Publications by authors named "Johan Berglund"

91 Publications

Cross-Sectional Study of Sexual Activity and Satisfaction Among Older Adult's ≥60 Years of Age.

Sex Med 2021 Apr 3;9(2):100316. Epub 2021 Mar 3.

Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden. Electronic address:

Introduction: Despite the rapidly increasing population of older adults, little is currently known about sexual activity and sexual satisfaction among the oldest people.

Aim: The present study aimed to investigate sexual activity and sexual satisfaction among people of ≥60 years of age. We also examined whether sexual activity and sexual satisfaction were influenced by age, gender, cohabiting, socioeconomic factors, education, functional ability, and self-reported health.

Methods: We performed a descriptive analysis of self-stated sexual activity and sexual satisfaction among 1680 participants who were 60 years and older from the Swedish National Study on Aging and Care. Chi-square tests and logistic regression were used to analyze relationships between factors.

Main Outcome Measure: Sexual activity and sexual satisfaction.

Results: Among participants aged ≥90 years, about 10% were sexually active. Within the total study population, 46% (654/1680) were sexually active. Overall, sexually activity was more commonly reported by men (55%) than women (40%). However, men in all age cohorts reported sexual dissatisfaction more commonly than women. In the total sample, 24% (246/1680) reported dissatisfaction with their sex life. Sexual activity and sexual satisfaction were positively associated with self-reported health and cohabitation.

Conclusion: The present results suggest that sexual activity is present throughout life. For persons older than 90 years, about 10% of participants were sexually active, regardless of gender. Every third man reported dissatisfaction with his sex life. Women were more satisfied with their sex lives than men, and this difference varies more widely among age cohorts. These findings confirm that it is important that health professional take sexuality into account during caring encounters with older persons. M Stentagg, L Skär, JS Berglund, et al. Cross-Sectional Study of Sexual Activity and Satisfaction Among Older Adult's ≥60 Years of Age. Sex Med 2021;9:100316.
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http://dx.doi.org/10.1016/j.esxm.2020.100316DOI Listing
April 2021

Periodontitis related to cardiovascular events and mortality: a long-time longitudinal study.

Clin Oral Investig 2021 Jan 28. Epub 2021 Jan 28.

University of Kristianstad, Elmetorpsvägen 15, 29188, Kristianstad, Sweden.

Objective: The present study assessed if individuals ≥ 60 years of age with periodontitis are more likely to develop stroke or ischemic heart diseases, or at a higher risk of death for 17 years.

Material And Methods: At baseline individuals ≥ 60 received a dental examination including a panoramic radiograph. Periodontitis was defined as having ≥ 30% sites with ≥ 5-mm distance from the cementoenamel junction to the marginal bone level. Medical records were annually reviewed from 2001 to 2018. Findings from the medical records identifying an ICD-10 code of stroke and ischemic heart diseases or death were registered.

Results: Associations between periodontitis and incidence of ischemic heart disease were found in this 17-year follow-up study in all individuals 60-93 years (HR: 1.5, CI: 1.1-2.1, p = 0.017), in women (HR: 2.1, CI: 1.3-3.4, p = 0.002), and in individuals 78-96 years (HR: 1.7, CI: 1.0-2.6, p = 0.033). Periodontitis was associated with mortality in all individuals (HR: 1.4, CI: 1.2-1.8, p = 0.002), specifically in men (HR: 1.5, CI: 1.1-1.9, p = 0.006) or in ages 60-72 years (HR: 2.2, CI: 1.5-3.2, p = 0.000). Periodontitis was more prevalent among men (OR: 1.8, CI: 1.3-2.4, p = 0.000).

Conclusions: Individuals with periodontitis have an increased risk for future events of ischemic heart diseases and death.

Clinical Relevance: Improving periodontal health in older individuals may reduce overall mortality and ischemic heart diseases. Both dental and medical professionals should be aware of the associations and ultimately cooperate.
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http://dx.doi.org/10.1007/s00784-020-03739-xDOI Listing
January 2021

Older People's Use and Nonuse of the Internet in Sweden.

Int J Environ Res Public Health 2020 12 4;17(23). Epub 2020 Dec 4.

Department of Health, Blekinge Institute of Technology, SE-371 79 Karlskrona, Sweden.

The use of the internet has considerably increased over recent years, and the importance of internet use has also grown as services have gone online. Sweden is largely an information society like other countries with high reported use amongst European countries. In line with digitalization development, society is also changing, and many activities and services today take place on the internet. This development could potentially lead to those older persons who do not use the internet or do not follow the development of services on the internet finding it difficult to take part in information and activities that no longer occur in the physical world. This has led to a digital divide between groups, where the older generations (60+), in particular, have been affected. In a large study of Sweden's adult population in 2019, 95 percent of the overall population was said to be internet users, and the corresponding number for users over 66 years of age was 84%. This study shows that the numbers reported about older peoples' internet use, most likely, are vastly overestimated and that real use is significantly lower, especially among the oldest age groups. We report that 62.4% of the study subjects are internet users and that this number most likely also is an overestimation. When looking at nonresponders to the questionnaire, we find that they display characteristics generally attributed to non-use, such as lower education, lower household economy, and lower cognitive functioning.
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http://dx.doi.org/10.3390/ijerph17239050DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7730010PMC
December 2020

Chemical shift encoding using asymmetric readout waveforms.

Magn Reson Med 2021 03 8;85(3):1468-1480. Epub 2020 Oct 8.

Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.

Purpose: To describe a new method for encoding chemical shift using asymmetric readout waveforms that enables more SNR-efficient fat/water imaging.

Methods: Chemical shift was encoded using asymmetric readout waveforms, rather than conventional shifted trapezoid readouts. Two asymmetric waveforms are described: a triangle and a spline. The concept was applied to a fat/water separated RARE sequence to increase sampling efficiency. The benefits were investigated through comparisons to shifted trapezoid readouts. Using asymmetric readout waveforms, the scan time was either shortened or maintained to increase SNR. A matched in-phase waveform is also described that aims to improve the SNR transfer function of the fat and water estimates. The sequence was demonstrated for cervical spine, musculoskeletal (MSK), and optic nerve applications at 3T and compared with conventional shifted readouts.

Results: By removing sequence dead times, scan times were shortened by 30% with maintained SNR. The shorter echo spacing also reduced blurring. Maintaining the scan times and using asymmetric readout waveforms achieved an SNR improvement in agreement with the prolonged sampling duration.

Conclusions: Asymmetric readout waveforms offer an additional degree of freedom in pulse sequence designs where chemical shift encoding is desired. This can be used to significantly shorten scan times or to increase SNR with maintained scan time.
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http://dx.doi.org/10.1002/mrm.28529DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7756491PMC
March 2021

Comparison of reliability of magnetic resonance imaging using cartilage and T1-weighted sequences in the assessment of the closure of the growth plates at the knee.

