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Knowledge of specific activity limitations due to cold hypersensitivity is sparse. To explore activity limitations caused by cold hypersensitivity and the associated environmental factors in patients with hand injuries. Descriptive study. Seventy-seven patients with multiple tissue hand injuries described activity limitations related to cold hypersensitivity in questionnaires six and/or 12 months after surgery. To characterize the activity limitations, we performed a quantitative content analysis applying the International classification of functioning and health (ICF). The respondents described on average 3.6 cold related activity limitations in leisure and/or work. The activities were most frequently (n) assigned to the ICF domains d920 Recreation and leisure (95), d440 Fine hand use (77), and d850 Remunerative employment (39). The most common related environmental factors were Products and technology for e140 Culture, recreation and sport (79) and for e135 Employment (71), respectively, and e225 Climate (71). Gloves were both a facilitator and a barrier for activity performance. The impact of cold hypersensitivity on activity was related to both the activity and the environment. The results call for clinical interventions and product development, for example of gloves, to help patients solve their cold related activity limitations. • Several activity limitations due to cold hypersensitivity were reported. • Cold hypersensitivity affected both fine and gross motor activities. • The ICF-domains Fine hand use and Recreation and leisure were typically affected. • Climate was the environmental factor most commonly related to activity limitations. • Gloves or mittens could both facilitate and hinder activity performance. [ABSTRACT FROM AUTHOR]

Time under tension (TUT) is an important variable in resistance training (RT). A stretch sensor (Bandcizer) attached to an elastic band during RT can quantify TUT reliably. To explore adherence to prescribed TUT for elastic band RT with the Bandcizer during supervised and unsupervised RT at different time points. 22 men and women (66.2 ± 2.1 years) performed one supervised and two unsupervised sessions weekly of elastic band RT for the upper and lower extremities with the Bandcizer during a 25-week period. Prescribed TUT was 4 s/repetition. Bandcizer data were extracted from week: 1, 8, and median 24. The effects of time point and supervision on adherence (%) to TUT and number of repetitions were analyzed by Two-way ANOVA. During supervised sessions, adherence to prescribed TUT was 79 ± 4%, 60 ± 4%, and 53 ± 5% in week: 1, 8, and median 24, respectively (p < 0.001). There was no difference in adherence between supervised and unsupervised sessions at any time points. Adherence to the prescribed number of repetitions in each training session was close to 100%. Adherence to prescribed TUT was low during both supervised and unsupervised, home-based elastic band RT and decreased over time despite weekly supervision. Our results highlight the need to focus on TUT when planning and implementing elastic band resistance training in retirement age individuals. • Adherence to prescribed time under tension in elastic band resistance training in older adults was low and declined over time despite supervision. • More focus on time under tension is mandatory in elastic band resistance training interventions in order to reach a satisfactory adherence. • Group-based weekly supervision during elastic band resistance training in older adults may not be sufficient to uphold the prescribed time under tension. [ABSTRACT FROM AUTHOR]

Hand hygiene (HH) among health care workers (HCWs) is crucial in preventing infections in nursing homes. However, HH compliance (HHC) among HCWs remains low. This study aimed to investigate the effect of feedback lights on HCWs' HHC. A 5-month interventional study was conducted in 3 wards in a nursing home in Denmark. During the intervention period, a green light with a smiley appeared on the alcohol-based hand rub (ABHR) dispensers when HCWs used the ABHR, acknowledging HCWs for using the ABHR. HHC was monitored using an automatic HH monitoring system (AHHMS). A total of 64 HCWs were enrolled. The AHHMS collected 23,696 HH opportunities in apartments and dirty utility rooms. Overall, HHC in the apartments increased from 50% at baseline (95% CI: 48, 53) to 56% (95% CI: 54, 58) during the intervention. However, the increased HHC level was not sustained during follow-up. The AHHMS enabled the assessment of the intervention. We found a significant effect of light-guided feedback in the apartments. However, the increased HHC was not sustained after the light was switched off. • Feedback with light on alcohol-based hand rub was investigated in nursing home wards. • Hand hygiene compliance (HHC) was measured using an automatic hand hygiene system. • The light had an immediate, significant effect on health care workers' (HCWs') HHC. • The increased HHC level was not sustained over time. • The light did not change HCWs' HHC in dirty utility rooms. [ABSTRACT FROM AUTHOR]

Elderly nursing home residents are vulnerable to infection from micro-organisms. Hand hygiene is considered one of the most important measures to prevent transmission. To determine the effect of increased accessibility to alcohol-based hand rub (ABHR) in nursing home wards by monitoring hand hygiene compliance (HHC) among healthcare workers (HCWs). An 11-month intervention study was conducted in a Danish six-ward nursing home. Data were collected using an automatic hand hygiene monitoring system (AHHMS). After a baseline period, one extra ABHR dispenser was placed in each of the 150 apartments. Baseline HHC was compared with the HHC during an immediate intervention period and a long-term intervention period. A total of 159 HCWs were included. The AHHMS registered 341,078 hand hygiene opportunities. Overall baseline HHC was 31% (95% confidence interval: 30–32). A significant +18% absolute immediate effect (first five months) (95% CI: 17–19; P < 0.0001) and +13 percentage points (95% CI: 11–14; P < 0.0001) long-term effect (another four months) were recorded. HCWs working day shifts and short-term employees had a higher baseline HHC than HCWs working evening/night shifts. However, HCWs working night shifts achieved the greatest long-term effect with a mean +27 percentage point difference (P < 0.0001). Placing an additional ABHR dispenser strategically within staff workflow significantly increased HHC among HCWs, demonstrating a noteworthy effect. The study is the first to report the effect on nursing home dispenser accessibility as a single intervention and to show a significant unmet potential. [ABSTRACT FROM AUTHOR]

Hospital-acquired infections are the most frequent adverse events in health care and can be reduced by improving the hand hygiene compliance (HHC) of health care workers (HCWs). We aimed to investigate the effect of nudging with sensor lights on HCWs' HHC. An 11-month intervention study was conducted in 2 inpatient departments at a university hospital. An automated monitoring system (Sani NudgeTM) measured the HHC. Reminder and feedback nudges with lights were displayed on alcohol-based hand rub dispensers. We compared the baseline HHC with HHC during periods of nudging and used the follow-up data to establish if a sustained effect had been achieved. A total of 91 physicians, 135 nurses, and 15 cleaning staff were enrolled in the study. The system registered 274,085 hand hygiene opportunities in patient rooms, staff restrooms, clean rooms, and unclean rooms. Overall, a significant, sustained effect was achieved by nudging with lights in relation to contact with patients and patient-near surroundings for both nurses and physicians. Furthermore, a significant effect was observed on nurses' HHC in restrooms and clean rooms. No significant effect was found for the cleaning staff. Reminder or feedback nudges with light improved and sustained physicians' and nurses' HHC, and constitute a new way of changing HCWs' hand hygiene behavior. • Nudges with lights improved hand hygiene (HH) compliance. • We found an effect of light nudges on nurses' and physicians' HH in patient rooms. • We found an effect of light nudges on nurses' HH in restrooms and clean rooms. • Light nudges did not significantly change cleaning staff's behavior. • Single nudges were as effective in changing HH behavior as combined nudges. [ABSTRACT FROM AUTHOR]

Continuous technologic development and updated recommendations for image acquisitions creates a need to update the current normal reference ranges for echocardiography. The best method of indexing cardiac volumes is unknown. The authors used 2- and 3-dimensional echocardiographic data from a large cohort of healthy individuals to provide updated normal reference data for dimensions and volumes of the cardiac chambers as well as central Doppler measurements. In the fourth wave of the HUNT (Trøndelag Health) study in Norway 2,462 individuals underwent comprehensive echocardiography. Of these, 1,412 (55.8% women) were classified as normal and formed the basis for updated normal reference ranges. Volumetric measures were indexed to body surface area and height in powers of 1 to 3. Normal reference data for echocardiographic dimensions, volumes, and Doppler measurements were presented according to sex and age. Left ventricular ejection fraction had lower normal limits of 50.8% for women and 49.6% for men. According to sex-specific age groups, the upper normal limits for left atrial end-systolic volume indexed to body surface area ranged from 44 mL/m2 to 53 mL/m2, and the corresponding upper normal limit for right ventricular basal dimension ranged from 43 mm to 53 mm. Indexing to height raised to the power of 3 accounted for more of the variation between sexes than indexing to body surface area. The authors present updated normal reference values for a wide range of echocardiographic measures of both left- and right-side ventricular and atrial size and function from a large healthy population with a wide age-span. The higher upper normal limits for left atrial volume and right ventricular dimension highlight the importance of updating reference ranges accordingly following refinement of echocardiographic methods. [Display omitted] [ABSTRACT FROM AUTHOR]

