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Garcia D, Galesic M, Olsson H. The Psychology of Collectives. Perspect Psychol Sci 2024; 19:316-319. [PMID: 37874955 DOI: 10.1177/17456916231201139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Affiliation(s)
- David Garcia
- Department of Politics and Public Administration, University of Konstanz
- Complexity Science Hub Vienna, Austria
| | - Mirta Galesic
- Complexity Science Hub Vienna, Austria
- Santa Fe Institute, Santa Fe, New Mexico
- Vermont Complex Systems Center, University of Vermont
| | - Henrik Olsson
- Complexity Science Hub Vienna, Austria
- Santa Fe Institute, Santa Fe, New Mexico
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Olsson H, Galesic M. Sampling complex social and behavioral phenomena. Behav Brain Sci 2024; 47:e55. [PMID: 38311453 DOI: 10.1017/s0140525x23002327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
We comment on the limits of relying on prior literature when constructing the design space for an integrative experiment; the adaptive nature of social and behavioral phenomena and the implications for the use of theory and modeling when constructing the design space; and on the challenges of measuring random errors and lab-related biases in measurement without replication.
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Affiliation(s)
- Henrik Olsson
- Complexity Science Hub, Vienna, Austria
- Santa Fe Institute, Santa Fe, NM, USA ; ://www.santafe.edu/people/profile/henrik-olsson; https://www.santafe.edu/people/profile/mirta-galesic
| | - Mirta Galesic
- Complexity Science Hub, Vienna, Austria
- Santa Fe Institute, Santa Fe, NM, USA ; ://www.santafe.edu/people/profile/henrik-olsson; https://www.santafe.edu/people/profile/mirta-galesic
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Olsson H, Tamire M, Samuelsson E, Addissie A, Andersson R, Skovbjerg S, Athlin S. Household air pollution and pneumococcal density related to nasopharyngeal inflammation in mothers and children in Ethiopia: A cross-sectional study. PLoS One 2024; 19:e0297085. [PMID: 38271409 PMCID: PMC10810524 DOI: 10.1371/journal.pone.0297085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 12/22/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Three billion people in low- and middle-income countries are exposed to household air pollution as they use biomass fuel for cooking. We investigated the associations between solid fuel use and nasopharyngeal (NP) inflammation, as well as the associations between high pneumococcal density and NP inflammation, in mothers and children in rural and urban Ethiopia. MATERIALS AND METHODS Sixty pairs of mothers (median age, 30 years; range, 19-45 years) with a child (median age, 9 months; range, 1-24 months) were included from rural Butajira (n = 30) and urban Addis Ababa (n = 30) in Ethiopia. The cohort was randomly selected from a previous study of 545 mother/child pairs included 2016. Questionnaire-based data were collected which included fuel type used (solid: wood, charcoal, dung or crop waste; cleaner: electricity, liquefied petroleum gas). Nasopharyngeal (NP) samples were collected from all mothers and children and analyzed for the levels of 18 cytokines using a Luminex immunoassay. Pneumococcal DNA densities were measured by a real-time multiplex PCR and a high pneumococcal density was defined as a cyclic threshold (Ct) value ≤ 30. RESULTS Mothers from rural areas had higher median CXCL8 levels in NP secretions than those from urban areas (8000 versus 1900 pg/mL; p < 0.01), while rural children had slightly higher IL-10 levels than those from the urban area (26 vs 13 pg/mL; p = 0.04). No associations between fuel type and cytokine levels were found. However, a high pneumococcal density was associated with higher levels of cytokines in both mothers (CCL4, CXCL8, IL-1β, IL-6 and VEGF-A) and children (CCL4, CXCL8, IL-1β, IL-6 and IL-18). CONCLUSIONS No significant associations were found between solid fuel use and NP inflammation in Ethiopian mothers and children, but the inflammatory activity was higher in individuals living in the rural compared to the urban area. In addition, high cytokine levels were associated with high pneumococcal density in both mothers and children, indicating a significant impact of NP pathogens on inflammatory mediator levels in upper airways.
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Affiliation(s)
- Henrik Olsson
- Department of Infectious Diseases, Örebro University Hospital, Örebro, Sweden
| | - Mulugeta Tamire
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ebba Samuelsson
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Clinical Microbiology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Adamu Addissie
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Rune Andersson
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Clinical Microbiology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Susann Skovbjerg
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Clinical Microbiology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Simon Athlin
- Department of Infectious Diseases, Örebro University Hospital, Örebro, Sweden
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Olsson H, Åhlund K, Alfredsson J, Andersson D, Boström AM, Guidetti S, Prytz M, Ekerstad N. Cross-cultural adaption and inter-rater reliability of the Swedish version of the updated clinical frailty scale 2.0. BMC Geriatr 2023; 23:803. [PMID: 38053055 PMCID: PMC10696827 DOI: 10.1186/s12877-023-04525-6] [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: 04/24/2023] [Accepted: 11/28/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Worldwide, there is a large and growing group of older adults. Frailty is known as an important discriminatory factor for poor outcomes. The Clinical Frailty Scale (CFS) has become a frequently used frailty instrument in different clinical settings and health care sectors, and it has shown good predictive validity. The aims of this study were to describe and validate the translation and cultural adaptation of the CFS into Swedish (CFS-SWE), and to test the inter-rater reliability (IRR) for registered nurses using the CFS-SWE. METHODS An observational study design was employed. The ISPOR principles were used for the translation, linguistic validation and cultural adaptation of the scale. To test the IRR, 12 participants were asked to rate 10 clinical case vignettes using the CFS-SWE. The IRR was assessed using intraclass correlation and Krippendorff's alpha agreement coefficient test. RESULTS The Clinical Frailty Scale was translated and culturally adapted into Swedish and is presented in its final form. The IRR for all raters, measured by an intraclass correlation test, resulted in an absolute agreement value among the raters of 0.969 (95% CI: 0.929-0.991) and a consistency value of 0.979 (95% CI: 0.953-0.994), which indicates excellent reliability. Krippendorff's alpha agreement coefficient for all raters was 0.969 (95% CI: 0.917-0.988), indicating near-perfect agreement. The sensitivity of the reliability was examined by separately testing the IRR of the group of specialised registered nurses and non-specialised registered nurses respectively, with consistent and similar results. CONCLUSION The Clinical Frailty Scale was translated, linguistically validated and culturally adapted into Swedish following a well-established standard technique. The IRR was excellent, judged by two established, separately used, reliability tests. The reliability test results did not differ between non-specialised and specialised registered nurses. However, the use of case vignettes might reduce the generalisability of the reliability findings to real-life settings. The CFS has the potential to be a common reference tool, especially when older adults are treated and rehabilitated in different care sectors.
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Affiliation(s)
- Henrik Olsson
- Department of Research and Development, NU Hospital Group, Trollhättan, Sweden
- Department of Cardiology, NU Hospital Group, Trollhättan, Sweden
| | - Kristina Åhlund
- Department of Research and Development, NU Hospital Group, Trollhättan, Sweden
- Department of Health Sciences, University West, Trollhättan, Sweden
| | - Joakim Alfredsson
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Unit of Cardiovascular Sciences, Linköping University, Linköping, Sweden
| | - David Andersson
- Department of Management and Engineering, Division of Economics, Linköping University, Linköping, Sweden
| | - Anne-Marie Boström
- Department of Neurobiology, Division of Nursing, Karolinska Institutet, Care Sciences&Society (NVS), Huddinge, Sweden
- Karolinska University Hospital, Theme Inflammation and Aging, Stockholm, Sweden
- Stockholms Sjukhem, Research and Development Unit, Stockholm, Sweden
| | - Susanne Guidetti
- Department of Neurobiology, Division of Occupational Therapy, Karolinska Institutet, Care Sciences&Society (NVS), Huddinge, Sweden
- Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Solna, Sweden
| | - Mattias Prytz
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy,, University of Gothenburg, Gothenburg, Sweden
- Department of Surgery, NU-Hospital Group, Region Västra Götaland, Trollhättan, Sweden
| | - Niklas Ekerstad
- Department of Research and Development, NU Hospital Group, Trollhättan, Sweden.
- Department of Health, Medicine, and Caring Sciences, Unit of Health Care Analysis, Linköping University, Linköping, Sweden.
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Nielsen C, Andréasson K, Olsson H, Engfeldt M, Jöud A. Cohort profile: The Swedish Tattoo and Body Modifications Cohort (TABOO). BMJ Open 2023; 13:e069664. [PMID: 37142309 PMCID: PMC10163470 DOI: 10.1136/bmjopen-2022-069664] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
PURPOSE The Swedish Tattoo and Body Modifications Cohort (TABOO) cohort was established to provide an infrastructure for epidemiological studies researching the role of tattoos and other body modifications as risk factors for adverse health outcomes. It is the first population-based cohort with detailed exposure assessment of decorative, cosmetic, and medical tattoos, piercing, scarification, henna tattoos, cosmetic laser treatments, hair dyeing, and sun habits. The level of detail in the exposure assessment of tattoos allows for investigation of crude dose-response relationships. PARTICIPANTS The TABOO cohort includes 13 049 individuals that participated in a questionnaire survey conducted in 2021 (response rate 49%). Outcome data are retrieved from the National Patient Register, the National Prescribed Drug Register and the National Cause of Death Register. Participation in the registers is regulated by Swedish law, which eliminates the risk of loss to follow-up and associated selection bias. FINDINGS TO DATE The tattoo prevalence in TABOO is 21%. The cohort is currently used to clarify the incidence of acute and long-lasting health complaints after tattooing based on self-reported data. Using register-based outcome data, we are investigating the role of tattoos as a risk factor for immune-mediated disease, including hypersensitisation, foreign body reactions and autoimmune conditions. FUTURE PLANS The register linkage will be renewed every third year to update the outcome data, and we have ethical approval to reapproach the responders with additional questionnaires.
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Affiliation(s)
- Christel Nielsen
- Occupational and Environmental Medicine, Laboratory Medicine, Lund University, Lund, Sweden
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Public Health, University of Southern Denmark, Odense, Denmark
| | | | - H Olsson
- Cancer Epidemiology, Clinical Sciences, Lund University, Lund, Sweden
| | - Malin Engfeldt
- Occupational and Environmental Medicine, Laboratory Medicine, Lund University, Lund, Sweden
- Occupational and Environmental Medicine, Region Skåne, Lund, Sweden
| | - Anna Jöud
- Occupational and Environmental Medicine, Laboratory Medicine, Lund University, Lund, Sweden
- Skåne University Hospital, Research and Education, Region Skåne, Lund, Sweden
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Ringbom A, Fritioff T, Aldener M, Axelsson A, Elmgren K, Hellesen C, Karlkvist L, Kastlander J, Olsson H, Berglund H, Hellman B, Pettersson O. SAUNA Q B - Array: The realization of a new concept in radioxenon detection. J Environ Radioact 2023; 261:107136. [PMID: 36796185 DOI: 10.1016/j.jenvrad.2023.107136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 02/04/2023] [Accepted: 02/07/2023] [Indexed: 06/18/2023]
Abstract
We introduce a new concept in radioxenon detection - the radioxenon Array, defined as a system where air sampling and activity measurement is performed at multiple locations, using measurement units that are less sensitive, but on the other hand less costly, and easier to install and operate, compared to current state-of-the-art radioxenon systems. The inter-unit distance in the Array is typically hundreds of kilometres. Using synthetic nuclear explosions together with a parametrized measurement system model, we argue that, when such measurement units are combined into an Array, the aggregated verification performance (detection, location, and characterization) can be high. The concept has been realized by developing a measurement unit named SAUNA QB, and the world's first radioxenon Array is now operating in Sweden. The operational principles and performance of the SAUNA QB and the Array is described, and examples of first measured data are presented, indicating a measurement performance according to expectations.
