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This study evaluates the effectiveness of five types of Granular Activated Carbon (GAC) and one anion exchange resin in a pilot plant for treating groundwater for drinking water production, specifically targeting the removal of persistent compounds like PFAS. Using liquid chromatography and supercritical fluid chromatography coupled with high-resolution mass spectrometry, hundreds of features (i.e. peak at specific mass and retention time) were detected in the groundwater by non-target analysis. Initially, after treating <3200 bed volumes (BV), the GAC filter materials showed < 6 % breakthrough for all features from the groundwater, with decreasing efficiency down to 79 % breakthrough after seven month (69,000 treated BV for µGAC). Using resin as a lag filter after GAC did not improve the removal of compounds detected in positive electrospray ionization mode. However, it enhanced removal by up to 35% for compounds detected in negative electrospray ionization mode, indicating higher selectivity of resin for acidic compounds like PFAS. The shortest detected PFAS (PFBA and PFPeA) broke through completely for all GAC and the resin material except the proprietary blended GAC (at 15,700 treated BV), which had only 19% breakthrough for PFPeA. The so far rarely detected perfluoro(4-ethylcyclohexane)sulfonic acid (PFECHS) was well adsorbed by GAC coupled to resin and by the proprietary blended GAC. Pesticides were effectively removed by GACs, but not by the resin filter. Contaminants not previously detected in groundwater, 2,4,5-trichlorobenzenesulfonic acid (TCBS) and 2-amino-4-chloro-5-methylbenzenesulfonic acid (ACMBS), were effectively removed (>92 %), but high ACMBS concentrations (360 ng/L) in groundwater are of concern. The drinking water after the resin filter revealed 20 new contaminants, such as tributylamine derivatives and monobutyl phthalate, indicating resin filters contribution to drinking water contamination. Accelerated migration experiments of the resin revealed additional contaminants, such as NDBA and further phthalates, highlighting the need for continued monitoring and evaluation of resin materials in water treatment systems., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

This study presents the integration of the single-particle extinction and scattering (SPES) method in a continuous flow analysis (CFA) setup. Continuous measurements with the instrument allow for the characterization of water-insoluble particles in ice cores at high resolution with a minimized risk of contamination. The SPES method can be used to investigate particles smaller than 1 μm, which previously could not be detected by instruments typically used in CFA. Moreover, the SPES method provides not only the particle concentration and size distribution but also the effective refractive index. We show that nonabsorbing mineral particles and absorbing particles from both wildfires and fossil fuel burning can be detected with the SPES method in shallow ice cores from North-East Greenland. The concentration record retrieved with SPES correlates well with established methods used in continuous measurements of dust content in ice cores. Year-to-year variations in the number distribution of the diameter are only detectable by stacking annual layers because of the low nonabsorbing particle concentration of late Holocene ice of approximately 6 × 10 4 mL -1 . The median diameter in the bottom 20 m of the EGRIP-S7 core is found to be 0.75 μm (0.72 μm) during the annual maximum (minimum) in dust concentration.

Background: Patients undergoing major lower extremity amputation (LEA) due to vascular disease face an increased risk of post-surgery anxiety and depression. The Hospital Anxiety and Depression Scale (HADS), widely used to identify anxiety and depressive symptoms, has been translated into Danish, but its content validity has not previously been tested in LEA patients. This study aims to test the validity and reliability of HADS in this population., Method: This methodological study involved cognitive interviews with 10 major LEA patients to assess content validity and HADS responses from 100 patients to evaluate the floor and ceiling effects, construct validity, and internal consistency reliability. Data were collected from seven orthopedic departments across Denmark., Results: In this hospital-based study, 20% had anxiety symptoms and 18% had depressive symptoms before discharge. Patients found the questionnaire relevant but had concerns about the one-week timeframe and the comprehensibility of certain items ("butterflies in the stomach" in item 9 and the term "things" in items 2 and 12). Floor effects were present across all items, with no ceiling effects. Confirmatory factor analysis supported both the original two-factor and a three-factor structure. Internal consistency reliability was good for both subscales., Conclusion: This study supports the validity and reliability of the Danish version of HADS for assessing anxiety and depression in patients with major lower extremity amputation (LEA). The questionnaire serves as a valuable tool for addressing psychosocial challenges, enabling patients to reflect on their mental health and recognize potential symptoms needing medical attention in the future., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: Distal radius fractures are common injuries managed frequently in emergency departments. While numerous studies focus on the surgical treatment of distal radius fractures, there is a lack of research about non-surgically treated patients' early experiences post-injury. The objective of this study was to explore adult patients' initial experiences following closed reduction treatment of distal radius fracture in the emergency department., Methods: This qualitative study involved semi-structured telephone interviews with 21 patients who underwent closed-reduction treatment at 2 hospitals in Southern Denmark. Interviews were conducted within the first week following ED treatment and analyzed thematically., Results: Patients were aged 42 to 91, and 3 were men. Three major themes emerged: (1) Pain Management: Patients reported significant pain during waiting periods and treatment, indicating a need for improved pain management strategies; (2) Information Dissemination: Participants expressed a need for clearer, continuous communication about their treatment and recovery expectations; and (3) Beyond the fracture: Patients were anxious about future functional abilities, especially those with dominant hand fractures, underscoring the need for holistic patient care that addresses psychological and social dimensions., Discussion: Effective pain management, both pharmacological and non-pharmacological, as well as comprehensive, clear communication, is crucial in the initial treatment phase of distal radius fracture. Acknowledging patients' broader concerns can enhance the quality of care and support improved recovery outcomes. These findings imply that future emergency nursing practice should prioritize swift and effective pain management, clear and empathetic communication, and a holistic approach to patient care to optimize recovery outcomes., (Copyright © 2025 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.)

Background: As healthcare systems evolve, individuals are expected to be more involved in managing their health and rehabilitation. A wireless medical accelerometer (SENS motion®) has been developed to collect objective data on physical activity. The number of patients requiring knee replacement is rising, but the motivational effect of medical accelerometers in the rehabilitation after knee replacement remains unexplored. This study aims to employ a user-driven approach to tailor the SENS motion® technology for patients undergoing knee replacement prior to testing the refined technology in a randomised controlled trial., Methods: The study used a Participatory Design research methodology, emphasising collaboration and user involvement. It was carried out in three sessions, each aimed at refining the SENS motion® system toward the needs of the patient group in focus. The first session involved six healthcare professionals who provided written feed-back. The second and third sessions included testing and subsequent interviews of patients (n = 10). After each session, conducted in iterative processes (plan, act, observe, reflect), SENS motion® system revisions were implemented according to the patient's wishes. The data collected were then analysed using qualitative content analysis., Results: Prior to patient testing, healthcare professionals identified functional and technical errors that required modifications. Patient interviews revealed that (1) there were positive attitudes towards the SENS motion® system, (2) patients were motivated by daily step counts and geographical locations, especially when they were familiar with landmarks, and (3) active involvement of family members was found to be feasible, which contributed to a sense of solidarity during the rehabilitation process., Conclusion: This study applied a user-driven approach to customise health technology for postoperative rehabilitation in knee replacement patients. Initially, the technology had both technical and functional problems, but system revisions based on patient feedback improved its acceptance. The refined technology is undergoing testing in a randomised design., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Introduction: External fixation is widely used in treating complex fractures and limb reconstruction. Pin site infections remain a significant complication, impacting on patients' physical and psychosocial wellbeing. This clinical improvement project at a University Hospital in Denmark aimed to enhance pin site care by involving patients and caregivers throughout the treatment pathway., Background: At our hospital, approximately 55 trauma patients are annually treated with lower limb external fixators. Pin site care is crucial for preventing serious infections/osteomyelitis and involves collaboration between hospital and municipal caregivers. Traditional pin site care in our unit was complex and time-consuming, causing patient anxiety and frequent unplanned clinic visits., Methods: Inspired by the Participatory Design research methodology, a quality improvement project was conducted in three phases: (1) identifying users' needs, (2) developing solutions collaboratively, and (3) testing/evaluating these solutions. Iterative cycles of planning, acting, observing, and reflecting were employed, facilitating mutual learning among participants. Interviews with patients, families and healthcare professionals and field observations both at the hospital and in the municipality were conducted. Inspiration was sought from international literature., Results: Phase 1 identified the need for improved education about infection recognition, a less painful and time-consuming dressing method, and an assessment tool for pin site infection. Phase 2 involved extensive user input to develop and implement a new dressing procedure using PolyMem™ along with an assessment tool. Phase 3 evaluated the new methods, revealing reduced patient pain, fewer clinic visits, and stable infection rates as well as less time-consuming pin site care., Conclusion: The project successfully enhanced pin site care, involving users in developing a new care process, thus improving patient satisfaction and care efficiency., Implications for Future Practice: Incorporating patient perspectives and collaborative methods can significantly improve clinical care pathways. Future efforts should focus on further integrating patient centered and participatory approaches in healthcare improvements., Competing Interests: Declaration of competing interest All authors declare no confict of interest., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Evidence on how to improve daily physical activity (PA) levels following total knee arthroplasty (TKA) or medial uni-compartmental knee arthroplasty (mUKA) by motivational feedback is lacking. Moreover, it is unknown whether a focus on increased PA after discharge from the hospital improves rehabilitation, physical function, and quality of life. The aim of this randomized controlled trial (RCT) nested in a prospective cohort is (a) to investigate whether PA, physical function, and quality of life following knee replacement can be increased using an activity monitoring device including motivational feedback via a patient app in comparison with activity monitoring without feedback (care-as-usual), and (b) to investigate the potential predictive value of PA level prior to knee replacement for the length of stay, return to work, and quality of life., Methods: The study is designed as a multicenter, parallel-group, superiority RCT with balanced randomization (1:1) and blinded outcome assessments. One hundred and fifty patients scheduled for knee replacement (TKA or mUKA) will be recruited through Odense University Hospital, Denmark, Vejle Hospital, Denmark and Herlev/Gentofte Sygehus, Denmark. Patients will be randomized to either 12 weeks of activity monitoring and motivational feedback via a patient app by gamification or 'care-as-usual,' including activity monitoring without motivational feedback. The primary outcome is the between-group change score from baseline to 12-week follow-up of cumulative daily accelerometer counts, which is a valid proxy for average objectively assessed daily PA., Discussion: Improving PA through motivational feedback following knee replacement surgery might improve post-surgical function, health-related quality of life, and participation in everyday life., Trial Registration: ClinicalTrials.gov, ID: NCT06005623. Registered on 2023-08-22., Trial Status: Recruiting., (© 2024. The Author(s).)

