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  • 17701. Wändell, Per
    et al.
    Carlsson, Axel C
    Gasevic, Danijela
    Holzmann, Martin J
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Karolinska institutet.
    Sundquist, Jan
    Sundquist, Kristina
    Socioeconomic factors and mortality in patients with atrial fibrillation-a cohort study in Swedish primary care2018In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, no 6, p. 1103-1109Article in journal (Refereed)
    Abstract [en]

    Background: Preventing ischaemic stroke attracts significant focus in atrial fibrillation (AF) cases. Less is known on the association between socioeconomic factors and mortality and cardiovascular outcomes in patients with AF.

    Methods: Our study population included adults (n=12 283) ≥45 years diagnosed with AF at 75 primary care centres in Sweden 2001-07. Cox regression was used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs) for the association between the exposures educational level, marital status, neighbourhood socioeconomic status and the outcomes all-cause mortality, after adjustment for age, and comorbid cardiovascular conditions.

    Results: During a mean of 5.8 years (SD 2.4) of follow-up, 3954 (32.3%) patients had died; 1971 were women (35.0%) and 1983 were men (29.8%). Higher educational level was associated with a reduced mortality in fully adjusted models: HR 0.85 (95% CI 0.77-0.96) for secondary school in men, HR 0.73 (95% CI 0.60-0.88) for college/university in women, and HR 0.82 (95% CI 0.71-0.94) for college/university in men, compared to primary school. Unmarried men and divorced men had an increased risk of death, compared with married men: HR 1.25 (95% CI 1.05-1.50), and HR 1.23 (95% CI 1.07-1.42), respectively. College/university education level was also associated with lower risk of myocardial infarction in men and women, and lower risk of congestive heart failure in women.

    Conclusion: More attention could be paid to individuals of lower levels of formal education, and unmarried men, in order to provide timely management for AF and prevent its debilitating complications.

  • 17702. Wändell, Per
    et al.
    Carlsson, Axel C
    Holzmann, Martin J
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Uppsala universitet.
    Johansson, Sven-Erik
    Sundquist, Jan
    Sundquist, Kristina
    Warfarin treatment and risk of myocardial infarction - A cohort study of patients with atrial fibrillation treated in primary health care2016In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 221, p. 789-793Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To study the risk of myocardial infarction (MI) in patients with atrial fibrillation (AF) treated in primary health care with warfarin or acetylsalicylic acid (ASA, aspirin).

    METHODS: The study population included subjects (n=12,283) 45years or older diagnosed with AF who were treated in 75 primary care centres in Sweden between 2001 and 2007. MI was defined as a hospital stay for MI during 2001 through 2010 registered in the Swedish Patient Register. Associations between warfarin or ASA treatment and incident MI were explored using Cox regression analysis, by estimating hazard ratios (HRs) and 95% confidence intervals (95% CIs). Adjustment was made for age, socio-economic factors and cardio-vascular co-morbidity.

    RESULTS: Persistent treatment ("per protocol" treatment) with warfarin alone was present among 32.4% of women and 37.4% of men, and with ASA alone among 30.0% of women and 28.1% of men. The fully adjusted HRs for MI, compared to those with no antithrombotic treatment, with warfarin treatment for women were 0.26 (95% CI 0.16-0.41) and for men 0.28 (95% CI 0.20-0.39); and the corresponding HRs for those treated with ASA were for women 0.57 (95% CI 0.37-0.87), and for men 0.44 95% CI (0.31-0.63). The fully adjusted HR for MI when comparing patients with warfarin treatment to those with ASA treatment was for women 0.46 (95% CI 0.27-0.80), and for men 0.58 (95% CI 0.38-0.89).

    CONCLUSIONS: Warfarin seems to prevent MI among AF patients in a primary healthcare setting, which emphasizes the importance of persistent anticoagulant treatment in those patients.

  • 17703. Wändell, Per
    et al.
    Carlsson, Axel C
    Holzmann, Martin J
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Uppsala universitet.
    Johansson, Sven-Erik
    Sundquist, Jan
    Sundquist, Kristina
    Warfarin treatment and risk of stroke among primary care patients with atrial fibrillation2016In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 50, no 5-6, p. 311-316Article in journal (Refereed)
    Abstract [en]

    Objective Our aim was to study the risk of a first ischemic stroke in patients with atrial fibrillation (AF) treated in primary health care. Design The study population included all adults (n = 11,517), 45 years and older diagnosed with AF, from 75 primary care centres in Sweden between 2001 and 2007. Ischemic stroke was defined as a hospital care event of stroke between 2001 and 2010. Association between incident stroke and warfarin treatment was explored using Cox regression analysis, with hazard ratios (HRs), and 95% confidence intervals (95% CIs). Adjustment was made for age, socioeconomic factors and co-morbidity. Results Persistent treatment with warfarin was present among 34.7% of women and 40.9% among men. Persistent warfarin treatment, compared to no persistent treatment, was associated with a stroke preventing effect with fully adjusted HRs of 0.25 (95% CI 0. 0.26-0.45) in women, and 0.25 (95% CI 0.28-0.43) in men. A CHA2DS2-VASc score of at least two among women, and three among men, was associated with a stroke risk exceeding 18% during a mean follow-up of 5.4 years. Risk of haemorrhagic stroke was not increased. Conclusions Warfarin is effective in preventing stroke in AF patients in primary health care.

  • 17704. Wändell, Per
    et al.
    Carlsson, Axel C
    Holzmann, Martin J
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Karolinska institutet.
    Sundquist, Jan
    Sundquist, Kristina
    Associations between relevant cardiovascular pharmacotherapies and incident heart failure in patients with atrial fibrillation: a cohort study in primary care2018In: Journal of Hypertension, ISSN 0263-6352, E-ISSN 1473-5598, Vol. 36, no 9, p. 1929-1935Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To study association between relevant cardiovascular pharmacotherapy and incident congestive heart failure (CHF) in patients with atrial fibrillation treated in primary health care.

    METHODS: Study population included all adults (n = 7975) aged 45 years and older diagnosed with atrial fibrillation at 75 primary care centers in Sweden between 2001 and 2007. Outcome was defined as a first diagnosis of CHF post-atrial fibrillation diagnosis. Association between CHF and treatment with relevant cardiovascular pharmacotherapies (beta blockers, calcium blockers, digitalis, diuretics, RAS blockers, and statins) was explored using Cox regression analysis with hazard ratios and 95% CIs. Adjustments were made for age, sociodemographic variables, and comorbid conditions (with or without cardiovascular disorders).

    RESULTS: During a mean of 5.7 years (SD 2.3) of follow-up, totally 1552 patients (19.5%; 803 women and 749 men) had a recorded CHF diagnosis. Thiazides (hazard ratio 0.74, 95% CI 0.65-0.84), vessel-active calcium channel blockers (hazard ratio 0.76, 95% CI 0.67-0.86), and nonselective beta blockers (hazard ratio 0.84, 95% CI 0.72-0.98), with specifically sotalol representing 80% of nonselective beta blockers (hazard ratio 0.81, 95% CI 0.69-0.97), were associated with lower CHF risk in fully adjusted models. Loop diuretics (hazard ratio 1.41, 95% CI 1.25-1.57) were associated with a higher risk. Findings for thiazides and vessel-active channel blockers were consistent in the tested subgroups.

    CONCLUSION: In this clinical setting, we found that thiazides, vessel-active calcium channel blockers, and nonselective beta blockers (specifically sotalol) were associated with a lower risk of incident CHF among patients with atrial fibrillation. The findings of the present study need to be confirmed in other settings.

  • 17705. Wändell, Per
    et al.
    Carlsson, Axel C
    Holzmann, Martin J
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Karolinska institutet; Uppsala universitet.
    Sundquist, Jan
    Sundquist, Kristina
    Comparison of mortality and nonfatal cardiovascular events in adults with atrial fibrillation with versus without levothyroxine treatment2017In: American Journal of Cardiology, ISSN 0002-9149, E-ISSN 1879-1913, Vol. 120, no 11, p. 1974-1979Article in journal (Refereed)
    Abstract [en]

    Levothyroxine has been suggested to be cardiotoxic, but previous studies on the risk of cardiovascular events associated with levothyroxine treatment have been inconclusive. We aimed to study the association between levothyroxine treatment and all-cause mortality as well as cardiovascular events. Study population included all adults (n = 12,283) ≥ 45 years diagnosed with atrial fibrillation (AF) at 75 primary care centers in Sweden in 2001 to 2007, with (n = 1,189; 283 men and 906 women) or without (n = 11,094) levothyroxine treatment. Outcome was defined as all-cause mortality and cardiovascular events, that is, myocardial infarction, ischemic stroke, and congestive heart failure until December 31, 2010. During a mean 5.8 years (standard deviation 2.4 years) of follow-up, a total of 3,954 patients died (32.2%), among whom 92 men (32.5%) and 266 women (29.4%) were treated with levothyroxine. In fully adjusted Cox regression models (age, co-morbidity, socioeconomic factors, and warfarin treatment), a significant association between levothyroxine treatment and lower mortality was found among women (hazard ratio 0.78, 95% confidence interval 0.68 to 0.91), but not among men (hazard ratio 0.87, 95% confidence interval 0.69 to 1.10). In the secondary analysis, levothyroxine treatment was not associated with the risk of myocardial infarction, ischemic stroke, or congestive heart failure (p > 0.05). In conclusion, in a large representative cohort, we found that levothyroxine treatment decreased the mortality risk in women with AF, which suggests that such treatment could be of benefit in this setting.

  • 17706. Wändell, Per
    et al.
    Carlsson, Axel C
    Holzmann, Martin J
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Karolinska institutet.
    Sundquist, Jan
    Sundquist, Kristina
    Mortality in patients with atrial fibrillation and common co-morbidities - a cohort study in primary care2018In: Annals of Medicine, ISSN 0785-3890, E-ISSN 1365-2060, Vol. 50, no 2, p. 156-163Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To study the association between cardiovascular co-morbidities and mortality risk in primary care patients with atrial fibrillation.

