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In this study, we explore how young people living with cognitive disabilities use digital technology to develop and maintain social relations. The analysis is based on video interviews with 25 participants, aged 14-27. Our findings present a comprehensive use of a wide range of consumer applications for multiple forms of social interactions among the young people. Against this background, we outline three overall experiences with social interaction via and around digital technology, involving 1) individual social relations, 2) interest-based groups and 3) national and global networks. Our findings draw attention to the participants' social needs and show how they find ways to fulfil these needs via and around digital technology. These insights complement dominating perspectives on disability and assistive technology and suggest future research focusing on how to advance insights and practices in using digital technology to develop and maintain social relations among youth with cognitive disabilities

Background The COVID-19 pandemic has accelerated the worldwide need for simple remotely delivered (digital) scalable interventions that can also be used preventatively to protect the mental health of health care staff exposed to psychologically traumatic events during their COVID-19–related work. We have developed a brief behavioral intervention that aims to reduce the number of intrusive memories of traumatic events but has only been delivered face-to-face so far. After digitalizing the intervention materials, the intervention was delivered digitally to target users (health care staff) for the first time. The adaption for staff’s working context in a hospital setting used a co-design approach. Objective The aims of this mixed method exploratory pilot study with health care staff who experienced working in the pandemic were to pilot the intervention that we have digitalized (for remote delivery and with remote support) and adapted for this target population (health care staff working clinically during a pandemic) to explore its ability to reduce the number of intrusive memories of traumatic events and improve related symptoms (eg, posttraumatic stress) and participant’s perception of their functioning, and to explore the feasibility and acceptability of both the digitalized intervention and digitalized data collection. Methods We worked closely with target users with lived experience of working clinically during the COVID-19 pandemic in a hospital context (registered nurses who experienced intrusive memories from traumatic events at work; N=3). We used a mixed method design and exploratory quantitative and qualitative analysis. Results After completing the digitalized intervention once with remote researcher support (approximately 25 minutes) and a brief follow-up check-in, participants learned to use the intervention independently. All 3 participants reported zero intrusive memories during week 5 (primary outcome: 100% digital data capture). Prior to study inclusion, two or more intrusions in the week were reported preintervention (assessed retrospectively). There was a general pattern of symptom reduction and improvement in perceived functioning (eg, concentration) at follow-up. The digitalized intervention and data collection were perceived as feasible and rated as acceptable (eg, all 3 participants would recommend it to a colleague). Participants were positive toward the digital intervention as a useful tool that could readily be incorporated into work life and repeated in the face of ongoing or repeated trauma exposure. Conclusions The intervention when delivered remotely and adapted for this population during the pandemic was well received by participants. Since it could be tailored around work and daily life and used preventatively, the intervention may hold promise for health care staff pending future evaluations of efficacy. Limitations include the small sample size, lack of daily intrusion frequency data in the week before the intervention, and lack of a control condition. Following this co-design process in adapting and improving intervention delivery and evaluation, the next step is to investigate the efficacy of the digitalized intervention in a randomized controlled trial.

The purpose of the present pilot study was to explore the moderating role of basal inflammation on the effects of behavioral pain treatment in 41 patients with long-standing pain. Baseline pro-inflammatory status moderated behavioral treatment outcomes: higher pre-treatment levels of Tumor Necrosis Factor (TNF)-α and Interleukin (IL)-6 were related to less improvement in pain intensity, psychological inflexibility and in mental health-related quality of life. The treatment outcomes improved in the subgroup that had low levels of pro-inflammatory cytokines at baseline, while the subjects with higher pro-inflammatory status did not. Altogether, results indicate that low-grade inflammation may influence the behavioral treatment outcomes and provide a possible explanation of the heterogeneity in treatment response. OA hybrid - CA extern