Participatory design (PD) is a methodology that emphasizes user participation in the design of new technologies to leverage change within organizations and services. PD originated in the computer science field in the 1970s and 1980s when new programs and technologies were developed to empower workers, by involving them in decisions that affected them. PD in health research has been proven to change clinical practice. Genuine user involvement that includes all stakeholders, and robust collaborations across sciences, sectors, and disciplines are basic elements of successful research to change clinical practice and to implement novel technical and organizational approaches. This paper summarizes seven case studies involving the use of PD in telehealth research. All cases presented promoted organizational changes supported by health information and communications technology, and have been implemented at either international, national, regional, or local levels. We describe how PD can be applied in health sciences and used to facilitate organizational changes, new perspectives, and new communications methods. The relevance and suitability of PD as a research design in health science is explained, and recommendations for conducting PD studies in telehealth research are presented. In PD, mutual learning and co-creation is facilitated. Consequently, learning from users, rather than studying them, corroborates our understanding and the emergence of new knowledge., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Patients often feel unprepared and concerned about their new life after a major lower extremity amputation (LEA). Therefore, we implemented an integrated care program, Safe Journey, to optimize the quality and continuity of care for patients with LEA due to vascular disease when transitioning from hospital to home. This study aims to illuminate and explore the experiences of patients with LEA and their relatives with the transition from hospital to home after implementing Safe Journey., Material and Methods: This qualitative, exploratory study individually interviewed six patients with a major LEA and four relatives and jointly interviewed eight patients with their relatives., Results: The participants' experiences transitioning from hospital to home were centered around two major themes: (1) Going home: mixed emotions and confusion, and (2) bridging the gap. The main themes encompassed six subthemes: (1) simultaneously expectant and worried, (2) a lack of knowledge creating uncertainty, (3) an unexpressed but pending need for psychosocial support, (4) reassurance but safety comes at a price, (5) navigating the system, and (6) lack of involvement., Conclusion: Transitioning from hospital to home after a major LEA creates mixed emotions. Knowledge, feeling involved, and being prepared and cared for were highlighted as important during the transition. The Safe Journey program made patients and relatives feel physically reassured and safe, but all the home visits strained the families. The program's benefits are consistent with existing knowledge on patients with complex needs benefitting from integrated care models. However, a more individualized and person-centered approach is needed., Competing Interests: Declaration of competing interest Authors have no conflicts of interest to report., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Distal radius fractures are a common presentation in emergency departments. Synthesis of qualitative research of treatment, care and rehabilitation this fracture presents from the patient perspective could improve clinical practice and care. The purpose of this systematic review was to synthesize the qualitative literature on patient experiences after sustaining a distal radius fracture., Methods: We searched Embase, MEDLINE, CINAHL, Psycinfo and CINAHL to identify qualitative studies published from database conception to May 2023. All studies were screened, extracted, analysed and quality assessed by two blinded reviewers. A thematic synthesis approach was used to analyse the findings from included studies., Results: A total of 9 studies interviewing 160 unique patients were included. We identified 3 themes in relation to patient experiences after sustaining a distal radius fracture: 1) Concerns about dependency, 2) Fear and pain and 3) Motivators for recovery. The themes did not exist as sharply demarcated topics but were intertwined with patients reflecting that more information and knowledge could assist in managing expectations and the recovery period., Conclusion: Our synthesis highlighted that adult patients with DRF experience a lack of information about the care and treatment inhibiting independence and successful management of expectations due to pain, fear and lack of motivation. Our findings can inform orthopaedic units and assist in tailoring information to patient needs., Competing Interests: Declaration of competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Aim(s): To discuss the methodological aspects of participatory design, arguing for a three-phase approach and the suitability of situating participatory design within a phenomenological-hermeneutical tradition in health science., Design and Methods: Methodological discussion based on participatory design theory, epistemology and research studies., Results: The epistemological and methodological discussions show how the core values and key elements of participatory design align with the phenomenological-hermeneutical approach. In addition, examples of participatory design studies are provided to illustrate how it can be conducted in health science., Conclusion: Participatory design is a flexible framework based on genuine participation, defined by three core values: having a say, mutual learning and democratization. The iterative processes allow for adjustments in alignment with the core values and the scientific stance that defines the choice of methods, tools and techniques. A phenomenological-hermeneutic approach in participatory design studies is relevant and aligned with the core values of participatory design. Thus, this paper argues for a close integration between the participatory design methodology and the phenomenological-hermeneutic scientific approach within health science., Implications for the Profession: Participatory design is a powerful methodology with core values that can co-design sustainable health technologies with potential to impact patient care and the clinical practice of nurses. When combined with qualitative research methods, patients' lived experiences serve as the foundation for improving clinical nursing practice. Discussing the epistemological aspects of participatory design provides nurse researchers with a coherent methodological understanding, essential for the continual development of nursing research., Impact: This paper discusses the research methodology of participatory design within health sciences. It aims to address the lack of understanding of the methodology, particularly within a specific scientific stance. The main finding is the elaboration on participatory design and the relevance of a phenomenological-hermeneutical approach. The paper has the potential to impact researchers, master's and PhD students, as well as others engaged in participatory design or other methodologies related to user involvement within health science., Reporting Method: No available EQUATOR guidelines were applicable to this methodological paper, as no new data were created or analysed., Patient or Public Contribution: There was no direct patient or public contribution, as this is a methodological paper., (© 2024 The Author(s). Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Acetylcholine is a neurotransmitter that plays a variety of roles in the central nervous system. It was previously shown that blocking muscarinic receptors with a nonselective antagonist prevents a form of experience-dependent plasticity termed "spatiotemporal sequence learning" in the mouse primary visual cortex (V1). Muscarinic signaling is a complex process involving the combined activities of five different G protein-coupled receptors, M1-M5, all of which are expressed in the murine brain but differ from each other functionally and in anatomical localization. Here we present electrophysiological evidence that M2, but not M1, receptors are required for spatiotemporal sequence learning in mouse V1. We show in male mice that M2 is highly expressed in the neuropil in V1, especially in thalamorecipient layer 4, and colocalizes with the soma in a subset of somatostatin-expressing neurons in deep layers. We also show that expression of M2 receptors is higher in the monocular region of V1 than it is in the binocular region but that the amount of experience-dependent sequence potentiation is similar in both regions and that blocking muscarinic signaling after visual stimulation does not prevent plasticity. This work establishes a new functional role for M2-type receptors in processing temporal information and demonstrates that monocular circuits are modified by experience in a manner similar to binocular circuits. NEW & NOTEWORTHY Muscarinic acetylcholine receptors are required for multiple forms of plasticity in the brain and support perceptual functions, but the precise role of the five subtypes (M1-M5) are unclear. Here we show that the M2 receptor is specifically required to encode experience-dependent representations of spatiotemporal relationships in both monocular and binocular regions of mouse V1. This work identifies a novel functional role for M2 receptors in coding temporal information into cortical circuits.