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Affiliation(s)
- Anders Ringbom
- Swedish Defence Research Agency (FOI), Gullfossgatan 6, SE-16490, Stockholm, Sweden.
| | - Tomas Fritioff
- Swedish Defence Research Agency (FOI), Gullfossgatan 6, SE-16490, Stockholm, Sweden
| | - Mattias Aldener
- Swedish Defence Research Agency (FOI), Gullfossgatan 6, SE-16490, Stockholm, Sweden
| | - Anders Axelsson
- Swedish Defence Research Agency (FOI), Gullfossgatan 6, SE-16490, Stockholm, Sweden
| | - Klas Elmgren
- Swedish Defence Research Agency (FOI), Gullfossgatan 6, SE-16490, Stockholm, Sweden
| | - Carl Hellesen
- Swedish Defence Research Agency (FOI), Gullfossgatan 6, SE-16490, Stockholm, Sweden
| | - Lindsay Karlkvist
- Swedish Defence Research Agency (FOI), Gullfossgatan 6, SE-16490, Stockholm, Sweden
| | - Johan Kastlander
- Swedish Defence Research Agency (FOI), Gullfossgatan 6, SE-16490, Stockholm, Sweden
| | - Henrik Olsson
- Swedish Defence Research Agency (FOI), Gullfossgatan 6, SE-16490, Stockholm, Sweden
| | - Helena Berglund
- Scienta Sensor Systems AB, Danmarksgatan 22, SE-753 23, Uppsala, Sweden
| | - Bo Hellman
- Scienta Sensor Systems AB, Danmarksgatan 22, SE-753 23, Uppsala, Sweden
| | - Ola Pettersson
- Scienta Sensor Systems AB, Danmarksgatan 22, SE-753 23, Uppsala, Sweden
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Olsson H, Barman-Adhikari A, Galesic M, Hsu HT, Rice E. Cognitive strategies for peer judgments. Decision 2023. [DOI: 10.1037/dec0000208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
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Jafaripour S, Melvin M, Olsson H, Parrish C, Wasik B, Zandberg W, Bergstrom K. A21 ROLE OF SIALIC ACID O-ACETYLATION IN MAINTAINING MUCUS INTEGRITY AND HOMEOSTASIS OF THE COLONIC MUCOSA. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991361 DOI: 10.1093/jcag/gwac036.021] [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: 03/09/2023] Open
Abstract
Background The mucus network provides innate immune defense to protect our gastrointestinal tract from pathogens, and promote homeostasis with our resident microbiota. This network is constituted by the mucin MUC2 (Muc2 in mouse), which is ~80% complex O-linked glycans by weight. Sialic acid (Sia) is a key capping monosaccharide on complex O-glycans which has recently been linked to preserving mucus integrity. Sia can undergo enzymatic modifications including the addition of O-acetyl groups. The 9-O-acetyltransferase CasD1 is responsible for the 9-OAc Sia variants. Functionally, the OAc-modification is known to inhibit microbial sialidase activities which may preserve Sia’s protective roles on mucins. However, the extent of these OAc modifications in human and murine Mucin-2, and how they influence mucus function is unclear. Purpose: To determine whether and how Sia O-acetylation on colonic mucus regulates mucus integrity, host-microbe interactions, and colitis susceptibility. Method We used viral-derived probes that target specific OAc-Sia analogues on mucus on sections from human feces and mouse feces and colon tissues to visualize their spatial arrangement and microbial interaction in situ. For glycomics, OAc-Sia analogues were quantitated on purified human MUC2 and mouse Muc2 by HPLC-MS after derivatization with 4,5-dimethyl-1,2-diaminobenzamine (DMBA). O-glycans were released via non-reductive ammonia-catalyzed β-elimination and analyzed by mass spectrometry. For in vivo work, we generated intestinal epithelial cell-specific Casd1 KO mice (Casd1flox/flox;VillinCre or IEC Casd1-/- mice) and analyzed their mucins. Sialidase activities were quantified in the supernatants of colon fecal materials from WT and IEC Casd1-/- mutants mice using a fluorogenic substrate 4-MU-NeuNAc. Colitis susceptibility was monitored using 1.5% w/v Dextran Sodium Sulfate (DSS). Result(s) We found Sias on both human MUC2 and murine Muc2 were heavily O-acetylated, with ~75% and ~45% of Sias having 9-OAc-based modification in humans and mice respectively, and were distributed throughout the niche and barrier layers of mucus in situ. IEC Casd1-/- mice were viable and healthy with knockdown confirmed by 9-OAc staining, western blot of protein lysates and mucins, and sialylomics. The mucus encapsulation appeared overall intact regardless of OAc status. However, IEC Casd1-/- mice showed heightened susceptibility to 1.5% DSS colitis, linked to thinning of the mucus in IEC Casd1-/- vs WT littermates after challenge. Consistent with the role of OAc Sia in sialidase inhibition, loss of OAc Sia was associated with increased sialidase activities as assessed by heightened 4 MU signal in fecal supernatants in WT vs littermate IEC Casd1-/- mice. O-glycomics also showed reduction in the number of sialylated O-glycan structures upon loss of 9-OAc Sia. Conclusion(s) Sia O-acetylation appears important in maintaining key aspects of Sia-dependent mucus function and protecting from inflammatory insult. Please acknowledge all funding agencies by checking the applicable boxes below: CCC Disclosure of Interest None Declared
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Affiliation(s)
- S Jafaripour
- Biology, University of British Columbia - Okanagan, Kelowna, Canada
| | - M Melvin
- Biology, University of British Columbia - Okanagan, Kelowna, Canada
| | - H Olsson
- Biology, University of British Columbia - Okanagan, Kelowna, Canada
| | - C Parrish
- Cornell Universty, Ithaca, United States
| | - B Wasik
- Cornell Universty, Ithaca, United States
| | - W Zandberg
- Chemistry, University of British Columbia - Okanagan, Kelowna, Canada
| | - K Bergstrom
- Biology, University of British Columbia - Okanagan, Kelowna, Canada
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Galesic M, Barkoczi D, Berdahl AM, Biro D, Carbone G, Giannoccaro I, Goldstone RL, Gonzalez C, Kandler A, Kao AB, Kendal R, Kline M, Lee E, Massari GF, Mesoudi A, Olsson H, Pescetelli N, Sloman SJ, Smaldino PE, Stein DL. Beyond collective intelligence: Collective adaptation. J R Soc Interface 2023; 20:20220736. [PMID: 36946092 PMCID: PMC10031425 DOI: 10.1098/rsif.2022.0736] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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: 10/08/2022] [Accepted: 02/27/2023] [Indexed: 03/23/2023] Open
Abstract
We develop a conceptual framework for studying collective adaptation in complex socio-cognitive systems, driven by dynamic interactions of social integration strategies, social environments and problem structures. Going beyond searching for 'intelligent' collectives, we integrate research from different disciplines and outline modelling approaches that can be used to begin answering questions such as why collectives sometimes fail to reach seemingly obvious solutions, how they change their strategies and network structures in response to different problems and how we can anticipate and perhaps change future harmful societal trajectories. We discuss the importance of considering path dependence, lack of optimization and collective myopia to understand the sometimes counterintuitive outcomes of collective adaptation. We call for a transdisciplinary, quantitative and societally useful social science that can help us to understand our rapidly changing and ever more complex societies, avoid collective disasters and reach the full potential of our ability to organize in adaptive collectives.
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Affiliation(s)
- Mirta Galesic
- Santa Fe Institute, Santa Fe, NM 87501, USA
- Complexity Science Hub Vienna, 1080 Vienna, Austria
- Vermont Complex Systems Center, University of Vermont, Burlington, VM 05405, USA
| | | | - Andrew M. Berdahl
- School of Aquatic and Fishery Sciences, University of Washington, Seattle, WA 98195, USA
| | - Dora Biro
- Department of Zoology, University of Oxford, Oxford OX1 3PS, UK
| | - Giuseppe Carbone
- Department of Mechanics, Mathematics and Management, Politecnico di Bari, Bari 70125, Italy
| | - Ilaria Giannoccaro
- Department of Mechanics, Mathematics and Management, Politecnico di Bari, Bari 70125, Italy
| | - Robert L. Goldstone
- Psychological and Brain Sciences, Indiana University, Bloomington, IN 47405, USA
| | - Cleotilde Gonzalez
- Department of Social and Decision Sciences, Carnegie Mellon University, Pittsburgh, PA 15213, USA
| | - Anne Kandler
- Department of Mathematics, Max-Planck-Institute for Evolutionary Anthropology, Leipzig 04103, Germany
| | - Albert B. Kao
- Santa Fe Institute, Santa Fe, NM 87501, USA
- Biology Department, University of Massachusetts Boston, Boston, MA 02125, USA
| | - Rachel Kendal
- Centre for Coevolution of Biology and Culture, Durham University, Anthropology Department, Durham, DH1 3LE, UK
| | - Michelle Kline
- Centre for Culture and Evolution, Division of Psychology, Brunel University London, Uxbridge, UB8 3PH, UK
| | - Eun Lee
- Department of Scientific Computing, Pukyong National University, 45 Yongso-ro, Nam-gu, Busan, 48513, Republic of Korea
| | | | - Alex Mesoudi
- Department of Ecology and Conservation, University of Exeter, Penryn TR10 9FE, UK
| | | | | | - Sabina J. Sloman
- Department of Social and Decision Sciences, Carnegie Mellon University, Pittsburgh, PA 15213, USA
- Department of Computer Science, University of Manchester, Manchester, M13 9PL, UK
| | - Paul E. Smaldino
- Santa Fe Institute, Santa Fe, NM 87501, USA
- Department of Cognitive and Information Sciences, University of California, Merced, CA 95343, USA
| | - Daniel L. Stein
- Santa Fe Institute, Santa Fe, NM 87501, USA
- Department of Physics and Courant Institute of Mathematical Sciences, New York University, New York, NY 10012, USA
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Egevad L, Delahunt B, Iczkowski KA, van der Kwast T, van Leenders GJLH, Leite KRM, Pan CC, Samaratunga H, Tsuzuki T, Mulliqi N, Ji X, Olsson H, Valkonen M, Ruusuvuori P, Eklund M, Kartasalo K. Interobserver reproducibility of cribriform cancer in prostate needle biopsies and validation of International Society of Urological Pathology criteria. Histopathology 2023; 82:837-845. [PMID: 36645163 DOI: 10.1111/his.14867] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/09/2022] [Accepted: 01/07/2023] [Indexed: 01/17/2023]
Abstract
AIMS There is strong evidence that cribriform morphology indicates a worse prognosis of prostatic adenocarcinoma. Our aim was to investigate its interobserver reproducibility in prostate needle biopsies. METHODS AND RESULTS A panel of nine prostate pathology experts from five continents independently reviewed 304 digitised biopsies for cribriform cancer according to recent International Society of Urological Pathology criteria. The biopsies were collected from a series of 702 biopsies that were reviewed by one of the panellists for enrichment of high-grade cancer and potentially cribriform structures. A 2/3 consensus diagnosis of cribriform and noncribriform cancer was reached in 90% (272/304) of the biopsies with a mean kappa value of 0.56 (95% confidence interval 0.52-0.61). The prevalence of consensus cribriform cancers was estimated to 4%, 12%, 21%, and 20% of Gleason scores 7 (3 + 4), 7 (4 + 3), 8, and 9-10, respectively. More than two cribriform structures per level or a largest cribriform mass with ≥9 lumina or a diameter of ≥0.5 mm predicted a consensus diagnosis of cribriform cancer in 88% (70/80), 84% (87/103), and 90% (56/62), respectively, and noncribriform cancer in 3% (2/80), 5% (5/103), and 2% (1/62), respectively (all P < 0.01). CONCLUSION Cribriform prostate cancer was seen in a minority of needle biopsies with high-grade cancer. Stringent diagnostic criteria enabled the identification of cribriform patterns and the generation of a large set of consensus cases for standardisation.
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Affiliation(s)
- Lars Egevad
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Brett Delahunt
- Southern Community Laboratory, Wellington, New Zealand and Aquesta Uropathology, Brisbane, QLD, Australia
| | | | - Theo van der Kwast
- Laboratory Medicine Program and Princess Margaret Cancer Center, University Health Network, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada
| | | | - Katia R M Leite
- Department of Urology, Laboratory of Medical Research, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Chin-Chen Pan
- Department of Pathology, Taipei Veterans General Hospital, Taipei, Taiwan
| | | | - Toyonori Tsuzuki
- Department of Surgical Pathology, Aichi Medical University, School of Medicine, Nagoya, Japan
| | - Nita Mulliqi
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Xiaoyi Ji
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Olsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Masi Valkonen
- Institute of Biomedicine, University of Turku, Turku, Finland
| | - Pekka Ruusuvuori
- Institute of Biomedicine, University of Turku, Turku, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Martin Eklund
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Kimmo Kartasalo
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Hagbom M, Carmona-Vicente N, Sharma S, Olsson H, Jämtberg M, Nilsdotter-Augustinsson Å, Sjöwall J, Nordgren J. Evaluation of SARS-CoV-2 rapid antigen diagnostic tests for saliva samples. Heliyon 2022; 8:e08998. [PMID: 35233472 PMCID: PMC8860750 DOI: 10.1016/j.heliyon.2022.e08998] [Citation(s) in RCA: 2] [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: 08/10/2021] [Revised: 11/18/2021] [Accepted: 02/18/2022] [Indexed: 12/23/2022] Open
Abstract
Using saliva samples would facilitate sample collection, diagnostic feasibility, and mass screening of SARS-CoV-2. We tested two rapid antigen (RAD) immunochromatographic tests designed for detection of SARS-CoV-2 in saliva: Rapid Response™ COVID-19 Antigen Rapid Test Cassette for oral fluids and DIAGNOS™ COVID-19 Antigen Saliva Test. Evaluation of detection limit was performed with purified SARS-CoV-2 nucleocapsid protein and live SARS-CoV-2 virus. Sensitivity and specificity were further evaluated with reverse transcription quantitative PCR (RT-qPCR) positive and negative saliva samples from hospitalized individuals with COVID-19 (n = 39) and healthcare workers (n = 20). DIAGNOS showed higher sensitivity than Rapid Response for both nucleocapsid protein and live virus. The limit of detection of the saliva test from DIAGNOS was further comparable with the Abbott Panbio™ COVID-19 Ag Rapid Test designed for nasopharyngeal samples. DIAGNOS and Rapid Response detected nine (50.0%) and seven (38.9%), respectively, of the 18 RT-qPCR positive saliva samples. All RT-qPCR negative saliva (n = 41) were negative with both tests. Only one of the RT-qPCR positive saliva samples contained infectious virus as determined by cell culture and was also positive using the saliva RADs. The results show that the DIAGNOS may be an important and easy-to-use saliva RAD complement to detect SARS-CoV-2 positive individuals, but validation with a larger sample set is warranted.