STUDY OBJECTIVES: Sleep problems are common in children and adolescents and can aggravate comorbid disorders. This meta-analysis examined the effect of cognitive and behavioral sleep interventions (with four or more treatment sessions) from randomized controlled trials on school-age children and adolescents. METHODS: In a systematic literature search, six randomized controlled trials were identified (n = 528; mean age = 14.6 years; female = 63%) that reported total sleep time (TST), sleep onset latency (SOL), wake after sleep onset, and daytime sleepiness from ratings and actigraphy. RESULTS: After intervention, no effect was seen on self-reported TST, but when measured with actigraphy, an effect favoring the intervention group was observed (+11.47 minutes, P = .05). SOL decreased in the intervention group compared to the control group after intervention as measured by both sleep diaries (−9.31 minutes, P = .007) and actigraphy (−19.48 minutes, P < .0001). Effect sizes ranged from small to large. No effect was found for wake after sleep onset or daytime sleepiness. Short-term (4 to 8 weeks) follow-up data from four studies indicated maintained positive effects on SOL: sleep diaries −15.85 minutes (P = .01) and actigraphy −23.67 minutes (P < .0001). At follow-up, the effects on wake after sleep onset from ratings (−14.41 minutes, P = .001) and actigraphy (−7.54 minutes, P = .01) were significant, favoring the intervention group (moderate to large effect sizes). No effect on TST was indicated. CONCLUSIONS: Cognitive and behavioral sleep interventions are indicated to improve sleep in school-age children and adolescents. However, because treatment protocols were heterogeneous and risk of bias high, results should be interpreted with caution. Large and rigorous trials are needed. CITATION: Åslund L, Arnberg F, Kanstrup M, Lekander M. Cognitive and behavioral interventions to improve sleep in school-age children and adolescents: a systematic review and meta-analysis. J Clin Sleep Med. 2018;14(11):1937–1947.

Purpose The successful design and innovation of eHealth solutions directly involve end users in the process to seek a better understanding of their needs. This article presents user-innovated eHealth solutions targeting older persons with hearing impairment. Our research question was: What are the key users' needs, expectations, and visions within future hearing rehabilitation service delivery? Method We applied a participatory design approach to facilitate the design of future eHealth solutions via focus groups. We involved older persons with hearing impairment ( n = 36), significant others ( n = 10), and audiologists ( n = 8) following 2 methods: (a) human-centered design for interactive systems and (b) user innovation management. Through 3 rounds of focus groups, we facilitated a process progressing from insights and visions for requirements (Phase 1), to app such as paper version wireframes (Phase 2), and to digital prototypes envisioning future eHealth solutions (Phase 3). Each focus group was video-recorded and photographed, resulting in a rich data set that was analyzed through inductive thematic analysis. Results The results are presented via (a) a storyboard envisioning future client journeys, (b) 3 key themes for future eHealth solutions, (c) 4 levels of interest and willingness to invest time and effort in digital solutions, and (d) 2 technical savviness types and their different preferences for rehabilitation strategies. Conclusions Future eHealth solutions must offer personalized rehabilitation strategies that are appropriate for every person with hearing impairment and their level of technical savviness. Thus, a central requirement is anchoring of digital support in the clients' everyday life situations by facilitating easy access to personalized information, communication, and learning milieus. Moreover, the participants' visions for eHealth solutions call for providing both traditional analogue and digital services. Supplemental Material https://doi.org/10.23641/asha.7310729

Tollund Man is one of the most famous Iron Age bog bodies due to his well-preserved head. Since he was unearthed in 1950 in Bjældskovdal, Denmark, he has been subjected to several scientific investigations, but until now no attempts to reconstruct his general diet through isotope analyses have been conducted. Furthermore, previous radiocarbon (14C) analyses have only been able to date him broadly to the 3rd–4th century BC. In this study, stable isotope measurements (δ13C, δ15N) on bone collagen from Tollund Man’s femur and rib showed that the diet of Tollund Man was terrestrial-based and that the crops he ate probably were grown on manured fields. Accelerator mass spectrometry (AMS) 14C dates were obtained on both the 30kDa fractions of ultrafiltered collagen. Results showed that the ultrafiltration removed contamination from older substances from the burial environment. The femur was dated to 2330±23 BP, the rib to 2322±30 BP. These dates statistically agree with a previously published AMS 14C age on skin. By combining the new dates with the previous date of his skin it was possible to narrow down the age of Tollund Man to the period 405–380 cal BC (95.4% confidence interval).

