26 research outputs found
Nodule detection in digital chest radiography: part of image background acting as pure noise
There are several factors that influence the radiologist's ability to detect a specific structure/lesion in a radiograph. Three factors that are commonly known to be of major importance are the signal itself, the system noise and the projected anatomy. The aim of this study was to determine to what extent the image background acts as pure noise for the detection of subtle lung nodules in five different regions of the chest. A receiver operating characteristic (ROC) study with five observers was conducted on two different sets of images, clinical chest X-ray images and images with a similar power spectrum as the clinical images but with a random phase spectrum, resulting in an image background containing pure noise. Simulated designer nodules with a full-width-at-fifth-maximum of 10 mm but with varying contrasts were added to the images. As a measure of the part of the image background that acts as pure noise, the ratio between the contrast needed to obtain an area under the ROC curve of 0.80 in the clinical images to that in the random-phase images was used. The ratio ranged from 0.40 (in the lateral pulmonary regions) to 0.83 (in the hilar regions) indicating that there was a large difference between different regions regarding to what extent the image background acted as pure noise; and that in the hilar regions the image background almost completely acted as pure noise for the detection of 10 mm nodule
Predictors of the first cardiovascular event in patients with systemic lupus erythematosus - a prospective cohort study
Systemic Lupus Erythematosus (SLE) is an autoimmune, inflammatory disease that mainly affects
women. The prognosis of SLE has improved dramatically, but mortality rates are still higher than in the
general population. With the improved general prognosis, cardiovascular disease (CVD) has emerged as a
major cause of morbidity and mortality among SLE patients. Previous studies have demonstrated that the
development of atherosclerosis is accelerated in SLE, and have identified a set of traditional and nontraditional
risk factors that characterize SLE patients with CVD. Nevertheless, many unsolved issues with
respect to SLE related CVD remain. The general aim of this thesis was to investigate risk factors for
manifest CVD and for cardiovascular mortality (CVM) in SLE, with special focus on traditional risk
factors, lupus phenotype, inflammatory and endothelial biomarkers, autoantibodies and genetic
predisposition.
In the first paper, we prospectively studied traditional and non-traditional risk factors for
the development of the first cardiovascular event (CVE) in 182 SLE patients with a follow-up time of 8
years. 24(13%) patients had a first event. We demonstrated that of the traditional risk factors, only age
and smoking predicted the first CVE. Additionally, antiphospholipid antibodies (aPL), endothelial
biomarkers, represented by soluble vascular cell adhesion molecule 1(sVCAM-1), and absence of
thrombocytopenia were independent predictors of CVE. Thus, activation of the endothelium and the
coagulation system are important features in SLE-related CVD and the importance to advocate smoking
cessation among SLE patients is underscored
In the second paper, we prospectively investigated causes of mortality and risk factors for
overall mortality and CVM in a cohort of 208 SLE patients, with a follow-up time of 12 years. We also
evaluated Systematic coronary risk evaluation (SCORE, tool for evaluating the 10 year risk for
cardiovascular death in the age span 40-65 years, based on traditional risk factors) in this population.
Cystatin C, a sensitive measure of renal function, in addition to traditional and non-traditional risk
factors, were evaluated as risk factors. 42 patients died, 48 % of which were due to CVM. Age, previous
arterial events and high cystatin C levels were the strongest predictors for overall mortality and for CVM.
After adjusting for these three variables, smoking, sVCAM-1 and high sensitiviy C-reactive protein
(hsCRP) predicted CVM. SCORE estimated 4 but we observed 9 cases of CVM, a non-significant
difference. We conclude that except for smoking, traditional risk factors are less important than cystatin
C, endothelial and inflammatory biomarkers as predictors of CVM in SLE patients.
In the third paper, we investigated whether a risk allele for SLE in the signal transducer
and activator of transcription factor 4 gene (STAT4) was associated with vascular events or presence of
antiphospholipid antibodies (aPL). A total of 578 unrelated SLE patients (424 from mid-Sweden and 154
from southern-Sweden) were included in a cross-sectional design. Occurrence of previous cardiovascular
events and aPL were tabulated. Matched controls (N=651) were genotyped as a comparison. The results
demonstrate that the STAT4 risk allele was associated with ischemic cerebrovascular disease (ICVD),
with a dose-dependent relationship between ICVD and number of risk alleles. The risk allele was
furthermore associated with the presence of two or more aPLs, also in a dose-dependent manner. The
association remained after adjustment for known traditional risk factors. We conclude that patients with
the STAT4 risk allele have an increased risk of ICVD. Our results imply that genetic predisposition is an
important risk factor for ICVD in SLE patients, and that aPL may be one underlying mechanism.
