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Alterations in cerebral perfusion is increasingly considered to play a crucial role in Alzheimer’s disease (AD) and together with accumulated amyloid-β, deficiencies in the brain microvascular circulation may result in local hypoxia. Here, we studied alterations in cerebral circulation and the correlation between amyloid-β load and cerebral perfusion in prodromal AD (pAD). Using dynamic susceptibility contrast MRI and PET, we evaluated cerebral perfusion and amyloid-β levels in 19 individuals with mild cognitive impairment (MCI) and high amyloid-β load (pAD-MCI), 13 MCI individuals without AD pathology and 21 healthy controls. The pAD-MCI group showed significantly lower microvascular blood flow and significantly higher heterogeneity of microvascular blood transit times (p < 0.01) compared with the other 2 groups. Additionally, in the pAD-MCI group raised amyloid-β levels correlated with decreased microvascular blood flow and increased heterogeneity of microvascular blood flow in frontal and temporal areas (p < 0.01). These results indicate a close connection between levels of amyloid-β deposition and brain microvascular perfusion in pAD. A vicious cycle may be established where amyloid-β load and deficiencies in brain perfusion may reinforce each other.

OBJECTIVE: To establish a generally accepted Danish definition of dysphagia to enhance collaboration across sectors and professions. METHODS: The study was initiated by a multi-professional group of experienced researchers and board members of the Danish Society for Dysphagia. We used a modified Delphi methodology to achieve consensus among experienced health care professionals from different professions and contexts. The initial stage consisted of a literature search leading to the draft of different definitions followed by two Delphi rounds between professionals and a stakeholder consultation round. RESULTS: We conducted two Delphi rounds until one definition was clearly preferred. A total of 194 participants responded in round one, and 279 in round two. Both rounds had a broad representation of sectors and geography and most participants had worked with dysphagia for more than four years. CONCLUSION: The preferred definition was 'Dysphagia is a functional impairment that either prevents or limits the intake of food and fluids, and which makes swallowing unsafe, inefficient, uncomfortable or affects quality of life'. The definition was widely accepted among different health professional groups, patients and across sectors. ispartof: SCANDINAVIAN JOURNAL OF GASTROENTEROLOGY vol:58 issue:6 pages:583-588 ispartof: location:England status: accepted

Older adults in the nursing home are at high risk for polypharmacy. This article provides a background of older adults in nursing homes and reviews key steps to address polypharmacy.

This study aims to estimate the size, sociodemographic characteristics, and rates of sexually transmitted infections (STIs) in three key populations in Panama in 2018. Key populations included persons who self-identified as men who have sex (MSM), sex workers, and transgender women. Nationwide, trained peers conducted capture and recapture during the last quarter of 2018 at key population social gathering sites. Participants completed a self-administered questionnaire and, optionally, could opt-in for a blood sample to be tested for four STIs (HIV, syphilis, and hepatitides B and C). Population estimates were calculated using the Sightability Model R package. Among the 1,886 consenting participants, 1,715 completed the study procedures (1,278 MSM, 250 sex workers, and 187 transgender women). The median age was 28 (interquartile range 23–36 years) and most participants were single, Latinx, completed at least high school, worked, and earned less than twice the minimum wage per month. The national estimates were 49,966 MSM (3.81% of adult men), 8,326 sex workers (0.63% of adult women), and 3,100 transgender women (118.4 per 100,000 population). Most (77.4%) participants consented for STI testing, which allowed estimation of positivity rates for HIV (10.0%), syphilis (2.0%), and hepatitides B (1.0%) and C (0.1%). Incorporating capture-recapture methods allowed more precise estimates of key population sizes and to characterize their sociodemographic and STI profiles, to be used in programmatic efforts for resource allocation and prevention programs. As an indirect result, we anticipate increased representation and visibility of key populations in population and public health programs.

To evaluate whether the involvement of surgeons-in-training was associated with increased infection rates, including both prosthetic joint infection (PJI) and surgical site infection (SSI), following primary total knee arthroplasty (TKA).This was a retrospective review of outcomes following primary total knee arthroplasty. Surgeries were divided into two groups: (a) attending-only and (b) trainee-involved. Association with PJI and SSI were evaluated with univariate analysis and multivariate analysis to adjust for sex, age, body mass index (BMI), Charlson Comorbidity Index (CCI), year of surgery, operative time, and hospital/surgeon volume.A single, large North-American integrated healthcare system between January 1, 2014 and December 31, 2017.A total of 12,664 primary TKAs with a minimum of one-year (mean of 2-years, range 1-4.5) follow-up were evaluated.Residents and fellows were more likely to participate in cases with longer operative times (p0.001) than the attending-only group. A significant difference existed on univariate analysis between the trainee-involved group and attending-only group for PJI incidence (p=0.015) but not for SSI (p=0.840). After adjusting for patient- and procedure-related features, however, neither PJI nor SSI were independently associated with trainee involvement (PJI: p=0.089; SSI: p=0.998).Trainee participation did not directly correlate with increased infection risk, despite their association with longer-operative times and increased medical complexity. Further approaches to mitigating the risk of SSI and PJI for patients with increased comorbidities and in complex TKA cases, which demand longer operative times, are still required.