Background: A lack of information during an emergency visit leads to the experience of powerlessness for patients and their family members, who may also feel unprepared to cope with acute symptoms. The ever-changing nature and fast-paced workflow in the emergency department (ED) often affect how health care professionals can tailor information and communication to the needs of the patient., Objective: This study aimed to evaluate the usability and experience of a newly developed information system. The system was developed together with patients and their family members to help provide the information needed in the ED., Methods: We conducted a mixed methods study consisting of quantitative data obtained from the System Usability Scale questionnaire and qualitative interview data obtained from purposively selected participants included in the quantitative part of the study., Results: A total of 106 patients and 14 family members (N=120) answered the questionnaire. A total of 10 patients and 3 family members participated in the interviews. Based on the System Usability Scale score, the information system was rated close to excellent, with a mean score of 83.6 (SD 12.8). Most of the participants found the information system easy to use and would like to use it again. The participants reported that the system helped them feel in control, and the information was useful. Simplifications were needed to improve the user experience for the older individuals., Conclusions: This study demonstrates that the usability of the information system is rated close to excellent. It was perceived to be useful as it enabled understanding and predictability of the patient's trajectory in the ED. Areas for improvement include making the system more usable by older individuals. The study provides an example of how a technological solution can be used to diminish the information gap in an ED context., (©Christina Østervang, Charlotte Myhre Jensen, Elisabeth Coyne, Karin B Dieperink, Annmarie Lassen. Originally published in JMIR Human Factors (https://humanfactors.jmir.org), 21.02.2024.)

Purpose: We aimed to illuminate the lived experiences and the path of recovery for adults sustaining a hip fracture before the age of 60., Methods: Participants were purposively sampled from a prospective multicenter cohort study in Sweden and Denmark, and narrative interviews were conducted with 19 individuals 0.7-3.5 years after the fracture. We used a phenomenological hermeneutic method to describe the participants' expressed essential meaning., Results: The experience of sustaining a hip fracture was expressed as a painful and protracted process of regaining self-confidence, function, and independence. It also implied a sense of growing old from one day to the next. Participants were afraid of new falls and fractures, resulting in an increased wariness. When expressing fears and persisting symptoms, participants described being neglected and marginalized by the healthcare system, which was perceived as non-receptive and routinely driven by a notion that hip fractures affect only the elderly. Rehabilitation targeted towards needs different from those of elderly individuals was requested., Conclusion: The lived experience of sustaining a hip fracture in individuals under 60 includes substantial challenges in everyday life, even up to 3.5 years after the injury. Rehabilitation pathways tailored to the needs of younger patients are requested.

Aim: The aim of this study was to translate and culturally adapt The Emergency Department-Consumer Assessment of Healthcare Providers and Systems (ED CAPHS) to the Danish ED context., Background: In Denmark, a large number of patients attend emergency departments (ED) every year. During their ED visits, examinations, tests and encounters with different healthcare professionals occur frequently. Moreover, patients receive much information. Patients' direct experiences of care can provide valuable insights into what works and what does not in health care. The emergency department-consumer assessment of healthcare providers and systems (ED CAPHS) is a valid questionnaire designed to measure patients' experiences with ED care and is intended for patients discharged home following their ED visit., Method: The translation process was systematically planned and executed using the principles of good practice for the translation and cultural adaptation process for patient-reported outcomes (PRO) guidelines by the ISPOR., Results: The translation and cultural adaption process were successfully conducted. Three items concerning language and race were omitted as they are not distinct in Danish ED context. Furthermore, a few conceptual factors and linguistic challenges were discussed and harmonised during the reconciliation and harmonisation process respectively. The Danish survey ED CAPHS DK containing 32 items was proofread and finalised., Conclusion: Overall, patients reported that the survey was relevant and comprehensive, as it focused on essential factors when discharged directly home after an ED admission. ED CAPHS DK is found to be content valid and ready for use. However, a future study testing the Danish version using confirmative factor analysis and internal consistency reliability is needed to ensure construct validity and reliability., (© 2023 The Authors. Scandinavian Journal of Caring Sciences published by John Wiley & Sons Ltd on behalf of Nordic College of Caring Science.)

Repeated exposure to visual sequences changes the form of evoked activity in the primary visual cortex (V1). Predictive coding theory provides a potential explanation for this, namely that plasticity shapes cortical circuits to encode spatiotemporal predictions and that subsequent responses are modulated by the degree to which actual inputs match these expectations. Here we use a recently developed statistical modeling technique called Model-Based Targeted Dimensionality Reduction (MbTDR) to study visually evoked dynamics in mouse V1 in the context of an experimental paradigm called "sequence learning." We report that evoked spiking activity changed significantly with training, in a manner generally consistent with the predictive coding framework. Neural responses to expected stimuli were suppressed in a late window (100-150 ms) after stimulus onset following training, whereas responses to novel stimuli were not. Substituting a novel stimulus for a familiar one led to increases in firing that persisted for at least 300 ms. Omitting predictable stimuli in trained animals also led to increased firing at the expected time of stimulus onset. Finally, we show that spiking data can be used to accurately decode time within the sequence. Our findings are consistent with the idea that plasticity in early visual circuits is involved in coding spatiotemporal information., (© The Author(s) 2023. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Sex hormones can affect cellular physiology and modulate synaptic plasticity, but it is not always clear whether or how sex-dependent differences identified in vitro express themselves as functional dimorphisms in the brain. Historically, most experimental neuroscience has been conducted using only male animals and the literature is largely mute about whether including female mice in will introduce variability due to inherent sex differences or endogenous estrous cycles. Though this is beginning to change following an NIH directive that sex should be included as a factor in vertebrate research, the lack of information raises practical issues around how to design experimental controls and apply existing knowledge to more heterogeneous populations. Various lines of research suggest that visual processing can be affected by sex and estrous cycle stage. For these reasons, we performed a series of in vivo electrophysiological experiments to characterize baseline visual function and experience-dependent plasticity in the primary visual cortex (V1) of male and female mice. We find that sex and estrous stage have no statistically significant effect on baseline acuity measurements, but that both sex and estrous stage have can modulate two mechanistically distinct forms of experience dependent cortical plasticity. We also demonstrate that resulting variability can be largely controlled with appropriate normalizations. These findings suggest that V1 plasticity can be used for mechanistic studies focusing on how sex hormones effect experience dependent plasticity in the mammalian cortex., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Schecter et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: This post-hoc analysis from three phase 3 treatment trials of rimegepant 75 mg - an oral small molecule calcitonin gene-related peptide receptor antagonist for acute and preventive treatment of migraine - assessed efficacy in adults with migraine based on triptan treatment experience., Methods: Participants were assigned to one of four groups based on triptan treatment experience: insufficient response (e.g. lack of efficacy and/or poor tolerability) to 1 triptan, insufficient response to ≥2 triptans, current triptan users, and triptan-naïve participants. The co-primary efficacy endpoints were pain freedom and most bothersome symptom freedom at two hours postdose., Results: In the three trials (N = 3507; rimegepant n = 1749, placebo n = 1758), 1235 (35.2%) participants had a history of insufficient response to 1 triptan (n = 910 [25.9%]) or ≥2 triptans (n = 325 [9.3%]), and 2272 (64.8%) had no history of insufficient response to triptans (current use = 595 [17.0%], naïve = 1677 [47.8%]). Rimegepant was effective on the co-primary endpoints in all subgroups ( p  ≤ 0.013), except for freedom from the most bothersome symptom in the triptan-naïve group ( p  = 0.06). No differences on co-primary endpoints were found in pairwise comparisons of rimegepant-treated participants., Conclusions: Rimegepant was effective for the acute treatment of migraine in adults with a history of insufficient response to 1 or ≥2 triptans and in current triptan users. Efficacy on co-primary endpoints did not differ based on the number of insufficient triptan responses.Trial registration: Clinicaltrials.gov: NCT03235479, NCT03237845, NCT03461757.