In the fourth paper, we evaluated the potential association between smoking and aPL. 367
SLE patients were investigated in a cross-sectional study. Occurrence of aPL (anticardiolipin (aCL) IgG
and IgM, anti-ÎČ2 glycoprotein-1 IgG (aÎČ2GP1 IgG), lupus anticoagulant (LAC)) and smoking habits
(never, ever, former, current) were tabulated. Never smoking was used as reference in all calculations. In
multivariable models, adjusted for age, sex and age at disease onset, aCL and aÎČ2GP1 of the IgG isotype
and LAC were associated with ever smoking, this association seemed to be driven mainly by the former
smoking group. Our results demonstrate that smoking is associated with pro-thrombotic aPL in SLE
patients, though we can not from this study draw firm conclusions about the temporal relationship
between exposure to smoking and occurrence of aPL. Further studies are warranted to investigate the
mechanisms behind these observations.
In prospective studies we have demonstrated that in particular smoking, systemic
inflammation, endothelial activation and aPL are major risk factors for SLE related CVD and CVM.
Furthermore, genetic predisposition, in our studies represented by a STAT4 SLE risk allele, contributes to
the high risk of ICVD and to the occurrence of aPL, a possible underlying pathogenic mechanism. Finally
we demonstrate that smoking, known to have unfavorable effects on the immune system and to
significantly increase cardiovascular risk in SLE patients, is also associated with pro-thrombotic aPL in
patients with SLE. Thus in SLE smoking stands out as the most important of the traditional risk factors
with potential influence also on lupus related risk factors such as aPL
Cytostatikautlöst smÀrta hos kvinnor med bröstcancer
Syftet med denna systematiska litteraturstudie var att beskriva cytostatikautlöst smĂ€rta och dess konsekvenser hos kvinnor med bröstcancer. Vid sökning gjordes begrĂ€nsning till engelsksprĂ„kig litteratur och 17 vetenskapliga artiklar, hittades pĂ„ Högskolan Dalarnas databas, Electronic Library Information Navigator (ELIN) med hjĂ€lp av olika kombinerade sökord. Ăven manuellt funna artiklar har anvĂ€nts. Resultatet visar att kvinnor som behandlats med cytostatika mot bröstcancer fĂ„r ökade smĂ€rtor av behandlingen. SmĂ€rtförekomsten varierar beroende pĂ„ vilken behandling kvinnan fĂ„tt. Högre doser av ingĂ„ende cytostatikalĂ€kemedel, tĂ€tare intervall mellan kurerna och lĂ€kemedelsval kan inverka negativt pĂ„ uppkomsten av smĂ€rta. De smĂ€rtor kvinnorna riskerar att fĂ„ av behandlingen Ă€r neuropatier, smĂ€rtor frĂ„n munhĂ„lan, hĂ€nder och fötter, smĂ€rtor i magen, muskler, skelett samt huvudvĂ€rk. Framför allt cytostatika ur gruppen taxaner ger en smĂ€rtprofil med mer neuropatiska smĂ€rtor. SmĂ€rta i samband med cytostatikabehandling interagera med ökad oro, rĂ€dsla, försĂ€mrad funktionsförmĂ„ga och kan ocksĂ„ ge sömnstörningar, trötthet, depression och ökad stress. SmĂ€rta inverkar menligt i det dagliga livet. SmĂ€rta kan ocksĂ„ vara en prediktor för minskat vĂ€lbefinnande vid behandlingens slut. Hur kvinnorna uppfattar smĂ€rtans inverkan pĂ„ det egna jaget och hur de tolkar den upplevda smĂ€rtans i ett meningssammanhang beskrivs inte alls. Slutsatsen blir att cytostatikarelaterad smĂ€rta hos kvinnor med bröstcancer krĂ€ver vidare forskning
Cytostatikautlöst smÀrta hos kvinnor med bröstcancer
Syftet med denna systematiska litteraturstudie var att beskriva cytostatikautlöst smĂ€rta och dess konsekvenser hos kvinnor med bröstcancer. Vid sökning gjordes begrĂ€nsning till engelsksprĂ„kig litteratur och 17 vetenskapliga artiklar, hittades pĂ„ Högskolan Dalarnas databas, Electronic Library Information Navigator (ELIN) med hjĂ€lp av olika kombinerade sökord. Ăven manuellt funna artiklar har anvĂ€nts. Resultatet visar att kvinnor som behandlats med cytostatika mot bröstcancer fĂ„r ökade smĂ€rtor av behandlingen. SmĂ€rtförekomsten varierar beroende pĂ„ vilken behandling kvinnan fĂ„tt. Högre doser av ingĂ„ende cytostatikalĂ€kemedel, tĂ€tare intervall mellan kurerna och lĂ€kemedelsval kan inverka negativt pĂ„ uppkomsten av smĂ€rta. De smĂ€rtor kvinnorna riskerar att fĂ„ av behandlingen Ă€r neuropatier, smĂ€rtor frĂ„n munhĂ„lan, hĂ€nder och fötter, smĂ€rtor i magen, muskler, skelett samt huvudvĂ€rk. Framför allt cytostatika ur gruppen taxaner ger en smĂ€rtprofil med mer neuropatiska smĂ€rtor. SmĂ€rta i samband med cytostatikabehandling interagera med ökad oro, rĂ€dsla, försĂ€mrad funktionsförmĂ„ga och kan ocksĂ„ ge sömnstörningar, trötthet, depression och ökad stress. SmĂ€rta inverkar menligt i det dagliga livet. SmĂ€rta kan ocksĂ„ vara en prediktor för minskat vĂ€lbefinnande vid behandlingens slut. Hur kvinnorna uppfattar smĂ€rtans inverkan pĂ„ det egna jaget och hur de tolkar den upplevda smĂ€rtans i ett meningssammanhang beskrivs inte alls. Slutsatsen blir att cytostatikarelaterad smĂ€rta hos kvinnor med bröstcancer krĂ€ver vidare forskning