Acta Radiol Open 2020 Sep 30;9(9):2058460120962732. Epub 2020 Sep 30.

Department of Pediatric Radiology, Karolinska University Hospital, Stockholm, Sweden.

Background: Growth development is traditionally evaluated with plain radiographs of the hand and wrist to visualize bone structures using ionizing radiation. Meanwhile, MRI visualizes bone and cartilaginous tissue without radiation exposure.

Purpose: To determine the state of growth plate closure of the knee in healthy adolescents and young adults and compare the reliability of staging using cartilage sequences and T1-weighted (T1W) sequence between pediatric and general radiologists.

Material And Methods: A prospective, cross-sectional study of MRI of the knee with both cartilage and T1W sequences was performed in 395 male and female healthy subjects aged between 14.0 and 21.5 years old. The growth plate of the femur and the tibia were graded using a modified staging scale by two pediatric and two general radiologists. Femur and tibia were graded separately with both sequences.

Results: The intraclass correlation was overall excellent. The inter- and intra-observer agreement for pediatric radiologists on T1W was 82% (κ0.73) and 77% (κ0.65) for the femur and 90% (κ0.82) and 87% (κ0.75) for the tibia. The inter-observer agreement for general radiologists on T1W was 69% (κ0.56) for the femur and 56% (κ0.34) for the tibia. Cohen's kappa coefficient showed a higher inter- and intra-observer agreement for cartilage sequences than for T1W: 93% (κ0.86) and 89% (κ0.79) for the femur and 95% (κ = 0.90) and 91% (κ0.81) for the tibia.

Conclusion: Cartilage sequences are more reliable than T1W sequence in the assessment of the growth plate in adolescents and young adults. Pediatric radiology experience is preferable.
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http://dx.doi.org/10.1177/2058460120962732DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7545521PMC
September 2020

Prospective motion correction for diffusion weighted EPI of the brain using an optical markerless tracker.

Magn Reson Med 2021 03 29;85(3):1427-1440. Epub 2020 Sep 29.

Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.

Purpose: To enable motion-robust diffusion weighted imaging of the brain using well-established imaging techniques.

Methods: An optical markerless tracking system was used to estimate and correct for rigid body motion of the head in real time during scanning. The imaging coordinate system was updated before each excitation pulse in a single-shot EPI sequence accelerated by GRAPPA with motion-robust calibration. Full Fourier imaging was used to reduce effects of motion during diffusion encoding. Subjects were imaged while performing prescribed motion patterns, each repeated with prospective motion correction on and off.

Results: Prospective motion correction with dynamic ghost correction enabled high quality DWI in the presence of fast and continuous motion within a 10° range. Images acquired without motion were not degraded by the prospective correction. Calculated diffusion tensors tolerated the motion well, but ADC values were slightly increased.

Conclusions: Prospective correction by markerless optical tracking minimizes patient interaction and appears to be well suited for EPI-based DWI of patient groups unable to remain still including those who are not compliant with markers.
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http://dx.doi.org/10.1002/mrm.28524DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7756594PMC
March 2021

Chronological Age Assessment in Young Individuals Using Bone Age Assessment Staging and Nonradiological Aspects: Machine Learning Multifactorial Approach.

JMIR Med Inform 2020 Sep 21;8(9):e18846. Epub 2020 Sep 21.

Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden.

Background: Bone age assessment (BAA) is used in numerous pediatric clinical settings as well as in legal settings when entities need an estimate of chronological age (CA) when valid documents are lacking. The latter case presents itself as critical as the law is harsher for adults and granted rights along with imputability changes drastically if the individual is a minor. Traditional BAA methods have drawbacks such as exposure of minors to radiation, they do not consider factors that might affect the bone age, and they mostly focus on a single region. Given the critical scenarios in which BAA can affect the lives of young individuals, it is important to focus on the drawbacks of the traditional methods and investigate the potential of estimating CA through BAA.

Objective: This study aims to investigate CA estimation through BAA in young individuals aged 14-21 years with machine learning methods, addressing the drawbacks of research using magnetic resonance imaging (MRI), assessment of multiple regions of interest, and other factors that may affect the bone age.

Methods: MRI examinations of the radius, distal tibia, proximal tibia, distal femur, and calcaneus were performed on 465 men and 473 women (aged 14-21 years). Measures of weight and height were taken from the subjects, and a questionnaire was given for additional information (self-assessed Tanner Scale, physical activity level, parents' origin, and type of residence during upbringing). Two pediatric radiologists independently assessed the MRI images to evaluate their stage of bone development (blinded to age, gender, and each other). All the gathered information was used in training machine learning models for CA estimation and minor versus adult classification (threshold of 18 years). Different machine learning methods were investigated.

Results: The minor versus adult classification produced accuracies of 0.90 and 0.84 for male and female subjects, respectively, with high recalls for the classification of minors. The CA estimation for the 8 age groups (aged 14-21 years) achieved mean absolute errors of 0.95 years and 1.24 years for male and female subjects, respectively. However, for the latter, a lower error occurred only for the ages of 14 and 15 years.

Conclusions: This study investigates CA estimation through BAA using machine learning methods in 2 ways: minor versus adult classification and CA estimation in 8 age groups (aged 14-21 years), while addressing the drawbacks in the research on BAA. The first achieved good results; however, for the second case, the BAA was not precise enough for the classification.
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http://dx.doi.org/10.2196/18846DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7536601PMC
September 2020

T -FLAIR imaging during continuous head motion: Combining PROPELLER with an intelligent marker.

Magn Reson Med 2021 02 1;85(2):868-882. Epub 2020 Sep 1.

Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden.

Purpose: The purpose of this work is to describe a T -weighted fluid-attenuated inversion recovery (FLAIR) sequence that is able to produce sharp magnetic resonance images even if the subject is moving their head throughout the acquisition.

Methods: The robustness to motion artifacts and retrospective motion correction capabilities of the PROPELLER (periodically rotated overlapping parallel lines with enhanced reconstruction) trajectory were combined with prospective motion correction. The prospective correction was done using an intelligent marker attached to the subject. This marker wirelessly synchronizes to the pulse sequence to measure the directionality and magnitude of the magnetic fields present in the MRI machine during a short navigator, thus enabling it to determine its position and orientation in the scanner coordinate frame. Three approaches to incorporating the marker-navigator into the PROPELLER sequence were evaluated. The specific absorption rate, and subsequent scan time, of the T -weighted FLAIR PROPELLER sequence, was reduced using a variable refocusing flip-angle scheme. Evaluations of motion correction performance were done with 4 volunteers and 3 types of head motion.

Results: During minimal out-of-plane movement, retrospective PROPELLER correction performed similarly to the prospective correction. However, the prospective clearly outperformed the retrospective correction when there was out-of-plane motion. Finally, the combination of retrospective and prospective correction produced the sharpest images even during large continuous motion.