Background: Periprosthetic joint infection (PJI) of the knee is associated with extended hospital stay, high doses of antibiotics, lengthy rehabilitation, and pain. Standard treatment is a two-stage procedure comprising two surgeries and two hospitalizations. To facilitate exploration of patients' perspectives, the qualitative study presented here was an adjunct to a Danish randomized controlled trial comparing one-stage and two-stage revision surgery., Aim: To explore patient experiences, before, during and after hospitalization and surgical treatment with one- or two-stage revision for PJI of the knee., Material and Methods: Qualitative, semi-structured telephone interviews were conducted with 10 individuals who had undergone either one- or two-stage revision because of PJI. Thematic analysis was employed., Results: The essence of the findings was that the infection was a transition point in a possible life-changing illness. The three themes representing this comprised: 1) physical, 2) psychological, and 3) social implications. Each theme is further illuminated with subthemes., Conclusions: Infection is a transition point in a possible life changing illness. Late diagnosis and delayed treatment are major issues. Individuals suffer from pain, weight loss, fatigue, and reduced mobility as well as dependency on family members, leading to psychological challenges including depression., Implications for Clinical Practice: Patients with PJI of the knee could be better informed, educated and involved before and during treatment. Information is needed not only about the physical consequences, but also the psychological and social consequences. More patient involvement and inter-professional and care sector coordination is important when caring for patients with PJI., Competing Interests: Declaration of competing interest The authors declare that they have no competing interests., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Objective: The successful development and implementation of sustainable healthcare technologies require an understanding of the clinical setting and its potential challenges from a user perspective. Previous studies have uncovered a gap between what emergency departments deliver and the needs and preferences of patients and family members. This study investigated whether a user-driven approach and participatory design could provide a technical solution to bridge the identified gap., Methods: We conducted four workshops, and five one-to-one workshops with patients, family members, healthcare professionals, and information technology specialists to codesign a prototype. Revisions of the prototype were made until an acceptable solution was agreed upon and tested by the participants. The data were analyzed following iterative processes (plan → act → observe → reflect)., Results: The participants emphasized the importance of a person-centered approach focusing on improved information. An already implemented system for clinicians' use only was redesigned into a unique patient module that provides a process line displaying continually updated informative features, including (1) person-centered activities, (2) general information videos, (3) a notepad, (4) estimated waiting time, and (5) the nurse and physician responsible for care and treatment., Conclusion: Participatory design is a usable approach to designing an information system for use in the emergency department. The process yielded insight into the complexity of translating ideas into technologies that can actually be implemented in clinical practice, and the user perspectives revealed the key to identifying these complex aspects. The iterations with the participants enabled us to redesign an existing technology., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2022.)

Spatial resolution in existing chest x-ray (CXR)-based scoring systems for coronavirus disease 2019 (COVID-19) pneumonia is low, and should be increased for better representation of anatomy, and severity of lung involvement. An existing CXR-based system, the Brixia score, was modified to increase the spatial resolution, creating the MBrixia score. The MBrixia score is the sum, of a rule-based quantification of CXR severity on a scale of 0 to 3 in 12 anatomical zones in the lungs. The MBrixia score was applied to CXR images from COVID-19 patients at a single tertiary hospital in the period May 4th-June 5th, 2020. The relationship between MBrixia score, and level of respiratory support at the time of performed CXR imaging was investigated. 37 hospitalized COVID-19 patients with 290 CXRs were identified, 22 (59.5%) were admitted to the intensive care unit and 10 (27%) died during follow-up. In a Poisson regression using all 290 MBrixia scored CXRs, a higher MBrixia score was associated with a higher level of respiratory support at the time of performed CXR. The MBrixia score could potentially be valuable as a quantitative surrogate measurement of COVID-19 pneumonia severity, and future studies should investigate the score's validity and capabilities of predicting clinical outcomes., (© 2022. The Author(s).)

Background: Arthroscopic distal clavicle resection (DCR) can be offered to patients with persistent acromioclavicular (AC) joint pain who do not benefit from conservative treatment. The aim of this study was to evaluate the outcome of combined arthroscopic DCR and concomitant arthroscopic subacromial decompression in a large consecutive and prospective cohort using patient-reported outcomes., Methods: Consecutive patients were identified from our online database and included based on their primary treatment code. All patients had a diagnosis of shoulder impingement syndrome and persistent AC joint pain resistant to at least six months of conservative treatment. The outcomes from the combined intervention were evaluated by patients through the Oxford Shoulder Score (OSS) questionnaire and EuroQol 5-Dimension 3-Level questionnaire, including a EuroQol visual analog scale score collected preoperatively and at a 2-year follow-up. Patient-reported satisfaction with the procedure was reported at the follow-up. Subgroups were formed to further evaluate outcome based on preoperative OSS (low, moderate, high) and age., Results: 131 patients (75%) were available for analysis at the 2-year follow-up. Sixty seven patients (51%) were female and the mean age was 51 years (range 19-82). A mean OSS change of 12.1 (95% confidence interval, 10.3-14.0; P  < .001) was observed within the entire study group. In both the low and moderate preoperative-OSS (pre-OSS) groups, a mean change of 14 was found with no difference between groups ( P  = .971). A mean change of 7 was found in the high pre-OSS group, which differed from both the moderate ( P  < .001) and low ( P  = .036) pre-OSS groups. A significant change in EuroQol 5-Dimension and EuroQol visual analog scale was observed within all the pre-OSS groups, and 107 patients (82%) replied that they were satisfied or very satisfied with their outcome of surgery at the follow-up., Conclusions: Patients who suffer from persistent AC joint pain largely benefit from arthroscopic DCR with arthroscopic subacromial decompression through relief of symptoms and improved quality of life, including those with a high self-reported and preoperative level of shoulder function., (© 2022 The Authors.)