    METHODS: The study population included all adults (n = 12,283) ≥ 45 years diagnosed with AF at 75 primary care centres in Sweden between 2001 and 2007. The outcome was mortality (until 2010) and data were explored for co-morbidities using Cox regression with hazard ratios (HRs). Analyses were performed stratified by sex and by age-group (45-64, 65-74 and ≥75 years of age) with adjustment for age, socio-economic factors and relevant co-morbidities.

    RESULTS: During a mean of 5.8 years (standard deviation 2.4) of follow-up, 3954 (32%) patients died (1971 (35%) women, and 1983 (30%) men). High HRs were found for congestive heart disease (CHF) and cerebrovascular diseases for all age-groups among men and women (except for the 45-64 year old women); for coronary heart disease among the oldest men; for diabetes among the 65-74 year old men and the 45-64 year old women. Low HRs were found for hypertension among women ≥75 years of age.

    CONCLUSIONS: In this clinical setting, CHF and cerebrovascular diseases were consistently associated with mortality in all age-groups. The possible protective effect by hypertension among elderly women should be interpreted with caution. KEY MESSAGES We found congestive heart failure and cerebrovascular diseases to be consistently associated with mortality in both women and men. We found hypertension to be associated with lower mortality risk among women ≥75 years of age, although this finding must be interpreted with caution. Depression was found to be associated with increased mortality risk among men and women aged 65-74 years of age.

  • 17707. Wändell, Per
    et al.
    Carlsson, Axel C
    Holzmann, Martin
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Uppsala universitet.
    Johansson, Sven-Erik
    Sundquist, Jan
    Sundquist, Kristina
    Association between antithrombotic treatment and hemorrhagic stroke in patients with atrial fibrillation: a cohort study in primary care2017In: European Journal of Clinical Pharmacology, ISSN 0031-6970, E-ISSN 1432-1041, Vol. 73, no 2, p. 215-221Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The objective of this study was to study the association between antithrombotic treatment and risk of hemorrhagic stroke (HS) in patients with atrial fibrillation (AF) treated in primary health care.

    METHODS: Study population included all adults (n = 12,215) 45 years and older diagnosed with AF at 75 primary care centers in Sweden 2001-2007. Outcome was defined as a first hospital episode with a discharge episode of HS after the AF diagnosis. Association between HS and persistent treatment with antithrombotic agents (warfarin, acetylsalicylic acid (ASA), clopidogrel) was explored using Cox regression analysis, with hazard ratios (HRs) and 95 % CIs. Adjustment was made for age, socioeconomic status, and co-morbid cardiovascular conditions.

    RESULTS: During a mean of 5.8 years (SD 2.4) of follow-up, 162 patients (1.3 %; 67 women and 95 men) with HS were recorded. The adjusted risk associated with persistent warfarin treatment compared to no antithrombotic treatment consistently showed no increased HS risk, HR for women 0.53 (95 % CI 0.23-1.27) and for men 0.55 (95 % CI 0.29-1.04); corresponding HRs for ASA were, for women, 0.45 (95 % CI 0.14-1.44) and, for men, 0.56 (95 % CI 0.24-1.29).

    CONCLUSIONS: In this clinical setting, we found no evidence pointing to an increased risk of HS with antithrombotic treatment.

  • 17708. Wändell, Per
    et al.
    Carlsson, Axel C
    Li, Xinjun
    Gasevic, Danijela
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Uppsala universitet.
    Holzmann, Martin J
    Sundquist, Jan
    Sundquist, Kristina
    Atrial fibrillation in immigrant groups: a cohort study of all adults 45 years of age and older in Sweden2017In: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 32, no 9, p. 785-796Article in journal (Refereed)
    Abstract [en]

    To study the association between country of birth and incident atrial fibrillation (AF) in several immigrant groups in Sweden. The study population included all adults (n = 3,226,752) aged 45 years and older in Sweden. AF was defined as having at least one registered diagnosis of AF in the National Patient Register. The incidence of AF in different immigrant groups, using Swedish-born as referents, was assessed by Cox regression, expressed in hazard ratios (HRs) and 95% confidence intervals (CI). All models were stratified by sex and adjusted for age, geographical residence in Sweden, educational level, marital status, and neighbourhood socioeconomic status. Compared to their Swedish-born counterparts, higher incidence of AF [HR (95% CI)] was observed among men from Bosnia 1.74 (1.56-1.94) and Latvia 1.29 (1.09-1.54), and among women from Iraq 1.96 (1.67-2.31), Bosnia 1.88 (1.61-1.94), Finland 1.14 (1.11-1.17), Estonia 1.14 (1.05-1.24) and Germany 1.08 (1.03-1.14). Lower incidence of AF was noted among men (HRs ≤ 0.60) from Iceland, Southern Europe (especially Greece, Italy and Spain), Latin America (especially Chile), Africa, Asia (including Iraq, Turkey, Lebanon and Iran), and among women from Nordic countries (except Finland), Southern Europe, Western Europe (except Germany), Africa, North America, Latin America, Iran, Lebanon and other Asian countries (except Turkey and Iraq). In conclusion, we observed substantial differences in incidence of AF between immigrant groups and the Swedish-born population. A greater awareness of the increased risk of AF development in some immigrant groups may enable for a timely diagnosis, treatment and prevention of its debilitating complications, such as stroke.

  • 17709. Wändell, Per
    et al.
    Carlsson, Axel C
    Li, Xinjun
    Gasevic, Danijela
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Karolinska institutet.
    Holzmann, Martin J
    Sundquist, Jan
    Sundquist, Kristina
    Atrial fibrillation in immigrants under the age of 45 y in Sweden2019In: International Health, ISSN 1876-3413, E-ISSN 1876-3405, Vol. 11, no 3, p. 193-202Article in journal (Refereed)
    Abstract [en]

    Aim: To study association between country of birth and risk of first-onset atrial fibrillation (AF) in first- and second-generation immigrants to Sweden under 45 y of age.

    Methods: The study population included all individuals (n = 3 248 457) under the age of 45 y in Sweden, including immigrants (n = 722 249). AF was defined as first registered diagnosis in the National Patient Register. Association between country of birth and risk of AF was assessed by Cox regression, calculating HRs and 95% CIs, using Swedish-born individuals as referents. All models were stratified by sex, and in different models were adjusted for age, area of residence in Sweden, educational level, marital status, neighbourhood socioeconomic status and co-morbidity(ies).

    Results: A higher fully adjusted HR of incident AF was found in the total sample of first-generation immigrants, 1.44 (95% CI 1.35 to 1.54), in males born in Denmark, Lebanon and Iraq, and in females born in Turkey and Iraq. Lower HRs were found in male and female immigrants from Latin America and Iran, and female immigrants from Finland. Among second-generation immigrants, the fully adjusted HR was significantly lower, 0.70 (95% CI 0.58 to 0.83).

    Conclusions: Clinicians may show a greater awareness of AF in some groups of younger immigrants to enable early diagnosis.

  • 17710. Wändell, Per
    et al.
    Carlsson, Axel C
    Li, Xinjun
    Gasevic, Danijela
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Karolinska institutet.
    Holzmann, Martin J
    Sundquist, Jan
    Sundquist, Kristina
    Heart failure in immigrant groups: a cohort study of adults aged 45 years and over in Sweden2018In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 52, no 6, p. 292-300Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: An increased risk of being diagnosed with coronary heart disease or atrial fibrillation has been shown among different immigrant groups. However, less is known on the risk of being diagnosed with congestive heart failure (CHF).

    DESIGN: We studied CHF in immigrants including all adults ≥45 years in Sweden (n = 3,274,119) from 1998 to 2012. CHF was defined as at the first event registered in the National Patient Register. Risk of incident CHF in immigrant groups compared to the Swedish-born population was assessed by Cox regression, stratified by sex, adjusting for age, socio-demographic status, and co-morbidities.

    RESULTS: During a mean follow-up of 14 years in total, a total of 302,340 (9.2%) events of CHF were registered. We found the following: higher incidence in men from Bosnia, Iraq, Lebanon, Russia and Africa; among women from Bosnia, Iraq, Lebanon, Turkey, Central Europe and Finland; lower incidence in men from Iceland, Latin America, Southern Europe, Norway and Western Europe; and among women from Iceland, Southern Europe, Norway, Denmark and Western Europe.

    CONCLUSION: It is important to be aware of the increased incidence of CHF in some immigrant groups, especially from countries and areas where the immigrants have been refugees, in order to enable for a timely diagnosis, treatment of and prevention of CHF and its debilitating complications.

  • 17711. Wändell, Per
    et al.
    Carlsson, Axel C
    Li, Xinjun
    Gasevic, Danijela
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Karolinska institutet.
    Sundquist, Jan
    Sundquist, Kristina
    End-stage kidney diseases in immigrant groups: a nationwide cohort study in Sweden2019In: American Journal of Nephrology, ISSN 0250-8095, E-ISSN 1421-9670, Vol. 49, no 3, p. 186-192Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Our aim was to study the association between the country of birth and incident end-stage kidney disease (ESKD) in several immigrant groups in Sweden, using individuals born in Sweden or with Swedish-born parents as referents.

    METHODS: A cohort study of first- and second-generation immigrants residing in Sweden between January 1, 1998 and December 31, 2012 was performed. Outcomes were defined as having at least one registered diagnosis of ESKD in the National Patient Register. The incidence of ESKD in different immigrant groups was used in the Cox regression models to estimate hazard ratios (HRs) and 95% CIs. All models were stratified by sex and adjusted for age, geographical residence, educational level, marital status, and neighbourhood socioeconomic status.

    RESULTS: Compared to their referents, higher incidence rates and HRs of ESKD (HR; 95% CI) were observed in general among foreign-born men (1.10; 1.04-1.16) and women (1.12; 1.04-1.21) but not among second-generation immigrants (persons born in Sweden with foreign-born parents). A particularly high -incidence was noted among men and women from -East-European countries, as well as from non-European regions. A lower incidence of ESKD was noted among men from Finland.

    CONCLUSIONS: We observed substantial differences in incidence of ESKD between immigrant groups and the Swedish-born population, which may be clinically relevant when monitoring preventive measures in patient subgroups with a higher risk of deteriorating kidney disease, and suggest higher attention to hypertension and diabetes control in immigrants. Mechanisms attributable to the migration process or ethnic differences may lead to an increased risk of ESKD.