Conclusion: Prospective motion correction of a PROPELLER sequence makes it possible to handle continuous, large, and high-speed head motions with only minor reductions in image quality.
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http://dx.doi.org/10.1002/mrm.28477DOI Listing
February 2021

The association between rheumatoid arthritis and periodontal disease in a population-based cross-sectional case-control study.

BMC Rheumatol 2020 20;4:31. Epub 2020 Jul 20.

Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden.

Background: The association between rheumatoid arthritis (RA) and periodontitis remains unclear.

Methods: We studied oral health and periodontitis in a population-based case-control study of individuals with ≥10 remaining teeth ≥61 years of age and either with, or without a diagnosis of RA. 126 dentate individuals with RA were recruited together with age-matched control individuals without RA. The control individuals were recruited from the general population from the same city ( = 249). A dental examination including a panoramic radiograph was performed on all participants. All individuals with RA were examined and medical records were reviewed by a rheumatologist. In the control group, none of the participants presented with symptoms of RA and their medical records were also negative.

Results: The RA group included more women (66.7% vs. 55.8%) ( < 0.01). Individuals in the RA group had a higher body mass index (BMI) ( < 0.001). A diagnosis of periodontitis was more common in the RA group (61.1%) than in the control group (33.7%) ( = 0.001). Binary logistic regression analysis identified that a BMI > 25 (OR 6.2, 95% CI 3.6, 10.5,  = 0.000), periodontitis (OR 2.5 95% CI 1.5, 4.2  = 0.000), and female gender (OR 2.3, 95% CI 1.3-4.0,  = 0.003) were associated with RA.

Conclusion: RA was associated a diagnosis of periodontitis.
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http://dx.doi.org/10.1186/s41927-020-00129-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7370413PMC
July 2020

Multiscale Characterizations of Surface Anisotropies.

Materials (Basel) 2020 Jul 7;13(13). Epub 2020 Jul 7.

Surface Metrology Lab, Worcester Polytechnic Institute, Worcester, MA 01609, USA.

Anisotropy can influence surface function and can be an indication of processing. These influences and indications include friction, wetting, and microwear. This article studies two methods for multiscale quantification and visualization of anisotropy. One uses multiscale curvature tensor analysis and shows anisotropy in horizontal coordinates i.e., topocentric. The other uses multiple bandpass filters (also known as sliding bandpass filters) applied prior to calculating anisotropy parameters, texture aspect ratios (Str) and texture directions (Std), showing anisotropy in horizontal directions only. Topographies were studied on two milled steel surfaces, one convex with an evident large scale, cylindrical form anisotropy, the other nominally flat with smaller scale anisotropies; a µEDMed surface, an example of an isotropic surface; and an additively manufactured surface with pillar-like features. Curvature tensors contain the two principal curvatures, i.e., maximum and minimum curvatures, which are orthogonal, and their directions, at each location. Principal directions are plotted for each calculated location on each surface, at each scale considered. Histograms in horizontal coordinates show altitude and azimuth angles of principal curvatures, elucidating dominant texture directions at each scale. Str and Std do not show vertical components, i.e., altitudes, of anisotropy. Changes of anisotropy with scale categorically failed to be detected by traditional characterization methods used conventionally. These multiscale methods show clearly in several representations that anisotropy changes with scale on actual surface measurements with markedly different anisotropies.
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http://dx.doi.org/10.3390/ma13133028DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7372363PMC
July 2020

RARE two-point Dixon with dual bandwidths.

Magn Reson Med 2020 11 25;84(5):2456-2468. Epub 2020 Apr 25.

Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden.

Purpose: To investigate the impact of dual readout bandwidths (dBW) in a dual echo fat/water acquisition and describe a dBW-rapid acquisition relaxation enhanced, or turbo spin echo sequence where the concept is used to improve SNR by removing dead times between refocusing pulses and avoiding redundant Chemical-shift encoded.

Methods: Cramér-Rao bounds and Monte Carlo simulations were used to investigate a two-point fat/water model where the difference in bandwidths is incorporated. In vivo images were acquired at 1.5 and 3 T with the dBW-rapid acquisition relaxation enhanced, or turbo spin echo sequence. Typical bandwidth ratios were 1:2. SNR was compared with a single bandwidth sequence under identical scan parameters at 3T.

Results: Monte Carlo simulations and Cramér-Rao analysis demonstrate that number of signal averages can be improved with dual bandwidths compared to conventional single bandwidth acquisitions. The dBW-rapid acquisition relaxation enhanced, or turbo spin echo sequence can acquire images with high readout resolutions with well-conditioned sampling. An SNR improvement of 52% was measured, in line with the theoretical gain of 54%.

Conclusions: The proposed dBW-rapid acquisition relaxation enhanced, or turbo spin echo sequence is a highly SNR-efficient two-point rapid acquisition relaxation enhanced, or turbo spin echo sequence without dead times, and can acquire images at higher resolutions than current vendor-supplied alternatives.
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http://dx.doi.org/10.1002/mrm.28293DOI Listing
November 2020

Projection-based 3D/2D registration for prospective motion correction.

Magn Reson Med 2020 09 10;84(3):1534-1542. Epub 2020 Mar 10.

Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden.

Purpose: To develop a registration method that is capable of estimating the full range of rigid body motion from three orthogonal collapsed images of the head. These images can be obtained using the collapsed FatNav, a previously introduced navigator for prospective motion correction. It combines a short duration with wide compatibility with different main sequences due to its robustness against spin history effects.

Theory And Methods: A projection-based 3D/2D registration method is presented and then modified to take into account the peculiarities of the collapsed FatNav. Water/fat separated volumes were used in simulations to assess the accuracy of the proposed method at different resolutions by comparison with high-resolution 3D registration. The sensitivity with respect to masking strategies and starting motion parameters was investigated. Finally, prospective experiments with a healthy volunteer were performed with different types of motion patterns. A PROPELLER main sequence was chosen to compare the prospective correction with PROPELLER's own retrospective correction.

Results: In the simulations the proposed method has shown comparable performance to 3D registration. Furthermore, evidence of its robustness with respect to masking strategies and starting motion parameters was presented. The combination with collapsed FatNav has performed well in correcting most of the motion artifacts prospectively with improved image quality compared to only using PROPELLER's retrospective motion correction.

Conclusions: The proposed 3D/2D registration together with collapsed FatNav is characterized by a good balance between navigator duration and estimate accuracy. Further work is needed to validate the method across a wider variety of subject anatomies.
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http://dx.doi.org/10.1002/mrm.28225DOI Listing
September 2020

Optimizing 3D EPI for rapid T -weighted imaging.

Magn Reson Med 2020 09 28;84(3):1441-1455. Epub 2020 Feb 28.

Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden.

Purpose: To investigate the use of 3D EPI for rapid T -weighted brain imaging, focusing on the RF pulse's influence on the contrast between gray and white matter.