Notifications to the Norwegian Institute of Public Health of outbreaks in Norwegian healthcare institutions are mandatory by law, but under-reporting is suspected due to failure to identify clusters, or because of human or system-based factors. This study aimed to establish and describe a fully automatic, register-based surveillance system to identify clusters of healthcare-associated infections (HAIs) of SARS-CoV-2 in hospitals and compare these with outbreaks notified through the mandated outbreak system Vesuv. We used linked data from the emergency preparedness register Beredt C19, based on the Norwegian Patient Registry and the Norwegian Surveillance System for Communicable Diseases. We tested two different algorithms for HAI clusters, described their size and compared them with outbreaks notified through Vesuv. A total of 5033 patients were registered with an indeterminate, probable, or definite HAI. Depending on the algorithm, our system detected 44 or 36 of the 56 officially notified outbreaks. Both algorithms detected more clusters then officially reported (301 and 206, respectively). It was possible to use existing data sources to establish a fully automatic surveillance system identifying clusters of SARS-CoV-2. Automatic surveillance can improve preparedness through earlier identification of clusters of HAIs, and by lowering the workloads of infection control specialists in hospitals. [ABSTRACT FROM AUTHOR]

• The system can capture hand hygiene behavior of staff under clinical conditions. • The sensitivity and positive predictive value (PPV) of sanitizations were 100%. • The sensitivity and PPV of patient contact were 100% and 94% (nurses and doctors). • The system shows less accuracy for cleaning assistants. More data are needed. • The system can be used as a supporting tool to provide reliable hand hygiene data. We aimed to test the accuracy of an electronic hand hygiene monitoring system (EHHMS) during daily clinical activities in different wards and with varying health care professions. The accuracy of an EHHMS (Sani Nudge) was assessed during real clinical conditions by comparing events registered by two observers in parallel with events registered by the EHHMS. The events were categorized as true-positive, false-positive, and false-negative registrations. Sensitivity and positive predictive value (PPV) were calculated. A total of 103 events performed by 25 health care workers (9 doctors, 11 nurses, and 5 cleaning assistants) were included in the analyses. The EHHMS had a sensitivity of 100% and a PPV of 100% when measuring alcohol-based hand rub. When looking at the hand hygiene opportunities of all health care workers combined taking place in the patient rooms and working rooms, the sensitivity was 75% and the PPV 95%. For doctors' and nurses' taking care of patients in their beds the EHHMS had a sensitivity of 100% and a PPV of 94%. The objective accuracy measures demonstrate that this EHHMS can capture hand hygiene behavior under clinical conditions in different settings with clinical health care workers but show less accuracy with cleaning assistants. [ABSTRACT FROM AUTHOR]

Marine microalgae are a promising innovation platform for carbon capture and utilization (CCU) biotechnologies to mitigate industrial greenhouse gas emissions. However, industrial-scale cultivation of algal mono-cultures is challenging and often unscalable. Non-axenic microalgae in large semi-open photobioreactors lead to the co-cultivation of diverse microbial communities. There is limited knowledge about the "bioreactor ecology" involving microalgae interacting with the microbiome and its subsequent impact on process stability and productivity. In this study, we describe the semi-continuous industrial mass cultivation of the cold-adapted marine diatom, Porosira glacialis UiT201, by investigating the prokaryotic and microeukaryotic (phytoplankton and heterotrophic protist) communities. Data were collected in two consecutive time series experiments, representing the initiation and operation of an industrial-scale CCU photobioreactor (300,000 L). The first experiment experienced a culture "crash" of the focal strain after 39 days, while the second culture remained stable and "healthy" for 60 days. The results highlight that this mass cultivation system represents a unique industrial marine microbial ecosystem. The succession of the prokaryotic community was primarily driven by species replacement, indicating turnover due to selective bioreactor conditions and/or biological interactions. Nonetheless, the bioreactor consistently harbors a recurring and abundant core microbiome, suggesting that the closely associated bacterial community is influenced by microalgae-specific properties and can endure a dynamic and variable environment. The observed culture collapse of P. glacialis coincided with changes in the core microbiome structure and different environmental growth conditions compared to the stable and "healthy" experiment. These findings imply that cohabiting microbial taxa within industrial microalgae cultivation likely play a critical role in stabilizing the conversion of industrial CO 2 into marine biomass, and changes in community structure serve as an indicator of process stability. • Cold-water diatom, Porosira glacialis , has potential for industrial mass cultivation • Change in cooccurring microbiome can impact the stability of algal production • Prokaryotic community succession was driven by turnover • A large CCU bioreactor harbored a reoccurring and abundant core microbiome [ABSTRACT FROM AUTHOR]

• Colorectal cancer (CRC) is the third leading cancer worldwide. • Old patients represent a major proportion of those diagnosed with CRC, most research is directed towards younger age groups. • Factors that affect coping capacity are important for facilitating a better return to optimal function after surgery. • Participants who received homecare nursing had lower coping capacity than participants who did not receive homecare nursing. To explore the associations between sense of coherence, perceived social support, and demographic and clinical characteristics among survivors ≥80 years treated for curable colorectal cancer. This exploratory, cross-sectional survey investigates 56 individuals surgically treated for stage I-III colorectal cancer between one and five years prior. Statistical analysis permitted exploration of associations between sense of coherence, perceived social support, and demographic- and clinical variables. Lower sense of coherence was associated with higher age, limitations in physical function, and the need for homecare nursing. Lower perceived social support was associated with re-admission, higher age at time of surgery, and male gender. No correlations were found between sense of coherence and perceived social support. The results are important for healthcare professionals to consider when dealing with older people who underwent surgery for colorectal cancer, especially in the discharge process to facilitate optimal follow-up care and recovery. [ABSTRACT FROM AUTHOR]

• The COVID-19 pandemic did not increase healthcare workers' hand hygiene compliance. • The automated hand hygiene system captured over 100,000 hand hygiene opportunities. • Studies are warranted to curb the challenges limiting hand hygiene compliance. Healthcare workers' (HCWs) adherence to hand hygiene is vital in combatting COVID-19 in hospitals. We aimed to investigate HCWs hand hygiene compliance before and during the COVID-19 pandemic and hypothesised that hand hygiene compliance would increase during the pandemic. We conducted a prospective observational study in three medical departments at the Regional Hospital of West Jutland, Denmark from April 2019 to August 2020. A total of 150 HCWs participated before the COVID-19 pandemic and 136 during the pandemic. Hand hygiene observations were assessed using an automated hand hygiene monitoring system. Students unpaired t-test was used to assess differences in hand hygiene compliance rates in each department. Comparison analyses showed, that hand hygiene compliance in department A and B was significantly higher before the COVID-19 pandemic than during the pandemic; a 7% difference in department A and a 5% difference in department B. For department C, the total hand hygiene compliance was unchanged during the pandemic compared to before. The COVID-19 pandemic did not raise hand hygiene compliance. Further studies are needed to verify these findings and further identify barriers to hand hygiene compliance among HCWs. [ABSTRACT FROM AUTHOR]

