Linköping University

About: Linköping University is a education organization based out in Linköping, Sweden. It is known for research contribution in the topics: Population & Health care. The organization has 15671 authors who have published 50013 publications receiving 1542189 citations.

Neonatal end-of-life decision making: Physicians' attitudes and relationship with self-reported practices in 10 European countries.

Abstract: ContextThe ethical issues surrounding end-of-life decision making for infants with adverse prognoses are controversial. Little empirical evidence is available on the attitudes and values that underlie such decisions in different countries and cultures.ObjectiveTo explore the variability of neonatal physicians' attitudes among 10 European countries and the relationship between such attitudes and self-reported practice of end-of-life decisions.Design and SettingSurvey conducted during 1996-1997 in 10 European countries (France, Germany, Italy, the Netherlands, Spain, Sweden, the United Kingdom, Estonia, Hungary, and Lithuania).ParticipantsA total of 1391 physicians (response rate, 89%) regularly employed in 142 neonatal intensive care units (NICUs).Main Outcome MeasuresScores on an attitude scale, which measured views regarding absolute value of life (score of 0) vs value of quality of life (score of 10); self-report of having ever set limits to intensive neonatal interventions in cases of poor neurological prognosis.ResultsPhysicians more likely to agree with statements consistent with preserving life at any cost were from Hungary (mean attitude scores, 5.2 [95% confidence interval {CI}, 4.9-5.5]), Estonia (4.9 [95% CI, 4.3-5.5]), Lithuania (5.5 [95% CI, 4.8-6.1]), and Italy (5.7 [95% CI, 5.3-6.0]), while physicians more likely to agree with the idea that quality of life must be taken into account were from the United Kingdom (attitude scores, 7.4 [95% CI, 7.1-7.7]), the Netherlands (7.3 [95% CI, 7.1-7.5]), and Sweden (6.8 [95% CI, 6.4-7.3]). Other factors associated with having a pro–quality-of-life view were being female, having had no children, being Protestant or having no religious background, considering religion as not important, and working in an NICU with a high number of very low-birth-weight newborns. Physicians with scores reflecting a more quality-of-life view were more likely to report that in their practice, they had set limits to intensive interventions in cases of poor neurological prognosis, with an adjusted odds ratio of 1.5 (95% CI, 1.3-1.7) per unit change in attitude score.ConclusionsIn our study, physicians' likelihood of reporting setting limits to intensive neonatal interventions in cases of poor neurological prognosis is related to their attitudes. After adjusting for potential confounders, country remained the most important predictor of physicians' attitudes and practices.

Normalized and Differential Convolution : Methods for Interpolation and Filtering of Incomplete and Uncertain Data

Abstract: In this paper it is shown how false operator responses due to missing or uncertain data can be signiflcantly reduced or eliminated. Perhaps the most well-knownofsuchefiectsarethevarious‘edgeefiects’ which invariably occur at the edges of the input data set. Further,itisshownhowoperatorshavingahigher degreeofselectivityandhighertoleranceagainstnoise can be constructed using simple combinations of appropriately chosen convolutions. The theory is based on linear operations and is general in that it allows for both data and operators to be scalars, vectors or tensors of higher order. Threenewmethodsarepresented: Normalized convolution, Difierential convolutionand Normalized Differential convolution. All three methods are examples of the power of the signal/certainty - philosophy, i.e. the separation of both data and operator into a signal part and a certainty part. Missing data is simply handled by setting the certainty to zero. In the case of uncertain data, an estimate of the certainty must accompany the data. Localization or ‘windowing’ of operators is done using an applicability function, the operator equivalent to certainty, not by changing the actual operator coe‐cients. Spatially or temporally limited operators are handled by setting the applicability function to zero outside the window. Consistentwiththephilosophyofthispaperallalgorithms produce a certainty estimate to be used if further processing is needed. Spectrum analysis is discussed and examples of the performance of gradient, divergence and curl operators are given.

ALPPS Improves Resectability Compared With Conventional Two-stage Hepatectomy in Patients With Advanced Colorectal Liver Metastasis Results From a Scandinavian Multicenter Randomized Controlled Trial (LIGRO Trial)

Abstract: Objective: The aim of the study was to evaluate if associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) could increase resection rates (RRs) compared with two-stage hepatectomy (TSH) in a randomized controlled trial (RCT). Background: Radical liver metastasis resection offers the only chance of a cure for patients with metastatic colorectal cancer. Patients with colorectal liver metastasis (CRLM) and an insufficient future liver remnant (FLR) volume are traditionally treated with chemotherapy with portal vein embolization or ligation followed by hepatectomy (TSH). This treatment sometimes fails due to insufficient liver growth or tumor progression. Methods: A prospective, multicenter RCT was conducted between June 2014 and August 2016. It included 97 patients with CRLM and a standardized FLR (sFLR) of less than 30%. Primary outcome - RRs were measured as the percentages of patients completing both stages of the treatment. Secondary outcomes were complications, radicality, and 90-day mortality measured from the final intervention. Results: Baseline characteristics, besides body mass index, did not differ between the groups. The RR was 92% [95% confidence interval (CI) 84%-100%] (44/48) in the ALPPS arm compared with 57% (95% CI 43%-72%) (28/49) in the TSH arm [rate ratio 8.25 (95% CI 2.6-26.6); P < 0.0001]. No differences in complications (Clavien-Dindo ≥3a) [43% (19/44) vs 43% (12/28)] [1.01 (95% CI 0.4-2.6); P = 0.99], 90-day mortality [8.3% (4/48) vs 6.1% (3/49)] [1.39 [95% CI 0.3-6.6]; P = 0.68] or R0 RRs [77% (34/44) vs 57% (16/28)] [2.55 [95% CI 0.9-7.1]; P = 0.11)] were observed. Of the patients in the TSH arm that failed to reach an sFLR of 30%, 12 were successfully treated with ALPPS. Conclusion: ALPPS is superior to TSH in terms of RR, with comparable surgical margins, complications, and short-term mortality. (Less)