Under the Surface in Teacher's Writing Tasks : Writing Discources within the Subject of Swedish in Upper Secondary School
Writing tasks are central in the subject of Swedish, and they can be designed in various ways. The variation in design when teachers construct their own writing tasks can be due to differing views of the teaching of writing and exercises in writing. The aim of this work is to investigate how different discourses about writing and learning to write become visible in teachersâ constructions of writing tasks, and whether there are different degrees of steering in the tasks in relation to the discourse(s) to which they can be said to belong. Twelve writing tasks were examined in the study with the aid of IvaniÄâs (2004) framework for analysis of discourses about writing and learning to write, and the result shows that the creativity discourse dominates among the tasks and that the sociopolitical discourse is sparsely represented among them. Several tasks have features of more than one discourse and can therefore be called hybrids. The degree of steering by the designer of the task differs between the tasks. In tasks that can be linked to the skills discourse there is usually a high degree of steering of the content, and in tasks that can be linked to the creativity discourse the designer of the task uses a different form of steering with questions which mean that the teacher gains access to personal information about the pupils
Computer Modelling of the Interaction between Water and Complex Solid Phases
In this work the program package PASSIPHIC is described. The program has been developed to calculate the equilibrium for an aqueous phase in contact with a complex solid. The complex solid is considered as consisting of pure minerals and /or solid solutions. Cement has been used as an example.<p /> Cementitious materials are likely to be present in large quantities in repositories for radioactive waste. The chemistry in the vicinity of such a repository will hence be influenced by the cement. Cement has been shown to serve as an immobiliser of many elements due to its high internal pH (> 12.5), large surface area and the ability of the hydrated phases in the cement matrix to incorporate radionuclides. Thus, the modelling of the evolution of cement-water interaction is an important factor in determining the release rates of radionuclides from a repository for radioactive waste.<p /> The PASSIPHIC program has been used to simulate leaching of cement with non-saline groundwater and the result is compared to experimental data. The agreement between experimental and calculated data has been found to be good
Bedömning - en konst
Syftet med undersökningen Àr att ta reda pÄ hur fem lÀrare i svenska och engelska verksamma i gymnasieskolan uttrycker sig om bedömning av estetiska lÀrprocesser. Metoden tar sin utgÄngspunkt inom ramen för diskursanalys. Materialet bestÄr av fem halvstrukturerade intervjuer vilka har analyserats utifrÄn ett diskursanalytiskt angreppssÀtt. Resultatet visar pÄ att det finns en skiljelinje mellan de lÀrare som bedömer den estetiska dimensionen och de som inte gör det
Bedömning - en konst
Syftet med undersökningen Àr att ta reda pÄ hur fem lÀrare i svenska och engelska verksamma i gymnasieskolan uttrycker sig om bedömning av estetiska lÀrprocesser. Metoden tar sin utgÄngspunkt inom ramen för diskursanalys. Materialet bestÄr av fem halvstrukturerade intervjuer vilka har analyserats utifrÄn ett diskursanalytiskt angreppssÀtt. Resultatet visar pÄ att det finns en skiljelinje mellan de lÀrare som bedömer den estetiska dimensionen och de som inte gör det
Taxane-induced pain : Experiences of women with breast cancer and nurses providing their care