Background: Intra-abdominal adhesions are frequent side effects of surgery, associated with risks of serious complications such as abdominal pain, infertility, and small bowel obstruction. This study investigated a new autologous blood-based approach to adhesion prophylaxis. Materials and method: Two autologous blood-derived patches (whole-blood-derived, n = 20, and plasma-derived, n = 20) were evaluated as anti-adhesives. The patches were tested in a rat uterine horn damage model. We simulated an intraabdominal surgery by cauterizing and suturing the uterine horns and created an opposing damage by denuding a part of the abdominal wall. Each rat served as its own control with one treated uterine horn and one untreated. After 14 d of post-surgical recovery, the adhesions were assessed and graded macroscopically and microscopically. Statistical analyses were performed with Wilcoxon signed rank and Mann–Whitney U tests. Results: Both whole-blood and plasma-derived patches resulted in significantly less macroscopic adhesions than were found in untreated uterine horns (P = 0.001 and P = 0.002, respectively). Unpaired analysis found no significant differences between the whole-blood and plasma-derived patch outcomes in this study design. Histopathological evaluation of inflammation and fibrosis did not reveal significant differences between the patches and their matched controls. Conclusions: The autologous blood-derived patches reduced macroscopic adhesion formation significantly compared with no treatment. There were no adverse events and no histological differences between treatment and control, suggesting that the treatments were feasible and safe. In summary, this study confirms the potential of autologous anti-adhesives for the use in intraabdominal surgery.

Patient-reported return-to-work and job functioning 6 and 12 months after hospital discharge and received rehabilitation interventions and unmet rehabilitation needs were explored in a consecutive population of out-of-hospital cardiac arrest survivors. Patients working prior to cardiac arrest were invited to participate in a telephone administered survey. Thirty-eight surveys were conducted and included for analysis, equivalent to a minimum response rate of 95%. Survivors of out-of-hospital cardiac arrest had extensive challenges returning to work. Six- and 12-months post-arrest, 58% and 45% were respectively on full time sick leave or working notably less (>10 h/week) and with extensive unmet rehabilitation needs.

The pathophysiological development of Alzheimer's disease (AD) begins in the brain years before the onset of clinical symptoms. The accumulation of beta-amyloid (Aβ) is thought to be the first cortical pathology to occur. Carrying one apolipoprotein E (APOE) ε4 allele increases the risk of developing AD at least 2–3 times and is associated with earlier Aβ accumulation. Although it is difficult to identify Aβ-related cognitive impairment in early AD with standard cognitive tests, more sensitive memory tests may be able to do this. We sought to examine associations between Aβ and performance on three tests within three subdomains of memory, verbal, visual, and associative memory, to elucidate which of these tests were sensitive to Aβ-related cognitive impairment in at-risk subjects. 55 APOE ε4 carriers underwent MRI, 11C-Pittsburgh Compound B (PiB) PET, and cognitive testing. A composite cortical PiB SUVR cut-off score of 1.5 was used to categorise subjects as either APOE ε4 Aβ+ or APOE ε4 Aβ−. Correlations were carried out using cortical surface analysis. In the whole APOE ε4 group, we found significant correlations between Aβ load and performance on verbal, visual, and associative memory tests in widespread cortical areas, the strongest association being with performance on associative memory tests. In the APOE ε4 Aβ+ group, we found significant correlations between Aβ load and performance of verbal and associative, but not visual, memory in localised cortical areas. Performance on verbal and associative memory tests provides sensitive markers of early Aβ-related cognitive impairment in at-risk subjects.

Perioperative bleeding is a common complication in surgeries that increases morbidity, risk of mortality, and leads to increased socioeconomic costs. In this study we investigated a blood-derived autologous combined leukocyte, platelet, and fibrin patch as a new means of activating coagulation and maintaining hemostasis in a surgical setting. We evaluated the effects of an extract derived from the patch on the clotting of human blood in vitro, using thromboelastography (TEG). The autologous blood-derived patch activated hemostasis, seen as a reduced mean activation time compared to both non-activated controls, kaolin-activated samples, and fibrinogen/thrombin-patch-activated samples. The accelerated clotting was reproducible and did not compromise the quality or stability of the resulting blood clot. We also evaluated the patch in vivo in a porcine liver punch biopsy model. In this surgical model we saw 100% effective hemostasis and a significant reduction of the time-to-hemostasis, when compared to controls. These results were comparable to the hemostatic properties of a commercially available, xenogeneic fibrinogen/thrombin patch. Our findings suggest clinical potential for the autologous blood-derived patch as a hemostatic agent. Graphical Abstract

Background: Potential supplemental disease-modifying and neuroprotective treatment strategies are warranted in multiple sclerosis (MS). Exercise is a promising non-pharmacological approach, and an uninvestigated ‘window of opportunity’ exists early in the disease course. Objective: To investigate the effect of early exercise on relapse rate, global brain atrophy and secondary magnetic resonance imaging (MRI) outcomes. Methods: This randomized controlled trial ( n = 84, disease duration Results: No between-group differences were observed for primary outcomes, relapse rate (incidence-rate-ratio exercise relative to control: (0.49 (0.15; 1.66), p = 0.25) and global brain atrophy rate (−0.04 (−0.48; 0.40)%, p = 0.87), or secondary measures of lesion load. Aerobic fitness increased in favour of the exercise group. Microstructural integrity was higher in four of eight a priori defined motor-related tracts and nuclei in the exercise group compared with the control (thalamus, corticospinal tract, globus pallidus, cingulate gyrus) at 48 weeks. Conclusion: Early supervised aerobic exercise did not reduce relapse rate or global brain atrophy, but does positively affect the microstructural integrity of important motor-related tracts and nuclei.

