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Utveckling av ett digitalt verktyg för systematisk optimering av angiografi
No full textDigital Imaging and Communications in Medicine (DICOM) is the global standard for managing electronic medical information regarding patients, medical images and dosimetric data. However, DICOM is limited. It does not include information on radiation from examinations. Radiation Dose Structured Reports (RDSR) are needed, they are a complement to the DICOM standard and contain a complete list and sum of all patient radiation exposures, per examination, medical imaging, and interventional procedure. This thesis study has the goal of creating a non-propietary software-based toolbox capable of analysing DICOM and RDSR data from SIEMENS angiography systems. The project objectives were summarised into five parts: Data collection; Development of Python script to load DICOM-RDSR files; Development of analytical toolbox to work on DICOM-RDSR files; Propose a design for a standardised report template and discussion with clinical staff to verify that the work is clinically reliable. Example data were collected over the last three years from an angiography system, ARTIS Pheno, SIEMENS Healthineers, ANG45 interventional suit located in the interventional radiology department in Huddinge. The data collected contained 96 276 radiation exposures. A Python script to convert DICOM-RDSR files to .json or .csv, for easier file management, was developed in unison with a Python script for analysis of converted data. A standardised report template was designed in Excel to visualise and present the results of the analytical script to clinical staff. The developed toolbox was then applied to several use cases. Among these; the first involved comparing the practices of two interventional angiography departments in terms of how they collimated the radiation field during procedures to minimise patient dose; the second use case was to map the dose-area-product contribution per acquisition protocol for one angiography department. The analytical toolbox, called RDSR-Analytic, proved to be both reliable and useful in calculating the cumulative dose-area-product per acquisition protocol. For example, we identified that during the 2021 - 2025 period the acquisition protocol called DCT Mjukvävnad CARE 4s was used 122 times for the ANG45 laboratory and contributed with 38% of the cumulative dose-area product of the laboratory. In conclusion, the developed software has successfully met the project objectives and enhances the current state of analytics by complementing existing analytical tools with a novel, modular software package.Digital Imaging and Communications in Medicine (DICOM) är den globala standarden för hantering av elektronisk medicinsk information avseende patienter, medicinska bilder och dosimetriska data. DICOM har emellertid begränsningar, då standarden inte inkluderar information om stråldoser från en undersökning. För detta ändamål används Radiation Dose Structured Reports (RDSR), som är ett tillägg till DICOM-standarden och innehåller en komplett lista samt summering av alla patienters strålningsexponeringar, per undersökning, medicinsk avbildning och interventionell procedur. Detta examensarbete har som mål att utveckla en icke-proprietär mjukvarubaserad verktygslåda för analys av DICOM- och RDSR-data från SIEMENS angiografisystem. Projektmålen sammanfattades i fem delar: Datainsamling; Utveckling av ett Python-skript för att läsa in DICOM-RDSR-filer; Utveckling av en analytisk verktygslåda för bearbetning av DICOM-RDSR-filer; Förslag på en design för en standardiserad rapportmall samt genom diskussion med klinisk personal verifiera att arbetet är kliniskt tillförlitligt. Exempeldata samlades in under de senaste tre åren från ett angiografisystem, ARTIS Pheno, SIEMENS Healthineers, ANG45 interventionssal vid den interventionella radiologiavdelningen i Huddinge. Den insamlade datan omfattade 96 276 strålningsexponeringar. Ett Python-skript för att konvertera DICOM-RDSR-filer till .json eller .csv, för att underlätta filhantering, utvecklades parallellt med ett analysverktyg för bearbetning av den konverterade datan. En standardiserad rapportmall utformades i Excel för att visualisera och presentera resultaten från det analytiska skriptet för klinisk personal. Verktygslådan tillämpades därefter på olika användningsfall. Bland dessa var det första att jämföra hur två olika interventionella angiografiavdelningar arbetar med att anpassa strålfältets storlek under en undersökning i syfte att minimera patientdosen; Det andra för att kartlägga dos-areaproduktens bidrag per insamlingsprotokoll för en angiografiavdelning. Den analytiska verktygslådan, benämnd RDSR-Analytic, visade sig vara både tillförlitlig och användbar för beräkning av kumulativ dos-areaprodukt per insamlingsprotokoll. Exempelvis identifierades att under perioden 2021 - 2025 användes insamlingsprotokollet DCT Mjukvävnad CARE 4s 122 gånger i ANG45-labbet, vilket stod för 38% av labbets kumulativa dos-areaprodukten. Sammanfattningsvis har den utvecklade mjukvaran framgångsrikt uppfyllt projektmålen och stärker det aktuella analyslandskapet genom att komplettera befintliga analytiska verktyg med ett nytt, modulärt mjukvarupaket