Methods: An interleaved 3D EPI sequence use partial Fourier and CAIPIRINHA sampling was used to acquire T -weighted brain volumes with isotropic resolution, low echo times, and low geometric distortions. Five different RF pulses were evaluated in terms of fat suppression performance and gray-white matter contrast. Two binomial RF pulses were compared to a single rectangular (WE-rect) RF pulse exciting only water, and two new RF pulses developed in this work, where one was an extension of the WE-rect, and the other was an SLR pulse. The technique was demonstrated in three clinical cases, where brain tumor patients were imaged before and after gadolinium administration.

Results: A fat-suppressed 3D EPI sequence with a phase encoding bandwidth of around 100 Hz was found to exhibit a good trade-off between geometrical distortions and scan duration. Whole-brain T -weighted 3D EPI images with 1.2 mm isotropic voxel size could be acquired in 24 seconds. The WE-rect, its extension, and the SLR RF pulses resulted in reduced magnetization transfer effects and provided a 20% mean increase in gray-white matter contrast.

Conclusion: Using a high phase encoding bandwidth and RF pulses that reduce magnetization transfer effects, a fat-suppressed multi-shot 3D EPI sequence can be used to rapidly acquire isotropic T -weighted volumes.
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http://dx.doi.org/10.1002/mrm.28222DOI Listing
September 2020

Age Assessment of Youth and Young Adults Using Magnetic Resonance Imaging of the Knee: A Deep Learning Approach.

JMIR Med Inform 2019 Dec 5;7(4):e16291. Epub 2019 Dec 5.

Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden.

Background: Bone age assessment (BAA) is an important tool for diagnosis and in determining the time of treatment in a number of pediatric clinical scenarios, as well as in legal settings where it is used to estimate the chronological age of an individual where valid documents are lacking. Traditional methods for BAA suffer from drawbacks, such as exposing juveniles to radiation, intra- and interrater variability, and the time spent on the assessment. The employment of automated methods such as deep learning and the use of magnetic resonance imaging (MRI) can address these drawbacks and improve the assessment of age.

Objective: The aim of this paper is to propose an automated approach for age assessment of youth and young adults in the age range when the length growth ceases and growth zones are closed (14-21 years of age) by employing deep learning using MRI of the knee.

Methods: This study carried out MRI examinations of the knee of 402 volunteer subjects-221 males (55.0%) and 181 (45.0%) females-aged 14-21 years. The method comprised two convolutional neural network (CNN) models: the first one selected the most informative images of an MRI sequence, concerning age-assessment purposes; these were then used in the second module, which was responsible for the age estimation. Different CNN architectures were tested, both training from scratch and employing transfer learning.

Results: The CNN architecture that provided the best results was GoogLeNet pretrained on the ImageNet database. The proposed method was able to assess the age of male subjects in the range of 14-20.5 years, with a mean absolute error (MAE) of 0.793 years, and of female subjects in the range of 14-19.5 years, with an MAE of 0.988 years. Regarding the classification of minors-with the threshold of 18 years of age-an accuracy of 98.1% for male subjects and 95.0% for female subjects was achieved.

Conclusions: The proposed method was able to assess the age of youth and young adults from 14 to 20.5 years of age for male subjects and 14 to 19.5 years of age for female subjects in a fully automated manner, without the use of ionizing radiation, addressing the drawbacks of traditional methods.
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http://dx.doi.org/10.2196/16291DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6923761PMC
December 2019

Fat/water separation in k-space with real-valued estimates and its combination with POCS.

Magn Reson Med 2020 02 16;83(2):653-661. Epub 2019 Aug 16.

Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.

Purpose: To develop reconstruction methods for improved image quality of chemical shift displacement-corrected fat/water imaging combined with partial Fourier acquisition.

Theory: Fat/water separation in k-space enables correction of chemical shift displacement. Modeling fat and water as real-valued rather than complex improves the conditionality of the inverse problem. This advantage becomes essential for k-space separation. In this work, it was described how to perform regularized fat/water imaging with real estimates in k-space, and how fat/water imaging can be combined with partial Fourier reconstruction using Projection Onto Convex Sets (POCS).

Methods: The reconstruction methods were demonstrated on chemical shift encoded gradient echo and fast spin echo data from volunteers, acquired at 1.5 T and 3 T. Both fully sampled and partial Fourier acquisitions were made. Data was retrospectively rejected from the fully sampled dataset to evaluate POCS and homodyne reconstruction.

Results: Fat/water separation in k-space eliminated chemical shift displacement, while real-valued estimates considerably reduced the noise amplification compared to complex estimates. POCS reconstruction could recover high spatial frequency information in the fat and water images with lower reconstruction error than homodyne. Partial Fourier in the readout direction enabled more flexible choice of gradient echo imaging parameters, in particular image resolution.

Conclusion: Chemical shift displacement-corrected fat/water imaging can be performed with regularization and real-valued estimates to improve image quality by reducing ill-conditioning of the inverse problem in k-space. Fat/water imaging can be combined with POCS, which offers improved image quality over homodyne reconstruction.
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http://dx.doi.org/10.1002/mrm.27949DOI Listing
February 2020

A Novel Instrument for Measuring Older People's Attitudes Toward Technology (TechPH): Development and Validation.

J Med Internet Res 2019 05 23;21(5):e13951. Epub 2019 May 23.

Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden.

Background: The use of health technology by older people is coming increasingly in focus with the demographic changes. Health information technology is generally perceived as an important factor in enabling increased quality of life and reducing the cost of care for this group. Age-appropriate design and facilitation of technology adoption are important to ensure functionality and removal of various barriers to usage. Development of assessment tools and instruments for evaluating older persons' technology adoption and usage as well as measuring the effects of the interventions are of high priority. Both usability and acceptance of a specific technology or service are important factors in evaluating the impact of a health information technology intervention. Psychometric measures are seldom included in evaluations of health technology. However, basic attitudes and sentiments toward technology (eg, technophilia) could be argued to influence both the level of satisfaction with the technology itself as well as the perception of the health intervention outcome.

Objective: The purpose of this study is to develop a reduced and refined instrument for measuring older people's attitudes and enthusiasm for technology based on relevant existing instruments for measuring technophilia. A requirement of the new instrument is that it should be short and simple to make it usable for evaluation of health technology for older people.

Methods: Initial items for the TechPH questionnaire were drawn from a content analysis of relevant existing technophilia measure instruments. An exploratory factor analysis was conducted in a random selection of persons aged 65 years or older (N=374) on eight initial items. The scale was reduced to six items, and the internal consistency and reliability of the scale were examined. Further validation was made by a confirmatory factor analysis (CFA).

Results: The exploratory factor analysis resulted in two factors. These factors were analyzed and labeled techEnthusiasm and techAnxiety. They demonstrated relatively good internal consistency (Cronbach alpha=.72 and .68, respectively). The factors were confirmed in the CFA and showed good model fit (χ=21.2, χ/df=2.65, comparative fit index=0.97, adjusted goodness-of-fit index=0.95, root mean square error of approximation=0.067, standardized root mean square residual=0.036).