Worldwide, ankle fractures are among the most common fractures encountered in emergency departments. To inform healthcare professionals about what is important to patients when organizing an individualized, high-quality treatment plan, patient perspectives on treatment, care, and early rehabilitation are highly relevant. This longitudinal interview study aims to explore the perspectives of patients with surgically (ST) and conservatively (CT) treated ankle fractures within ten days and six weeks after an ankle fracture. Fourteen patients were interviewed using a semi-structured interview guide. Data were analyzed according to qualitative content analysis. Findings revealed themes regarding pain, independence, information, and worries about the future. Initially, all patients had a pragmatic attitude toward the future, but this attitude was significantly different after 6 weeks as many of the ST patients were still in pain and were more worried about the future. Patients' feelings of uncertainty were linked to a lack of information. Our findings indicate a need for further research to develop a more specific description of symptoms patients should expect as treatment progresses for patients with ankle fractures. With the goal of decreasing psycho-social concerns regarding mobility, autonomy, and working ability post fracture., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Objective: Besides working in a fast-paced environment, healthcare professionals (HCPs) in the emergency department (ED) are required to promptly respond to patients' needs and simultaneously achieve their organisational goals, which can be challenging. This study investigates how HCPs perceive and support the needs of patients discharged after a brief ED stay, as well as their family members., Design: The study used focus group discussions. The text material was analysed using systematic text condensation., Setting: Data were collected from two large EDs in Denmark., Participants: Sixteen HCPs were sampled purposively to participate in three focus group discussions., Results: Three main themes were condensed: (1) creating a trustful and reassuring relationship; (2) responding to family members: a bother or a benefit; and (3) working as an interdisciplinary team. The study indicated the need for increased interdisciplinary collaboration to reduce discrepancies in information dissemination, to meet patient and family needs and to deliver a holistic approach. A technical solution was suggested to facilitate collaborative teamwork., Conclusion: The study highlighted an existing gap between emergency HCPs' perceptions of patients' and family members' needs and the provision of the current patient and family support. Suggestions for future interventions include focusing on interdisciplinary teamwork, facilitated by a technical solution to support a person-centred and family-centred informative approach., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: There is an increase in patients being discharged after short stays in the emergency department, but there is limited knowledge of their perspectives on treatment and care. This study aims to explore and understand the needs and preferences of emergency care from the perspective of patients and family members discharged from the emergency department within 24 hours of admission., Design: The study reports from the first phase in an overall participatory design project. Systematic text condensation was used to identify key themes from field observations and interviews with patients and family members., Setting: This study was conducted in two emergency departments in the Region of Southern Denmark., Participants: All adults aged ≥18 years who had been discharged from the emergency department within 24 hours were eligible to take part. Purposeful sampling was used to recruit patients and family members with different sociodemographic features., Results: Field observational studies (n=50 hours), individual interviews with patients (N=19) and family members (N=3), and joint interviews with patients and family members (N=4) were carried out. Four themes were derived from the material: (1) being in a vulnerable place-having emotional concerns; (2) having a need for person-centred information; (3) the atmosphere in the emergency department and (4) implications of family presence., Conclusion: This study demonstrates a gap between patients' and family members' needs and preferences and what current emergency departments deliver. The findings highlight the importance of family and person-centred care. Tailored communication and information with genuine involvement of family members is found to be essential needs during acute illness., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: To classify short-term and long-term rehabilitation goals and analyse how they capture functioning in a biopsychosocial International Classification of Functioning, Disability and Health (ICF) perspective., Materials and Methods: A retrospective study was conducted at two specialised outpatient multidisciplinary rehabilitation centres for polio survivors and accident victims. Rehabilitation goals extracted from patient journals were linked to the ICF according to linking rules., Results: One hundred patients were included. Four hundred and eighty-seven short-term and long-term rehabilitation goals were linked to the ICF. Fifty-seven per cent were linked to Activity and Participation, 22% to Body Functions, 1% to Body Structure, 4% to Environmental Factors, 4% to Personal Factors, whereas 11% were not defined and 1% was not covered. The identified categories covered all ICF domains. The most frequent categories for short-term goals were d450 "Walking" and d570 "Looking after one's health." For long-term goals, d850 "Remunerative Employment" and d920 "Recreation and Leisure" were the most frequent., Conclusion: The study showed challenges in capturing all aspects of biopsychosocial functioning in rehabilitation goals, particularly Contextual Factors. This study indicates that rehabilitation goals capture capacity rather than performance . Further research could highlight if functioning is captured in the rehabilitation plan, and in this way include both capacity and performance .Implications for rehabilitationHealth professionals in a post-acute or long-term rehabilitation setting should pay attention to capacity and performance when rehabilitation goals are set.The rehabilitation plan should contain goals and a description of patient's contextual factors and both should be equally valued and combined in a description of functioning.In a post-acute or long-term rehabilitation setting short-term and long-term goals are affected by the context. A longer rehabilitation intervention lead to goals linked to activity and participation.

We report high resolution measurements of the stable isotope ratios of ancient ice (δ 18 O, δD) from the North Greenland Eemian deep ice core (NEEM, 77.45° N, 51.06° E). The record covers the period 8-130 ky b2k (y before 2000) with a temporal resolution of ≈0.5 and 7 y at the top and the bottom of the core respectively and contains important climate events such as the 8.2 ky event, the last glacial termination and a series of glacial stadials and interstadials. At its bottom part the record contains ice from the Eemian interglacial. Isotope ratios are calibrated on the SMOW/SLAP scale and reported on the GICC05 (Greenland Ice Core Chronology 2005) and AICC2012 (Antarctic Ice Core Chronology 2012) time scales interpolated accordingly. We also provide estimates for measurement precision and accuracy for both δ 18 O and δD.

Background: The main long-term benefit of operative treatment of displaced midshaft clavicular fractures is the reduction in nonunion risk, and as this risk is generally low, the ideal approach would be to operate only patients at high risk of nonunion. However, most current surgical decision models use baseline variables to estimate the nonunion risk, and the value of these models remains unclear. Pain in the early weeks after fracture could be potentially be an indirect measurement of fracture healing, and so it is a potential proxy variable that could lead to simpler prediction models., Questions/purposes: (1) Is pain a possible proxy variable for the development of symptomatic nonunion after nonoperative treatment of midshaft clavicular fractures? (2) How reliable is the model we created that uses pain as a proxy variable for symptomatic nonunion of nonoperatively treated clavicle fractures?, Methods: In this secondary retrospective analysis of an earlier randomized trial, we studied prospectively collected data from 64 nonoperatively treated patients aged 18 years to 60 years. In the original randomized trial, we compared operative and nonoperative treatment of displaced midshaft clavicular fractures. In all, 150 patients were included in the study, of whom 71 received nonoperative treatment. Patients were predominantly males (75%, 48 of 64) with a mean age of 38 ± SD 12 years; most fractures were comminuted and shortened more than 1 cm. All 71 patients who were nonoperatively treated were potentially eligible for this secondary analysis; of those, 11% (8 of 71) were lost to follow-up, leaving 63 patients from the nonoperative treatment arm and one patient from the operative treatment arm (who declined surgical treatment after randomization but was followed in this group according to the intention-to-treat principle) for analysis here. Nonunion was defined as lack of callus formation, persistent fracture lines and/or sclerotic edges of the bones at the fracture site on plain radiographs at 6 months follow-up. Nonunions were regarded as symptomatic if pain, tenderness, and local crepitation were present at the fracture site. Seventeen percent (11 of 64) of patients had symptomatic nonunions. After investigating differences in early pain scores between the union and nonunion groups, we defined the VASratio as the VAS pain score at 4 weeks divided by the VAS pain score at 2 weeks. Week 2 VAS pain score was chosen as baseline after visual inspection of a linear mixed model that showed increased divergence in pain scores between union and nonunion group at 2 weeks after fracture. Week 4 was chosen as the cutoff because we wanted a reasonable time frame for the detection of pain reduction and did not want to delay surgical treatment more than necessary. Odds ratios for various risk factors were calculated using logistic regression analyses. We used a receiver operating characteristic curve analysis to identify cutoff values for the VASratio., Results: An increase in absolute pain score at 4 weeks after fracture (odds ratio 1.8 per 1 point increase [95% confidence interval 1.1 to 3.4]) was associated with an increased risk of nonunion 6 months after fracture. Likewise, we found that an increasing VASratio (OR 1.02 per 0.01 point increase [95% CI 1.002 to 1.06]) was also associated with nonunion. Receiver operating curve analysis found that the best cutoff value of VASratio was about 0.6. Patients with a VASratio above 0.6 had a relative risk of developing nonunion of 18 (95% CI 2 to 130) compared with patients with a VASratio below 0.6. Sparse-data bias could be present, as is evident from this wide confidence interval, though even at the low end of the confidence interval, the relative risk was 2, which may still improve surgical decision-making., Conclusion: A pain score that exhibits no or minimal change from 2 to 4 weeks after nonoperative treatment of a displaced midshaft fracture of the clavicle is associated with a high risk that symptomatic nonunion will develop. Patients with no or minimal change in pain in the early weeks may be candidates for surgery to reduce the risk of symptomatic nonunion. As this was a retrospective study, with a risk of sparse-data bias, the predictive value of the VASratio needs to be further investigated in large prospective studies before clinical use., Level of Evidence: Level III, diagnostic study., Competing Interests: All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request., (Copyright © 2020 by the Association of Bone and Joint Surgeons.)

