Invasive intraductal papillary mucinous neoplasm and pancreatic ductal adenocarcinoma : a comparison in clinicopathology and long-term outcome

Background: The resections for both pre-malignant and invasive intraductal papillary mucinous neoplasm (inv-IPMN) have increased the last decades. Long term outcome, and the impact of adjuvant chemotherapy, non-regional lymph node status and recurrence pattern on overall survival (OS) is known for conventional pancreatic ductal adenocarcinoma (PDAC), but not so for inv-IPMN. Aims: I) Investigate differences and similarities in clinicopathology and overall survival between patients resected for inv-IPMN and PDAC. II) Elucidate whether the raised numbers of pancreatic resections for inv-IPMN in combination with the improvement in OS recent years have influenced outcome. III) Assess the prognostic significance of para-aortal lymph node (PALN) involvement in patients resected for inv-IPMN and PDAC in the pancreatic head. IV) Explore the impact of adjuvant chemotherapy and spatio-temporal recurrence pattern on overall survival for inv-IPMN compared with PDAC. Methods: All studies were retrospective observational studies of consecutive patients ≥ 18 years of age resected for inv-IPMN and PDAC. Study I-III were single-centre studies of in total 515 patients resected at Karolinska University Hospital between 2009-2018, Study IV was a national multi-centre study of patients resected in Sweden between 2010–2019. Clinicopathological variables were analysed in multivariable Cox regression models. Outcome was assessed by calculating two- or three-year OS rate and estimating OS using the Kaplan-Meier model. Survival functions were compared with log-rank test. In study I were clinicopathological variables also analysed in multivariable logistic regression models. Study II only comprised patients with PDAC or inv-IPMN in the pancreatic head who underwent partial or total pancreatoduodenectomy including PALN resection. In study III, that only included patients residing in the Stockholm area, different initial recurrence sites and time frames as well as predictors for death including the impact of adjuvant chemotherapy were assessed with multivariable logistic and Cox regressions. In study IV, clinicopathological variables were retrieved from the Swedish national pancreatic and periampullary cancer registry. The effect on death was assessed in two multivariable Cox regression models, one for patients resected 2010-2015, one for patients resected 2016-2019. Results: In study I, 513 patients were included, 122 inv-IPMN and 391 PDAC. The proportion resected inv-IPMN and two-year OS increased during the study period. In Kaplan-Meier survival analysis, inv-IPMN had more favourable median OS compared to PDAC. In multivariable Cox Regression analysis, tumour type was not a predictor for death. In study II, 403 patients were included, 89 inv-IPMN and 314 PDAC. PALN were metastatic in 16% and there was no difference between the groups. N0- and N2-stage were present in 16% and 53% respectively for patients with inv-IPMN compared to 6% and 65% respectively for patients with PDAC (p=0.007). Median OS was 12.7 and 22.7 months in the presence or absence of PALN metastases respectively (p<0.001), and similar in N2-stage regardless the presence of PALN status. PALN status was not an independent prognostic factor. In study III, 396 patients were included, 92 inv-IPMN and 304 PDAC. Both recurrence rate and death rate within three-years were lower for inv-IPMN compared to PDAC. The most common recurrence patterns were multi-site (25%), single-site liver (21%) and single-site locoregional (10%) recurrence. The most important predictors for death were multi-site, single-site peritoneal and single-site liver recurrence. These predictors were less common in inv-IPMN compared to PDAC. Adjuvant chemotherapy had similar effect in the two groups. In study IV, 1909 patients were included, 293 inv-IPMN and 1616 PDAC. Tumour type was an independent predictor for death in the 2016-2019 cohort, but not in the 2010-2015 cohort. In Kaplan-Meier survival analysis, inv-IPMN was associated with longer median OS in stage N0-1 and in stage M0 compared to PDAC. However, in stage T2-4 and stage N2 median OS was similar, whereas median OS in stage M1 was even shorter for inv-IPMN compared to PDAC. Conclusions: Inv-IPMN seemed to have favourable survival outcome compared to PDAC in lower stages, and similar to worse in higher. Outcome was dependent on the combination of a pronounced increase in resected inv-IPMN and a concurrent hazard reduction for death within 2 years during the study period. PALN status is not an independent risk factor for death and does not influence survival in N2-staged disease. The M1-stage for PALN positivity may therefore need reconsideration. Resected inv-IPMN exhibited a less aggressive recurrence pattern than PDAC that translated into a more favourable overall survival

