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Arkelius K, Wendt TS, Andersson H, Arnou A, Gottschalk M, Gonzales RJ, Ansar S. LOX-1 and MMP-9 Inhibition Attenuates the Detrimental Effects of Delayed rt-PA Therapy and Improves Outcomes After Acute Ischemic Stroke. Circ Res 2024; 134:954-969. [PMID: 38501247 DOI: 10.1161/circresaha.123.323371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 03/06/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Acute ischemic stroke triggers endothelial activation that disrupts vascular integrity and increases hemorrhagic transformation leading to worsened stroke outcomes. rt-PA (recombinant tissue-type plasminogen activator) is an effective treatment; however, its use is limited due to a restricted time window and hemorrhagic transformation risk, which in part may involve activation of MMPs (matrix metalloproteinases) mediated through LOX-1 (lectin-like oxLDL [oxidized low-density lipoprotein] receptor 1). This study's overall aim was to evaluate the therapeutic potential of novel MMP-9 (matrix metalloproteinase 9) ± LOX-1 inhibitors in combination with rt-PA to improve stroke outcomes. METHODS A rat thromboembolic stroke model was utilized to investigate the impact of rt-PA delivered 4 hours poststroke onset as well as selective MMP-9 (JNJ0966) ±LOX-1 (BI-0115) inhibitors given before rt-PA administration. Infarct size, perfusion, and hemorrhagic transformation were evaluated by 9.4-T magnetic resonance imaging, vascular and parenchymal MMP-9 activity via zymography, and neurological function was assessed using sensorimotor function testing. Human brain microvascular endothelial cells were exposed to hypoxia plus glucose deprivation/reperfusion (hypoxia plus glucose deprivation 3 hours/R 24 hours) and treated with ±tPA and ±MMP-9 ±LOX-1 inhibitors. Barrier function was assessed via transendothelial electrical resistance, MMP-9 activity was determined with zymography, and LOX-1 and barrier gene expression/levels were measured using qRT-PCR (quantitative reverse transcription PCR) and Western blot. RESULTS Stroke and subsequent rt-PA treatment increased edema, hemorrhage, MMP-9 activity, LOX-1 expression, and worsened neurological outcomes. LOX-1 inhibition improved neurological function, reduced edema, and improved endothelial barrier integrity. Elevated MMP-9 activity correlated with increased edema, infarct volume, and decreased neurological function. MMP-9 inhibition reduced MMP-9 activity and LOX-1 expression. In human brain microvascular endothelial cells, LOX-1/MMP-9 inhibition differentially attenuated MMP-9 levels, inflammation, and activation following hypoxia plus glucose deprivation/R. CONCLUSIONS Our findings indicate that LOX-1 inhibition and ± MMP-9 inhibition attenuate negative aspects of ischemic stroke with rt-PA therapy, thus resulting in improved neurological function. While no synergistic effect was observed with simultaneous LOX-1 and MMP-9 inhibition, a distinct interaction is evident.
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Affiliation(s)
- Kajsa Arkelius
- Applied Neurovascular Research, Neurosurgery, Department of Clinical Sciences, Lund University, Sweden (K.A., H.A., A.A., S.A.)
| | - Trevor S Wendt
- Department of Basic Medical Sciences, University of Arizona College of Medicine, Phoenix, AZ (T.S.W., R.J.G.)
| | - Henrik Andersson
- Applied Neurovascular Research, Neurosurgery, Department of Clinical Sciences, Lund University, Sweden (K.A., H.A., A.A., S.A.)
| | - Anaële Arnou
- Applied Neurovascular Research, Neurosurgery, Department of Clinical Sciences, Lund University, Sweden (K.A., H.A., A.A., S.A.)
| | | | - Rayna J Gonzales
- Department of Basic Medical Sciences, University of Arizona College of Medicine, Phoenix, AZ (T.S.W., R.J.G.)
| | - Saema Ansar
- Applied Neurovascular Research, Neurosurgery, Department of Clinical Sciences, Lund University, Sweden (K.A., H.A., A.A., S.A.)
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Andersson H, Svensson E, Magnusson A, Holmqvist R, Zetterqvist M. Young adults looking back at their experiences of treatment and care for nonsuicidal self-injury during adolescence: a qualitative study. Child Adolesc Psychiatry Ment Health 2024; 18:16. [PMID: 38245758 PMCID: PMC10800066 DOI: 10.1186/s13034-024-00706-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 01/05/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Nonsuicidal self-injury (NSSI) is associated with stigma, and negative attitudes among healthcare professionals toward NSSI have been reported. A person-centered approach that focuses on how individuals with lived experience of NSSI perceive the treatment and care they receive is invaluable in reducing barriers to help-seeking and improving treatment and mental healthcare services. The aim of the current qualitative study was to explore the perceptions of young adults when they look back upon their experiences of psychiatric treatment for NSSI during adolescence. METHODS Twenty-six individuals with lived experience of NSSI who were in contact with child and adolescent psychiatry during adolescence were interviewed. The interviews were analyzed using thematic analysis. RESULTS Three main themes were developed: Changed perceptions in retrospect, The importance of a collaborative conceptualization and Lasting impression of the relationship. Participants' perception of themselves as well as the treatment changed over time. The importance of a joint understanding of NSSI and an agreed-upon treatment focus was emphasized. The relationship to the mental health professionals, and experiences of how NSSI was communicated, were salient several years later. CONCLUSIONS Healthcare professionals need to communicate about NSSI in a respectful manner and include the perspective of the adolescent with lived experience of NSSI in a joint conceptualization of NSSI and treatment focus.
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Affiliation(s)
- H Andersson
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping university, Linköping, Sweden
| | - E Svensson
- Department of Behavioural Sciences and Learning, Linköping university, Linköping, Sweden
| | - A Magnusson
- Department of Behavioural Sciences and Learning, Linköping university, Linköping, Sweden
| | - R Holmqvist
- Department of Behavioural Sciences and Learning, Linköping university, Linköping, Sweden
| | - M Zetterqvist
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping university, Linköping, Sweden.
- Department of Child and Adolescent Psychiatry, Region Östergötland, Linköping, Sweden.
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Blixt PJ, Nguyen M, Cholley B, Hammarskjöld F, Toiron A, Bouhemad B, Lee S, De Geer L, Andersson H, Aneq MÅ, Engvall J, Chew MS. Association between left ventricular systolic function parameters and myocardial injury, organ failure and mortality in patients with septic shock. Ann Intensive Care 2024; 14:12. [PMID: 38236316 PMCID: PMC10796855 DOI: 10.1186/s13613-023-01235-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 12/21/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Left ventricular ejection fraction (LVEF) is inconsistently associated with poor outcomes in patients with sepsis. Newer parameters such as LV longitudinal strain (LVLS), mitral annular plane systolic excursion (MAPSE) and LV longitudinal wall fractional shortening (LV-LWFS) may be more sensitive indicators of LV dysfunction, but are sparsely investigated. Our objective was to evaluate the association between five traditional and novel echocardiographic parameters of LV systolic function (LVEF, peak tissue Doppler velocity at the mitral valve (s´), LVLS, MAPSE and LV-LWFS) and outcomes in patients admitted to the Intensive Care Unit (ICU) with septic shock. METHODS A total of 152 patients admitted to the ICU with septic shock from two data repositories were included. Transthoracic echocardiograms were performed within 24 h of ICU admission. The primary outcome was myocardial injury, defined as high-sensitivity troponin T ≥ 45 ng/L on ICU admission. Secondary outcomes were organ support-free days (OSFD) and 30-day mortality. We also tested for the prognostic value of the systolic function parameters using multivariable analysis. RESULTS LVLS, MAPSE and LV-LWFS, but not LVEF and s´, differed between patients with and without myocardial injury. After adjustment for age, pre-existing cardiac disease, Simplified Acute Physiology (SAPS3) score, Sequential Organ Failure Assessment (SOFA) score, plasma creatinine and presence of right ventricular dysfunction, only MAPSE and LV-LWFS were independently associated with myocardial injury. None of the systolic function parameters were associated with OSFD or 30-day mortality. CONCLUSIONS MAPSE and LV-LWFS are independently associated with myocardial injury and outperform LVEF, s´ and LVLS. Whether these parameters are associated with clinical outcomes such as the need for organ support and short-term mortality is still unclear. Trial registration NCT01747187 and NCT04695119.
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Affiliation(s)
- Patrik Johansson Blixt
- Department of Anaesthesiology and Intensive Care, Biomedical and Clinical Sciences, Linköping University, S-58185, Linköping, Sweden
| | - Maxime Nguyen
- Department of Anaesthesiology and Intensive Care, Dijon University Hospital, Dijon, France
| | - Bernard Cholley
- Department of Anaesthesiology and Intensive Care Medicine, Hôpital Européen Georges Pompidou, Paris, France
- UMR-S1140 "Innovations Thérapeutiques en Hémostase", Université Paris Cité, INSERM, Paris, France
| | - Fredrik Hammarskjöld
- Department of Anaesthesia and Intensive Care, Ryhov County Hospital, Jönköping, Sweden
| | - Alois Toiron
- Department of Anaesthesiology and Intensive Care Medicine, Hôpital Européen Georges Pompidou, Paris, France
| | - Belaid Bouhemad
- Department of Anaesthesiology and Intensive Care, Dijon University Hospital, Dijon, France
| | - Shaun Lee
- Intensive Care Unit, St Georges Hospital, London, UK
| | - Lina De Geer
- Department of Anaesthesiology and Intensive Care, Biomedical and Clinical Sciences, Linköping University, S-58185, Linköping, Sweden
| | - Henrik Andersson
- Department of Anaesthesiology and Intensive Care, Biomedical and Clinical Sciences, Linköping University, S-58185, Linköping, Sweden
| | - Meriam Åström Aneq
- Department of Clinical Physiology, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Jan Engvall
- Department of Clinical Physiology, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Michelle S Chew
- Department of Anaesthesiology and Intensive Care, Biomedical and Clinical Sciences, Linköping University, S-58185, Linköping, Sweden.
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Jakobsson G, Andersson H, Chew M, Schiopu A. Reply to "Potential confounders in linking elevated S100A8/A9 to left ventricular dysfunction in septic shock patients". Crit Care 2024; 28:9. [PMID: 38167162 PMCID: PMC10762927 DOI: 10.1186/s13054-023-04789-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 12/22/2023] [Indexed: 01/05/2024] Open
Affiliation(s)
| | - Henrik Andersson
- Department of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Michelle Chew
- Department of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Alexandru Schiopu
- Department of Translational Medicine, Lund University, Lund, Sweden.
- Cardiac Inflammation Research Group, Clinical Research Center, 91:12, Jan Waldenströms Gata 35, 21 428, Malmö, Sweden.
- Department of Internal Medicine, Skane University Hospital, Lund, Sweden.
- Nicolae Simionescu Institute of Cellular Biology and Pathology, Bucharest, Romania.
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Olander A, Andersson H, Sundler AJ, Hagiwara MA, Bremer A. The onset of sepsis as experienced by patients and family members: A qualitative interview study. J Clin Nurs 2023; 32:7402-7411. [PMID: 37277982 DOI: 10.1111/jocn.16785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 05/11/2023] [Accepted: 05/25/2023] [Indexed: 06/07/2023]
Abstract
AIMS AND OBJECTIVES To explore the onset of sepsis based on patients' and family members' experiences. BACKGROUND Knowledge about the onset of sepsis is limited among patients and their families, which makes early recognition of sepsis difficult. Previous studies argue that their stories are important to recognising sepsis and reduced suffering and mortality. DESIGN A descriptive design with a qualitative approach was used. METHODS In total, 29 patients and family members participated in 24 interviews with open-ended questions, including five dyadic and 19 individual interviews. The interviews were conducted during 2021, and participants were recruited from a sepsis group on social media. A thematic analysis based on descriptive phenomenology was performed. The study followed the COREQ checklist. FINDINGS Two themes emerged from the experiences: (1) When health changes into something unknown, including the two subthemes; Bodily symptoms and signs being vague but still tangible and Feelings of uncertainty, and (2) Turning points when warnings signs are deemed as serious, including the two subthemes Passing borders when feeling out of control and Difficulties understanding the seriousness. CONCLUSIONS Patients' and family members' stories of the onset of sepsis indicate that symptoms and signs appeared insidiously and then noticeably worsen. The symptoms and signs seemed not be attributed to sepsis; instead, there was uncertainty about what the symptoms and signs meant. It was mainly family members who possibly understood the seriousness of the disease. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE Patients' experiences of their symptoms and signs and family members' unique knowledge of the patient, indicate that healthcare professionals should listen and try to understand what the patient and family members are telling and take their concerns seriously. How the condition appears, and family members' concerns are important pieces of the assessment to recognise patients with sepsis. PATIENT OR PUBLIC CONTRIBUTION Patients and family members contributed to the data collected.
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Affiliation(s)
- Agnes Olander
- Centre for Prehospital Research, University of Borås, PreHospen, Borås, Sweden
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
- Faculty of Health Science, Kristianstad University, Kristianstad, Sweden
| | - Henrik Andersson
- Centre for Prehospital Research, University of Borås, PreHospen, Borås, Sweden
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
- Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
| | - Annelie J Sundler
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Magnus Andersson Hagiwara
- Centre for Prehospital Research, University of Borås, PreHospen, Borås, Sweden
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Anders Bremer
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
- Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
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Jakobsson G, Papareddy P, Andersson H, Mulholland M, Bhongir R, Ljungcrantz I, Engelbertsen D, Björkbacka H, Nilsson J, Manea A, Herwald H, Ruiz-Meana M, Rodríguez-Sinovas A, Chew M, Schiopu A. Therapeutic S100A8/A9 blockade inhibits myocardial and systemic inflammation and mitigates sepsis-induced myocardial dysfunction. Crit Care 2023; 27:374. [PMID: 37773186 PMCID: PMC10540409 DOI: 10.1186/s13054-023-04652-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/19/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND AND AIMS The triggering factors of sepsis-induced myocardial dysfunction (SIMD) are poorly understood and are not addressed by current treatments. S100A8/A9 is a pro-inflammatory alarmin abundantly secreted by activated neutrophils during infection and inflammation. We investigated the efficacy of S100A8/A9 blockade as a potential new treatment in SIMD. METHODS The relationship between plasma S100A8/A9 and cardiac dysfunction was assessed in a cohort of 62 patients with severe sepsis admitted to the intensive care unit of Linköping University Hospital, Sweden. We used S100A8/A9 blockade with the small-molecule inhibitor ABR-238901 and S100A9-/- mice for therapeutic and mechanistic studies on endotoxemia-induced cardiac dysfunction in mice. RESULTS In sepsis patients, elevated plasma S100A8/A9 was associated with left-ventricular (LV) systolic dysfunction and increased SOFA score. In wild-type mice, 5 mg/kg of bacterial lipopolysaccharide (LPS) induced rapid plasma S100A8/A9 increase and acute LV dysfunction. Two ABR-238901 doses (30 mg/kg) administered intraperitoneally with a 6 h interval, starting directly after LPS or at a later time-point when LV dysfunction is fully established, efficiently prevented and reversed the phenotype, respectively. In contrast, dexamethasone did not improve cardiac function compared to PBS-treated endotoxemic controls. S100A8/A9 inhibition potently reduced systemic levels of inflammatory mediators, prevented upregulation of inflammatory genes and restored mitochondrial function in the myocardium. The S100A9-/- mice were protected against LPS-induced LV dysfunction to an extent comparable with pharmacologic S100A8/A9 blockade. The ABR-238901 treatment did not induce an additional improvement of LV function in the S100A9-/- mice, confirming target specificity. CONCLUSION Elevated S100A8/A9 is associated with the development of LV dysfunction in severe sepsis patients and in a mouse model of endotoxemia. Pharmacological blockade of S100A8/A9 with ABR-238901 has potent anti-inflammatory effects, mitigates myocardial dysfunction and might represent a novel therapeutic strategy for patients with severe sepsis.
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Affiliation(s)
- Gabriel Jakobsson
- Department of Translational Medicine, Lund University, Lund, Sweden
- Cardiac Inflammation Research Group, Clinical Research Center, 91:12, Jan Waldenströms Gata 35, 21 428, Malmö, Sweden
| | | | - Henrik Andersson
- Department of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Megan Mulholland
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Ravi Bhongir
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Irena Ljungcrantz
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | | | - Harry Björkbacka
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Jan Nilsson
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Adrian Manea
- Nicolae Simionescu Institute of Cellular Biology and Pathology, Bucharest, Romania
| | - Heiko Herwald
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Marisol Ruiz-Meana
- Cardiovascular Diseases Research Group, Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain
| | - Antonio Rodríguez-Sinovas
- Cardiovascular Diseases Research Group, Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain
| | - Michelle Chew
- Department of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Alexandru Schiopu
- Department of Translational Medicine, Lund University, Lund, Sweden.
- Nicolae Simionescu Institute of Cellular Biology and Pathology, Bucharest, Romania.
- Department of Internal Medicine, Skane University Hospital, Lund, Sweden.
- Cardiac Inflammation Research Group, Clinical Research Center, 91:12, Jan Waldenströms Gata 35, 21 428, Malmö, Sweden.
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Fransson V, Mellander H, Ramgren B, Andersson H, Arena F, Ydström K, Ullberg T, Wassélius J. Image quality of spectral brain computed tomography angiography using halved dose of iodine contrast medium. Neuroradiology 2023; 65:1333-1342. [PMID: 37452885 PMCID: PMC10425475 DOI: 10.1007/s00234-023-03190-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 06/26/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE Reduction in iodinated contrast medium (CM) dose is highly motivated. Our aim was to evaluate if a 50% reduction of CM, while preserving image quality, is possible in brain CT angiography (CTA) using virtual monoenergetic images (VMI) on spectral CT. As a secondary aim, we evaluated if VMI can salvage examinations with suboptimal CM timing. METHODS Consecutive patients older than 18 years without intracranial stenosis/occlusion were included. Three imaging protocols were used: group 1, full CM dose; group 2, 50% CM dose suboptimal timing; and group 3, 50% CM dose optimized timing. Attenuation, noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were measured in the internal carotid artery, M2 segment of the middle cerebral artery, and white matter for conventional images (CI) and VMI (40-200 keV). Qualitative image quality for CI and VMI (50 and 60 keV) was rated by 4 experienced reviewers. RESULTS Qualitatively and quantitatively, VMI (40-60 keV) improved image quality within each group. Significantly higher attenuation and CNR was found for group 3 VMI 40-50 keV, with unchanged SNR, compared to group 1 CI. Group 3 VMI 50 keV also received significantly higher rating scores than group 1 CI. Group 2 VMI (40-50 keV) had significantly higher CNR compared to group 3 CI, but the subjective image quality was similar. CONCLUSION VMI of 50 keV with 50% CM dose increases qualitative and quantitative image quality over CI with full CM dose. Using VMI reduces non-diagnostic examinations and may salvage CTA examinations deemed non-diagnostic due to suboptimal timing.