Background/Introduction Isolated tumor cells (ITC) are tumor cells identified in the regional lymph nodes of patients with adeno- or squamous cell carcinoma of the esophagogastric junction (EGJ) or the esophagus. The current staging guidelines for these cancers do not assign any prognostic relevance to ITC, but their role remains debatable. We evaluated current literature to provide an overview of the prognostic relevance of ITC in regional lymph nodes of patients diagnosed with node negative cancer of the esophagus and EGJ. Methods A systematic search of several databases according to PRISMA guidelines. Three main criteria for inclusion were selected: 1. The studies had to include a group of patients with histopathologically identified ITC as defined by the Union for International Cancer Control Tumor, Node, Metastasis-classification 8th edition. 2. The studies had to include a group of patients classified as pN0. 3. The studies had to present the survival rate of patients with pN0, ITC. Results A total of five studies met the inclusion criteria. Combined, the studies included 434 pN0-patients of which 88 patients had ITC when evaluating the lymph nodes more extensively. The rate of ITC varied from 8% to 56% between studies. Significant differences in surgical techniques, neoadjuvant treatment and histological subtypes were observed. Three studies found a significant prognostic impact of ITC while one did not, and one had conflicting results. The largest difference in 5-year-survival was 33% for patients with ITC compared with 60% without ITC. Conclusion Although, the results were conflicting, ITC appeared to be a negative prognostic factor in esophageal and EGJ cancer. However, heterogeneity between the studies did not allow for a definitive conclusion.

Examinations of the participation in design processes are important to continuously advance the field of participatory design. This paper presents an analysis of how 22 young adults diagnosed with depression and anxiety participated in a design process focused on technology for health promotion. The findings identify concepts related to rhythm, tempi and investments in participation as central for designers who aim to cooperate with vulnerable users and embrace diversity in future health IT 1

This paper describes the design of MOVE, a mobile app to support people in forming social relations around exercise in residential areas. MOVE was developed in collaboration with residents and health professionals in a neighbourhood identified as a high-risk health area. The app is targeted to those who are motivated but challenged to do exercise and based on a conceptual model to provide users a social horizon of exercise activities in their residential area. We present the design and first evaluation of MOVE, including usability evaluations in controlled and natural settings. Results from these evaluations indicate that MOVE is a promising platform to support local social health relations once the identified usability problems are resolved.

Objective Activity trackers are designed to support individuals in monitoring and increasing their physical activity. The use of activity trackers among individuals diagnosed with depression and anxiety has not yet been examined. This pilot study investigates how this target group engages with an activity tracker during a 10-week health intervention aimed to increase their physical activity level and improve their physical and mental health. Methods Two groups of 11 young adults (aged 18–29 years) diagnosed with depression or anxiety participated in the digital health intervention. The study used mixed methods to investigate the research question. Quantitative health data were used to assess the intervention’s influence on the participants’ health and qualitative data provided insights into the participants’ digital health experience. Results The study demonstrated an ambiguous influence from the use of an activity tracker with positive physical and mental health results, but a fading and even negative digital health engagement and counterproductive competition. Conclusions The ambiguous results identify a need for (1) developing strategies for health professionals to provide supervised use of activity trackers and support the target groups’ abilities to convert health information about physical activity into positive health strategies, and (2) designing alternatives for health promoting IT targeted users who face challenges and need motivation beyond self-tracking and competition.