Conclusions: The construed TechPH score showed expected relations to external real-world criteria, and the two factors showed interesting internal relations. Different technophilia personality traits distinguish clusters with different behaviors of adaptation as well as usage of new technology. Whether there is an independent association with the TechPH score against outcomes in health technology projects needs to be shown in further studies. The instrument must also be validated in different contexts, such as other countries.
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http://dx.doi.org/10.2196/13951DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6552448PMC
May 2019

Everyday life when growing up with a mother with an intellectual or developmental disability: Four retrospective life-stories.

Scand J Occup Ther 2020 Aug 20;27(6):418-430. Epub 2019 Jan 20.

Faculty of Health and Society, Malmö University, Malmö, Sweden.

The voices of those who have grown up in a family with maternal intellectual or developmental disability (IDD) are valuable for gaining an understanding of their situation, which is essential in order to be able to support these families and avoid potentially detrimental situations. The study aim was to describe the experience of having grown up in a family where the mother has an IDD, with a focus on everyday life and perceived health consequences in adult life. A qualitative method with retrospective narrative interviews and narrative content analysis was chosen. In-depth interviews were performed with four women who had experiences of a childhood with maternal IDD. Four themes emerged: Living under adverse circumstances; Dealing with one's everyday life situation; Receiving insufficient support and wishing for more; and The echo from childhood into adult life. The findings revealed a distressing childhood, characterized by neglect, abuse, anxiety, and overburdening responsibilities, and also endeavors to keep the family situation a secret, while at the same time wanting the adult world to react. The findings can hopefully stimulate occupational therapists and other professionals to more effectively identify the situation of these children and provide support to prevent adverse future health conditions and poor well-being.
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http://dx.doi.org/10.1080/11038128.2018.1554087DOI Listing
August 2020

Most Influential Qualities in Creating Satisfaction Among the Users of Health Information Systems: Study in Seven European Union Countries.

JMIR Med Inform 2018 Nov 30;6(4):e11252. Epub 2018 Nov 30.

Department of Health Science, Blekinge Institute of Technology, Karlskrona, Sweden.

Background: Several models suggest how the qualities of a product or service influence user satisfaction. Models such as the Customer Satisfaction Index (CSI), Technology Acceptance Model (TAM), and Delone and McLean Information Systems Success demonstrate those relations and have been used in the context of health information systems.

Objective: This study aimed to investigate which qualities foster greater satisfaction among patient and professional users. In addition, we are interested in knowing to what extent improvement in those qualities can explain user satisfaction and whether this makes user satisfaction a proxy indicator of those qualities.

Methods: The Unified eValuation using ONtology (UVON) method was used to construct an ontology of the required qualities for 7 electronic health (eHealth) apps being developed in the Future Internet Social and Technological Alignment Research (FI-STAR) project, a European Union (EU) project in electronic health (eHealth). The eHealth apps were deployed across 7 EU countries. The ontology included and unified the required qualities of those systems together with the aspects suggested by the Model for ASsessment of Telemedicine apps (MAST) evaluation framework. Moreover, 2 similar questionnaires for 87 patient users and 31 health professional users were elicited from the ontology. In the questionnaires, the user was asked if the system has improved the specified qualities and if the user was satisfied with the system. The results were analyzed using Kendall correlation coefficients matrices, incorporating the quality and satisfaction aspects. For the next step, 2 partial least squares structural equation modeling (PLS-SEM) path models were developed using the quality and satisfaction measure variables and the latent construct variables that were suggested by the UVON method.

Results: Most of the quality aspects grouped by the UVON method are highly correlated. Strong correlations in each group suggest that the grouped qualities can be measures that reflect a latent quality construct. The PLS-SEM path analysis for the patients reveals that the effectiveness, safety, and efficiency of treatment provided by the system are the most influential qualities in achieving and predicting user satisfaction. For the professional users, effectiveness and affordability are the most influential. The parameters of the PLS-SEM that are calculated allow for the measurement of a user satisfaction index similar to CSI for similar health information systems.

Conclusions: For both patients and professionals, the effectiveness of systems highly contributes to their satisfaction. Patients care about improvements in safety and efficiency, whereas professionals care about improvements in the affordability of treatments with health information systems. User satisfaction is reflected more in the users' evaluation of system output and fulfillment of expectations but slightly less in how far the system is from ideal. Investigating satisfaction scores can be a simple and fast way to infer if the system has improved the abovementioned qualities in treatment and care.
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http://dx.doi.org/10.2196/11252DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6294876PMC
November 2018

Carotid calcifications in panoramic radiographs are associated with future stroke or ischemic heart diseases: a long-term follow-up study.

Clin Oral Investig 2019 Mar 2;23(3):1171-1179. Epub 2018 Jul 2.

University of Kristianstad, Elmetorpsvägen 15, 291 88, Kristianstad, Sweden.

Objective: To assess if carotid calcifications detected in panoramic radiographs are associated with future events of stroke, and/or ischemic heart diseases over 10-13 years in individuals between 60 and 96 years.

Materials And Methods: Baseline (2001-2004) panoramic radiographs were assessed for evidence of carotid calcifications from individuals with no previous history of stroke and/or ischemic heart diseases. A radiopaque nodular mass adjacent to the cervical vertebrae, at or below the intervertebral space C3-C4, was interpreted as carotid calcification. Annual medical records were searched for ICD 10 codes through 2014.

Results: Signs of carotid calcification was demonstrated in 238/635 (37.5%) of the study individuals. Signs of carotid calcification was associated with future stroke and/or ischemic heart diseases (χ = 9.1, OR 1.6, 95% CI 1.2, 2.2, p < 0.002). In individuals 60-72 years, a significant association between radiographic signs of carotid calcification and stroke and/or ischemic heart diseases (χ = 12.4, OR 2.4, 95% CI 1.5, 4.0, p < 0.000) (adjusted for high blood pressure, diabetes type 2, BMI; OR 1.9, 95% CI 1.1, 3.5, p = 0.03). Individuals (60-72 years) with radiographic evidence of carotid calcifications had a mean cumulative stroke and/or ischemic heart diseases survival time of 12.1 years compared to those without such evidence (13.0 years) (log rank Mantel-Cox χ = 10.7, p = 0.001).

Conclusions: Evidence of carotid calcifications in panoramic radiographs is associated with an event of stroke and/or ischemic heart diseases in 60-96-year-old individuals.

Clinical Relevance: Radiographic evidence of carotid calcifications is associated with stroke and/or ischemic heart diseases. Patients with signs of carotid calcifications should therefore be referred for medical examination.
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http://dx.doi.org/10.1007/s00784-018-2533-8DOI Listing
March 2019

Quality of Life Impact of an Adjuvanted Recombinant Zoster Vaccine in Adults Aged 50 Years and Older.