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Affiliation(s)
- Veronica Fransson
- Radiation Physics, Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
- Medical Radiation Physics, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Helena Mellander
- Department of Medical Imaging and Physiology, Skåne University Hospital, 22185, Lund, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Birgitta Ramgren
- Department of Medical Imaging and Physiology, Skåne University Hospital, 22185, Lund, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Henrik Andersson
- Department of Medical Imaging and Physiology, Skåne University Hospital, 22185, Lund, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Francesco Arena
- Department of Medical Imaging and Physiology, Skåne University Hospital, 22185, Lund, Sweden
| | - Kristina Ydström
- Radiation Physics, Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
- Medical Radiation Physics, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Teresa Ullberg
- Neurology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Johan Wassélius
- Department of Medical Imaging and Physiology, Skåne University Hospital, 22185, Lund, Sweden.
- Department of Clinical Sciences, Lund University, Lund, Sweden.
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Olander A, Magnusson C, Sundler AJ, Bremer A, Andersson H, Herlitz J, Axelsson C, Andersson Hagiwara M. Prediction of the Risk of Sepsis by Using Analysis of Plasma Glucose and Serum Lactate in Ambulance Services: A Prospective Study. Prehosp Disaster Med 2023; 38:160-167. [PMID: 36752111 DOI: 10.1017/s1049023x23000110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
INTRODUCTION The early recognition of patients with sepsis is difficult and the initial assessment outside of hospitals is challenging for ambulance clinicians (ACs). Indicators that ACs can use to recognize sepsis early are beneficial for patient outcomes. Research suggests that elevated point-of-care (POC) plasma glucose and serum lactate levels may help to predict sepsis in the ambulance service (AS) setting. STUDY OBJECTIVE The aim of this study was to test the hypothesis that the elevation of POC plasma glucose and serum lactate levels may help to predict Sepsis-3 in the AS. METHODS A prospective observational study was performed in the AS setting of Gothenburg in Sweden from the beginning of March 2018 through the end of September 2019. The criteria for sampling POC plasma glucose and serum lactate levels in the AS setting were high or intermediate risk according to the Rapid Emergency Triage and Treatment System (RETTS), as red, orange, yellow, and green if the respiratory rate was >22 breaths/minutes. Sepsis-3 were identified retrospectively. A primary and secondary analyses were carried out. The primary analysis included patients cared for in the AS and emergency department (ED) and were hospitalized. In the secondary analysis, patients who were only cared for in the AS and ED without being hospitalized were also included. To evaluate the predictive ability of these biomarkers, the area under the curve (AUC), sensitivity, specificity, and predictive values were used. RESULTS A total of 1,057 patients were included in the primary analysis and 1,841 patients were included in the secondary analysis. In total, 253 patients met the Sepsis-3 criteria (in both analyses). The AUC for POC plasma glucose and serum lactate levels showed low accuracy in predicting Sepsis-3 in both the primary and secondary analyses. Among all hospitalized patients, regardless of Sepsis-3, more than two-thirds had elevated plasma glucose and nearly one-half had elevated serum lactate when measured in the AS. CONCLUSIONS As individual biomarkers, an elevated POC plasma glucose and serum lactate were not associated with an increased likelihood of Sepsis-3 when measured in the AS in this study. However, the high rate of elevation of these biomarkers before arrival in hospital highlights that their role in clinical decision making at this early stage needs further evaluation, including other endpoints than Sepsis-3.
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Affiliation(s)
- Agnes Olander
- University of Borås, PreHospen - Centre for Prehospital Research, Borås, Sweden
- University of Borås, Faculty of Caring Science, Work Life and Social Welfare, Borås, Sweden
| | - Carl Magnusson
- University of Borås, PreHospen - Centre for Prehospital Research, Borås, Sweden
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Annelie J Sundler
- University of Borås, Faculty of Caring Science, Work Life and Social Welfare, Borås, Sweden
| | - Anders Bremer
- University of Borås, Faculty of Caring Science, Work Life and Social Welfare, Borås, Sweden
- Linnaeus University, Faculty of Health and Life Sciences, Växjö, Sweden
| | - Henrik Andersson
- University of Borås, PreHospen - Centre for Prehospital Research, Borås, Sweden
- University of Borås, Faculty of Caring Science, Work Life and Social Welfare, Borås, Sweden
- Linnaeus University, Faculty of Health and Life Sciences, Växjö, Sweden
| | - Johan Herlitz
- University of Borås, PreHospen - Centre for Prehospital Research, Borås, Sweden
- University of Borås, Faculty of Caring Science, Work Life and Social Welfare, Borås, Sweden
| | - Christer Axelsson
- University of Borås, PreHospen - Centre for Prehospital Research, Borås, Sweden
- University of Borås, Faculty of Caring Science, Work Life and Social Welfare, Borås, Sweden
| | - Magnus Andersson Hagiwara
- University of Borås, PreHospen - Centre for Prehospital Research, Borås, Sweden
- University of Borås, Faculty of Caring Science, Work Life and Social Welfare, Borås, Sweden
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Gualandro DM, Puelacher C, Chew MS, Andersson H, Lurati Buse G, Glarner N, Mueller D, Cardozo FAM, Burri-Winkler K, Mork C, Wussler D, Shrestha S, Heidelberger I, Fält M, Hidvegi R, Bolliger D, Lampart A, Steiner LA, Schären S, Kindler C, Gürke L, Rikli D, Lardinois D, Osswald S, Buser A, Caramelli B, Mueller C. Acute heart failure after non-cardiac surgery: incidence, phenotypes, determinants and outcomes. Eur J Heart Fail 2023; 25:347-357. [PMID: 36644890 DOI: 10.1002/ejhf.2773] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 11/27/2022] [Accepted: 01/08/2023] [Indexed: 01/17/2023] Open
Abstract
AIMS Primary acute heart failure (AHF) is a common cause of hospitalization. AHF may also develop postoperatively (pAHF). The aim of this study was to assess the incidence, phenotypes, determinants and outcomes of pAHF following non-cardiac surgery. METHODS AND RESULTS A total of 9164 consecutive high-risk patients undergoing 11 262 non-cardiac inpatient surgeries were prospectively included. The incidence, phenotypes, determinants and outcome of pAHF, centrally adjudicated by independent cardiologists, were determined. The incidence of pAHF was 2.5% (95% confidence interval [CI] 2.2-2.8%); 51% of pAHF occurred in patients without known heart failure (de novo pAHF), and 49% in patients with chronic heart failure. Among patients with chronic heart failure, 10% developed pAHF, and among patients without a history of heart failure, 1.5% developed pAHF. Chronic heart failure, diabetes, urgent/emergent surgery, atrial fibrillation, cardiac troponin elevations above the 99th percentile, chronic obstructive pulmonary disease, anaemia, peripheral artery disease, coronary artery disease, and age, were independent predictors of pAHF in the logistic regression model. Patients with pAHF had significantly higher all-cause mortality (44% vs. 11%, p < 0.001) and AHF readmission (15% vs. 2%, p < 0.001) within 1 year than patients without pAHF. After Cox regression analysis, pAHF was an independent predictor of all-cause mortality (adjusted hazard ratio [aHR] 1.7 [95% CI 1.3-2.2]; p < 0.001) and AHF readmission (aHR 2.3 [95% CI 1.5-3.7]; p < 0.001). Findings were confirmed in an external validation cohort using a prospective multicentre cohort of 1250 patients (incidence of pAHF 2.4% [95% CI 1.6-3.3%]). CONCLUSIONS Postoperative AHF frequently developed following non-cardiac surgery, being de novo in half of cases, and associated with a very high mortality.
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Affiliation(s)
- Danielle M Gualandro
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
- Unidade de Medicina Interdisciplinar em Cardiologia, Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Christian Puelacher
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Michelle S Chew
- Departments of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Henrik Andersson
- Departments of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Giovanna Lurati Buse
- Department of Anesthesiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Noemi Glarner
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Daria Mueller
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Francisco A M Cardozo
- Unidade de Medicina Interdisciplinar em Cardiologia, Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Katrin Burri-Winkler
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Constantin Mork
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Desiree Wussler
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Internal Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Samyut Shrestha
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Isabelle Heidelberger
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Mikael Fält
- Departments of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Reka Hidvegi
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Anesthesiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Daniel Bolliger
- Department of Anesthesiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Andreas Lampart
- Department of Anesthesiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Luzius A Steiner
- Department of Anesthesiology, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Stefan Schären
- Department of Spinal Surgery, University Hospital Basel, Basel, Switzerland
| | - Christoph Kindler
- Department of Anesthesiology, Kantonsspital Aarau, Aarau, Switzerland
| | - Lorenz Gürke
- Department of Vascular Surgery, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Daniel Rikli
- Clinic for Orthopedics and Trauma Surgery, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Didier Lardinois
- Department of Thoracic Surgery, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Stefan Osswald
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Andreas Buser
- Department of Hematology and Blutspendezentrum, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Bruno Caramelli
- Unidade de Medicina Interdisciplinar em Cardiologia, Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Christian Mueller
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
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10
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Halvorsen EO, Andersson H. Optimizing environmental and economic aspects of collaborative transportation and logistics related to infrastructure projects - A case study from Norway. Waste Manag 2023; 156:159-167. [PMID: 36463671 DOI: 10.1016/j.wasman.2022.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 11/11/2022] [Accepted: 11/14/2022] [Indexed: 06/17/2023]
Abstract
The main challenge addressed in this paper is how to handle and recycle the large amount of C&D waste that is generated from infrastructure projects. The study is motivated by Bærum Ressursbank in Norway and their aim of finding logistical solutions to an expected surplus of 15 million m3 of waste from infrastructure projects in the next decade. We identify the key decisions as the design of the distribution network for both surplus waste materials and new construction materials and the investments in processing machinery at each recycling facility, and we call the problem representing this situation the Infrastructure Waste Management Problem (IWMP). The methodologies used are mathematical programming and operations research. We formulate the IWMP as a mixed integer linear program and identify two objectives; to minimize transportation costs and to minimize the environmental impact of the operations. The description of the problem, assumptions, and data are based on cases that represent the situation of Bærum Ressursbank. A special emphasis in the analysis is to quantify the gains from collaboration. Comparing individual planning of each project with an ideal situation of complete collaboration gives a cost reduction of more than 29% and a reduction in emissions of more than 14%. The study supports the conjecture by Bærum Ressursbank that large cost savings and considerable reductions in environmental impact are possible through collaboration.
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Affiliation(s)
- Eirik Oskari Halvorsen
- Department of Industrial Economics and Technology Management, Norwegian University of Science and Technology, Trondheim, Norway
| | - Henrik Andersson
- Department of Industrial Economics and Technology Management, Norwegian University of Science and Technology, Trondheim, Norway.
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11
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Alijagic A, Scherbak N, Kotlyar O, Karlsson P, Wang X, Odnevall I, Benada O, Amiryousefi A, Andersson L, Persson A, Felth J, Andersson H, Larsson M, Hedbrant A, Salihovic S, Hyötyläinen T, Repsilber D, Särndahl E, Engwall M. A Novel Nanosafety Approach Using Cell Painting, Metabolomics, and Lipidomics Captures the Cellular and Molecular Phenotypes Induced by the Unintentionally Formed Metal-Based (Nano)Particles. Cells 2023; 12:281. [PMID: 36672217 PMCID: PMC9856453 DOI: 10.3390/cells12020281] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/01/2023] [Accepted: 01/09/2023] [Indexed: 01/12/2023] Open
Abstract
Additive manufacturing (AM) or industrial 3D printing uses cutting-edge technologies and materials to produce a variety of complex products. However, the effects of the unintentionally emitted AM (nano)particles (AMPs) on human cells following inhalation, require further investigations. The physicochemical characterization of the AMPs, extracted from the filter of a Laser Powder Bed Fusion (L-PBF) 3D printer of iron-based materials, disclosed their complexity, in terms of size, shape, and chemistry. Cell Painting, a high-content screening (HCS) assay, was used to detect the subtle morphological changes elicited by the AMPs at the single cell resolution. The profiling of the cell morphological phenotypes, disclosed prominent concentration-dependent effects on the cytoskeleton, mitochondria, and the membranous structures of the cell. Furthermore, lipidomics confirmed that the AMPs induced the extensive membrane remodeling in the lung epithelial and macrophage co-culture cell model. To further elucidate the biological mechanisms of action, the targeted metabolomics unveiled several inflammation-related metabolites regulating the cell response to the AMP exposure. Overall, the AMP exposure led to the internalization, oxidative stress, cytoskeleton disruption, mitochondrial activation, membrane remodeling, and metabolic reprogramming of the lung epithelial cells and macrophages. We propose the approach of integrating Cell Painting with metabolomics and lipidomics, as an advanced nanosafety methodology, increasing the ability to capture the cellular and molecular phenotypes and the relevant biological mechanisms to the (nano)particle exposure.
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Affiliation(s)
- Andi Alijagic
- Man-Technology-Environment Research Center (MTM), Örebro University, SE-701 82 Örebro, Sweden
- Inflammatory Response and Infection Susceptibility Centre (iRiSC), Faculty of Medicine and Health, Örebro University, SE-701 82 Örebro, Sweden
- Faculty of Medicine and Health, School of Medical Sciences, Örebro University, SE-701 82 Örebro, Sweden
| | - Nikolai Scherbak
- Man-Technology-Environment Research Center (MTM), Örebro University, SE-701 82 Örebro, Sweden
| | - Oleksandr Kotlyar
- Man-Technology-Environment Research Center (MTM), Örebro University, SE-701 82 Örebro, Sweden
- Centre for Applied Autonomous Sensor Systems (AASS), Mobile Robotics and Olfaction Lab (MRO), Örebro University, SE-701 82 Örebro, Sweden
| | - Patrik Karlsson
- Department of Mechanical Engineering, Örebro University, SE-701 82 Örebro, Sweden
| | - Xuying Wang
- KTH Royal Institute of Technology, Department of Chemistry, Division of Surface and Corrosion Science, SE-100 44 Stockholm, Sweden
| | - Inger Odnevall
- KTH Royal Institute of Technology, Department of Chemistry, Division of Surface and Corrosion Science, SE-100 44 Stockholm, Sweden
- AIMES—Center for the Advancement of Integrated Medical and Engineering Sciences at Karolinska Institutet and KTH Royal Institute of Technology, SE-100 44 Stockholm, Sweden
- Department of Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Oldřich Benada
- Institute of Microbiology of the Czech Academy of Sciences, 140 00 Prague, Czech Republic
| | - Ali Amiryousefi
- Faculty of Medicine and Health, School of Medical Sciences, Örebro University, SE-701 82 Örebro, Sweden
| | - Lena Andersson
- Inflammatory Response and Infection Susceptibility Centre (iRiSC), Faculty of Medicine and Health, Örebro University, SE-701 82 Örebro, Sweden
- Faculty of Medicine and Health, School of Medical Sciences, Örebro University, SE-701 82 Örebro, Sweden
- Department of Occupational and Environmental Medicine, Örebro University Hospital, SE-701 85 Örebro, Sweden
| | - Alexander Persson
- Inflammatory Response and Infection Susceptibility Centre (iRiSC), Faculty of Medicine and Health, Örebro University, SE-701 82 Örebro, Sweden
- Faculty of Medicine and Health, School of Medical Sciences, Örebro University, SE-701 82 Örebro, Sweden
| | | | | | - Maria Larsson
- Man-Technology-Environment Research Center (MTM), Örebro University, SE-701 82 Örebro, Sweden
| | - Alexander Hedbrant
- Inflammatory Response and Infection Susceptibility Centre (iRiSC), Faculty of Medicine and Health, Örebro University, SE-701 82 Örebro, Sweden
- Faculty of Medicine and Health, School of Medical Sciences, Örebro University, SE-701 82 Örebro, Sweden
| | - Samira Salihovic
- Man-Technology-Environment Research Center (MTM), Örebro University, SE-701 82 Örebro, Sweden
- Inflammatory Response and Infection Susceptibility Centre (iRiSC), Faculty of Medicine and Health, Örebro University, SE-701 82 Örebro, Sweden
- Faculty of Medicine and Health, School of Medical Sciences, Örebro University, SE-701 82 Örebro, Sweden
| | - Tuulia Hyötyläinen
- Man-Technology-Environment Research Center (MTM), Örebro University, SE-701 82 Örebro, Sweden
| | - Dirk Repsilber
- Faculty of Medicine and Health, School of Medical Sciences, Örebro University, SE-701 82 Örebro, Sweden
| | - Eva Särndahl
- Inflammatory Response and Infection Susceptibility Centre (iRiSC), Faculty of Medicine and Health, Örebro University, SE-701 82 Örebro, Sweden
- Faculty of Medicine and Health, School of Medical Sciences, Örebro University, SE-701 82 Örebro, Sweden
| | - Magnus Engwall
- Man-Technology-Environment Research Center (MTM), Örebro University, SE-701 82 Örebro, Sweden
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12
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Andersson H, Tamaddon A, Malekian M, Ydström K, Siemund R, Ullberg T, Wasselius J. Comparison of image quality between a novel mobile CT scanner and current generation stationary CT scanners. Neuroradiology 2023; 65:503-512. [PMID: 36441234 PMCID: PMC9905188 DOI: 10.1007/s00234-022-03089-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 11/12/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Point-of-care imaging with mobile CT scanners offers several advantages, provided that the image quality is satisfactory. Our aim was to compare image quality of a novel mobile CT to stationary scanners for patients in a neurosurgical intensive care unit (ICU). METHODS From November 2020 to April 2021, all patients above 18 years of age examined by a mobile CT scanner at a neurosurgical ICU were included if they also had a stationary head CT examination during the same hospitalization. Quantitative image quality parameters included attenuation and noise in six predefined regions of interest, as well as contrast-to-noise ratio between gray and white matter. Subjective image quality was rated on a 4-garde scale, by four radiologists blinded to scanner parameters. RESULTS Fifty patients were included in the final study population. Radiation dose and image attenuation values were similar for mobCT and stationary CTs. There was a small statistically significant difference in subjective quality rating between mobCT and stationary CT images. Two radiologists favored the stationary CT images, one was neutral, and one favored mobCT images. For overall image quality, 14% of mobCT images were rated grade 1 (poor image quality) compared to 8% for stationary CT images. CONCLUSION Point-of-care brain CT imaging was successfully performed on clinical neurosurgical ICU patients with small reduction in image quality, predominantly affecting the posterior fossa, compared to high-end stationary CT scanners.
