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SPARK: an mHealth intervention for self-management and treatment of gestational diabetes mellitus in Sweden - protocol for a randomised controlled trial
No full textIntroduction Gestational diabetes mellitus (GDM) is increasingly becoming a serious public health challenge. Innovative, effective and scalable lifestyle interventions to support women with GDM to manage their condition and prevent adverse obstetric and neonatal outcomes as well as later morbidity are required. This study aims to evaluate whether a novel, multilingual and scalable mobile health (mHealth) intervention (SPARK; SmartPhone App for gestational diabetes patients suppoRting Key lifestyle behaviours and glucose control) can improve self-management and treatment of GDM and prevent adverse maternal and offspring outcomes.Methods/analyses SPARK is a multicentre two-arm randomised controlled trial recruiting women diagnosed with GDM in south-eastern Sweden. A total of 412 women will be randomised to either standard care (control) or the SPARK intervention. The SPARK online platform (accessed through a mobile app) provides a behaviour change programme for healthy eating, physical activity and glycaemic control. To increase reach, SPARK is available in Swedish, English, Arabic and Somali. SPARK also comes with a clinician portal where healthcare professionals monitor and intervene when glycaemic control is unsatisfactory (above certain cut-offs). Primary outcomes are glycaemic control that is, time in range and HbA1c, while diet, physical activity (ActiGraph), gestational weight gain, metabolic and inflammatory biomarkers in weeks 37-38, adherence to protocol for daily glucose sampling, as well as adverse obstetric and neonatal outcomes are secondary outcomes. Secondary outcomes also include cardiometabolic risk evaluation, physical activity and healthy eating behaviours 1 year postpartum. A health economic evaluation of SPARK vs standard care will also be conducted.Ethics and dissemination This study has been approved by the Swedish Ethical Review Authority (2021-06627-01; 2022-03842-02; 2023-05911-02). Results will be disseminated through scientific papers in peer-reviewed journals, posts in traditional and social media, and presentations at scientific and healthcare professionals' conferences.Trial registration number This trial was registered at the ClinicalTrials.gov register platform (ID NCT05348863) 27 April 2022.Funding Agencies|Swedish Research Council [2021- 03093]; Swedish Research Council for Health, Working Life and Welfare [2018- 01410]; FORSS [968482]; ALF Grants Region Ostergoetland [974949, 994518]; Diabetesfonden [2021- 636]; Strategic Research Area Health Care Science (SFO-V) Karolinska Institutet; Centre of Research Excellence in Translating the Early Prevention of Obesity in Childhood [GNT2006999]</p
Holistic approaches in systemic lupus erythematosus: do physicians avoid addressing difficult-to-treat but highly relevant symptoms?
No full textDespite advancements in the management of systemic lupus erythematosus (SLE), patients experience poor health-related quality of life (hrQoL) and premature death due to disease severity and treatment side effects. Achieving remission offers substantial benefits, including improved hrQoL and reduced mortality, yet the complexity of SLE, with its diverse underlying immune mechanisms and clinical manifestations, hampers progress. Involvement of the central nervous system with symptoms like fatigue, pain and brain fog often goes unaddressed due to limited evidence-based guidance and measurement tools. This neglect reflects gaps in training, discomfort in addressing untreatable symptoms and an overemphasis on evidence-based medicine, compromising holistic care. Recognising patient-reported outcomes has shifted SLE care towards a more patient-centred model, addressing hrQoL and aligning treatment goals. Embracing this approach and prioritising symptom management, even when a definitive cure is lacking, ensures compassionate, comprehensive care that improves adherence, satisfaction and the overall lived experience of patients with SLE.Funding Agencies|Swedish Rheumatism Association [R- 995882]</p
Nonlinear modelling of transient tyre dynamics
No full textIn this paper, a modern and refined formulation of the nonlinear full contact patch tyre model is developed and analysed. In particular, the representation introduced in the present work, formulated in terms of hyperbolic partial differential equations (PDEs) with boundary terms, considers explicitly the closed-loop dynamics between the tread particles travelling inside the contact patch and the compliance of the tyre carcass. A linearised version of the model-renamed linearised full contact patch-is also derived. In particular, the solution to governing PDEs of the linearised formulation is provided in closed form, and its regularity is discussed within different functional settings. A rigorous stability analysis of the linearised full contact patch model is also performed, revealing that the latter is exponentially stable owing to the assumption of a diagonal stiffness matrix for the tyre carcass. Finally, the transient behaviour predicted by the linearised version of the model is validated against the full nonlinear formulation for different operating conditions of the tyre, providing important indications about its domain of applicability.Funding Agencies|Linkoping University; FASTEST - Swedish Research Council [2023-06511]</p