J Gerontol A Biol Sci Med Sci 2019 07;74(8):1231-1238

University of Bristol, UK.

Background: To determine the efficacy of an adjuvanted recombinant zoster vaccine in reducing the herpes zoster (HZ) burden of illness, HZ burden of interference with activities of daily living, and HZ impact on quality of life.

Methods: The assessments were integrated in two Phase III trials, ZOE-50 (NCT01165177) and ZOE-70 (NCT01165229). HZ burden of illness and HZ burden of interference with activities of daily living were assessed by the Zoster Brief Pain Inventory (ZBPI) instrument and quality of life by the EuroQol-5 Dimension (EQ-5D) utility index and the SF-36 health survey. We report the ZOE-50 results and a pooled analysis of patients aged 70 years and older from the trials combined.

Results: The estimated vaccine efficacy in reducing HZ burden of illness and HZ burden of interference was greater than 90% in both the ZOE-50 and the pooled ZOE-70 analysis. In confirmed HZ cases, adjuvanted recombinant zoster vaccine reduced the maximal ZBPI worst-pain score in the pooled ZOE-70 analysis (p = .032) and the maximal ZBPI average-pain scores in both the ZOE-50 (p = .049) and the pooled ZOE-70 analysis (p = .043). In breakthrough HZ cases, trends for diminished loss of quality of life compared with placebo-recipient HZ cases were observed, with differences up to 0.14 on the EQ-5D index at time points during the 4 weeks following HZ onset.

Conclusions: Adjuvanted recombinant zoster vaccine reduced the HZ burden of illness significantly, particularly due to its very high vaccine efficacy in preventing HZ. For breakthrough HZ cases, the results suggest that the adjuvanted recombinant zoster vaccine mitigated severity of HZ-related pain, burden of interference with activities of daily living, and recipients' utility loss.
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http://dx.doi.org/10.1093/gerona/gly150DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6625590PMC
July 2019

Relationship between pain and Quality of Life-Findings from the Swedish National Study on Aging and Care-Blekinge study.

Scand J Pain 2014 Oct 1;5(4):270-275. Epub 2014 Oct 1.

Department of Health Sciences, Division of Geriatric Medicine, Lund University, Lund, Sweden.

Background and aims The influence of pain as well as Quality of Life (QoL) varies in accordance with biological, social, psychological and existential factors. This study investigates the influence of such factors on the relationship between pain and QoL among older adults from a gender perspective. Methods The Swedish National Study on Aging and Care (SNAC-Blekinge) baseline sample comprised 1402 individuals aged 60-96 years, of whom 769 (55%) reported pain. The participants were invited by a letter to take part in the study, which was carried out by research staff in two sessions of three hour each. Participants gave informed consent and completed a questionnaire between the two sessions. The reason for non-participation was registered among subjects who declined the invitation. Pain and insomnia were self-reported. Data on age, gender and if living alone or not were collected from the questionnaire. Co-morbidity was obtained from electronic patients records for a period of up to two years prior to participating in the SNAC study. SoC was measured by a translated short form from the original twenty-nine question instrument. QoL, was estimated using the HRQL Medical Outcome Study-Short Form (SF 12). In a model, pain, age, sex, insomnia, co-morbidity, living alone, sense of coherence (SOC), household economy, education and QoL were calculated through multivariate logistic regression. Results Among women, pain was found to have the highest OR (odds ratio) for low QoL [OR 2.27 (CI 1.36-3.78)], followed by low economic status [OR 1.75 (CI 1.08-2.84)], co-morbidity [OR 1.24 (CI 1.05-1.46)], low SOC [OR 1.08 (CI 1.06-1.10)] and lower age [OR 1.05 (CI 1.02-1.08)]. In men, insomnia was found to be the main contributor to low QoL [OR 1.86 (CI 1.04-3.33)], followed by low SOC [OR 1.08 (CI 1.05-1.11)] and lower age [OR 1.04 (CI 1.01-1.07)]. Conclusions Pain has a strong relationship with low QoL among elderly women. Insomnia is associated with low QoL among men who suffer less from pain. Thus the main result is a striking gender difference: Elderly women suffer from pain, elderly men suffer from insomnia. Implications It is importanttotake accountof sex, age, sleep problems, co-morbidity, SOC and economic status in order to understand the relationship between pain and QoL among older adults.
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http://dx.doi.org/10.1016/j.sjpain.2014.05.029DOI Listing
October 2014

The influence of personality traits on perception of pain in older adults - Findings from the Swedish National Study on Aging and Care - Blekinge study.

Scand J Pain 2015 Apr 1;7(1):3-8. Epub 2015 Apr 1.

Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden.

Background and aims The experience of pain may vary in accordance with personality traits and individual characteristics. Neuroticism is demonstrated to constitute a vulnerability factor among younger and middle-aged pain patients. The combination of openness and neuroticism is associated with high anxiety/depression scores among adult individuals with chronic conditions. The aim of this study was to investigate possible associations between pain and the personality dimensions of neuroticism, extroversion, openness, agreeableness and conscientiousness among persons aged 60 years and older. An additional aim was to explore whether such associations are equally gender expressed. Methods The Swedish National Study on Aging and Care includes a randomly selected sample from the National Population Register. The data collection was conducted at four research centres and was approved by the Ethics Committees of Lund University and the Karolinska Institutet, Stockholm, Sweden. The Blekinge sample includes 1402 individuals, aged 60-96 years, of whom 769 (55%) reported pain. A total of 2312 individuals had been invited to participate. The reason for non-participation was registered. Participants underwent medical examination and testing by research personnel, conducted in two sessions, each of which lasted about 3 h. A questionnaire was completed between the two sessions. Pain was self-reported and based on the question: Have you had ache/pain during the last 4 weeks? Information on personality traits was obtained by means of the personality SGC1 questionnaire; a 60-item Swedish version of Costa & McCrae's FFM questionnaire. Personality traits were then tested based on gender by means of multivariate forward logistic regression in models adjusted for age, insomnia, financial status and educational level. Results When adjusting for covariates among women, neuroticism had a small but significant odds ratio of experiencing pain (OR 1.05, CI 1.02-1.08). Insomnia had the highest odds ratio (OR 2.19, CI 1.52-3.15) followed by low education (OR 1.59, CI 1.07-2.36), while belonging to the younger part of the older adult cohort was also associated with pain (OR 1.02, CI 1.005-1.04). In men, neuroticism (OR 1.03, CI 1.002-1.06) followed by openness (OR 1.03 CI 1.001-1.07) had a small but significant odds ratio of experiencing pain. Insomnia had the highest odds ratio (OR 1.98, CI 1.24-3.15). Conclusions Personality traits and pain were related among the older adults but there were gender differences. The relationship between pain and neuroticism in women was about the same in strength as the relation between pain and neuroticism/openness in men. Both sexes suffer from insomnia. The relationship between personality traits and pain was only affected to a minor extent by insomnia. Implications There is a need to increase awareness of the impact of personality as well as to provide improved treatment for pain and insomnia in older people.
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http://dx.doi.org/10.1016/j.sjpain.2014.12.002DOI Listing
April 2015

T1 weighted fat/water separated PROPELLER acquired with dual bandwidths.