Although tumour budding is an adverse prognostic factor for many cancer types, the molecular mechanisms governing this phenomenon are incompletely understood. Therefore, understanding the molecular basis of tumour budding may provide new therapeutic and diagnostic options. We employ digital image analysis to demonstrate that the number of tumour buds in cytokeratin-stained sections correlates with patients having lymph node metastases at diagnosis. The tumour bud count was also a predictor of overall survival, independent of TNM stage. Tumour buds and paired central tumour areas were subsequently collected from oral squamous cell carcinoma (OSCC) specimens, using laser capture microdissection, and examined with RNA sequencing and miRNA-qPCR arrays. Compared with cells from the central parts of the tumours, budding cells exhibited a particular gene expression signature, comprising factors involved in epithelial-mesenchymal transition (EMT) and activated TGFβ signalling. Transcription factors ZEB1 and PRRX1 were up-regulated concomitantly with the decreased expression of mesenchymal-epithelial (MET) transcription factors (eg OVOL1) in addition to Kruppel-like factors and Grainyhead-like factors. Moreover, miR-200 family members were down-regulated in budding tumour cells. We used immunohistochemistry to validate five markers of the EMT/MET process in 199 OSCC tumours, as well as in situ hybridization in 20 OSCC samples. Given the strong relationship between tumour budding and the development of lymph node metastases and an adverse prognosis, therapeutics based on inhibiting the activation of TGFβ signalling may prove useful in the treatment of OSCC.

Purpose of review The aim of this paper is to provide an overview of research on ACT for youths with physical concerns. Findings Studies were identified by searches in PubMed and PsychInfo and comprised correlational designs as well as evaluations of treatment outcome, change processes, parental interventions, and ACT-measurements. Study samples included pain, sickle cell disease, cystic fibrosis, and acquired brain injuries. Summary The majority of studies are conducted on patients with chronic pain, and although ACT appears promising more studies are needed to evaluate the effects of treatment. Also, analyses of change processes suggest the importance of psychological flexibility, but further research to explore moderators and mediators of change with pediatric patients are warranted to clarify how this treatment works and for whom. Furthermore, more research is needed to explore the utility of this approach in other areas than chronic pain.

Designing technology-mediated connections between patients, relatives and healthcare providers is a main focus of electronic healthcare (eHealth). Involving future users in the innovation and design of eHealth is important for understanding the complex socio-technical challenge of connecting key actors in health management. This paper presents the results of a research project on the design of eHealth solutions for hearing healthcare. We introduce a client journey perspective on hearing rehabilitation and present how we engaged elderly hearing aid users, relatives and healthcare providers in inventing future eHealth-assisted client journeys. Our analysis of this problem space presents a series of boundaries and barriers and possible bridges and connections for future hearing rehabilitation. We synthesise these results by developing an integrated model of the complex interplay between information, communication and learning among key actors in hearing rehabilitation and we outline four implications for design within this framework.

This paper explores participatory design walks (PD walks) as a first step toward a participatory design of health information technology (HIT) aimed at tackling health inequality in a neighbourhood identified as a high-risk health area. Existing research shows that traditional methods for health promotion, such as campaigns and teaching, have little to no effect in high-risk health areas. Rather, initiatives must be locally anchored - integrated into the local culture, and based on social relationships and group activities. This paper explains how we conducted PD walks with residents and community workers in the neighbourhood and how this participatory approach supported a first step toward HIT design that tackles health inequality. This is important, as people in neighbourhoods with high health risks are not the target audience for the health technology innovation currently taking place despite the fact that this group suffers the most from health inequality and weigh most on the public healthcare services and costs. The study identifies social and cultural aspects that influence everyday health management and presents how a citizen-driven approach like PD walks, can contribute valuable insights for design of HIT. The paper provides concrete methodological recommendations on how to conduct PD walks that are valuable to HIT designers and developers who aim to do PD with neighbourhoods.