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Affiliation(s)
- Marie Hagbom
- Division of Molecular Medicine and Virology, Department of Biomedical and Clinical Sciences, Linköping University, 581 85, Linköping, Sweden
| | - Noelia Carmona-Vicente
- Division of Molecular Medicine and Virology, Department of Biomedical and Clinical Sciences, Linköping University, 581 85, Linköping, Sweden
| | - Sumit Sharma
- Division of Molecular Medicine and Virology, Department of Biomedical and Clinical Sciences, Linköping University, 581 85, Linköping, Sweden
| | - Henrik Olsson
- Noviral Sweden AB, Västmannagatan 3, 111 24, Stockholm, Sweden
| | - Mikael Jämtberg
- Noviral Sweden AB, Västmannagatan 3, 111 24, Stockholm, Sweden
| | - Åsa Nilsdotter-Augustinsson
- Infectious Diseases/Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Johanna Sjöwall
- Infectious Diseases/Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Johan Nordgren
- Division of Molecular Medicine and Virology, Department of Biomedical and Clinical Sciences, Linköping University, 581 85, Linköping, Sweden
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12
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Olsson H, Karlson BW, Herlitz J, Karlsson T, Hellberg J, Prytz M, Sernert N, Ekerstad N. Predictors of short- and long-term mortality in critically ill, older adults admitted to the emergency department: an observational study. BMC Emerg Med 2022; 22:15. [PMID: 35086496 PMCID: PMC8793240 DOI: 10.1186/s12873-022-00571-2] [Citation(s) in RCA: 2] [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: 09/16/2021] [Accepted: 01/03/2022] [Indexed: 11/30/2022] Open
Abstract
Background In the future, we can expect an increase in older patients in emergency departments (ED) and acute wards. The main purpose of this study was to identify predictors of short- and long-term mortality in the ED and at hospital discharge. Methods This is a retrospective, observational, single-center, cohort study, involving critically ill older adults, recruited consecutively in an ED. The primary outcome was mortality. All patients were followed for 6.5–7.5 years. The Cox proportional hazards model was used. Results Regarding all critically ill patients aged ≥ 70 years and identified in the ED (n = 402), there was a significant association between mortality at 30 days after ED admission and unconsciousness on admission (HR 3.14, 95% CI 2.09–4.74), hypoxia on admission (HR 2.51, 95% CI 1.69–3.74) and age (HR 1.06 per year, 95% CI 1.03–1.09), (all p < 0.001). Of 402 critically ill patients aged ≥ 70 years and identified in the ED, 303 were discharged alive from hospital. There was a significant association between long-term mortality and the Charlson Comorbidity Index (CCI) > 2 (HR 1.90, 95% CI 1.46–2.48), length of stay (LOS) > 7 days (HR 1.72, 95% CI 1.32–2.23), discharge diagnosis of pneumonia (HR 1.65, 95% CI 1.24–2.21) and age (HR 1.08 per year, 95% CI 1.05–1.10), (all p < 0.001). The only symptom or vital sign associated with long-term mortality was hypoxia on admission (HR 1.70, 05% CI 1.30–2.22). Conclusions Among critically ill older adults admitted to an ED and discharged alive the following factors were predictive of long-term mortality: CCI > 2, LOS > 7 days, hypoxia on admission, discharge diagnosis of pneumonia and age. The following factors were predictive of mortality at 30 days after ED admission: unconsciousness on admission, hypoxia and age. These data might be clinically relevant when it comes to individualized care planning, which should take account of risk prediction and estimated prognosis.
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Affiliation(s)
- Henrik Olsson
- Department of Cardiology, NU Hospital Group, Trollhättan, Sweden
| | - Björn W Karlson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,AstraZeneca Gothenburg, Mölndal, Sweden
| | - Johan Herlitz
- Center for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Thomas Karlsson
- Biostatistics, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jenny Hellberg
- Department of Cardiology, NU Hospital Group, Trollhättan, Sweden
| | - Mattias Prytz
- Department of Surgery, NU-Hospital Group, Region Västra Götaland, Trollhättan, Sweden
| | - Ninni Sernert
- Department of Orthopaedics Sahlgrenska Academy, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Niklas Ekerstad
- Department of Gothenburg Health, Medicine and Caring Sciences, Unit of Health Care Analysis, Linköping University, Linköping, Sweden.
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13
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Khoshkar Y, Westerberg M, Adolfsson J, Bill‐Axelson A, Olsson H, Eklund M, Akre O, Garmo H, Aly M. Mortality in men with castration‐resistant prostate cancer—A long‐term follow‐up of a population‐based real‐world cohort. BJUI Compass 2021; 3:173-183. [PMID: 35474724 PMCID: PMC8988790 DOI: 10.1002/bco2.116] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 09/18/2021] [Indexed: 01/02/2023] Open
Abstract
Objectives The objective of this study is to find clinical variables that predict the prognosis for men with castration‐resistant prostate cancer (CRPC) in a Swedish real‐life CRPC cohort, including a risk group classification to clarify the risk of succumbing to prostate cancer. This is a natural history cohort representing the premodern drug era before the introduction of novel hormonal drug therapies. Methods PSA tests from the clinical chemistry laboratories serving health care in six regions of Sweden were retrieved and cross‐linked to the National Prostate Cancer Registry (NPCR) to identify men with a prostate cancer diagnosis. Through further cross‐linking with data sources at the Swedish Board of Health and Welfare, we retrieved other relevant information such as prescribed drugs, hospitalizations, and cause of death. Men entered the CRPC cohort at the first date of doubling of their PSA nadir value with the last value being >2 ng/ml, or an absolute increase of >5 ng/ml or more, whilst on 3 months of medical castration or if they had been surgically castrated (n = 4098). By combining the two variables with the largest C‐statistics, “PSA at time of CRPC” and “PSA doubling time,” a risk group classification was created. Results PSA‐DT and PSA at date of CRPC are the strongest variables associated with PC specific survival. At the end of follow‐up, the proportion of men who died due to PC was 57%, 71%, 81%, 86%, and 89% for risk categories one through five, respectively. The median overall survival in our cohort of men with CRPC was 1.86 years (95% CI: 1.79–1.97). Conclusion For a man with castration‐resistant prostate cancer, there is a high probability that this will be the main cause contributing to his death. However, there is a significant difference in mortality that varies in relation to tumor burden assessed as PSA doubling time and PSA at time of CRCP. This information could be used in a clinical setting when deciding when to treat more or less aggressively once entering the CRPC phase of the disease.
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Affiliation(s)
- Yashar Khoshkar
- Department of Molecular Medicine and Surgery Karolinska Institute Stockholm Sweden
| | - Marcus Westerberg
- Department of Mathematics Uppsala University Uppsala Sweden
- Department of Surgical Sciences Uppsala University Uppsala Sweden
| | - Jan Adolfsson
- Department of Clinical Science, Intervention and Technology Karolinska Institute Stockholm Sweden
| | | | - Henrik Olsson
- Department of Medical Epidemiology and Biostatistics Karolinska Institute Stockholm Sweden
| | - Martin Eklund
- Department of Medical Epidemiology and Biostatistics Karolinska Institute Stockholm Sweden
| | - Olof Akre
- Department of Molecular Medicine and Surgery Karolinska Institute Stockholm Sweden
- Prostate Cancer Flow, Patient Area Pelvic Cancer Karolinska Sjukhuset Solna Stockholm Sweden
| | - Hans Garmo
- Department of Surgical Sciences Uppsala University Uppsala Sweden
- Translational Oncology & Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences King's College London London UK
- Regional Cancer Centre, Division of Central Sweden Uppsala Sweden
| | - Markus Aly
- Department of Molecular Medicine and Surgery Karolinska Institute Stockholm Sweden
- Prostate Cancer Flow, Patient Area Pelvic Cancer Karolinska Sjukhuset Solna Stockholm Sweden
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14
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Mulliqi N, Kartasalo K, Olsson H, Ji X, Egevad L, Eklund M, Ruusuvuori P. OpenPhi: An interface to access Philips iSyntax whole slide images for computational pathology. Bioinformatics 2021; 37:3995-3997. [PMID: 34358287 PMCID: PMC8570784 DOI: 10.1093/bioinformatics/btab578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/30/2021] [Accepted: 08/05/2021] [Indexed: 11/21/2022] Open
Abstract
Summary Digital pathology enables applying computational methods, such as deep learning, in pathology for improved diagnostics and prognostics, but lack of interoperability between whole slide image formats of different scanner vendors is a challenge for algorithm developers. We present OpenPhi—Open PatHology Interface, an Application Programming Interface for seamless access to the iSyntax format used by the Philips Ultra Fast Scanner, the first digital pathology scanner approved by the United States Food and Drug Administration. OpenPhi is extensible and easily interfaced with existing vendor-neutral applications. Availability and implementation OpenPhi is implemented in Python and is available as open-source under the MIT license at: https://gitlab.com/BioimageInformaticsGroup/openphi. The Philips Software Development Kit is required and available at: https://www.openpathology.philips.com. OpenPhi version 1.1.1 is additionally provided as Supplementary Data. Supplementary information Supplementary data are available at Bioinformatics online.
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Affiliation(s)
- Nita Mulliqi
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Kimmo Kartasalo
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Henrik Olsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Xiaoyi Ji
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Lars Egevad
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Martin Eklund
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Pekka Ruusuvuori
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Institute of Biomedicine, University of Turku, Turku, Finland
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15
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Galesic M, Bruine de Bruin W, Dalege J, Feld SL, Kreuter F, Olsson H, Prelec D, Stein DL, van der Does T. Human social sensing is an untapped resource for computational social science. Nature 2021; 595:214-222. [PMID: 34194037 DOI: 10.1038/s41586-021-03649-2] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 05/17/2021] [Indexed: 02/06/2023]
Abstract
The ability to 'sense' the social environment and thereby to understand the thoughts and actions of others allows humans to fit into their social worlds, communicate and cooperate, and learn from others' experiences. Here we argue that, through the lens of computational social science, this ability can be used to advance research into human sociality. When strategically selected to represent a specific population of interest, human social sensors can help to describe and predict societal trends. In addition, their reports of how they experience their social worlds can help to build models of social dynamics that are constrained by the empirical reality of human social systems.
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Affiliation(s)
- Mirta Galesic
- Santa Fe Institute, Santa Fe, NM, USA. .,Complexity Science Hub Vienna, Vienna, Austria. .,Vermont Complex Systems Center, University of Vermont, Burlington, VT, USA. .,Harding Center for Risk Literacy, University of Potsdam, Potsdam, Germany.
| | - Wändi Bruine de Bruin
- Sol Price School of Public Policy, University of South California, Los Angeles, CA, USA
| | | | - Scott L Feld
- Department of Sociology, Purdue University, West Lafayette, IN, USA
| | - Frauke Kreuter
- Joint Program in Survey Methodology, University of Maryland, Maryland, MD, USA.,Ludwig Maximilians Universität München, München, Germany
| | | | - Drazen Prelec
- Sloan School of Management, MIT, Cambridge, MA, USA.,Department of Economics, MIT, Cambridge, MA, USA.,Department of Brain and Cognitive Sciences, MIT, Cambridge, MA, USA
| | - Daniel L Stein
- Department of Physics and Courant Institute of Mathematical Sciences, New York University, New York, NY, USA
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16
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Nordgren J, Sharma S, Olsson H, Jämtberg M, Falkeborn T, Svensson L, Hagbom M. SARS-CoV-2 rapid antigen test: High sensitivity to detect infectious virus. J Clin Virol 2021; 140:104846. [PMID: 33971580 PMCID: PMC8105081 DOI: 10.1016/j.jcv.2021.104846] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [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: 01/21/2021] [Revised: 03/24/2021] [Accepted: 04/16/2021] [Indexed: 02/06/2023]
Abstract
Background The COVID-19 pandemic has highlighted the need for rapid, cost effective and easy-to-use diagnostic tools for SARS-CoV-2 infections that can be used in point of care settings to limit disease transmission. Objective We evaluated two rapid antigen immunochromatographic tests, Abbott Panbio™ COVID-19 Ag Rapid Test (Panbio) and Zhejiang Orient Gene/Healgen Biotech Coronavirus Ag rapid test cassette (Orient gene) for detection of infectious SARS-CoV-2. Results The tests were evaluated on nasopharyngeal samples taken from individuals having respiratory and/or COVID-19 related symptoms, which had been analyzed for SARS-CoV-2 RNA using real-time PCR. In total 156 PCR-positive, and 130 (Panbio) and 176 (Orient Gene) PCR-negative samples were analyzed. Overall sensitivity and specificity were 71.8% and 100% for Panbio and 79.5% and 74.4% for the Orient Gene test respectively. The false positives by the Orient Gene test were verified as SARS-CoV-2 negative by in-house real-time PCR assay and were negative for the four seasonal coronaviruses. Subgroup analysis revealed that the antigen tests had high sensitivity for samples with Ct-values <25 (>88%) and for samples containing infectious viruses as determined by cultivation on Vero cells, 94.1% and 97.1% for the Panbio and Orient gene tests, respectively. Furthermore, both tests had a sensitivity of <50 picogram for nucleocapsid protein. No sample with a Ct-value >27 was shown to contain infectious virus. Conclusion The results indicate that the rapid antigen tests, especially the Panbio tests may be a valuable tool to detect contagious persons during the ongoing pandemic.