Declines in European bird populations are reported for decades but the direct effect of major anthropogenic pressures on such declines remains unquantified. Causal relationships between pressures and bird population responses are difficult to identify as pressures interact at different spatial scales and responses vary among species. Here, we uncover direct relationships between population time-series of 170 common bird species, monitored at more than 20,000 sites in 28 European countries, over 37 y, and four widespread anthropogenic pressures: agricultural intensification, change in forest cover, urbanisation and temperature change over the last decades. We quantify the influence of each pressure on population time-series and its importance relative to other pressures, and we identify traits of most affected species. We find that agricultural intensification, in particular pesticides and fertiliser use, is the main pressure for most bird population declines, especially for invertebrate feeders. Responses to changes in forest cover, urbanisation and temperature are more species-specific. Specifically, forest cover is associated with a positive effect and growing urbanisation with a negative effect on population dynamics, while temperature change has an effect on the dynamics of a large number of bird populations, the magnitude and direction of which depend on species' thermal preferences. Our results not only confirm the pervasive and strong effects of anthropogenic pressures on common breeding birds, but quantify the relative strength of these effects stressing the urgent need for transformative changes in the way of inhabiting the world in European countries, if bird populations shall have a chance of recovering.

This thesis concerns PAH and metal residuals from the Baltic Carrier oil spill accident in Grønsund in 2001. The main objective of this thesis is to examine the presence of polycyclic aromatic hydrocarbons (PAH) and the presence of Zinc (Zn), Cubber (Cu), Cobalt (Co), Chromium (Cr), Nickel (Ni), Lead (Pb) and Cadmium (Cd) in sediment and benthic animals; blue mussel M. Edulis and ragworm N. Diversicolor collected from four distinct sites in South Zealand; two contaminated sites (Bredemage Hage and Farø), an anthropogenic site (Vordingborg) and a pristine site (Nyord). Animal samples analyzed included Nereis Diversicolor and Mytilus Edulis. Mainly three different experimental approaches, ICP, GC-MS and Organic Matter Content (OMC), were applied to determine concentration and enrichment at different depths in the sediment and accumulated concentrations in animal tissue. The analysis of sampled sediment cores revealed buried PAH residuals possibly from the oil spill in depth 16-18 at both contaminated sites; Bredemage Hage and Farø. The two contaminated sites also revealed a high enrichment of especially Cd in the same depths. Results from Bredemage Hage showed a hotspot area, where oil appeared in higher concentrations. Animal tissue showed mainly PAH concentrations under the detection limit, with the exception of naphthalene and showed relatively high metal concentrations compared to concentrations found in various regions of the world. An analysis of results from previous studies indicates that there has been an overall decrease in the concentration of PAH in sediment during the last 22 years, which in this thesis is discussed in context to weathering processes and time in general.

A prospective cohort study to inform early neurorehabilitation after acquired brain injury and tracheostomy. The objective of this study is to identify and explore potential clinical and physiological factors and patterns related to swallowing, weaning progression and decannulation.

Background: Current guidelines in HER2-positive metastatic breast cancer (mBC) recommend the combination of trastuzumab and a chemotherapeutic agent for 3rd line or later treatments. This study aims to describe the treatment of HER2-positive mBC in 3rd line or later after previous treatment with T-DM1 for mBC in a real-world setting.Material and methods: This observational population-based study included all women diagnosed with HER2-positive mBC in Denmark, previously treated with T-DM1 in the metastatic setting. Patients were included on the date of progression leading to initiation of 3rd line treatment if the patient had received T-DM1 in 1st or 2nd line. If the patient received T-DM1 in 3rd line or later the inclusion was based on the date of progression on T-DM1. The primary end points were overall survival (OS) and progression-free survival (PFS).Results: The study included 272 women with a mean age of 59 (27-86) and a median of 3 (2-11) treatment lines prior to inclusion. At index, all patients had received T-DM1 and 167 (62%) patients had received pertuzumab in the metastatic setting. During follow-up 183 patients received chemotherapy. Of these patients, 120 received chemotherapy combined with trastuzumab, 50 received chemotherapy combined with other HER2-targeted therapy, and 13 received chemotherapy as monotherapy. The remaining 89 patients received either HER2-targeted monotherapy (41), endocrine therapy (31), experimental treatment (10), or no treatment (7). Median PFS was 5.5 months (95% CI, 4.8-6.5) and median OS was 18.5 months (95% CI, 16.2-21.3).Conclusion: In this real-world study, we found that patients were treated with a wide variety of anti-cancer agents with modest efficacy. However, patients in this study did not have access to newer therapies like tucatinib and T-DXd. Background: Current guidelines in HER2-positive metastatic breast cancer (mBC) recommend the combination of trastuzumab and a chemotherapeutic agent for 3rd line or later treatments. This study aims to describe the treatment of HER2-positive mBC in 3rd line or later after previous treatment with T-DM1 for mBC in a real-world setting.Material and methods: This observational population-based study included all women diagnosed with HER2-positive mBC in Denmark, previously treated with T-DM1 in the metastatic setting. Patients were included on the date of progression leading to initiation of 3rd line treatment if the patient had received T-DM1 in 1st or 2nd line. If the patient received T-DM1 in 3rd line or later the inclusion was based on the date of progression on T-DM1. The primary end points were overall survival (OS) and progression-free survival (PFS).Results: The study included 272 women with a mean age of 59 (27-86) and a median of 3 (2-11) treatment lines prior to inclusion. At index, all patients had received T-DM1 and 167 (62%) patients had received pertuzumab in the metastatic setting. During follow-up 183 patients received chemotherapy. Of these patients, 120 received chemotherapy combined with trastuzumab, 50 received chemotherapy combined with other HER2-targeted therapy, and 13 received chemotherapy as monotherapy. The remaining 89 patients received either HER2-targeted monotherapy (41), endocrine therapy (31), experimental treatment (10), or no treatment (7). Median PFS was 5.5 months (95% CI, 4.8-6.5) and median OS was 18.5 months (95% CI, 16.2-21.3).Conclusion: In this real-world study, we found that patients were treated with a wide variety of anti-cancer agents with modest efficacy. However, patients in this study did not have access to newer therapies like tucatinib and T-DXd.