  • 17712.
    Wängdahl, Jessica
    Dalarna University, School of Humanities and Media Studies, Swedish.
    Skönlitteraturens roll i gymnasieelevers identitetsskapande - en litteraturstudie2017Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Har skönlitteraturen en given plats i skolan eller är den formen av litteratur någonting med

    ett historiskt rosa skimmer kring och inte någonting som i själva verket har någon större

    inverkan på elevernas identitetsskapande, självinsikt och vidgade perspektiv? Detta är en

    av de undersökta frågorna i studien som har utformats som en systematisk litteraturstudie

    som innebär att systematiskt söka, kritiskt granska och sammanställa funnen litteratur.

    Det råder delade meningar bland forskare om skönlitteraturens explicita roll gällande

    medverkandet till elevernas personliga utveckling. Men studien visar att skönlitteraturen

    har en särställning gällande dessa frågor dels genom att det går att utnyttja

    skönlitteraturens lättillgänglighet för att eleven ska få en djupare förståelse för innebörden

    av det lästa, och på så sätt även få en djupare förståelse för sin person. Detta är betydligt

    svårare att genomföra med andra medier i det vidgade textbegreppet. Samtidigt visar den

    sociokulturella teorin att samtliga texttyper inom det vidgade textbegreppet står i beroende

    av varandra och samarbetar. Den eventuella särställningen mot andra medier inom

    utbildningar syns även genom att skönlitteraturen numera ingår i utbildningar inom

    läkarutbildningen, prästutbildningen samt polisutbildningen för att ge omvärldsförståelse.

    Detta tyder på skönlitteraturens särställning och användningsområde i ämnet.

  • 17713.
    Wängdahl, Jessica
    Dalarna University, School of Humanities and Media Studies, Swedish.
    Varför skönlitteratur i skolan?: En studie angående lärares syn på skönlitteraturens roll i gymnasieskolan2018Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Syftet med denna studie är att undersöka motivet till användande av skönlitteratur i skolundervisningen samt att undersöka vilken/vilka ämnesbeskrivningar/ ämnesförståelser lärarna lutar sig mot vid användningen av skönlitteratur i undervisningen. Studien har genomförts genom intervjuer med nu verksamma svensklärare. Ett anmärkningsvärt resultat är att fyra av fem svensklärare först svarade att de använder skönlitteraturen för att det står i läroplanen. Sedan nämndes andra motiv som ordförståelse, läsförståelse, personlig utveckling och omvärldsförståelse. Det har visat sig vara att vanligt förfarande gällande varför-frågan att direkt hänvisa till läroplanen, både när det gäller de utfrågade lärarna i denna studie samt i tidigare forskning. Magnussons tre olika ämnesbeskrivningar: erfarenhets-, färdighets- och bildningsmotiven visade sig ha en betydande spridning gällande de utfrågade svensklärarnas tankesätt. Ingen av de utfrågade lärarna använde sig endast av en ämnesbeskrivning. Lärarna använde två och ibland alla tre olika ämnesbeskrivningar för att motivera användandet av skönlitteratur i undervisningen. Det visade sig att bedömning av läsning enade lärarna i ett färdighetspedagogiskt tänkande. Det är betydligt enklare att bedöma och mäta vad elever kan om litteraturen istället för att mäta och bedöma vad eleverna kan genom litteraturen. Samtliga fem lärare hade också olika erfarenhetspedagogiska motiv gällande läsning av skönlitteratur. Detta kan tolkas såsom att lärarna i viss mån använder sig av sociokulturella glasögon i undervisningen eftersom erfarenhetspedagogiken och den sociokulturella teorin har stora likheter. De bildningspedagogiska motiven visade sig främst genom valet av litteratur. Några lärare använde sig av skönlitteratur skrivna av nobelpristagare. Ett pris som ger författaren status. Det anses av flera lärare att det är bildande att läsa en text författad av en nobelpristagare. Därför kan valet av nobelpristagares böcker ses som en form av bildningsmotiv.

  • 17714.
    Wänn, Anna
    et al.
    Dalarna University, School of Technology and Business Studies, Business Administration and Management.
    Visone, Daniel
    Dalarna University, School of Technology and Business Studies, Business Administration and Management.
    Revisorns oberoende: Faktorer som kan påverka uppfattningen om revisornsoberoende2015Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Lately media has featured many corporate scandals in which the auditors’ actions has beenquestioned. The high-profile scandals have contributed to the deterioration of confidence in the auditindustry. Due to this the requirements for auditor independence has increased.The purpose of this study is to investigate how five different factors influence the perception ofauditor independence. The examined factors are the audit firms economic dependence on the client,whether the audit firm also offers advisory services to the client, the length of audit assignments, thesize of audit firm, and whether the client has an audit committee or not. Through a survey wequestioned business advisors on banks in Dalarna, Sweden. We asked how they perceived that thesefactors affect the auditor's independence. The results shows that the audit firms economicdependence was the factor that most responders considered reduced auditor independence. Offeringof advisory services and having a long audit assignments was also considered by many responders tolead to poor auditor independence. How big the accounting firm was did not affect independenceaccording to most respondents. But those who thought that it did affect believed that a largeaccounting firm gave the auditor greater independence. Most respondents did not know how theauditors’ independence would be affected if the client had an audit committee. The reason for theuncertainty was probably because relatively few of their clients had an audit committee.The results from this study corresponds well with previous studies. Like this study, most previousstudies in this field used the method of questionnaire survey (Beattie et al., 2013; Dart, 2011; Alleyneet al., 2006; Bakar et al., 2005; Beattie et al., 1999; White, 1989; Shockley, 1981). Our surveyincluded some background questions. These show that our respondents often considered and placedgreat importance on auditor independence. Several other studies have turned to similar respondents,consumers of accounting in general and specifically bank advisors (Guiral et al., 2014; Holm &Zaman, 2012; Dart, 2011; Alleyne et al., 2006; Bakar et al., 2005; Alleyne, 2002; White, 1989). Thismeans that our results are well comparable. Previous studies were conducted in countries with anAnglo-Saxon accounting tradition, while Sweden has a continental accounting tradition. Thisdifference does however not appear to have influenced the views of auditor independence.Our study shows that Swedish banking officials' opinions about what affects the auditor'sindependence is consistent with the international opinions. Since the respondents are limited toDalarna, further studies is needed before the results can be generalizes to the whole of Sweden.

  • 17715.
    Wänström, Johan
    Linköpings universitet.
    Kommunalt koalitionsbyggande i ett nytt parlamentariskt landskap: Pragmatism i policyorienterade möjlighetsfönster2018In: Sociologisk forskning, ISSN 0038-0342, Vol. 55, no 2-3, p. 225-248Article in journal (Refereed)
    Abstract [en]

    Coalition formation in a new municipal parliamentary landscape. Pragmatism in policy-related windows of opportunities

    Coalition building in Swedish municipalities has traditionally been dominated by two political blocks at the opposite sides of the ideological left–right scale (Bäck 2003; Wångmar 2006). The success of the Sweden Democrats in the last elections have challenged that pattern. Statistics on coalition formation since the 2014 election indicate that the traditional policy scale no longer dominates local government. Coalitions of parties closely situated next to each other on the left–right scale are not as common as before. Interviews with 19 leading politicians in five Swedish municipalities that formed majority coalitions, including parties on the left as well as the right block, indicate that neither the traditional left–right scale nor the GAL–TAN dimension played a decisive role in these coalition formation processes. Instead, the ability of political parties to cooperate within the coalitions and building on personal chemistry, was considered the most important factor in the coalition building process on the municipal level.

  • 17716.
    Wärman Rainer, Frida
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    För barn eller akademiker?: En studie om socialtjänstens webbaserade information för barn och unga.2016Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    The purpose of this study is to reach an understanding about how the social services in Dalarna are informing children and youths about their functions and services through the Internet. A combination of qualitative and quantitative methods has been used and data has been collected through content analysis of all web sites of Dalarnas counties. The data that has been collected has been analyzed from a child perspective and through theories of strategic communication. The results have disclosed that there from a child perspective are many faults in the web based information provided by the counties and it seems like they do not have any strategies for how communication with children and youths should be handled. The result also reveals that current law and the UN conventions on the rights of the child are not taken into consideration.

  • 17717.
    Wärme, Robert
    Dalarna University, School of Languages and Media Studies, Sound and Music Production.
    Höj min sång!: En studie om medhörning för musiker med hörselskada2007Independent thesis Basic level (degree of Bachelor)Student thesis
  • 17718.
    Wärme, Robert
    Dalarna University, School of Education and Humanities, Comparative Literature.
    Stranger than fiction: En studie kring berättarstruktur i en film2008Independent thesis Basic level (degree of Bachelor)Student thesis
    Abstract [sv]

    Denna uppsats är en narratologisk analys av berättarstrukturen inom filmen Stranger than fiction. Uppsatsen inleder med en terminologi samt en teoridel kring vad som är berättarstruktur. Utifrån detta analyserar jag filmen för att grundläggande redogöra kring hur den är berättad genom att först beskriva filmens totala fabula för att sedan analysera vad som egentligen förmedlas och på så sätt även komma fram till en slutsats kring filmens totala berättarstruktur. Resultatet visar på att Stranger than fiction är berättad genom flertalet olika nivåer som visar på två olika berättare inom två olika diegeser som förmedlas genom samma berättare. Detta resultat leder till en tematisk diskussion ett postmodernt ontologiskt syfte som genom filmens komplicerade narratologiska struktur försöker förmedla budskapet ”lev det liv du vill ha” samt ”livet blir viktigt först när döden gör sig synlig.