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Affiliation(s)
- Henrik Andersson
- Department of Medical Imaging and Physiology, Skåne University Hospital, 221 85 Lund, Sweden ,Department of Clinical Sciences, Lund University, 22100 Lund, Sweden
| | - Ashkan Tamaddon
- Department of Medical Imaging and Physiology, Skåne University Hospital, 221 85 Lund, Sweden
| | - Mazdak Malekian
- Department of Medical Imaging and Physiology, Skåne University Hospital, 221 85 Lund, Sweden
| | - Kristina Ydström
- Radiation Physics, Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, 22185 Lund, Sweden ,Medical Radiation Physics Malmö, Department of Translational Medicine, Lund University, 22100 Lund, Sweden
| | - Roger Siemund
- Department of Medical Imaging and Physiology, Skåne University Hospital, 221 85 Lund, Sweden ,Department of Clinical Sciences, Lund University, 22100 Lund, Sweden
| | - Teresa Ullberg
- Department of Medical Imaging and Physiology, Skåne University Hospital, 221 85 Lund, Sweden ,Department of Clinical Sciences, Lund University, 22100 Lund, Sweden
| | - Johan Wasselius
- Department of Medical Imaging and Physiology, Skåne University Hospital, 221 85, Lund, Sweden. .,Department of Clinical Sciences, Lund University, 22100, Lund, Sweden.
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13
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Sterner A, Sköld R, Andersson H. Effects of Blended Simulation on Nursing Students' Critical Thinking Skills: A Quantitative Study. SAGE Open Nurs 2023; 9:23779608231177566. [PMID: 37223219 PMCID: PMC10201174 DOI: 10.1177/23779608231177566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/14/2023] [Accepted: 05/06/2023] [Indexed: 05/25/2023] Open
Abstract
Introduction Critical thinking is regarded as imperative to healthcare quality and patient outcomes; therefore, effective strategies in nursing education are required to promote students' critical thinking abilities, leading to their success in clinical work. Accordingly, simulation-based education has been suggested as a measure for achieving this goal. Objective The aim of this study was to explore whether a nursing education course with blended simulation activities (hands-on simulations with high-fidelity manikins and a web-based interactive simulation program) could increase nursing students' critical thinking skills. Method A quasiexperimental, one-group pretest and post-test design was utilized. Data were collected through premeasurement and postmeasurement using a critical thinking questionnaire and were analyzed using paired sample t-tests, independent sample t-tests, and the nonparametric Wilcoxon signed-rank test. The effect size was calculated using Cohen's d formula. Results Sixty-one nursing students (57 women and four men, mean age 30 years) participated in the study. Findings of the paired sample t-test showed a significantly higher mean score for posteducation than pre-education, indicating a significant change in nurses' critical thinking capabilities (p < .001). The results for Cohen's d formula ( - 0.87) of the mean scores between pre-education and posteducation indicated a large effect size. The Wilcoxon signed-rank test also showed a statistically significant increase in the students' critical thinking abilities between pre-education and posteducation measures (p < .001). No statistically significant differences were found in the mean score according to age or sex. Conclusion This study concluded that blended simulation-based education can increase nursing students' critical thinking capabilities. As a result, this study builds on the use of simulation as a measure for developing and promoting critical thinking abilities during nursing education.
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Affiliation(s)
- Anders Sterner
- Faculty of Caring Sciences, Work Life and
Social Welfare, University of Borås, Borås, Sweden
| | - Robert Sköld
- Faculty of Caring Sciences, Work Life and
Social Welfare, University of Borås, Borås, Sweden
| | - Henrik Andersson
- Faculty of Caring Sciences, Work Life and
Social Welfare, University of Borås, Borås, Sweden
- Centre for Prehospital Research,
Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås,
Sweden
- Centre of Interprofessional Cooperation
within Emergency Care (CICE), Linnaeus University, Växjö, Sweden
- Department of Health and Caring
Sciences, Linnaeus University, Växjö, Sweden
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14
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Lundquist H, Andersson H, Chew MS, Das J, Turkina MV, Welin A. The Olfactomedin-4-Defined Human Neutrophil Subsets Differ in Proteomic Profile in Healthy Individuals and Patients with Septic Shock. J Innate Immun 2022; 15:351-364. [PMID: 36450268 PMCID: PMC10701106 DOI: 10.1159/000527649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 10/17/2022] [Indexed: 12/26/2023] Open
Abstract
The specific granule glycoprotein olfactomedin-4 (Olfm4) marks a subset (1-70%) of human neutrophils and the Olfm4-high (Olfm4-H) proportion has been found to correlate with septic shock severity. The aim of this study was to decipher proteomic differences between the subsets in healthy individuals, hypothesizing that Olfm4-H neutrophils have a proteomic profile distinct from that of Olfm4 low (Olfm4-L) neutrophils. We then extended the investigation to septic shock. A novel protocol for the preparation of fixed, antibody-stained, and sorted neutrophils for LC-MS/MS was developed. In healthy individuals, 39 proteins showed increased abundance in Olfm4-H, including the small GTPases Rab3d and Rab11a. In Olfm4-L, 52 proteins including neutrophil defensin alpha 4, CXCR1, Rab3a, and S100-A7 were more abundant. The data suggest differences in important neutrophil proteins that might impact immunological processes. However, in vitro experiments revealed no apparent difference in the ability to control bacteria nor produce oxygen radicals. In subsets isolated from patients with septic shock, 24 proteins including cytochrome b-245 chaperone 1 had significantly higher abundance in Olfm4-H and 30 in Olfm4-L, including Fc receptor proteins. There was no correlation between Olfm4-H proportion and septic shock severity, but plasma Olfm4 concentration was elevated in septic shock. Thus, the Olfm4-H and Olfm4-L neutrophils have different proteomic profiles, but there was no evident functional significance of the differences in septic shock.
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Affiliation(s)
- Hans Lundquist
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Henrik Andersson
- Department of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Michelle S Chew
- Department of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Jyotirmoy Das
- Bioinformatics, Core Facility, Division of Cell Biology, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
- Clinical Genomics Linköping, SciLife Laboratory, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Maria V Turkina
- Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Amanda Welin
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
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15
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Gualandro DM, Puelacher C, Chew MS, Andersson H, Lurati Buse G, Glarner N, Mueller D, Cardozo FAM, Burri K, Mork C, Wussler D, Bolliger D, Osswald S, Caramelli B, Mueller C. Acute heart failure after non-cardiac surgery: incidence, phenotypes, determinants and outcomes. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Primary acute heart failure (AHF) is an established and common cause of hospitalization. AHF may also develop secondarily, e.g. postoperatively (pAHF). Little is known about pAHF.
Purpose
To assess the incidence, phenotypes, determinants and outcomes of pAHF following non-cardiac surgery.
Methods
We prospectively included 9,164 consecutive patients at high cardiovascular risk undergoing 11,262 non-cardiac surgeries. The incidence, phenotypes, determinants and outcome of pAHF, centrally adjudicated by independent cardiologists, was determined. Logistic regression models identified the risk factors for pAHF. Cox regression analysis compared mortality and AHF readmission within 1 year in patients with and without pAHF. External validation was performed using a prospective cohort multicenter study of 1250 patients.
Results
The incidence of pAHF was 2.5% (95% confidence interval [CI] 2.2–2.8%). pAHF most often occurred on postoperative day 2 (median day 4). About half of pAHF (51%) occurred in patients without known HF (de novo pAHF), and 49% in patients with chronic HF. Preserved left ventricular ejection fraction (LVEF) was the dominant phenotype among de novo pAHF (72%), while reduced LVEF was dominant among pAHF in chronic HF (43%). Age, coronary artery disease, peripheral artery disease, diabetes, urgent/emergent surgery, chronic HF, atrial fibrillation, chronic obstructive pulmonary disease, anemia, and chronic myocardial injury were independent predictors of pAHF. Patients with pAHF had significantly higher all-cause mortality (44% vs. 11%, p<0.001) and AHF readmission (15% vs. 2%, p<0.001) within 1 year than patients without pAHF. pAHF was an independent predictor of all-cause mortality (adjusted hazard ratio [aHR] 1.7 [95% CI 1.3–2.2]; P<0.001) and AHF readmission (aHR 2.7 [95% CI 1.7–4.2]; P<0.001) within 1 year. Findings were confirmed in an external validation cohort of 1250 patients, e.g. incidence of pAHF 2.4% (95% CI, 1.6–3.3%).
Conclusions
pAHF frequent developed following non-cardiac surgery, being de novo in about half of cases, and associated with an unacceptable high mortality. Strategies focusing on early detection and treatment of pAHF seem warranted.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Swiss National Science FoundationSwiss Heart Foundation
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Affiliation(s)
| | - C Puelacher
- University Hospital Basel , Basel , Switzerland
| | - M S Chew
- Linköping University , Linköping , Sweden
| | | | - G Lurati Buse
- University Hospital Düsseldorf , Düsseldorf , Germany
| | - N Glarner
- University Hospital Basel , Basel , Switzerland
| | - D Mueller
- University Hospital Basel , Basel , Switzerland
| | - F A M Cardozo
- Heart Institute (InCor), University of São Paulo Medical School, Cardiology , São Paulo , Brazil
| | - K Burri
- University Hospital Basel , Basel , Switzerland
| | - C Mork
- University Hospital Basel , Basel , Switzerland
| | - D Wussler
- University Hospital Basel , Basel , Switzerland
| | - D Bolliger
- University Hospital Basel , Basel , Switzerland
| | - S Osswald
- University Hospital Basel , Basel , Switzerland
| | - B Caramelli
- Heart Institute (InCor), University of São Paulo Medical School, Cardiology , São Paulo , Brazil
| | - C Mueller
- University Hospital Basel , Basel , Switzerland
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16
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Soerensen NA, Fakhri Y, Gossling A, Neumann JT, Haller PM, Toprak B, Lehmacher J, Twerenbold R, Westermann D, Andersson H, Jensen LO, Holmvang L, Blankenberg S, Clemmensen P. Comparative diagnostic and prognostic implications of right versus left bundle branch block in patients with suspected ST-segment elevation myocardial infarction. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Current ESC guidelines on management of acute myocardial infarction in patients presenting with ST-segment elevation (STEMI) recommend emergent invasive management in patients with ischemic symptoms and bundle branch block (BBB). While left bundle branch block (LBBB) is a well-known high-risk feature in patients with acute myocardial infarction, data on the diagnostic and prognostic impact of right bundle branch block (RBBB) in comparison to LBBB in the context of STEMI are scarce.
Methods
A prospective cohort of 2,139 patients with suspected STEMI were triaged by the on-call cardiologist to acute coronary angiography based on a prehospital, tele-transmitted digital 12-lead electrocardiogram. All discharge diagnoses were independently adjudicated. The diagnostic accuracy of RBBB or LBBB was calculated. 30-day and 1-year all-cause mortality were from a central national registry and compared for LBBB, RBBB and patients without BBB using the Kaplan Meier method. Unadjusted and adjusted (age, sex, hypertension, hyperlipoproteinemia, smoking status and history of coronary artery disease) hazard ratios for 1-year mortality were calculated for both BBB-types.
Results
The final diagnosis of STEMI was adjudicated in 1,832/2,139 (85.6%) of patients. RBBB was present in 117 (5.5%), LBBB in 61 (2.9%) patients, respectively. Patients with BBB were older than non-BBB patients: Median age was 69.7 years in RBBB, 68.9 years in LBBB and 62.6 years in non-BBB patients. Comparing both BBB types, LBBB patients more often had prior heart failure (6.3% in RBBB vs 11.5% in LBBB), while RBBB patients more often developed cardiac arrest before angiography (15.3% vs 3.7% in RBBB and LBBB patients respectively) and more frequently revealed Thrombolysis in Myocardial Infarction (TIMI) grade flow of 0 (61.0% vs 47.2%, respectively).
Specificity for the final diagnosis of STEMI was not significantly different in both BBB-types: 95.1% (95% CI 92.1–97.0) in RBBB versus 92.8% (95% CI 89.4–95.2) in LBBB patients (p=0.25).
Patients with RBBB had significantly higher 30-day and 1-year mortality (Figure 1), while LBBB and non-BBB patients showed similar outcome. Unadjusted hazard ratio for 1-year mortality comparing RBBB to non-BBB patients was 3.35 (95% CI 2.11–5.34, p<0.001) and 1.4 (95% CI 0.57–3.44, p=0.46) when comparing LBBB to non-BBB patients. After adjustment hazard ratio for RBBB patients was 2.3 (95% CI 1.25–4.21, p=0.007).
Conclusion
In the context of suspected STEMI, RBBB is an ominous sign associated with adverse clinical features like cardiac arrest prior to PCI, TIMI grade 0 flow, compared to LBBB or non-BBB presenters. Consequently, RBBB patients had poorer outcome after 12 months. Our data therefore reinforce current guidelines in designating RBBB-patients as very high-risk, demanding immediate management and triage.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Regional Research Foundation in Region Sjaelland, Denmark
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Affiliation(s)
- N A Soerensen
- University Heart & Vascular Center Hamburg , Hamburg , Germany
| | - Y Fakhri
- Zealand University Hospital, Department of Cardiology , Roskilde , Denmark
| | - A Gossling
- University Heart & Vascular Center Hamburg , Hamburg , Germany
| | - J T Neumann
- University Heart & Vascular Center Hamburg , Hamburg , Germany
| | - P M Haller
- University Heart & Vascular Center Hamburg , Hamburg , Germany
| | - B Toprak
- University Heart & Vascular Center Hamburg , Hamburg , Germany
| | - J Lehmacher
- University Heart & Vascular Center Hamburg , Hamburg , Germany
| | - R Twerenbold
- University Heart & Vascular Center Hamburg , Hamburg , Germany
| | - D Westermann
- University Heart & Vascular Center Hamburg , Hamburg , Germany
| | - H Andersson
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Centre , Copenhagen , Denmark
| | - L O Jensen
- Odense University Hospital, Department of Cardiology , Odense , Denmark
| | - L Holmvang
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Centre , Copenhagen , Denmark
| | - S Blankenberg
- University Heart & Vascular Center Hamburg , Hamburg , Germany
| | - P Clemmensen
- University Heart & Vascular Center Hamburg , Hamburg , Germany
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Jansson S, Blixt PJ, Didriksson H, Jonsson C, Andersson H, Hedström C, Engvall J, Aneq MÅ, Chew MS. Incidence of acute myocardial injury and its association with left and right ventricular systolic dysfunction in critically ill COVID-19 patients. Ann Intensive Care 2022; 12:56. [PMID: 35727386 PMCID: PMC9210044 DOI: 10.1186/s13613-022-01030-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 06/07/2022] [Indexed: 12/26/2022] Open
Abstract
Background Previous studies have found an increase in cardiac troponins (cTns) and echocardiographic abnormalities in patients with COVID-19 and reported their association with poor clinical outcomes. Whether acute injury occurs during the course of critical care and if it is associated with cardiac function is unknown. The purpose of this study was to document the incidence of acute myocardial injury (AMInj) and echocardiographically defined left ventricular (LV) and right ventricular (RV) systolic dysfunction in consecutive patients admitted to an intensive care unit (ICU) for COVID-19. The relationship between AMInj and echocardiographic abnormalities during the first 14 days of ICU admission was studied. Finally, the association between echocardiographic findings, AMInj and clinical outcome was evaluated. Methods Seventy-four consecutive patients (≥18 years) admitted to the ICU at Linköping University Hospital between 19 Mar 2020 and 31 Dec 2020 for COVID-19 were included. High-sensitivity troponin-T (hsTnT) was measured daily for up to 14 days. Transthoracic echocardiography was conducted within 72 h of ICU admission. Acute myocardial injury was defined as an increased hsTnT > 14ng/l and a > 20% absolute change with or without ischaemic symptoms. LV and RV systolic dysfunction was defined as at least 2 abnormal indicators of systolic function specified by consensus guidelines. Results Increased hsTnT was observed in 59% of patients at ICU admission, and 82% developed AMInj with peak levels at 8 (3–13) days after ICU admission. AMInj was not statistically significantly associated with 30-day mortality but was associated with an increased duration of invasive mechanical ventilation (10 (3–13) vs. 5 days (0–9), p=0.001) as well as ICU length of stay (LOS) (19.5 (11–28) vs. 7 days (5–13), p=0.015). After adjustment for SAPS-3 and admission SOFA score, the effect of AMInj was significant only for the duration of mechanical ventilation (p=0.030). The incidence of LV and RV dysfunction was 28% and 22%, respectively. Only indices of LV and RV longitudinal contractility (mitral and tricuspid annular plane systolic excursion) were associated with AMInj. Echocardiographic parameters were not associated with clinical outcome. Conclusions Myocardial injury is common in critically ill patients with COVID-19, with AMInj developing in more than 80% after ICU admission. In contrast, LV and RV dysfunction occurred in approximately one-quarter of patients. AMInj was associated with an increased need for mechanical ventilation and ICU LOS but neither AMInj nor ventricular dysfunction was significantly associated with mortality. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-022-01030-8.
