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This article presents findings from a research project that aimed to replace physical books with an adaptive learning platform, Area9 Rhapsode™, for nursing students' class preparation. As the project expanded, it became evident that students employed diverse preparation practices, prompting an investigation into their preparation habits. This is done through the following research questions: (1) how do students feel about class preparation? (2) what learning resources do students choose? (3) when and where do they prepare for class? This is conducted through a mixed methods design that draws on empirical data from interviews, mobile ethnography, surveys, and log data. The results highlight the wide range of resources students utilise, including digital and analogue tools, the various temporal patterns of preparation, and students' spectrum of feelings in their preparation. The findings suggest the importance of understanding individual students' preparation habits to facilitate targeted teaching approaches that cater to diverse learning needs. The article contributes to the existing literature on study habits and strategies, emphasising the need for educators to recognise and adapt to students' unique preparation behaviours in order to enhance their academic success.

This article investigates teachers' lived experiences of an online professional development (OPD) course in Denmark -- that is, Teknosofikum -- through a hermeneutic phenomenological perspective, and it relies on the interpretive analysis of 15 semi-structured interviews. The article's contribution focuses on the theme of 'time' and highlights it as a multifaceted construct that plays a relevant role in learning. By relying on the ideas of "temporal structuring" and "multiple temporalities," the article shows that OPD courses and HE teachers' engagement nest themselves into pre-existing and complex nexus of commitments and duties, each of which has its own temporality and rhythm, along with longer-term aspirations for pedagogical development. As time emerged as a relevant aspect characterizing OPD course design and HE teachers' experiences, the article provides simple recommendations for 'time-aware' OPD courses.

This paper explores how the culture within a Danish university study programme affects students' aspirations of becoming a high school chemistry teacher. We draw on ethnographic fieldwork and qualitative interviews to describe and analyse the culture of the programme. In the analysis we foreground the case of two students to understand their identity negotiations and changes in their teacher aspirations over time. By combining a 'domains-of-power framework' with the concept of 'science identity', we show how everyday practices formed a culture of power that positioned research in the centre and teaching as a less attractive career path. By unfolding the subtle mechanisms that together form a culture of power, which works both to include and exclude, we show the ways in which the two student's aspirations for becoming high school chemistry teachers somewhat diminished over time. The study concludes that negotiating a science identity at a research-intensive university programme, makes it almost impossible to develop and keep an aspiration for becoming a high school teacher. To address the current and future shortage of science teachers across Europe, our findings underline the need for a more inclusive culture at the university to support science students' diverse aspirations.

Abstract Background The purpose of this study was to clarify the potentially life-saving critical interventions performed on children below the age of seven by the physician-manned mobile emergency care unit (MECU) in Odense, Denmark. We investigated critical interventions in relation to morbidity and mortality. Methods A retrospective cohort study of all MECU missions involving children below the age of seven. The study period was from October 1 2007 to December 31 2020. Data sources were the MECU Odense database, the Danish National Patient Registry, and the Danish Civil Registration System. Variables were critical interventions, the severity of injury/illness, MECU on-scene time, in-hospital diagnosis and 7-day, 30-day, and 90-day mortality. Results The MECU carried out 4,032 missions to children below 7 years. 88 patients (2.2%) received at least one critical prehospital intervention. Upper airway suction was performed in 39 cases (1.0%), endotracheal intubation (all causes) in 36 cases (0.9%), and intraosseous access in 21 cases (0.5%). General anaesthesia was induced in 29 cases (0.7%). Seventeen patients (0.4%) received cardiopulmonary resuscitation and two patients received manual defibrillation (

Abstract: Secondary central nervous system lymphoma (SCNSL) is a rare manifestation of diffuse large B-cell lymphoma (DLBCL) with a poor prognosis. We present updated data from a nationwide study on the incidence and clinical characteristics of SCNSL. The incidence of SCNSL was calculated considering death or relapse without SCNSL as competing risks. Risk factors associated with SCNSL were identified using a cause-specific Cox proportional hazards model. A total of 1972 patients with DLBCL were included, of which 68 (3.4%) experienced SCNSL at the first relapse. The crude 1- and 2-year cumulative incidence of SCNSL was 2.0% (95% confidence interval [CI], 1.5-2.7) and 2.6% (95% CI, 2.0-3.4), respectively. For patients with a high-risk central nervous system international prognostic index (CNS-IPI) score, the 1- and 2-year cumulative incidence was 6.4% and 7.5%, respectively. The number and location of extranodal (EN) sites were the most significant predictors of SCNSL. Specific EN sites associated with an increased risk were the bone marrow, heart, kidneys/adrenal glands, ovaries, testes, and uterus. The median overall survival (OS) after SCNSL was 3.2 months. SCNSL within 6 months after the end of treatment (EOT) was associated with a higher baseline CNS-IPI score and worse OS than SCNSL >6 months after EOT. Patients with a combination of low-risk CNS-IPI and late-onset SCNSL had the most favorable prognosis. In conclusion, updated real-world population-based data on SCNSL at first relapse, adjusted for competing risks, demonstrated a lower incidence of SCNSL than previously reported, with the number and location of EN sites being the most significant predictors of SCNSL.

