En studie av skogsbrandshantering – Med fokus på skogsbranden i Västmanland

The aim of this project was to examine the forest fire management in Sweden and ascertain what benefits can be drawn by comparing with international methods. The study is manufactured by studying literature, interviews and visits to the fire­‐affected forest in Västmanland. The main conclusions of the project is the great need for a national advocacy group with vast knowledge and experience of forest fire managing that the rescue service can commerce when essential. Also it is necessary to create procedures for cooperation between forest owners, County Board and the rescue service. Another outcome is that the use of fire risk forecasts need to be broadened when working with prevention. It is also found that the use of water­‐bombing airborne vehicles need to be developed and for the rescue service not to hesitate if, and when, those resources is needed. At last, drones should be implemented in forest fire managing because of the benefits economically, in terms of safety and with a wide application range

Brandteknisk riskvärdering av Torpa Stenhus

A risk evaluation with regards to fire safety has been performed at Torpa Stenhus. The focus of the evaluation was the safety of the people inside the building in case of a fire. As part of the education for future fire protection engineers at LTH a risk evaluation report is performed in the course Brandteknisk riskvärdering (VBR054). Torpa Stenhus was built during the 15th century and is located in the vicinity of Borås by the lake Åsunden. Torpa Stenhus is one of the best preserved castles in Sweden. The building is open for the general public but it is also used for other events such as weddings, parties and conferences. The two main halls have a capacity of 100 and 110 persons each. Torpa Stenhus has only got one door leading outside. The five floors of Torpa Stenhus are linked by a common stairwell. The existing systems with regards to fire safety consist of optical smoke detectors and handheld fire-extinguishers spread across the five floors. The project was initiated by an onsite visit where the students, accompanied by mentors from both the Södra Älvsborgs fire department and LTH, met the owner and operator Pehr Zethelius. During the onsite visit focus was directed towards identifying all plausible fire scenarios and noting the physical measurements of the building. Objectives for an adequate level of protection and the highest acceptable levels of exposure in case of a fire were defined in light of the report’s focus. The objectives were that none of the persons evacuating the building should be exposed to these highest acceptable levels. A coarse analysis of all plausible scenarios gave the most hazardous fire scenarios. This analysis was made by comparing statistics from similar buildings and via subjective assessments where the probability and consequence was transformed into a risk. Using an event tree, different scenarios based on what sort of evacuation that took place were obtained. Using computer programs, namely FDS, Simulex and DETACT T2 different evacuation and fire scenarios were simulated. The different simulations combined with reasoning supported by experimental data led to that both the total evacuation time and the time until the highest acceptable exposure levels was exceeded, were obtained. By comparing these two times in an event tree for every scenario the conclusion was made that at present day Torpa Stenhus does not fulfill the objectives for and adequate level of protection in case of a fire. To reach an adequate level of protection in case of a fire the following measures should be adopted: - Accommodate safe evacuation through the stairwell - Install sealed doors - Install automatic door closers to the chapel - Improve the possibilities of navigations in the building - Replace the existing evacuation signs to backlit evacuation signs - Install backlit evacuation signs for the new evacuation route - Measures for systematic fire prevention - Staffeducation - Inspections - Responsibility areas for the staff - Install a detector in the Staffroom - Reduce the risk of fire in the Staffroom - Reduce the amount of combustible material - Install a timer on electrical outlets - Install spoken message as an evacuation alarm - Reopena evacuation route - Install exit devices - Provide evacuation route with emergency lightning and railings To further improve the level of protection in case of a fire the following measures may be taken: - Request a response plan from the Rescue Service - Install a lightning rod - Reduce the use of candles - Flameproof furnishing and interiors - Change the detectors error message - Install automatic fire alarm - Install manual buttons to alarm rescue services - Regularly inspect the electrical equipment and cabling - Lower the maximum allowed capacity of the two main hall

A five-year observational prospective mono-center study of the efficacy of alemtuzumab in a real-world cohort of patients with multiple sclerosis

