Tillvaratagandet av allmänna intressen - En diskussion av allmänna intressen i miljöprocessen

The aim of this essay is to investigate the role of public interests in Swedish environmental law. Furthermore the essay aims to explain under which circumstances individuals, organizations and government agencies may represent public interests. The essay also discusses the question of who rules in matters concerning public interests. Since a variety of different public interests may occur in Swedish environmental law, a delimitation has been made to the weaker public interests, in the first hand environmental issues such as habitats and clean air, which focuses the essay on environmental law. To discern which interests can qualify as public, the term is initially defined. As public interests first and foremost are a way for legislators to regulate certain matters, there are few common denominators other than that the selection made by the legislator is based on sociopolitical consideration. Public interests are interesting as the protection established by law means that they can form the basis for standing or right to complain. Particularly interesting is the fact that associations and non-governmental organizations can represent them. The essay focuses on standing and right to complain according to the 16th chapter 12, 13 §§ in the Swedish environmental code. It is also concerned with the importance of the Aarhus Convention, for the partaking of individuals and organizations in the environmental law process. The fact that legislation is founded in the regard of public interests, as a rule is open-natured will affect the guarding of public interests. The type of legislation can connote a shift of power from politics to law, whish forces the applier of the law to take a stand in political matters. This can affect their work, as according to the principle of objectivity, decisions made in public administration has to be founded in the starting conditions of the case, without being affected by irrelevant aspects. The essay concerns the significance of some public law principles for public interests as well as the responsibility of investigation put on authorities and environmental and land courts in certain types of cases. The parts of environmental and public law intended to ensure that legal decisions are well founded can protect public interests. The essay discusses some errors that may prevent such investigation. As influence of different kinds can affect the practitioner, especially on a local level where the interests in politics can trump the interests in a strict practice, the parts of the environmental law intended to inhibit errors also are an interesting subject of discussion. Such a counterweight can be that individuals or organizations are allowed to appeal against decisions they consider incorrect. The essay is concluded with some words concerning the future development of the right to standing in regarding public interests. Finally, it is found that as the Aarhus Convention drives the development of the possibility to represent the public interests and as the legislator is hesitant to a broaden right to complain, eventual adaptation will probably happen in the court level through change of practice.Syftet med uppsatsen är att undersöka vilken roll allmänna intressen spelar i den svenska miljöprocessen. Vidare avser arbetet redogöra för de förutsättningar under vilka enskilda, organisationer och myndigheter kan företräda sådana intressen. Uppsatsen berör även vilka som beslutar i frågor som rör allmänna intressen. Då det finns en mängd allmänna intressen som kan aktualiseras i svensk rätt har en avgränsning gjorts. Uppsatsen fokuserar på svagare allmänna intressen, såsom miljöintressen, biotoper och ren luft, vilket ger ett fokus på miljörätten. Inledningsvis definieras begreppet allmänna intressen för att se vilka intressen som kan kvalificera sig som sådan. Då allmänna intressen främst är ett sätt för lagstiftaren att reglera vissa frågor, finns få andra gemensamma nämnare än att lagstiftaren har valt ut dem och att urvalet ofta bygger på sociopolitiska överväganden. Allmänna intressen är intressanta då det skydd som upprättats genom lag innebär att de kan grunda tale- eller klagorätt. Särskilt intressant är att de kan företrädas av intresseorganisationer vilket tidigare varit mindre vanligt i svensk rätt. Uppsatsen fokuserar på tale- och klagorätt enligt 16 kap 12, 13 §§ MB, samt berör Århuskonventionens betydelse för utvecklingen av enskilda och organisationers deltagande i miljöprocessen. Då lagstiftning som bygger på beaktandet av allmänna intressen i regel är öppen till sin natur inverkar detta faktum på bevakandet av allmänna intressen. Lagstiftningstypen kan innebära att en maktförskjutning från politiken till juridiken, vilket gör att rättstillämparen måste ta ställning i politiska frågor. Det kan påverka dennes arbete då förvaltningsbeslut enligt objektivitetsprincipen ska utgå från förutsättningarna i fallet, utan att ovidkommande aspekter tillåts inverka. Några offentligrättsliga principers betydelse för allmänna intressens del berörs samt det utredningsansvar som lagts på myndigheter och mark- och miljödomstolar inom ramen för vissa måltyper. De delar av miljöprocessen och de offentligrättsliga regler som är tänkta att tillse att beslut är välgrundade kan innebära ett skydd för allmänna intressen. Uppsatsen berör några felkällor som kan motverka sådan utredning. Då påverkan av olika slag kan inverka på rättstillämparen, särskilt på kommunal nivå där intresset för politik kan övertrumfa intresset för en rigid praxis blir även de delar av miljöprocessen som är tänkta att motverka fel intressanta. En sådan motvikt kan utgöras av att enskilda och organisationer tillåts överklaga beslut som de anser vara felaktiga. Då Århuskonventionen innebär en successiv utveckling av enskildas och organisationers tale- och klagorätt, samtidig som andra samhällstendenser inverkar på skyddet för allmänna intressen avslutas uppsatsen med några resonemang kring den framtida utvecklingen av tale- och klagorätten. Avslutningsvis konstateras att då Århuskonventionen driver utvecklingen av möjligheten att företräda allmänna intressen och då lagstiftaren är tveksam till en vidgad klagorätt kommer eventuell anpassning förmodligen att ske på domstolsnivå genom ändring av praxis