Shotgun sequencing is a DNA analysis method that potentially determines the nucleotide sequence of every DNA fragment in a sample, unlike PCR-based genotyping methods that is widely used in forensic genetics and targets predefined short tandem repeats (STRs) or predefined single nucleotide polymorphisms (SNPs). Shotgun DNA sequencing is particularly useful for highly degraded low-quality DNA samples, such as ancient samples or those from crime scenes. Here, we developed a statistical model for human identification using shotgun sequencing data and developed formulas for calculating the evidential weight as a likelihood ratio (L R). The model uses a dynamic set of binary SNP loci and takes the error rate from shotgun sequencing into consideration in a probabilistic manner. To our knowledge, the method is the first to make this possible. Results from replicated shotgun sequencing of buccal swabs (high-quality samples) and hair samples (low-quality samples) were arranged in a genotype-call confusion matrix to estimate the calling error probability by maximum likelihood and Bayesian inference. Different genotype quality filters may be applied to account for genotyping errors. An error probability of zero resulted in the commonly used L R formula for the weight of evidence. Error probabilities above zero reduced the L R contribution of matching genotypes and increased the L R in the case of a mismatch between the genotypes of the trace and the person of interest. In the latter scenario, the L R increased from zero (occurring when the error probability was zero) to low positive values, which allow for the possibility that the mismatch may be due to genotyping errors. We developed an open-source R package, wgsLR, which implements the method, including estimation of the calling error probability and calculation of L R values. The R package includes all formulas used in this paper and the functionalities to generate the formulas. • Evidential weight as a likelihood ratio (L R) is given for shotgun sequencing data. • The L R accounts for the genotype calling error probability that we can estimate. • The method uses binary SNP loci chosen dynamically based on the trace sample. • We provide an open-source R package, wgsLR, which implements the method. [ABSTRACT FROM AUTHOR]

• Serum Borrelia burgdorferi (Bb) seropositivity is not associated with heart failure. • Being tested for Bb antibodies was associated with heart failure. • Individuals tested for Bb antibodies differ from background population due to bias. • Bb seropositive individuals should be compared with Bb seronegative individuals. Lyme borreliosis is a tick-borne disease caused by the bacterium Borrelia burgdorferi (Bb) sensu lato complex. Previous studies have suggested an association between Lyme borreliosis and heart failure, which have been suggested to be a possible manifestation of Lyme carditis. We aimed to investigate the risk of heart failure among individuals tested for serum Bb antibodies, and serum Bb seropositive individuals. We performed a matched nationwide cohort study (Denmark, 1993–2020) and included 52,200 Bb seropositive individuals, and two age- and sex-matched comparison cohorts: 1) 104,400 Bb seronegative comparison cohort members, and 2) 261,000 population controls. We investigated the risk associated with 1) being tested for serum Bb antibodies, and 2) being Bb seropositive. Outcomes were: 1) a composite of heart failure, cardiomyopathy, and/or myocarditis diagnosis, and 2) redemption of cardiovascular medicine used for treatment of heart failure. We calculated short-term odds ratios (aOR) (within 1 month) and long-term hazard rates (aHR) (after 1 month) adjusted for age, sex, diabetes, pre-existing heart failure, and kidney disease. Compared with the population controls, individuals tested for Bb antibodies, regardless of the test result, had increased short-term risk of heart failure, cardiomyopathy, and myocarditis (aOR 8.3, 95 %CI: 6.7–10.2), and both increased short- and long-term risk of redemption of cardiovascular medicine (aOR 4.3, 95 %CI: 3.8–4.8, aHR 1.13, 95 % CI: 1.11–1.15). The Bb seropositive individuals had no increased short- or long-term risk of any outcome compared with Bb seronegative comparison cohort members. In conclusion, Bb antibody tests seemed to be performed in the diagnostic work-up of heart failure, but Bb seropositivity was not associated with heart failure. [ABSTRACT FROM AUTHOR]

Objectives: Long-term functional outcomes of brain abscess remains sparsely elucidated.Methods: Nationwide, population-based cohort study of all Danish patients with a culture verified brain abscess and a comparison cohort from the general population individually matched on date of birth and sex.Results: Among 435 patients and 1740 members of the comparison cohort, 61% were men and median age was 54 years. In the year of study inclusion, patients with brain abscess had more hospital admission days, more outpatient visits and more sick leave days, compared with the comparison cohort. With time, these differences subsided. Brain abscess was associated with permanent lower employment rates and a higher risk of disability pension (difference of proportion employed of -26% (95% CI: -36% to -17%) and of proportion on disability pension of 29% (95% CI: 20% to 38%) 5 years after study inclusion). Two years after study inclusion, 1.4% of patients with brain abscess lived in residential care homes (difference of 1.1% (-0.2% to 2.5%)).Conclusions: In this nationwide, population-based cohort study, brain abscess was associated with permanently decreased employment rates. Only a minority were dependent on residential care residency following a diagnosis of brain abscess suggesting that severe disability is probably rare. [ABSTRACT FROM AUTHOR]

About 50% of patients with cancer are expected to need radiotherapy (RT), and the majority of these are older. To improve outcomes for older patients with cancer, geriatric assessment (GA) with management (GAM) is highly recommended. Evidence for its benefits is still scarce, in particular for patients receiving RT. We report the protocol of a cluster-randomised pilot study designed to test the effect, feasibility and health economic impact of a GAM intervention for patients ≥65 years, referred for palliative or curative RT. The randomising units are municipalities and city districts. The intervention is municipality-based and carried out in collaboration between hospital and municipal health services from the start of RT to eight weeks after the end of RT. Its main constituents are an initial GA followed by measures adapted to individual patients' impairments and needs, systematic symptom assessments and regular follow-up by municipal cancer nurses, appointed to coordinate the patient's care. Follow-up includes at least one weekly phone call, and a house call four weeks after the end of RT. All patients receive an individually adapted physical exercise program and nutritional counselling. Detailed guidelines for management of patients' impairments are provided. Patients allocated to the intervention group will be compared to controls receiving standard care. The primary outcome is physical function assessed by the European Organisation of Research and Treatment of Cancer Quality of Life Questionnaire C-30. Secondary outcomes are global quality of life, objectively tested physical performance and use of health care services. Economic evaluation will be based on a comparison of costs and effects (measured by the main outcome measures). Feasibility will be assessed with mixed methodology, based on log notes and questionnaires filled in by the municipal nurses and interviews with patients and nurses. The study is carried out at two Norwegian RT centres. It was opened in May 2019. Follow-up will proceed until June 2022. Statistical analyses will start by the end of 2021. We expect the trial to provide important new knowledge about the effect, feasibility and costs of a GAM intervention for older patients receiving RT. Trial registration : ClinTrials.gov , ID NCT03881137 , initial release 13th of March 2019. [ABSTRACT FROM AUTHOR]

Surgical oncology is a defined specialty within the European Board of Surgery within the European Union of Medical Specialists (UEMS). Variation in training and specialization still occurs across Europe. There is a need to align the core knowledge needed to fulfil the criteria across subspecialities in surgical oncology. The core curriculum, established in 2013, was developed with contributions from expert advisors from within the European Society of Surgical Oncology (ESSO), European Society for Radiotherapy and Oncology (ESTRO) and European Society of Medical Oncology (ESMO) and related subspeciality experts. The current version reiterates and updates the core curriculum structure needed for current and future candidates who plans to train for and eventually sit the European fellowship exam for the European Board of Surgery in Surgical Oncology. The content included is not intended to be exhaustive but, rather to give the candidate an idea of expectations and areas for in depth study, in addition to the practical requirements. The five elements included are: Basic principles of oncology; Disease site specific oncology; Generic clinical skills; Training recommendations, and, lastly; Eligibility for the EBSQ exam in Surgical Oncology. As evidence-based care for cancer patients evolves through research into basic science, translational research and clinical trials, the core curriculum will evolve, mature and adapt to deliver continual improvements in cancer outcomes for patients. [ABSTRACT FROM AUTHOR]

• Doctors (surgeons) have lower baseline hand hygiene compliance than nurses. • Light-guided nudging and data-driven performance feedback improve compliance. • Individual performance feedback might be more effective than group feedback. • The Sani nudge system detects more opportunities than using manual observations. • Nurses and doctors disinfect hands more often after rather than before patient contact. [Display omitted] Evidence-based practices to increase hand hygiene compliance (HHC) among health care workers are warranted. We aimed to investigate the effect of a multimodal strategy on HHC. During this 14-month prospective, observational study, an automated monitoring system was implemented in a 29-bed surgical ward. Hand hygiene opportunities and alcohol-based hand rubbing events were measured in patient and working rooms (medication, utility, storerooms, toilets). We compared baseline HHC of health care workers across periods with light-guided nudging from sensors on dispensers and data-driven performance feedback (multimodal strategy) using the Student's t test. The doctors (n = 10) significantly increased their HHC in patient rooms (16% vs 42%, P <.0001) and working rooms (24% vs 78%, P =.0006) when using the multimodal strategy. The nurses (n = 26) also increased their HHC significantly from baseline in both patient rooms (27% vs 43%, P =.0005) and working rooms (39% vs 64%, P <.0001). The nurses (n = 9), who subsequently received individual performance feedback, further increased HHC, compared with the period when they received group performance feedback (patient rooms: 43% vs 55%, P <.0001 and working rooms: 64% vs 80%, P <.0001). HHC of doctors and nurses can be significantly improved with light-guided nudging and data-driven performance feedback using an automated hand hygiene system. [ABSTRACT FROM AUTHOR]