Magn Reson Med 2018 12 24;80(6):2501-2513. Epub 2018 Apr 24.

Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden.

Purpose: To describe a fat/water separated dual receiver bandwidth (rBW) spin echo PROPELLER sequence that eliminates the dead time associated with single rBW sequences. A nonuniform noise whitening by regularization of the fat/water inverse problem is proposed, to enable dual rBW reconstructions.

Methods: Bipolar, flyback, and dual spin echo sequences were developed. All sequences acquire two echoes with different rBW without dead time. Chemical shift displacement was corrected by performing the fat/water separation in k-space, prior to gridding. The proposed sequences were compared to fat saturation, and single rBW sequences, in terms of SNR and CNR efficiency, using clinically relevant acquisition parameters. The impact of motion was investigated.

Results: Chemical shift correction greatly improved the image quality, especially at high resolution acquired with low rBW, and also improved motion estimates. SNR efficiency of the dual spin echo sequence was up to 20% higher than the single rBW acquisition, while CNR efficiency was 50% higher for the bipolar acquisition. Noise whitening was deemed necessary for all dual rBW acquisitions, rendering high image quality with strong and homogenous fat suppression.

Conclusion: Dual rBW sequences eliminate the dead time present in single rBW sequences, which improves SNR efficiency. In combination with the proposed regularization, this enables highly efficient T1-weighted PROPELLER images without chemical shift displacement.
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http://dx.doi.org/10.1002/mrm.27228DOI Listing
December 2018

Implementation of a web-based national child health-care programme in a local context: A complex facilitator role.

Scand J Public Health 2018 Feb;46(20_suppl):80-86

Department of Health, Faculty of Technology, Blekinge Institute of Technology, Sweden.

Aim: The aim of this study was to investigate child health-care coordinators' experiences of being a facilitator for the implementation of a new national child health-care programme in the form of a web-based national guide.

Methods: The study was based on eight remote, online focus groups, using Skype for Business. A qualitative content analysis was performed.

Results: The analysis generated three categories: adapt to a local context, transition challenges and led by strong incentives. There were eight subcategories. In the latent analysis, the theme 'Being a facilitator: a complex role' was formed to express the child health-care coordinators' experiences.

Conclusions: Facilitating a national guideline or decision support in a local context is a complex task that requires an advocating and mediating role. For successful implementation, guidelines and decision support, such as a web-based guide and the new child health-care programme, must match professional consensus and needs and be seen as relevant by all. Participation in the development and a strong bottom-up approach was important, making the web-based guide and the programme relevant to whom it is intended to serve, and for successful implementation. The study contributes valuable knowledge when planning to implement a national web-based decision support and policy programme in a local health-care context.
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http://dx.doi.org/10.1177/1403494817744119DOI Listing
February 2018

Periodontitis, tooth loss and cognitive functions among older adults.

Clin Oral Investig 2018 Jun 21;22(5):2103-2109. Epub 2017 Dec 21.

Blekinge Institute of Technology, Karlskrona, Sweden.

Objective: This study aims to evaluate the potential association between periodontitis, the number of teeth and cognitive functions in a cohort of older adults in Sweden.

Material And Methods: In total, 775 individuals from 60 to 99 years of age were selected for the study. A clinical and radiographic examination was performed. The number of teeth and prevalence of periodontal pockets and bone loss was calculated and categorised. Cognitive functions were assessed using the Mini-Mental State Examination (MMSE) and clock test. The education level was obtained from a questionnaire. Data were analysed using chi-square tests and multivariate logistic regression.

Results: Age and gender were associated with the prevalence of bone loss. Age and education were associated with lower number of teeth. Gender was also associated with the presence of pockets. The multivariate logistic regression analysis demonstrated a statistically significant association between prevalence of bone loss, the number of teeth and the outcome on MMSE test. This association remained even after adjustment for age, education and gender. Tooth loss was also associated with lower outcome on clock test. Presence of periodontal pockets ≥ 5 mm was not associated with cognitive test outcome.

Conclusions: A history of periodontitis and tooth loss may be of importance for cognitive functions among older adults.

Clinical Relevance: Diseases with and inflammatory profile may have an impact on cognitive decline.
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http://dx.doi.org/10.1007/s00784-017-2307-8DOI Listing
June 2018

Better platelet function, less fibrinolysis and less hemolysis in re-transfused residual pump blood with the Ringer's chase technique - a randomized pilot study.

Perfusion 2018 04 27;33(3):185-193. Epub 2017 Sep 27.

6 Department of Cardio-Thoracic and Vascular Surgery and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.

Introduction: Residual pump blood from the cardiopulmonary bypass (CPB) circuit is often collected into an infusion bag (IB) and re-transfused. An alternative is to chase the residual blood into the circulation through the arterial cannula with Ringer's acetate. Our aim was to assess possible differences in hemostatic blood quality between these two techniques.

Methods: Forty adult patients undergoing elective coronary artery bypass graft surgery with CPB were randomized to receive the residual pump blood by either an IB or through the Ringer's chase (RC) technique. Platelet activation and function (impedance aggregometry), coagulation and hemolysis variables were assessed in the re-transfused blood and in the patients before, during and after surgery. Results are presented as median (25-75 quartiles).

Results: Total hemoglobin and platelet levels in the re-transfused blood were comparable with the two methods, as were soluble platelet activation markers P-selectin and soluble glycoprotein VI (GPVI). Platelet aggregation (U) in the IB blood was significantly lower compared to the RC blood, with the agonists adenosine diphosphate (ADP) 24 (10-32) vs 46 (33-65), p<0.01, thrombin receptor activating peptide (TRAP) 50 (29-73) vs 69 (51-92), p=0.04 and collagen 24 (17-28) vs 34 (26-59), p<0.01. The IB blood had higher amounts of free hemoglobin (mg/L) (1086 (891-1717) vs 591(517-646), p<0.01) and D-dimer 0.60 (0.33-0.98) vs 0.3 (0.3-0.48), p<0.01. Other coagulation variables showed no difference between the groups.

Conclusions: The handling of blood after CPB increases hemolysis, impairs platelet function and activates coagulation and fibrinolysis. The RC technique preserved the blood better than the commonly used IB technique.
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http://dx.doi.org/10.1177/0267659117733891DOI Listing
April 2018

The effect of radiotherapy on fat content and fatty acids in myxoid liposarcomas quantified by MRI.

Magn Reson Imaging 2017 11 8;43:37-41. Epub 2017 Jul 8.

Department of Medical Radiation Physics, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.