Allt kan transformeras till ett användbart läromedel

Hur lärare i slöjd i Finland och Sverige uppfattar och använder läromedel beskrivs och analyseras i denna artikel. Det empiriska materialet består av enkätsvar från både flervalsfrågor och öppna frågor av 143 lärare, insamlat våren 2016. Resultatet visar att lärarna å ena sidan definierar läromedel på ett mycket brett sätt genom att inkludera i princip allt som används i undervisningen som läromedel, medan de å andra sidan också använder en snäv definition på läromedel som endast omfattar för ändamålet publicerade läroböcker. Resultatet visar att många lärare i slöjd producerar läromedel som stöder den egna undervisningens målsättningar, den egna elevgruppens behov och matchar krav som deras undervisningskontext ställer och hjälper dem själv att utveckla och upprätthålla sina färdigheter. Många lärare i slöjd är del av olika slags webbaserade delningskulturer där de delar med sig av sina egenproducerade läromedel och vidareutvecklar läromedel som de fått sig tilldelade av kolleger. Internet framhålls som en guldgruva för att hitta material som kan omvandlas till läromedel för slöjdprocessens olika faser och för att differentiera undervisningen. I diskussionen framkommer att lärare i slöjd har en pluralistisk uppfattning om läromedel som speglar det pedagogiska dilemmat mellan frihet och ansvar för undervisningens utformning och innehåll som läromedel exemplifierar.Sökord: läromedel, slöjdundervisning, pedagogiskt dilemma, internet, pragmatisk transformering Sökord: läromedel, slöjdundervisning, lärare, dilemma, pluralistis

Ungulate use of an at-grade fauna passage and roadside animal detection system: A pilot study from Southern Sweden

Wildlife-vehicle collisions (WVC) cost millions of euros each year in loss of life and damages. Wildlife crossing structures and fencing are commonly implemented mitigation strategies to reduce WVC and increase landscape connectivity for wildlife. Typically, crossing structures are over- or under-pass structures that allow animals to safely cross the road, while separating them from the road and traffic. An alternative strategy could be an at-grade fauna passage coupled with a Roadside Animal Detection System (RADS). At-grade fauna passages are designated locations where a gap in fencing allows animals to cross over the road, while RADS alert drivers of animals at the upcoming passage, so that they can adjust their driving behaviour accordingly and avoid collisions. In this pilot study, we investigated the use of one at-grade fauna passage by roe deer (Capreolus capreolus), red deer (Cervus elaphus) and wild boar (Sus scrofa) in southern Sweden, and compared changes in the number of WVCs before, during and after the construction of the passage. We collected a total of 326 wildlife crossings from 722 individuals over 1 year of monitoring (24 January 2020-24 January 2021). We found that crossing events tended to be dominated by the time animals spent in the roadside verge from which they approached the at-grade fauna passage, particularly for roe deer that spent a lot of time browsing in the roadside verge during dusk. We also found that animals spent longer in the passage if vehicles were present. In our 1 year of surveys, we only recorded three accidents, and when comparing the annual collision statistics before, during, and after construction of the at-grade fauna passage, we demonstrated an overall reduction in collisions by 66%. While our pilot only evaluates a single site, it does provide promising preliminary results that suggest that at-grade fauna passages can help in efforts to reduce collisions, while maintaining connectivity over medium-sized roads for large ungulates

Secondary effects of the COVID-19 pandemic on surgical management of hepatopancreatobiliary malignancies in the Nordic capitals