LLMs in Power Grid Administration : GDPR-Compliant Personal Data Assessment
No full textAccording to GDPR articles 7, 17, and 25, companies are required by law to be transparent with personal information stored in their database. Organizations that allow users to save unstructured data struggle to comply with GDPR requirements. Especially when personal information is saved and needs to be managed. This becomes a time consuming task when managing larger sets of data. This study evaluated LLMs in alocal environment to help system administrators comply with GDPR requirements on Swedish unstructured data from Metria’s Markkoll containing personal information. Previous studies utilize powerful hardware and mixed technologies. This study focused on smaller open-source LLMs in a local environment to provide a cost-effective alternative. To answer the specified problems, the study conducted a controlled experiment to benchmark models straight out of the box and a comparative user evaluation to test the system’s capability to help users comply with GDPR requirements. The two best Gemma3:12B and Llama3.1:8B scored a F1-score of 0.722 and 0.648, respectively. The users displayed positive results when using Llama3.1:8B in the comparative user evaluation and thought the system reduced the workload significantly. The study concludes that although current models are not accurate enough to fully automate the identification of personal information straight out of the box, integrating local LLMs as an assistive tool shows strong potential and provides value inreal-world GDPR compliance
Investigating the relationship of plasma microRNAs and colorectal cancer risk using genetic evidence
No full textBackground: MicroRNAs (miRNAs) are short, single-stranded RNAs that function as post-transcriptional regulators of gene expression. Although circulating miRNAs have been linked to carcinogenesis, they have not yet been systematically investigated in relation to risk of colorectal cancer (CRC). Methods: We used Mendelian randomization (MR) and colocalization analyses to investigate the association of genetically predicted plasma miRNA concentrations (2083 miRNAs in 710 individuals) with risk of CRC (58,221 cases and 67,694 controls). For miRNAs associated with CRC risk, we also investigated their association with circulating plasma proteins (4907 proteins in 35,559 participants), bidirectionally, using MR. We performed pathway enrichment analysis (PEA) to explore downstream molecular pathways. Results: Associations of five miRNAs with CRC were found in MR and supported in colocalization analyses. Specifically, miR-146a-5p, miR-21-5p, and miR-4707-3p were positively, and miR-1908-5p and miR-6810-3p were inversely associated with CRC risk. Several protein associations were found for these miRNAs (range of proteins with P < 0.05: 78–796; 211 with FDR < 5%), and 11 pathways were identified in PEA, including regulation of Erb-B2 receptor tyrosine kinase 4 (miR-6810-3p) and insulin-like growth factor pathways (miR-1908-5p). Conclusions: Our results support a potential implication of miR-146a-5p, miR-21-5p, miR-4707-3p, miR-1908-5p, and miR-6810-3p to CRC risk. However, their downstream effects should be elucidated before they can be utilized as preventive targets
Immunogenicity and safety of a quadrivalent meningococcal conjugate vaccine (MenACYW-TT) administered with routine pediatric vaccines : a European randomized controlled trial
No full textIntroduction: The immunogenicity and safety of MenACYW-TT (MenQuadfi®) were compared to another quadrivalent meningococcal conjugate vaccine, MCV4-TT (Nimenrix®), when administered in infants alongside routine childhood vaccines in Europe. Methods: One set of healthy infants was randomized 1:1 to receive MenACYW-TT (group 1; n = 714) or MCV4-TT (group 2; n = 726) at age 2, 4, and 12-18 months (2 + 1 regimen) concomitantly with routine vaccines (including 10-valent pneumococcal conjugate vaccine). Another set was randomized 1:1 to receive MenACYW-TT in a 2 + 1 regimen (group 3; n = 112) or a 3 + 1 regimen at age 2, 4, 6, and 12-18 months (group 4; n = 108) concomitantly with routine vaccines (including 13-valent pneumococcal conjugate vaccine). Immune responses against