Introduction: The development of acute symptoms or changes in diseases led to feelings of fear and vulnerability and the need for health professional support. Therefore, the care provided in the acute medical and surgical areas of the emergency department (ED) is highly important as it influences the confidence of patients and families in managing everyday life after discharge. There is an increase in short-episode (<24 hours) hospital admissions, related to demographic changes and a focus on outpatient care. Clear discharge information and inclusion in treatment decisions increase the patient's and family's ability to understand and manage health needs after discharge, reduces the risk of readmission. This study aims to identify the needs for ED care and develop a solution to improve outcomes of patients discharged within 24 hours of admission., Methods and Analysis: The study comprises the three phases of a participatory design (PD). Phase 1 aims to understand and identify patient and family needs when discharged within 24 hours of admission. A qualitative observational study will be conducted in two different EDs, followed by 20 joint interviews with patients and their families. Four focus group interviews with healthcare professionals will provide understanding of the short pathways. Findings from phase 1 will inform phase 2, which aims to develop a solution to improve patient outcomes. Three workshops gathering relevant stakeholders are arranged in the design plus development of a solution with specific outcomes. The solution will be implemented and tested in phase 3. Here we report the study protocol of phase 1 and 2., Ethics and Dissemination: The study is registered with the Danish Data Protection Agency (19/22672). Approval of the project has been granted by the Regional Committees on Health Research Ethics for Southern Denmark (S-20192000-111). Findings will be published in suitable international journals and disseminated through conferences., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Study Design: Systematic review of qualitative studies., Objective: To synthesise qualitative research exploring the experiences and perspectives of persons with spinal cord injury (SCI), relatives and health professionals concerning goal setting in SCI rehabilitation., Methods: Five electronic databases were searched. A search strategy was constructed with key concepts identified using PICo (Population, phenomena of Interest and Context). Peer reviewed studies complying with the inclusion criteria were selected. Interpretive Description methodology guided analysis and synthesis of the findings., Results: The search yielded 427 records. Of 12 full text studies assessed for eligibility, four were included describing goal setting in SCI rehabilitation from the perspective of persons with SCI and health professionals. Persons with SCI described a need for goal setting to be related to their everyday life, whereas the health professionals tended to use the hospital setting as their point of reference. Persons with SCI emphasised the importance of being self-directed and taking an active role in goal setting and rehabilitation. No studies presented the perspective of relatives., Conclusions: This review illuminates the divergence in the understanding of goal setting between persons with SCI and health professionals. Goal setting in SCI rehabilitation often directly reflects physical functioning goals set by the health professionals, which does not prepare persons with SCI for everyday life and emotional issues. There is lack of focus on goals addressing psychosocial components such as family issues and change of roles. A shared process with goal setting relevant to persons with SCI and their everyday life is needed.

Aims and Objectives: To use a Habermasian lifeworld theoretical perspective to illuminate a treatment gap for hip fracture patients in a Danish university hospital to guide future healthcare services., Background: Most healthcare systems focus on systematised guidelines to help reduce hospital length of stay in response to increasing demand because of the ageing of the global population. For patients with hip fractures, a previous study demonstrated that there is a lack of patient empowerment and a gap between patients' needs and wishes and what was provided by the healthcare system., Design: In this follow-up study, the previous findings were introduced to a mixed group of health professionals (HPs) who participated in focus group discussions (n = 3, with a total of 18 HPs)., Methods: Data were analysed using qualitative content analysis. By analysing the discourse of the discussions using Habermas' perspective, the lack of patient-empowerment was illuminated and facilitated, describing it in terms of the gap it creates in communicative actions between HPs and patients., Results: Information and education of patients in systematised pathways, such as those for patients with hip fractures, are dominated by a biomedical discourse. Patients are overwhelmed by the psycho-social implications of the hip fracture, leaving them in a shock-like state of mind., Conclusion: Empowerment of patients should involve empowerment of HPs by providing them with skills to support patients in a shock-like state of mind. There is also a need to provide HPs with a more individually targeted means of informing and educating patients., Competing Interests: Declaration of competing interest The authors declare no conflicts of interest with respect to the authorship and/or the publication of this article., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Metal borohydrides are considered promising materials for hydrogen storage applications due to their high volumetric and gravimetric hydrogen density. Recently, different Lewis bases have been complexed with Mg(BH4)2 in efforts to improve hydrogenation/dehydrogenation properties. Notably, Mg(BH4)2·xTHF adducts involving tetrahydrofuran (THF; C4H8O) have proven to be especially interesting. This work focuses on exploring the physicochemical properties of the THF-rich Mg(BH4)2·3THF adduct using neutron-scattering methods and molecular DFT calculations. Structural analysis, based on neutron diffraction measurements of Mg(11BH4)2·3TDF (D - deuterium), has confirmed a lowering of the symmetry upon cooling, from monoclinic C2/c to P1[combining macron] via a triclinic distortion. Vibrational properties are strongly influenced by the THF environment, showing a splitting in spectral features as a result of changes in the bond lengths, force constants, and lowering of the overall symmetry. Interestingly, the orientational mobilities of the BH4- anions obtained from quasielastic neutron scattering (QENS) are not particularly sensitive to the presence of THF and compare well with the mobilities of BH4- anions in unsolvated Mg(BH4)2. The QENS data point to uniaxial 180° jump reorientations of the BH4- anions around a preferred C2 anion symmetry axis. The THF rings are also found to be orientationally mobile, undergoing 180° reorientational jumps around their C2 molecular symmetry axis with jump frequencies about an order of magnitude lower than those for the BH4- anions. In contrast, no dynamical behavior of the THF rings is observed with QENS for a more THF-deficient 2Mg(BH4)2·THF adduct. This lack of comparable THF mobility may reflect a stronger Mg2+-THF bonding interaction for lower THF/Mg(BH4)2 stoichiometric ratios, which is consistent with DFT calculations showing a decrease in the binding energy with each additional THF ring in the adduct. Based on the combined experimental and computational results, we propose that combining THF and Mg(BH4)2 is beneficial to (i) preventing weakly bound THF from coming free from the Mg2+ cation and reducing the concentration of any unwanted impurity in the hydrogen and (ii) disrupting the stability of the crystalline phase, leading to a lower melting point and enhanced kinetics for any potential hydrogen storage applications.

Continuous flow analysis (CFA) has become widely used for the measurement of aerosol-derived impurities in ice-core samples, resulting in high-resolution data sets of past aerosol deposition. Here, we present first results from coupling an inductively coupled plasma time-of-flight mass spectrometer (TOFMS) to a traditional CFA system. This setup enables the measurement of exactly coregistered elemental concentrations over the full mass range without degradation of sensitivity with an increasing number of analytes. The resulting total elemental concentration records have similar or better resolution than the established spectrophotometric methods. The unique capability of a TOFMS to measure fast transient signals and to still cover the full mass range furthermore enables the detection of the ionization of individual insoluble particles entering the plasma. The resulting mass spectra of the particles can be used to investigate the relative elemental composition of the mineral dust particles preserved in ice. The presented analysis of iron-bearing particles indicates that most of the particulate iron in Greenland ice is associated with Mg and Al and is likely part of clay minerals such as illite.

The use of medicines to treat attention deficit/hyperactivity disorder (ADHD) has increased worldwide, including the use of amphetamine-based medicines or prodrugs that metabolise to amphetamine in vivo. At the same time, drugs-of-abuse testing by non-specific, point-of-care immunoassay methods ('quick tests') has increased. This article discusses the risk of 'false positive' results or post-analytical misinterpretations of results when immunoassays are used to analyse biological samples from ADHD patients. A rapid evidence review was conducted to identify studies that have focused on the risk of 'false positive' test results in immunoassay testing of patients treated with atomoxetine, bupropion, clonidine, guanfacine, methylphenidate, and modafinil. There is only evidence to suggest that bupropion should cause 'false positive' immunoassay results. However, there is a lack of systematic, updated evaluations and validations of cross-reactivity patterns for immunoassays in the literature. Advanced laboratory methods can distinguish the use of medicines from illicit amphetamine by stereospecific analysis of dextro- and levoamphetamine; however, these analytical services are not commonly available for routine drug testing. The present situation calls for more awareness, proper education and information on these critical ethical issues in drug testing, both for clinicians, other healthcare professionals involved in drug testing and for patients in medical treatment for ADHD. The pitfalls of immunoassays due to cross-reactivity and insufficient specificity/sensitivity can have serious negative consequences for patients safety with regard to incorrect laboratory drug-testing results. Consequently, confirmatory laboratory analysis should always be performed for 'presumptive' positive immunoassay screening results.