  • 17719.
    Wärn, Jennie
    Dalarna University, School of Health and Social Studies, Sociology.
    Alkohol: En undersökning av första års programstudenter vid campus Borlänge2006Independent thesis Basic level (degree of Bachelor)Student thesis
    Abstract [sv]

    I denna uppsats har en undersökning av studenters alkoholvanor gjorts. Syftet med arbetet var att få en uppfattning om första års programstudenters alkoholvanor vid Högskolan Dalarna campus Borlänge. Följande frågeställningar belyses i studien: Hur ofta och hur mycket dricker studenter vid respektive program, hur ser kvinnornas alkoholvanor ut jämfört med männens, samt om alkoholvanorna skiljer sig mellan programmen. Jag har använt mig av en kvantitativ enkätundersökning där totalt 60 studenter från tre olika program har medverkat. Studenterna går första året på Högskolan Dalarna och är i åldrarna 19-24 år. De program som undersöktes var Grafisk teknologi och design, Materialdesign samt Ekonomprogrammet. Jag vill påpeka att bortfallet i undersökningen är litet och de flesta har svarat på enkäten (60/74). Vid ett eventuellt bortfall bör man fråga sig om de frånvarande studenterna skiljer sig avsevärt från de studenter som deltog i undersökningen. Orsaken till att några studenter inte var närvarande vid undersökningen kan jag inte uttala mig om. De teorier som används i uppsatsen är teorier om identitetsfinnande, rusets betydelse för konsumtionen, samt en teori om normer och avvikande beteende. Innan jag genomförde undersökningen tog jag kontakt med några av skolans studieadministratörer för att få tillgång till antal registrerade studenter på de olika programmen. Därefter tog jag kontakt med lärare på respektive program och bestämde datum och tid för utlämnande av enkäten. Då kunde jag själv dela ut och samla in enkäten. Efter att jag fått in svar på enkäten sammanställdes all information för att få en övergripande syn på studenternas alkoholvanor. Resultatet av undersökningen visar att 91,7% av studenterna konsumerar alkohol. Den visar också att männen dricker oftare än vad kvinnorna gör och även större mängder vid ett och samma tillfälle. Dock är det många kvinnor som dricker ofta och mycket. Detta kan bero på att de existerande könsroller som finns håller på att lösas upp. Studenter på Materialdesignprogrammet har högst konsumtion om man jämför med de övriga programmen. På detta program dricker många av studenterna fler än 1 gång i veckan. De dricker också stora mängder. Ekonomprogrammet har låg konsumtion både när det gäller hur ofta och hur mycket de dricker. Det mest häpnadsväckande resultatet har programmet Grafisk teknologi och design där det faktiskt är kvinnorna som står för den högsta konsumtionen.

  • 17720.
    Wärnfeldt, Anna
    Dalarna University, School of Education, Health and Social Studies, Educational Work.
    Lärares arbete med hållbar utveckling i naturvetenskapsundervisningen: En kvalitativ studie om lärares val av metod och innehåll i undervisningen för hållbar utveckling i åk 4-62019Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
  • 17721.
    Wätterbjörk, Inger
    et al.
    School of Health and Medical Sciences, Örebro University, and Family Medicine Research Center, Örebro, Sweden.
    Häggström-Nordin, Elisabet
    epartment of Women's and Children's Health, Uppsala University, Uppsala, and School of Health, Care and Social Welfare, Mälardalen University, Sweden.
    Hägglund, Doris
    Family Medicine Research Center, Örebro, and School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Provider strategies for contraceptive counselling among Swedish midwives2011In: British journal of midwifery, ISSN 0969-4900, E-ISSN 2052-4307, Vol. 19, no 5, p. 296-301Article in journal (Refereed)
    Abstract [en]

    Previous studies have shown that in contraceptive counselling the provider sets the agenda. The aim of this study was to describe how a group of Swedish nurse-midwives think and act in their role as contraceptive counsellors. Semi-structured questions were put to a convenience sample of 16 nurse-midwives. Data were analysed using qualitative content analysis. Five categories were identified: exploring the woman's situation; providing information about contraceptive methods; performing medical evaluation; guiding the decision-making process; and following up on the counselling. Results showed that the providers had developed their own strategies and suggest the use of interventions which combine counselling methods to provide information, with a theory for decision-making, to help in giving advice. This study could contribute to personal reflection on contraceptive counselling in practice, both for experienced counsellors and those new to the task

  • 17722.
    Wåhlin-Larsson, Britta
    Dalarna University, School of Health and Social Studies, Medical Science.
    Skeletal muscle morphology in Restless Legs Syndrome and Obstructive Sleep Apnoea Syndrome: methods in analyzing the capillary network in skeletal muscle2008In: Nordforsk PhD Seminar, 2008Conference paper (Other academic)
  • 17723.
    Wåhlin-Larsson, Britta
    et al.
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Kadi, Fawzi
    Ulfberg, Jan
    Peihl Aulin, Karin
    Skeletal muscle morphology in patients with Restless legs syndrome (RLS)2007In: European Journal of Neurology, ISSN 1351-5101, E-ISSN 1468-1331, Vol. 58, no 3, p. 133-137Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of the study was to assess the cellular and structural properties of skeletal muscle in Restless legs Syndrome (RLS).

    Method: Twenty patients and 16 controls were included. Aerobic performance was assessed using a sub maximal test. On muscle biopsies taken from the tiabialis anterior, fibre distribution and fibre area were analysed together with parameters surveying the microvascularisation, especially the tortuosity which is expressed as a percent of muscle fibre perimeter in contact with the wall of the microvessel, LC/PF-index (length of capillary / perimeter of fibre).

    Result: RLS group had significantly lower predicted maximal oxygen uptake (p = 0.01) and significantly higher LC/PF index (P=0.01) compared to the controls. In conclusion, the higher capillary tortuosity in RLS patients indicates the occurrence of significant remodelling in capillary geometry in RLS.

  • 17724.
    Wåhlin-Larsson, Britta
    et al.
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Kadi, Fawzi
    Ulfberg, Jan
    Piehl Aulin, Karin
    Skeletal muscle function and morphology in persons with restless legs syndrome (RLS)2005In: 19th Annual Meeting of the Associated Professional Sleep Societies, 2005Conference paper (Other academic)
  • 17725.
    Wåhlin-Larsson, Britta
    et al.
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Kadi, Fawzi
    Ulfberg, Jan
    Piehl Aulin, Karin
    Skeletal muscle morphology and aerobic capacity in patients with obstructive sleep apnoea syndrome2008In: Respiration, ISSN 0025-7931, E-ISSN 1423-0356, Vol. 76, no 1, p. 21-27Article in journal (Refereed)
    Abstract [en]

    Background: Despite the fact that patients with obstructive sleep apnoea syndrome (OSAS) often have symptoms at the level of skeletal muscle such as fatigue, the question of whether the structural, cellular and functional properties of limb skeletal muscles are affected have not been fully examined.

    Objective: The aim was to examine physiological and muscular parameters in patients with OSAS and to assess the relationship between these parameters and the clinical symptoms.

    Method: Eighteen patients with OSAS and 16 controls participated. Aerobic capacity was assessed using a sub maximal test. Fibre type distribution and fibre area were analysed on muscle biopsies taken from the tibialis anterior, The microvascularisation was assessed using the following parameters: 1) the number of capillaries per fibre (CAF), 2) CAF per fibre area (CAFA), 3) CFPE-index, which represents the interface between muscle fibre and capillaries, 4) LC/PF-index or capillary tortuosity, which represents the percent of muscle fibre perimeter in contact with the wall of the microvessel.

    Results: The OSAS group had significantly lower predicted relative maximal oxygen uptake (p = 0.0047) which was inversely correlated to AHI (apnoea/hypopnoea-index) (r = -0.6, p = 0.017). There was a significantly higher CFPE-index for slow type I fibres (p= 0.007) and fast type II fibres (p= 0.0126) and significantly higher LC/PF-index for type I fibres (p=0.0003) and type II fibres (p= 0.0285) in OSAS patients compared to controls.

    Conclusion: OSAS patients have a higher muscle microvascularisation and a lower aerobic capacity than controls. Furthermore the aerobic capacity was inversely correlated to AHI.

  • 17726.
    Wåhlin-Larsson, Britta
    et al.
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Ulfberg, Jan
    Piehl Aulin, Karin
    Kadi, Fawzi
    The expression of vascular endothelial growth factor in skeletal muscle of patients with sleep disorders2009In: Muscle and Nerve, ISSN 0148-639X, E-ISSN 1097-4598, Vol. 40, no 4, p. 556-561Article in journal (Refereed)
    Abstract [en]

    An increased capillary network has been observed in the skeletal muscle in patients with Restless Legs Syndrome (RLS) and bstructive sleep apnea syndrome (OSAS). These changes could be due to pregulation of growth factors responsible for angiogenesis. The aim of the study was to examine the occurrence and localization of VEGF and capillary proliferation in skeletal muscle of RLS (n=12), OSAS (n=12) and controls (n=11). Double-immunofluorescence staining for capillaries (CD31) and VEGF, and proliferating cells (Ki-67), was carried out on biopsies taken from the tibialis anterior. The percentage of capillaries expressing VEGF (CD31,VEGF+) was significantly higher in OSAS and RLS compared to controls. The percentage of proliferating apillaries (CD31,Ki-67+) was significantly higher in OSAS ompared with controls. In conclusion our study shows the occurrence of proliferation of endothelial cells in skeletal muscle in RLS and OSAS, supporting an upregulation of VEGF located in capillaries probably due to local hypoxia.