Background: Atrial arrhythmias (ie, intra-atrial reentrant tachycardia and atrial fibrillation) are a leading cause of morbidity and hospitalization in adults with congenital heart disease (CHD). Little is known about their effect on quality of life and other patient-reported outcomes (PROs) in adults with CHD.Objective: The purpose of this study was to assess the impact of atrial arrhythmias on PROs in adults with CHD and explore geographic variations.Methods: Associations between atrial arrhythmias and PROs were assessed in a cross-sectional study of adults with CHD from 15 countries spanning 5 continents. A propensity-based matching weight analysis was performed to compare quality of life, perceived health status, psychological distress, sense of coherence, and illness perception in patients with and those without atrial arrhythmias.Results: A total of 4028 adults with CHD were enrolled, 707 (17.6%) of whom had atrial arrhythmias. After applying matching weights, patients with and those without atrial arrhythmias were comparable with regard to age (mean 40.1 vs 40.2 years), demographic variables (52.5% vs 52.2% women), and complexity of CHD (15.9% simple, 44.8% moderate, and 39.2% complex in both groups). Patients with atrial arrhythmias had significantly worse PRO scores with respect to quality of life, perceived health status, psychological distress (ie, depression), and illness perception. A summary score that combines all PRO measures was significantly lower in patients with atrial arrhythmias (-3.3%; P = .0006). Differences in PROs were consistent across geographic regions.Conclusion: Atrial arrhythmias in adults with CHD are associated with an adverse impact on a broad range of PROs consistently across various geographic regions. [ABSTRACT FROM AUTHOR]

• During a 1-day course, experienced helicopter emergency medical service (HEMS) physicians gained increasing skill levels in lifesaving and limb-saving prehospital procedures. • A 1-day intense course model can lead to significant increases in self-reported theoretical knowledge among experienced providers. • It is feasible to ensure the effective use of animals in an ethical and responsible manner during procedural training. • A training model with live anesthetized pigs is effective for improving skill level for HEMS crews. Patients with life- or limb-threatening severe injuries pose a challenge to prehospital services. Time-critical decision making and treatment are challenging because of occasional incomplete information, limited resources, adverse environments, and a range of basic and advanced technical skills available. To prepare for these infrequent critical situations, medical personnel from the helicopter emergency medical service at Oslo University Hospital developed a 1-day advanced trauma training course focusing on individual skills and teamwork during resuscitative procedures. Participants were trained under supervision in teams on an established live tissue model with anesthetized pigs. A questionnaire-based evaluation was conducted before and after training to measure the feasibility of covering the allocated learning objectives in the time allotted and participants' perception of any change in their skills as a result of the course. The self-reported skill level in all learning objectives improved significantly. Combining all learning objectives, the median self-reported skill level was significantly increased from 4 to 6 points (P <.001). Experienced prehospital physicians and other health staff reported an increased level of skill and competence in lifesaving and limb-saving procedures after completing a brief, intense 1-day course using living anesthetized pigs and cadaver models. [ABSTRACT FROM AUTHOR]

Comprehensive Geriatric Assessment (CGA) can identify health problems in older persons. In addition, CGA includes intervention towards the identified problems. With follow up, more problems may be identified and the interventions can be adjusted. We wanted to compare CGA with or without tailored follow-up in a randomised design. Patients 70+ years referred for oncology treatment with four primary tumour sites. Participants were randomised 1:1 to either control group with no follow-up or intervention group with a tailored follow-up by a multidisciplinary team. Primary outcome was adherence to cancer treatment. Secondary outcomes were daily life activities, physical performance and hospitalisation. In total, 363 participants were randomised. After randomisation only 301 were planned to receive specific cancer treatment. Median age was 75 years. Among the 301 participants, 52% of control group vs. 61% of intervention group completed treatment. Risk Rate (RR): 1.16 (95% Confidence Interval (CI): 0.95–1.42), p =.14. The impact varied between the included tumour-sites, p <.01. We found no difference in 90 days physical performance or daily life activities between groups. During the study period, 55% of controls vs. 47% in the intervention group were admitted to hospital, RR: 0.86 (95%CI: 0.69–1.07), p =.19. In frail and vulnerable patients with cancer, a tailored follow-up on CGA showed no differences in ability to complete initially planned cancer treatment. The impact varied between the included tumour sites. We did not find any impact of tailored follow-up on daily life activities, physical performance or hospitalisation. [ABSTRACT FROM AUTHOR]

The definition of tumor involved volumes in patients with head and neck cancer poses great challenges with the increasing use of highly conformal radiotherapy techniques eg, volumetric modulated arc therapy and intensity modulated proton therapy. The risk of underdosing the tumor might increase unless great care is taken in the process. The information gained from imaging is increasing with both PET and MRI becoming readily available for the definition of targets. The information gained from these techniques is indeed multidimensional as one often acquire data on eg, metabolism, diffusion, and hypoxia together with anatomical and structural information. Nevertheless, much work remains to fully exploit the available information on a patient-specific level. Multimodality target definition in radiotherapy is a chain of processes that must be individually scrutinized, optimized and quality assured. Any uncertainties or errors in image acquisition, reconstruction, interpretation, and delineation are systematic errors and hence will potentially have a detrimental effect on the entire radiotherapy treatment and hence; the chance of cure or the risk of unnecessary side effects. Common guidelines and procedures create a common minimum standard and ground for evaluation and development. In Denmark, the treatment of head and neck cancer is organized within the multidisciplinary Danish Head and Neck Cancer Group (DAHANCA). The radiotherapy quality assurance group of DAHANCA organized a workshop in January 2020 with participants from oncology, radiology, and nuclear medicine from all centers in Denmark, treating patients with head and neck cancer. The participants agreed on a national guideline on imaging for target delineation in head and neck cancer radiotherapy, which has been approved by the DAHANCA group. The guidelines are available in the Supplementary. The use of multimodality imaging is being recommended for the planning of all radical treatments with a macroscopic tumor. 2-[18F]FDG-PET/CT should be available, preferable in the treatment position. The recommended MRI sequences are T1, T2 with and without fat suppression, and T1 with contrast enhancement, preferable in the treatment position. The interpretation of clinical information, including thorough physical examination as well as imaging, should be done in a multidisciplinary setting with an oncologist, radiologist, and nuclear medicine specialist. [ABSTRACT FROM AUTHOR]

The overall aim of the Swedish Breast Reconstruction Outcome Study was to investigate national long-term outcomes after mastectomy with or without breast reconstruction. The current report evaluates breast reconstruction (BR) patterns in Sweden over time. This is a cross-sectional, registry-based study where all women operated with mastectomy 2000, 2005, 2010 were identified (N = 5853). Geographical differences in type of BR were investigated using heatmaps. Distribution of continuous variables were compared using the Mann-Whitney U test, categorical variables were compared using the chi-square test. Mean age at survey was 69 years (SD=±11.4) and response rate was 50%, responders were on average six years younger than the non-responders and had a more favourable tumor stage (both p < 0.01). Of the 2904 responders, 31% (895/2904) had received a BR: implant-based in 58% (516/895)autologous in 31% (281/895). BR was immediate in 20% (176/895) and delayed in 80% (719/895) women. Women with BR were on average one year older, more often had a normal BMI, reported to be married or had a partner, had a higher educational level and a higher annual income when compared to those without BR (all p < 0.001). The independent factors of not receiving BR were older age and given radiotherapy. To our knowledge, this is the first national long-term follow-up study on women undergoing mastectomy with and without BR. Around 30% of the survey responders have had a BR with a significant geographical variation highlighting the importance of information, availability and standardisation of indications for BR. [ABSTRACT FROM AUTHOR]