Background: Frozen shoulder is a painful joint disease. Patients with diabetes seem to have worse clinical symptoms and surgery in this patient population is believed to be more common.The objective postoperative evaluation indicates inferior results when surgically treating diabetics, but no previous studies have investigated exclusively the subjective patient satisfaction with arthroscopic capsular release., Materials and Methods: A total of 93 patients were included. All had persistent symptoms despite conservative treatment for at least six months. The patients were retrospectively divided into two groups based on diabetes status: Group 1 consisted of patients with type 1 or type 2 diabetes (18) and group 2 consisted of the remaining patients (75). Evaluation was performed prior to arthroscopic capsular release and at six months follow-up. The web-based questionnaire consisted of two different evaluation forms: The Oxford Shoulder Score (OSS) and a visual quality scale (VQS)., Results: Both groups reported a statistically significant improvement in both evaluations. OSS in group 1 improved by 11.5 [95% CI: 6.2 ; 16.4] and by 15.8 [95% CI: 13.6 ; 17.9] in group 2. The improvement was more pronounced in group 2, though not statistically significant (p = 0.09). The VQS improved 39.6 in group 1 and 44.5 in group 2, (p = 0.50)., Conclusion: Diabetic and non-diabetic patients reported equal symptom relief after arthroscopic capsular release of frozen shoulder when selected for operation without considering diabetic status. We will continue to select patients for arthroscopic release without differences in preoperative counseling between diabetics and non-diabetics.

Volcanic eruptions are widely used in ice core science to date or synchronize ice cores. Volcanoes emit large amounts of SO 2 that is subsequently converted in the atmosphere into sulfuric acid/sulphate. Its discrete and continuous quantification is currently used to determine the ice layers impacted by volcanic emissions, but available high-resolution sulphate quantification methods in ice core (Continuous Flow Analysis (CFA)) struggle with insufficient sensitivity. Here, we present a new high-resolution CFA chemiluminescence method for the continuous determination of Fe 2+ species in ice cores that shows clear Fe 2+ peaks concurrent with volcanic sulphate peaks in the ice core record. The method, applied on a Greenland ice core, correctly identifies all volcanic eruptions from between 1588 to 1611 and from 1777 to 1850. The method has a detection limit of ∽5 pg g -1 and a quadratic polynomial calibration range of up to at least 1760 pg g -1 . Our results show that Fe 2+ is a suitable proxy for identifying past volcanic events., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Telemedicine or tele-health is increasingly used to help meet challenges in health care linked to demographic changes and an aging population. This study aimed to investigate whether a tele-health solution, an "app" presented on a tablet, can assist patients in their recovery following a hip fracture and accommodate individual learning and health literacy needs to support them in self-care and empowerment. Twenty patients with a hip fracture were informed and educated using an app during hospital admission and for 3 to 4 weeks after discharge. A qualitative approach employed field observation and individual interviews with patients and their relatives. Data were analyzed using qualitative content analysis. Patients found that the app supported their ability to perform self-care and their desire for autonomy. They would not have downloaded the app by themselves but found the use of the app presented on a tablet very supportive in their everyday life while rehabilitating after a hip fracture. Findings indicate that health-care professionals can support information and education for patients with a hip fracture using an app that accommodates different learning styles. This demonstrates that apps used for the dissemination of health knowledge can be used by elderly hip fracture patients even if they are not used to technology., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2019.)

Situs inversus totalis is a rare congenital condition where organs are mirrored across the sagittal plane of the body. In the absence of associated comorbidities, most people have normal health and lifespan. Challenges with mirrored image anatomy arise when needing an operative procedure involving the intraabdominal organs. There are few reported cases in the literature of laparoscopic surgery in patients with situs inversus, with even fewer in the field of bariatric surgery. Obesity and obesity-related comorbidities continue to increase in our society, and bariatric surgery is a treatment option for weight loss. We report the perioperative approach used in a 59-year-old obese woman with confirmed situs inversus totalis undergoing laparoscopic sleeve gastrectomy., Competing Interests: The authors have declared that no competing interests exist.

Aims: Recent studies of nonoperatively treated displaced midshaft clavicular fractures have shown a high incidence of nonunion and unsatisfactory functional outcome. Some studies have shown superior functional results and higher rates of healing following operative treatment. The aim of this study was to compare the outcome in these patients after nonoperative management with those treated with fixation., Patients and Methods: In a multicentre, parallel randomized controlled trial, 146 adult patients with an acute displaced fracture of the midthird of the clavicle were randomized to either nonoperative treatment with a sling (71, 55 men and 16 women with a mean age of 39 years, 18 to 60) or fixation with a pre-contoured plate and locking screws (75, 64 men and 11 women with a mean age of 40 years, 18 to 60). Outcome was assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) Score, the Constant Score, and radiographical evidence of union. Patients were followed for one year., Results: A total of 60 patients in the nonoperative group and 64 in the operative group completed one-year follow-up. At three months' follow-up, both the median DASH (1.7 vs 8.3) and median Constant scores (97 vs 90) were significantly better in the operated group (both p = 0.02). After six months and one year, there was no difference in the median DASH or Constant scores. The rate of nonunion was lower in the operative group (2 vs 11 patients, p < 0.02). Nine patients in the nonoperative group underwent surgery for nonunion. The plate was subsequently removed in 16 patients (25%). One patient had a new fracture after removal of the plate and one underwent revision surgery for failure of fixation., Conclusion: Fixation of a displaced midshaft clavicular fracture using a pre-contoured plate and locking screws results in faster functional recovery and a higher rate of union compared with nonoperative management, but the function of the shoulder is equal after six months and at one year. Cite this article: Bone Joint J 2018;100-B:1385-91.

Objectives: In future healthcare systems, individuals are expected to be more involved in managing their health and preventing illness. A previous study of patient empowerment on a hip fracture pathway uncovered a gap between what the healthcare system provided and patients' needs and wishes. The aim of this study was to investigate whether a user-driven approach and a participatory design could provide a solution that would bridge this gap., Methods: Four workshops and a laboratory test were conducted with healthcare professionals to co-create a final prototype. This was performed in iterative processes through continuous interviews and face-to-face evaluation with patients, together with field studies in patients' homes, to maintain relevance to end-users, that is, patients and healthcare professionals. The data were analysed according to the plan, act, observe and reflect methodology of iterative processes in participatory design., Results: Our results contribute to a key research area within patient involvement. By using participatory design, patients and healthcare professionals gained a mutual understanding and collaborated to create a technological solution that would encompass needs and wishes. Patient empowerment also involved giving healthcare professionals a means of empowerment, by providing them with a platform to support patient education. We found that one solution to bridging the aforementioned gap could be an app, including a range of educational features that would accommodate different learning styles., Conclusion: In developing a technological solution, user involvement in a participatory design ensures usability and inclusion of the requested functionalities. This can help bridge the gap between what the healthcare system provided and patients' needs and wishes and support patients' individual empowerment needs and self-care capacity. Together with the tools and techniques, the setting in which PD unfolds should be thoughtfully planned., Competing Interests: Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

This systematic review provides synthesised knowledge and guidance to health professionals on the experiences and perspectives of being diagnosed with osteoporosis from the patient's point of view. Using individuals' experiences and meanings can promote tailored and targeted information and guidance on osteoporosis, bone care and treatment at different stages of the osteoporosis trajectory., Introduction: To be diagnosed with osteoporosis with or without fragility fractures affects individuals differently. The aim of this review was firstly to aggregate existing qualitative evidence regarding an individual's experience of being diagnosed with osteoporosis at different stages, and secondly, to use a systematic approach to develop a conceptual understanding of central issues relevant for health professionals in order to provide support and guidance to patients/individuals., Methods: This study used a systematic review methodology and methods for qualitative synthesis as recommended by Cochrane and integrated the findings of qualitative research from eight databases (Medline, PubMed, CINAHL, Embase, SweMed+, PsycINFO, ERIC, Web of Science) to July 2016. Selection and assessment were performed by three authors while four authors were involved in the analysis. Findings were cross-checked with the original article to ensure consistency with the individual's accounts., Results: Our findings have revealed that individuals diagnosed with osteoporosis do not perceive osteoporosis as a biomedical trajectory but as a self-perceived continuum of severity and health. To be diagnosed with osteoporosis affects individuals differently depending on, for example, personal experience, pre-conceived notions of or knowledge about the disease, fragility fractures or pain. Hence, individuals will create a meaning of the diagnosis based on self-perceived fracture risk, self-perceived severity of osteoporosis and at the same time, self-perceived health., Conclusions: This meta-synthesis provides knowledge for health professionals on the experiences and perspectives of being diagnosed with osteoporosis from the patient's point of view. The experience, meaning and significance of osteoporosis must be taken into consideration and can be used to promote tailored and targeted information and guidance on osteoporosis, bone care and treatment at different stages of the osteoporosis trajectory.