Visual assessment of biliary excretion of Gd-EOB-DTPA in patients with suspected diffuse liver disease – A biopsy-verified prospective study

AbstractObjectivesTo qualitatively evaluate late dynamic contrast phases, 10, 20 and 30min, after administration of Gd-EOB-DTPA with regard to biliary excretion in patients presenting with elevated liver enzymes without clinical signs of cirrhosis or hepatic decompensation and to compare the visual assessment of contrast agent excretion with histo-pathological fibrosis stage, contrast uptake parameters and blood tests.Methods29 patients were prospectively examined using 1.5T MRI. The visually assessed presence or absence of contrast agent for each of five anatomical regions in randomly reviewed time-series was summarized on a four grade scale for each patient. The scores, including a total visual score, were related to the histo-pathological findings, the quantitative contrast agent uptake parameters, expressed as KHep or LSC_N, and blood tests.ResultsNo relationship between the fibrosis grade or contrast uptake parameters could be established. A negative correlation between the visual assessment and alkaline phosphatase (ALP) was found. Comparing a sub-group of cholestatic patients with fibrosis score and Gd-EOB-DTPA dynamic parameters did not add any additional significant correlation.ConclusionsNo correlation between visually assessed biliary excretion of Gd-EOB-DTPA and histo-pathological or contrast uptake parameters was found. A negative correlation between the visual assessment and alkaline phosphatase (ALP) was found

Quantitative Evaluation of Contrast Agent Dynamics in Liver MRI Linköping University Medical Dissertations No. 1196

provision of financial support and access to cutting-edge research infrastructure

Quantitative Evaluation of Contrast Agent Dynamics in Liver MRI

The studies presented here evaluate the biliary, parenchymal and vascular enhancement effects of two T1-shortening liver-specific contrast agents, Gd-BOPTA and Gd-EOB-DTPA, in Magnetic Resonance Imaging (MRI) of healthy subjects and of patients. Ten healthy volunteers were examined with both contrast agents in a 1.5 T MRI system using three-dimensional gradient echo sequences for dynamic imaging until five hours after injection. The enhancement of the common hepatic duct in contrast to the liver parenchyma was analyzed in the first study. This was followed by a study of the image contrasts of the hepatic artery, portal vein and middle hepatic vein versus the liver parenchyma. While Gd-EOB-DTPA gave an earlier and more prolonged enhancement and image contrast of the bile duct, Gd-BOPTA achieved higher maximal enhancement and higher image contrast for all vessels studied during the arterial and portal venous phases. There was no significant difference in the maximal enhancement obtained in the liver parenchyma. In a third study, another 10 healthy volunteers were examined with the same protocol in another 1.5 T MRI system. Using signal normalization and a more quantitative, pharmacokinetic analysis, the hepatocyte-specific uptake of Gd-EOB-DTPA and Gd-BOPTA was calculated. A significant between-subjects correlation of the uptake estimates was found and the ratio of these uptake rates was of the same magnitude as has been reported in pre-clinical studies. The procedure also enabled quantitative analysis of vascular enhancement properties of these agents. Gd-BOPTA was found to give higher vessel-to-liver contrast than Gd-EOB-DTPA when recommended doses were given. In the final study, retrospectively gathered datasets from patients with hepatobiliary disease were analyzed using the quantitative estimation of hepatic uptake of Gd-EOB-DTPA described in the third study. The uptake rate estimate provided significant predictive ability in separating normal from disturbed hepatobiliary function, which is promising for future evaluations of regional and global liver disease. In conclusion, the differing dynamic enhancement profiles of the liver-specific contrast agents presented here can be beneficial in one context and challenging in another. Diseases of the liver and biliary system may affect the vasculature, parenchyma or biliary excretion, or a combination of these. The clinical context in terms of the relative importance of vascular, hepatic parenchymal and biliary processes should therefore determine the contrast agent for each patient and examination. A quantitative approach to analysis of contrast-enhanced liver MRI examinations is feasible and may prove valuable for their interpretation