  • 17727.
    Wærness, Kari
    Universitetet i Bergen.
    Debatt: Kommentar til ”Till Kritiken av den Kvalitativa Metoden” av Margareta Bertilsson, Sociologisk Forskning 4, 19951996In: Sociologisk forskning, ISSN 0038-0342, Vol. 33, no 2-3, p. 130-132Article in journal (Other academic)
  • 17728.
    Wölger, Kristina
    Dalarna University, School of Education, Health and Social Studies, Educational Work.
    Att läsa eller inte läsa?: - En fallstudie av hur pensionerade gymnasielärare i engelska upplevde elevers läsande2016Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Syftet och ambitionen med denna fallstudie var att ta reda på olika aspekter av momentet läsning i engelska på gymnasienivå i Engelska B/Engelska 6 sett ur lärarperspektivet. Fem pensionerade språklärare har intervjuats och fokus har varit dessa engelsklärares upplevelser av elevers textläsning i Engelska B/Engelska 6. Intervjuerna syftade till att söka svar på fyra frågeställningar vilka går in på olika texttyper, behandlar elevernas inställning till läsning, om lärarna upplevde att det fanns faktorer som påverkade läsmomentet, hur valet av material ägde rum samt eventuella lärdomar som dessa fem lärares ämneslärargärning skulle kunna bidra med inför framtiden. Med dessa intervjuers hjälp i kombination med de teorier om läsning som lästs in har vissa svar erhållit vad det kan bero på huruvida elever lyckas eller inte lyckas med momentet läsning och att svaren inte enbart ligger i nuet, under elevens pågående kurs, utan finns att söka såväl bakåt i tiden, under uppväxten, som annorstädes i elevens omgivningar och möten med människor. Att läsa eller inte läsa är en stor fråga och detta arbete har enbart nosat på alla de svar som finns. Dock bekräftar teorierna och Respondenterna varandra i de faktorer som påverkar att lyckas eller inte lyckas med momentet läsning. Ett antal faktorer, som har lyfts fram, är avgörande för att elever ska klara av det bättre eller sämre, och dessa faktorer är elevens bakgrund, förkunskaper, ordförrådsnivå, språkerfarenheter i svenska, attityd och inställning, motivation och förutsättningar. Även organisatoriska parametrar såsom gruppkonstellationer, gruppstorlek och klassrumssituation är omständigheter som kan påverka. Dessutom finns det ytterligare förhållanden som påverkar läsning och inlärning överhuvudtaget, nämligen att vårt språk är vårt redskap för att tänka och känna och orden vi kan är våra budbärare för förståelse av text. Många saker kan samspela och bidra till att läsupplevelser kan äga rum eller motverka och hämma läsningen. En av respondenterna, E, sätter fingret på den komplexitet som momentet läsning i Engelska B/6 innebär genom att säga "det finns lika många lärare som det finns olika sätt att göra det"!

  • 17729.
    Xi, Xiaochuan
    Dalarna University, School of Technology and Business Studies, Economics.
    A Study on China's Income Inequality and the Relationship with Economic Growth2009Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    The purpose of this paper is to study China’s income inequality under rapid economic growth. Does the relationship between economic growth and income inequality in China follow the Kuznets hypothesis? What is the main cause and trend of China’s income inequality? We use data which covers the period 1980-2005 to analyze the overall inequality, and data covering the period 1980-2002 to analyze the inequality inside rural and urban areas. The derived results doubt the validity of Kuznets hypothesis on explaining the relationship between economic growth and income inequality in China. Also we derive the trend of China’s increased income inequality and find that the urban-rural income disparity is the main cause of China’s income inequality.

  • 17730.
    Xiao, Jing
    Dalarna University, School of Technology and Business Studies, Economics.
    The Impact of Foreign Direct Investment on International Trade: An Empirical Study of China2008Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    This paper investigates the impact of inward FDI (Foreign Direct Investment) on international trade of China empirically on the country level by using panel data from 1984 to 2007. Two separate transformed models which are based on the gravity equation and refer to the econometric models of some previous studies, are used in this paper to estimate the effect of FDI inflows on exports and imports respectively. The estimation results confirmed the complementary relationship between FDI inflows and trade of China both on exports and imports, which has also been supported by previous empirical studies.

  • 17731. Xiao, M
    et al.
    Tang, L
    Zhang, Xingxing
    Dalarna University, School of Technology and Business Studies, Energy Technology.
    Yu-Fat-Lun, I
    Li, G
    Analysis on cooling technologies of concentrated solar power system: a review2017Conference paper (Refereed)
    Abstract [en]

    The application of the Concentrated Solar Power (CSP) system has attracted an ever-increasing attention with the deepening worldwide energy crisis. Operating temperature is one of the most important factors for CSP system that affects the solar photoelectric conversion efficiency. Reasonable cooling method cannot only decrease the operative temperature, balance flare inhomogeneity, also should display the characteristics of convenient installation, low power consumption and high reliability. Based on a comprehensive literature review, this work conducted a thorough compilation on different cooling techniques of CSP system. It includes the commonly used air cooling and water cooling, also illustrates the promising ground coupled cooling, impinging jet cooling, liquid immersion cooling, microchannel cooling, heat pipe cooling and Phase Change Material systems etc. Besides, the advantages and disadvantages of different cooling technologies are briefly analysed. It is expected that this paper could provide guidance for development and optimization of cooling technologies in CSP system.

  • 17732. Xiao, Manxuan
    et al.
    Tang, Llewelly
    Zhang, Xingxing
    Dalarna University, School of Technology and Business Studies, Energy Technology.
    Lun, Isaac Yu Fat
    Yuan, Yanping
    A Review on Recent Development of Cooling Technologies for Concentrated Photovoltaics (CPV) Systems2018In: Energies, ISSN 1996-1073, E-ISSN 1996-1073, Vol. 11, no 12, article id 3416Article in journal (Refereed)
    Abstract [en]

    Concentrated Photovoltaics (CPV) technology, as an energy saving method which can directly generate electricity from the Sun, has attracted an ever-increasing attention with the deepening worldwide energy crisis. However, operating temperature is one of the main concerns that affect the CPV system. Excess cell temperature causes electrical conversion efficiency loss and cell lifespan decrease. Thus, reasonable cooling methods should decrease the operating temperature and balance the flare inhomogeneity. They also need to display high reliability, low power consumption, and convenient installation. This paper presented the architectural, commercial, and industrial usage of CPV system, reviewed the recent research developments of different cooling techniques of CPV systems during last few years, including the spectral beam splitting technology, cogeneration power technology, commonly used and promising cooling techniques, active and passive cooling methods. It also analysed the design considerations of the cooling methods in CPV systems, introduced the classification and basic working principles and provided a thorough compilation of different cooling techniques with their advantages, current research limitations, challenges, and possible further research directions. The aim of this work is to find the research gap and recommend feasible research direction of cooling technologies for CPV systems. 

  • 17733.
    Xiao, Yumin
    et al.
    Dalarna University, School of Technology and Business Studies, Statistics.
    Wang, Heng
    Dalarna University, School of Technology and Business Studies, Statistics.
    Aviation accident insurance: actuarial modeling, pricing, and demonstrating the long-term risk via simulation2010Independent thesis Basic level (degree of Bachelor)Student thesis
    Abstract [en]

    Background: Since the 9.11 air disaster has happened, the degree of concern for aviation accident insurance is higher than before. Having been reformed for several times since 1989, the aviation accident insurance is still dissatisfied with the reality in China. The view that the aviation accident insurance can make huge profits spreads widely. Two obvious defects, huge profits and lack of risk resisting abilities, needs to be solved by the insurers. To understand the problem and propose reasonable strategies, we introduced an actuarial model and did simulations for different scenarios, to see how the premium and risk are connected on the long-term scale. Results: Our simulation results show a monotonic pattern between the yearly premium and the bankruptcy probability for scenarios of 50-200 years periods. Only for the low accident rate of 1/8000000 which is close to the Chinese situation, a yearly premium amount of a single-crash compensation can control the bankruptcy probability to about 5%. Conclusions: The accident rate of the insured airlines needs to be controlled to reduce risk, comprehensive reserve system and reinsurance might also need to be set up.

  • 17734. Xiong, Y
    et al.
    Bo, L
    Qiang, M
    Wu, Y
    Zhang, Xingxing
    Dalarna University, School of Technology and Business Studies, Energy Technology. University of Nottingham.
    Xu, P
    Ma, C
    A characteristic study on the start-up performance of molten-salt heat pipes: Experimental investigation2017In: Experimental Thermal and Fluid Science, ISSN 0894-1777, E-ISSN 1879-2286, Vol. 82, p. 433-438Article in journal (Refereed)
    Abstract [en]

    This paper reports a fundamental experimental investigation of the start-up characteristics of heat pipes using a dedicated molten-salt mixture as the working fluid. Based on four single salt, i.e. NaNO3(AR), KNO3(AR), LiNO3(AR) and Ca(NO3)2(AR), a quaternary molten-salt working fluid was developed and charged at different masses into four heat pipes with the same dimensions of 980 mm in length and 22 mm in diameter. A parallel comparison on the start-up performance of these heat pipes was then conducted to observe the influence of the charging mass and the inclination angle under the consistent lab-controlled conditions. The experimental results showed the heat pipe with molten-salt charge of 40 g responded much quicker than those with molten salt charge of 60 g, 70 g and 80 g respectively; meanwhile, the molten-salt heat pipe achieved the maximum condensation temperature at inclination angle of 50°. Comparing to the conventional naphthalene heat pipe, the dedicated molten-salt heat pipe had a much shorter start-up time when they were charged with the same amount of 40 g. The overall research result is expected to provide certain guidance for further design and operation of molten-salt heat pipe in high-and-medium-temperature heat transfer and storage scenarios. 

  • 17735. Xiong, Zibo
    et al.
    Xu, Hong
    Huang, Xiaoyan
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Qureshi, Abdul Rashid
    Cederholm, Tommy
    Sjogren, Per
    Lindholm, Bengt
    Riserus, Ulf
    Carrero, Juan Jesus
    Nonesterified fatty acids and cardiovascular mortality in elderly men with CKD2015In: American Society of Nephrology. Clinical Journal, ISSN 1555-9041, E-ISSN 1555-905X, Vol. 10, no 4, p. 584-591Article in journal (Refereed)
    Abstract [en]

    Background and objectives Although nonesterified fatty acids (NEFAs) are essential as energy substrate for the myocardium, an excess of circulating NEFAs can be harmful. This study aimed to assess plausible relationships between serum NEFA and mortality due to cardiovascular disease (CVD) in individuals with CKD. Design, setting, participants, & measurements This was a prospective cohort study from the third examination cycle of the Uppsala LongitudinaL Study of Adult Men, a population-based survey of 1221 elderly men aged 70-71 years residing in Uppsala, Sweden. Data collection took place during 1991-1995. All participants had measures of kidney function; this study investigated 623 (51.7%) of these patients with manifest CKD (defined as either eGFR<60 ml/min per 1.73 m(2) or urine albumin excretion rate >= 20 mu g/min). Follow-up for mortality was done from examination date until death or December 31, 2007. After a median follow-up of 14 years (nterquartile range, 8-16.8), associations of NEFAs with mortality (related to all causes, CVD, ischemic heart disease [IHD], or acute myocardial infarction) were ascertained. Results The median serum NEFA was 14.1 mg/dl (interquartile range, 11.3-17.8). No association was found with measures of kidney function. Diabetes and serum triglycerides were the only multivariate correlates of NEFA. During follow-up, 453 participants died, of which 209 deaths were due to CVD, including 88 IHD deaths, with 41 attributed to acute myocardial infarction (AMI). In fully adjusted covariates, serum NEFA was an independent risk factor for all-cause mortality (hazard ratio [HR] per log(2) increase, 1.22; 95% confidence interval [95% CI], 1.00 to 1.48) and CVD-related death (HR, 1.51; 95% CI, 1.15 to 1.99), including both IHD (HR, 1.51; 95% CI, 1.00 to 2.32) and AMI mortality (HR, 2.08; 95% CI, 1.09 to 3.98). Conclusions Elevated serum NEFA associated with CVD mortality, and particularly with mortality due to AMI, in a homogeneous population of older men with moderate CKD.