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Affiliation(s)
- Johan Nordgren
- Division of Molecular Medicine and Virology, Department of Biomedical and Clinical Sciences, Linköping University, 581 85 Linköping, Sweden
| | - Sumit Sharma
- Division of Molecular Medicine and Virology, Department of Biomedical and Clinical Sciences, Linköping University, 581 85 Linköping, Sweden
| | - Henrik Olsson
- Noviral Sweden AB, Västmannagatan 3, 111 24 Stockholm, Sweden
| | - Mikael Jämtberg
- Noviral Sweden AB, Västmannagatan 3, 111 24 Stockholm, Sweden
| | - Tina Falkeborn
- Division of Clinical Microbiology, Linköping University Hospital, 581 85 Linköping, Sweden
| | - Lennart Svensson
- Division of Molecular Medicine and Virology, Department of Biomedical and Clinical Sciences, Linköping University, 581 85 Linköping, Sweden; Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institute, 171 76 Stockholm, Sweden
| | - Marie Hagbom
- Division of Molecular Medicine and Virology, Department of Biomedical and Clinical Sciences, Linköping University, 581 85 Linköping, Sweden.
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17
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Abstract
Social categorizations divide people into “us” and “them”, often along continuous attributes such as political ideology or skin color. This division results in both positive consequences, such as a sense of community, and negative ones, such as group conflict. Further, individuals in the middle of the spectrum can fall through the cracks of this categorization process and are seen as out-group by individuals on either side of the spectrum, becoming inbetweeners. Here, we propose a quantitative, dynamical-system model that studies the joint influence of cognitive and social processes. We model where two social groups draw the boundaries between “us” and ‘them” on a continuous attribute. Our model predicts that both groups tend to draw a more restrictive boundary than the middle of the spectrum. As a result, each group sees the individuals in the middle of the attribute space as an out-group. We test this prediction using U.S. political survey data on how political independents are perceived by registered party members as well as existing experiments on the perception of racially ambiguous faces, and find support.
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Affiliation(s)
| | | | - Henrik Olsson
- Santa Fe Institute, Santa Fe, NM, United States of America
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18
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Galesic M, Olsson H, Dalege J, van der Does T, Stein DL. Integrating social and cognitive aspects of belief dynamics: towards a unifying framework. J R Soc Interface 2021; 18:20200857. [PMID: 33726541 DOI: 10.1098/rsif.2020.0857] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Belief change and spread have been studied in many disciplines-from psychology, sociology, economics and philosophy, to biology, computer science and statistical physics-but we still do not have a firm grasp on why some beliefs change more easily and spread faster than others. To fully capture the complex social-cognitive system that gives rise to belief dynamics, we first review insights about structural components and processes of belief dynamics studied within different disciplines. We then outline a unifying quantitative framework that enables theoretical and empirical comparisons of different belief dynamic models. This framework uses a statistical physics formalism, grounded in cognitive and social theory, as well as empirical observations. We show how this framework can be used to integrate extant knowledge and develop a more comprehensive understanding of belief dynamics.
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Affiliation(s)
- Mirta Galesic
- Santa Fe Institute, 1399 Hyde Park Road, Santa Fe, NM 87501, USA.,Complexity Science Hub Vienna, Austria
| | - Henrik Olsson
- Santa Fe Institute, 1399 Hyde Park Road, Santa Fe, NM 87501, USA
| | - Jonas Dalege
- Santa Fe Institute, 1399 Hyde Park Road, Santa Fe, NM 87501, USA
| | | | - Daniel L Stein
- Santa Fe Institute, 1399 Hyde Park Road, Santa Fe, NM 87501, USA.,Department of Physics and Courant Institute of Mathematical Sciences, New York University, New York, NY, USA.,NYU-ECNU Institutes of Physics and Mathematical Sciences at NYU Shanghai, Shanghai, People's Republic of China
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19
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Egevad L, Ström P, Kartasalo K, Olsson H, Samaratunga H, Delahunt B, Eklund M. The utility of artificial intelligence in the assessment of prostate pathology. Histopathology 2021; 76:790-792. [PMID: 32402150 DOI: 10.1111/his.14060] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Lars Egevad
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden.,Department of Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Peter Ström
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Kimmo Kartasalo
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Henrik Olsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Hemamali Samaratunga
- Aquesta Pathology, Brisbane, Queensland, Australia.,University of Queensland School of Medicine, Brisbane, Queensland, Australia
| | - Brett Delahunt
- Department of Pathology and Molecular Medicine, Wellington School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand
| | - Martin Eklund
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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20
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Egevad L, Delahunt B, Samaratunga H, Tsuzuki T, Olsson H, Ström P, Lindskog C, Häkkinen T, Kartasalo K, Eklund M, Ruusuvuori P. Interobserver reproducibility of perineural invasion of prostatic adenocarcinoma in needle biopsies. Virchows Arch 2021; 478:1109-1116. [PMID: 33534005 PMCID: PMC8203540 DOI: 10.1007/s00428-021-03039-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 12/08/2020] [Revised: 01/15/2021] [Accepted: 01/20/2021] [Indexed: 12/17/2022]
Abstract
Numerous studies have shown a correlation between perineural invasion (PNI) in prostate biopsies and outcome. The reporting of PNI varies widely in the literature. While the interobserver variability of prostate cancer grading has been studied extensively, less is known regarding the reproducibility of PNI. A total of 212 biopsy cores from a population-based screening trial were included in this study (106 with and 106 without PNI according to the original pathology reports). The glass slides were scanned and circulated among four pathologists with a special interest in urological pathology for assessment of PNI. Discordant cases were stained by immunohistochemistry for S-100 protein. PNI was diagnosed by all four observers in 34.0% of cases, while 41.5% were considered to be negative for PNI. In 24.5% of cases, there was a disagreement between the observers. The kappa for interobserver variability was 0.67–0.75 (mean 0.73). The observations from one participant were compared with data from the original reports, and a kappa for intraobserver variability of 0.87 was achieved. Based on immunohistochemical findings among discordant cases, 88.6% had PNI while 11.4% did not. The most common diagnostic pitfall was the presence of bundles of stroma or smooth muscle. It was noted in a few cases that collagenous micronodules could be mistaken for a nerve. The distance between cancer and nerve was another cause of disagreement. Although the results suggest that the reproducibility of PNI may be greater than that of prostate cancer grading, there is still a need for improvement and standardization.
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Affiliation(s)
- Lars Egevad
- Department of Oncology and Pathology, Karolinska Institutet, Karolinska University Hospital, Radiumhemmet P1:02, 171 76, Stockholm, Sweden.
| | - Brett Delahunt
- Department of Pathology and Molecular Medicine, Wellington School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand
| | - Hemamali Samaratunga
- Aquesta Uropathology and University of Queensland, Brisbane, Queensland, Australia
| | - Toyonori Tsuzuki
- Department of Surgical Pathology, Aichi Medical University, School of Medicine, Nagoya, Japan
| | - Henrik Olsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Peter Ström
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Cecilia Lindskog
- Department of Immunology, Genetics, and Pathology, Uppsala University, Uppsala, Sweden
| | - Tomi Häkkinen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Tays Cancer Center, Tampere University Hospital, Tampere, Finland
| | - Kimmo Kartasalo
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Martin Eklund
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Pekka Ruusuvuori
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Institute of Biomedicine, University of Turku, Turku, Finland
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21
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Vigneswaran HT, Palsdottir T, Olsson H, Haug ES, Picker W, Löffeler S, Grönberg H, Eklund M, Nordström T. Biomarker discrimination and calibration with MRI-targeted biopsies: an analysis with the Stockholm3 test. Prostate Cancer Prostatic Dis 2020; 24:457-464. [PMID: 33168965 DOI: 10.1038/s41391-020-00297-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/24/2020] [Accepted: 10/13/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND The validated Stockholm3 test is used to improve PC detection. Stockholm3, however, was developed using systematic biopsies. We aimed to assess Stockholm3 operating performance when using MRI-targeted biopsies for PC detection. METHODS A prospective cohort of 532 men was considered for prostate biopsy during 2016-2017. All men underwent Stockholm3 testing and MRI before biopsy. All PIRADs ≥3 lesion underwent targeted biopsy; all men underwent systematic biopsy. The primary outcome was ISUP Grade Group ≥2 (GG ≥ 2) PC. Detection strategies included: (1) systematic biopsies alone, (2) targeted biopsies alone, (3) targeted with associated systematic biopsies for MRI+, and (4) all biopsies in all men. For each strategy, the Stockholm3 operating characteristics were assessed with discrimination, calibration, and decision curve analysis (DCA). RESULTS Median age was 65 years, median PSA was 6.2 ng/mL, median Stockholm3 score was 16.5%, and overall detection of GG ≥ 2 PC was 36% (193/532). Stockholm3 showed accurate discrimination for separating GG ≥ 2 cancer from benign and GG1, with an area under the curve of 0.84-0.86 depending on the biopsy strategy. Calibration analysis showed that Stockholm3 underestimated risks for GG ≥ 2 PC risk using MRI-targeted biopsies: there was a net benefit over biopsies in all men for Stockholm3 at risk thresholds varying from >3% in systematic biopsies to >15% in targeted with systematic biopsies in MRI+ men. When using a Stockholm3 score of >10% cutoff, a range of 32-38% of biopsies could be avoided while missing 5-11% of GG ≥ 2 PC and 0-3% of GG ≥ 3 PC. CONCLUSIONS Stockholm3 shows high discriminatory performance in an MRI-targeted biopsy setting, however risks are underpredicted due to MRI-targeted biopsies being more sensitive than the systematic biopsies for which Stockholm3 was developed. Stockholm3, along with any risk prediction model developed for systematic prostate biopsy decisions, will need recalibration for optimal use in an MRI-driven biopsy setting.
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Affiliation(s)
- Hari T Vigneswaran
- Department of Urology, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA. .,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
| | - Thorgerdur Palsdottir
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Olsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Erik S Haug
- Department of Urology, Vestfold Hospital Trust, Tønsberg, Norway.,Oslo University Hospital, Institute of Cancer Genomics and Informatics, Oslo, Norway
| | | | - Sven Löffeler
- Department of Urology, Vestfold Hospital Trust, Tønsberg, Norway
| | - Henrik Grönberg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Martin Eklund
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Tobias Nordström
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
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Olsson H, Nordström T, Jäderling F, Egevad L, Vigneswaran HT, Annerstedt M, Grönberg H, Eklund M, Lantz A. Incorporating Magnetic Resonance Imaging and Biomarkers in Active Surveillance Protocols - Results From the Prospective Stockholm3 Active Surveillance Trial (STHLM3AS). J Natl Cancer Inst 2020; 113:632-640. [PMID: 32866231 PMCID: PMC8096373 DOI: 10.1093/jnci/djaa131] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/05/2020] [Accepted: 08/20/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Active surveillance (AS) for men with low-risk prostate cancer (PC) can lead to patient morbidity and healthcare overutilization. The aim of this study was to evaluate an AS protocol using the Stockholm3 test and magnetic resonance imaging (MRI) to reduce biopsy intensity. METHODS We conducted a prospective multicenter study of 280 invited men from a contemporary screening study (STHLM3), with Gleason Score (GS) 3 + 3 PC on a current AS protocol. Patients underwent prostate-MRI and blood sampling for analysis of the Stockholm3 test including protein biomarkers, genetic variants, and clinical variables to predict risk of GS ≥3 + 4 PC followed by systematic biopsies and targeted biopsies (for Prostate Imaging Reporting and Data System version 2 ≥3 lesions) in all men. Primary outcomes were reclassification to GS ≥3 + 4 PC and clinically significant PC (csPCa), including unfavorable intermediate risk PC or higher based on National Comprehensive Cancer Network guidelines. RESULTS Adding MRI-targeted biopsies to systematic biopsies increased sensitivity of GS ≥3 + 4 PC compared with systematic biopsies alone (relative sensitivity [RS] = 1.52, 95% confidence interval [CI] = 1.28 to 1.85). Performing biopsies in only MRI positive increased sensitivity of GS ≥3 + 4 PC (RS = 1.30, 95% CI = 1.04 to 1.67) and reduced number of biopsy procedures by 49.3% while missing 7.2% GS ≥3 + 4 PC and 1.4% csPCa. Excluding men with negative Stockholm3 test reduced the number of MRI investigations at follow-up by 22.5% and biopsies by 56.8% while missing 6.9% GS ≥3 + 4 PC and 1.3% csPCa. CONCLUSION Including MRI and targeted/systematic biopsies in the follow-up for men on AS increased sensitivity of PC reclassification. Incorporation of risk prediction models including biomarkers may reduce the need for MRI use in men with low-risk PC.