Multi-staged forehead flaps are a well-recognised reconstructive workhorse for subtotal and total nasal defects. It carries the disadvantage of repeated trips to theatre for revisional surgery, which is not suited to all patient cohorts. The single-stage islanded forehead flap eliminates this need. We detail our indications and outcomes of using this flap to highlight the maintained versatility of the technique without significant compromise on reconstructive and patient outcome. A prospective surgical database was collated where patients were categorised as partial or total reconstruction. We detail surgical technique and review of rationale of patient selection. Patient demographics, perioperative data and follow-up course were recorded. A total of 22 patients were recorded from both the U.K. and Ethiopia via working with the charity Facing Africa. Defects occurred from a mixture of trauma, Noma and cancer resections. Thirteen were total nasal reconstructions and nine partial. The mean follow-up period was 2.25 years. We experienced two major complications which required minor revision in the theatre and two minor complications, all resolved satisfactorily. We demonstrate good outcomes and safety of the procedure in this first report of a varied cohort of nasal reconstructions in a heterogenous cohort of patients. We advocate the use of this flap in the multi-morbid patient where recovery can be expedited or those who have limitations from economical restraints. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate how LBBB and CRT modify RV free wall function by direct ventricular interaction. Right ventricular (RV) function influences prognosis in patients with left bundle branch block (LBBB) and cardiac resynchronization therapy (CRT). There is, however, limited insight into how LBBB and CRT affect RV function. In 24 patients with LBBB with nonischemic cardiomyopathy, RV and left ventricular (LV) strain by speckle-tracking echocardiography was measured before and after CRT. Underlying mechanisms were studied in 16 anesthetized dogs with ultrasonic dimension crystals and micromanometers. Patients with LBBB demonstrated distinct early systolic shortening in the RV free wall, which coincided with the typical abnormal early systolic septal shortening. In animals, this RV free wall contraction pattern resulted in reduced myocardial work as a large portion of the shortening occurred against low pressure during early systole, coinciding with abnormal leftward septal motion. RV systolic function was maintained by vigorous contraction in the late-activated LV lateral wall, which pushed the septum toward the RV. CRT reduced abnormal septal motion and increased RV free wall work because there was less inefficient shortening against low pressure. LBBB reduces workload on the RV free wall because of abnormal septal motion and delayed activation of the LV lateral wall. Restoring septal and LV function by CRT increases workload in RV free wall and may explain why patients with RV failure respond poorly to CRT. (Contractile Reserve in Dyssynchrony: A Novel Principle to Identify Candidates for Cardiac Resynchronization Therapy [CRID-CRT]; NCT02525185) [ABSTRACT FROM AUTHOR]

Image, graphical abstract Hand hygiene compliance (HHC) among health care workers remains suboptimal, and good monitoring systems are lacking. We aimed to evaluate HHC using an automated monitoring system. A prospective, observational study was conducted at 2 Danish university hospitals employing a new monitoring system (Sani nudge). Sensors were located on alcohol-based sanitizers, health care worker name tags, and patient beds measuring hand hygiene opportunities and sanitations. In total, 42 nurses were included with an average HHC of 52% and 36% in hospitals A and B, respectively. HHC was lowest in patient rooms (hospital A: 45%; hospital B: 29%) and highest in staff toilets (hospital A: 72%; hospital B: 91%). Nurses sanitized after patient contact more often than before, and sanitizers located closest to room exits and in hallways were used most frequently. There was no association found between HHC level and the number of beds in patient rooms. The HHC level of each nurse was consistent over time, and showed a positive correlation between the number of sanitations and HHC levels (hospital A: r = 0.69; hospital B: r = 0.58). The Sani nudge system can be used to monitor HHC at individual and group levels, which increases the understanding of compliance behavior. [ABSTRACT FROM AUTHOR]

Background: Implantable cardioverter-defibrillators (ICDs) are increasingly being used to prevent sudden death in the growing population of adults with congenital heart disease (CHD). However, little is known about their impact on patient-reported outcomes (PROs).Objective: The purpose of this study was to assess and compare PROs in adults with CHD with and without ICDs.Methods: A propensity-based matching weight analysis was conducted to evaluate PROs in an international cross-sectional study of adults with CHD from 15 countries across 5 continents.Results: A total of 3188 patients were included: 107 with ICDs and 3081 weight-matched controls without ICDs. ICD recipients were an average age of 40.1 ± 12.4 years, and >95% had moderate or complex CHD. Defibrillators were implanted for primary and secondary prevention in 38.3% and 61.7%, respectively. Perceived health status, psychological distress, sense of coherence, and health behaviors did not differ significantly among patients with and without ICDs. However, ICD recipients had a more threatening view of their illness (relative % difference 8.56; P = .011). Those with secondary compared to primary prevention indications had a significantly lower quality-of-life score (Linear Analogue Scale 72.0 ± 23.1 vs 79.2 ± 13.0; P = .047). Marked geographic variations were observed. Overall sense of well-being, assessed by a summary score that combines various PROs, was significantly lower in ICD recipients (vs controls) from Switzerland, Argentina, Taiwan, and the United States.Conclusion: In an international cohort of adults with CHD, ICDs were associated with a more threatening illness perception, with a lower quality of life in those with secondary compared to primary prevention indications. However, marked geographic variability in PROs was observed. [ABSTRACT FROM AUTHOR]

The purpose of this systematic review was to assess the perioperative clinical outcomes in using local/regional anesthesia (LA/RA) or general anesthesia (GA) in patients undergoing endovascular abdominal aortic aneurysm repair. A comprehensive electronic literature search was undertaken from inception to September 2018, identifying all randomized and nonrandomized studies comparing LA/RA versus GA in patients with abdominal aortic aneurysm who underwent endovascular repair. A total of 12,024 patients (n = 1,664 LA/RA, n = 10,360 GA) were analyzed from 12 observational studies included in this analysis. No difference in mean age between LA/RA and GA group was noted (73.8 ± 7.8 y v 72.4 ± 7.6 y, 95% confidence interval 0.85 [–0.08 to 1.79]; p = 0.07). No differences in preoperative rate of chronic obstructive pulmonary disease, ischemic heart disease, diabetes mellitus, and American Society of Anesthesiologists grades were noted between the 2 groups (p = 0.21, p = 0.85, p = 0.46, and p = 0.67, respectively). Shorter total surgical time in LA/RA patients was reported (135 ± 40 min v 164 ± 43 min; p < 0.00001). Shorter hospital stay was observed in LA/RA patients (3.6 ± 3.3 d v 4.6 ± 5 d; p = 0.002). No difference in cardiac or renal complications was noted between the LA/RA and GA groups postoperatively (2.7% v 2.5%; p = 0.46 and 1.2% v 1.6%; p = 0.13). Similarly, no difference in vascular complications was noted in LA/RA versus GA patients (8.4% v 7.7%; p = 0.44). Thirty-day morality was not different between the 2 cohorts (2% v 1.7%; p = 0.97). Use of LA/RA in selective endovascular abdominal aortic aneurysm repair procedures provides satisfactory and comparable perioperative outcomes with those of GA, with the advantage of a shorter hospital stay. A large randomized controlled trial or multicenter study is required to confirm the present study's findings. [ABSTRACT FROM AUTHOR]

Background: Multi-resistant bacteria (MRB) are an emerging problem. Early identification of patients colonized with MRB is mandatory to avoid in-hospital transmission and to target antibiotic treatment. Since most patients pass through specialized emergency departments (EDs), these departments are crucial in early identification. The Danish National Board of Health (DNBH) has developed exposure-based targeted screening tools to identify and isolate carriers of meticillin-resistant Staphylococcus aureus (MRSA) and carbapenemase-producing Enterobacteriaceae (CPE).Aim: To assess the national screening tools for detection of MRSA and CPE carriage in a cohort of acute patients. The objectives were to investigate: (i) if the colonized patients were detected; and (ii) if the colonized patients were isolated.Methods: This was a multi-centre cross-sectional survey of adults visiting EDs. The patients answered the DNBH questions, and swabs were taken from the nose, throat and rectum. The collected samples were examined for MRSA and CPE. Screening performances were calculated.Findings: Of the 5117 included patients, 16 were colonized with MRSA and four were colonized with CPE. The MRSA screening tool had sensitivity of 50% [95% confidence interval (CI) 25-75%] for carrier detection and 25% (95% CI 7-52%) for carrier isolation. The CPE screening tool had sensitivity of 25% (95% CI 1-81%) and none of the CPE carriers were isolated.Conclusion: The national screening tools were of limited use as the majority of MRSA and CPE carriers passed unidentified through the EDs, and many patients were isolated unnecessarily. [ABSTRACT FROM AUTHOR]