meningococcal serogroups A, C, W, and Y were measured by serum bactericidal assay using human complement (hSBA). Non-inferiority of MenACYW-TT versus MCV4-TT was based on hSBA geometric mean titers (GMTs) 30 days post-booster (dose 3; primary endpoint) and rates of seroprotection 30 days post-dose 2 (secondary endpoint) against all vaccine meningococcal serogroups. Immune responses to co-administered vaccines and safety were also assessed. Post hoc, non-inferiority of MenACYW-TT was also assessed based on seroresponse rates 30 days post-booster. Results: Non-inferiority of MenACYW-TT versus MCV4-TT, based on GMTs post-booster, was demonstrated for serogroups C, W, and Y but not for A. GMTs against serogroups C, W, and Y were 1.5- to 4.5-fold higher with MenACYW-TT than MCV4-TT; those against serogroup A were marginally lower. Antibody responses in groups 3 and 4 against all serogroups were similar to group 1. Non-inferiority of MenACYW-TT based on seroresponse rates post-booster against all serogroups was demonstrated post hoc. No interference with concomitant routine vaccines nor safety concerns were identified. Conclusions: Consideration of all immunogenicity and safety data generated in this study supports the incorporation of MenACYW-TT into the routine childhood vaccination schedule as a 2 + 1 regimen starting at age 6 weeks. ClinicalTrials.gov identifier: NCT03547271
Plant traits and associated ecological data from global change experiments and climate gradients in Norway
No full textPlant functional trait-based approaches are powerful tools to assess the consequences of global environmental changes for plant ecophysiology, population and community ecology, ecosystem functioning, and landscape ecology. Here, we present data capturing these ecological dimensions from grazing, nitrogen addition, and warming experiments conducted along a 821 m a.s.l. elevation gradient and from a climate warming experiment conducted across a 3,200 mm precipitation gradient in boreal and alpine grasslands in Vestland County, western Norway. From these systems we collected 28,762 plant and leaf functional trait measurements from 76 vascular plant species, 88 leaf assimilation-temperature responses, 577 leaf handheld hyperspectral readings, 2.26 billion leaf temperature measurements, 3,696 ecosystem CO2 flux measurements, and 10.69 ha of multispectral (10-band) and RGB cm-resolution imagery from 4,648 individual images obtained from airborne sensors. These data augment existing longer-term data on local climate, soils, plant populations, plant community composition, and ecosystem functioning from within the same experiments and study systems and from similar systems in other mountain regions globally
Decoding nucleoside supplementation : how thymidine outperforms ribonucleosides in accelerating mammalian replication forks
No full textDisruptions in deoxynucleoside triphosphate (dNTP) supply impair DNA replication and lead to genomic instability. While exogenous ribonucleosides (rNuc) have been suggested to alleviate replication stress by increasing dNTP levels, their precise metabolic effects remain unclear. Here, we show that rNuc supplementation primarily elevates CTP and UTP levels, with only modest increases in dCTP, and has minimal impact on replication fork speed across multiple mammalian cell lines. In contrast, thymidine (dThd), either alone or in combination with rNuc-as in EmbryoMax Nucleosides-significantly increases dTTP and dGTP levels, leading to accelerated replication fork progression. Notably, dThd, rather than rNuc, drives fork acceleration and counteracts fork slowdown caused by elevated dUTP, consistent with primer extension assays showing that dUTP transiently inhibits Pol ϵ-mediated DNA synthesis at template adenines. These results clarify the distinct roles of nucleosides in nucleotide metabolism, providing a mechanistic basis for how dThd promotes fork progression and preserves genomic stability
Developing and validating the co-creation rainbow framework for intrinsic evaluation of methods : a health CASCADE structured review of models representing co-creation principles