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Affiliation(s)
- Henrik Olsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Tobias Nordström
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Sciences, Danderyd's Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Jäderling
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Radiology, Capio St Göran Hospital, Stockholm, Sweden
| | - Lars Egevad
- Department of Oncology Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Hari T Vigneswaran
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | | | - Henrik Grönberg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Martin Eklund
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Anna Lantz
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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Björnebo L, Olsson H, Nordström T, Jäderling F, Grönberg H, Eklund M, Lantz A. Predictors of adverse pathology on radical prostatectomy specimen in men initially enrolled in active surveillance for low-risk prostate cancer. World J Urol 2020; 39:1797-1804. [PMID: 32734463 PMCID: PMC8217019 DOI: 10.1007/s00345-020-03394-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 06/05/2020] [Accepted: 07/24/2020] [Indexed: 12/01/2022] Open
Abstract
Purpose To evaluate clinical variables, including magnetic resonance imaging (MRI) predictive of adverse pathology (AP) at radical prostatectomy (RP) in men initially enrolled in active surveillance (AS). Methods A population-based cohort study of men diagnosed with low-risk prostate cancer (PCa), in Stockholm County, Sweden, during 2008–2017 enrolled in AS their intended primary treatment followed by RP. AP was defined as ISUP grade group ≥ 3 and/or pT-stage ≥ T3. Association between clinical variables at diagnosis and time to AP was evaluated using Cox regression and multivariate logistic regression to evaluate the association between AP and clinical variables at last biopsy before RP. Results In a cohort of 6021 patients with low-risk PCa, 3116 were selected for AS and 216 underwent RP. Follow-up was 10 years, with a median time on AS of 23 months. 37.7% of patients had AP at RP. Clinical T-stage [Hazard ratio (HR): 1.81, 95% confidence interval (CI) 1.04–3.18] and PSA (HR: 1.31, 95% CI 1.17–1.46) at diagnosis and age [Odds Ratio (OR): 1.09, 95% CI 1.02–1.18), PSA (OR: 1.22, 95% CI 1.07–1.41), and PI-RADS (OR 1.66, 95% CI 1.11–2.55)] at last re-biopsy were significantly associated with AP. Conclusion PI-RADS score is significantly associated with AP at RP and support current guidelines recommending MRI before enrollment in AS. Furthermore, age, cT-stage, and PSA are significantly associated with AP. Electronic supplementary material The online version of this article (10.1007/s00345-020-03394-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lars Björnebo
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.
| | - Henrik Olsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Tobias Nordström
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.,Department of Clinical Sciences, Danderyds Hospital, Danderyd Hospital, Danderyd, Sweden
| | - Fredrik Jäderling
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Diagnostic Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - Henrik Grönberg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Martin Eklund
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Anna Lantz
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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24
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Stojić H, Olsson H, Analytis PP. Linear integration and lexicographic models of choice: A cue weight learning perspective. J Exp Psychol Learn Mem Cogn 2020; 46:1836-1856. [PMID: 32406723 DOI: 10.1037/xlm0000853] [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] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Choosing between options characterized by multiple cues can be a daunting task. People may integrate all information at hand or just use lexicographic strategies that ignore most of it. Notably, integrative strategies require knowing exact cue weights, whereas lexicographic heuristics can operate by merely knowing the importance order of cues. Here we study how using integrative or lexicographic strategies interacts with learning about cues. In our choice-learning-estimation paradigm people first make choices, learning about cues from the experienced qualities of chosen options, and then estimate qualities of new options. We developed delta-elimination (DE), a new lexicographic strategy that generalizes previous heuristics to any type of environment, and compared it to the integrative weighted-additive (WADD) strategy. Our results show that participants learned cue weights, regardless of whether the DE strategy or the WADD strategy described their choices the best. Still, there was an interaction between the adopted strategy and the cue weight learning process: the DE users learned cue weights slower than the WADD users. This work advances the study of lexicographic choice strategies, both empirically and theoretically, and deepens our understanding of strategy selection, in particular the interaction between the strategy used and learning the structure of the environment. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Hrvoje Stojić
- Department of Economics and Business, Pompeu Fabra University
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25
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Lantz A, Olsson H, Nordström T, Jäderling F, Egevad L, Annerstedt M, Gronberg H, Eklund M. Incorporating mpMRI and biomarkers in active surveillance protocols: The prospective Stockholm3 Active Surveillance trial (STHLM3AS). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.6_suppl.tps379] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS379 Background: Level one evidence shows that men with low-risk prostate cancer undergoing active surveillance (AS) with repeated PSA tests and systematic biopsies have low mortality. However, monitoring sometimes misses significant cancer progression and causes patient morbidity. The objective of this study is to evaluate a new proposed protocol for AS using the combination of the Stockholm3 test and MRI targeted biopsies in comparison to conventional follow-up using PSA and systematic biopsies. Methods: A prospective multicenter study with paired design was used to evaluate our proposed protocol (Stockholm3, MRI, targeted biopsies) compared with the conventional protocol according to Swedish National Guidelines (PSA, systematic biopsies) for follow-up of men on AS. The STHLM3 study was performed between 2012-2014. In the study 1 374 men were diagnosed with ISUP grade 1 disease. Out of these, 541 men currently on AS were invited to the STHLM3AS study. Eligible individuals had to be alive without any severe comorbidity, without contraindications for MRI and without a history of initiating prostate cancer treatment. The primary endpoint ISUP grade ≥2 cancer and the secondary endpoint number of performed biopsies will be evaluated using relative sensitivity (RS). At baseline a blood test for PSA and Stockholm3 test as well as a bi-parametric MRI was performed. For men with PIRADS ≥ 3 targeted and systematic biopsies were performed. For men with PIRADS < 3 only systematic biopsies were performed. The study is registered at ClinicalTrials.gov (NCTNCT03956108). Results: 301 men on AS have been included in the study. Since this is a trial in progress, no results will be presented. Conclusions: To our knowledge, this is the largest prospective multicenter study evaluating the performance of MRI for disease monitoring in an AS-cohort. Prediction models using biomarkers and MRI will likely both have an increasing role in the monitoring of AS patients in the future. We hypothesise that the sequential use of first Stockholm3 test followed by MRI will decrease the number of biopsies, while retaining the sensitivity to detect ISUP grade ≥2 cancer compared with using systematic biopsies in all men. Clinical trial information: NCTNCT03956108.
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Affiliation(s)
| | - Henrik Olsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Tobias Nordström
- Karolinska Institutet, Department of Medical Epidemiology and Biostatistics, Stockholm, Sweden
| | | | - Lars Egevad
- Karolinska Institutet, Department of Oncology-Pathology (OnkPat), Karolinska University Hospital, Stockholm, Sweden
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Ström P, Kartasalo K, Olsson H, Solorzano L, Delahunt B, Berney DM, Bostwick DG, Evans AJ, Grignon DJ, Humphrey PA, Iczkowski KA, Kench JG, Kristiansen G, van der Kwast TH, Leite KRM, McKenney JK, Oxley J, Pan CC, Samaratunga H, Srigley JR, Takahashi H, Tsuzuki T, Varma M, Zhou M, Lindberg J, Lindskog C, Ruusuvuori P, Wählby C, Grönberg H, Rantalainen M, Egevad L, Eklund M. Artificial intelligence for diagnosis and grading of prostate cancer in biopsies: a population-based, diagnostic study. Lancet Oncol 2020; 21:222-232. [PMID: 31926806 DOI: 10.1016/s1470-2045(19)30738-7] [Citation(s) in RCA: 263] [Impact Index Per Article: 65.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 10/11/2019] [Accepted: 10/22/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND An increasing volume of prostate biopsies and a worldwide shortage of urological pathologists puts a strain on pathology departments. Additionally, the high intra-observer and inter-observer variability in grading can result in overtreatment and undertreatment of prostate cancer. To alleviate these problems, we aimed to develop an artificial intelligence (AI) system with clinically acceptable accuracy for prostate cancer detection, localisation, and Gleason grading. METHODS We digitised 6682 slides from needle core biopsies from 976 randomly selected participants aged 50-69 in the Swedish prospective and population-based STHLM3 diagnostic study done between May 28, 2012, and Dec 30, 2014 (ISRCTN84445406), and another 271 from 93 men from outside the study. The resulting images were used to train deep neural networks for assessment of prostate biopsies. The networks were evaluated by predicting the presence, extent, and Gleason grade of malignant tissue for an independent test dataset comprising 1631 biopsies from 246 men from STHLM3 and an external validation dataset of 330 biopsies from 73 men. We also evaluated grading performance on 87 biopsies individually graded by 23 experienced urological pathologists from the International Society of Urological Pathology. We assessed discriminatory performance by receiver operating characteristics and tumour extent predictions by correlating predicted cancer length against measurements by the reporting pathologist. We quantified the concordance between grades assigned by the AI system and the expert urological pathologists using Cohen's kappa. FINDINGS The AI achieved an area under the receiver operating characteristics curve of 0·997 (95% CI 0·994-0·999) for distinguishing between benign (n=910) and malignant (n=721) biopsy cores on the independent test dataset and 0·986 (0·972-0·996) on the external validation dataset (benign n=108, malignant n=222). The correlation between cancer length predicted by the AI and assigned by the reporting pathologist was 0·96 (95% CI 0·95-0·97) for the independent test dataset and 0·87 (0·84-0·90) for the external validation dataset. For assigning Gleason grades, the AI achieved a mean pairwise kappa of 0·62, which was within the range of the corresponding values for the expert pathologists (0·60-0·73). INTERPRETATION An AI system can be trained to detect and grade cancer in prostate needle biopsy samples at a ranking comparable to that of international experts in prostate pathology. Clinical application could reduce pathology workload by reducing the assessment of benign biopsies and by automating the task of measuring cancer length in positive biopsy cores. An AI system with expert-level grading performance might contribute a second opinion, aid in standardising grading, and provide pathology expertise in parts of the world where it does not exist. FUNDING Swedish Research Council, Swedish Cancer Society, Swedish eScience Research Center, EIT Health.
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Affiliation(s)
- Peter Ström
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Kimmo Kartasalo
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Henrik Olsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Leslie Solorzano
- Centre for Image Analysis, Department of Information Technology, Uppsala University, Uppsala, Sweden
| | - Brett Delahunt
- Department of Pathology and Molecular Medicine, Wellington School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand
| | - Daniel M Berney
- Barts Cancer Institute, Queen Mary University of London, London, UK
| | | | - Andrew J Evans
- Laboratory Medicine Program, University Health Network, Toronto General Hospital, Toronto, ON, Canada
| | - David J Grignon
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Peter A Humphrey
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | | | - James G Kench
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and Central Clinical School, University of Sydney, Sydney, NSW, Australia
| | | | - Theodorus H van der Kwast
- Laboratory Medicine Program, University Health Network, Toronto General Hospital, Toronto, ON, Canada
| | - Katia R M Leite
- Department of Urology, Laboratory of Medical Research, University of São Paulo Medical School, São Paulo, Brazil
| | - Jesse K McKenney
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jon Oxley
- Department of Cellular Pathology, Southmead Hospital, Bristol, UK
| | - Chin-Chen Pan
- Department of Pathology, Taipei Veterans General Hospital, Taipei, Taiwan
| | | | - John R Srigley
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Hiroyuki Takahashi
- Department of Pathology, Jikei University School of Medicine, Tokyo, Japan
| | - Toyonori Tsuzuki
- Department of Surgical Pathology, School of Medicine, Aichi Medical University, Nagakute, Japan
| | - Murali Varma
- Department of Cellular Pathology, University Hospital of Wales, Cardiff, UK
| | - Ming Zhou
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Johan Lindberg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Cecilia Lindskog
- Department of Immunology, Genetics, and Pathology, Uppsala University, Uppsala, Sweden
| | - Pekka Ruusuvuori
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Carolina Wählby
- Centre for Image Analysis, Department of Information Technology, Uppsala University, Uppsala, Sweden; BioImage Informatics Facility of SciLifeLab, Uppsala, Sweden
| | - Henrik Grönberg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Oncology, St Göran Hospital, Stockholm, Sweden
| | - Mattias Rantalainen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Lars Egevad
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Martin Eklund
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
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Beckmann K, Crawley D, Nordström T, Aly M, Olsson H, Lantz A, Binti Abd Jalal N, Garmo H, Adolfsson J, Eklund M, Van Hemelrijck M. Association Between Antidiabetic Medications and Prostate-Specific Antigen Levels and Biopsy Results. JAMA Netw Open 2019; 2:e1914689. [PMID: 31693126 PMCID: PMC6865613 DOI: 10.1001/jamanetworkopen.2019.14689] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
IMPORTANCE Diabetic men appear to have a lower risk of prostate cancer. Whether antidiabetic medications are protective or potentially mask prostate cancer by lowering prostate-specific antigen (PSA) levels is unclear. OBJECTIVE To examine the associations of antidiabetic medication use with (1) PSA levels, (2) frequency of PSA testing, (3) receipt of biopsy following elevated PSA results, and (4) prostate cancer detection at biopsy. DESIGN, SETTING, AND PARTICIPANTS Population-based cohort study using data from the Stockholm PSA and Biopsy Register. Participants were all prostate cancer-free men aged 40 to 79 years residing in Stockholm County, Sweden, between January 1, 2006, and December 31, 2015. Data were analyzed from November 2018 to March 2019. EXPOSURES One or more prescription for metformin, sulfonylurea, or insulin, as recorded in Sweden's National Prescribed Drug Register. MAIN OUTCOMES AND MEASURES Levels of PSA following first exposure to antidiabetic medications were assessed using multivariable linear regression. Frequency of PSA testing was assessed via multivariable Poisson regression. Biopsy following elevated PSA (≥3.0 ng/mL) and prostate cancer detection at biopsy were assessed via multivariable logistic regression. RESULTS The cohort of 564 666 men (median [range] age, 65 [40-79] years) consisted of 4583 men initially exposed to metformin, 1104 exposed to sulfonylurea, and 978 exposed to insulin who were age matched with unexposed men (1:5). Exposed men had lower median (interquartile range) PSA levels before starting antidiabetic medications compared with unexposed men (1.2 [0.7-2.5] vs 1.6 [0.8-3.2] ng/mL). After accounting for baseline differences, PSA levels did not vary from those of unexposed men following exposure to antidiabetic medications. Frequency of PSA testing was higher for those receiving metformin (rate ratio, 1.07; 95% CI, 1.06-1.09) and sulfonylurea (rate ratio, 1.06; 95% CI, 1.03-1.08) but was lower for those receiving insulin (rate ratio, 0.79; 95% CI, 0.77- 0.81). Likelihood of biopsy after elevated PSA was lower among men receiving metformin (odds ratio, 0.87; 95% CI, 0.80-0.96) and insulin (odds ratio, 0.83; 95% CI, 0.74-0.93). There were no differences in prostate cancer detection at biopsy, regardless of PSA levels that triggered the biopsy. CONCLUSIONS AND RELEVANCE This study's findings do not support the hypothesis that the inverse association between diabetes and prostate cancer is mediated through antidiabetic medications lowering PSA levels to mask prostate cancer. They do suggest potential detection bias due to fewer biopsies among men receiving antidiabetic medications, which may explain the lower prostate cancer risk in men with diabetes.