Recent declines of many European bird species have been linked with various environmental changes, especially land-use change and climate change. Since the intensity of these environmental changes varies among different countries, we can expect geographic variation in bird population trends. Here, we compared the population trends of bird species among neighbouring countries within central Europe (Czech Republic, Denmark, Germany, Switzerland) between 1990 and 2016 and examined trait-associations with population trends at both national and international scales. We found that Denmark had the highest proportion of declining species while Switzerland had the lowest. Species associated with farmland had negative trends, but the effect size tended to differ among countries. A preference for higher temperature was positively associated with population trends and its effect size was similar among countries. Species that were increasing across all four countries were associated with forest; while species that were decreasing across all countries were long-distance migrants or farmland birds. Our results suggest that land-use change tends to be a more regionally variable driver of common bird population trends than climate change in central Europe. For species declining across all countries, international action plans could provide a framework for more efficient conservation. However, farmland birds likely need both, coordinated international action (e.g. through a green agricultural policy) to tackle their widespread declines as well as regionally different approaches to address varying national effect trajectories.

The marsh fritillary (Euphydryas aurinia) is a critically endangered butterfly species in Denmark known to be particularly vulnerable to habitat fragmentation due to its poor dispersal capacity. We identified and genotyped 318 novel SNP loci across 273 individuals obtained from 10 small and fragmented populations in Denmark using a genotyping-by-sequencing (GBS) approach to investigate its population genetic structure. Our results showed clear genetic substructuring and highly significant population differentiation based on genetic divergence (FST) among the 10 populations. The populations clustered in three overall clusters, and due to further substructuring among these, it was possible to clearly distinguish six clusters in total. We found highly significant deviations from Hardy–Weinberg equilibrium due to heterozygote deficiency within every population investigated, which indicates substructuring and/or inbreeding (due to mating among closely related individuals). The stringent filtering procedure that we have applied to our genotype quality could have overestimated the heterozygote deficiency and the degree of substructuring of our clusters but is allowing relative comparisons of the genetic parameters among clusters. Genetic divergence increased significantly with geographic distance, suggesting limited gene flow at spatial scales comparable to the dispersal distance of individual butterflies and strong isolation by distance. Altogether, our results clearly indicate that the marsh fritillary populations are genetically isolated. Further, our results highlight that the relevant spatial scale for conservation of rare, low mobile species may be smaller than previously anticipated.

BACKGROUND Patient-centred care (PCC) including collaborative practices is the core component of modern health care. Despite this, it has proven difficult to implement. AIMS To examine (1) healthcare professionals' (HCPs') perception of whether they perceive a PCC culture, their attitudes towards involving patients in decisions and their experiences of barriers for PCC; and (2) variables that may contribute to explain differences in perceived person-centred culture. METHODS A questionnaire survey of HCPs from 27 different departments from two university hospitals in Denmark. HCPs were eligible if they held a profession as physician, Registered Nurse, nurse assistant, physiotherapist, occupational therapist, dietician, midwife or psychologist and excluded if they reported not being involved in patient treatment and care. The questionnaire consisted of four items from the Context Assessment Index (CAI). The remaining items were purpose-designed. RESULTS In total 1140 (24% response rate) HCPs completed the questionnaire and were included in the analyses. Most of the HCPs perceived a culture of PCC (e.g. 91% agreed or agreed to a high degree that patients were provided with opportunities to participate in decisions). Most HCPs also held positive attitudes towards involving patients in decisions. Time and prioritisation from the management were perceived as barriers for PCC, and many HCPs also believed that involving patients in decisions could be difficult for the patients. The HCPs who were least involved in treatment and care, and working in the acute setting or in surgery, were least likely to perceive a PCC culture. HCPs with the longest or shortest educations, and HCPs working primarily with outpatients or with planned inpatients, were most likely to perceive a person-centred culture. CONCLUSION The HCPs generally perceived a culture of PCC and held positive attitudes towards involving patients in decisions. To further promote PCC, time and prioritisation must be invested at an organisational level.

Med udgangspunkt i de politiske ønsker om en læreruddannelse, der har mere praksis, analyseres og diskuteres, hvordan praksis kan kvalifi ceres. Artiklen indledes med en påstand om, at en studiemæssig kvalifi cering af praksis ikke skal drivespå afveje af akademisering, men udfordres af høj faglighed i pædagogik, fag og akademiske dyder. Herfra argumenterer vi for et perspektivskifte i forståelsen af praksis, hvor det centrale er refl ekteret arbejde med fokuseret empiri og udvikling af den studerendes dømmekraft. Med udgangspunkt i fænomenet kernepraksis gøres fokuseret empiri til ”kernen” i perspektivskiftet. Vi har valgt at fremhæve et eksempel fra praksis for at argumentere for, at en dialektisk omgang med empiri skaber en refl ekterende sammentænkning af teori og praksis. Den dialektiske arbejdsform er kendetegnet ved at være dynamisk og ved, at den udfordrer de studerendes dømmekraft ved at bringe viden, didaktik og erfaring i spil i forhold til den fokuserede empiri. Afslutningsvis foreslår vi etablering af undersøgelsesfællesskaber som rammesættende for et rum, hvor refl eksion og dømmekraft kan faciliteres. I disse fællesskaber skaber teori og praksis mulighed for at kvalifi cere empirien og dermed den studerendes praksis og faglige refl eksion. Endelig konkretiseres fokuseret empiri, som det kan tage form i et refl ekteret undersøgelsesfællesskab.