  • 17736. Xu, H.
    et al.
    Rossi, M.
    Campbell, K. L.
    Sencion, G. L.
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Uppsala universitet.
    Cederholm, T.
    Sjögren, P.
    Risérus, U.
    Lindholm, B.
    Carrero, J. J.
    Excess protein intake relative to fiber and cardiovascular events in elderly men with chronic kidney disease.2016In: NMCD. Nutrition Metabolism and Cardiovascular Diseases, ISSN 0939-4753, E-ISSN 1590-3729, Vol. 26, no 7, p. 597-602Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND AIMS: The elevated cardiovascular (CVD) risk observed in chronic kidney disease (CKD) may be partially alleviated through diet. While protein intake may link to CVD events in this patient population, dietary fiber has shown cardioprotective associations. Nutrients are not consumed in isolation; we hypothesize that CVD events in CKD may be associated with dietary patterns aligned with an excess of dietary protein relative to fiber.

    METHODS AND RESULTS: Prospective cohort study from the Uppsala Longitudinal Study of Adult Men. Included were 390 elderly men aged 70-71 years with CKD and without clinical history of CVD. Protein and fiber intake, as well as its ratio, were calculated from 7-day dietary records. Cardiovascular events were registered prospectively during a median follow-up of 9.1 (inter-quartile range, 4.5-10.7) years. The median dietary intake of protein and fiber was 66.7 (60.7-71.1) and 16.6 (14.5-19.1) g/day respectively and the protein-to-fiber intake ratio was 4.0 (3.5-4.7). Protein-to-fiber intake ratio was directly associated with serum C-reactive protein levels. During follow-up, 164 first-time CVD events occurred (incidence rate 54.5/1000 per year). Protein-fiber intake ratio was an independent risk factor for CVD events [adjusted hazard ratio, HR per standard deviation increase (95% confidence interval, CI) 1.33 (1.08, 1.64)]. Although in opposing directions, dietary protein [1.18 (0.97, 1.44)], dietary fiber alone [0.81 (0.64, 1.02)], were not significantly associated with CVD events.

    CONCLUSIONS: An excess of dietary protein relative to fiber intake was associated with the incidence of cardiovascular events in a homogeneous population of older men with CKD.

  • 17737. Xu, H
    et al.
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Uppsala universitet.
    Sandhagen, B
    Risérus, U
    Lindholm, B
    Lind, L
    Carrero, J J
    Lipophilic index, kidney function, and kidney function decline2016In: NMCD. Nutrition Metabolism and Cardiovascular Diseases, ISSN 0939-4753, E-ISSN 1590-3729, Vol. 26, no 12, p. 1096-1103Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND AIMS: Unhealthy dietary fats are associated with faster kidney function decline. The cell membrane composition of phospholipid fatty acids (FAs) is a determinant of membrane fluidity and rheological properties. These properties, which have been linked to kidney damage, are thought to be reflected by the lipophilic index (LI). We prospectively investigated the associations of LI with kidney function and its decline.

    METHODS AND RESULTS: Observational study from the Prospective Investigation of Vasculature in Uppsala Seniors including 975 men and women with plasma phospholipid FAs composition and cystatin-C estimate glomerular filtration rate (eGFR). Of these, 780 attended re-examination after 5 years, and eGFR changes were assessed. Participants with a 5-year eGFR reduction ≥30% were considered chronic kidney disease (CKD) progressors (n = 198). LI was calculated as the sum of the products of the FA proportions with the respective FAs melting points. Blood rheology/viscosity measurements were performed in a random subsample of 559 subjects at baseline. Increased LI showed a statistically significant but overall weak association with blood, plasma viscosity (both Spearman rho = 0.16, p < 0.01), and erythrocyte deformability (rho = -0.09, p < 0.05). In cross-sectional analyses, LI associated with lower eGFR (regression coefficient 3.00 ml/min/1.73 m(2) 1-standard deviation (SD) increment in LI, 95% CI: -4.31, -1.69, p < 0.001). In longitudinal analyses, LI associated with a faster eGFR decline (-2.13 [95% CI -3.58, -0.69] ml/min/1.73 m(2), p < 0.01) and with 32% increased odds of CKD progression (adjusted OR 1.32 [95%, CI 1.05-1.65]).

    CONCLUSIONS: A high LI was associated with lower kidney function, kidney function decline, and CKD progression.

  • 17738. Xu, Hong
    et al.
    Evans, Marie
    Gasparini, Alessandro
    Szummer, Karolina
    Spaak, Jonas
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Uppsala universitet.
    Lindholm, Bengt
    Jernberg, Tomas
    Carrero, Juan Jesús
    Outcomes associated to serum phosphate levels in patients with suspected acute coronary syndrome2017In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 245, p. 20-26Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: We investigated the association between phosphate and the risk of adverse clinical outcomes in patients with manifest cardiovascular disease (CVD).

    METHODS: Observational study of patients hospitalized during 2006-2011 in Stockholm, Sweden, because of suspected acute coronary syndrome (ACS). The exposure was serum phosphate during the hospitalization. We modeled the association between phosphate and in-hospital death or in-hospital events (composite of myocardial infarction, cardiogenic shock, resuscitated cardiac arrest, atrial fibrillation, or atrioventricular block) as well as the one-year post-discharge risk of death or cardiovascular event (composite of myocardial re-infarction, heart failure and stroke). Confounders included demographics, comorbidities, kidney function, diagnoses, in-hospital procedures and therapies.

    RESULTS: Included were 2547 patients (68% men, mean age 67±14years) with median phosphate of 1.10 (range 0.14-4.20) mmol/L. During hospitalization, 198 patients died and 328 suffered an adverse event. Within one year post-discharge, further 381 deaths and 632 CVD events occurred. The associations of phosphate with mortality and CVD were J-shaped, with highest risk magnitudes at higher phosphate levels. For instance, compared to patients in the 50th percentile of phosphate distribution, those above the 75th percentile (1.3mmol/L, normal range) had significantly higher odds for in-hospital death [odds ratio 1.36, 95% confidence interval (CI) (1.08-1.71)] and of CVD post-discharge [sub-hazard ratios 1.17 (1.03-1.33)].

    CONCLUSIONS: In patients with suspected ACS, both higher and lower phosphate levels associated with increased risk of adverse outcomes during the index hospitalization and within one year post-discharge. The risk association was present already within normal-range serum phosphate values.

  • 17739. Xu, Hong
    et al.
    Gasparini, Alessandro
    Ishigami, Junichi
    Mzayen, Khaled
    Su, Guobin
    Barany, Peter
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Uppsala universitet.
    Lindholm, Bengt
    Elinder, Carl Gustaf
    Carrero, Juan Jesús
    eGFR and the risk of community-acquired infections2017In: American Society of Nephrology. Clinical Journal, ISSN 1555-9041, E-ISSN 1555-905X, Vol. 12, no 9, p. 1399-1408Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND OBJECTIVES: Community-acquired infections are common, contributing to adverse outcomes and increased health care costs. We hypothesized that, with lower eGFR, the incidence of community-acquired infections increases, whereas the pattern of site-specific infections varies.

    DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Among 1,139,470 health care users (mean age =52±18 years old, 53% women) from the Stockholm CREAtinine Measurements Project, we quantified the associations of eGFR with the risk of infections, overall and major types, over 12 months.

    RESULTS: A total of 106,807 counts of infections were recorded throughout 1,128,313 person-years. The incidence rate of all infections increased with lower eGFR from 74/1000 person-years for individuals with eGFR=90-104 ml/min per 1.73 m(2) to 419/1000 person-years for individuals with eGFR<30 ml/min per 1.73 m(2). Compared with eGFR of 90-104 ml/min per 1.73 m(2), the adjusted incidence rate ratios of community-acquired infections were 1.08 (95% confidence interval, 1.01 to 1.14) for eGFR of 30-59 ml/min per 1.73 m(2) and 1.53 (95% confidence interval, 1.39 to 1.69) for eGFR<30 ml/min per 1.73 m(2). The relative proportions of lower respiratory tract infection, urinary tract infection, and sepsis became increasingly higher along with lower eGFR strata (e.g., low respiratory tract infection accounting for 25% versus 15% of community-acquired infections in eGFR<30 versus 90-104 ml/min per 1.73 m(2), respectively). Differences in incidence associated with eGFR were in general consistent for most infection types, except for nervous system and upper respiratory tract infections, for which no association was observed.

    CONCLUSIONS: This region-representative health care study finds an excess community-acquired infections incidence in individuals with mild to severe CKD. Lower respiratory tract infection, urinary tract infection, and sepsis are major infections in CKD.

  • 17740.
    Xu, Hong
    et al.
    Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden ; Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China.
    Huang, Xiaoyan
    Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden ; Division of Nephrology, Peking University Shenzhen Hospital, Peking University, Shenzhen, China.
    Risérus, Ulf
    Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden.
    Cederholm, Tommy
    Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden.
    Lindholm, Bengt
    Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Department of Public Health and Caring Sciences, Section of Geriatrics, Uppsala University, Uppsala, Sweden.
    Carrero, Juan Jesús
    Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden ; Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden ; Center for Gender Medicine, Karolinska Institutet, Stockholm, Sweden.
    Urinary albumin excretion, blood pressure changes and hypertension incidence in the community: effect modification by kidney function2014In: Nephrology, Dialysis and Transplantation, ISSN 0931-0509, E-ISSN 1460-2385, Vol. 29, no 8, p. 1538-1545Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Both increased albuminuria and reduced kidney function may predict blood pressure (BP) progression in the community, while they exacerbate each other's effects. We investigated associations and interactions between these two risk factors, BP changes and hypertension incidence in community-dwelling elderly men.