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Affiliation(s)
- Saga Jansson
- Department of Anaesthesiology and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Patrik Johansson Blixt
- Department of Anaesthesiology and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Helen Didriksson
- Department of Anaesthesiology and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Carina Jonsson
- Department of Anaesthesiology and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Henrik Andersson
- Department of Anaesthesiology and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Cassandra Hedström
- Department of Clinical Physiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Jan Engvall
- Department of Clinical Physiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Meriam Åstrom Aneq
- Department of Clinical Physiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Michelle S Chew
- Department of Anaesthesiology and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
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Hoffmann-Vold AM, Fretheim H, Diep PP, Lerang K, Andersson H, Midtvedt Ø, Garen T, Durheim M, Aaløkken TM, Palm Ø, Molberg Ø. POS0065 INTERSTITIAL LUNG DISEASE ASSOCIATED WITH PRIMARY SJÖGREN’S SYNDROME IS FREQUENTLY PROGRESSIVE. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundInterstitial lung disease (ILD) in primary Sjögren’s syndrome (pSS) has been reported to be present in 10-15% of patients, but pSS-ILD behavior over time is not well characterized.ObjectivesAssess the pattern of ILD in pSS, its disease behavior and factors associated with disease progression in a well-characterized pSS-ILD cohort.MethodsAll pSS patients from the Oslo University Hospital (OUH) were included if ILD was diagnosed on HRCT. Clinical characteristics, lung function tests including forced vital capacity (FVC) and diffusing capacity for carbon monoxide (DLCO) and ILD pattern on HRCT assessed by a radiologist were evaluated. We determined ILD progression, defined as absolute FVC decline >5% or absolute DLCO decline >10% over 12 +/-6 months and increasing extent of ILD on HRCT over the observation period. Factors associated with disease progression were chosen based on expert opinion. Descriptive analyses were conductedResultsOf 702 pSS patients followed at OUH, we identified 60 pSS patients with ILD with 33 (55%) having follow-up at 12 months (Table 1). Patients with pSS-ILD were characterized by high number of males (18%) and by frequent other extra-pulmonary organ involvement (48%) (Table 1). Mean time from pSS diagnosis to ILD diagnosis was 7.4 years. In 67% ILD was diagnosed after pSS, in 13% simultaneously, in 11% before pSS diagnosis and in 9% unknown. In total, 28 (47%) were diagnosed with lymphocytic interstitial pneumonia (LIP) and 32 (53%) with reticular pattern on HRCT. Over mean follow-up of 10.9 months (SD 4.2), 7/33 (21%) showed a FVC >5% decline, 9/32 (28%) a DLCO >10% decline and 12 (36%) had at least one of these defined lung function declines on standard of care treatment. Treatment was registered as ever used and by any indication. Over an observation period of 15.4 (SD 10.6) years, 27/47 (45%) showed any ILD progression on HRCT. HRCT pattern was not associated with risk of >10% DLCO decline or ILD progression on HCRT. >5% FVC decline occurred more frequently in patients with reticular pattern compared to LIP (6/17 (35%) vs 1/16 (6%), p=0.041). Factors significantly associated with ILD progression on lung function included higher baseline FVC (99% (SD16.4) vs 87% (SD14.9), p=0.032), higher DLCO (81% (SD13.1) vs 67% (SD17.4), p=0.020), increased CRP (2/10 (20%) vs 0/16 (0%), p=0.045) and presence of polyneuropathy (2/9 (22%) vs 1/17 (6%), p=0.045).Table 1.Clinical characteristics, demographics and outcome of pSS with ILDpSS-ILD(n=60)Age at pSS diagnosis, y (SD)50 (21.9)Time from pSS to ILD diagnosis, y (SD)7.4 (8.9)Male sex, n (%)11 (18)Anti-SSA AB, n/50 (%)46 (92)Increased CRP, n/47 (%)7 (15)Low complements, n/49 (%)5 (10)Extra-pulmonary involvement, n/46 (%)22 (48)Deceased, n (%)10 (17)Pulmonary involvementFVC% predicted (SD)91 (18.7)FVC decline>5%, n/33 (%)7 (21)DLCO% predicted (SD)70 (20.7)DLCO decline >10%, n/32 (%)9 (32)ILD progression on HRCT, n/47 (%)27 (45)Treatment during follow upRituximab, n (%)11 (18)Any other immunosuppressive, n (%)20 (33)Hydroxychloroquine, n (%)16 (27)Nintedanib, n (%)1 (2)Lung transplant, n (%)1 (2)ConclusionA substantial number of patients with pSS-ILD progressed during the time of observation. This highlights the importance of close monitoring and active consideration of treatment options in pSS-ILD. Recommendations for disease management including screening, diagnosis, disease monitoring and treatment for pulmonary involvement in pSS are lacking to date, but are highly needed.Disclosure of InterestsAnna-Maria Hoffmann-Vold Speakers bureau: Actelion, Boehringer Ingelheim, Jansen, Lilly, Medscape, Merck Sharp & Dohme, Roche, Consultant of: Actelion, ARXX, Bayer, Boehringer Ingelheim, Jansen, Lilly, Medscape, Merck Sharp & Dohme, Roche, Grant/research support from: Boehringer Ingelheim, Håvard Fretheim Consultant of: Bayer, Grant/research support from: Jansen, Phuong Phuong Diep Speakers bureau: Boehringer Ingelheim, Karoline Lerang: None declared, Helena Andersson: None declared, Øyvind Midtvedt: None declared, Torhild Garen: None declared, Mike Durheim Speakers bureau: Boehringer Ingelheim, Consultant of: Boehringer Ingelheim and Roche, Grant/research support from: Boehringer Ingelheim and Roche, Trond M Aaløkken Speakers bureau: Boehringer Ingelheim, Øyvind Palm: None declared, Øyvind Molberg: None declared
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Garen T, Tollisen A, Andersson H, Gudbrandsson B, Palm Ø. POS1575-PARE WORKING AND HEALTH STATUS IN NORWEGIAN PATIENTS WITH TAKAYASU ARTERITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundTakayasu arteritis (TAK) is a rare vasculitis of large vessels, mainly in young women, with a point prevalence of 25.6/106 in a Norwegian population. TAK is most prevalently limited to the aortic arch and its branches (Type 1) among North Europeans (1). Early symptoms include fever, myalgia and loss of appetite. Later, irreversible vascular damage and ischemic symptoms with claudication of the extremities may occur. We have previously observed a reduced life expectancy, mainly due to cardiovascular complications and a median age among those deceased of only 58 years (2). These findings clearly indicate that TAK may have severe impact on the wellbeing of the patients and their physical capacity. Furthermore, being part of the working life is a major component of life but is affected in chronic autoimmune diseases (3,4)Objectives(i) To describe general health status and quality of life in patients with different working status.(ii) To estimate the rates of patients having paid work or receiving disability benefits, compared to the general Norwegian population.MethodsPatients with TAK registered in “The Norwegian Systemic Connective Tissue Disease and Vasculitis Registry” (NOSVAR) were included. All patients fulfilled the American College of Rheumatology classification criteria and/or the modified Ishikawa diagnostic criteria for TAK. (3). General health status was measured with 10-cm visual analogue scale (VAS) of pain and fatigue, ranging from 0 (best possible score) to 10 (worst possible score) and with Patients´ global assessment (PtGA) of health measured by a five-point Likert scale with scores ranging from 1 (very good health) to 5 (very bad health). The SF-36 was applied to measure health related quality of life and included 8 scales with score ranging from 0 (worse) to 100 (best). Disease duration was defined as the time from diagnosis to date of registration. Working full- or part time was defined as paid work. We adjusted for age, gender and residence counties in southeast Norway using reference data from Norway Statistics. Indirect standardization with 95% confidence interval rates was calculated. Descriptive analyses were conducted.ResultsPatients with paid work were more educated compared with those receiving disability benefits (81% vs 19% p=0.031). Patients receiving disability benefits reported higher levels of pain (3,4 vs.1,4, p=0.024) and disease activity (3,8 vs. 0,8, p=0.025), more frequently claudication in legs (83% vs. 17%, p= 0.009) and impaired quality of life measured with SF- 36, physical functioning (66 vs 88, p=0.002) and role physical (32 vs 65, p=0.017) compared to patients with paid work/students (Figure 1).Compared with the age and gender matched general population, the disability rate of female patients was 16 % higher, adjusted ratio (CI 95%) 2 (1,2-3,3), p=0.038. The paid work rate was 51% lower in women with TAK compared to the general population, adjusted ratio (CI 95%) 0,38 (0,23-0,64), p=0.001 .ConclusionTAK-patients receiving disability benefits reported lower health status and lower quality of life by physical functioning and role physical in SF 36. Work disability in female TAK patients was 16 % higher and for paid work 51 % lower compared to the general population.References[1]Gudbrandsson B, Molberg Ø, Garen T, Palm Ø, Arthritis Care Resb (Hoboken), 2017 Sept;69:1384-1390[2]Garen T, Lerang K, Hoffmann-Vold AM, Andersson H, Midtvedt Ø, Brunborg C, Kilian K, Gudbrandsson B, Gunnarsson R, Norby G, Chaudhary A, Thoen J, Forseth KØ, Fresjar K, Førre Ø, Haugen M, Haga HJ, Gran JT, Gilboe IM, Molberg Ø, Palm Ø. Rheumatology (Oxford). 2019 Feb 1;58(2):313-320.[3]Abularrage CJ, Slidell MB, Sidawy AN, Kreishman P, Amdur RL, Arora S. Quality of life of patients with Takayasu’s arteritis. Journal of vascular surgery. 2008;47(1):131-6; discussion 6-7.[4]Janine M Ouimet 1, Janet E Pope, Iris Gutmanis, John Koval Work disability in scleroderma is greater than in rheumatoid arthritis and is predicted by high HAQ scores. 2008;2:44-52. doi: 10.2174/1874312900802010044. Epub 2008 Sep 23.Disclosure of InterestsNone declared
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Leclair V, Galindo-Feria AS, Rothwell S, Kryštůfková O, Mann H, Pyndt Diederichsen L, Andersson H, Klein M, Tansley S, Mchugh N, Lamb J, Vencovský J, Chinoy H, Holmqvist M, Padyukov L, Lundberg IE, Diaz-Gallo LM. OP0160 HLA-DRB1 ASSOCIATIONS WITH AUTOANTIBODY-DEFINED SUBGROUPS IN IDIOPATHIC INFLAMMATORY MYOPATHIES (IIM). Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundThere is a gap between how IIM patients are classified in practice and current validated classification criteria1. Also, different associations with genetic variations in HLA can inform about different T-cell mechanisms involved in disease pathogenesis.ObjectivesWe aimed to systematically study associations between HLA-DRB1 alleles, clinical manifestations, and autoantibody-defined IIM subgroups.MethodsWe included 1348 IIM patients from five European countries. An unsupervised cluster analysis was performed using 14 autoantibodies: anti-Jo1, -PL7, -PL12, -EJ, -OJ, -SRP, -U1RNP, -Ro52, -Mi2, -TIF1γ, -MDA5, -PMScl, -SAE1, and -NXP2 to identify patients’ subgroups. Logistic regressions were used to estimate the associations between HLA-DRB1 alleles, clinical manifestations and the identified subgroups.ResultsEight subgroups were defined by the autoantibody status (Table 1). Three of the subgroups (1, 2 and 6) have overlapping autoantibodies, while four are almost monospecific (3,4,5 and 7), and one (8) has patients negative for tested autoantibodies. Figure 1 represents the significant associations between HLA-DRB1 alleles and the eight subgroups. Heliotrope rash and Gottron’s sign were significantly more frequent in subgroups 3 (OR:2.2 95%CI:[1.1-4.8], OR:2.6 95%CI:[1.3-5.9], respectively), 4 (OR:12 95%CI:[3.6-75], OR:7.8 95%CI:[2.8-33], respectively) and 7 (OR:22 95%CI:[4.5-385], OR:10 95%CI:[3.1-65], respectively), and Raynaud’s phenomenon was significantly more frequent in subgroup 6 (OR:3.3 95%CI:[1.2-11]).Table 1.Autoantibody-defined subgroups using an unsupervised cluster analysis.Subgroups/ MedoidsVariables1 Ro522 U1RNP3 PMScl4 Mi25 Jo16 Jo1/Ro527 TIF18 None*Alln (%)137 (10)183 (14)107 (8)65 (5)119 (9)140 (10)78 (6)519 (39)1348 (100)Female (%)93 (68)116 (63)79 (74)45 (69)76 (64)96 (69)64 (82)313 (60)882 (65)Age at diagnosis, median (IQR)56 (16)51.5 (23)51 (25)57 (22.5)47.5 (23.25)52 (19.5)53.5 (21.75)58 (22)55 (23)AutoantibodiesAnti-Jo106 (3)01 (2)119 (100)140 (100)00266 (20)Anti-PL77 (5)13 (7)00000020 (1.5)Anti-PL125 (4)3 (2)1 (1)01 (1)00010 (0.7)Anti-EJ2 (2)00000002 (0.1)Anti-OJ07 (4)0000007 (0.5)Anti-TIF110 (7)2 (1)2 (2)00078 (100)092 (7)Anti-Mi21 (1)1 (1)1 (1)65 (100)02 (1)0070 (5)Anti-SAE18 (6)23 (13)00000031 (2)Anti-NXP21 (1)23 (13)1 (1)0000025 (2)Anti-MDA59 (7)10 (6)1 (1)1 (2)01 (1)0022 (2)Anti-SRP8 (6)32 (18)00000040 (3)Anti-Ro52137 (100)16 (9)000140 (100)00293 (22)Anti-PMScl11 (8)1 (1)107 (100)00000119 (9)Anti-U1RNP079 (43)0003 (2)0082 (6)*IIM patients negative for the tested autoantibodies.Figure 1.Forest plot of significant associations of HLA. *DRB1 alleles with autoantibody-defined subgroups. Scandinavia includes patients from Denmark, Norway, and Sweden.ConclusionOur study reveals that certain subgroups of IIM patients are characterized by overlap of myositis -specific and -associated autoantibodies, which in turn are associated with different HLA-DRB1 alleles including potential novel associations. These results point to different disease mechanisms in the subgroups, as well as suggest that IIM classification could be improved by integrating broader serological and genetic data.References[1]Parker MJS, Oldroyd A, Roberts ME, et al. The performance of the European League Against Rheumatism/American College of Rheumatology idiopathic inflammatory myopathies classification criteria in an expert-defined 10 year incident cohort. Rheumatology (Oxford). 2019;58(3):468-475.AcknowledgementsWe thank all the patients who participated in the study.Disclosure of InterestsValerie Leclair: None declared, Angeles Shunashy Galindo-Feria: None declared, Simon Rothwell: None declared, Olga Kryštůfková: None declared, Heřman Mann: None declared, Louise Pyndt Diederichsen: None declared, helena andersson: None declared, Martin Klein: None declared, Sarah Tansley: None declared, Neil McHugh: None declared, Janine Lamb: None declared, Jiří Vencovský Speakers bureau: Abbvie, Biogen, Boehringer, Eli Lilly, Gilead, MSD, Novartis, Pfizer, Roche, Sanofi, UCB, Werfen, Consultant of: Abbvie, Argenx, Boehringer, Eli Lilly, Gilead, Octapharma, Pfizer, UCB, Grant/research support from: Abbvie, Hector Chinoy: None declared, Marie Holmqvist: None declared, Leonid Padyukov: None declared, Ingrid E. Lundberg Shareholder of: Roche and Novartis, Consultant of: Corbus Pharmaceuticals Inc, Astra Zeneca, Bristol Myer´s Squibb, Corbus Pharmaceutical, EMD Serono Research & Development Institute, Argenx, Octapharma, Kezaar, Orphazyme, and Janssen, Grant/research support from: Astra Zeneca, Lina M. Diaz-Gallo: None declared
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Andersson H, Svensson A, Frank C, Rantala A, Holmberg M, Bremer A. Ethics education to support ethical competence learning in healthcare: an integrative systematic review. BMC Med Ethics 2022; 23:29. [PMID: 35305627 PMCID: PMC8933936 DOI: 10.1186/s12910-022-00766-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/07/2022] [Indexed: 01/07/2023] Open
Abstract
Background Ethical problems in everyday healthcare work emerge for many reasons and constitute threats to ethical values. If these threats are not managed appropriately, there is a risk that the patient may be inflicted with moral harm or injury, while healthcare professionals are at risk of feeling moral distress. Therefore, it is essential to support the learning and development of ethical competencies among healthcare professionals and students. The aim of this study was to explore the available literature regarding ethics education that promotes ethical competence learning for healthcare professionals and students undergoing training in healthcare professions. Methods In this integrative systematic review, literature was searched within the PubMed, CINAHL, and PsycInfo databases using the search terms ‘health personnel’, ‘students’, ‘ethics’, ‘moral’, ‘simulation’, and ‘teaching’. In total, 40 articles were selected for review. These articles included professionals from various healthcare professions and students who trained in these professions as subjects. The articles described participation in various forms of ethics education. Data were extracted and synthesised using thematic analysis. Results The review identified the need for support to make ethical competence learning possible, which in the long run was considered to promote the ability to manage ethical problems. Ethical competence learning was found to be helpful to healthcare professionals and students in drawing attention to ethical problems that they were not previously aware of. Dealing with ethical problems is primarily about reasoning about what is right and in the patient’s best interests, along with making decisions about what needs to be done in a specific situation. Conclusions The review identified different designs and course content for ethics education to support ethical competence learning. The findings could be used to develop healthcare professionals’ and students’ readiness and capabilities to recognise as well as to respond appropriately to ethically problematic work situations.
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Zhang R, Örtegren J, Hummelgård M, Olsen M, Andersson H, Olin H. A review of the advances in composites/nanocomposites for triboelectric nanogenerators. Nanotechnology 2022; 33:212003. [PMID: 35030545 DOI: 10.1088/1361-6528/ac4b7b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 01/14/2022] [Indexed: 06/14/2023]
Abstract
Material development is essential when studying triboelectric nanogenerators (TENGs). This importance is because the performance of TENGs is highly dependent on the properties of the utilized triboelectric materials. To obtain more specific properties, composites have been developed that combine the features of their components. According to Google Scholar, 55% of published papers related to triboelectric nanogenerators have utilized or mentioned composites. This number is 34.5% if one searches with the keyword nanocomposites instead of composites. The importance of composites is because they can exhibit new dielectric properties, better mechanical strength, enhanced charge affinities, etc. Therefore, the development of new composites has great importance in TENG studies. In this paper, we review the production of nanocomposites, the types of nanocomposites, and their application in TENG studies. This review gives an overview of how nanocomposites boost the performance of TENGs and provides guidance for future studies.
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Affiliation(s)
- Renyun Zhang
- Department of Natural Sciences, Mid Sweden University, Holmgatan 10, SE-85170 Sundsvall, Sweden
| | - Jonas Örtegren
- Department of Natural Sciences, Mid Sweden University, Holmgatan 10, SE-85170 Sundsvall, Sweden
| | - Magnus Hummelgård
- Department of Natural Sciences, Mid Sweden University, Holmgatan 10, SE-85170 Sundsvall, Sweden
| | - Martin Olsen
- Department of Natural Sciences, Mid Sweden University, Holmgatan 10, SE-85170 Sundsvall, Sweden
| | - Henrik Andersson
- Department of Electronics Design, Mid Sweden University, Holmgatan 10, SE-85170 Sundsvall, Sweden
| | - Håkan Olin
- Department of Natural Sciences, Mid Sweden University, Holmgatan 10, SE-85170 Sundsvall, Sweden
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Chew MS, Puelacher C, Patel A, Hammarskjöld F, Lyckner S, Kollind M, Jawad M, Andersson U, Fredrikson M, Sperber J, Johnsson P, Elander L, Zeuchner J, Linhardt M, De Geer L, Rolander WG, Gagnö G, Didriksson H, Pearse R, Mueller C, Andersson H. Identification of myocardial injury using perioperative troponin surveillance in major noncardiac surgery and net benefit over the Revised Cardiac Risk Index. Br J Anaesth 2021; 128:26-36. [PMID: 34857357 DOI: 10.1016/j.bja.2021.10.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 09/12/2021] [Accepted: 10/05/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Patients with perioperative myocardial injury are at risk of death and major adverse cardiovascular and cerebrovascular events (MACCE). The primary aim of this study was to determine optimal thresholds of preoperative and perioperative changes in high-sensitivity cardiac troponin T (hs-cTnT) to predict MACCE and mortality. METHODS Prospective, observational, cohort study in patients ≥50 yr of age undergoing elective major noncardiac surgery at seven hospitals in Sweden. The exposures were hs-cTnT measured before and days 0-3 after surgery. Two previously published thresholds for myocardial injury and two thresholds identified using receiver operating characteristic analyses were evaluated using multivariable logistic regression models and externally validated. The weighted comparison net benefit method was applied to determine the additional value of hs-cTnT thresholds when compared with the Revised Cardiac Risk Index (RCRI). The primary outcome was a composite of 30-day all-cause mortality and MACCE. RESULTS We included 1291 patients between April 2017 and December 2020. The primary outcome occurred in 124 patients (9.6%). Perioperative increase in hs-cTnT ≥14 ng L-1 above preoperative values provided statistically optimal model performance and was associated with the highest risk for the primary outcome (adjusted odds ratio 2.9, 95% confidence interval 1.8-4.7). Validation in an independent, external cohort confirmed these findings. A net benefit over RCRI was demonstrated across a range of clinical thresholds. CONCLUSIONS Perioperative increases in hsTnT ≥14 ng L-1 above baseline values identifies acute perioperative myocardial injury and provides a net prognostic benefit when added to RCRI for the identification of patients at high risk of death and MACCE. CLINICAL TRIAL REGISTRATION NCT03436238.