The purpose of this study was to compare clinical outcomes between open repair and thoracic endovascular aortic repair (TEVAR) in traumatic ruptured thoracic aorta. A comprehensive search was undertaken of the four major databases (PubMed, Embase, Scopus, and Ovid) to identify all published data comparing open vs endovascular repair. Databases were evaluated to July 2018. Odds ratios (ORs), weighted mean differences, or standardized mean differences and their 95% confidence intervals (CIs) were analyzed. The primary outcomes were stroke, paraplegia, and 30-day mortality rates; secondary outcomes were requirement for reintervention and 1-year and five-year mortality rates. A total of 1968 patients were analyzed in 21 articles. TEVAR was performed in 29% (n = 578) and open repair in 71% (n = 1390). TEVAR and open repair did not differ in the mean age of patients (42.1 ± 14 years vs 44.1 ± 14 years; P =.48). There was no difference in duration of intensive care and total hospital stay between TEVAR and open repair groups (12.7 ± 11.1 days vs 12.6 ± 8 days P =.35] and 27.5 ± 14.6 days vs 25.9 ± 11 days P =.80], respectively). Similarly, no statistically significant difference in postoperative paraplegia or stroke rate was noted between TEVAR and open repair (1.4% vs 2.3% [OR, 1.27; 95% CI, 0.59-2.70; P =.54] and 1% vs 0.5% [OR, 0.63; 95% CI, 0.18-2.18; P =.46]). Lower 30-day and 1-year mortality was noted in TEVAR (7.9% vs 20% [OR, 2.94; 95% CI, 1.92-4.49; P <.00001] and 8.7% vs 17% [OR, 2.11; 95% CI, 0.99-4.52; P =.05]). There was no difference in 5-year mortality (23% vs 17%; OR, 0.07; 95% CI, −0.07 to 0.20; P =.33). However, there was a higher rate of reintervention at 1 year in the endovascular group (0% vs 6%; OR, 0.17; 95% CI, 0.03-0.96; P =.04). TEVAR carries lower in-hospital mortality and provides satisfactory perioperative outcomes compared with open repair in traumatic ruptured thoracic aorta. It also provides a favorable 1-year survival at the expense of higher reintervention rates. [ABSTRACT FROM AUTHOR]

• Extensions of an existing likelihood ratio for Ancestry Informative Markers. • Handles first-order admixed individuals. • Implemented in freely available software. • Tested on data from eight meta populations from Africa, Europe and Asia. • Results demonstrate robustness and relevance to simulated profiles. Analysis of Ancestry Informative Markers (AIMs) is of interest to forensic geneticists for the purpose of assessing the origin of individuals. Often AIMs are used to produce investigative leads for potential suspects in crime cases and identification in missing persons mass disaster cases. We have previously suggested to assess the origin of the profile of interest by a likelihood ratio test on Fisher's exact test. The likelihood ratio test assesses the likelihood of the data under two competing hypotheses, where the null hypothesis assume common origin of the profile of interest and those in a specified population. However, in the case of a profile of an individual of admixed ancestry, there is an increased risk that the profile will be rejected in the constituting populations. The likelihood ratio test approach is extended by allowing for profile admixture implying the profile of interest is a mixture of profiles from two populations. The Expectation-Maximisation (EM) algorithm is used to handle the ambiguity of allocation of alleles at heterozygous markers. To demonstrate the approach, admixed profiles are simulated using AIMs genotypes in eight global meta populations. [ABSTRACT FROM AUTHOR]

The food systems upon which humanity depends face multiple interdependent environmental, social and economic threats in the 21st Century. Yet, the governance of these systems, which determines to a large extent the ability to adapt and transform in response to these challenges, is underresearched. This perspective piece synthesises the findings of two recent reviews of food systems governance and transformations and proposes a comprehensive research agenda for the coming years. These reviews highlight the influence of governance on food systems, methodological obstacles to explaining the effectiveness of governance in realising food sustainability, and conditions that have historically supported food system transformations. We argue that the following steps are key to improving our knowledge of the role of governance in food systems: (1) developing more comparable research designs for building generalisable explanations of the governance elements that are most effective in realising food systems goals; (2) using the lens of polycentricity to help disentangle complex governance networks; (3) giving greater attention to the conditions and pre-conditions associated with historical food system transformations; (4) identifying adaptations that strengthen or weaken path dependency; and, (5) focusing research on how transformations can be supported by institutions that facilitate collective action and stakeholder agency. [ABSTRACT FROM AUTHOR]

This study measured spatial distribution of marine debris stranded on beaches in South Eleuthera, The Bahamas. Citizen science, fetch modeling, relative exposure index and predictive mapping were used to determine marine debris source and abundance. Citizen scientists quantified debris type and abundance on 16 beaches within three coastal exposures (The Atlantic Ocean, Great Bahama Bank and The Exuma Sound) in South Eleuthera. Marine debris, (~2.5 cm or larger) on each beach was monitored twice between March–May and September–November 2013 at the same locations using GPS. Approximately, 93% of all debris items were plastic with plastic fragments (≤2.5 cm) being the most common. There were spatial differences (p ≤ 0.0001) in plastic debris abundance between coastal exposures. Atlantic Ocean beaches had larger quantities of plastic debris by weight and by meter (m) of shoreline. Stranded plastic may be associated with Atlantic Ocean currents associated with leakage from the North Atlantic sub-tropical gyre. Unlabelled Image • Marine debris characteristics were studied on 16 beaches within three coastal exposures in South Eleuthera, The Bahamas. • Trained citizen science volunteers surveyed beaches during spring and fall 2013. • Plastic accounted for 93% of marine debris and plastic fragments ≤2.5 cm were the most common items found. • Spatial differences in plastic abundance between coastal exposures were observed. • Atlantic Ocean beaches received the largest quantities of plastic debris. [ABSTRACT FROM AUTHOR]

Highlights • Conventional adaptation narrows the problem context, ignoring political economy. • Technological adaptation strategies are out of step with how households adapt. • In particular, adaptation in agriculture needs to move beyond impacts on production. • We understand this as an epistemological problem; adaptation needs a wider framing. • This means asking: what changes are people facing? How do these link to climate? Abstract Adaptation research and practice too often overlooks the wider social context within which climate change is experienced. Mainstream approaches frame adaptation problems in terms of the consequences that flow from biophysical impacts and as a result, we argue, ask the wrong questions. A complementary approach gaining ground in the field, foregrounding the social, economic and political context, reveals differentiation in adaptation need, and how climate impacts interconnect with wider processes of change. In this paper, we illustrate how this kind of approach frames a different set of questions about adaptation using the case of Nepal. Drawing on fieldwork and a review of literature, we contrast the questions that emerge from adaptation research and practice that take climate risk as a starting point with the questions that emerge from examination of contemporary rural livelihoods. We find that while adaptation efforts are often centred around securing agricultural production and are predicated on climate risk management, rural livelihoods are caught in a wider process of transformation. The numbers of people involved in farming are declining, and households are experiencing the effects of rising education, abandonment of rural land, increasing wages, burgeoning mechanisation, and high levels of migration into the global labour market. We find the epistemological framing of adaptation too narrow to account for these changes, as it understands the experiences of rural communities through the lens of climate risk. We propose that rather than seeking to integrate local understandings into a fixed, impacts-orientated epistemology, it is necessary to premise adaptation on an epistemology capable of exploring how change occurs. Asking the right questions thus means opening up adaptation by asking: 'what are the most significant changes taking place in people's lives?', along with the more standard: 'what are the impacts of climate change?' Viewing adaptation as occurring between and within these two perspectives has the potential to reveal new vulnerabilities and opportunities for adaptation practice to act upon. [ABSTRACT FROM AUTHOR]

The Physics of the Accelerating Universe (PAU) Survey is an international project for the study of cosmological parameters associated with Dark Energy. The PAU 18-CCD camera (PAUCam) is installed at the primary focus of the William Herschel Telescope at Observatorio del Roque de los Muchachos (La Palma, Canary Islands). The camera incorporates a unique set of 40 narrow band filters in the optical range from 450 nm to 850 nm and a set of 6 standard broad band filters. It is used to scan part of the northern sky in order to collect low resolution spectral information from millions of galaxies. The PAU data management (PAUdm) team is in charge of treating the data, including data transfer from the observatory to the PAU Survey data center, hosted at Port d'Informació Científica (PIC). PAUdm is also in charge of the storage, data reduction and, finally, of making the results available to the scientific community. We describe the technical solutions adopted to cover different aspects of the PAU Survey data management, from the computing infrastructure to the software tools and web services for the processing orchestration and data exploration. We give special attention to the PAU database, developed to preserve and guarantee the consistency of data and metadata and also used to coordinate the different PAUdm tasks. [ABSTRACT FROM AUTHOR]

