benefit analysis of the Compare-Acute trial
- 2020
-
In: Eurointervention. - : Europa Digital & Publishing. - 1774-024X. ; 16:3, s. 225-232
-
Journal article (peer-reviewed)abstract
- Aims: The Compare-Acute trial showed superiority of fractional flow reserve (FFR)-guided acute complete revascularisation compared to culprit-only treatment in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease (MVD) at one year. The aim of this study was to investigate the outcome at three years, together with cost analysis of this strategy. Methods and results: After primary percutaneous coronary intervention (PCI), 885 patients with STEMI and MVD were randomised (1:2 ratio) to FFR-guided complete revascularisation (295 patients) or infarct-related artery (IRA)-only treatment (590 patients). After 36 months, the primary endpoint (composite of death, myocardial infarction, revascularisation, stroke) occurred significantly less frequently in the FFR-guided complete revascularisation group: 46/295 patients (15.6%) versus 178/590 patients (30.2%) (HR 0.46, 95% CI: 0.33-0.64; p<0.001). This benefit was driven mainly by the reduction of revascularisations in the follow-up (12.5% vs 25.2%; HR 0.45, 95% CI: 0.31-0.64; p<0.001). Cost analysis shows benefit of the FFR-guided complete revascularisation strategy, which can reduce the cost per patient by up to 21% at one year (8,150(sic) vs 10,319(sic)) and by 22% at three years (8,653(sic) vs 11,100(sic)). Conclusions: In patients with STEMI and MVD, FFR-guided complete revascularisation is more beneficial in terms of outcome and healthcare costs compared to IRA-only revascularisation at 36 months.
|
|
| 15. |
- Ytreberg, Erik, 1980, et al.
(author)
-
Metal and PAH loads from ships and boats, relative other sources, in the Baltic Sea
- 2022
-
In: Marine Pollution Bulletin. - : Elsevier BV. - 0025-326X .- 1879-3363. ; 182
-
Journal article (peer-reviewed)abstract
- The Baltic Sea is a sensitive environment that is affected by chemical pollution derived from multiple natural and anthropogenic sources. The overall aim of this study was to estimate the load of metals and polycyclic aromatic hydrocarbons (PAHs) from shipping and leisure boating, relative other sources, to the Baltic Sea and to identify possible measures that could lead to major reductions in the loads of hazardous substances from maritime shipping and leisure boating. The use of copper-based antifouling paints, and operation of scrubbers in open loop mode, were the two most dominant identified sources of hazardous substances to the Baltic Sea. Open loop scrubbers accounted for 8.5 % of the total input of anthracene to the sea. More than a third of the total load of copper can be reduced if copper-free antifouling paints or other biocide-free antifouling strategies are used on ships and leisure boats.
|
|