Design of Health Technology for elderly and care personnel has a high priority because of a severe increase of elderly citizens in need of health care combined with a decrease of resources in the health care sector. Desires for maintaining and improving the quality of care while reducing costs has resulted in a search for approaches that support co-operation between technology designers, elderly persons and health care professionals on innovating future care technology. Living laboratories, where areas of a care environment are transformed into a so-called platform for technology innovation, are popular. Expectations for living laboratories are high but examinations of how such laboratories support the intended participatory innovation are few. This paper presents and examines eight living laboratories set up in Danish nursing homes for technology innovation. We present the notion of a living laboratory and explicate the aspirations and expectations of this approach, and discuss why these expectations are hard to meet both on a general level and in the investigated labs. We question the basic assumptions of the possibility of reconciling the different interests of the stakeholders involved. In our analysis we focus on users in the living laboratories. We use guiding principles developed within Participatory Design to reveal the role and participation of the users - the health care professionals and the elderly - in the eight living laboratories. In general, these users played a minor role, in the labs where technical problems turned out to be main activity. We conclude that living laboratories do not nullify different/conflicting interests and that a real-life setting by itself is no guarantee for user participation.

This special issue on participatory design in an era of participation presents emerging topics and discussions from the thirteenth Participatory Design Conference (PDC), held at Aarhus University i...

Examinations of living labs are scarce even though the approach is increasingly used as an opportunity to bring design activities into real-life use context and consequently facilitate cooperations between designers and users in future technology innovation. Furthermore, examinations of living labs that focus on the people living in the labs do not exist. This paper presents a study of eight living labs set up in care homes for innovation in health technologies and focuses on the work carried out by care workers, service staff, residents and management, i.e. people living and working in the labs. The analysis reveals a comprehensive system of work carried out by people living and working in the labs and identifies that linking the lab-work-system to the ongoing existing work-system is a major challenge. The study demonstrates that the work of people living and working in the labs is critical to the success of living labs and recommends greater focus on work balance, user gains and collaborative in...

Current concepts of prehistoric manuring are founded on limited and mainly circumstantial evidence, giving rise to much ambiguity with respect to the onset of systematic use of manure to enhance cereal production. This paper reports carbon (C) and nitrogen (N) contents and isotopic compositions (δ13C, δ15N) of charred grains of naked barley, emmer and spelt dating to the first four millennia of early agriculture in Denmark. The δ15N values ranged from c. 0.5‰–5.5‰, 0.5‰–6.0‰ and 1.5‰–8‰ for spelt, emmer and naked barley, respectively. This study represents the until now most comprehensive investigation of long term trends in δ15N values of charred cereal grains, which previous research have proposed as an indicator for prehistoric manuring practice. Our study suggests a long-term (3900–500 BC) decrease of manuring intensity in emmer cropping. Conversely the long-term (2300 BC – AD 1) trend for naked barley cropping displays a more distinct and significant increase (+2‰) in grain δ15N values, reflecting an increased manuring intensity with an average δ15N value of as high as 6‰. We interpret this trend as indicating the initiation of a more intensive and systematic manuring practice associated with cultivation of barley in the Early Iron Age (500 BC- 0). Although the isotopic signal ascribed to manuring was (somewhat) variable, the relative manuring effect was detected throughout the chronological continuum being investigated. Further, we observed that the conventional sample pre-treatment (acid-base-acid) induced an average δ15N offset of 0.7‰ (pre-treated sample > non pre-treated sample). This has not previously been reported. Methodological advancements are needed to remedy this issue and provide consensus about appropriate pre-treatment of grain samples from archaeological sites. We conclude that N-isotope analysis of charred cereal grains constitutes a new and direct source of information about prehistoric manuring practice.

Background: Children and adolescents attending health care due to chronic pain commonly presents with insomnia. Previous research suggests that problems with sleep are associated with depression an ...