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Affiliation(s)
- Michelle S Chew
- Departments of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
| | - Christian Puelacher
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University Basel, Basel, Switzerland
| | - Akshaykumar Patel
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Fredrik Hammarskjöld
- Department of Anesthesiology and Intensive Care, Ryhov County Hospital, Jönköping, Sweden
| | - Sara Lyckner
- Department of Anesthesiology, Mälarsjukhuset, Centre for Clinical Research Sörmland, Eskilstuna, Sweden
| | - Malin Kollind
- Department of Anaesthesia and Intensive Care, Centralsjukhuset Kristianstad, Kristianstad, Sweden
| | - Monir Jawad
- Department of Anaesthesia and Intensive Care, Centralsjukhuset Kristianstad, Kristianstad, Sweden; Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Ulrika Andersson
- Department of Clinical Sciences Lund, Anaesthesiology and Intensive Care, Skåne University Hospital Lund, Lund University, Sweden
| | - Mats Fredrikson
- Department of Clinical and Experimental Medicine, Faculty of Medicine and Health, Linköping University, Linköping, Sweden
| | - Jesper Sperber
- Department of Anesthesiology, Mälarsjukhuset, Centre for Clinical Research Sörmland, Eskilstuna, Sweden
| | - Patrik Johnsson
- Department of Clinical Sciences, Anaesthesiology and Intensive Care, Skåne University Hospital Malmö, Lund University, Sweden
| | - Louise Elander
- Department of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Vrinnevi Hospital, Norrköping, Sweden
| | - Jakob Zeuchner
- Department of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Vrinnevi Hospital, Norrköping, Sweden
| | - Michael Linhardt
- Departments of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Lina De Geer
- Departments of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Wictor Gääw Rolander
- Departments of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Gunilla Gagnö
- Departments of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Helén Didriksson
- Departments of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Rupert Pearse
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Christian Mueller
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University Basel, Basel, Switzerland
| | - Henrik Andersson
- Departments of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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Svensson A, Bremer A, Rantala A, Andersson H, Devenish S, Williams J, Holmberg M. Ambulance clinicians' attitudes to older patients' self-determination when the patient has impaired decision-making ability: A Delphi study. Int J Older People Nurs 2021; 17:e12423. [PMID: 34510764 DOI: 10.1111/opn.12423] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The proportion of older people is increasing and reflects in the demand on ambulance services (AS). Patients can be more vulnerable and increasingly dependent, especially when their decision-making ability is impaired. Self-determination in older people has a positive relation to quality of life and can raise ethical conflicts in AS. Hence, the aim of this study was to empirically explore attitudes among Swedish ambulance clinicians (ACs) regarding older patients' self-determination in cases where patients have impaired decision-making ability, and who are in urgent need of care. MATERIALS AND METHODS An explorative design was adopted. A Delphi technique was used, comprising four rounds, involving a group (N = 31) of prehospital emergency nurses (n = 14), registered nurses (n = 10) and emergency medical technicians (n = 7). Focus group conversations (Round 1) and questionnaires (Rounds 2-4) generated data. Round 1 was analysed using manifest content analysis, which ultimately resulted in the creation of discrete items. Each item was rated with a five-point Likert scale together with free-text answers. Consensus (≥70%) was calculated by trichotomising the Likert scale. RESULTS Round 1 identified 108 items which were divided into four categories: (1) attitudes regarding the patient (n = 35), (2) attitudes regarding the patient relationship (n = 8), (3) attitudes regarding oneself and one's colleagues (n = 45), and (4) attitudes regarding other involved factors (n = 20). In Rounds 2-4, one item was identified in the free text from Round 2, generating a total of 109 items. After four rounds, 72 items (62%) reached consensus. CONCLUSIONS The findings highlight the complexity of ACs' attitudes towards older patients' self-determination. The respect of older patients' self-determination is challenged by the patient, other healthcare personnel, significant others and/or colleagues. The study provided a unique opportunity to explore self-determination and shared decision-making. AS have to provide continued ethical training, for example to increase the use of simulation-based training or moral case deliberations in order to strengthen the ACs' moral abilities within their professional practice. IMPLICATIONS FOR PRACTICE Ambulance services must develop opportunities to provide continued training within this topic. One option would be to increase the use of simulation-based training, focusing on ethical aspects of the care. Another option might be to facilitate moral case deliberations to strengthen the ACs' abilities to manage these issues while being able to share experiences with peers. These types of interventions should illuminate the importance of the topic for the individual AC, which, in turn, may strengthen and develop the caring abilities within an integrated care team.
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Affiliation(s)
- Anders Svensson
- Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden.,Centre of Interprofessional Collaboration within Emergency care (CICE), Linnaeus University, Växjö, Sweden.,Department of Ambulance Service, Växjö, Sweden
| | - Anders Bremer
- Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden.,Centre of Interprofessional Collaboration within Emergency care (CICE), Linnaeus University, Växjö, Sweden.,Department of Ambulance Service, Kalmar, Sweden
| | - Andreas Rantala
- Centre of Interprofessional Collaboration within Emergency care (CICE), Linnaeus University, Växjö, Sweden.,Department of Health Sciences, Lund University, Lund, Sweden.,Emergency Department, Helsingborg General Hospital, Helsingborg, Sweden
| | - Henrik Andersson
- Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden.,Centre of Interprofessional Collaboration within Emergency care (CICE), Linnaeus University, Växjö, Sweden.,Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Scott Devenish
- Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Julia Williams
- Paramedic Clinical Research Unit (ParaCRU), University of Hertfordshire, Hatfield, UK
| | - Mats Holmberg
- Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden.,Centre of Interprofessional Collaboration within Emergency care (CICE), Linnaeus University, Växjö, Sweden.,Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden.,Department of Ambulance Service, Region Sörmland, Katrineholm, Sweden
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25
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Håkansson C, Tamaddon A, Andersson H, Torisson G, Mårtensson G, Truong M, Annertz M, Londos E, Björkman-Burtscher IM, Hansson O, van Westen D. Inter-modality assessment of medial temporal lobe atrophy in a non-demented population: application of a visual rating scale template across radiologists with varying clinical experience. Eur Radiol 2021; 32:1127-1134. [PMID: 34328536 PMCID: PMC8794965 DOI: 10.1007/s00330-021-08177-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 06/03/2021] [Accepted: 06/25/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To assess inter-modality agreement and accuracy for medial temporal lobe atrophy (MTA) ratings across radiologists with varying clinical experience in a non-demented population. METHODS Four raters (two junior radiologists and two senior neuroradiologists) rated MTA on CT and MRI scans using Scheltens' MTA scale. Ratings were compared to a consensus rating by two experienced neuroradiologists for estimation of true positive and negative rates (TPR and TNR) and over- and underestimation of MTA. Inter-modality agreement expressed as Cohen's κ (dichotomized data), Cohen's κw, and two-way mixed, single measures, consistency ICC (ordinal data) were determined. Adequate agreement was defined as κ/κw ≥ 0.80 and ICC ≥ 0.80 (significance level at 95% CI ≥ 0.65). RESULTS Forty-nine subjects (median age 72 years, 27% abnormal MTA) with cognitive impairment were included. Only junior radiologists achieved adequate agreement expressed as Cohen's κ. All raters achieved adequate agreement expressed as Cohen's κw and ICC. True positive rates varied from 69 to 100% and TNR varied from 85 to 100%. No under- or overestimation of MTA was observed. Ratings did not differ between radiologists. CONCLUSION We conclude that radiologists with varying experience achieve adequate inter-modality agreement and similar accuracy when Scheltens' MTA scale is used to rate MTA on a non-demented population. However, TPR varied between radiologists which could be attributed to rating style differences. KEY POINTS • Radiologists with varying experience achieve adequate inter-modality agreement with similar accuracy when Scheltens' MTA scale is used to rate MTA on a non-demented population. • Differences in rating styles might affect accuracy, this was most evident for senior neuroradiologists, and only junior radiologists achieved adequate agreement on dichotomized (abnormal/normal) ratings. • The use of an MTA scale template might compensate for varying clinical experience which could make it applicable for clinical use.
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Affiliation(s)
- Claes Håkansson
- Department of Imaging and Function, Skåne University Hospital, Lund, Sweden.
- Department of Clinical Sciences, Diagnostic Radiology, Lund University, Lund, Sweden.
| | - Ashkan Tamaddon
- Department of Imaging and Function, Skåne University Hospital, Lund, Sweden
| | - Henrik Andersson
- Department of Imaging and Function, Skåne University Hospital, Lund, Sweden
| | - Gustav Torisson
- Department of Translational Medicine, Clinical Infection Medicine, Lund University, Malmö, Sweden
- Department of Clinical Sciences Malmö, Clinical Memory Research Unit, Lund University, Malmö, Sweden
| | - Gustav Mårtensson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - My Truong
- Department of Imaging and Function, Skåne University Hospital, Lund, Sweden
- Department of Clinical Sciences, Diagnostic Radiology, Lund University, Lund, Sweden
| | - Mårten Annertz
- Department of Imaging and Function, Skåne University Hospital, Lund, Sweden
| | - Elisabet Londos
- Department of Clinical Sciences Malmö, Clinical Memory Research Unit, Lund University, Malmö, Sweden
- Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | | | - Oskar Hansson
- Department of Clinical Sciences Malmö, Clinical Memory Research Unit, Lund University, Malmö, Sweden
- Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - Danielle van Westen
- Department of Imaging and Function, Skåne University Hospital, Lund, Sweden
- Department of Clinical Sciences, Diagnostic Radiology, Lund University, Lund, Sweden
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Hoffmann-Vold AM, Andersson H, Reiseter S, Fretheim H, Barua I, Garen T, Midtvedt Ø, Gunnarsson R, Durheim M, Aaløkken TM, Molberg Ø. OP0174 SUBCLINICAL INTERSTITIAL LUNG DISEASE IS FREQUENT AND PROGRESSES ACROSS DIFFERENT CONNECTIVE TISSUE DISEASES. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Based on the argument that symptoms define disease, physicians commonly apply the terms “preclinical” or “subclinical” disease to describe patients with disease-related findings but no accompanying symptoms for connective tissue disease associated interstitial lung disease (CTD-ILD). The term subclinical frequently applies to patients with mild ILD changes on high resolution chest tomography (HRCT), normal forced vital capacity (FVC), and without respiratory symptoms. Previous work in systemic sclerosis (SSc)-ILD did show that patients with even minor extent of ILD at baseline often progressed and had increased mortality risk, suggesting that it is not appropriate to define these patients as “subclinical.”Objectives:To identify the prevalence of subclinical ILD across CTD diagnoses, and assess the rate of progression of lung fibrosis compared to CTD without ILD and with clinical ILD.Methods:All CTD patients, including SSc, anti-synthetase syndrome (ASS) and mixed connective tissue disease (MCTD) from the Oslo University Hospital diagnosed before 2015 and assessed for the presence of ILD by HRCT were included. The year 2015 was chosen to secure an observation time of at least five years from ILD diagnosis to study end on 01.01.2021 or time of death. All patients fulfilled the respective CTD classification criteria. Subclinical ILD was defined as an ILD extent <5% by semi-quantitative assessment of baseline HRCT, preserved lung function with FVC >80% predicted and without respiratory symptoms. Clinical ILD was defined as >5% extent of ILD or <5% extent of ILD on HRCT with respiratory symtoms or FVC<80%. The outcome was ILD progression, defined as increasing extent of ILD from basline to follow-up HRCT by semi-quantitative assessment. Vital status was available in all patients and mortality was evaluated. Descriptive statistical analyses were conducted and time to ILD progression determined by Kaplan-Meier estimates.Results:We identified 525 CTD patients, including 296 with SSc, 135 with MCTD and 94 with ASS who had conducted a baseline HRCT. Of these, 227 (43%) had no ILD, 67 (13%) subclinical and 231 (44%) clinical ILD (Table). Of the 67 subclinical ILD patients, 45 (15%) had SSc, 13 (10%) MCTD and 9 (10%) ASS of thespecific cohorts. Over a median time of 4.5 years between baseline and follow-up HRCT, 95/395 (24%) showed progression of ILD, including 72 (26%) SSc and 23 (19%) MCTD patients. Disease progression frequently occurred in both subclinical ILD (38%) and clinical ILD (51%) patients (Figure). Age, gender, underlying CTD, and baseline lung function were not predictive for the progression of lung fibrosis. Progression was too infrequent to allow for meaningful multivariable regression analyses. After a median observation period of 12 years, 153 (29%) of the patients died. The 1-, 5- and 10-year survival rates in those without ILD, subclinical and clinical ILD were 97%/97%/99%, 88%/91%/82%, and 82%/85%/68% (p<0.001), respectively.Table 1.Clinical characteristics, demographics and outcomeNo ILD (n=227)Subclinical ILD (n=67)Clinical ILD (n=231)Age, y (SD)50 (15.4)51 (14.4)52 (15.3)Male sex, n (%)89 (39)22 (33)111 (48)Deceased, n (%)50 (22)12 (18)91 (39)Observation period, y median (range)13.7 (18.6)13.9 (17.9)11.5 (17.1)FVC% (SD)97 (18.6)99 (17.9)81 (20.9)FVC decline% (SD)-0.70 (11.1)-0.81 (16.5)-1.61 (15.9)DLCO% (SD)73 (19.4)73 (16.9)55 (17.4)Extent of ILD% (SD)0 (0)2.3 (1.5)19.3 (16.8)ILD progression% (SD)0.08 (1.0)3.1 (6.2)3.6 (9.9)ILD progressors, n (%)3 (2)20 (38)72 (51)Figure 1.Time to ILD progression in CTD without ILD, with subclinical and clinical ILDConclusion:Subclinical ILD is frequently present across CTDs and progresses over time in a substantial subgroup of patients, comparable to patients with clinical ILD. Our findings question the terms sub- and preclinical ILD, which may potentially lead to a suboptimal “watchful waiting management strategy”. Monitoring all CTD patients with any ILD is of high importance to identify disease progression early.Disclosure of Interests:Anna-Maria Hoffmann-Vold Speakers bureau: Actelion, Boehringer Ingelheim, Roche, Merck Sharp & Dohme, Lilly and Medscape, Consultant of: Actelion, Boehringer Ingelheim, Bayer, ARXX, and Medscape, Grant/research support from: Boehringer Ingelheim, Helena Andersson: None declared, Silje Reiseter: None declared, Håvard Fretheim Consultant of: Actelion, Bayer., Imon Barua: None declared, Torhild Garen: None declared, Øyvind Midtvedt: None declared, Ragnar Gunnarsson: None declared, Mike Durheim Speakers bureau: Boehringer Ingelheim and Roche, Consultant of: Boehringer Ingelheim, Grant/research support from: Boehringer Ingelheim, Trond M Aaløkken: None declared, Øyvind Molberg: None declared
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Olander A, Bremer A, Sundler AJ, Hagiwara MA, Andersson H. Assessment of patients with suspected sepsis in ambulance services: a qualitative interview study. BMC Emerg Med 2021; 21:45. [PMID: 33836665 PMCID: PMC8033740 DOI: 10.1186/s12873-021-00440-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 03/23/2021] [Indexed: 12/23/2022] Open
Abstract
Background The initial care of patients with sepsis is commonly performed by ambulance clinicians (ACs). Early identification, care and treatment are vital for patients with sepsis to avoid adverse outcomes. However, knowledge about how patients with sepsis are assessed in ambulance services (AS) by AC is limited. Therefore, the aim of this study was to explore the meaning of ACs’ lived experiences in assessing patients suspected of having sepsis. Methods A descriptive design with a qualitative approach was used. Fourteen ACs from three Swedish ambulance organizations participated in dyadic and individual semistructured interviews. A thematic analysis based on descriptive phenomenology was performed. Results AC experiences were grouped into four themes: (1) being influenced by previous experience; (2) searching for clues to the severity of the patient’s condition; (3) feeling confident when signs and symptoms were obvious; and (4) needing health-care professionals for support and consultation. Conclusions This study indicates that several factors are important to assessments. ACs needed to engage in an ongoing search for information, discuss the cases with colleagues and reconsider the assessment throughout the entire ambulance mission. A reflective and open stance based on professional knowledge could contribute to recognizing patients with sepsis.
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Affiliation(s)
- Agnes Olander
- University of Borås, PreHospen, Centre for Prehospital Research, SE- 405 30, Borås, Sweden. .,University of Borås, Faculty of Caring Science, Work Life and Social Welfare, Borås, Sweden.
| | - Anders Bremer
- University of Borås, PreHospen, Centre for Prehospital Research, SE- 405 30, Borås, Sweden.,University of Borås, Faculty of Caring Science, Work Life and Social Welfare, Borås, Sweden.,Linnaeus University, Faculty of Health and Life Sciences, Växjö, Sweden
| | - Annelie J Sundler
- University of Borås, Faculty of Caring Science, Work Life and Social Welfare, Borås, Sweden
| | - Magnus Andersson Hagiwara
- University of Borås, PreHospen, Centre for Prehospital Research, SE- 405 30, Borås, Sweden.,University of Borås, Faculty of Caring Science, Work Life and Social Welfare, Borås, Sweden
| | - Henrik Andersson
- University of Borås, PreHospen, Centre for Prehospital Research, SE- 405 30, Borås, Sweden.,University of Borås, Faculty of Caring Science, Work Life and Social Welfare, Borås, Sweden
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Johansson Blixt P, Chew MS, Åhman R, de Geer L, Blomqwist L, Åström Aneq M, Engvall J, Andersson H. Left ventricular longitudinal wall fractional shortening accurately predicts longitudinal strain in critically ill patients with septic shock. Ann Intensive Care 2021; 11:52. [PMID: 33782770 PMCID: PMC8007689 DOI: 10.1186/s13613-021-00840-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 03/11/2021] [Indexed: 11/16/2022] Open
Abstract
Background Left ventricular longitudinal strain (LVLS) may be a sensitive indicator of left ventricular (LV) systolic function in patients with sepsis, but is dependent on high image quality and analysis software. Mitral annular plane systolic excursion (MAPSE) and the novel left ventricular longitudinal wall fractional shortening (LV-LWFS) are bedside echocardiographic indicators of LV systolic function that are less dependent on image quality. Both are sparsely investigated in the critically ill population, and may potentially be used as surrogates for LVLS. We assessed if LVLS may be predicted by LV-LWFS and MAPSE in patients with septic shock. We also assessed the repeatability and inter-rater agreement of LVLS, LV-LWFS and MAPSE measurements. Results 122 TTE studies from 3 echocardiographic data repositories of patients admitted to ICU with septic shock were retrospectively assessed, of which 73 were suitable for LVLS analysis using speckle tracking. The correlations between LVLS vs. LV-LWFS and LVLS vs. MAPSE were 0.89 (p < 0.001) and 0.81 (p < 0.001) with mean squared errors of 5.8% and 9.1%, respectively. Using the generated regression equation, LV-LWFS predicted LVLS with a high degree of accuracy and precision, with bias and limits of agreement of -0.044 ± 4.7% and mean squared prediction error of 5.8%. Interobserver repeatability was good, with high intraclass correlation coefficients (0.96–0.97), small bias and tight limits of agreement (≤ 4.1% for all analyses) between observers for all measurements. Conclusions LV-LWFS may be used to estimate LVLS in patients with septic shock. MAPSE also performed well, but was slightly inferior compared to LV-LWFS in estimating LVLS. Feasibility of MAPSE and LV-LWFS was excellent, as was interobserver repeatability.