Developing Red and Near-Infrared Delayed Fluorescence Emission in Nitrogen-Substituted Donor-Acceptor Polycyclic Hydrocarbon OLED Emitters: A Theoretical Study
No full textNitrogen substitutions have shown a great impact for the development of thermally activated delayed fluorescence (TADF)-based organic light-emitting diode (OLED) materials. In particular, much focus has been devoted to nitrogen-substituted polycyclic aromatic hydrocarbons (PAHs) for TADF emitters. In this context, we provide here a molecular design approach for symmetric nitrogen substitutions in fused benzene ring PAHs based on the dibenzo[a,c]picene (DBP) molecule. We designed possible donor-acceptor (D-A) compounds with dimethylcarbazole (DMCz) and dimethyldiphenylamine (DMDPA) donors and studied the structure and photophysics of the designed D-A compounds. The twisted and extended D-A-type PAH emitters demonstrate red and near-infrared (NIR) TADF emission. Nitrogen substitutions lead to significant LUMO stabilization and reduced HOMO-LUMO energy gaps as well. Additionally, we computed significantly smaller singlet-triplet energy splittings (Delta E ST) in comparison to non-nitrogen-substituted compounds. The investigated ortho-linked D-A compounds show relatively large donor-acceptor twisting separation and small Delta E ST compared to their para-linked counterparts. For higher number nitrogen (4N)-substituted emitters, we predict small adiabatic Delta E ST (Delta E ST adia) in the range 0.01-0.13 eV, and with the tert-butylated donors, we even obtained Delta E ST adia values as small as 0.007 eV. Computed spin-orbit coupling (SOC) for the T1 triplet state on the order of 0.12-2.28 cm-1 suggests significant repopulation of singlet charge transfer (1CT) excitons from the triplet CT and locally excited (3CT+LE) states. Importantly, the small Delta E ST adia and large SOC values induce a reverse intersystem crossing (RISC) rate as high as 1 x 106 s-1, which will cause red and NIR delayed fluorescence in the 4N-substituted D-A emitters. Notably, we predict red TADF emission for the para-linked compound B4 at 670 nm and the ortho-linked compound D4 at 713 nm and delayed NIR emission at 987 and 1217 nm for the ortho-linked compounds D3 and E3, respectively.Funding Agencies|J. Gustaf Richert Stiftelse [NAISS 2023/3-40, NAISS 2023/5-77, NAISS 2024/5-73]; Olle Engkvists Stiftelse (Sweden) [212-0136]; Richert Foundation</p
Modulation of the modulated magnetic structure of an Ho i-MAX phase described by a magnetic (3+2)-dimensional superspace group
No full textThe magnetic structures of the Ho-based i-MAX phase (Mo2/3Ho1/3)(2)GaC were studied with neutron powder diffraction at low temperature. (Mo2/3Ho1/3)(2)GaC crystallizes in the orthorhombic space group Cmcm. The material undergoes two successive antiferromagnetic transitions at T-N1 = 10 K and T-N2 = 7.2 K. The magnetic structure below T-N1 is incommensurate with the propagation vector k(1) = (0, k(y), 0) with k(y) = 0.696 (1) at 9 K. For the analysis of the magnetic structure, a group-theoretical approach based on the space group of the nuclear structure and its subgroups was employed. A model in the (3+1)D superspace group Cmcm.1'(0 beta 0)s0ss yielded the most accurate results in neutron powder diffraction refinements. The determined structure was found to be an incommensurate longitudinal amplitude-modulated magnetic structure. Below T-N2, additional magnetic satellites develop. They could be indexed by a propagation vector k(2) = (tau(x), 0, 0) with the tau(x) value increasing below T-N2 until it stabilizes at approximately 3 K at 0.075. A magnetic structure determination considering two propagation vectors k(1) and k(2) was carried out using the superspace formalism by building the corresponding (3+2)D model. The determination was based on the observation that the additional magnetic peaks emerge exclusively in the vicinity of the incommensurate magnetic peaks with propagation vector k(1), and not in the vicinity of nuclear peaks. This indicates that only mixed-index reflections were observed, and not reflections purely related to k(2). The magnetic superspace group (MSSG) that was determined is Amma.1' (0,beta,0)00s0 (0,0,gamma)ss0s. The structure can be described as a longitudinal amplitude-modulated structure, which itself is amplitude-modulated in a perpendicular direction. This represents a very unusual case of a 2-k magnetic structure with no symmetry relation between the propagation vectors
Sealing Zone Failure Decreases the Long Term Durability of Endovascular Aneurysm Repair