Abstract Background During the early part of the COVID-19 pandemic, travel restrictions were implemented in Greenland to contain SARS-CoV-2 transmission. Despite their widespread use, empirical evidence supporting the effectiveness of travel restrictions is scarce. Greenland was in a unique position to maintain pre-departure testing among travellers, and we aimed to describe the effectiveness of pre-departure testing to inform the implementation of travel restrictions in future outbreaks. Methods Our analysis included SARS-Cov-2 PCR test results from travellers, including children, arriving in Greenland from Denmark between June 15, 2020, and January 26, 2022. Additionally, we identified positive tests performed within 14 days post-arrival to Greenland in this population. We estimated the sensitivity of pre-departure screening by dividing the number of positive cases identified pre-departure by the sum of cases identified pre-departure and within 14 days post-arrival in Greenland. Results Our analysis covered around 43% of all travellers who underwent pre-departure screening. Out of 26,406 SARS-CoV-2 PCR tests, the proportion of positive tests was 0.6%, which varied over time according to the incidence in Denmark. Overall sensitivity of pre-departure screening was 59% and decreased over time, reaching a minimum of 36% in January 2022. The overall proportion of positive PCR post-arrival tests among all travellers was 0.4%. Conclusions Implementing pre-departure PCR testing for SARS-CoV-2 among travellers can be effective in the early stages of outbreaks, particularly in geographical regions like Greenland where community transmission had not yet occurred. Our findings suggest that pre-departure screening of travellers contributed to delaying community transmission in Greenland compared to most other countries, thereby reducing the COVID-19 disease burden.

Internationalization is often regarded as a tool for enhancing the quality of education and research, but the question is how are they related? This paper aims to address this by analysing the way quality and internationalization are represented in strategy documents of four universities, looking into how quality and internationalization are discussed together, what kinds of premises are present about their relationship, and how quality relates to universities’ geographical positioning. We do so by analysing strategies in four European universities; two ‘capital’ universities and two ‘town’ universities. First, we analyse what quality means in relation to internationalization within the strategies and show that the meaning is often empty; then, we unfold the implicit meanings of this ‘self-evident quality’. With a spatial perspective we analyse how the universities position themselves in the world and how this is intertwined with notions of quality. The discussion compares and contrasts the four strategies and shows more similarities between universities of town or capital origin rather than universities with the same nationality.

Abstract Background While energy communities working on electricity provision have been extensively studied, thermal energy communities (TECs) focusing on bringing district heating (DH) systems to decarbonise heat systems in buildings have been relatively under-researched. This study addresses this gap by presenting the first comprehensive examination of key factors influencing the emergence and development of TEC projects in Denmark, Germany, and the Netherlands. The study uses an established analytical framework from previous research encompassing seven dimensions: market structure, hard- and soft institutions, financing, physical infrastructure, capacity, and interactions with other stakeholders. Data are gathered through a literature review and interviews. Results TECs have emerged at different times in each country, shaped by contextual circumstances and diverse forms of institutional support. Elements that have supported the development of TECs are regulatory frameworks promoting DH growth, heat decarbonisation policies, economic incentives to use waste heat in plants, targeted financing mechanisms, and assistance to enhance the capacity of TECs. External factors such as high oil prices, seismic events, and recent rising energy prices have also spurred project initiation. TECs also rely on additional factors for success, including organisational and entrepreneurial abilities to engage with stakeholders, gain social acceptance, and secure commitment from community members. Involvement from local government, intermediary organisations, and private companies is crucial for TEC implementation. Among the studied countries, Danish TECs stand out as the most developed, benefiting from a stable policy environment, decades of experience with DH and TEC, and positive societal perceptions. Conversely, Dutch and German TECs face challenges because of the early stage of their heat transition, dealing with financial obstacles, underdeveloped policies, unfamiliarity with DH technology and with TECs, as well as the need for expensive infrastructure changes. Shared challenges across regions include capacity limitations in small projects and implementing cost-effective, local, and sustainable heat sources. Conclusions In light of the study's findings, policymakers must consider establishing stable, integral and flexible policies supporting heat decarbonisation and TECs, addressing TECs' reliance on limited capacities, involving TECs in local heat municipal plans, and facilitating high DH connection rates where DH is the most cost-effective solution from a socio-economic perspective.