Non peer reviewe

Speech Communication

Contains reports on five research projects.C.J. Lebel FellowshipNational Institutes of Health (Grant 5 T32 NSO7040)National Institutes of Health (Grant 5 R01 NS04332)National Institutes of Health (Grant 5 R01 NS21183)National Institutes of Health (Grant 5 P01 NS13126)National Institutes of Health (Grant 1 PO1-NS23734)National Science Foundation (Grant BNS 8418733)U.S. Navy - Naval Electronic Systems Command (Contract N00039-85-C-0254)U.S. Navy - Naval Electronic Systems Command (Contract N00039-85-C-0341)U.S. Navy - Naval Electronic Systems Command (Contract N00039-85-C-0290)National Institutes of Health (Grant RO1-NS21183), subcontract with Boston UniversityNational Institutes of Health (Grant 1 PO1-NS23734), subcontract with the Massachusetts Eye and Ear Infirmar

Speech Communication

Contains table of contents for Part IV, table of contents for Section 1 and reports on five research projects.Apple Computer, Inc.C.J. Lebel FellowshipNational Institutes of Health (Grant T32-NS07040)National Institutes of Health (Grant R01-NS04332)National Institutes of Health (Grant R01-NS21183)National Institutes of Health (Grant P01-NS23734)U.S. Navy / Naval Electronic Systems Command (Contract N00039-85-C-0254)U.S. Navy - Office of Naval Research (Contract N00014-82-K-0727

Passager för större däggdjur vid väg och järnväg

Denna rapport redovisar studier av faunapassagers effektivitet för större däggdjur, med fokus på betydelsen av dimensioner (bredd, höjd, längd), markbeläggning och vegetation, skärmning mot trafikbuller, och mänskliga störningar såsom friluftsliv och lokaltrafik i passagen. Studierna genomfördes inom forskningsprogrammet TRIEKOL under åren 2017-2024, vid ett 40-tal passager utspridda över Sverige, anlagda specifikt för vilt eller för annat ändamål men väl anpassade till vilt. Vi valde de vilda klövdjuren som fokusarter: älg, rådjur, dovhjort, vildsvin och kronhjort (den sistnämnda kom slutligen inte att ingå i analyserna på grund av få observationer). Därtill ingick friströvande ren i viss mån i studierna. Den huvudsakliga metoden för datainsamling var med automatiska kameror (s.k. åtelkameror) monterade i och kring passagerna, för att samla in bilder på besökande djur dygnet runt och vid alla årstider. För varje besök noterade vi art, antal individer, riktning, tidpunkt och datum, i några fall ålder, kön och beteenden, samt inte minst om djuren passerade eller ej. Det senare låg till grund för att beräkna ett effektivitetsindex (andelen av besöken som resulterade i att djuren passerade). För planskilda passager (över- eller underpassager) pekade resultaten på att längden är den av dimensionerna som är av störst betydelse, alltså hur långt djuren behöver gå från ena sidan infrastrukturen till den andra, eller för underpassager hur långt de måste gå under brotaket. För de kortaste passagerna (20 m mellan vägsidor eller 7 m under tak) var effektiviteten 70%, men den minskade successivt till 30% för de längsta (>60 m mellan vägsidor eller 20-40 m under tak). Även bredden hade betydelse, men resultaten var motstridiga; högre effektivitet i bredare passager i några av analyserna men inget samband i andra. Möjligen går det att identifiera ett gränsvärde på ca 20 m bredd för älg, över vilket ytterligare bredd inte leder till bättre effektivitet. Höjden i underpassager verkade sakna betydelse för effektiviteten. De här resultaten pekar delvis i en annan riktning än tidigare forskning. En positiv tolkning av resultaten är att även relativt smala och låga passager kan ha en funktion för större däggdjur, och att andra faktorer är mer avgörande. Resultaten pekade vidare på att djuren föredrar jämna underlag och öppen mark i passagerna, och att de även kan passera via vattendrag och mindre vägar som går genom passagerna. Mänskliga störningar ledde till sämre effektivitet, särskilt sådana störningar som skedde i gryningen; djuren dröjde då upp till 30 timmar längre med att använda passagerna. Men tack vare långa perioder utan mänskliga störningar i de studerade passagerna fanns ändå möjligheter för djur att passera. Vissa resultat pekade på att effektiviteten ökade med avståndet till närmaste alternativa passagemöjlighet. Studier av betydelsen av skärmning mot trafiken är ännu pågående och inga resultat kan presenteras nu. Studierna av passager i plan med viltvarningssystem pekade på att dessa är nästan lika effektiva som planskilda passager när det gäller att få djur att passera, men där finns fortfarande en risk för viltolyckor planpassagerna eftersom djuren där måste passera över vägbanan. Vi diskuterar studiernas begränsningar, och föreslår alternativa och kompletterande analyser. Sådana analyser skulle även kunna omfatta fördjupade studier av redan insamlade data. Resultaten från studierna kan utgöra underlag i samband med uppdateringar av Trafikverkets styrande dokument för lokalisering och utformning av faunapassager