    METHODS: Observational study from the Uppsala Longitudinal Study of Adult Men, which included 1051 men (all aged 71 years) with assessments on urinary albumin excretion rate (UAER), 24-hour ambulatory BP monitoring (ABPM) and cystatin-C estimated glomerular filtration rate (eGFR). Of these, 574 men attended re-examination after 6 years, and ABPM measurements were again recorded to assess blood pressure changes and hypertension incidence.

    RESULTS: UAER was found to be associated with ABPM measurements both at baseline and longitudinally. In longitudinal analysis, there were significant interactions between UAER and kidney function in its association with the changes of systolic BP, mean arterial pressure and pulse pressure. After stratification for renal function state, UAER independently predicted BP changes only in those who had eGFR <60 mL/min/1.73 m(2). At re-examination, 71 new cases of hypertension were recorded. In multivariable logistic models, similar interactions were observed on hypertension incidence: UAER was an independent predictor of incident hypertension only in those with reduced renal function. These associations were evident also in the subpopulation of non-diabetics and in participants with normal range UAER (<20 µg/min).

    CONCLUSIONS: In community-dwelling elderly men, UAER associates with BP progression and hypertension incidence, even within the normal range. Concurrent reduction of renal function modifies and exacerbates these associations.

  • 17741.
    Xu, Hong
    et al.
    Karolinska institutet .
    Huang, Xiaoyan
    Karolinska institutet; Peking University Shenzhen Hospital.
    Risérus, Ulf
    Uppsala universitet.
    Cederholm, Tommy
    Uppsala universitet.
    Sjögren, Per
    Uppsala universitet.
    Lindholm, Bengt
    Karolinska institutet .
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Carrero, Juan Jesús
    Karolinska institutet .
    Albuminuria, renal dysfunction and circadian blood pressure rhythm in older men: a population-based longitudinal cohort study2015In: Clinical Kidney Journal, ISSN 2048-8505, E-ISSN 2048-8513, Vol. 8, no 5, p. 560-6Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Both albuminuria and kidney dysfunction may affect circadian blood pressure (BP) rhythm, while exacerbating each other's effects. We investigated associations and interactions of these two risk factors with circadian BP rhythm variation and non-dipper pattern progression in community-dwelling older men.

    METHODS: This was a cross-sectional and longitudinal analyses in the third and fourth cycles of the Uppsala Longitudinal Study of Adult Men, including 1051 men (age 71 years) with assessments on urinary albumin excretion rate (UAER), 24-h ambulatory BP monitoring (ABPM) and cystatin-C-estimated glomerular filtration rate (eGFR). Of these, 574 men attended re-examination after 6 years. Study outcomes were ABMP changes and non-dipping BP pattern (prevalence and progression).

    RESULTS: UAER associated with circadian BP rhythm both cross-sectionally and longitudinally. Longitudinally, significant interactions were observed between UAER and kidney dysfunction (eGFR < 60 mL/min/1.73 m(2)) in its association with the changes of both night-time systolic BP (SBP) and night-day SBP ratio. After stratification, UAER strongly predicted night-day SBP ratio change only in those with concurrent kidney dysfunction. At re-examination, 221 new cases of non-dipper were identified. In multivariable logistic models, high UAER associated with increased likelihood of non-dipper progression, but more strongly so among individuals with concurrent kidney dysfunction. These associations were evident also in the subpopulation of non-diabetics and in participants with normal range UAER.

    CONCLUSIONS: UAER associates with circadian BP rhythm variation and non-dipper progression in elderly men. Concurrent renal dysfunction modifies and exacerbates these associations.

  • 17742. Xu, Hong
    et al.
    Huang, Xiaoyan
    Risérus, Ulf
    Krishnamurthy, Vidya M
    Cederholm, Tommy
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Uppsala universitet.
    Lindholm, Bengt
    Sjögren, Per
    Carrero, Juan Jesús
    Dietary fiber, kidney function, inflammation, and mortality risk2014In: American Society of Nephrology. Clinical Journal, ISSN 1555-9041, E-ISSN 1555-905X, Vol. 9, no 12, p. 2104-2110Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND OBJECTIVES: In the United States population, high dietary fiber intake has been associated with a lower risk of inflammation and mortality in individuals with kidney dysfunction. This study aimed to expand such findings to a Northern European population.

    DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Dietary fiber intake was calculated from 7-day dietary records in 1110 participants aged 70-71 years from the Uppsala Longitudinal Study of Adult Men (examinations performed during 1991-1995). Dietary fiber was adjusted for total energy intake by the residual method. Renal function was estimated from the concentration of serum cystatin C, and deaths were registered prospectively during a median follow-up of 10.0 years.

    RESULTS: Dietary fiber independently and directly associated with eGFR (adjusted difference, 2.6 ml/min per 1.73 m(2) per 10 g/d higher; 95% confidence interval [95% CI], 0.3 to 4.9). The odds of C-reactive protein >3 mg/L were lower (linear trend, P=0.002) with higher fiber quartiles. During follow-up, 300 participants died (incidence rate of 2.87 per 100 person-years at risk). Multiplicative interactions were observed between dietary fiber intake and kidney dysfunction in the prediction of mortality. Higher dietary fiber was associated with lower mortality in unadjusted analysis. These associations were stronger in participants with kidney dysfunction (eGFR<60 ml/min per 1.73 m(2)) (hazard ratio [HR], 0.58; 95% CI, 0.35 to 0.98) than in those without (HR, 1.30; 95% CI, 0.76 to 2.22; P value for interaction, P=0.04), and were mainly explained by a lower incidence of cancer-related deaths (0.25; 95% CI, 0.10 to 0.65) in individuals with kidney dysfunction versus individuals with an eGFR≥60 ml/min per 1.73 m(2) (1.61; 95% CI, 0.69 to 3.74; P value for interaction, P=0.01).

    CONCLUSIONS: High dietary fiber was associated with better kidney function and lower inflammation in community-dwelling elderly men from Sweden. High dietary fiber was also associated with lower (cancer) mortality risk, especially in individuals with kidney dysfunction.

  • 17743.
    Xu, Hong
    et al.
    Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden;Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China;.
    Huang, Xiaoyan
    Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Division of Nephrology, Peking University Shenzhen Hospital, Peking University, Shenzhen, China;.
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Department of Public Health and Caring Sciences, Section of Geriatrics, and Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden.
    Cederholm, Tommy
    Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden;.
    Stenvinkel, Peter
    Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
    Lindholm, Bengt
    Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
    Risérus, Ulf
    Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden;.
    Carrero, Juan Jesús
    Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden; Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden;.
    Clinical correlates of insulin sensitivity and its association with mortality among men with CKD stages 3 and 42014In: American Society of Nephrology. Clinical Journal, ISSN 1555-9041, E-ISSN 1555-905X, Vol. 9, no 4, p. 690-697Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND OBJECTIVES: Insulin resistance participates in the pathogenesis of multiple metabolic and cardiovascular diseases. CKD patients have impaired insulin sensitivity, but the clinical correlates and outcome associations of impaired insulin sensitivity in this vulnerable population are not well defined.

    DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The prospective cohort study was from the third examination cycle of the Uppsala Longitudinal Study of Adult Men, a population-based survey of elderly men ages 70-71 years; insulin sensitivity was assessed by glucose disposal rate as measured with euglycemic clamps. Inclusion criterion was eGFR<60 ml/min per 1.73 m(2) (n=543). Exclusion criteria were incomplete data on euglycemic clamp and diabetes (n=97), leaving 446 men with CKD stages 3 and 4 (eGFR median=51.9 ml/min per 1.73 m(2); range=20.2-59.5 ml/min per 1.73 m(2)).

    RESULTS: The mean of glucose disposal rate was 5.4 ± 1.9 mg/kg per minute. In multivariable analysis, the independent clinical correlates of glucose disposal rate were eGFR (slope, 0.02; 95% confidence interval, 0.01 to 0.04), hypertension (-0.48; 95% confidence interval, -0.86 to -0.11), hyperlipidemia (-0.51; 95% confidence interval, -0.84 to -0.18), and body mass index (-0.32; 95% confidence interval, -0.37 to -0.27). During follow-up (median=10.0 years; interquartile range=8.7-11.0 years), 149 participants died. In Cox regression models, glucose disposal rate was not associated with all-cause or cardiovascular mortality. Multiplicative interactions (P<0.05) were observed between glucose disposal rate and physical activity or smoking in total mortality association. After subsequent stratification, glucose disposal rate was an independent correlate of all-cause mortality in smokers (adjusted hazard ratio, 0.72; 95% confidence interval, 0.54 to 0.96 per 1 mg/kg per minute glucose disposal rate increase) and physically inactive individuals (hazard ratio, 0.77; 95% confidence interval, 0.61 to 0.97) but not their counterparts.

    CONCLUSION: eGFR, together with various components of the metabolic syndrome, contributed to explain the variance of insulin sensitivity in men with CKD stages 3 and 4. Insulin sensitivity was associated with a lower mortality risk in individuals who smoked and individuals who were physically inactive.

  • 17744.
    Xu, Hong
    et al.
    Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska University Hospital K56, Karolinska Institutet, 14186, Stockholm, Sweden ; Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China.
    Jia, Ting
    Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska University Hospital K56, Karolinska Institutet, 14186, Stockholm, Sweden.
    Huang, Xiaoyan
    Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska University Hospital K56, Karolinska Institutet, 14186, Stockholm, Sweden ; Division of Nephrology, Peking University Shenzhen Hospital, Peking University, Shenzhen, China.
    Risérus, Ulf
    Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden.
    Cederholm, Tommy
    Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden.
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Department of Public Health and Caring Sciences, Section of Geriatrics, Uppsala University, Uppsala, Sweden .
    Sjögren, Per
    Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden.
    Lindholm, Bengt
    Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska University Hospital K56, Karolinska Institutet, 14186, Stockholm, Sweden.
    Carrero, Juan-Jesús
    Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska University Hospital K56, Karolinska Institutet, 14186, Stockholm, Sweden ; Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.
    Dietary acid load, insulin sensitivity and risk of type 2 diabetes in community-dwelling older men2014In: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428, Vol. 57, no 8, p. 1561-1568Article in journal (Refereed)
    Abstract [en]

    AIMS/HYPOTHESIS: We tested the hypothesis that dietary acid load may increase the risk of type 2 diabetes, and studied the association between acid load and insulin sensitivity as a possible mechanism involved.

