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Esophagectomy is a complex and complication laden procedure. Despite centralization, variations in perioparative strategies reflect a paucity of evidence regarding optimal routines. The use of nasogastric (NG) tubes post esophagectomy is typically associated with significant discomfort for the patients. We hypothesize that immediate postoperative removal of the NG tube is non-inferior to current routines. All Nordic Upper Gastrointestinal Cancer centers were invited to participate in this open-label pragmatic randomized controlled trial (RCT). Inclusion criteria include resection for locally advanced esophageal cancer with gastric tube reconstruction. A pretrial survey was undertaken and was the foundation for a consensus process resulting in the Kinetic trial, an RCT allocating patients to either no use of a NG tube (intervention) or 5 days of postoperative NG tube use (control) with anastomotic leakage as primary endpoint. Secondary endpoints include pulmonary complications, overall complications, length of stay, health related quality of life. A sample size of 450 patients is planned (Kinetic trial: https://www.isrctn.com/ISRCTN39935085). Thirteen Nordic centers with a combined catchment area of 17 million inhabitants have entered the trial and ethical approval was granted in Sweden, Norway, Finland, and Denmark. All centers routinely use NG tube and all but one center use total or hybrid minimally invasive-surgical approach. Inclusion began in January 2022 and the first annual safety board assessment has deemed the trial safe and recommended continuation. We have launched the first adequately powered multi-center pragmatic controlled randomized clinical trial regarding NG tube use after esophagectomy with gastric conduit reconstruction. [ABSTRACT FROM AUTHOR]

The present study was undertaken to address the recent spate of pasteurellosis outbreaks among sea-farmed Atlantic salmon (Salmo salar) in Norway and Scotland, coinciding with sporadic disease episodes in lumpfish (Cyclopterus lumpus) used for delousing purposes in salmon farms. Genome assemblies from 86 bacterial isolates cultured from diseased salmon or lumpfish confirmed them all as bona fide members of the Pasteurellaceae family, with phylogenetic reconstruction dividing them into two distinct branches sharing <88% average nucleotide identity. These branches therefore constitute two separate species, namely Pasteurella skyensis and the as-yet invalidly named "Pasteurella atlantica". Both species further stratify into multiple discrete genomovars (gv.) and/or lineages, each being nearly or fully exclusive to a particular host, geographic region, and/or time period. Pasteurellosis in lumpfish is, irrespective of spatiotemporal origin, linked almost exclusively to the highly conserved "P. atlantica gv. cyclopteri" (Pac). In contrast, pasteurellosis in Norwegian sea-farmed salmon, dominated since the late-1980s by "P. atlantica gv. salmonicida" (Pas), first saw three specific lineages (Pas-1, -2, and -3) causing separate, geographically restricted, and short-lived outbreaks, before a fourth (Pas-4) emerged recently and became more widely disseminated. A similar situation involving P. skyensis (Ps) has apparently been unfolding in Scottish salmon farming since the mid-1990s, where two historic (Ps-1 and -2) and one contemporary (Ps-3) lineages have been recorded. While the epidemiology underlying all these outbreaks/epizootics remains unclear, repeated detection of 16S rRNA gene amplicons very closely related to P. skyensis and "P. atlantica" from at least five cetacean species worldwide raises the question as to whether marine mammals may play a part, possibly as reservoirs. In fact, the close relationship between the studied isolates and Phocoenobacter uteri associated with harbor porpoise (Phocoena phocoena), and their relatively distant relationship with other members of the genus Pasteurella, suggests that both P. skyensis and "P. atlantica" should bemoved to the genus Phocoenobacter. [ABSTRACT FROM AUTHOR]