Abstract Objectives Fast-track programs for diagnostic work-up and start of cancer treatment are defined by legislation in Denmark. The aim was to examine whether age, comorbidity or WHO performance status influence the time from referral due to suspicion of cancer to start of treatment (waiting time) in the Danish fast-track program. Material and methods For this descriptive cohort study, consecutive head and neck cancer (HNC) patients who underwent radiotherapy or surgery from January 2014 to July 2016 at Odense University Hospital (OUH) were identified in the database of the Danish Head and Neck Cancer group (DAHANCA). Age (<70 vs. ≥70 years), comorbidity (none vs. any), and WHO performance status (0–1 vs. 2–4) were correlated to waiting time. Results In total, 650 HNC-patients were included and of those, 92% were discussed at the multidisciplinary team conference. Patients ≥70 years were less frequently discussed in a multidisciplinary setting compared to younger patients (88% vs. 93%, p < 0.05). The time spent for diagnostic workup and treatment planning (waiting time) was longer for patients having primary radiotherapy than for primary surgery (p < 0.001), and 21% of patients treated with primary radiation exceeded the recommended maximum waiting time, whereas this was the case for only 7% of the patients treated with primary surgery. However, age ≥ 70 years, presence of comorbidity or poor performance status did not significantly influence the waiting time. Conclusion Age ≥ 70 years, comorbidity and poor WHO performance status did not influence the waiting time among patients with head and neck cancer treated at OUH. [ABSTRACT FROM AUTHOR]

Purpose: The study purpose was to assess whether mandibular setback surgery by intraoral vertical ramus osteotomy (IVRO) induces obstructive apnea and hypopnea in healthy Class III patients without a history of respiratory dysfunction. We hypothesized that the apnea-hypopnea index (AHI) would not exceed 5 events per hour after surgery.Patients and Methods: A prospective cohort study was conducted. The sample was composed of healthy Class III patients without a history of obstructive sleep apnea treated with isolated mandibular setback surgery by the IVRO procedure at a university hospital. In-home respiratory sleep recordings (Nox T3; Nox Medical, Reykjavik, Iceland) and self-administered questionnaires were obtained before and at least 3 months after surgery. The AHI was the primary outcome variable. Other study variables were as follows: peripheral capillary oxygen saturation, oxygen desaturation index, snore index, body mass index, Epworth Sleepiness Scale, and Oral Impact on Daily Performance index. Descriptive and bivariate statistics were computed, and the significance level was set at .05.Results: The sample was composed of 8 patients. The mean age at surgery was 23.2 years (range, 18.2 to 33.4 years). The mean amount of surgical setback was 4.3 mm (range, 2.5 to 7.4 mm). The mean body mass index was 24.2 kg/m2 (standard error [SE], 1.3 kg/m2) and 23.9 kg/m2 (SE, 1.4 kg/m2) at the presurgical and postsurgical sleep recordings, respectively. The mean AHI was 1.3 events per hour (SE, 0.3; range, 0.1 to 2.5) before surgery and 1.8 events per hour (SE, 0.4; range, 0.3 to 3.3) after surgery. No statistically significant changes in AHI (P = .412), peripheral capillary oxygen saturation (P = .443), oxygen desaturation index (P = .194), snore index (P = .363), or Epworth Sleepiness Scale (P = .812) were observed. The patients' self-reported oral health-related quality of life was statistically significantly improved after surgery (P = .034).Conclusions: Mandibular setback surgery with the IVRO procedure in the range of 2.5 to 7.4 mm did not induce obstructive sleep apnea, measured as an AHI above 5 events per hour, in the 8 healthy, young adult Class III patients presented in this study. More studies including larger patient samples are needed. [ABSTRACT FROM AUTHOR]

Cervical intraepithelial neoplasia grade 2 has historically been the threshold for surgical excision, but because of high regression rates, many countries are transitioning to active surveillance. However, estimates for regression rates are based on small studies with heterogeneous definitions of regression and progression. This study aimed to describe regression and progression rates of cervical intraepithelial neoplasia grade 2 using nationwide healthcare registry data. This was a nationwide population-based cohort study on women aged 18 to 40 years who had undergone active surveillance for cervical intraepithelial neoplasia grade 2 in Denmark from 1998 to 2020. This study excluded women with a previous record of cervical intraepithelial neoplasia grade 2 or worse or surgical excision. Cumulative incidence functions were used to estimate the rates of regression and progression at 6, 12, 18, and 24 months after diagnosis. In addition, a modified Poisson regression was used to estimate the crude and adjusted relative risks of progression within 24 months stratified by index cytology and age. During the study period, 11,056 women underwent active surveillance, 6767 of whom regressed and 3580 of whom progressed within 24 months. This corresponded to regression rates of 62.9% (95% confidence interval, 61.9–63.8) and progression rates of 33.3% (95% confidence interval, 32.4–34.2) at 24 months of follow-up. Most women regressed (90%) or progressed (90%) within the first 12 months. Women with high-grade index cytology had a higher risk of progression than women with normal index cytology (adjusted relative, 1.58; 95% confidence interval, 1.43–1.76), whereas there was no difference in the risk of progression between women aged 30 and 40 years and women aged 23 to 29 years (adjusted relative risk, 0.98; 95% confidence interval, 0.88–1.10). The observed high regression rates of cervical intraepithelial neoplasia grade 2 supported the transition in clinical management from surgical excision to active surveillance, particularly among women with low-grade or normal index cytology. [ABSTRACT FROM AUTHOR]

• We have followed neurodevelopment after early maternal fish oil supplementation. • We saw effects on early communication and prosocial behavior at 7 yr; mainly in boys. • As presented, socioemotional outcomes in adolescence do not appear to be affected. • The assessment of effects presents methodological issues, especially in boys. Early dietary long-chain n-3PUFA (n-3LCPUFA) may affect brain development. We investigated if fish oil supplementation of lactating mothers affected socioemotional wellbeing in adolescents in a potentially gender-specific manner. At age 13, we invited 92 children of mothers who completed a randomized trial with 1.5 g/d n-3 LCPUFA or olive oil during the first 4 months of lactation and 48 children of mothers with a high habitual fish intake. Children and parents answered validated questionnaires regarding socioemotional wellbeing and physical activity was monitored by ActiGraph for 7 days. Participation rate was 71%. Univariate correlations between children's and parents' ratings on the individual scales were moderate-strong, but correlations across questionnaires indicated that parents might base their ratings on proxy markers. We found no group differences in self-rated socioemotional outcomes or physical activity. Although the study was small, it was the first follow-up on effects of perinatal n-3LCPUFA supply on socioemotional wellbeing in adolescence. [ABSTRACT FROM AUTHOR]

Summary Background & aims High intakes of the phytoestrogen lignans and high blood concentrations of its main biomarker, enterolactone, has been associated with a better breast cancer prognosis. We investigated the association between pre-diagnostic plasma concentrations of enterolactone and breast cancer prognosis (i.e. recurrence, breast cancer-specific mortality and all-cause mortality). Methods Plasma and data was available from the Danish Diet, Cancer and Health cohort. Information on treatment and clinical characteristics from registries and clinical databases and both pre-diagnostic and diagnostic plasma measurement of enterolactone on a sub-set. Enterolactone was quantified in plasma using a high-throughput LC−MS/MS method. We followed 1457 breast cancer cases from date of diagnosis and until censoring or end-of-follow-up (median 9 years), during this time 404 died (250 of breast cancer) and 267 experienced recurrence. Cox proportional hazards models were used to estimate hazard ratios (HR) with 95% confidence intervals (CI). Results Plasma enterolactone were borderline significantly associated with lower breast cancer-specific mortality (HR doubling = 0.93, 95% CI:0.86, 1.00, P = 0.0501), but not associated with all-cause mortality (HR doubling = 0.95, 95% CI:0.89, 1.01) and recurrence (HR doubling = 0.96, 95% CI: 0.89, 1.04) in the models adjusted for smoking, schooling, BMI, physical activity and use of menopausal hormones. Adjusting further for clinical characteristics and treatment did not change the results considerably. In the sensitivity analyses, an inverse association was found with all-cause and breast cancer-specific mortality for those where blood was collected ≤5 years before diagnosis. Conclusions Overall, no clear association was found between pre-diagnostic plasma concentrations of enterolactone and breast cancer prognosis. Graphical abstract [ABSTRACT FROM AUTHOR]