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Affiliation(s)
- Patrik Johansson Blixt
- Department of Anaesthesiology and Intensive Care, Biomedical and Clinical Sciences, Linköping University, S-58185, Linköping, Sweden.
| | - Michelle S Chew
- Department of Anaesthesiology and Intensive Care, Biomedical and Clinical Sciences, Linköping University, S-58185, Linköping, Sweden
| | - Rasmus Åhman
- Department of Anaesthesiology and Intensive Care, Biomedical and Clinical Sciences, Linköping University, S-58185, Linköping, Sweden
| | - Lina de Geer
- Department of Anaesthesiology and Intensive Care, Biomedical and Clinical Sciences, Linköping University, S-58185, Linköping, Sweden
| | - Lill Blomqwist
- Department of Anaesthesiology and Intensive Care, Skane University Hospital, Malmö, Sweden
| | - Meriam Åström Aneq
- Department of Clinical Physiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Jan Engvall
- Department of Clinical Physiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Center of Medical Image Science and Visualization, Linköping University, Linköping, Sweden
| | - Henrik Andersson
- Department of Anaesthesiology and Intensive Care, Biomedical and Clinical Sciences, Linköping University, S-58185, Linköping, Sweden
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Zhang R, Dahlström C, Zou H, Jonzon J, Hummelgård M, Örtegren J, Blomquist N, Yang Y, Andersson H, Olsen M, Norgren M, Olin H, Wang ZL. Cellulose-Based Fully Green Triboelectric Nanogenerators with Output Power Density of 300 W m -2. Adv Mater 2020; 32:e2002824. [PMID: 32803872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 06/08/2020] [Indexed: 06/11/2023]
Abstract
Triboelectric nanogenerators (TENGs) have attracted increasing attention because of their excellent energy conversion efficiency, the diverse choice of materials, and their broad applications in energy harvesting devices and self-powered sensors. New materials have been explored, including green materials, but their performances have not yet reached the level of that for fluoropolymers. Here, a high-performance, fully green TENG (FG-TENG) using cellulose-based tribolayers is reported. It is shown that the FG-TENG has an output power density of above 300 W m-2 , which is a new record for green-material-based TENGs. The high performance of the FG-TENG is due to the high positive charge density of the regenerated cellulose. The FG-TENG is stable after more than 30 000 cycles of operations in humidity of 30%-84%. This work demonstrates that high-performance TENGs can be made using natural green materials for a broad range of applications.
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Affiliation(s)
- Renyun Zhang
- Department of Natural Sciences, Mid Sweden University, Holmgatan 10, Sundsvall, SE-85170, Sweden
| | - Christina Dahlström
- FSCN, Surface and Colloid Engineering, Mid Sweden University, Holmgatan 10, Sundsvall, SE-85170, Sweden
| | - Haiyang Zou
- School of Materials Science and Engineering, Georgia Institute of Technology, Atlanta, GA, 30332-0245, USA
| | - Julia Jonzon
- Department of Natural Sciences, Mid Sweden University, Holmgatan 10, Sundsvall, SE-85170, Sweden
| | - Magnus Hummelgård
- Department of Natural Sciences, Mid Sweden University, Holmgatan 10, Sundsvall, SE-85170, Sweden
| | - Jonas Örtegren
- Department of Natural Sciences, Mid Sweden University, Holmgatan 10, Sundsvall, SE-85170, Sweden
| | - Nicklas Blomquist
- Department of Natural Sciences, Mid Sweden University, Holmgatan 10, Sundsvall, SE-85170, Sweden
| | - Ya Yang
- Beijing Institute of Nanoenergy and Nanosystems, Chinese Academy of Sciences, Beijing, 100083, P. R. China
| | - Henrik Andersson
- Department of Electronics Design, Mid Sweden University, Holmgatan 10, Sundsvall, SE-85170, Sweden
| | - Martin Olsen
- Department of Natural Sciences, Mid Sweden University, Holmgatan 10, Sundsvall, SE-85170, Sweden
| | - Magnus Norgren
- FSCN, Surface and Colloid Engineering, Mid Sweden University, Holmgatan 10, Sundsvall, SE-85170, Sweden
| | - Håkan Olin
- Department of Natural Sciences, Mid Sweden University, Holmgatan 10, Sundsvall, SE-85170, Sweden
| | - Zhong Lin Wang
- School of Materials Science and Engineering, Georgia Institute of Technology, Atlanta, GA, 30332-0245, USA
- Beijing Institute of Nanoenergy and Nanosystems, Chinese Academy of Sciences, Beijing, 100083, P. R. China
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Holmberg M, Hammarbäck S, Andersson H. Registered nurses’ experiences of assessing patients with mental illness in emergency care: A qualitative descriptive study. ACTA ACUST UNITED AC 2020. [DOI: 10.1177/2057158520941753] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Patients with mental illness are exposed and experience themselves as not being taken seriously in emergency care. Registered nurses need to assess patients with mental illness from a holistic perspective comprising both a physical and an existential dimension. The aim of the study was to describe registered nurses’ (RNs) experiences of assessing patients with mental illness in emergency care. Twenty-eight RNs in prehospital and in-hospital emergency care were individually interviewed. The interviews were analysed descriptively. The design followed the COREQ-checklist. One main theme ‘A conditional patient assessment’ and two themes; ‘A challenged professional role’ and ‘A limited openness for the patient’, comprising in turn four sub-themes emerged. Although the RNs showed willingness to understand the mental illness aspects of their patients, they were insufficient in their assessments. This implies the importance of developing emergency care RNs’ competence, knowledge and self-confidence in assessments and care of patients with mental illness.
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Affiliation(s)
- Mats Holmberg
- Region Sörmland, Department of Ambulance Service, Katrineholm, Sweden
- Linnaeus University, Faculty of Health and Life Sciences, Växjö, Sweden
- Linnaeus University, Centre of Interprofessional Collaboration within Emergency care (CICE), Växjö, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Staffan Hammarbäck
- Region Sörmland, Department of Ambulance Service, Katrineholm, Sweden
- Linnaeus University, Faculty of Health and Life Sciences, Växjö, Sweden
- Linnaeus University, Centre of Interprofessional Collaboration within Emergency care (CICE), Växjö, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Henrik Andersson
- University of Borås, PreHospen – Centre for Prehospital Research, Borås, Sweden
- University of Borås, Faculty of Caring Science, Work Life and Social Welfare, Borås, Sweden
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Bremer A, Andersson Hagiwara M, Tavares W, Paakkonen H, Nyström P, Andersson H. Translation and further validation of a global rating scale for the assessment of clinical competence in prehospital emergency care. Nurse Educ Pract 2020; 47:102841. [PMID: 32768897 DOI: 10.1016/j.nepr.2020.102841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 05/30/2020] [Accepted: 07/13/2020] [Indexed: 10/23/2022]
Abstract
Global rating scales are useful to assess clinical competence at a general level based on specific word dimensions. The aim of this study was to translate and culturally adapt the Paramedic Global Rating Scale, and to contribute validity evidence and instrument usefulness in training results and clinical competence assessments of students undergoing training to become ambulance nurses and paramedics at Swedish and Finnish universities. The study included translation, expert review and inter-rater reliability (IRR) tests. The scale was translated and culturally adapted to clinical and educational settings in both countries. A content validity index (CVI) was calculated using eight experts. IRR tests were performed with five registered nurses working as university lecturers, and with six clinicians working as ambulance nurses. They individually rated the same simulated ambulance assignment. Based on the ratings IRR was calculated with intra-class correlation (ICC). The scale showed excellent CVI for items and scale. The ICC indicated substantial agreement in the group of lecturers and a high degree of agreement in the group of clinicians. This study provides validity evidence for a Swedish version of the scale, supporting its use in measuring clinical competence among students undergoing training to become ambulance nurses and paramedics.
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Affiliation(s)
- Anders Bremer
- PreHospen - Centre for Prehospital Research, University of Borås, Sweden; Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Sweden; Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden.
| | - Magnus Andersson Hagiwara
- PreHospen - Centre for Prehospital Research, University of Borås, Sweden; Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Sweden.
| | - Walter Tavares
- The Wilson Centre, Department of Medicine, University of Toronto/University Health Network, Toronto, Canada; Post-MD Education (Post-Graduate Medical Education/Continued Professional Development), University of Toronto, Toronto, Canada; Paramedic and Senior Services, Community and Health Services Department, Regional Municipality of York, Newmarket, ON, Canada.
| | - Heikki Paakkonen
- Department of Health and Welfare, Arcada University of Applied Sciences, Helsinki, Finland.
| | - Patrik Nyström
- Department of Health and Welfare, Arcada University of Applied Sciences, Helsinki, Finland.
| | - Henrik Andersson
- PreHospen - Centre for Prehospital Research, University of Borås, Sweden; Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Sweden.
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Schanberg L, Nigrovic P, Cooper A, Chatham W, Akoghlanian S, Singh N, Rabinovich E, Thatayatikom A, Taxter A, Hausmann J, Zdravkovic M, Ohlman S, Andersson H, Cederholm S, Wikén M, Schneider R, De Benedetti F. AB1059 A RANDOMIZED, PLACEBO-CONTROLLED STUDY OF ANAKINRA IN PATIENTS WITH STILL´S DISEASE. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Adult-onset Still’s disease (AOSD) and systemic juvenile idiopathic arthritis (SJIA) are rare autoinflammatory disorders associated with an activated IL-1 pathway, characterized by spiking fever, rash, arthritis, lymphadenopathy, hepatosplenomegaly and serositis. There is a growing understanding that SJIA and AOSD are one disease with different ages of onset, i.e. Still’s disease. The anaSTILLs study (anakinra inStill´sdisease) was designed to further evaluate efficacy and safety of anakinra in patients with Still´s disease across all age groups.Objectives:The primary objective was to demonstrate efficacy of anakinra versus placebo as assessed by ACR30 response with absence of fever at Week 2. Secondary objectives included: early onset of efficacy, sustained efficacy, time to study drug discontinuation, safety, pharmacokinetics, clinical signs and biomarkers.Methods:‘anaSTILLs’ was a randomized, double-blind, placebo-controlled, 12-week study including patients with active and newly diagnosed (6 months) Still´s disease according to adapted ILAR criteria if <16, or Yamaguchi criteria, if ≥16 years of age at disease onset. Patients were randomized to anakinra 2 mg/kg (max 100 mg/day), 4 mg/kg (max 200 mg/day) or placebo.Results:12 patients were randomized and received study drug: 6 anakinra (2 mg/kg n=2, 4 mg/kg n=4) and 6 placebo, the study was terminated early due to slow recruitment. 1 patient on placebo had lymphoma, not Still’s disease, and was excluded; thus in total 11 patients were analyzed for efficacy, 8 were children [median (range) age=4.0 (1-11) years] and 3 were adults [median (range) age=32.0 (25-51) years]. 55% were male and the mean symptom duration was 74.2 days. All patients on anakinra but none on placebo achieved ACR30 response with absence of fever at Week 2 (p-value=0.0022). The efficacy of anakinra was further demonstrated by superiority to placebo in ACR50/70/90 responses with absence of fever at Week 2. All placebo patients discontinued the study within 6 weeks, 2 due to progressive disease, 2 due to lack of efficacy and 1 due to withdrawal by patient. There was a numerically higher proportion with early onset of efficacy (Week 1) in the anakinra group compared to placebo. The ACR30/50/70/90 responses in the anakinra group were sustained throughout the study period. Patients in the anakinra group had a prompt and persistent decrease in CRP and ferritin levels at Week 1, which was not observed in the placebo group. There were no unexpected safety findings. All anakinra patients developed anti-drug antibodies (ADAs) at some timepoint during the study. ADAs were persistent throughout the treatment period, except in one patient. Titers were low to moderate. One placebo patient had low ADA titers at one occasion. No neutralizing antibodies were observed and the ADAs did not appear to impact clinical efficacy or safety.Conclusion:Anakinra is superior to placebo in the treatment of Still’s disease. ADAs occur frequently but do not appear to adversely impact efficacy or safety. These results confirm the benefits of anakinra treatment in patients with active, newly diagnosed Still´s disease across ages.Disclosure of Interests:Laura Schanberg Grant/research support from: Sobi, BMS, Consultant of: Aurinia, UCB, Sanofi, Peter Nigrovic Grant/research support from: Novartis, BMS, Pfizer, Consultant of: Novartis, BMS, Pfizer, Sobi, Miach Orthopedics, Simcere, XBiotech, Quench Bio, Ashley Cooper: None declared, Winn Chatham Grant/research support from: Sobi, Consultant of: Sobi, Shoghik Akoghlanian: None declared, Namrata Singh: None declared, Egla Rabinovich Grant/research support from: AbbVie, UCB Pharma, Janssen Research & Development, Akaluck Thatayatikom: None declared, Alysha Taxter: None declared, Jonathan Hausmann Consultant of: Novartis, Milan Zdravkovic Shareholder of: Sobi, Employee of: Sobi, Sven Ohlman Shareholder of: Sobi, Employee of: Former employee of Sobi, Henrik Andersson Employee of: Sobi, Susanna Cederholm Shareholder of: Sobi, Employee of: Sobi, Margareta Wikén Shareholder of: Sobi, Employee of: Former employee of Sobi, Rayfel Schneider Grant/research support from: Roche, Novartis, Sobi, Pfizer, Consultant of: Sobi, Novartis, Novimmune, Fabrizio De Benedetti Grant/research support from: AbbVie, Pfizer, Novartis, Novimmune, Sobi, Sanofi, Roche, Speakers bureau: AbbVie, Novartis, Roche, Sobi
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Andersson H. Ethnic Enclaves, Self-employment, and the Economic Performance of Refugees: Evidence from a Swedish Dispersal Policy. International Migration Review 2020. [DOI: 10.1177/0197918320912195] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article estimates the causal effect of residential concentration of co-ethnics (ethnic enclaves) on the probability to start a business among refugees in Sweden. Results indicate that the share of self-employed co-ethnics in the port of entry municipality increases refugees’ probability of entry into self-employment, while the actual share of local co-ethnics has no effect or, in some cases, a negative effect. The results support the conclusion that skills and resources within the local ethnic enclave, particularly skills relevant for self-employment, are crucial for generating new entry into self-employment for refugees, while simply more co-ethnics, plausibly increasing an ethnic market’s size, are of less importance. Moreover, the results suggest that being placed with a larger share of self-employed co-ethnics is negatively related to refugees’ long-term disposable income; however, assuming there is no or little selection of high-ability refugees into self-employment, this negative relationship can be counteracted by the choice of self-employment. The study adds new knowledge on the arguably crucial topic of socio-economic integration of an important group of international migrants — namely, refugees.
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van Hoof M, Wigren S, Ivarsson Blechert J, Molin M, Andersson H, Mateijsen DJM, Bom SJH, Calmels MN, van der Rijt AJM, Flynn MC, van Tongeren J, Hof JR, Brunings JW, Anteunis LJC, Marco Algarra J, Stokroos RJ, Joore MA. A Multinational Cost-Consequence Analysis of a Bone Conduction Hearing Implant System-A Randomized Trial of a Conventional vs. a Less Invasive Treatment With New Abutment Technology. Front Neurol 2020; 11:106. [PMID: 32231633 PMCID: PMC7082879 DOI: 10.3389/fneur.2020.00106] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 01/30/2020] [Indexed: 02/03/2023] Open
Abstract
Background: It is hypothesized that, for patients with hearing loss, surgically placing an implant/abutment combination whilst leaving the subcutaneous tissues intact will improve cosmetic and clinical results, increase quality of life (QoL) for the patient, and reduce medical costs. Here, incremental costs and consequences associated with soft tissue preservation surgery with a hydroxyapatite (HA)-coated abutment (test) were compared with the conventional approach, soft tissue reduction surgery with an all-titanium abutment (control). Methods: A cost-consequence analysis was performed based on data gathered over a period of 3 years in an open randomized (1:1) controlled trial (RCT) running in four European countries (The Netherlands, Spain, France, and Sweden). Subjects with conductive or mixed hearing loss or single-sided sensorineural deafness were included. Results: During the first year, in the Netherlands (NL), France (FR), and Spain (ES) a net cost saving was achieved in favor of the test intervention because of a lower cost associated with surgery time and adverse event treatments [NL €86 (CI -50.33; 219.20), FR €134 (CI -3.63; 261.30), ES €178 (CI 34.12; 97.48)]. In Sweden (SE), the HA-coated abutment was more expensive than the conventional abutment, which neutralized the cost savings and led to a negative cost (SE €-29 CI -160.27; 97.48) of the new treatment modality. After 3 years, the mean cost saving reduced to €17 (CI -191.80; 213.30) in the Netherlands, in Spain to €84.50 (CI -117.90; 289.50), and in France to €80 (CI -99.40; 248.50). The mean additional cost in Sweden increased to €-116 (CI -326.90; 68.10). The consequences in terms of the subjective audiological benefit and Health-related quality of life (HRQoL) were comparable between treatments. A trend was identified for favorable results in the test group for some consequences and statistical significance is achieved for the cosmetic outcome as assessed by the clinician. Conclusions: From this multinational cost-consequence analysis it can be discerned that health care systems can achieve a cost saving during the first year that regresses after 3 years, by implementing soft tissue preservation surgery with a HA-coated abutment in comparison to the conventional treatment. The cosmetic results are better. (sponsored by Cochlear Bone Anchored Solutions AB; Clinical and health economic evaluation with a new Baha® abutment design combined with a minimally invasive surgical technique, ClinicalTrials.gov NCT01796236).