Background/Objectives: Government guidance promote benchmarking comparing quality of care including both clinical values and patient reported outcome measures in young persons with type 1 diabetes. The aim was to test if the Nordic DISABKIDS health‐related quality of life (HrQoL) modules were construct valid and measurement comparable within the three Nordic countries. Methods: Data from three DISABKIDS validation studies in Sweden, Denmark, and Norway were compared using Rasch and the graphical log‐linear Rasch modeling. Monte Carlo methods were used to estimate reliability coefficient and target was defined as the point with the lowest SE of the mean. Self‐report data were available from 99 Danish (8‐18 years), 103 Norwegian (7‐19 years), and 131 Swedish (8‐18 years) young people. Results: For the DISABKIDS higher scores on most subscales were noted in the Norwegian population. The Swedish sample had a significantly higher score on the "Diabetes treatment" subscale and scores closer to optimal target than the other countries. For each country, construct validity and sensitivity were acceptable when accounting for differential item function (DIF) and local dependency (LD). Less LD and DIF were found if only Denmark and Norway were included. The combined model was reliable; however, some differences were noted in the scale translations relating to the stem and response alternatives, which could explain the discrepancies. Conclusion: The Nordic versions of the DISABKIDS questionnaires measures valid and reliable HrQoL both within and between countries when adjusted for DIF and LD. Adjusting the Likert scales to the same respond categories may improve comparability. [ABSTRACT FROM AUTHOR]

Understanding of long-term dynamics of glaciers and ice caps is vital to assess their recent and future changes, yet few long-term reconstructions using ice flow models exist. Here we present simulations of the maritime Hardangerjøkulen ice cap in Norway from the mid-Holocene through the Little Ice Age (LIA) to the present day, using a numerical ice flow model combined with glacier and climate reconstructions. In our simulation, under a linear climate forcing, we find that Hardangerjøkulen grows from ice-free conditions in the mid-Holocene to its maximum extent during the LIA in a nonlinear, spatially asynchronous fashion. During its fastest stage of growth (2300-1300 BP), the ice cap triples its volume in less than 1000 years. The modeled ice cap extent and outlet glacier length changes from the LIA until today agree well with available observations. Volume and area for Hardangerjøkulen and several of its outlet glaciers vary out-of-phase for several centuries during the Holocene. This volume-area disequilibrium varies in time and from one outlet glacier to the next, illustrating that linear relations between ice extent, volume and glacier proxy records, as generally used in paleoclimatic reconstructions, have only limited validity. We also show that the present-day ice cap is highly sensitive to surface mass balance changes and that the effect of the ice cap hypsometry on the mass balance-altitude feedback is essential to this sensitivity. A mass balance shift by +0.5mw.e. relative to the mass balance from the last decades almost doubles ice volume, while a decrease of 0.2mw.e. or more induces a strong mass balance-altitude feedback and makes Hardangerjøkulen disappear entirely. Furthermore, once disappeared, an additional +0.1mw.e. relative to the present mass balance is needed to regrow the ice cap to its present-day extent. We expect that other ice caps with comparable geometry in, for example, Norway, Iceland, Patagonia and peripheral Greenland may behave similarly, making them particularly vulnerable to climate change. [ABSTRACT FROM AUTHOR]

Background and aim The Nordic countries have similar health care systems and registries simplifying epidemiological research. Differences in treatment traditions can, however, hamper the possibility to assess results and to harmonize control arms in joint randomized trials. In the process to set up a Nordic multi-center randomized trial regarding use of nasogastric tube (NG-tube) decompression after esophagectomy, we aimed to investigate perioperative routines in 12 University Hospitals in Sweden, Denmark, Norway and Finland. Methods All Nordic University Hospitals were contacted regarding a Nordic randomized controlled trial exploring effects and complications associated with the use of nasogastric tube use after esophagectomy for cancer. Those who chose to join the trial were sent a questionnaire regarding surgical and perioperative routines. Results Twelve centers with a combined catchment area of 16 million inhabitants and an annual volume of 400 esophagectomies joined the trial network. All but one used totally minimally invasive or hybrid surgical approach. All 12 centers reported routine use of NG-tube and 5 employed continuous suction. The NG-tube was removed between 3 and 7 days postoperatively. A routine pylorus drainage procedure was reported from two centers. Jejunostomy was used universally in 5 centers and selectively in 6 centers. One center did not use jejunostomy. Conclusion Differences in perioperative care after esophagectomy is apparent in the Nordic countries, highlighting the need for high-level evidence regarding these practices. A unified approach may facilitate clinical trial initiatives. There is a paucity of evidence regarding optimal NG-tube use after esophagectomy for cancer and a randomized trial investigating this issue is under way. [ABSTRACT FROM AUTHOR]