Estimating the regional distribution of men who have sex with men (MSM) based on Internet surveys

<p>Abstract</p> <p>Background</p> <p>Measurement of prevalence and incidence of infections in a hard to reach population like men who have sex with men (MSM) is hampered by its unknown size and regional distribution. Population-based surveys have recently been used to estimate the total number of MSM, but these surveys are usually not large enough to measure regional differences in the proportion of MSM in the population. We explored the use of the proportional regional distribution of participants of large internet-based surveys among MSM from Germany to estimate the regional distribution of MSM in Germany.</p> <p>Methods</p> <p>We compared participants from two separate MSM behavioural surveys with each other and with the distribution of user profiles of the largest contact and dating website for gay and other MSM in Germany in terms of the representativeness of the regional distribution. In addition, we compared the regional distribution of reportedly HIV positive survey participants with the regional distribution of HIV notifications within the national surveillance system that can be attributed to transmission through homosexual contacts.</p> <p>Results</p> <p>Regional distribution of survey participants was almost identical in both surveys, despite little overlap between survey participants. Slight discrepancies between surveys and user profiles could be observed. Proportional regional distribution of survey participants with HIV diagnosis resembled national surveillance data.</p> <p>Conclusion</p> <p>Considering the difficulties to obtain representative data by other sampling methods for "hidden" populations like MSM, internet-based surveys may provide an easy and low cost tool to estimate the regional population distribution – at least in Western post-industrialized countries. Some uncertainties remain about the exact place of residence of MSM in larger cities or catchment areas of these cities. Slightly different results from different datasets may be due to unequal popularity of MSM websites in different regions. The total population size of the MSM population can be estimated based on e.g. data from representative national population surveys. Both estimates can then be combined to calculate the absolute size of regional MSM populations.</p

Beginning of activity in 67P/Churyumov-Gerasimenko and predictions for 2014–2015

Context. Comet 67P/Churyumov-Gerasimenko was selected in 2003 as the new target of the Rosetta mission. It has since been the subject of a detailed campaign of observations to characterise its nucleus and activity. Aims. We present previously unpublished data taken around the start of activity of the comet in 2007/8, before its last perihelion passage. We constrain the time of the start of activity, and combine this with other data taken throughout the comet’s orbit to make predictions for its likely behaviour during 2014/5 while Rosetta is operating. Methods. A considerable difficulty in observing 67P during the past years has been its position against crowded fields towards the Galactic centre for much of the time. The 2007/8 data presented here were particularly difficult, and the comet will once again be badly placed for Earth-based observations in 2014/5. We make use of the difference image analysis technique, which is commonly used in variable star and exoplanet research, to remove background sources and extract images of the comet. In addition, we reprocess a large quantity of archival images of 67P covering its full orbit, to produce a heliocentric lightcurve. By using consistent reduction, measurement and calibration techniques we generate a remarkably clean lightcurve, which can be used to measure a brightness-distance relationship and to predict the future brightness of the comet. Results. We determine that the comet was active around November 2007, at a pre-perihelion distance from the Sun of 4.3 AU. The comet will reach this distance, and probably become active again, in March 2014. We find that the dust brightness can be well described by Afρ ∝ r-3.2 pre-perihelion and ∝ r-3.4 post-perihelion, and that the comet has a higher dust-to-gas ratio than average, with log (Afρ/Q(H2O)) = − 24.94 ± 0.22 cm s molecule-1 at r < 2 AU. A model fit to the photometric data suggests that only a small fraction (1.4%) of the surface is active