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Affiliation(s)
- Kerri Beckmann
- Translational Oncology and Urology Research, Comprehensive Cancer Centre, King’s College London, London, United Kingdom
- University of South Australia Cancer Research Institute, University of South Australia, Adelaide, Australia
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Danielle Crawley
- Translational Oncology and Urology Research, Comprehensive Cancer Centre, King’s College London, London, United Kingdom
| | - Tobias Nordström
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Markus Aly
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Olsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Anna Lantz
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Noor Binti Abd Jalal
- Translational Oncology and Urology Research, Comprehensive Cancer Centre, King’s College London, London, United Kingdom
| | | | - Jan Adolfsson
- Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Martin Eklund
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Mieke Van Hemelrijck
- Translational Oncology and Urology Research, Comprehensive Cancer Centre, King’s College London, London, United Kingdom
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Eklund M, Kartasalo K, Olsson H, Ström P. The importance of study design in the application of artificial intelligence methods in medicine. NPJ Digit Med 2019; 2:101. [PMID: 31646183 PMCID: PMC6802122 DOI: 10.1038/s41746-019-0174-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 08/21/2019] [Indexed: 12/02/2022] Open
Affiliation(s)
- Martin Eklund
- 1Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Kimmo Kartasalo
- 2Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Henrik Olsson
- 1Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Peter Ström
- 1Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Beckmann K, Kinsella N, Olsson H, Wallerstedt Lantz A, Nordstrom T, Aly M, Adolfsson J, Eklund M, Van Hemelrijck M. Is there any association between prostate-specific antigen screening frequency and uptake of active surveillance in men with low or very low risk prostate cancer? BMC Urol 2019; 19:73. [PMID: 31383015 PMCID: PMC6683376 DOI: 10.1186/s12894-019-0502-4] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 07/18/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient-related factors such as concern about cancer are believed to influence both men's decisions to undergo prostate specific antigen (PSA) testing and to have definitive treatment if diagnosed with low risk prostate cancer (PCa). The potential link between screening frequency and choice of active surveillance (AS) for low risk disease has not been studied previously. Our aim was to investigate whether there is any association between PCa screening frequency or previous negative prostate biopsy and uptake of AS among men with low risk PCa. METHODS This register-based study included all men ≤75 years from Stockholm who were diagnosed with low risk PCa from 2008 to 2014 (n = 4336). Pre-diagnostic PSA testing and biopsy histories were obtained from the Stockholm PSA and Biopsy Register, a population-based register for the Stockholm country. The association between previous screening/biopsy history and AS uptake (based on primary treatment recorded in the National Prostate Cancer Register) was examined using multivariable logistic regression. RESULTS Forty seven percent of men with low risk PCa underwent AS. Uptake was associated with older age, very low risk disease, more recent diagnosis and absence of family history. None of the screening/biopsy measures (testing frequency, mean interval, PSA velocity, highest pre-diagnostic PSA or prior negative biopsy) were associated with uptake of AS among men with low risk PCa. Generalisability to settings with different policies and practices may be limited. CONCLUSION We found no evidence that screening frequency and negative biopsy influence uptake of AS among Swedish men with low risk PCa. Further research is required to determine factors that still present barriers for men taking up AS.
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Affiliation(s)
- Kerri Beckmann
- Translational Oncology & Urology Research, Comprehensive Cancer Centre, King's College London, 3rd Floor, Bermondsey Wing, Guy's Hospital, London, SE1 9RT, UK. .,University of South Australia, Centre for population Health Research Adelaide Australia, Adelaide, Australia.
| | - Netty Kinsella
- Translational Oncology & Urology Research, Comprehensive Cancer Centre, King's College London, 3rd Floor, Bermondsey Wing, Guy's Hospital, London, SE1 9RT, UK.,Department of Urology, The Royal Marsden Hospital, London, UK
| | - Henrik Olsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Anna Wallerstedt Lantz
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Tobias Nordstrom
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Markus Aly
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Jan Adolfsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,CLINTEC-Department, Karolinska Institutet, Stockholm, Sweden
| | - Martin Eklund
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Mieke Van Hemelrijck
- Translational Oncology & Urology Research, Comprehensive Cancer Centre, King's College London, 3rd Floor, Bermondsey Wing, Guy's Hospital, London, SE1 9RT, UK.,Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Olsson H, Nordström T, Clements M, Grönberg H, Lantz AW, Eklund M. Intensity of Active Surveillance and Transition to Treatment in Men with Low-risk Prostate Cancer. Eur Urol Oncol 2019; 3:640-647. [PMID: 31235395 DOI: 10.1016/j.euo.2019.05.005] [Citation(s) in RCA: 11] [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] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 05/07/2019] [Accepted: 05/27/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Active surveillance (AS) is increasingly utilized for low-risk prostate cancers, to delay or avoid treatment. OBJECTIVE To (1) describe uptake and surveillance intensity of real-world use of AS and compare with national guidelines, and (2) describe transitions from conservative to curative treatment by different indications of disease progression. DESIGN, SETTING, AND PARTICIPANTS A population-based cohort study of men diagnosed with low-risk prostate cancer, in Stockholm County, Sweden, during 2008-2017. Follow-up was up to 10yr, with a median of 3.5yr. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Poisson regression was used to estimate incidence rate ratios of prostate-specific antigen (PSA) testing and biopsies. Cox regression was used to estimate hazard ratios of starting curative treatment. RESULTS AND LIMITATIONS A total of 6021 men with low-risk prostate cancer were included in the analysis; 3116 (52%) had AS recorded as the intended primary management (AS cohort). During 1, 2, and 3yr after diagnosis, the frequencies of at least one PSA test were 90%, 92%, and 88%, respectively, and those of postdiagnostic surveillance biopsies were 42%, 19% and 18%, respectively. During surveillance, 13% of men in the AS cohort were upgraded on rebiopsy, with Gleason upgrading being the strongest factor for starting curative treatment. One limitation is the generalizability to other populations because of differences between surveillance protocols and clinical settings. CONCLUSIONS Our results show that AS is underutilized and that monitoring differs from current guidelines. Optimization of AS protocols is important in order to increase adherence and avoid overtreatment. PATIENT SUMMARY Active surveillance has the potential to reduce overtreatment and avoid treatment-related side effects. Our results show that few men receive the recommended monitoring.
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Affiliation(s)
- Henrik Olsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
| | - Tobias Nordström
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Sciences at Danderyd's Hospital, Karolinska Institutet, Sweden
| | - Mark Clements
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Grönberg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Anna Wallerstedt Lantz
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Urology, Karolinska University Hospital Solna, Sweden
| | - Martin Eklund
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Simonsson M, Winell H, Olsson H, Szummer K, Alfredsson J, Hall M, Dondo TB, Gale CP, Jernberg T. Development and Validation of a Novel Risk Score for In-Hospital Major Bleeding in Acute Myocardial Infarction:-The SWEDEHEART Score. J Am Heart Assoc 2019; 8:e012157. [PMID: 30803289 PMCID: PMC6474938 DOI: 10.1161/jaha.119.012157] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 01/30/2019] [Indexed: 02/07/2023]
Abstract
Background Bleeding risk stratification in acute coronary syndrome is of highest clinical interest but current risk scores have limitations. We sought to develop and validate a new in-hospital bleeding risk score for patients with acute myocardial infarction. Methods and Results From the nationwide SWEDEHEART (Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) register, 97,597 patients with acute myocardial infarction enrolled from 2009 until 2014 were selected. A full model with 23 predictor variables and 8 interaction terms was fitted using logistic regression. The full model was approximated by a model with 5 predictors and 1 interaction term. Calibration, discrimination, and clinical utility was evaluated and compared with the ACTION (Acute Coronary Treatment and Intervention Outcomes Network) and CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Ad verse Outcomes With Early Implementation of the ACC /AHA Guidelines) scores. Internal and temporal validity was assessed. In-hospital major bleeding, defined as fatal, intracranial, or requiring surgery or blood transfusion, occurred in 1356 patients (1.4%). The 5 predictors in the approximate model that constituted the SWEDEHEART score were hemoglobin, age, sex, creatinine, and C-reactive protein. The ACTION and CRUSADE scores were poorly calibrated in the derivation cohort and therefore were recalibrated. The SWEDEHEART score showed higher discriminative ability than both recalibrated scores, overall ( C-index 0.80 versus 0.73/0.72) and in all predefined subgroups. Decision curve analysis demonstrated consistently positive and higher net benefit for the SWEDEHEART score compared with both recalibrated scores across all clinically relevant decision thresholds. The original ACTION and CRUSADE scores showed negative net benefit. Conclusions The 5-item SWEDEHEART score discriminates in-hospital major bleeding in patients with acute myocardial infarction and has superior model performance compared with the recalibrated ACTION and CRUSADE scores.
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Affiliation(s)
- Moa Simonsson
- Department of Clinical SciencesKarolinska InstitutetDanderydSweden
- Department of CardiologyKarolinska University HospitalSolnaSweden
| | - Henric Winell
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetSolnaSweden
- Department of StatisticsUppsala UniversityUppsalaSweden
| | - Henrik Olsson
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetSolnaSweden
| | - Karolina Szummer
- Department of CardiologyKarolinska University HospitalSolnaSweden
- Department of MedicineKarolinska InstitutetHuddingeSweden
| | - Joakim Alfredsson
- Department of CardiologyDepartment of Medical and Health SciencesLinköping UniversityLinköpingSweden
| | - Marlous Hall
- Leeds Institute of Cardiovascular and Metabolic MedicineUniversity of LeedsUnited Kingdom
| | - Tatendashe B. Dondo
- Leeds Institute of Cardiovascular and Metabolic MedicineUniversity of LeedsUnited Kingdom
| | - Chris P Gale
- Leeds Institute of Cardiovascular and Metabolic MedicineUniversity of LeedsUnited Kingdom
| | - Tomas Jernberg
- Department of Clinical SciencesKarolinska InstitutetDanderydSweden
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Löfman I, Szummer K, Olsson H, Carrero JJ, Lund LH, Jernberg T. Association Between Mineralocorticoid Receptor Antagonist Use and Outcome in Myocardial Infarction Patients With Heart Failure. J Am Heart Assoc 2018; 7:JAHA.118.009359. [PMID: 29980521 PMCID: PMC6064826 DOI: 10.1161/jaha.118.009359] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background There are no studies of mineralocorticoid receptor antagonist (MRA) treatment examining outcome in unselected real‐life patients with myocardial infarction (MI) and heart failure (HF). There is uncertainty regarding effects of MRA in relation to left ventricular ejection fraction (LVEF) and chronic kidney disease (CKD). The aim was to assess MRA use and compare outcomes in MI patients with HF in relation to LVEF and CKD. Methods and Results Patients with MI and HF registered in the Swedish myocardial infarction registry, SWEDEHEART, 2005–2014, were included. Associations between MRA use and all‐cause mortality up to 3 years were assessed with multivariable Cox regression, stratified by EF groups and presence of CKD (estimated glomerular filtration rate <60 mL/min per 1.73 m2). Of 45 071 patients with MI and HF, 4470 (9.9%) received MRA. Those with HF and LVEF <40% more often had MRA (19.6%) compared with those with LVEF 40% to 49% (9.1%) or LVEF ≥50% (4.7%). 8.6% of patients with CKD received MRA. After adjustment, MRA use was associated with lower mortality in those with LVEF <40% (hazard ratio [95% confidence interval] 0.81 [0.75–0.88]) and LVEF 40% to 49% (0.88 [0.75–1.03]) but not in those with LVEF ≥50% (1.29 [1.09–1.53]), with significant interaction between MRA and LVEF (P<0.0001). The association between MRA use and mortality was similar in those without (0.96 [0.88–1.05]) and with (0.92 [0.85–0.99]) CKD. Conclusions In patients with MI and HF, MRA use was associated with better long‐term survival in patients with LVEF <40% but not in those with LVEF ≥50%, while the mortality risk was similar in MRA‐treated patients with or without CKD.