Magnetresonanstomografi av lever och gallvägar med levercellsspecifika kontrastmedel

There are two Gadolinium-based liver-specific contrast media for Magnetic Resonance Imaging on the market, Gd-BOPTA (MultiHance®, Bracco Imaging, Milan, Italy) and Gd-EOB-DTPA (Primovist®, Bayer Schering Pharma, Berlin, Germany). The aim of this study in two parts was to evaluate the dynamics of biliary, parenchymal and vascular enhancement using these contrast media in healthy subjects. Ten healthy volunteers were examined in a 1.5 T magnetic resonance system using three-dimensional Volumetric Interpolated Breath-Hold (VIBE) sequences for dynamic imaging with both contrast media – at two different occasions – until five hours after injection. The doses given were 0.025 mmol/kg for Gd-EOB-DTPA and 0.1 mmol/kg for Gd-BOPTA. The enhancement over time of the common biliary duct in contrast to the liver parenchyma was analyzed in the first study. This was followed by a study of the image contrasts of the hepatic artery, portal vein and middle hepatic vein versus the liver parenchyma.While Gd-EOB-DTPA gave an earlier and more prolonged enhancement of the biliary duct, Gd-BOPTA achieved higher image contrast for all vessels studied, during the arterial and portal venous phases. There was no significant difference in the maximal enhancement obtained in the liver parenchyma.At the obtained time-points and at the dosage used, the high contrast between the common biliary duct and liver parenchyma had an earlier onset and longer duration for Gd-EOB-DTPA, while Gd-BOPTA achieved higher maximal enhancement of the hepatic artery, portal vein and middle hepatic vein than Gd-EOB-DTPA. Diseases of the liver and biliary system may affect the vasculature, parenchyma, biliary excretion or a combination of these. The clinical context regarding the relative importance of vascular, hepatic parenchymal and biliary processes should determine the choice of contrast media for each patient and examination.

Magnetresonanstomografi av lever och gallvägar med levercellsspecifika kontrastmedel

There are two Gadolinium-based liver-specific contrast media for Magnetic Resonance Imaging on the market, Gd-BOPTA (MultiHance®, Bracco Imaging, Milan, Italy) and Gd-EOB-DTPA (Primovist®, Bayer Schering Pharma, Berlin, Germany). The aim of this study in two parts was to evaluate the dynamics of biliary, parenchymal and vascular enhancement using these contrast media in healthy subjects. Ten healthy volunteers were examined in a 1.5 T magnetic resonance system using three-dimensional Volumetric Interpolated Breath-Hold (VIBE) sequences for dynamic imaging with both contrast media – at two different occasions – until five hours after injection. The doses given were 0.025 mmol/kg for Gd-EOB-DTPA and 0.1 mmol/kg for Gd-BOPTA. The enhancement over time of the common biliary duct in contrast to the liver parenchyma was analyzed in the first study. This was followed by a study of the image contrasts of the hepatic artery, portal vein and middle hepatic vein versus the liver parenchyma.While Gd-EOB-DTPA gave an earlier and more prolonged enhancement of the biliary duct, Gd-BOPTA achieved higher image contrast for all vessels studied, during the arterial and portal venous phases. There was no significant difference in the maximal enhancement obtained in the liver parenchyma.At the obtained time-points and at the dosage used, the high contrast between the common biliary duct and liver parenchyma had an earlier onset and longer duration for Gd-EOB-DTPA, while Gd-BOPTA achieved higher maximal enhancement of the hepatic artery, portal vein and middle hepatic vein than Gd-EOB-DTPA. Diseases of the liver and biliary system may affect the vasculature, parenchyma, biliary excretion or a combination of these. The clinical context regarding the relative importance of vascular, hepatic parenchymal and biliary processes should determine the choice of contrast media for each patient and examination.