No full textBackground: The growing interest in co-creation for public health innovation highlights the need for systematic approaches to stakeholder engagement. Despite its potential, co-creation faces substantial challenges, including unresolved power dynamics, poor reporting of methods and the absence of a universally agreed-upon definition. Current research reveals substantial fragmentation in co-creation literature, with limited guidance on method selection and principle alignment. This study addresses these gaps by developing a framework for systematically evaluating method alignment with key co-creation principles, offering a structured approach to fostering more effective and adaptive collaborative processes. Methods: Using a structured review approach based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, image-based models representing co-creation principles from academic and non-academic sources were identified and assessed. A framework was created through an iterative development process. The framework was subsequently validated by 12 geographically diverse co-creation researchers using a closed card sort method, ensuring its robustness and applicability across different research contexts. Results: The Co-Creation Rainbow Framework was developed by integrating key features from 20 included models, creating an individual-to-collective continuum with five sections (informing, understanding, stimulating, collaborating and collective decision-making), and three themes (engage, participate and empower). Successfully mapping 416 methods to the framework demonstrated its robust capability to differentiate and categorize co-creation methods, and reveaed nuanced variations in methodological strategies used by researchers and practitioners across different contexts. Conclusions: The Co-Creation Rainbow Framework addresses the disconnect between theoretical and practical co-creation approaches through operationalising co-creation principles. By challenging traditional linear models and acknowledging the diversity of co-creation methods, the framework provides a nuanced and adaptable tool for systematically evaluating method alignment. The framework offers researchers and practitioners a robust tool for meaningful collaborative innovation, ultimately opening new pathways for collective problem-solving and knowledge generation
Intrasellärt tryck hos patienter med hypofystumör : koppling till syn- och endokrina funktioner, komplikationer och prognos efter kirurgi
No full textBackground: The pathophysiological mechanisms behind the development, symptoms, operative results, and complications of pituitary tumors are not fully understood. A much-neglected factor is the pressure profile in the sellaturcica (intrasellar pressure) which harbors the pituitary gland. Hypothesis and Aim: The aim of this thesis is to explore the pathophysiological mechanisms involved in pituitary tumordisease, with special focus on the role of intrasellar pressure (ISP). The underlying hypothesis is that ISP is associated with symptoms and prognosis after pituitary tumor surgery. Method: The thesis includes four studies of different aspects of pituitary tumor disease, and their associations with ISP. These were single-center, retrospective studies based on the same well-characterized and consecutively collected population, albeit with some differences in exclusion criteria. All subjects were operated on for a pituitary tumor at the Neurosurgical Department, Umeå University Hospital, in 2009–2015, and had their ISP measured intraoperatively. Data on patient and tumor characteristics, symptoms, complications, and recovery were collected from medical files from the preoperative investigation and postoperative follow-up (3 months). Results: In Paper I, we analyzed the impact of tumor anatomy and growth pattern on ISP. There was a positive correlation between ISP and tumor volume. Coronal tumor diameter (i.e., tumor width) showed stronger correlation with increased ISP than tumor growth in the other planes. Invasive tumors in the parasellar direction (Knosp III–IV) showed higher mean ISP than non-invasively growing tumors. In Paper II, we evaluated hormonal disturbances pre- and postoperatively in relation to ISP. ISP was positively associated with the risk of preoperative hyperprolactinemia (in non-prolactinoma tumors) and the risk of preoperative thyroidstimulating hormone insufficiency. No association between ISP and the risk of preoperative adrenocorticotropic hormone insufficiency was found. No correlations were found between ISP and the risk of postoperative hormonal insufficiency at 3months after surgery. In Paper III, the relations of ISP and tumor and patient characteristics to pre- and postoperative visual acuity, visual field,and cranial nerve III, IV, and VI deficits were studied. High ISP and large tumor volume were associated with increased risk of postoperative visual acuity deficits after pituitary surgery. High age was a risk factor for postoperative visual field deficits and decreased the chance of visual acuity improvement after surgery. Large tumor volume, suprasellar tumor extension, and female sex were risk factors for preoperative visual acuity and visual field deficits. In Paper IV, the risk factors for intra- and postoperative complications in endoscopic transsphenoidal pituitary surgery(ETS) were explored. There was no