    METHODS: An observational survey with prospective follow-up including 911 non-diabetic Swedish men aged 70-71 years was carried out. The gold standard euglycaemic-hyperinsulinaemic clamp technique and the OGTT were used to determine insulin sensitivity and beta cell function, respectively. Diabetes incidence was assessed during 18 years of follow-up. Renal function was estimated from serum cystatin C concentrations. Dietary acid load was calculated as potential renal acid load (PRAL) and net endogenous acid production (NEAP) algorithms from 7 day food records. Adequate dietary reporters were identified by Goldberg cut-offs.

    RESULTS: PRAL and NEAP were not associated with insulin sensitivity or beta cell function. Underlying kidney function or consideration of dietary adequate reporters did not modify these null findings. During follow-up, 115 new cases of diabetes were validated. Neither PRAL nor NEAP was associated with diabetes incidence.

    CONCLUSIONS/INTERPRETATION: Our results do not support the hypothesis that dietary acid load influences insulin sensitivity, beta cell function or diabetes risk. Interventional studies modifying acid-base dietary intake are needed to further elucidate a possible role of acid load in the development of type 2 diabetes.

  • 17745. Xu, Hong
    et al.
    Matsushita, Kunihiro
    Su, Guobin
    Trevisan, Marco
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Karolinska Institutet.
    Barany, Peter
    Lindholm, Bengt
    Elinder, Carl-Gustaf
    Lambe, Mats
    Carrero, Juan-Jesus
    Estimated glomerular filtration rate and the risk of cancer2019In: American Society of Nephrology. Clinical Journal, ISSN 1555-9041, E-ISSN 1555-905X, Vol. 14, no 4, p. 530-539Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND OBJECTIVES: Community-based reports regarding eGFR and the risk of cancer are conflicting. We here explore plausible links between kidney function and cancer incidence in a large Scandinavian population-based cohort.

    DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In the Stockholm Creatinine Measurements project, we quantified the associations of baseline eGFR with the incidence of cancer among 719,033 Swedes ages ≥40 years old with no prior history of cancer. Study outcomes were any type and site-specific cancer incidence rates on the basis of International Classification of Diseases-10 codes over a median follow-up of 5 years. To explore the possibility of detection bias and reverse causation, we divided the follow-up time into different time periods (≤12 and >12 months) and estimated risks for each of these intervals.

    RESULTS: In total, 64,319 cases of cancer (affecting 9% of participants) were detected throughout 3,338,226 person-years. The relationship between eGFR and cancer incidence was U shaped. Compared with eGFR of 90-104 ml/min, lower eGFR strata associated with higher cancer risk (adjusted hazard ratio, 1.08; 95% confidence interval, 1.05 to 1.11 for eGFR=30-59 ml/min and adjusted hazard ratio, 1.24; 95% confidence interval, 1.15 to 1.35 for eGFR<30 ml/min). Lower eGFR strata were significantly associated with higher risk of skin, urogenital, prostate, and hematologic cancers. Any cancer risk as well as skin (nonmelanoma) and urogenital cancer risks were significantly elevated throughout follow-up time, but they were higher in the first 12 months postregistration. Associations with hematologic and prostate cancers abrogated after the first 12 months of observation, suggesting the presence of detection bias and/or reverse causation.

    CONCLUSIONS: There is a modestly higher cancer risk in individuals with mild to severe CKD driven primarily by skin and urogenital cancers, and this is only partially explained by bias.

  • 17746. Xu, Hong
    et al.
    Sjogren, Per
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Banerjee, Tanushree
    Cederholm, Tommy
    Riserus, Ulf
    Lindholm, Bengt
    Lind, Lars
    Carrero, Juan Jesus
    A proinflammatory diet is associated with systemic inflammation and reduced kidney function in elderly adults2015In: Journal of Nutrition, ISSN 0022-3166, E-ISSN 1541-6100, Vol. 145, no 4, p. 729-735Article in journal (Refereed)
    Abstract [en]

    Background: Diet can affect kidney health through its effects on inflammation. Objective: We tested whether the Adapted Dietary Inflammatory Index (ADII) is associated with kidney function and whether effects of diet on chronic low-grade inflammation explain this association. Methods: This was an observational analysis in 1942 elderly community-dwelling participants aged 70-71 y from 2 independent cohorts: the Uppsala Longitudinal Study of Adult Men (n = 1097 men) and the Prospective Investigation of Vasculature in Uppsala Seniors (n = 845 men and women). The ADII was calculated from 7-d food records, combining putatively proinflammatory and anti-inflammatory effects of nutrients, vitamins, and trace elements. The ADII was validated against serum C-reactive protein (CRP) concentrations. The estimated glomerular filtration rate (eGFR) was assessed from serum cystatin C (cys) and creatinine (crea). Associations between the ADII and eGFR were investigated, and CRP was considered to be a mediator. Results: In adjusted analysis, a 1-SD higher ADII was associated with higher CRP (beta: 6%, 95% Cl: 1%, 10%; P= 0.01) and lower eGFR [Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI)(cys): -2.1%, 95% Cl: -3.2%, -1.1%; CKD-EPi(cys+crea): -1.8%; 95% Cl: -2.7%, -0.9%; both P < 0.001]. CRP was also inversely associated with eGFR. Mediation analyses showed that of the total effect of the ADII on kidney function, 15% and 17% (for CKD-EPIcys+crea and CKD-EPIcys equations, respectively) were explained/mediated by serum CRP. Findings were similar when each cohort was analyzed separately. Conclusions: A proinflammatory diet was associated with systemic inflammation as well as with reduced kidney function in a combined analysis of 2 community-based cohorts of elderly individuals. Our results also suggest systemic inflammation to be one potential pathway through which this dietary pattern is linked to kidney function.

  • 17747. Xu, Hong
    et al.
    Xiong, Zibo
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Uppsala university.
    Qureshi, Abdul Rashid
    Cederholm, Tommy
    Sjögren, Per
    Lindholm, Bengt
    Risérus, Ulf
    Carrero, Juan Jesus
    Circulating alpha-tocopherol and insulin sensitivity among older men with chronic kidney disease2016In: Journal of renal nutrition (Print), ISSN 1051-2276, E-ISSN 1532-8503, Vol. 26, no 3, p. 177-182Article in journal (Refereed)
    Abstract [en]

    Objective: Insulin resistance is common in individuals with chronic kidney disease (CKD) and may be partly explained by modifiable risk factors. In the general population, vitamin E supplementation has been suggested to improve both insulin sensitivity and secretion. We here explore the potential role of vitamin E as a modifiable risk factor for insulin resistance among individuals with CKD.

    Design: Observational study.

    Setting: A total of 273 nondiabetic men aged 70 to 71 years with CKD defined as either cystatin C estimated glomerular filtration rate &lt; 60 mL/minute/1.73 m2 or urinary albumin excretion rate ≥ 20 mg/minute from the third examination cycle of Uppsala Longitudinal Study of Adult Men.

    Subjects: A total of 273 nondiabetic men aged 70 to 71 years with CKD defined as either cystatin C estimated glomerular filtration rate &lt; 60 mL/minute/1.73 m2 or urinary albumin excretion rate ≥ 20 μg/minute.

    Methods: Serum α-, β-, and γ-tocopherol concentrations were measured by high-performance liquid chromatography and expressed as μmol/total serum cholesterol and triglycerides (in mmol). Dietary vitamin E intake was estimated from 7-day food records.

    Main Outcome Measure: Insulin sensitivity index (M/I ratio) was measured by hyperinsulinemic-euglycemic glucose clamps. Univariate and multivariate regression models were fitted to assess the association between M/I and circulating concentrations of tocopherols.

    Results: The mean serum concentration of α-, β-, and γ- was 37.4 ± 6.58, 0.89 ± 0.23, and 4.32 ± 1.69 μmol/mmol, respectively. Median dietary vitamin E intake was 6.14 (interquartile range, 5.48-6.82) mg/day. In crude and fully-adjusted multivariate regression analyses, serum α-tocopherol levels were directly and strongly associated with M/I (standard β = 0.17, P = .003). No such association was observed for dietary vitamin E, serum β-, and γ-tocopherol concentrations.

    Conclusions: Serum α-tocopherol concentration associates with insulin sensitivity in nondiabetic older men with CKD. 

  • 17748. Xu, Jihuan
    et al.
    Zhang, Xingxing
    A novel water heating system by low-temperature solar capillary heat pipe assisted with heat pump2012Patent (Other (popular science, discussion, etc.))
  • 17749. Xu, Peng
    et al.
    Liu, Chenchen
    Zhang, Xingxing
    Tang, Llewellyn
    Numerical study on the thermal performance of earth-tube system for green building in Ningbo, China2016Conference paper (Refereed)
  • 17750. Xu, Peng
    et al.
    Shen, Jingchun
    University of Nottingham, Ningbo.
    Zhang, Xingxing
    University of Hull; University of Nottingham .
    He, Wei
    Zhao, Xudong
    Design, fabrication and experimental study of a novel loop-heat-pipe based solar thermal facade water heating system2015In: Energy Procedia, ISSN 1876-6102, E-ISSN 1876-6102, Vol. 75, p. 566-571Article in journal (Refereed)
    Abstract [en]

    This paper investigated a novel loop-heat-pipe based solar thermal facade heat-pump system for hot water from concept design, prototype fabrication and experimental test. Given the specific testing conditions, the solar thermal efficiency of the facade module achieved nearly 0.71 in average and the mean system's COP was about 5.0. It is expected that such novel LHP based solar thermal facade technology would further contributed to the development of the renewable (solar) driven heating/hot water service and therefore lead to significant environmental benefits.

352353354355356357358 17701 - 17750 of 18574
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