BackgroundAlemtuzumab (ALZ) is a pulsed immune reconstitution therapy for multiple sclerosis (MS).ObjectiveTo assess basic characteristics, therapeutic effects, and prognostic biomarkers on clinical and imaging parameters of disease activity for relapsing–remitting MS (RRMS) patients selected for ALZ, in a real-world long-term setting.MethodsFifty-one RRMS patients [female = 31; mean age 36 (standard deviation 7.1) years; median expanded disability status scale (EDSS) 2 (interquartile range (IQR) 1.5)] initiating ALZ treatment, were consecutively included. Patients were assessed at baseline and thereafter annually for 5 years with clinical measures, symbol digit modality test (SDMT), and magnetic resonance imaging (MRI). Concentrations of glial fibrillary acidic protein (GFAP), reflecting astrogliosis, and neurofilament light (NfL), reflecting axonal damage, were measured in cerebrospinal fluid (CSF) and serum samples collected at baseline and after 2 years in CSF, and annually in serum. Control subjects were symptomatic controls (SCs, n = 27), who were examined at baseline and after 5 years without evidence of neurological disease.ResultsWhile the mean annualized relapse rate was significantly reduced from baseline at each year of follow-up, disability was essentially maintained at a median EDSS of 1.5 and IQR between 1.13 and 2.25. New MRI activity was recorded in 26 patients (53%) over 5 years. The proportion of patients who achieved no evidence of disease activity (NEDA-3), 6-months confirmed disability worsening (CDW), and 6-months confirmed disability improvement (CDI) at 5 years were 33, 31, and 31%, respectively. The SDMT score was reduced for patients (p < 0.001), but unchanged for SCs. ALZ treatment did not change GFAP levels, whereas there was a significant decrease for RRMS patients in median CSF and serum NfL levels at follow-up [CSF month 24: 456 pg./mL (IQR 285.4) (p = 0.05); serum month 24: 6.7 pg/mL (IQR 4.7) (p < 0.01); serum month 60: 7.2 pg/mL (IQR 4.7) (p < 0.01)], compared to baseline [CSF: 1014 pg/mL (IQR 2832.5); serum 8.6 pg/mL (IQR 17.4)].ConclusionIn this real-world mono-center population, we observed a progression-free survival of 69%, cumulative NEDA-3 of 33%, and reduced NfL levels, over a five-year follow-up. This confirms ALZ as an effective pulsed immune reconstitution therapy that significantly reduces neuro axonal loss, and therefore has the potential to reduce long-term neurological disability. ALZ did not appear to affect astrogliosis

Data_Sheet_1_A five-year observational prospective mono-center study of the efficacy of alemtuzumab in a real-world cohort of patients with multiple sclerosis.PDF

BackgroundAlemtuzumab (ALZ) is a pulsed immune reconstitution therapy for multiple sclerosis (MS).ObjectiveTo assess basic characteristics, therapeutic effects, and prognostic biomarkers on clinical and imaging parameters of disease activity for relapsing–remitting MS (RRMS) patients selected for ALZ, in a real-world long-term setting.MethodsFifty-one RRMS patients [female = 31; mean age 36 (standard deviation 7.1) years; median expanded disability status scale (EDSS) 2 (interquartile range (IQR) 1.5)] initiating ALZ treatment, were consecutively included. Patients were assessed at baseline and thereafter annually for 5 years with clinical measures, symbol digit modality test (SDMT), and magnetic resonance imaging (MRI). Concentrations of glial fibrillary acidic protein (GFAP), reflecting astrogliosis, and neurofilament light (NfL), reflecting axonal damage, were measured in cerebrospinal fluid (CSF) and serum samples collected at baseline and after 2 years in CSF, and annually in serum. Control subjects were symptomatic controls (SCs, n = 27), who were examined at baseline and after 5 years without evidence of neurological disease.ResultsWhile the mean annualized relapse rate was significantly reduced from baseline at each year of follow-up, disability was essentially maintained at a median EDSS of 1.5 and IQR between 1.13 and 2.25. New MRI activity was recorded in 26 patients (53%) over 5 years. The proportion of patients who achieved no evidence of disease activity (NEDA-3), 6-months confirmed disability worsening (CDW), and 6-months confirmed disability improvement (CDI) at 5 years were 33, 31, and 31%, respectively. The SDMT score was reduced for patients (p ConclusionIn this real-world mono-center population, we observed a progression-free survival of 69%, cumulative NEDA-3 of 33%, and reduced NfL levels, over a five-year follow-up. This confirms ALZ as an effective pulsed immune reconstitution therapy that significantly reduces neuro axonal loss, and therefore has the potential to reduce long-term neurological disability. ALZ did not appear to affect astrogliosis.</p

Rituximab in multiple sclerosis : a retrospective observational study on safety and efficacy

Objective: To investigate the safety and efficacy of rituximab in multiple sclerosis (MS). Methods: In this retrospective uncontrolled observational multicenter study, off-label rituximab-treated patients with MS were identified through the Swedish MS register. Outcome data were collected from the MS register and medical charts. Adverse events (AEs) grades 2-5 according to the Common Terminology Criteria for Adverse Events were recorded. Results: A total of 822 rituximab-treated patients with MS were identified: 557 relapsing-remitting MS (RRMS), 198 secondary progressive MS (SPMS), and 67 primary progressive MS (PPMS). At baseline, 26.2% had contrast-enhancing lesions (CELs). Patients were treated with 500 or 1,000 mg rituximab IV every 6-12 months, during a mean 21.8 (SD 14.3) months. During treatment, the annualized relapse rates were 0.044 (RRMS), 0.038 (SPMS), and 0.015 (PPMS), and 4.6% of patients displayed CELs. Median Expanded Disability Status Scale remained unchanged in RRMS (p = 0.42) and increased by 0.5 and 1.0 in SPMS and PPMS, respectively (p = 0.10 and 0.25). Infusion-related AEs occurred during 7.8% of infusions and most were mild. A total of 89 AEs grades &gt;= 2 (of which 76 infections) were recorded in 72 patients. No case of progressive multifocal leukoencephalopathy was detected. Conclusions: This is the largest cohort of patients with MS treated with rituximab reported so far. The safety, clinical, and MRI findings in this heterogeneous real-world cohort treated with different doses of rituximab were similar to those reported in previous randomized controlled trials on B-cell depletion therapy in MS. Classification of evidence: This study provides Class IV evidence that for patients with MS, rituximab is safe and effective