Breast cancer patients receiving taxane chemotherapy run a substantial risk of develop taxane-induced pain, but little is known about womenâs experiences of such pain. The aim of this thesis was to explore womenâs acute and longstanding experiences of taxane-induced pain, to evaluate the pain intensity and distribution using different assessment methods, and to study nursesÂŽ perceptions of taxane-induced pain in people with breast cancer. The women experienced pain during chemotherapy with 37â 48% incidence of acute taxane-induced pain. The subjective burden of taxane-induced pain described by the women covered narratives from manageable pain to very difficult and disabling pain with a major impact on their lifeworld (Study I). Longstanding pain in the lifeworld of women with previous breast cancer, was explored through a retrospective reflection after 12 months. The descriptions of pain revealed a time perspective; as pain perceived at that specific time, currently ongoing pain, and pain expectations for the future. This resulted in the women sensing themselves of being somewhere between health and illness gazing into an uncertain future (Study II). A quantitative longitudinal assessment of taxane-induced pain using; the body image, the VAS, and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30) showed the womenâs estimated pain; its intensity, distribution and occurrence - as it appeared during the actual taxane treatment and up to a year afterward. The baseline measurement on the VAS revealed low initial pain, VAS <10, which changed at treatment Cycle 1. The body image revealed intense and widespread pain, and pain after 12 months, as did the EORTC QLQ -C30 (Study III). The nursesâ estimations of taxane-induced pain varied to large extent in both prevalence and intensity. Large parts of the body were expected to be involved in the pain. Nurses lacked local and/or national guidelines reflecting a low level of generalized use of prophylaxis against taxane pain (Study IV). In conclusion, taxane-induced pain is a common debilitating symptom during taxane chemotherapy for women with breast cancer. Pain impacts womenÂŽs life during as well as long time after the completion of taxane treatment. Taxane pain can be accurately or successfully estimated using various pain assessment tools. Furthermore, guidelines for dealing with taxane-induced pain are needed
Taxane-induced pain : Experiences of women with breast cancer and nurses providing their care
Breast cancer patients receiving taxane chemotherapy run a substantial risk of develop taxane-induced pain, but little is known about womenâs experiences of such pain. The aim of this thesis was to explore womenâs acute and longstanding experiences of taxane-induced pain, to evaluate the pain intensity and distribution using different assessment methods, and to study nursesÂŽ perceptions of taxane-induced pain in people with breast cancer. The women experienced pain during chemotherapy with 37â 48% incidence of acute taxane-induced pain. The subjective burden of taxane-induced pain described by the women covered narratives from manageable pain to very difficult and disabling pain with a major impact on their lifeworld (Study I). Longstanding pain in the lifeworld of women with previous breast cancer, was explored through a retrospective reflection after 12 months. The descriptions of pain revealed a time perspective; as pain perceived at that specific time, currently ongoing pain, and pain expectations for the future. This resulted in the women sensing themselves of being somewhere between health and illness gazing into an uncertain future (Study II). A quantitative longitudinal assessment of taxane-induced pain using; the body image, the VAS, and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30) showed the womenâs estimated pain; its intensity, distribution and occurrence - as it appeared during the actual taxane treatment and up to a year afterward. The baseline measurement on the VAS revealed low initial pain, VAS <10, which changed at treatment Cycle 1. The body image revealed intense and widespread pain, and pain after 12 months, as did the EORTC QLQ -C30 (Study III). The nursesâ estimations of taxane-induced pain varied to large extent in both prevalence and intensity. Large parts of the body were expected to be involved in the pain. Nurses lacked local and/or national guidelines reflecting a low level of generalized use of prophylaxis against taxane pain (Study IV). In conclusion, taxane-induced pain is a common debilitating symptom during taxane chemotherapy for women with breast cancer. Pain impacts womenÂŽs life during as well as long time after the completion of taxane treatment. Taxane pain can be accurately or successfully estimated using various pain assessment tools. Furthermore, guidelines for dealing with taxane-induced pain are needed