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Affiliation(s)
- Marc van Hoof
- Ear, Nose and Throat (ENT) Department, School for Mental Health and Neuroscience (MHENS), Maastricht University Medical Center, Maastricht, Netherlands
| | - Stina Wigren
- Cochlear Bone Anchored Solutions AB, Mölnlycke, Sweden
| | | | | | | | | | - Steven J H Bom
- ENT Department, Deventer Hospital, Deventer, Netherlands
| | - M N Calmels
- ENT Department, Purpan Hospital, Toulouse, France
| | | | - Mark C Flynn
- Cochlear Bone Anchored Solutions AB, Mölnlycke, Sweden
- Research and Innovation, University of Newcastle, Callaghan, NSW, Australia
| | - Joost van Tongeren
- Ear, Nose and Throat (ENT) Department, School for Mental Health and Neuroscience (MHENS), Maastricht University Medical Center, Maastricht, Netherlands
- Isala Clinics, Department of ENT, Zwolle, Netherlands
| | - Janny R Hof
- Ear, Nose and Throat (ENT) Department, School for Mental Health and Neuroscience (MHENS), Maastricht University Medical Center, Maastricht, Netherlands
| | - Jan Wouter Brunings
- Ear, Nose and Throat (ENT) Department, School for Mental Health and Neuroscience (MHENS), Maastricht University Medical Center, Maastricht, Netherlands
| | - Lucien J C Anteunis
- Ear, Nose and Throat (ENT) Department, School for Mental Health and Neuroscience (MHENS), Maastricht University Medical Center, Maastricht, Netherlands
| | | | - Robert Jan Stokroos
- Department of Otolaryngology, Head and Neck Surgery, Brain Center Rudolph Magnus, University Medical Center Utrecht, Utrecht, Netherlands
| | - Manuela A Joore
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, Netherlands
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Andersson H, Granberg TA, Christiansen M, Aartun ES, Leknes H. Using optimization to provide decision support for strategic emergency medical service planning - Three case studies. Int J Med Inform 2019; 133:103975. [PMID: 31704491 DOI: 10.1016/j.ijmedinf.2019.103975] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 07/02/2019] [Accepted: 09/22/2019] [Indexed: 10/25/2022]
Abstract
To achieve high performing emergency medical services (EMS), planning is of vital importance. EMS planners face several challenges when managing ambulance stations and the fleet of ambulances. In this paper, three strategic cases for EMS planners are presented together with potential solutions. In the first case, the effects of closing down a local emergency room (ER) are analyzed together with how adding an ambulance station and an ambulance to the area affected by the closing of the ER can be used to mitigate the negative consequences from the closing. The second case investigates a change in the organization of EMS. Currently, many non-urgent transport assignments are performed by ambulances which make them unavailable for more urgent calls. The potential for a more effective utilization of the ambulances is explored through transferring these assignments to designated transport vehicles. The third case is more technical and challenges the common practice regarding how time dependent demand is handled. Looking at the busiest hour or the average daily demand, is compared with taking time varying demand into account. The cases and solutions are studied using a recently developed strategic ambulance station location and ambulance allocation model for the Maximum Expected Performance Location Problem with Heterogeneous Regions (MEPLP-HR). The model has been extended to also include multiple time periods. This article demonstrates an innovative use of the model and how it can be applied to find and evaluate solutions to real cases within the field of strategic planning of EMS. The model is found to be a useful decision support tool when analyzing the cases and the expected performance of potential solutions.
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Affiliation(s)
- Henrik Andersson
- Department of Industrial Economics and Technology Management, Norwegian University of Science and Technology, Trondheim, Norway.
| | | | - Marielle Christiansen
- Department of Industrial Economics and Technology Management, Norwegian University of Science and Technology, Trondheim, Norway
| | - Eirik Skorge Aartun
- Department of Industrial Economics and Technology Management, Norwegian University of Science and Technology, Trondheim, Norway
| | - Håkon Leknes
- Department of Industrial Economics and Technology Management, Norwegian University of Science and Technology, Trondheim, Norway
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Andersson H, Christensen TE, Ahtarovski K, Rasmussen T, Ghotbi A, Thomsen JH, Soeholm H, Nepper-Christensen L, Engstroem T, Vejlstrup N, Grande P, Bang LE, Clemmensen P, Hasbak P, Holmvang L. P612Multimodal cardiac imaging in patients with suspected ST-elevation myocardial infarction and no obstructive coronary arteries. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Patients with suspected ST-elevation myocardial infarction (STEMI) and normal coronary arteries comprise a heterogeneous group with various underlying causes of disease.
Purpose
To study pathophysiology and underlying diagnoses in patients with suspected STEMI and normal coronary arteries using multimodal cardiac imaging.
Methods
We consecutively included patients with suspected STEMI, normal coronary arteries on acute coronary angiography, and elevated troponin T levels at a tertiary heart center (2012–14). Patients were examined with echocardiography, cardiac magnetic resonance imaging, and 13NH3/82Rb and 18F-FDG positron emission tomography within one week from symptom onset.
Results
We included 42 patients (60% male, median age 58 (IQR 50–65) years. Median troponin T levels were 783 (IQR 566–1208) ng/l. Multimodal cardiac imaging findings are presented in Table 1. Multimodal cardiac imaging showed signs of cardiac involvement in all but one patient (98%). Underlying diagnoses were acute myocardial infarction (36%), Takotsubo cardiomyopathy (29%), perimyocarditis (10%), and cardiomyopathy (7%). The diagnosis was unclear in 19% of patients.
Echocardiography Left ventricular ejection fraction <40%, n (%) 12 (29) Moderate to severe left ventricular hypertrophy, n (%) 3 (7) Moderate to severe valvular disease, n (%) 3 (7) Pericardial effusion, n (%) 5 (12) Apical thrombus, n (%) 1 (2) Magnetic resonance imaging Left ventricular end diastolic volume, ml (IQR) 157 (125–185) Left ventricular end systolic volume, ml (IQR) 75 (63–88) Left ventricular stroke volume, ml (IQR) 73 (57–93) Edema, n (%) 38 (91) Late gadolinium enhancement, n (%) 22 (52) 13NH3/82Rb and 18F-FDG positron emission computer tomography Myocardial perfusion defect, n (%) 29 (69) Myocardial perfusion-metabolism mismatch, n (%) 12/30 (40) Reduced myocardial viability, n (%) 6/30 (20)
Conclusion
The majority of patients with suspected STEMI and normal coronary arteries had signs of cardiac involvement by multimodal cardiac imaging and were diagnosed with cardiac disease.
Acknowledgement/Funding
The Danish Heart Foundation, the A.P. Møller Foundation, the Foundation of Reinholdt W. Jorck and Wife, Rigshospitalet's Research Foundation
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Affiliation(s)
- H Andersson
- Rigshospitalet - Copenhagen University Hospital, The Heart Centre, Department of Cardiology, Copenhagen, Denmark
| | - T E Christensen
- Rigshospitalet - Copenhagen University Hospital, Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Copenhagen, Denmark
| | - K Ahtarovski
- Rigshospitalet - Copenhagen University Hospital, The Heart Centre, Department of Cardiology, Copenhagen, Denmark
| | - T Rasmussen
- Rigshospitalet - Copenhagen University Hospital, Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Copenhagen, Denmark
| | - A Ghotbi
- Rigshospitalet - Copenhagen University Hospital, Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Copenhagen, Denmark
| | - J H Thomsen
- Rigshospitalet - Copenhagen University Hospital, The Heart Centre, Department of Cardiology, Copenhagen, Denmark
| | - H Soeholm
- Rigshospitalet - Copenhagen University Hospital, The Heart Centre, Department of Cardiology, Copenhagen, Denmark
| | - L Nepper-Christensen
- Rigshospitalet - Copenhagen University Hospital, The Heart Centre, Department of Cardiology, Copenhagen, Denmark
| | - T Engstroem
- Rigshospitalet - Copenhagen University Hospital, The Heart Centre, Department of Cardiology, Copenhagen, Denmark
| | - N Vejlstrup
- Rigshospitalet - Copenhagen University Hospital, The Heart Centre, Department of Cardiology, Copenhagen, Denmark
| | - P Grande
- Nykøbing F Hospital - University of Southern Denmark, Odense, Denmark, Department of Medicine, Nykøbing Falster, Denmark
| | - L E Bang
- Rigshospitalet - Copenhagen University Hospital, The Heart Centre, Department of Cardiology, Copenhagen, Denmark
| | - P Clemmensen
- University Heart Center, Hamburg-Eppendorf, Department of General and Interventional Cardiology, Hamburg, Germany
| | - P Hasbak
- Rigshospitalet - Copenhagen University Hospital, Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Copenhagen, Denmark
| | - L Holmvang
- Rigshospitalet - Copenhagen University Hospital, The Heart Centre, Department of Cardiology, Copenhagen, Denmark
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Andersson H, Laustsen LS, Laustsen A, Pedersen F, Bang LE, Bates ER, Nallamothu BK, Blankenberg S, Grande P, Clemmensen P, Holmvang L. P885Cardiovascular events in patients with suspected ST-elevation myocardial infarction and no obstructive coronary artery disease. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Patients with suspected ST-elevation myocardial infarction (STEMI) and no obstructive coronary artery disease (CAD) comprise a heterogeneous group with varying prognoses.
Purpose
To evaluate the prognostic value of cardiac troponin T (cTnT) in patients with suspected STEMI and no obstructive CAD.
Methods
Patients with suspected STEMI and no obstructive (<50% diameter stenosis) CAD were consecutively included from 2009–2014. Patients were classified as having normal cTnT, dynamic cTnT elevation, or stationary cTnT elevation. All patients were followed with respect to major adverse cardiovascular events (MACE), cardiovascular readmission, and repeat coronary procedures, until 1 year after discharge.
Results
The study included 502 patients with suspected STEMI and no obstructive CAD: 165 (33%) had normal cTnT, 293 (58%) had dynamic cTnT elevation and 44 (9%) had stationary cTnT elevation. Within one year after admission, 40 (8%) had MACE, 81 (16%) had cardiovascular readmission, and 8 (2%) underwent repeat coronary procedures. The risk of MACE was elevated in patients with stationary cTnT elevation compared with normal cTnT (OR 13.6, 95% CI 2.3–80.2, p=0.004). There was no statistically significant difference between those with dynamic cTnT elevation and normal cTnT (OR 2.9, 95% CI 0.6–14.0, p=0.189). Adding cTnT pattern to a conventional risk model, area under the receiver operating curve for predicting the 1-year risk of MACE improved significantly (80% vs. 85%, p=0.004, Figure 1).
Figure 1
Conclusion
In patients with suspected STEMI and no obstructive CAD, cTnT pattern during acute hospitalization is associated with the 1-year risk of MACE and improves risk prediction for the individual patient.
Acknowledgement/Funding
The Danish Heart Foundation, the A.P. Møller Foundation, the Foundation of Reinholdt W. Jorck and Wife, Rigshospitalet's Research Foundation
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Affiliation(s)
- H Andersson
- Rigshospitalet - Copenhagen University Hospital, The Heart Centre, Department of Cardiology, Copenhagen, Denmark
| | - L S Laustsen
- Rigshospitalet - Copenhagen University Hospital, The Heart Centre, Department of Cardiology, Copenhagen, Denmark
| | - A Laustsen
- Rigshospitalet - Copenhagen University Hospital, The Heart Centre, Department of Cardiology, Copenhagen, Denmark
| | - F Pedersen
- Rigshospitalet - Copenhagen University Hospital, The Heart Centre, Department of Cardiology, Copenhagen, Denmark
| | - L E Bang
- Rigshospitalet - Copenhagen University Hospital, The Heart Centre, Department of Cardiology, Copenhagen, Denmark
| | - E R Bates
- University of Michigan, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor, United States of America
| | - B K Nallamothu
- University of Michigan, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor, United States of America
| | - S Blankenberg
- University Heart Center, Hamburg-Eppendorf, Department of General and Interventional Cardiology, Hamburg, Germany
| | - P Grande
- Nykøbing F Hospital - University of Southern Denmark, Odense, Denmark, Department of Medicine, Nykøbing Falster, Denmark
| | - P Clemmensen
- University Heart Center, Hamburg-Eppendorf, Department of General and Interventional Cardiology, Hamburg, Germany
| | - L Holmvang
- Rigshospitalet - Copenhagen University Hospital, The Heart Centre, Department of Cardiology, Copenhagen, Denmark
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Andersson U, Maurin Söderholm H, Wireklint Sundström B, Andersson Hagiwara M, Andersson H. Clinical reasoning in the emergency medical services: an integrative review. Scand J Trauma Resusc Emerg Med 2019; 27:76. [PMID: 31426839 PMCID: PMC6700770 DOI: 10.1186/s13049-019-0646-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 07/15/2019] [Indexed: 11/25/2022] Open
Abstract
Abstract Clinical reasoning is the process of gathering and understanding information conducted by clinicians in the emergency medical services (EMS) so as to make informed decisions. Research on clinical reasoning spans several disciplines, but a comprehensive view of the process is lacking. To our knowledge, no review of clinical reasoning in the EMS has been conducted. Aim The aim was to investigate the nature, deployment, and factors influencing EMS clinicians’ clinical reasoning by means of a review. Method Data was collected through searches in electronic databases, networking among research teams, colleagues and friends, “grey literature,” and through ancestry searches. A total of 38 articles were deemed eligible for inclusion and were analyzed using descriptive thematic analysis. The analysis resulted in an overarching finding - namely, the importance for EMS clinicians to adjust for perceived control in unpredictable situations. Within this finding, 3 themes emerged in terms of EMS clinicians’ clinical reasoning: (1) maintaining a holistic view of the patient; (2) keeping an open mind; and (3) improving through criticism. Seven subthemes subsequently emerged from these three themes. Results This review showed that EMS clinicians’ clinical reasoning begins with the information that they are given about a patient. Based on this information, clinicians calculate the best route to the patient and which equipment to use, and they also assess potential risks. They need to be constantly aware of what is happening on the scene and with the patient and strive to control the situation. This striving also enables EMS clinicians to work safely and effectively in relation to the patient, their relatives, other clinicians, associated organizations, and the wider community. A lack of contextually appropriate guidelines results in the need for creativity and forces EMS clinicians to use “workarounds” to solve issues beyond the scope of the guidelines available. In addition, they often lack organizational support and fear repercussions such as litigation, unemployment, or blame by their EMS or healthcare organization or by patients and relatives. Conclusion Clinical reasoning is influenced by several factors. Further research is needed to determine which influencing factors can be addressed through interventions to minimize their impact on patient outcomes. Electronic supplementary material The online version of this article (10.1186/s13049-019-0646-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ulf Andersson
- Faculty of Caring Science, Work Life, and Social Welfare, University of Borås, Borås, Sweden. .,PreHospen-Centre for Prehospital Research, University of Borås, Borås, Sweden.
| | - Hanna Maurin Söderholm
- Faculty of Caring Science, Work Life, and Social Welfare, University of Borås, Borås, Sweden.,PreHospen-Centre for Prehospital Research, University of Borås, Borås, Sweden.,Swedish School of Library and Information Science, University of Borås, Borås, Sweden
| | - Birgitta Wireklint Sundström
- Faculty of Caring Science, Work Life, and Social Welfare, University of Borås, Borås, Sweden.,PreHospen-Centre for Prehospital Research, University of Borås, Borås, Sweden
| | - Magnus Andersson Hagiwara
- Faculty of Caring Science, Work Life, and Social Welfare, University of Borås, Borås, Sweden.,PreHospen-Centre for Prehospital Research, University of Borås, Borås, Sweden
| | - Henrik Andersson
- Faculty of Caring Science, Work Life, and Social Welfare, University of Borås, Borås, Sweden.,PreHospen-Centre for Prehospital Research, University of Borås, Borås, Sweden
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Olander A, Andersson H, Sundler AJ, Bremer A, Ljungström L, Andersson Hagiwara M. Prehospital characteristics among patients with sepsis: a comparison between patients with or without adverse outcome. BMC Emerg Med 2019; 19:43. [PMID: 31387528 PMCID: PMC6685242 DOI: 10.1186/s12873-019-0255-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 07/19/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The prehospital care of patients with sepsis are commonly performed by the emergency medical services. These patients may be critically ill and have high in-hospital mortality rates. Unfortunately, few patients with sepsis are identified by the emergency medical services, which can lead to delayed treatment and a worse prognosis. Therefore, early identification of patients with sepsis is important, and more information about the prehospital characteristics that can be used to identify these patients is needed. Based on this lack of information, the objectives of this study were to investigate the prehospital characteristics that are identified while patients with sepsis are being transported to the hospital by the emergency medical services, and to compare these values to those of the patients with and without adverse outcomes during their hospital stays. METHODS This was a retrospective observational study. The patients' electronic health records were reviewed and selected consecutively based on the following: retrospectively diagnosed with sepsis and transported to an emergency department by the emergency medical services. Data were collected on demographics, prehospital characteristics and adverse outcomes, defined as the in-hospital mortality or treatment in the intensive care unit, and analysed by independent sample t-test and chi-square. Sensitivity, specificity and likelihood ratio, of prehospital characteristics for predicting or development of adverse outcome were analysed. RESULTS In total, 327 patients were included. Of these, 50 patients had adverse outcomes. When comparing patients with or without an adverse outcome, decreased oxygen saturation and body temperature, increased serum glucose level and altered mental status during prehospital care were found to be associated with an adverse outcome. CONCLUSIONS The findings suggests that patients having a decreased oxygen saturation and body temperature, increased serum glucose level and altered mental status during prehospital care are at risk of a poorer patient prognosis and adverse outcome. Recognizing these prehospital characteristics may help to identify patients with sepsis early and improve their long-term outcomes. However further research is required to predict limit values of saturation and serum glucose and to validate the use of prehospital characteristics for adverse outcome in patients with sepsis.