The diagnosis and treatment of head and neck cancer (HNC) can have substantial impact on swallowing function, nutritional balance, physical function and quality of life (QoL). Early initiated swallowing exercises are hypothesized to improve swallowing function in HNC patients. The aim was to investigate the effects of swallowing exercises and progressive resistance training (PRT) during radiotherapy on swallowing function, physical function and QoL in patients with pharynx-, larynx-, oral cavity cancer or unknown primary compared to usual care. In a multi-centre RCT participants were assigned to (a) twice-weekly PRT and daily swallowing exercises throughout treatment or (b) usual care. Outcomes were measured at end of treatment and 2, 6 and 12 months after. Primary outcome was penetration aspiration score (PAS). Data were analysed on an “intention-to-treat” basis by GEE logistic regression model, linear mixed effects model and cox regression. Of 371 invited HNC patients, 240 (65%) enrolled. Five participants were excluded. At 12 months follow-up, 59 (25%) participants were lost. Analyses showed significant effect on mouth opening, QoL, depression and anxiety at 12 months when comparing intervention to non-active controls. The trial found no effect on swallowing safety in HNC undergoing radiotherapy, but several positive effects were found on secondary outcomes when comparing to non-active controls. The intervention period may have been too short, and the real difference between groups is too small. Nevertheless, the need to identify long-lasting intervention to slow down or avoid functional deteriorations is ever more crucial as the surviving HNC population is growing.

Introduction: The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) delivered in a group format could facilitate the implementation of evidence-based psychological treatments. Objective: This study compared the efficacy of group UP and diagnosis-specific cognitive behavioral therapy (dCBT) for anxiety and depression in outpatient mental health services. Methods: In this pragmatic, multi-center, single-blinded, non-inferiority, randomized controlled trial (RCT), we assigned 291 patients with major depressive disorder, social anxiety disorder, panic disorder, or agoraphobia to 14 weekly sessions in mixed-diagnosis UP or single-diagnosis dCBT groups. The primary test was non-inferiority, using a priori criteria, on the World Health Organisation 5 Well-Being Index (WHO-5) at the end of the treatment. Secondary outcomes were functioning and symptoms. We assessed outcomes at baseline, end-of-treatment, and at a 6-month follow-up. A modified per-protocol analysis was performed. Results: At end-of-treatment, WHO-5 mean scores for patients in UP (n = 148) were non-inferior to those of patients in dCBT (n = 143; mean difference –2.94; 95% CI –8.10 to 2.21). Results were inconclusive for the WHO-5 at the 6-month follow-up. Results for secondary outcomes were non-inferior at end-of-treatment and the 6-month follow-up. Client satisfaction and rates of attrition, response, remission, and deterioration were similar across conditions. Conclusions: This RCT demonstrated non-inferior acute-phase outcomes of group-delivered UP compared with dCBT for major depressive disorder, social anxiety disorder, panic disorder, and agoraphobia in outpatient mental health services. The long-term effects of UP on well-being need further investigation. If study findings are replicated, UP should be considered a viable alternative to dCBT for common anxiety disorders and depression in outpatient mental health services.

Background: Despite the intriguing potential of physical exercise being able to preserve or even restore brain volume (grey matter volume in particular)—a tissue essential for both cognitive and physical function—no reviews have so far synthesized the existing knowledge from randomized controlled trials investigating exercise-induced changes of the brain’s grey matter volume in populations at risk of neurodegeneration. Our objective was to critically review the existing evidence regarding this topic. Methods: A systematic search was carried out in MEDLINE and EMBASE databases primo April 2020, to identify randomized controlled trials evaluating the effects of aerobic training, resistance training or concurrent training on brain grey volume changes (by MRI) in adult clinical or healthy elderly populations. Results: A total of 20 articles (from 19 RCTs) evaluating 3–12 months of aerobic, resistance, or concurrent training were identified and included, involving a total of 1662 participants (populations: healthy older adults, older adults with mild cognitive impairment or Alzheimer’s disease, adults with schizophrenia or multiple sclerosis or major depression). While few studies indicated a positive effect—although modest—of physical exercise on certain regions of brain grey matter volume, the majority of study findings were neutral (i.e., no effects/small effect sizes) and quite divergent across populations. Meta-analyses showed that different exercise modalities failed to elicit any substantial effects on whole brain grey volume and hippocampus volume, although with rather large confidence interval width (i.e., variability). Conclusion: Altogether, the current evidence on the effects of physical exercise on whole/regional grey matter brain volume appear sparse and inconclusive, and does not support that physical exercise is as potent as previously proposed when it comes to affecting brain grey matter volume.

The Green Protein Network gathers startups, corporates and universities to explore the challenges and possibilities within new innovative green protein sources. The group sets the agenda for the network and we will cover topics like new ingredients sources, consumer insights, new technologies and market trends. Join the Green Protein Network if you want to get inspiration, find new partners, share and gain knowledge and be part of finding new innovative solutions.