Background/Introduction Lymphocytic colitis (LC) and the incomplete form (LCi) are common causes of chronic watery diarrhea. Endoscopy is often inconspicuous, and the diagnosis relies on histopathological assessment of colonic biopsies. Digital Image Analysis (DIA) eliminates interobserver variation. The aim of this study was to establish digital cutoff values for LC and LCi on CD3 stained slides. Material and methods One hundred and six patients with a hematoxylin and eosin (HE) diagnosis of normal colonic mucosa (N = 19), non-specific reactive changes (N = 24), LCi (N = 23) and LC (N = 40) were eligible for analysis. The number of intraepithelial lymphocytes (IELs) reached by DIA in the total surface epithelium and in hot spots of the biopsies was compared with the diagnostic category assigned by the pathologists based on HE stained slides. The digitalized slides were analyzed for number of IELs using Visiopharm Quantitative Digital Pathology software. All digitalized slides were examined manually to identify differences in the approach to the evaluation of the biopsies by the pathologists and DIA. Results The median IEL counts and interquartile range in the total surface epithelium were 3.6 (3.2–4.3), 4.4 (3.4–5.3), 19.8 (16.6–30.0) and 41.3 (37.0–47.8) in normal colon mucosa, mucosa with non-specific reactive changes, LCi and LC, respectively. Discrimination between normal mucosa and non-specific reactive changes was not possible. Digital cutoff values with the best separation between non-LC, LCi and LC were > 13 IELs/100 epithelial cells for LCi and > 36 IELs/100 epithelial cells for LC. These cutoff values resulted in an agreement between the pathologist’s and DIA that was very good with a kappa value of 0.90. Conclusion Despite differences among the approach of DIA and the pathologist’s assessment of IELs in colonic mucosa DIA is able discriminate between the HE based diagnoses of the three subgroups non-LC, LCi and LC with high accuracy.

The diagnosis of microscopic colitis (MC) is based on histologic findings and includes collagenous colitis (CC) and lymphocytic colitis (LC). Incomplete MC (MCi) denotes patients with chronic diarrhea and a normal endoscopy and morphological changes that do not completely meet the histologic criteria of LC or CC. The aim of this study was to investigate the intraobserver and interobserver agreement on the MC subtypes of CC, LC, and MCi and the ability to discriminate MCi from normal and inflammatory bowel disease/nonspecific reactive changes. A single hematoxylin and eosin-stained specimen from biopsies of the following 5 groups were randomly selected and blinded: CC, LC, MCi, inflammatory bowel disease, and normal. Three pathologists independently reviewed the specimens. The specimens were relabeled and reinterpreted 4 months later. Intraobserver and interobserver agreement was evaluated by κ statistics. κ values for intraobserver agreement were good for 5 diagnostic groups varying from 0.70 to 0.83 and very good when simplifying to only 3 diagnostic groups varying from 0.88 to 0.96, separating MC/MCi from non-MC. κ values for interobserver agreement varied from 0.60 to 0.75 for 5 diagnostic groups and 0.81 to 0.89 for 3 diagnostic groups. The study shows that the intraobserver and interobserver agreement is high for discriminating between MC/MCi and non-MC, whereas the ability to discriminate MCi from CC and LC is lower. A revision and consensus on the histologic criteria of the MC subtypes seem warranted.

In pediatric chronic pain, research indicates a positive relation between parental psychological flexibility (i.e., the parent’s willingness to experience distress related to the child’s pain in the service of valued behavior) and level of functioning in the child. This points to the utility of targeting parental psychological flexibility in pediatric chronic pain. The Parent Psychological Flexibility Questionnaire (PPFQ) is currently the only instrument developed for this purpose, and two previous studies have indicated its reliability and validity. The current study sought to validate the Swedish version of the 17-item PPFQ (PPFQ-17) in a sample of parents (n = 263) of children with chronic pain. Factor structure and internal reliability were evaluated by means of principal component analysis (PCA) and Cronbach’s alpha. Concurrent criterion validity was examined by hierarchical multiple regression analyses with parental anxiety and depression as outcomes. The PCA supported a three-factor solution with 10 items explaining 69.5% of the total variance. Cronbach’s alpha (0.86) indicated good internal consistency. The 10-item PPFQ (PPFQ-10) further explained a significant amount of variance in anxiety (29%), and depression (35.6%), confirming concurrent validity. In conclusion, results support the reliability and validity of the PPFQ-10, and suggest its usefulness in assessing psychological flexibility in parents of children with chronic pain.