substantial correlation between ISP and complications. Large tumor volume was a riskfactor for intraoperative complications, and low age a risk factor for postoperative cerebrospinal fluid leakage. Conclusions: ISP is elevated above expected normal levels in patients with a pituitary tumor. ISP is positively associated with tumor volume. Tumor growth in a parasellar direction gives rise to higher ISP than growth in other directions. High ISP is associated with a higher risk of preoperative hyperprolactinemia and hypopituitarism in the thyroid axis. These results harmonize with the “stalk compression theory.” ISP seems not to affect hormonal recovery at 3 months. Anassociation between ISP and postoperative visual acuity impairment was seen, however, ISP was not identified as an important risk factor for visual symptoms or outcome. ISP does not seem to be a significant risk factor for intra- orpostoperative complications in ETS. ISP is heterogeneously associated with tumor anatomy, symptoms, pathophysiology and surgical outcomes in pituitary tumor disease. This thesis provides no evidence supporting routine ISP measurement during pituitary surgery, unless ISP is the primary variable of interest in research.
Status and future prospect of deregistered woodland key habitats in Northwestern Sweden
No full textExtensive primary boreal forests within Europe are primarily located in Fennoscandia and northwestern Russia. These forests host numerous endemic and red-listed species but are rapidly being exploited and transformed to production forests that lack the habitat characteristics that are required for sustained biodiversity. Over the past 30 years, certain highly valuable areas within Swedish forests have been designated and registered as “woodland key habitats” (WKH) to be safeguarded from clear-cutting. However, despite their high conservation values, WKH lack proper legislative protection. Recently, many WKH were deregistered and thereby lost their potential protection against clear-cutting, jeopardizing biodiversity values in these forests. Moreover, the former way of classifying WKH has been criticized for being too lenient, making conventional forestry difficult. To assess the leniency of WKH registration and effect of WKH deregistration, we conducted a field inventory of WKH following a new inventory method proposed by the Swedish Forest Agency, featuring more stringent criteria for classification of WKH in north-western Sweden. The inventory was conducted in 9 still registered and 9 recently deregistered WKH to assess their conservation values. Our inventory results show that all 18 areas reach the criteria for WKH with the new method, despite higher, more stringent thresholds for conservation values. Hence, formerly registered WKH were not deregistered due to lower values. Moreover, analysis of recent harvest actions within deregistered WKH in Sweden showed that almost 1,200 hectares (~ 2%) of these areas were clear-cut or reported for clear-cutting 1–7 years post deregistration. As such, our results indicate that WKH contain high values, even using more stringent classification criteria, but also that deregistration of WKH does not consider these values and increases the risk of losing them to forest management. Given past and current declines in forest biodiversity, this is concerning, as conservation of areas containing high conservation values are needed, in order to preserve biodiversity in boreal forests
Autonomy in business process execution : why we need first-class abstractions for goals and normative frames
No full textWith the increased deployment of AI-based technologies—recently and most notably large language models—framing the autonomy of goal-oriented agents that enact business processes can be expected to be a key challenge. In this paper, we argue that addressing this challenge requires new formal foundations for process specifications. Traditional business process specifications focus on the how of business operations and treat neither goals nor norm-based constraints as first-class abstractions. Although goals play a central role in informal notions of business processes, formal definitions tend to treat them as implicit, embedded within procedural specifications that may only partially, and not explicitly, reflect normative boundaries. However, to maximize autonomy within a given normative frame, which expands upon the traditional idea of process models as operational frames, agents require formally specified goals, from which they can then synthesize their plans and actions, considering the normative frame as a set of deontic constraints. In this paper, we articulate this vision, highlight practical challenges, and propose action items for supporting its implementation