No full textObjective: Endovascular aneurysm repair (EVAR) has a higher long term aneurysm related mortality rate compared with open surgery, mainly due to aneurysm rupture. Loss of stent graft to vessel apposition at the EVAR sealing zones is a potential cause of post-EVAR rupture. This study aimed to investigate sealing zone failure and its relationship with post-EVAR rupture. Methods: This was a retrospective structured review of pre- and post-operative computed tomography (CT) scans of 399 consecutive patients treated with standard bifurcated EVAR. The primary outcome was total loss of seal at last post-operative CT. Secondary outcomes were partial loss of seal, standard follow up detection, post-EVAR rupture, aneurysm sac development, and endoleaks. Results: During a median follow up of 5.3 years, total and partial loss of seal occurred in 85 (21.3%) and 78 (19.5%) patients, respectively. Initial mean sealing zone lengths were within current recommendations but decreased over time, mainly due to vessel dilatation. Mean proximal sealing length at the one month CT was 15.5 +/- 10.5 mm (95% confidence interval [CI] 12.6- 18.5 mm) in the group with total loss of seal, 14.3 +/- 6.9 mm (95% CI 12.2- 16.4 mm) with partial loss of seal, and 23.2 +/- 7.4 mm (95% CI 22.3- 24.0 mm) with preserved seal through follow up (p &lt; .001). Mean iliac sealing lengths were 22.4 +/- 12.1 mm (95% CI 18.9- 25.8 mm) if total loss and 21.8 +/- 10.0 mm (95% CI 19.6- 24.0 mm) if partial loss of seal vs. 34.7 +/- 12.4 mm (95% CI 33.8- 35.7 mm) if preserved seal. Larger vessel diameters were associated with loss of seal in both the proximal and distal sealing zones. During the study period, 13 post-EVAR ruptures occurred, all preceded by CT findings of total (n = 7) or partial (n = 6) loss of seal. Aneurysm sac expansion was seen in 40% of patients with total loss of seal, 18% with partial loss of seal, and 6.6% with preserved seal. Conclusion: Loss of seal after EVAR is frequent and associated with post-EVAR rupture. Increased recommended sealing zones lengths and focus on sealing zones in surveillance may reduce post-EVAR ruptures and aneurysm related death.Funding Agencies|Swedish Heart-Lung Foundation [20220476]; Swedish government; ALF [77190]; Goteborgs lakaresallskap [GLS-961782, GLS-986778]; Futurum, the academy for healthcare, Jonkoeping County [FUTURUM-963529]; FoU Region Norrbotten [NLL-995470]</p
Adsorption of organic contaminants of emerging concern using microalgae-derived hydrochars
No full textThis study explored the adsorption capacity of hydrochars derived from a strain of microalgae biomass native to northern Sweden for contaminants of emerging concern (CECs) such as caffeine, chloramphenicol, trimethoprim, carbamazepine, bisphenol A, diclofenac, and triclosan. The findings indicate that the surface functionality of the microalgae-derived hydrochars – a blend of alkane/alkene and aromatic structures, coupled with different oxygen-containing functional groups (hydroxyl, carboxyl, and lactone) – significantly influenced the adsorption of the contaminants. The alkane/alkene and aromatic structures increased with increasing hydrothermal treatment temperature, while the oxygen- and nitrogen-containing groups diminished. Bisphenol A and triclosan, which were the compounds with the highest distribution coefficients, displayed improved adsorption on the hydrochars. The study measured peak adsorption values for the hydrochars processed at 180 °C, which achieved adsorption levels of 25.8 mg g− 1 for bisphenol A and 58.8 mg g− 1 for triclosan. The hydrochars produced using lower carbonisation temperatures (180 and 220 °C) exhibited enhanced adsorption of positively charged molecules such as trimethoprim, which was attributed to the increased presence of negatively charged oxygen-containing functional groups. Contrastingly, negatively charged molecules such as diclofenac and chloramphenicol demonstrated either low adsorption (2.5 mg g− 1 for chloramphenicol on hydrochar prepared at 180 °C) or no adsorption (diclofenac) due to repulsion by the negatively charged functional groups on the surface of the hydrochars.Funding Agencies|Umea University; Vinnova [2017-03301]; Swedish Research Council for Environment, Agricultural Sciences and Spatial Planning (Formas) [2018-00532]</p
Aortic valve calcification across stages of dysglycemia in middle-aged individuals from the general population
No full textBackground Aortic valve calcification (AVC) is an underlying pathophysiological mechanism in aortic stenosis, which shares many risk factors with diabetes. However, the association between dysglycemia and early stages of AVC remains unclear. The aim was to examine the associations between stages of dysglycemia and signs of AVC among middle-aged individuals from the general population. Methods This was a cross-sectional study from the Swedish CArdioPulmonary bioImage Study (SCAPIS) randomly enrolling 30,154 middle-aged men and women from six study sites in Sweden between 2013 and 2018. Glycemic status was based on the World Health Organization criteria (fasting blood glucose and/or HbA1c) and questionnaire-based answers on previous diseases and categorized as normoglycemia, prediabetes, newly detected diabetes and known diabetes. AVC was assessed on cardiac computed tomography (CT) and defined as evident or not. Results Of 29,331 