We study employee absence in Danish public and private organizations. Using data from four private and four public organizations we establish sector differences and that absence is predominantly an individualized phenomenon. Because the within-group variation in absence clearly dominates the between-group variation, we conclude that organizations need to invoke individualized policies to reduce employee absence, and we establish that incentives related to promotions and dismissals can be useful tools, as absence behaviour interacts with such incentives.

The peroxyoxalate reaction is one of the most efficient chemiluminescence transformations, with emission quantum yields of up to 50%; additionally, it is widely utilized in analytical and bioanalytical assays. Although the real reason for its extremely high efficiency is still not yet understood, the mechanism of this transformation has been well elucidated in anhydrous medium. Contrarily, only few mechanistic studies have been performed in aqueous media, which would be of great importance for its application in biological systems. We report here our experimental results of the peroxyoxalate reaction in completely aqueous carbonate buffer, using fluorescein as chemiluminescence activator. The kinetics are very fast in the used basic conditions (pH > 9); despite this, reproducible kinetic results were obtained. The reaction proceeds by specific base catalysis, with rate-limiting attack of hydrogen peroxide anion to the oxalic ester, in competition with ester hydrolysis by hydroxide ion. Emission quantum yields increase with the hydrogen peroxide concentration up to an optimal concentration of 10 mmol L-1 . The infinite singlet quantum yield of (5.8 ± 0.2) × 10-7 is much lower than in anhydrous medium; however, it is similar to quantum yields measured before in partially aqueous media.

This review presents the current status of knowledge on e-commerce trade of groceries, and perishable foods, and offers highlights of the different important aspects crucial for trading quality sea...

Highlights • Compared with matched normative data, impaired cognitive function was substantial. • Several correlations between radiation dose and cognitive impairment were present. • Radiation-induced white matter hyperintensities were present in 2/27 participants. • One participant displayed radiation-induced necrosis in the temporal lobe. • The domains affecting quality of life the most were fatigue and quality of sleep., Purpose The aim of the study was to evaluate neurocognitive late effects, structural alterations and associations between cognitive impairment and radiation doses as well as cerebral tissue damage after radiotherapy for sinonasal cancer. Furthermore, the aim was to report quality of life (QoL) and self-reported cognitive capacity. Materials and methods Recurrence-free patients previously treated with intensity-modulated radiotherapy with a curative intent were eligible for the study. Study examinations comprised comprehensive neurocognitive testing, MRI of the brain, and self-reported outcomes. Results A total of 27 patients were included. Median age was 67 years (range 47–83). The majority of test outcomes were below normative values in any degree, and 37% of the participants had clinically significant neurocognitive impairment when compared with normative data. Correlations between absorbed doses to specific substructures of the brain and neurocognitive outcomes were present for Wechsler’s Adult Intelligence Scale-digit span and Controlled Oral Word Association Test-S. Structural MRI revealed macroscopic abnormalities in three patients; infarction (n = 1), diffuse white matter intensities (n = 2) and necrosis (n = 1). In the analysis of atrophy of cerebral tissue, no correlations were present with neither radiation dose to cerebral substructures nor neurocognitive impairment. The global QoL of the cohort was 75. The most affected outcomes were ‘fatigue’, ‘insomnia’, and ‘drowsiness’. A total of 59% of participants reported significantly impaired quality of sleep. Self-reported cognitive function revealed that ‘memory’ was the most affected cognitive domain. For the domains of ‘memory’ and ‘language’, self-reported functioning was associated with objectively measured neurocognitive outcomes. Conclusion Cerebral toxicity after radiotherapy for sinonasal cancer was substantial. Clinically significant cognitive impairment was present in more than one third of the participants, and several dose–response associations were present. Furthermore, the presence of macroscopic radiation sequelae indicated considerable impact of radiotherapy on brain tissue.

Objective: Individual patient characteristics are important in trying to understand why people respond differently to group CBT. Only a few studies have explored therapists’ perceptions of within-p...

Background Only about half of all patients with anxiety disorders or major depression respond to cognitive behaviour therapy (CBT), even though this is an evidence-based treatment. Personalized treatment offers an approach to increase the number of patients who respond to therapy. The aim of this study was to examine predictors and moderators of (differential) treatment outcomes in transdiagnostic versus diagnosis-specific group CBT. Methods A sample of 291 patients from three different mental health clinics in Denmark was randomized to either transdiagnostic or diagnosis-specific group CBT. The study outcome was the regression slope of the individual patient's repeated scores on the WHO-5 Well-being Index. Pre-treatment variables were identified as moderators or predictors through a two-step variable selection approach. Results While the two-step approach failed to identify any moderators, four predictors were found: level of positive affect, duration of disorder, the detachment personality trait, and the coping strategy of cognitive reappraisal. A prognostic index was constructed, but did not seem to be robust across treatment sites. Conclusions Our findings give insufficient evidence to support a recommendation of either transdiagnostic or diagnosis-specific CBT for a given patient or to predict the response to the applied group therapies.

Following the call in Sandlund, Sundqvist, and Nyroos (2016) for incorporating discursive approaches into the field of oral second language (L2) testing, this paper proposes an interactional usage-based approach to the analysis of oral L2 performance. Based on Eskildsen (2018a), we combine analytic tools from usage-based linguistics and conversation analysis. We draw on usage-based linguistics to analyze performance in terms of test-takers’ inventories of linguistic constructions and on conversation analysis to understand their interactional competence in terms of the relation between the linguistic constructions and the actions they are used to accomplish. Performance assessment is thus constructional and interactional. Participants in this pilot study were two Danish primary school children who performed two consecutive oral tasks: a semi-guided interview and a picture-elicited narrative task. Data were analyzed by means of cross-child comparisons and cross-task comparisons within each child. Our data confirm the observation from previous research that simple question-answer(-assessment) sequences dominate oral test formats, but also that the format is sometimes abandoned, which allows for the accomplishment of new social actions. Moreover, the picture-description task affords a different speech exchange system with the interviewer participating more as an active listener when the children do not voluntarily carry out the requested task.