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Affiliation(s)
- Ida Löfman
- Unit of Cardiology, Heart and Vascular Theme, Huddinge, Department of Medicine, Karolinska Institutet Karolinska University Hospital, Stockholm, Sweden
| | - Karolina Szummer
- Unit of Cardiology, Heart and Vascular Theme, Huddinge, Department of Medicine, Karolinska Institutet Karolinska University Hospital, Stockholm, Sweden
| | - Henrik Olsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Juan-Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Lars H Lund
- Unit of Cardiology, Heart and Vascular Theme, Solna, Department of Medicine, Karolinska Institutet Karolinska University Hospital, Stockholm, Sweden
| | - Tomas Jernberg
- Department of Clinical Sciences, Danderyd University Hospital Karolinska Institutet, Stockholm, Sweden
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Tedner SG, Lundholm C, Olsson H, Almqvist C. Depression or anxiety in adult twins is associated with asthma diagnosis but not with offspring asthma. Clin Exp Allergy 2017; 46:803-12. [PMID: 27228571 DOI: 10.1111/cea.12714] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 01/06/2016] [Accepted: 01/16/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Asthma is common in both children and adults in the Western world, just like anxiety and depression. While some research has revealed that these diseases might share important environmental and pathophysiological aspects, the exact mechanisms still remain unclear. OBJECTIVE To study the correlation firstly between depression or anxiety and asthma diagnosis in adult twins and secondly the association between parental depression or anxiety and offspring asthma in children of twins. METHODS In total, 24 685 adult twins aged 20-47 years were interviewed or completed a Web-based questionnaire and their children were identified through the Multi-Generation Register. Asthma diagnosis was obtained from the Patient Register and the Prescribed Drug Register. Assessment of depression and anxiety was obtained from questionnaires using Center for Epidemiologic Studies Depression Scale (CES-D), major depression and generalized anxiety disorder (GAD) from DSM-IV. The association between depression or anxiety and asthma was analyzed with logistic regression adjusting for confounders in twins and offspring. To address genetic and familial environmental confounding, we performed a cotwin analysis using disease-discordant twin pairs. RESULTS We found an association between asthma and CES-D, major depression and GAD, for example adjusted OR for major depression and register-based asthma 1.56 (1.36-1.79). Most of the point estimates remained in the co-twin control analysis, indicating that the association was likely not due to genetic or familial environmental factors. There was no association between parental depression and/or anxiety and asthma diagnosis in the offspring which implies lack of genetic confounding. CONCLUSIONS We found an association between own asthma diagnosis and anxiety or depression, but not with offspring asthma. Our results indicate that the associations were not due to confounding from genes or environment shared by the twins.
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Affiliation(s)
- S G Tedner
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - C Lundholm
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - H Olsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - C Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Lung and Allergy Unit, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
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Lofman I, Szummer K, Olsson H, Carrerro J, Evans M, Lund L, Jernberg T. 249Long-term outcome in myocardial infarction patients with heart failure treated with aldosterone receptor antagonist in relation to ejection fraction and kidney function. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Simonsson M, Olsson H, Winell H, Szummer K, Alfredsson J, Jernberg T. 255Development and validation of a new in-hospital bleeding risk model for patients with acute coronary syndrome - the SWEDEHEARTscore. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Lindqvist PG, Olsson H. Are low sun exposure habits a genuine strong risk factor for all-cause mortality or the result of bias? J Intern Med 2017; 281:620-621. [PMID: 28334474 DOI: 10.1111/joim.12612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- P G Lindqvist
- Department of Obstetrics and Gynecology, Clintec, Karolinska University Hospital, Huddinge, Stockholm
| | - H Olsson
- Departments of Oncology and Cancer Epidemiology, Lund University Hospital, Lund, Sweden
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He W, Smedby KE, Fang F, Olsson H, Margolin S, Hall P, Czene K. Treatment Restarting After Discontinuation of Adjuvant Hormone Therapy in Breast Cancer Patients. J Natl Cancer Inst 2017; 109:3114122. [PMID: 28423398 DOI: 10.1093/jnci/djx041] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 02/22/2017] [Indexed: 11/14/2022] Open
Abstract
Background Over half of breast cancer patients discontinue their adjuvant hormone therapy, permanently or temporarily. We aimed to identify predictors of treatment restarting after discontinuation of adjuvant hormone therapy and to test the hypothesis that treatment restarting is associated with better breast cancer outcomes. Methods We conducted a population-based cohort study by linking data from the Stockholm-Gotland Breast Cancer Register, the Swedish Prescribed Drug Register, and a self-reported questionnaire. We followed women diagnosed with breast cancer (Stockholm, Sweden, 2005-2008) from their first prescription of tamoxifen or aromatase inhibitors through January 31, 2015, and categorized them as continuers (n = 1 607), restarters (n = 953), and nonrestarters (n = 511) of adjuvant hormone therapy. All statistical tests were two-sided. Results Factors that decrease the likelihood of treatment restarting included younger age (<50 years), higher Charlson Comorbidity Score (≥2), smaller tumor size (<20 mm), human epidermal growth factor receptor 2 negative, lymph node negative, family history of breast cancer negative, using hormone therapy, using symptom relieving drugs, and switching therapy between tamoxifen and aromatase inhibitors. Restarting adjuvant hormone therapy was statistically significantly associated with prolonged disease-free survival, with an adjusted hazard ratio of 0.61 (95% confidence interval = 0.43 to 0.87, P = .006) for restarters vs nonrestarters. Conclusions Our study provides-for the first time to our knowledge-evidence that restarting adjuvant hormone therapy is associated with better breast cancer outcomes. Clinicians now have further evidence to encourage patients to restart their treatment after discontinuation of adjuvant hormone therapy.
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Affiliation(s)
- Wei He
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Karin E Smedby
- Clinical Epidemiology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Fang Fang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Olsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Sara Margolin
- Department of Oncology-Pathology, Karolinska Institute Solna, Stockholm, Sweden
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Kamila Czene
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Schrijver LH, Olsson H, Antoniou AC, Milne RL, Phillips KA, Andrieu N, Easton DF, Goldgar D, Engel C, Kast K, Roos-Blom MJ, Mooij TM, Hopper JL, van Leeuwen FE, Terry MB, Rookus MA. Abstract P5-08-09: Use of oral contraceptives and risk of breast cancer in BRCA1 and BRCA2 mutation carriers: An international prospective cohort study; for the studies of EMBRACE, GENEPSO, HEBON, kConFab and BCFR. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p5-08-09] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
This abstract was withdrawn by the authors.
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Affiliation(s)
- LH Schrijver
- Netherlands Cancer Institute, Amsterdam, Netherlands; Lund University, Lund, Sweden; University of Cambridge, Cambridge, United Kingdom; University of Melbourne, Melbourne, Australia; Cancer Council Victoria, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Institute Curie, PSL Research University, INSERM, U900, Paris, France; University of Utah, Salt Lake City, UT; University of Leipzig, Leipzig, Germany; University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany; German Cancer Consortium (DKTK), Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany; Colombia University, New York, NY
| | - H Olsson
- Netherlands Cancer Institute, Amsterdam, Netherlands; Lund University, Lund, Sweden; University of Cambridge, Cambridge, United Kingdom; University of Melbourne, Melbourne, Australia; Cancer Council Victoria, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Institute Curie, PSL Research University, INSERM, U900, Paris, France; University of Utah, Salt Lake City, UT; University of Leipzig, Leipzig, Germany; University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany; German Cancer Consortium (DKTK), Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany; Colombia University, New York, NY
| | - AC Antoniou
- Netherlands Cancer Institute, Amsterdam, Netherlands; Lund University, Lund, Sweden; University of Cambridge, Cambridge, United Kingdom; University of Melbourne, Melbourne, Australia; Cancer Council Victoria, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Institute Curie, PSL Research University, INSERM, U900, Paris, France; University of Utah, Salt Lake City, UT; University of Leipzig, Leipzig, Germany; University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany; German Cancer Consortium (DKTK), Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany; Colombia University, New York, NY
| | - RL Milne
- Netherlands Cancer Institute, Amsterdam, Netherlands; Lund University, Lund, Sweden; University of Cambridge, Cambridge, United Kingdom; University of Melbourne, Melbourne, Australia; Cancer Council Victoria, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Institute Curie, PSL Research University, INSERM, U900, Paris, France; University of Utah, Salt Lake City, UT; University of Leipzig, Leipzig, Germany; University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany; German Cancer Consortium (DKTK), Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany; Colombia University, New York, NY
| | - K-A Phillips
- Netherlands Cancer Institute, Amsterdam, Netherlands; Lund University, Lund, Sweden; University of Cambridge, Cambridge, United Kingdom; University of Melbourne, Melbourne, Australia; Cancer Council Victoria, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Institute Curie, PSL Research University, INSERM, U900, Paris, France; University of Utah, Salt Lake City, UT; University of Leipzig, Leipzig, Germany; University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany; German Cancer Consortium (DKTK), Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany; Colombia University, New York, NY
| | - N Andrieu
- Netherlands Cancer Institute, Amsterdam, Netherlands; Lund University, Lund, Sweden; University of Cambridge, Cambridge, United Kingdom; University of Melbourne, Melbourne, Australia; Cancer Council Victoria, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Institute Curie, PSL Research University, INSERM, U900, Paris, France; University of Utah, Salt Lake City, UT; University of Leipzig, Leipzig, Germany; University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany; German Cancer Consortium (DKTK), Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany; Colombia University, New York, NY
| | - DF Easton
- Netherlands Cancer Institute, Amsterdam, Netherlands; Lund University, Lund, Sweden; University of Cambridge, Cambridge, United Kingdom; University of Melbourne, Melbourne, Australia; Cancer Council Victoria, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Institute Curie, PSL Research University, INSERM, U900, Paris, France; University of Utah, Salt Lake City, UT; University of Leipzig, Leipzig, Germany; University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany; German Cancer Consortium (DKTK), Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany; Colombia University, New York, NY
| | - D Goldgar
- Netherlands Cancer Institute, Amsterdam, Netherlands; Lund University, Lund, Sweden; University of Cambridge, Cambridge, United Kingdom; University of Melbourne, Melbourne, Australia; Cancer Council Victoria, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Institute Curie, PSL Research University, INSERM, U900, Paris, France; University of Utah, Salt Lake City, UT; University of Leipzig, Leipzig, Germany; University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany; German Cancer Consortium (DKTK), Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany; Colombia University, New York, NY
| | - C Engel
- Netherlands Cancer Institute, Amsterdam, Netherlands; Lund University, Lund, Sweden; University of Cambridge, Cambridge, United Kingdom; University of Melbourne, Melbourne, Australia; Cancer Council Victoria, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Institute Curie, PSL Research University, INSERM, U900, Paris, France; University of Utah, Salt Lake City, UT; University of Leipzig, Leipzig, Germany; University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany; German Cancer Consortium (DKTK), Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany; Colombia University, New York, NY
| | - K Kast
- Netherlands Cancer Institute, Amsterdam, Netherlands; Lund University, Lund, Sweden; University of Cambridge, Cambridge, United Kingdom; University of Melbourne, Melbourne, Australia; Cancer Council Victoria, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Institute Curie, PSL Research University, INSERM, U900, Paris, France; University of Utah, Salt Lake City, UT; University of Leipzig, Leipzig, Germany; University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany; German Cancer Consortium (DKTK), Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany; Colombia University, New York, NY
| | - M-J Roos-Blom
- Netherlands Cancer Institute, Amsterdam, Netherlands; Lund University, Lund, Sweden; University of Cambridge, Cambridge, United Kingdom; University of Melbourne, Melbourne, Australia; Cancer Council Victoria, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Institute Curie, PSL Research University, INSERM, U900, Paris, France; University of Utah, Salt Lake City, UT; University of Leipzig, Leipzig, Germany; University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany; German Cancer Consortium (DKTK), Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany; Colombia University, New York, NY
| | - TM Mooij
- Netherlands Cancer Institute, Amsterdam, Netherlands; Lund University, Lund, Sweden; University of Cambridge, Cambridge, United Kingdom; University of Melbourne, Melbourne, Australia; Cancer Council Victoria, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Institute Curie, PSL Research University, INSERM, U900, Paris, France; University of Utah, Salt Lake City, UT; University of Leipzig, Leipzig, Germany; University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany; German Cancer Consortium (DKTK), Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany; Colombia University, New York, NY
| | - JL Hopper