Talus fractures are rare but often associated with complications and significant post-traumatic patient morbidity. They frequently occur at high-energy traumas such as traffic accidents. This is a case report of a young woman who after a fall from a roof, presented in an emergency department with a dislocated ankle which was initially misdiagnosed as a bimalleolar fracture and attempted repositioned as such before X-ray. Dislocated talus fractures, however, need urgent anatomic reduction after diagnostic imaging and often subsequent and acute osteosynthesis.

In a randomized, double-blind, placebo controlled trial, we investigated the postoperative analgesic effect of a single intra-articular injection of 40 mg methylprednisolone acetate (MP) administered 1 week before total knee arthroplasty (TKA). Forty-eight patients with high pain osteoarthritis (≥5 on a numeric rating scale during walk) and sensitization (pressure pain threshold <250 kPa), aged 50 to 80 years and scheduled for primary unilateral TKA under spinal anaesthesia were included. The primary outcome was the proportion of patients with moderate/severe pain during a 5-m walk test 24 hours postoperatively. Secondary outcomes included pain at 48 hours, during the first 14 days, sensitization (quantitative sensory testing with pressure pain threshold and wind-up from temporal summation), and inflammatory changes (systemic C-reactive protein, intra-articular interleukin [IL]-6). No difference in the proportion of patients with moderate/severe pain was found between MP/placebo groups at 24 hours (67% and 74%, χ 2  = .2, P = .63, odds ratio = .7, 95% confidence interval = .2-2.8) or at 48 hours (57% and 68%, χ 2  = .5, P = .46, odds ratio = .6, 95% confidence interval = .2-2.3), and no difference between groups in postoperative sensitization was found (P > .4) despite reduced preoperative intra-articular inflammation (IL-6) in the MP group versus placebo (median change in IL-6 = -70 pg/mL, interquartile range = -466 to 0 vs. 32 pg/mL, interquartile range = -26 to 75, P = .029). Alternative central or peripheral analgesic interventions in this high-risk group are required., Perspective: Peripherally driven inflammatory pain and nociceptive changes before TKA has been suggested to be a cause for increased acute postoperative pain. However, preoperative intra-articular MP in patients with high pain osteoarthritis and sensitization did not reduce acute post-TKA pain or sensitization despite a preoperative reduction of intra-articular inflammatory markers., (Copyright © 2017 The American Pain Society. Published by Elsevier Inc. All rights reserved.)

Hip fractures are amongst the leading causes of admission to an orthopaedic ward. Systematized pathways with reduced admission time have become increasingly common as an essential tool for quality development and to improve efficiency in the hospital setting.  The aim of this study was to clarify if the patients feel empowered and able to perform self-care after short time stay in hospital (STSH) due to a hip fracture. The study used descriptive phenomenology to describe experiences of the pathway. Field studies were conducted in hospitals and in the patients' homes.  Interviews were performed with 10 patients recruited from two wards at a Danish University hospital, 4 family members and 15 health professionals from three hospitals.  The open attitude of reflective lifeworld research guided the analysis. The findings revealed that patients felt unprepared and insecure about their future, but also had a strong desire to be in charge of their own lives.  Of all the patients interviewed, none had any recollection of the information given to them by health professionals during their hospital admission. This study demonstrates that empowerment of patients with hip fractures is not adequately achieved in the pathway with STSH.

Background: Formalized and systematic assessment of survivorship care and rehabilitation needs is prerequisite for ensuring cancer patients sufficient help and support through their cancer trajectory. Patients are often uncertain as to how to express and address their survivorship care and rehabilitation needs, and little is known about specific, unmet needs and the plans necessary to meet them. There is a call for both ensuring survivorship care and rehabilitation for cancer patients in need and further for documenting the specific needs related to the cancer disease and its treatment. Thus the aim of this study was to describe specific survivorship care and rehabilitation needs and plans as stated by patients with cancer at hospitals when diagnosed and when primary care survivorship care and rehabilitation begins., Methods: Needs assessment forms from cancer patients at two hospitals and two primary care settings were analyzed. The forms included stated needs and survivorship care and rehabilitation plans. All data were categorized using the International Classification of Functioning, Disability and Health (ICF)., Results: Eighty-nine patients at hospitals and 99 in primary care, stated their needs. Around 50% of the patients completed a survivorship care and rehabilitation plan. In total, 666 (mean 7.5) needs were stated by hospital patients and 836 (mean 8.0) by those in primary care. The needs stated were primarily within the ICF component "body functions and structure", and the most frequent needs were (hospitals/primary care) fatigue (57%/67%), reduced muscle strength (55%/67%) and being worried (37%/36%)., Conclusions: The results underpin an urgent need for a systematic procedure to assess needs in clinical practice where cancer patients are being left without survivorship care and rehabilitation needs assessment. Gaining knowledge on needs assessment and the detailed description of needs and plans can facilitate targeted interventions. The findings indicate an urgent need to change the practice culture to be systematic in addressing and identifying survivorship care needs among patients with cancer. Further the findings call for considering the development of a new needs assessment form with involvement of both patients and healthcare professionals., Competing Interests: The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Shoulder impingement syndrome is the most common shoulder disorder. Even though conservative treatment is the primary treatment of choice, surgery has increased substantially in several countries during the last 20 years. This has resulted in recommended clinical guidelines for treatment of shoulder impingement syndrome in countries such as The Netherlands and Denmark during recent years. The aim of this study was to investigate the effectiveness of an arthroscopic subacromial decompression in 244 patients selected for surgery according to national clinical guidelines., Materials and Methods: Patients were included from an Internet-based shoulder and elbow database. They were asked to complete 2 questionnaires consisting of the Oxford Shoulder Score (OSS) and the EuroQol 5-Dimension 3-Level and visual analog scale preoperatively and at 6-month follow-up. All patients were carefully selected for surgery according to the national guidelines, with symptoms persisting for at least 6 months. Furthermore, subgroups related to the OSS were formed to assess the clinical outcome according to preoperative status and age., Results: For the complete study group, an OSS change of 10 (8.8-11.2; P = .0001) was found at 6-month follow-up. No significant difference was found between the genders (P = .17). The largest clinical effect from the intervention was found in the low preoperative OSS (pre-OSS) group, in which a mean change of 17 was found. The moderate and high pre-OSS groups had mean changes of 13 and 5, respectively. Similarly, according to the EuroQol 5-Dimension 3-Level and visual analog scale, the largest improvements were seen in the low and moderate pre-OSS groups., Conclusion: Arthroscopic subacromial decompression is a valid treatment, reducing pain and improving quality of life for patients selected for surgery according to the Danish national guidelines., (Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

An effective route based on space-confined chemical reaction to synthesize uniform Li 2 Mg(NH) 2 nanoparticles is reported. The hierarchical pores inside the one-dimensional carbon nanofibers (CNFs), induced by the creation of well-dispersed Li 3 N, serve as intelligent nanoreactors for the reaction of Li 3 N with Mg-containing precursors, resulting in the formation of uniformly discrete Li 2 Mg(NH) 2 nanoparticles. The nanostructured Li 2 Mg(NH) 2 particles inside the CNFs are capable of complete hydrogenation and dehydrogenation at a temperature as low as 105 °C with the suppression of ammonia release. Furthermore, by virtue of the nanosize effects and space-confinement by the porous carbon scaffold, no degradation was observed after 50 de/rehydrogenation cycles at a temperature as low as 130 °C for the as-prepared Li 2 Mg(NH) 2 nanoparticles, indicating excellent reversibility. Moreover, the theoretical calculations demonstrate that the reduction in particle size could significantly enhance the H 2 sorption of Li 2 Mg(NH) 2 by decreasing the relative activation energy barrier, which agrees well with our experimental results. This method could represent an effective, general strategy for synthesizing nanoparticles of complex hydrides with stable reversibility and excellent hydrogen storage performance.

This paper addresses the possibilities of evaluating technology-induced errors, through the utilization of experiences of the Danish adverse event reporting system. The learning loop in the adverse event reporting system is identified and analyzed, to examine which elements can be utilized to evaluate technologies. The empirical data was collected through interviews and a workshop with members of the nursing staff at a nursing home in Aalborg, Denmark. It was found that, the establishment of sustainable feedback learning loops depends on shared visions in the organization and how creating shared visions requires involvement and participation. Secondly, care workers must possess fundamental knowledge about the technologies available to them. Thirdly comprehensive classification of adverse events should be established to allow for a systematic and goal directed feed-back process.