Abstract Carcinogenesis encompasses processes that lead to increased mutation rates, enhanced cellular division (tumour growth), and invasive growth. Colorectal cancer (CRC) carcinogenesis in carriers of pathogenic APC (path_APC) and pathogenic mismatch repair gene (path_MMR) variants is initiated by a second hit affecting the corresponding wild-type allele. In path_APC carriers, second hits result in the development of multiple adenomas, with CRC typically emerging after an additional 20 years. In path_MLH1 and path_MSH2 carriers, second hits lead to the formation of microscopically detectable, microsatellite unstable (MSI) crypts, from which CRC develops in about half of carriers over their lifetime, often without progressing through a diagnosable adenoma stage. These divergent outcomes reflect the distinct functions of. the APC and MMR genes. In path_MLH1 and path_MSH2 carriers, a direct consequence of stochastic mutations may be the occurrence of invasive growth before tumour expansion, challenging the paradigm that an invasive cancer must always have an non-invasive precursor. In contrast to other path_ MMR carriers, path_PMS2 carriers who receive colonoscopic surveillance exhibit minimal increase in CRC incidence. This is consistent with a hybrid model: the initial mutation may cause an adenoma, and the second hit in the wild-type PMS2 allele may drive the adenoma towards become cancerous with MSI. Since all mutational events are stochastic, interventions aimed at preventing or curing cancer should ideally target the initial mutational events. Interventions focused on downstream events are external factors that influence which tumour clones survive Darwinian selection. In Lynch Syndrome, surveillance colonoscopy to remove adenomas may select for carcinogenetic pathways that bypass the adenoma stage.

Abstract Metabolic flexibility in skeletal muscle is essential for maintaining healthy glucose and lipid metabolism, and its dysfunction is closely linked to metabolic diseases. Exercise enhances metabolic flexibility, making it an important tool for discovering mechanisms that promote metabolic health. Here we show that pantothenate kinase 4 (PanK4) is a new conserved exercise target with high abundance in muscle. Muscle-specific deletion of PanK4 impairs fatty acid oxidation which is related to higher intramuscular acetyl-CoA and malonyl-CoA levels. Elevated acetyl-CoA levels persist regardless of feeding state and are associated with whole-body glucose intolerance, reduced insulin-stimulated glucose uptake in glycolytic muscle, and impaired glucose uptake during exercise. Conversely, increasing PanK4 levels in glycolytic muscle lowers acetyl-CoA and enhances glucose uptake. Our findings highlight PanK4 as an important regulator of acetyl-CoA levels, playing a key role in both muscle lipid and glucose metabolism.

Abstract Introduction Validated patient-reported outcome measures (PROMs) are crucial for assessing patients’ experiences in the healthcare system. Both clinically and theoretically, patient-centered consultations are essential in patient-care, and are often suggested as the optimal strategy in caring for patients with multimorbidity. Aim To either identify or develop and validate a patient-reported outcome measure (PROM) to assess patient-centredness in consultations for patients with multimorbidity in general practice. Methods We attempted to identify an existing PROM through a systematic literature review. If a suitable PROM was not identified, we planned to (1) construct a draft PROM based on items from existing PROMs, (2) conduct group and individual interviews among members of the target population to ensure comprehensibility, comprehensiveness and relevance, and (3) perform a psychometric validation in a broad sample of patients from primary care. Results We did not identify an eligible PROM in the literature review. The item extraction and face validity meetings resulted in a new PROM consisting of 47 items divided into five domains: biopsychosocial perspective; `patient-as-person’; sharing power and responsibility; therapeutic alliance; and coordinated care. The interviews resulted in a number of changes to the layout and phrasing as well as the deletion of items. The PROM used in the psychometric validation consisted of 28 items. Psychometric validation showed high internal consistency, overall high reliability, and moderate fit indices in the confirmatory factor analysis for all five domains. Few items demonstrated differential item functioning concerning variables such as age, sex, and education. Conclusions This study successfully developed and validated a PROM to measure patient-centredness in consultations for patients with multimorbidity. The five domains demonstrated high reliability and validity, making it a valuable tool for measuring patient-centredness of consultations in general practice. Trial registration Trial registration number (data for psychometric validation): https://clinicaltrials.gov : NCT05676541 Registration Date: 2022-12-16.

In this paper we study how children aged 12-15 years learn together with their parents while solving a series of playful inquiry-based tasks with an educational robot. The purpose of the study is to understand how children and their parents learn mathematics and computational thinking in non-formal out-of-school learning activities. For the study we designed tasks that included mathematic problem solving and programming. The tasks were designed based on input from three mathematics teachers who participated in individual workshops. Over a period of approximately six weeks, three families worked together on the tasks. In the process, they were told to self-record and self-assess the process. The families video-recorded the process and after each task they completed they answered a few questions. At the end of the intervention, we interviewed the families about the process. The results showed examples of how the families worked with mathematics and programming within different practices. In general, the children were more challenged when it came to understanding the problems, the abstraction process and problem solving. In this part they received guidance from the parents. Conversely, the children were not particularly challenged by programming and in applying mathematics in the solutions.