In applied spectroscopy, the purpose of multivariate calibration is almost exclusively to relate analyte concentrations and spectroscopic measurements. The multivariate calibration model provides estimates of analyte concentrations based on the spectroscopic measurements. Predictive performance is often evaluated based on a mean squared error. While this average measure can be used in model selection, it is not satisfactory for evaluating the uncertainty of individual predictions. For a calibration, the uncertainties are sample specific. This is especially true for multivariate calibration, where interfering compounds may be present. Consider in-line spectroscopic measurements during a chemical reaction, production, etc. Here, reference values are not necessarily available. Hence, one should know the uncertainty of a given prediction in order to use that prediction for telling the state of the chemical reaction, adjusting the process, etc. In this paper, we discuss the influence of variance and bias on sample-specific prediction errors in multivariate calibration. We compare theoretical formulae with results obtained on experimental data. The results point towards the fact that bias contribution cannot necessarily be neglected when assessing sample-specific prediction ability in practice.

Study question Which morphokinetic and morphological factors during embryo development before vitrification and after warming predict the chance of clinical pregnancy in single vitrified blastocyst transfer (SVBT)? Summary answer Time to reach blastocyst stage, numeric Gardner score before vitrification and blastocyst size after warming correlate with clinical pregnancy but not post-warming expansion rate. What is known already Several studies have evaluated pre-vitrification and post-warming characteristics of vitrified-warmed blastocysts to identify parameters that correlate with implantation. New pre-vitrification and post-warming morphokinetic parameters were identified by culturing embryos in time-lapse incubation systems before vitrification as well as after warming. Among others, the number of collapses before vitrification, the size after warming in combination with the post-warming expansion rate and the maximal expansion size was reported to have a significant correlation with implantation. To our knowledge these findings were so far not re-evaluated in another, independent study. Study design, size, duration Analysis of 549 treatment/cryo cycles in 349 patients participating in a multicenter observational trial (IMBOS trial). Subjects received one controlled ovarian stimulation with follitropin delta (Rekovelle). Of 377 transfers, 195 were fresh day 5 single blastocyst transfers and 182 were SVBTs from blastocysts that were vitrified on day 5. Both fresh and vitrified-warmed embryos were cultured in a time-lapse system. Various morphokinetic parameters, including Gardner score, were assessed in the fresh cycle and after vitrification-warming. Participants/materials, setting, methods Associations between clinical pregnancy (positive fetal heartbeat), morphokinetic parameters, blastocyst collapse, KIDScore D5, Gardner score before vitrification, blastocyst size after warming, re-expansion rate, and Gardner score before SVBT were investigated. Mixed logistic regression models were used with clinical pregnancy as dependent variable and different morphokinetic/morphological parameters as factors or covariates. Repeated transfers were accounted for by including subject as a random factor in models, with the log-odds for different subjects assumed to be normally distributed. Main results and the role of chance A total of 182 SVBT resulted in 89 clinical pregnancies. For pre-vitrification parameters no clear association was found between the number of collapses (P = 0.6095) or the maximal collapse size (P = 0.9122) before vitrification and clinical pregnancy. Multifactorial analysis of Gardner score before vitrification only showed significant association with clinical pregnancy for trophectoderm grading (P = 0.0247), and not for expansion and hatching status and inner cell mass. There was no significant association for any of the Gardner score parameters when assessed immediately before SVBT. However, when the Gardner score was transformed into a total numerical score, significant associations with clinical pregnancy was noted both when assessed before vitrification (P = 0.0003) and before cryotransfer (P = 0.0005). From the analysis of time-lapse parameters, the time to reach blastocyst (tB-tPNf; P = 0.0288) and KIDScore D5 (P = 0.0035) were significantly associated with clinical pregnancy. Multifactorial analysis showed that size after warming was significantly associated with clinical pregnancy (P = 0.0257), but not rate of expansion (P = 0.4241) or maximal expansion size (P = 0.1789). The prognostic potential of trophectoderm grading and KIDScore D5 was previously reported. Further analysis showed a positive correlation between numeric Gardner score before vitrification and size after warming, but not between time to reach blastocyst (tB-tPNf) and size after warming. Limitations, reasons for caution Blastocysts for SVBT were selected by each laboratorýs policy, which may constitute a selection bias. The proposed factors were derived by statistical analysis of a fixed dataset; offset thresholds for any of the parameters were not defined. Any potential clinical application must be tested and validated on an independent dataset. Wider implications of the findings Selection for which vitrified blastocyst to warm first may benefit from using tB-tPNf rather than Gardner score. Size after warming does constitute an early post-warming parameter if a decision is needed to eventually warm another blastocyst. Trial registration number NCT03697031