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Affiliation(s)
- Agnes Olander
- PreHospen - Centre for Prehospital Research, University of Borås, Allégatan 1, SE- 405 30, Borås, Sweden. .,Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden.
| | - Henrik Andersson
- PreHospen - Centre for Prehospital Research, University of Borås, Allégatan 1, SE- 405 30, Borås, Sweden.,Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Annelie J Sundler
- PreHospen - Centre for Prehospital Research, University of Borås, Allégatan 1, SE- 405 30, Borås, Sweden
| | - Anders Bremer
- PreHospen - Centre for Prehospital Research, University of Borås, Allégatan 1, SE- 405 30, Borås, Sweden.,Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden.,Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
| | - Lars Ljungström
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Infectious Diseases, Skaraborg Hospital, RegionVästra Götaland, Skövde, Sweden
| | - Magnus Andersson Hagiwara
- PreHospen - Centre for Prehospital Research, University of Borås, Allégatan 1, SE- 405 30, Borås, Sweden.,Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
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Olsen M, Zhang R, Örtegren J, Andersson H, Yang Y, Olin H. Frequency and voltage response of a wind-driven fluttering triboelectric nanogenerator. Sci Rep 2019; 9:5543. [PMID: 30944397 PMCID: PMC6447574 DOI: 10.1038/s41598-019-42128-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 03/25/2019] [Indexed: 11/28/2022] Open
Abstract
Triboelectric nanogenerators (TENG:s) are used as efficient energy transducers in energy harvesting converting mechanical energy into electrical energy. Wind is an abundant source of mechanical energy but how should a good triboelectric wind harvester be designed? We have built and studied a TENG driven by air flow in a table-top sized wind tunnel. Our TENG constitutes of a plastic film of size 10 cm × 2 cm which is fluttering between two copper electrodes generating enough power to light up a battery of LED:s. We measured the voltage and frequency of fluttering at different wind speeds from zero up to 8 m/s for three electrode distances 6 mm, 10 mm and 14 mm. We found that the frequency increases linearly with the wind speed with a cutoff at some low speed. Power was generated already at 1.6 m/s. We seem to be able to explain the observed frequency dependence on wind speed by assuming excitation of the film into different harmonics in response to von Kármán vortices. We also find that the voltage increase linearly with frequency. We anticipate that TENG:s of this design could be useful both as generators and speed sensors because they work at low air speeds.
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Affiliation(s)
- Martin Olsen
- Department of Natural Sciences, Mid Sweden University, 851 70, Sundsvall, Sweden.
| | - Renyun Zhang
- Department of Natural Sciences, Mid Sweden University, 851 70, Sundsvall, Sweden
| | - Jonas Örtegren
- Department of Natural Sciences, Mid Sweden University, 851 70, Sundsvall, Sweden
| | - Henrik Andersson
- Department of Electronics Design, Mid Sweden University, 851 70, Sundsvall, Sweden
| | - Ya Yang
- CAS Center for Excellence in Nanoscience, Beijing Institute of Nanoenergy and Nanosystems, Chinese Academy of Sciences, Beijing, 100083, P. R. China
| | - Håkan Olin
- Department of Natural Sciences, Mid Sweden University, 851 70, Sundsvall, Sweden
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Maurin Söderholm H, Andersson H, Andersson Hagiwara M, Backlund P, Bergman J, Lundberg L, Sjöqvist BA. Research challenges in prehospital care: the need for a simulation-based prehospital research laboratory. Adv Simul (Lond) 2019; 4:3. [PMID: 30783539 PMCID: PMC6375122 DOI: 10.1186/s41077-019-0090-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 02/05/2019] [Indexed: 11/20/2022] Open
Abstract
There is a need for improved research in the field of prehospital care. At the same time, there are many barriers in prehospital research due to the complex context, posing unique challenges for research, development, and evaluation. The present paper argues for the potential of simulation for prehospital research, e.g., through the development of an advanced simulation-based prehospital research laboratory. However, the prehospital context is different from other healthcare areas, which implies special requirements for the design of this type of laboratory, in terms of simulation width (including the entire prehospital work process) and depth (level of scenario detail). A set of features pertaining to simulation width, scenario depth, equipment, and personnel and competence are proposed. Close tailoring between these features and the prehospital research problems and context presents great potential to improve and further prehospital research.
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Affiliation(s)
- Hanna Maurin Söderholm
- 1PreHospen - Centre for Prehospital Research, Faculty of Librarianship, Information, Education and IT, University of Borås, SE-501 90 Borås, Sweden
| | - Henrik Andersson
- 2PreHospen - Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90 Borås, Sweden
| | - Magnus Andersson Hagiwara
- 2PreHospen - Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90 Borås, Sweden
| | - Per Backlund
- 3School of Informatics, University of Skövde, Box 408, SE-541 28 Skövde, Sweden
| | - Johanna Bergman
- PICTA - Prehospital ICT Arena, Lindholmen Science Park AB, SE-402 78 Göteborg, Sweden
| | - Lars Lundberg
- 2PreHospen - Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90 Borås, Sweden
| | - Bengt Arne Sjöqvist
- 5Biomedical Signals and Systems, Department of Electrical Engineering, Chalmers University of Technology, SE-412 96 Gothenburg, Sweden
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Andersson H, Levivier E, Lindberg G. Private and public willingness to pay for safety: A validity test. Accid Anal Prev 2019; 123:170-175. [PMID: 30517899 DOI: 10.1016/j.aap.2018.11.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 11/14/2018] [Accepted: 11/27/2018] [Indexed: 06/09/2023]
Abstract
Stated preference (SP) methods are often used to elicit an affected population's preferences for, e.g., increased safety or better environmental quality. SP methods are based on hypothetical market scenarios which have advantages, since decision alternatives are known to the analysis, but also necessitate thorough validity tests of the results, since decisions are hypothetical. This study suggests a validity test based on theoretical predictions and empirical findings for private and public safety measures. According to the test, willingness to pay (WTP) for a public safety measure should exceed or be equal to the private one. Based on a rich data set eliciting both private and public WTP the results show that private WTP exceeds public WTP. Hence, the findings in this study highlight the importance of validity tests of preference estimates for safety, and suggest that WTP also for a private safety measure should be elicited in studies eliciting WTP for public safety measures, to allow for the validity test.
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Affiliation(s)
- Henrik Andersson
- Toulouse School of Economics, University of Toulouse Capitole, Toulouse, France.
| | - Elodie Levivier
- Toulouse School of Economics, University of Toulouse Capitole, Toulouse, France
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Woo LA, Tkachenko S, Ding M, Plowright AT, Engkvist O, Andersson H, Drowley L, Barrett I, Firth M, Akerblad P, Wolf MJ, Bekiranov S, Brautigan DL, Wang QD, Saucerman JJ. High-content phenotypic assay for proliferation of human iPSC-derived cardiomyocytes identifies L-type calcium channels as targets. J Mol Cell Cardiol 2018; 127:204-214. [PMID: 30597148 DOI: 10.1016/j.yjmcc.2018.12.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 12/21/2018] [Accepted: 12/27/2018] [Indexed: 01/06/2023]
Abstract
Over 5 million people in the United States suffer from heart failure, due to the limited ability to regenerate functional cardiac tissue. One potential therapeutic strategy is to enhance proliferation of resident cardiomyocytes. However, phenotypic screening for therapeutic agents is challenged by the limited ability of conventional markers to discriminate between cardiomyocyte proliferation and endoreplication (e.g. polyploidy and multinucleation). Here, we developed a novel assay that combines automated live-cell microscopy and image processing algorithms to discriminate between proliferation and endoreplication by quantifying changes in the number of nuclei, changes in the number of cells, binucleation, and nuclear DNA content. We applied this assay to further prioritize hits from a primary screen for DNA synthesis, identifying 30 compounds that enhance proliferation of human induced pluripotent stem cell-derived cardiomyocytes. Among the most active compounds from the phenotypic screen are clinically approved L-type calcium channel blockers from multiple chemical classes whose activities were confirmed across different sources of human induced pluripotent stem cell-derived cardiomyocytes. Identification of compounds that stimulate human cardiomyocyte proliferation may provide new therapeutic strategies for heart failure.
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Affiliation(s)
- Laura A Woo
- Department of Biomedical Engineering and Robert M. Berne Cardiovascular Research Center, University of Virginia, USA
| | - Svyatoslav Tkachenko
- Department of Biomedical Engineering and Robert M. Berne Cardiovascular Research Center, University of Virginia, USA
| | - Mei Ding
- Discovery Sciences, IMED Biotech Unit, AstraZeneca Gothenburg, Sweden
| | - Alleyn T Plowright
- Medicinal Chemistry, Cardiovascular, Renal and Metabolism, IMED Biotech Unit, AstraZeneca Gothenburg, Sweden
| | - Ola Engkvist
- Discovery Sciences, IMED Biotech Unit, AstraZeneca Gothenburg, Sweden
| | - Henrik Andersson
- Discovery Sciences, IMED Biotech Unit, AstraZeneca Gothenburg, Sweden
| | - Lauren Drowley
- Bioscience Heart Failure, Cardiovascular, Renal and Metabolism, IMED Biotech Unit, AstraZeneca Gothenburg, Sweden
| | - Ian Barrett
- Discovery Sciences, IMED Biotech Unit, AstraZeneca Cambridge, UK
| | - Mike Firth
- Discovery Sciences, IMED Biotech Unit, AstraZeneca Cambridge, UK
| | - Peter Akerblad
- Bioscience Heart Failure, Cardiovascular, Renal and Metabolism, IMED Biotech Unit, AstraZeneca Gothenburg, Sweden
| | - Matthew J Wolf
- Department of Medicine and Robert M. Berne Cardiovascular Research Center, University of Virginia, USA
| | - Stefan Bekiranov
- Department of Biochemistry and Molecular Genetics, University of Virginia, USA
| | - David L Brautigan
- Center for Cell Signaling, Department of Microbiology, Immunology & Cancer Biology, University of Virginia, USA
| | - Qing-Dong Wang
- Bioscience Heart Failure, Cardiovascular, Renal and Metabolism, IMED Biotech Unit, AstraZeneca Gothenburg, Sweden
| | - Jeffrey J Saucerman
- Department of Biomedical Engineering and Robert M. Berne Cardiovascular Research Center, University of Virginia, USA.
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Holmberg M, Andersson H, Winge K, Lundberg C, Karlsson T, Herlitz J, Wireklint Sundström B. Association between the reported intensity of an acute symptom at first prehospital assessment and the subsequent outcome: a study on patients with acute chest pain and presumed acute coronary syndrome. BMC Cardiovasc Disord 2018; 18:216. [PMID: 30486789 PMCID: PMC6260754 DOI: 10.1186/s12872-018-0957-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 11/16/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND To decrease the morbidity burden of cardiovascular disease and to avoid the development of potentially preventable complications, early assessment and treatment of acute coronary syndrome (ACS) are important. The aim of this study has therefore been to explore the possible association between patients' estimated intensity of chest pain when first seen by the ambulance crew in suspected ACS, and the subsequent outcome before and after arrival in hospital. METHODS Data was collected both prospectively and retrospectively. The inclusion criteria were chest pain raising suspicion of ACS and a reported intensity of pain ≥4 on the visual analogue scale. RESULTS All in all, 1603 patients were included in the study. Increased intensity of chest pain was related to: 1) more heart-related complications before hospital admission; 2) a higher proportion of heart failure, anxiety and chest pain after hospital admission; 3) a higher proportion of acute myocardial infarction and 4) a prolonged hospitalisation. However, there was no significant association with mortality neither in 30 days nor in three years. Adjustment for possible confounders including age, a history of smoking and heart failure showed similar results. CONCLUSION The estimated intensity of chest pain reported by the patients on admission by the ambulance team was associated with the risk of complications prior to hospital admission, heart failure, anxiety and chest pain after hospital admission, the final diagnosis and the number of days in hospital. TRIAL REGISTRATION ClinicalTrials.gov 151:2008/4564 Identifier: NCT00792181. Registred 17 November 2008 'retrospectively registered'.
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Affiliation(s)
- Mats Holmberg
- Department of Ambulance Service, Sörmland County Council, Eskilstuna, Sweden
- School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna, Sweden
- PreHospen – Centre for Prehospital Research, University of Borås, Borås, Sweden
| | - Henrik Andersson
- PreHospen – Centre for Prehospital Research, University of Borås, Borås, Sweden
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Karin Winge
- Ambulance Department, South Älvsborgs Hospital, Borås, Sweden
| | | | - Thomas Karlsson
- Health Metrics at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Johan Herlitz
- PreHospen – Centre for Prehospital Research, University of Borås, Borås, Sweden
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Birgitta Wireklint Sundström
- PreHospen – Centre for Prehospital Research, University of Borås, Borås, Sweden
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
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Balliu E, Andersson H, Engholm M, Öhlund T, Nilsson HE, Olin H. Selective laser sintering of inkjet-printed silver nanoparticle inks on paper substrates to achieve highly conductive patterns. Sci Rep 2018; 8:10408. [PMID: 29991735 PMCID: PMC6039461 DOI: 10.1038/s41598-018-28684-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 06/26/2018] [Indexed: 11/30/2022] Open
Abstract
Development of cost-effective and environmentally friendly manufacturing methods will enable important advances for the production of large-scale flexible electronics. Laser processing has shown to be a promising candidate that offers a fast and non-destructive way to produce highly conductive patterns on flexible substrates such as plastics. However, an emerging option with a lower environmental impact is instead the use of cellulose-based flexible substrates, such as paper. In this work we investigate the use of laser sintering of silver nanoparticle inks, which were inkjet-printed on three different types of paper. Patterns with a high conductivity could be manufactured where a special care was taken to prevent the substrates from damage by the intense laser light. We found that the best results was obtained for a photopaper, with a conductivity of 1.63 ∗ 107 S/m corresponding to nearly 26% of the bulk silver conductivity. In addition, we demonstrate laser sintering to fabricate a fully functional near field communication tag printed on a photopaper. Our results can have an important bearing for the development of cost-effective and environmentally friendly production methods for flexible electronics on a large scale.
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Affiliation(s)
- Enkeleda Balliu
- Mid Sweden University, Department of Electronics Design, Sundsvall, 851 70, Sweden.
| | - Henrik Andersson
- Mid Sweden University, Department of Electronics Design, Sundsvall, 851 70, Sweden
| | - Magnus Engholm
- Mid Sweden University, Department of Electronics Design, Sundsvall, 851 70, Sweden
| | - Thomas Öhlund
- Mid Sweden University, Department of Natural Sciences, Sundsvall, 851 70, Sweden
| | - Hans-Erik Nilsson
- Mid Sweden University, Faculty of Science, Technology and Media, Sundsvall, 851 70, Sweden
| | - Håkan Olin
- Mid Sweden University, Department of Natural Sciences, Sundsvall, 851 70, Sweden
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Olsen M, Örtegren J, Zhang R, Reza S, Andersson H, Olin H. Schottky model for triboelectric temperature dependence. Sci Rep 2018; 8:5293. [PMID: 29593333 PMCID: PMC5871784 DOI: 10.1038/s41598-018-23666-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 03/16/2018] [Indexed: 11/09/2022] Open
Abstract
The triboelectric effect, charging by contact, is the working principle in a device called a triboelectric nanogenerator. They are used as efficient energy transducers in energy harvesting. In such generators the charging of surfaces at contact is followed by a separation of the surfaces increasing the electrical energy which can subsequently be used. Different materials have different triboelectric potentials leading to charging at contact. The temperature dependence of the charging has just recently been studied: the triboelectric effect is decreasing with temperature for a generator of Al-PTFE-Cu. Here, we suggest a mechanism to explain this effect assuming ion transfer using a two-level Schottky model where the two levels corresponds to the two surfaces. The difference in binding energy for ions on the two surfaces then enters the formula for charging. We fit the triboelectric power density as a function of temperature obtained from a two-level Schottky model to measured data for nanogenerators made of Al-PTFE-Cu found in three references. We obtain an average separation energy corresponding to a temperature of 365 K which is of the right magnitude for physically adsorbed atoms. We anticipate that this model could be used for many types of triboelectric nanogenerators.
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Affiliation(s)
- Martin Olsen
- Department of Natural Sciences, Mid Sweden University, Sundsvall, 851 70, Sweden.
| | - Jonas Örtegren
- Department of Natural Sciences, Mid Sweden University, Sundsvall, 851 70, Sweden
| | - Renyun Zhang
- Department of Natural Sciences, Mid Sweden University, Sundsvall, 851 70, Sweden
| | - Salim Reza
- Department of Electronics Design, Mid Sweden University, Sundsvall, 851 70, Sweden
| | - Henrik Andersson
- Department of Electronics Design, Mid Sweden University, Sundsvall, 851 70, Sweden
| | - Håkan Olin
- Department of Natural Sciences, Mid Sweden University, Sundsvall, 851 70, Sweden
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Andersson H, Sonnesen L. Sleepiness, occlusion, dental arch and palatal dimensions in children attention deficit hyperactivity disorder (ADHD). Eur Arch Paediatr Dent 2018. [DOI: 10.1007/s40368-018-0330-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Virtanen TE, Moreira P, Ulvseth H, Andersson H, Tetler S, Kuorelahti M. Analyzing Measurement Invariance of the Students’ Engagement Instrument Brief Version: The Cases of Denmark, Finland, and Portugal. Canadian Journal of School Psychology 2017. [DOI: 10.1177/0829573517699333] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The promotion of students’ engagement with school is an internationally acknowledged challenge in education. There is a need to examine the structure of the concept of student engagement and to discover the best practices for fostering it across societies. That is why the cross-cultural invariance testing of students’ engagement measures is highly needed. This study aimed, first, to find the reduced set of theoretically valid items to represent students’ affective and cognitive engagement forming the Brief-SEI (brief version of the Student Engagement Instrument; SEI). The second aim was to test the measurement invariance of the Brief-SEI across three countries (Denmark, Finland, and Portugal). A total of 4,437 seventh-grade students completed the SEI questionnaires in the three countries. The analyses revealed that of the total 33 original instrument items, 15 items indicated acceptable psychometric properties of the Brief-SEI. With these 15 items, cross-national factorial validity and invariances across genders and students with different levels of academic performance (samples from Finland and Portugal) were demonstrated. This article discusses the utility of the Brief-SEI in cross-cultural research and its applicability in different national school contexts.
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Affiliation(s)
| | - P. Moreira
- Lusíada University (Porto); CIPD; and Calouste Gulbenkian Foundation (Lisbon), Portugal
| | | | | | - S. Tetler
- Aarhus University, Copenhagen, Denmark
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Abstract
Background Nurses working in Home healthcare (HHC) are facing major challenges since more advanced care and treatment are increasingly being carried out in patients’ homes. The aim of this study has been to explore how nurses experience their competencies in HHC situations. Methods This study has a qualitative and explorative design. Ten nurses were interviewed and data was analyzed using content analysis. Results The themes “Being a capable nurse”, “Being a useful nurse” and “Being a subordinate and dependent nurse” were identified. Nurses want to be capable of taking care of patients, to develop their competencies and to perform their duties in the way required. They also want their work to be useful and to provide good and safe HHC. Finally, nurses want to improve HHC care by applying their competencies. Simultaneously, they are subordinate and dependent in relation to their manager and also dependent upon their manager’s interest in encouraging nurses’ competence development. Conclusions Nurses in HHC are responsible for many seriously ill patients and they want to contribute to good and safe patient care. To maintain patient safety, reduce the risk for burnout and staff turnover as well as to contribute to a sustainable development of the work, strategies for transferring competencies between nurses and efforts for competence development are needed.
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Affiliation(s)
- Henrik Andersson
- University of Borås, Faculty of Caring Science, Work Life and Social Welfare, Borås, Sweden
| | - Maria Lindholm
- Centre for Adult Education, Härryda municipality, SE-435 80 Mölnlycke, Sweden
| | | | - Lise-Lotte Jonasson
- University of Borås, Faculty of Caring Science, Work Life and Social Welfare, Borås, Sweden
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