- Netherlands Cancer Institute, Amsterdam, Netherlands; Lund University, Lund, Sweden; University of Cambridge, Cambridge, United Kingdom; University of Melbourne, Melbourne, Australia; Cancer Council Victoria, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Institute Curie, PSL Research University, INSERM, U900, Paris, France; University of Utah, Salt Lake City, UT; University of Leipzig, Leipzig, Germany; University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany; German Cancer Consortium (DKTK), Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany; Colombia University, New York, NY
| | - FE van Leeuwen
- Netherlands Cancer Institute, Amsterdam, Netherlands; Lund University, Lund, Sweden; University of Cambridge, Cambridge, United Kingdom; University of Melbourne, Melbourne, Australia; Cancer Council Victoria, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Institute Curie, PSL Research University, INSERM, U900, Paris, France; University of Utah, Salt Lake City, UT; University of Leipzig, Leipzig, Germany; University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany; German Cancer Consortium (DKTK), Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany; Colombia University, New York, NY
| | - M-B Terry
- Netherlands Cancer Institute, Amsterdam, Netherlands; Lund University, Lund, Sweden; University of Cambridge, Cambridge, United Kingdom; University of Melbourne, Melbourne, Australia; Cancer Council Victoria, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Institute Curie, PSL Research University, INSERM, U900, Paris, France; University of Utah, Salt Lake City, UT; University of Leipzig, Leipzig, Germany; University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany; German Cancer Consortium (DKTK), Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany; Colombia University, New York, NY
| | - MA Rookus
- Netherlands Cancer Institute, Amsterdam, Netherlands; Lund University, Lund, Sweden; University of Cambridge, Cambridge, United Kingdom; University of Melbourne, Melbourne, Australia; Cancer Council Victoria, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Institute Curie, PSL Research University, INSERM, U900, Paris, France; University of Utah, Salt Lake City, UT; University of Leipzig, Leipzig, Germany; University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany; German Cancer Consortium (DKTK), Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany; Colombia University, New York, NY
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Affiliation(s)
- P G Lindqvist
- Department of Obstetrics and Gynecology, Clintec, Karolinska University Hospital, Huddinge, Stockholm
| | - H Olsson
- Departments of Oncology and Cancer Epidemiology, Lund University Hospital, Lund, Sweden
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Cajander SB, Bondestam E, Höckenström T, Karlsson K, Olsson H, Vasco J. Telepathology in northern Sweden—concept, technical platform, validation and follow-up. J Telemed Telecare 2016. [DOI: 10.1258/1357633991933134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- S B Cajander
- Department of Pathology, Umeå University Hospital
| | - E Bondestam
- Department of Gynaecology, Skellefteå Hospital
| | | | - K Karlsson
- Departmentof Clinical Chemistry, Umeå University Hospital, Umea
| | - H Olsson
- Department Surgery, Skellefteå Hospital, Sweden
| | - J Vasco
- Department of Pathology, Umeå University Hospital
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Martling A, Smedby KE, Birgisson H, Olsson H, Granath F, Ekbom A, Glimelius B. Risk of second primary cancer in patients treated with radiotherapy for rectal cancer. Br J Surg 2016; 104:278-287. [PMID: 27802358 DOI: 10.1002/bjs.10327] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 07/16/2016] [Accepted: 08/24/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Many patients with rectal cancer receive radiotherapy (RT) to reduce the risk of local recurrence. Radiation may give rise to adverse effects, including second primary cancers. In view of the divergent results of previous studies, the present study evaluated the risk of second primary cancer following RT in all randomized RT rectal cancer trials conducted in Sweden and in the Swedish ColoRectal Cancer Registry (SCRCR). METHODS Patients included in five randomized trials and the SCRCR were linked to the Swedish Cancer Registry. Cox regression models estimated the hazard ratio (HR) of second primary cancer among patients who received RT compared with those who did not. RESULTS A total of 13 457 patients were included in this study; 7024 (52·2 per cent) received RT and 6433 (47·8 per cent) had surgery alone. Overall, no increased risk of second primary cancer was observed with RT (HR 1·03; 95 per cent c.i. 0·92 to 1·15), independently of follow-up time and location within or outside of the irradiated volume. In the randomized trials, with longer follow-up (maximum 31 years), a slight increase was observed outside of (HR 1·33, 1·01 to 1·74) but not within (HR 1·11, 0·73 to 1·67) the irradiated volume. Irradiated men had a lower risk of prostate cancer than those treated with surgery alone (HR 0·68, 0·51 to 0·91). CONCLUSION Overall, there was no increased risk of second primary cancer following RT for rectal cancer within or outside of the irradiated volume up to 20 years of follow-up. Men with rectal cancer who received RT had a reduced risk of prostate cancer.
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Affiliation(s)
- A Martling
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - K E Smedby
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - H Birgisson
- Departments of Surgical Science, Uppsala University, Uppsala, Sweden
| | - H Olsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - F Granath
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - A Ekbom
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - B Glimelius
- Departments of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
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Aljabery F, Shabo I, Olsson H, Gimm O, Jahnson S. Radio guided sentinel lymph node detection and mapping in invasive urinary bladder cancer - a prospective clinical study. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw373.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lindqvist PG, Epstein E, Nielsen K, Landin-Olsson M, Ingvar C, Olsson H. Avoidance of sun exposure as a risk factor for major causes of death: a competing risk analysis of the Melanoma in Southern Sweden cohort. J Intern Med 2016; 280:375-87. [PMID: 26992108 DOI: 10.1111/joim.12496] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [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] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Women with active sunlight exposure habits experience a lower mortality rate than women who avoid sun exposure; however, they are at an increased risk of skin cancer. We aimed to explore the differences in main causes of death according to sun exposure. METHODS We assessed the differences in sun exposure as a risk factor for all-cause mortality in a competing risk scenario for 29 518 Swedish women in a prospective 20-year follow-up of the Melanoma in Southern Sweden (MISS) cohort. Women were recruited from 1990 to 1992 (aged 25-64 years at the start of the study). We obtained detailed information at baseline on sun exposure habits and potential confounders. The data were analysed using modern survival statistics. RESULTS Women with active sun exposure habits were mainly at a lower risk of cardiovascular disease (CVD) and noncancer/non-CVD death as compared to those who avoided sun exposure. As a result of their increased survival, the relative contribution of cancer death increased in these women. Nonsmokers who avoided sun exposure had a life expectancy similar to smokers in the highest sun exposure group, indicating that avoidance of sun exposure is a risk factor for death of a similar magnitude as smoking. Compared to the highest sun exposure group, life expectancy of avoiders of sun exposure was reduced by 0.6-2.1 years. CONCLUSION The longer life expectancy amongst women with active sun exposure habits was related to a decrease in CVD and noncancer/non-CVD mortality, causing the relative contribution of death due to cancer to increase.
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Affiliation(s)
- P G Lindqvist
- Clintec, Karolinska Institutet, Department of Obstetrics and Gynecology, Karolinska University Hospital, Huddinge, Stockholm, Sweden.
| | - E Epstein
- Department of Obstetrics and Gynecology, Mothers and Childrens Health, Karolinska University Hospital, Solna, Stockholm, Sweden
| | - K Nielsen
- Department of Dermatology, Helsingborg Hospital, Clinical Sciences, Lund University, Lund, Sweden
| | - M Landin-Olsson
- Department of Endocrinology, Clinical Sciences, Lund University Hospital, Lund, Sweden
| | - C Ingvar
- Department of Surgery, Clinical Sciences, University Hospital, Lund, Sweden
| | - H Olsson
- Departments of Oncology and Cancer Epidemiology, Lund University Hospital, Lund, Sweden
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Almqvist C, Olsson H, Fall T, Lundholm C. Sibship and risk of asthma in a total population: A disease comparative approach. J Allergy Clin Immunol 2016; 138:1219-1222.e3. [PMID: 27325436 DOI: 10.1016/j.jaci.2016.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 04/14/2016] [Accepted: 05/03/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Catarina Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Astrid Lindgren Children's Hospital, Lung and Allergy Unit, Karolinska University Hospital, Stockholm, Sweden.
| | - Henrik Olsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Tove Fall
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Cecilia Lundholm
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Maracle C, Kucharzewska P, Helder B, Olsson H, Tas S. OP0272 Identification of New Inhibitors of Angiogenesis in A Novel 3d Model of Rheumatoid Arthritis Synovial Angiogenesis. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
Although much learning in real-life environments relies on highly selective feedback about outcomes, virtually all cognitive models of learning, judgment, and categorization assume complete and representative feedback. We investigated empirically the effect of selective feedback on decision making and how people code experience with selective feedback. The results showed that, in contrast to a commonly raised concern, performance was not impaired following learning with selective and biased feedback. Furthermore, even in a simple decision task, the experience that people acquired was not a mere recording of the observed outcomes, but rather a reconstruction from general task knowledge.
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Möllerberg ML, Sandgren A, Lithman T, Noreen D, Olsson H, Sjövall K. The effects of a cancer diagnosis on the health of a patient's partner: a population-based registry study of cancer in Sweden. Eur J Cancer Care (Engl) 2016; 25:744-52. [DOI: 10.1111/ecc.12487] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2016] [Indexed: 01/28/2023]
Affiliation(s)
- M.-L. Möllerberg
- Department of Health and Caring Sciences; Linnaeus University; Växjö Sweden
- Department of Oncology; Skåne University Hospital; Lund Sweden
| | - A. Sandgren
- Department of Health and Caring Sciences; Linnaeus University; Växjö Sweden
- Center for Collaborative Palliative Care; Linnaeus University; Växjö Sweden
| | - T. Lithman
- Department of Cancer Epidemiology; Clinical Sciences; Lund University; Lund Sweden
| | - D. Noreen
- Department of Cancer Epidemiology; Clinical Sciences; Lund University; Lund Sweden
| | - H. Olsson
- Department of Oncology; Skåne University Hospital; Lund Sweden
- Department of Cancer Epidemiology; Clinical Sciences; Lund University; Lund Sweden
- Department of Oncology; Clinical Sciences; Lund University; Lund Sweden
| | - K. Sjövall
- Department of Oncology; Skåne University Hospital; Lund Sweden
- Department of Oncology; Clinical Sciences; Lund University; Lund Sweden
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Falck AK, Röme A, Fernö M, Olsson H, Chebil G, Bendahl PO, Rydén L. St Gallen molecular subtypes in screening-detected and symptomatic breast cancer in a prospective cohort with long-term follow-up. Br J Surg 2016; 103:513-23. [PMID: 26856820 PMCID: PMC5067683 DOI: 10.1002/bjs.10070] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [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: 06/30/2015] [Revised: 09/03/2015] [Accepted: 10/29/2015] [Indexed: 12/14/2022]
Abstract
Background Diagnosis by screening mammography is considered an independent positive prognostic factor, although the data are not fully in agreement. The aim of the study was to explore whether the mode of detection (screening‐detected versus symptomatic) adds prognostic information to the St Gallen molecular subtypes of primary breast cancer, in terms of 10‐year cumulative breast cancer mortality (BCM). Methods A prospective cohort of patients with primary breast cancer, who had regularly been invited to screening mammography, were included. Tissue microarrays were constructed from primary tumours and lymph node metastases, and evaluated by two independent pathologists. Primary tumours and lymph node metastases were classified into St Gallen molecular subtypes. Cause of death was retrieved from the Central Statistics Office. Results A total of 434 patients with primary breast cancer were included in the study. Some 370 primary tumours and 111 lymph node metastases were classified into St Gallen molecular subtypes. The luminal A‐like subtype was more common among the screening‐detected primary tumours (P = 0·035) and corresponding lymph node metastases (P = 0·114) than among symptomatic cancers. Patients with screening‐detected tumours had a lower BCM (P = 0·017), and for those diagnosed with luminal A‐like tumours the 10‐year cumulative BCM was 3 per cent. For patients with luminal A‐like lymph node metastases, there was no BCM. In a stepwise multivariable analysis, the prognostic information yielded by screening detection was hampered by stage and tumour biology. Conclusion The prognosis was excellent for patients within the screening programme who were diagnosed with a luminal A‐like primary tumour and/or lymph node metastases. Stage, molecular pathology and mode of detection help to define patients at low risk of death from breast cancer. Low‐risk group identified
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Affiliation(s)
- A K Falck
- Departments of Surgery, Clinical Sciences Lund, Lund, Sweden.,Department of Surgery, Hospital of Helsingborg, Helsingborg, Sweden
| | - A Röme
- Department of Surgery, Clinical Sciences Malmö, Lund University, Lund, Sweden.,Department of Surgery, Skåne University Hospital, Malmö, Sweden
| | - M Fernö
- Departments of Oncology and Pathology, Clinical Sciences Lund, Lund, Sweden
| | - H Olsson
- Molecular and Immunological Pathology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - G Chebil
- Unilabs Pathology Unit, Helsingborg, Sweden
| | - P O Bendahl
- Departments of Oncology and Pathology, Clinical Sciences Lund, Lund, Sweden
| | - L Rydén
- Departments of Surgery, Clinical Sciences Lund, Lund, Sweden.,Department of Surgery, Skåne University Hospital, Lund, Sweden
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Maracle CX, Kucharzewska P, Helder B, Olsson H, Tas SW. A7.14 Identification of new inhibitors of angiogenesis in a novel 3d model of rheumatoid arthritis synovial angiogenesis. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-209124.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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