Study question Do increased levels of oxidative stress (OS) and seminal antioxidant affect semen quality? Summary answer Increased OS measured by MiOXSYS negatively affected sperm concentration, motility, and total motile sperm count (TMSC). Reduced levels of seminal glutathione are associated with OS. What is known already The enzymatic seminal antioxidants superoxide dismutase (SOD) and catalase (CAT), and the non-enzymatic antioxidant glutathione possess important roles in the defense against oxidative damage and form the first line of defense against reactive oxygen species (ROS). It is known from the literature, that excessive levels of ROS are highly implicated in the pathogenesis of male infertility. The level of oxidative stress can be estimated by MiOXSYS Analyzer (Aytu BioScience Inc.) expressing the ‘oxidative reduction potential’ (ORP). Assessing ORP is one of the latest advancements in male infertility diagnostics, providing sensitive detection of increased OS in semen. Study design, size, duration This correlation study aims to explore the level of OS in a small cross-section of potentially infertile Danish males. Eighty-one (81) males from the Fertility Clinic at Odense University Hospital delivered a semen sample. The level of OS was compared to semen parameters and levels of SOD, CAT, and glutathione. Participants/materials, setting, methods Semen samples were collected and analyzed according to 2010 WHO criteria (concentration, volume, and %motility). TMSC was included additionally. A direct measure of OS was performed on raw sperm using MiOXSYS. Three assays were applied (Sigma-Aldrich and Abcam) to measure the enzymatic activity of SOD and CAT, and the level of total glutathione in the sperm samples. Spectrophotometric analysis of the absorbance in a plate reader was used to quantify the biochemical level of antioxidants. Main results and the role of chance Results showed that 43.2% of all study participants had increased levels of OS. Statistical analysis revealed a significant correlation (p< 0.01) between increased OS and reduced concentration, motility, and TMSC in the ejaculates. When adjusted for smoke, motility and TMSC were found to be significant (p < 0.05). Adjusting for weekly alcohol intake and body mass index (BMI) did not affect the correlation. Collectively, the results demonstrated that sperm abnormalities are related to increased levels of OS, suggesting OS to be a mediator of male fertility potential. Furthermore, a negative correlation (p< 0.05) was found between the reduced level of seminal glutathione and increased levels of OS. The finding suggests that OS is increased in the spermatozoa when the level of glutathione is low. No significant correlation between OS and reduced SOD or CAT was found. A potential inverse relationship between the effect of SOD on CAT and GSH levels was investigated, but no significant relationship was identified. There were no statistical indications that the level of SOD is associated with the levels of CAT and GSH. Limitations, reasons for caution Morphology was not included as a part of the WHO criteria due to time limitations. DNA fragmentation analysis was not included, but future research should be devoted to this aspect. Wider implications of the findings The findings support a suggestion of an association between high OS levels in semen and reduced semen quality. It was expected that at least 30% of men would show excessive OS in sperm. The study population of the Fertility-Clinic showed higher OS than what was presented in the general population. Trial registration number Not applicable

By allowing participants to co-construct geolocated Venetian soundscapes through interactive, sonified objects, this artwork re-imagines how humans can coexist in post-pandemic public spaces.

Background Delayed brain development, brain injury, and neurodevelopmental disabilities are commonly observed in infants operated for complex congenital heart defect. Our previous findings of poorer neurodevelopmental outcomes in individuals operated for simple congenital heart defects calls for further etiological clarification. Hence, we examined the microstructural tissue composition in cerebral cortex and subcortical structures in comparison to healthy controls and whether differences were associated with neurodevelopmental outcomes. Methods and Results Adults (n=62) who underwent surgical closure of an atrial septal defect (n=33) or a ventricular septal defect (n=29) in childhood and a group of healthy, matched controls (n=38) were enrolled. Brain diffusional kurtosis imaging and neuropsychological assessment were performed. Cortical and subcortical tissue microstructure were assessed using mean kurtosis tensor and mean diffusivity and compared between groups and tested for associations with neuropsychological outcomes. Alterations in microstructural tissue composition were found in the parietal, temporal, and occipital lobes in the congenital heart defects, with distinct mean kurtosis tensor cluster‐specific changes in the right visual cortex (pericalcarine gyrus, P =0.002; occipital part of fusiform and lingual gyri, P =0.019). Altered microstructural tissue composition in the subcortical structures was uncovered in atrial septal defects but not in ventricular septal defects. Associations were found between altered cerebral microstructure and social recognition and executive function. Conclusions Children operated for simple congenital heart defects demonstrated altered microstructural tissue composition in the cerebral cortex and subcortical structures during adulthood when compared with healthy peers. Alterations in cerebral microstructural tissue composition were associated with poorer neuropsychological performance. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03871881.

Lavprotein-blandinger giver mere energi til søernes mælkeydelse, hvilket betyder, at pattegrisene vokser bedre i den efterfølgende diegivnings-periode.

Partial least squares (PLS) regression is widely used to predict chemical analytes from spectroscopic data, thus reducing the need for expensive and time-consuming wet chemical reference analysis in industrial process monitoring. However, predictions via PLS by definition carry sample-specific errors, and estimation of these errors is essential for correct interpretation of results. To increase trust in PLS regression-based predictions, reliable prediction error estimates must be reported. This can be achieved by determining realistic sample-specific prediction errors using an unbiased mean squared prediction error estimate. This work provides a guide for estimating sample-specific prediction errors, showing the importance of choosing an appropriate error estimator prior to deploying PLS models for industrial applications. We reviewed recent and established methods for estimating the sample-specific prediction error and test them through simulation studies. The methods were subsequently applied for estimating prediction errors in two real-life datasets from the food ingredients industry, where near-infrared spectroscopy was used to quantify i) urea in process water and ii) individual protein concentrations in ultrafiltration retentates from a protein fractionation process. Both the simulations and real data examples showed that the mean squared error of calibration is always a downward biased estimator. Although leave-one-out-cross-validation performed surprisingly well in the data analysed in this work, this paper demonstrated that the appropriate choice of error estimator requires the user to make an informed, data-centered decision.