CLINICAL AUDIT OF IMAGE QUALITY IN RADIOLOGY USING VISUAL GRADING CHARACTERISTICS ANALYSIS

The aim of this work was to assess whether an audit of clinical image quality could be efficiently implemented within a limited time frame using visual grading characteristics (VGC) analysis. Lumbar spine radiography, bedside chest radiography and abdominal CT were selected. For each examination, images were acquired or reconstructed in two ways. Twenty images per examination were assessed by 40 radiology residents using visual grading of image criteria. The results were analysed using VGC. Inter-observer reliability was assessed. The results of the visual grading analysis were consistent with expected outcomes. The inter-observer reliability was moderate to good and correlated with perceived image quality (r2 5 0.47). The median observation time per image or image series was within 2 min. These results suggest that the use of visual grading of image criteria to assess the quality of radiographs provides a rapid method for performing an image quality audit in a clinical environment

Contrast-enhanced magnetic resonance cholangiography with Gd-BOPTA and Gd-EOB-DTPA in healthy subjects

PURPOSE: To evaluate the biliary enhancement dynamics of the two gadolinium chelates Gd-BOPTA (MultiHance) and Gd-EOB-DTPA (Primovist) in normal healthy subjects. MATERIAL AND METHODS: Ten healthy volunteers were evaluated with both agents by magnetic resonance (MR) imaging at 1.5T using a breath-hold gradient-echo T1-weighted VIBE sequence. The relative signal intensity (SI) differences between the common hepatic duct (CHD) and liver parenchyma were measured before and 10, 20, 30, 40, 130, 240, and 300 min after contrast medium injection. RESULTS: Biliary enhancement was obvious 10 min post-injection for Gd-EOB-DTPA and was noted at 20 min for Gd-BOPTA. At 40 min delay, Gd-BOPTA reached its peak biliary enhancement, but at neither 30 nor 40 min delay was there any significant difference compared with that of Gd-EOB-DTPA. At later delays, the contrast between CHD and liver continued to increase for Gd-EOB-DTPA, whereas it decreased for Gd-BOPTA. CONCLUSION: The earlier onset and longer duration of a high contrast between CHD and liver for Gd-EOB-DTPA facilitates examination of hepatobiliary excretion. Therefore, Gd-EOB-DTPA may provide adequate hepatobiliary imaging within a shorter time span than Gd-BOPTA and facilitate scheduling at the MR unit. Further studies in patients are required to compare the imaging advantages of Gd-EOB-DTPA and Gd-BOPTA in clinical practice.This is an electronic version of an article published in: Nils Dahlström, Anders Persson, Nils Albiin, Örjan Smedby and Torkel Brismar, Contrast-enhanced magnetic resonance cholangiography with Gd-BOPTA and Gd-EOB-DTPA in healthy subjects, 2007, Acta Radiologica, (48), 4, 362-368. Acta Radiologica is available online at informaworldTM: http://dx.doi.org/10.1080/02841850701196922 Copyright: Taylor &amp; Francis http://www.tandf.co.uk/journals/default.asp</p

Radiography Students Learning During Clinical Placements : Developing Professional Knowing in Practice

Radiographers work with image production in medical imaging, a professional field that is undergoing rapid technical development. There is a need to understand how students in radiography education learn within this evolving practice. The aim of this paper is to investigate how radiography students learn professional knowledge in practice during clinical placements. Data collection was through qualitative design using observations and individual interviews. The theoretical framework for the study was a practice-orientated approach. Three themes describing the learning in practice of radiography students emerged as the final result. 1) Attuning to practice: Learning through listening and observing showed how students reconstruct prior knowledge into practical knowing and learn the situated practice. 2) Embodied knowing: Learning through acting in practice illustrated how students reconstructed prior embodied knowledge through their own acting in practice. 3) Dealing with the unexpected: Learning from breakdowns explains how students learn in situations in which unexpected things happen with materiality or relations. On these occasions, relationships with other people were important for developing the students knowing about the relationship between materiality, actions and people practicing radiography. This study it gives insight into radiography students learning during clinical placement, which can be useful for planning curricula, as well as clinical learning in radiography education

F.E.M. Stress-Investigation of Scolios Apex

In scoliosis, kypholordos and wedge properties of the vertebrae should be involved in determining how stress is distributed in the vertebral column. The impact is logically expected to be maximal at the apex