Background: Myxoid liposarcomas are highly radiosensitive. Consequently radiotherapy is often used pre-operatively to reduce tumor volume and lessen the post-operative deficit. In soft-tissue sarcomas therapy response is mainly evaluated using magnetic resonance imaging (MRI) and the fundamental criterion for a positive response is decreased tumor size. In myxoid liposarcomas an increased fat content is also known to occur as a response to radiotherapy.

Objective: To highlight the difficulties of MRI for therapy response evaluation in irradiated myxoid liposarcomas, by using MRI Dixon techniques enabling objective quantification of proton density fat fraction (%) and the number of double bonds (ndb; unsaturation degree) of fatty acids. Secondly, to compare quantitative fat fraction measurements versus visual grading of fat content on T1-weighted images.

Case Descriptions: Prior to surgery, two patients with myxoid liposarcoma were treated with 50Gy. Following radiotherapy, both tumors on MRI showed reduced size, elevated fat fraction and transformed fat fraction histograms with diverse changes of ndb, while histopathological specimens showed discordant treatment effects; one case having good response and the other having poor response.

Conclusions: A decrease in tumor size and increase in fat content on MRI cannot be interpreted as positive therapy response in radiotherapy of myxoid liposarcomas. Our data also give further supporting evidence that differentiation and maturation of tumor cells is the cause for the lipoma-like areas seen after radiotherapy. Finally, quantitative MRI Dixon techniques are preferable to visual grading for estimating the fat content in lipomatous tumors.
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http://dx.doi.org/10.1016/j.mri.2017.07.005DOI Listing
November 2017

Machine learning and microsimulation techniques on the prognosis of dementia: A systematic literature review.

PLoS One 2017 29;12(6):e0179804. Epub 2017 Jun 29.

Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden.

Background: Dementia is a complex disorder characterized by poor outcomes for the patients and high costs of care. After decades of research little is known about its mechanisms. Having prognostic estimates about dementia can help researchers, patients and public entities in dealing with this disorder. Thus, health data, machine learning and microsimulation techniques could be employed in developing prognostic estimates for dementia.

Objective: The goal of this paper is to present evidence on the state of the art of studies investigating and the prognosis of dementia using machine learning and microsimulation techniques.

Method: To achieve our goal we carried out a systematic literature review, in which three large databases-Pubmed, Socups and Web of Science were searched to select studies that employed machine learning or microsimulation techniques for the prognosis of dementia. A single backward snowballing was done to identify further studies. A quality checklist was also employed to assess the quality of the evidence presented by the selected studies, and low quality studies were removed. Finally, data from the final set of studies were extracted in summary tables.

Results: In total 37 papers were included. The data summary results showed that the current research is focused on the investigation of the patients with mild cognitive impairment that will evolve to Alzheimer's disease, using machine learning techniques. Microsimulation studies were concerned with cost estimation and had a populational focus. Neuroimaging was the most commonly used variable.

Conclusions: Prediction of conversion from MCI to AD is the dominant theme in the selected studies. Most studies used ML techniques on Neuroimaging data. Only a few data sources have been recruited by most studies and the ADNI database is the one most commonly used. Only two studies have investigated the prediction of epidemiological aspects of Dementia using either ML or MS techniques. Finally, care should be taken when interpreting the reported accuracy of ML techniques, given studies' different contexts.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0179804PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5491044PMC
September 2017

Experiences of Older Adults With Mobile Phone Text Messaging as Reminders of Home Exercises After Specialized Manual Therapy for Recurrent Low Back Pain: A Qualitative Study.

JMIR Mhealth Uhealth 2017 Mar 30;5(3):e39. Epub 2017 Mar 30.

Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden.

Background: Clinical experience of manual therapy for musculoskeletal pain is that patients often suffer from recurrent pain and disorders, but that they do not continue to perform their physical home exercises when they are free from symptoms. The chance of positive long-term effects of manual therapy would probably increase if patients were reminded that they are to continue to perform their exercises. Mobile phone text messaging (short messaging service, SMS) is increasingly used as an innovative intervention to remind patient to exercise. However, there are only a few studies on such interventions in the field of low back pain (LBP). Qualitative studies of patients' experiences of receiving text messages as reminders of home exercises after manual treatment for recurrent LBP have to the best of our knowledge never been published.

Objectives: The aim of this study was to explore older persons' common experiences of receiving reminders of home exercises through mobile phone text messaging after specialized manual therapy for recurrent LBP.

Methods: A total of 7 men and 8 women (67-86 years), who had sought specialized manual therapy (Naprapathic manual therapy) for recurrent LBP were included in the study. Individual one-way text messages as reminders of home exercises (to be performed on a daily basis) were sent to each patient every third day for 3 weeks, then once a week for another 2 weeks. Semistructured interviews with 2 broad, open-ended questions were held and data were analyzed with systematic text condensation, based on Giorgi's principles of psychological phenomenological analysis.

Results: The participants appreciated the messages, which were perceived as timely and usable, and also stimulated memorizing. The messages made the participants reflect on the aim of the exercise, value of being reminded, and on their improvement in pain. During the interviews, the participants created their own routines for continued adherence to the exercises.

Conclusions: It seems plausible that mobile phone text messaging may serve as a useful tool for patient empowerment with regard to recurrent LBP in older persons. Further studies are needed to explore whether future compliance with the exercises will be as large if the participants are not being interviewed.
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http://dx.doi.org/10.2196/mhealth.7184DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5391433PMC
March 2017

Multi-scale graph-cut algorithm for efficient water-fat separation.

Magn Reson Med 2017 09 6;78(3):941-949. Epub 2016 Oct 6.

Department of Radiology, Uppsala University Hospital, Uppsala, Sweden.

Purpose: To improve the accuracy and robustness to noise in water-fat separation by unifying the multiscale and graph cut based approaches to B -correction.

Methods: A previously proposed water-fat separation algorithm that corrects for B field inhomogeneity in 3D by a single quadratic pseudo-Boolean optimization (QPBO) graph cut was incorporated into a multi-scale framework, where field map solutions are propagated from coarse to fine scales for voxels that are not resolved by the graph cut. The accuracy of the single-scale and multi-scale QPBO algorithms was evaluated against benchmark reference datasets. The robustness to noise was evaluated by adding noise to the input data prior to water-fat separation.

Results: Both algorithms achieved the highest accuracy when compared with seven previously published methods, while computation times were acceptable for implementation in clinical routine. The multi-scale algorithm was more robust to noise than the single-scale algorithm, while causing only a small increase (+10%) of the reconstruction time.

Conclusion: The proposed 3D multi-scale QPBO algorithm offers accurate water-fat separation, robustness to noise, and fast reconstruction. The software implementation is freely available to the research community. Magn Reson Med 78:941-949, 2017. © 2016 International Society for Magnetic Resonance in Medicine.
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http://dx.doi.org/10.1002/mrm.26479DOI Listing
September 2017