Abstract Fish are an important food source for South Pacific (SP) island countries, yet there is little information on contamination of commercial marine fish species by plastic. The aim of our study was to perform a broad-scale assessment of plastic ingestion by fish common in the diet of SP inhabitants. We examined 932 specimens from 34 commercial fish species across four SP locations, and some of the prey they ingested, for the presence of marine plastics. Plastic was found in 33 species, with an average ingestion rate (IR) of 24.3 ± 1.4% and plastic load of 2.4 ± 0.2 particles per fish. Rapa Nui fish exhibited the greatest IR (50.0%), significantly greater than in other three locations. Rapa Nui is located within the SP subtropical gyre, where the concentration of marine plastics is high and food is limited. Plastic was also found in prey, which confirms the trophic transfer of microplastics. [ABSTRACT FROM AUTHOR]

Highlights • We analysed allelic drop-outs in STR massively parallel sequencing (MPS) data. • We extended the capillary electrophoresis (CE) peak height models to model the coverage of MPS data. • The coverage model accounts for the large marker imbalances seen with MPS data. • We also took into account the increased complexity of the stutter behaviour due to the enhanced resolution of the allelic sequences. • We investigated the performance of the coverage model by comparing observed and expected Brier scores. Abstract We used a Poisson-gamma model to analyse the allele coverage of autosomal short tandem repeat (STR) systems obtained by massively parallel sequencing (MPS). The Poisson-gamma coverage model was created using the peak height models from capillary electrophoresis (CE) based detection of PCR products as a starting point. The CE models were modified to account for the differences between CE and MPS signals by accounting for the large marker imbalances seen for MPS data and by using the Poisson-gamma distribution instead of the normal, log-normal, or gamma distributions that were applied for CE data. We took two approaches to estimate the marker imbalance parameters by (1) using a work-flow data base, and (2) using the results of replicate investigations of the samples. The Poisson-gamma model was used to estimate the rate of drop-outs of (1) single contributor dilution series experiments and (2) the minor contributor in two-person mixture samples. We examined the predictive capabilities of the model by comparing the observed and expected Brier scores of each sample. We derived the expected Brier scores and their variances to create asymptotic confidence intervals of the Brier scores. We found that the Poisson-gamma model performed well when using the work-flow data base, but that the replicate approach is not necessarily a viable option. [ABSTRACT FROM AUTHOR]

This study investigated 36 patients at 10–15 years after they had undergone mandibular setback surgery by intraoral vertical ramus osteotomy (IVRO) and subsequent intermaxillary fixation for 6 weeks. The patients completed a 37-item structured questionnaire to evaluate patient satisfaction and possible long-term effects of the treatment. Visual analogue scales were used to measure self-perceived changes in seven items concerning oral function and appearance. Oral health-related quality of life was assessed using the Oral Impacts on Daily Performance (OIDP) index. The main reasons for seeking treatment were to improve chewing function and appearance. The treatment had resulted in significant improvements regarding chewing function, appearance, bullying, and self-confidence in social settings (all P < 0.05). All patients were either very satisfied (61%) or reasonably satisfied (39%) with the treatment result. The mean OIDP frequency score was 8.49 on a scale from 8 to 40. Seventy-four percent of the patients reported no oral impacts on quality of life. In conclusion, 10–15 years after combined orthodontic and IVRO surgical treatment of mandibular prognathism, the patients were satisfied, and oral health-related quality of life was reported to be good. [ABSTRACT FROM AUTHOR]

Stutters are common and well documented artefacts of amplification of short tandem repeat (STR) regions when using polymerase chain reaction (PCR) occurring as strands one or more motifs shorter or longer than the parental allele. Understanding the mechanism and rate by which stutters are created is especially important when the samples contain small amounts of DNA or DNA from multiple contributors. It has been shown that there is a linear relationship between the longest uninterrupted stretch (LUS) and the stutter ratio. This holds if there is only a single type of stutter variant. However, with massively parallel sequencing (MPS), we see that alleles may create different stutters corresponding to stuttering of different parts of the parental allele. This calls for a refinement of the LUS concept. We analysed all uninterrupted stretches, here called blocks, and identified the block from which the stutter originated. We defined the block length of the missing motif (BLMM) as the length of the identified block. We found that the relationship between the stutter ratio and BLMM was linear using a simple system of recurrence relations. We found that the mean square error decreased by a factor up to 17.5 for compound and complex autosomal markers when using BLMM instead of LUS. [ABSTRACT FROM AUTHOR]

Collecting AIS messages from ships by satellites allows for maritime situational awareness, and a wide range of commercial applications, at global and regional scales. This work provides methods and indicators for evaluation of the maritime picture in terms of completeness as well as update intervals of ship tracks. The distribution of the maximum daily time gap between messages of each ship gives good understanding of the freshness of the maritime picture. The distribution is however very skewed, and therefore not well described by the mean and standard deviation. As a single indicator, the median value gives a description of the typical quality of service, whereas percentile levels give insight in the spread. The data used were collected in August 2015 in the Eastern and Southern Africa/Indian Ocean region. Four providers of satellite AIS data were used, plus coastal AIS, making the data set one of the most complete available. Typically 575,000 AIS messages from 1630 ships were received per day. The median value of the longest time gap in ship tracks was 4.3 h; and the 70- and 90-percentiles were 6.7 h and 19.5 h, respectively. When subsets of all data are used, starting with the data from one provider and adding the others one by one, it is found that the completeness increases asymptotically, but the median of the maximum daily time gap keeps decreasing linearly, showing that additional data in the first place help to track the ships that are already known. [ABSTRACT FROM AUTHOR]

The variation in Level of Service (LOS) and the objective of the Public Service Obligation (PSO) system raises the need for a method for determining the LOS based on social efficiency measures. Such a method is developed for assessing PSO and LOS in Norway. This paper presents and discusses this method, which may be relevant for other countries that employs similar supporting systems for air transport. A stepwise procedure is suggested for assessing PSO routes: Firstly, a framework for deciding upon LOS for air transport under PSO is presented. Secondly, we present a way of doing rough calculations of socio-economic profitability of PSO routes compared with best alternative transport. Finally, a model is presented which refines these calculations. One finding from the model simulations is that loosening the LOS restrictions on this type of regional aviation may lead to increased ticket prices and a reduced LOS. PSO restrictions may lead to a situation close to social optimum if wisely chosen. The most important step in future research is probably to test and refine the numerical model. [ABSTRACT FROM AUTHOR]

Although algae are often grown at pH values between 6 and 8, shifting to more alkali or acidic conditions may benefit CO 2 delivery to algal cultures. To assess the impact of culture pH on growth rate and uptake of CO 2 , we grew three relatively fast growing acidophilic ( Coccomyxa sp., Euglena mutabilis and Euglena gracilis ) and three alkaliphilic ( Thalassiosira pseudonana , Phaeodactylum tricornutum , Chlamydomonas sp.) algal species at pH values near neutral and near the extreme of their growth range. All six species showed similar growth and CO 2 uptake ability at extreme as at neutral pH values. Cultures of the alkaliphilic species captured a higher proportion of CO 2 from the gas stream than the acidophilic species; removing 50 to 65% of CO 2 from air compared to only 38% removed by acidophilic species (or 10–24% from CO 2 enriched air). Alkaliphilic species did not become carbon limited when fed CO 2 at the concentration provided by air (0.04% CO 2 ), but produced less biomass and captured less total CO 2 (0.06 to 0.08 g CO 2 per day) than the acidophilic species (0.6–0.8 g CO 2 day −1 ) which required CO 2 enriched air to avoid carbon limitation. Bicarbonate feeding reduced the loss of CO 2 to the environment, compared to feeding gaseous CO 2 , but with a potential cost in reduced specific growth rate or biomass production. [ABSTRACT FROM AUTHOR]