individuals with data on glycemic status and AVC available, mean age was 57.5 years and normoglycemia was present in 76%, prediabetes in 16%, newly detected diabetes in 3% and known diabetes in 5%. The prevalence of AVC increased progressively across glycemic categories, particularly in males (8%, 11%, 14% and 17%; P &lt; 0.01) compared to females (5%, 6%, 8% and 9%; P &lt; 0.01). There was an association with AVC already in the early stages of dysglycemia; prediabetes (OR 1.16, 95% CI 1.02-1.31), newly detected diabetes (1.34 [1.05-1.71]) and known diabetes (1.61 [1.34-1.93]) after adjusting for age, sex, smoking, study site, low density lipoprotein-cholesterol and hypertension. Conclusions In this large, contemporary, and randomly selected population of middle-aged individuals, prediabetes, newly detected diabetes and known diabetes were all associated with CT-detected AVC. Further studies are warranted to investigate if managing dysglycemia, even in its early stages, may help slow down AVC progression.Funding Agencies|Karolinska Institute; Swedish Heart-Lung Foundation [20210578, 20220524]; Knut and Alice Wallenberg Foundation; Swedish Research Council [2022-01472]; University of Gothenburg; Sahlgrenska University Hospital; Karolinska Institutet [2-116/2023]; Stockholm county council [FoUI-988371]; Linkoping University; University Hospital; Lund University; Skane University Hospital; Umea University; Uppsala University; Capio Sankt Goerans hospital; Swedish Society for Medical Research (SSMF) [SG-23-0142-B]; Swedish Society of Medicine (SLS) [987010]</p
Adaptation of dose-prescription for vestibular schwannoma radiosurgery taking body contouring method and heterogeneous material into account
No full textBackground: Majority of vestibular schwannoma (VS) patients have undergone gamma-knife radiosurgery (GKRS) with favorable results. Clinical evidence is derived from doses calculated with a type-a algorithm, which in this case assumes all material to be water. A type-b algorithm (Convolution algorithm [CA]) taking tissue heterogeneity into account is available. Historically, body contour is defined using a 16-point approximation, whereas modern softwares generate the body from Magnetic Resonance Imaging (MRI). The accuracy in dose-calculation algorithms (DCA) and contouring method (CM) will have a significant influence in the relation between clinical outcome and dosimetric data. The objective was to investigate the impact of DCA and CMs on dose distribution while preserving treatment conditions. Methods: Treatment plans for 16 VS patients were recalculated in terms of DCA and CM. The difference in the dose covering 99% of the VS (DVS99%) depending on CM and DCA was estimated. The difference in DVS99% was used to adopt the prescription of new CA-based plans. CA-plans were recalculated to TMR10 to evaluate clinical treatability, as clinical evidence is derived from TMR10-doses. Results: Both CM and DCA had a significant impact on the dose to VS and surrounding structures. CM altered the doses homogenously by 2.1-3.3%, whereas DCA heterogeneously by 5.0-10.7%. An increase of 9.1[8.1, 10.0]% was found for DVS99% and the CA-plans recalculated into TMR10 resulted in clinically treatable plans. Interpretation: We conclude that transferring to more modern algorithms that take tissue heterogeneity into account heterogeneously alter dose distributions. This work establishes a safe pathway to adopt prescription dose for VS while preserving clinical treatability
Vapor phase polymerization of thieno[3,4-b]thiophene-tosylate and its application for dynamic structural coloration
No full textConducting polymers are important for areas including energy storage, displays, sensors, nanooptics, and bioelectronics. Vapor phase polymerization (VPP) of conducting polymers can provide highly conductive homogenous thin films but was so far reported only for a limited number of materials. Here, we report VPP deposition of the low bandgap conducting polymer poly(thieno[3,4-b]thiophene):tosylate (pT34bT:Tos) and propose an application for dynamic structural coloration. Optimized films show high electrical conductivity of around 750 S cm-1, manifested optically as wide infrared absorption extending beyond 2000 nm. Electrochemical reduction reveals a neutral low bandgap peak around 1030 nm, making pT34bT comparably transparent also in its neutral state as opposed to other common conducting polymers. Moreover, the VPP process allows to spatially control the polymer properties and thickness via a UV exposure step before polymerization. We exploit this technique to create structurally colored images using the polymer as cavity spacer layer, locally varying its thickness and optical properties. We finally demonstrate dynamic tunability of structural colors based on the application of different potentials in an electrochemical cell.Funding Agencies|Knut and Alice Wallenberg Foundation [2018.0058, 2019.0163, KAW 2021.0313]; Swedish Research Council [2020-00287]; European Research Council [101086683]; Swedish Government Strategic Research Area in Materials Science on Functional Materials at Linkoeping University [2009 00971]</p