Pediatric chronic pain is a major health problem commonly associated with impaired functioning. There is a great need for more knowledge regarding the complex interplay between demographic variables such as age and gender, pain, and functioning in pediatric chronic pain. Objective: The objective of the study was to investigate if; (1) pediatric chronic pain patients with high and low levels of functioning differ in demographic variables, pain, and pain interference; (2) explore the mediating function of pain interference in the relationship between pain and functioning (i.e., depression and functional disability). Method: The study includes a consecutive sample of children and adolescents referred to a tertiary pain clinic due to chronic pain (n = 163). Cross-sectional data was analyzed to investigate the interrelationships between variables. Analyses of indirect effects were used to assess the impact of pain interference on the relation between pain and depression. Results: Findings illustrate high levels of depression, school absence and pain interference in this sample. Furthermore, pain interference mediated the relationship between pain and depression. Conclusion: Thus, this study adds to the growing support of findings suggesting that functioning and pain interference should be routinely assessed in pediatric chronic pain and a central target in treatment. Particularly, these findings imply a need for interventions specifically aimed at improved functioning for patients with chronic debilitating pain.

Anne-Marie Kanstrup Fiehn,1,2 Martin Kristensson,3 Ulla Engel,4 Lars Kristian Munck,5,6 Susanne Holck,4 Peter Johan Heiberg Engel1,6 1Department of Pathology, Roskilde Hospital, Roskilde, 2Department of Pathology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, 3Digital Pathology, Visiopharm, Hørsholm, 4Department of Pathology, Copenhagen University Hospital, Hvidovre, 5Department of Gastroenterology, Koege Hospital, Koege, 6Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark Purpose: The aim of this study was to develop an automated image analysis software to measure the thickness of the subepithelial collagenous band in colon biopsies with collagenous colitis (CC) and incomplete CC (CCi). The software measures the thickness of the collagenous band on microscopic slides stained with Van Gieson (VG). Patients and methods: A training set consisting of ten biopsies diagnosed as CC, CCi, and normal colon mucosa was used to develop the automated image analysis (VG app) to match the assessment by a pathologist. The study set consisted of biopsies from 75 patients. Twenty-five cases were primarily diagnosed as CC, 25 as CCi, and 25 as normal or near-normal colonic mucosa. Four pathologists individually reassessed the biopsies and categorized all into one of the abovementioned three categories. The result of the VG app was correlated with the diagnosis provided by the four pathologists. Results: The interobserver agreement for each pair of pathologists ranged from Κ-values of 0.56–0.81, while theΚ-value for the VG app vs each of the pathologists varied from 0.63 to 0.79. The overall agreement between the four pathologists wasΚ=0.69, while the overall agreement between the four pathologists and the VG app wasΚ=0.71. Conclusion: In conclusion, the Visiopharm VG app is able to measure the thickness of a subepithelial collagenous band in colon biopsies with an accuracy comparable to the performance of a pathologist and thereby provides a promising supplementary tool for the diagnosis of CC and CCi and in particular for research. Keywords: microscopic colitis, collagenous colitis, incomplete collagenous colitis, automated image analysis

The paper presents the design and exploration of a mobile quantified self-tracking prototype for patients with whiplash-associated disorders. The analytic lens is social learning theory and the patients' experiences of the artefact in their formation of practice. The intertwined processes of interpreting user--device interactions are addressed in terms of how patients attributed these interactions as efficacy information and provides insights into why the whiplash patients failed to convert quantified self-information into self-management strategies. The paper concludes that future designs should focus on accommodating patients' needs and desires for exerting control over the condition as a means of facilitating a gradual expansion of the patients' locus of control through tracking and visualization features that support an ongoing maintenance of equilibrium with the condition.

Physical activity is important for people's health, but it can be challenging especially for people who are vulnerable because of mental disorders. This paper contributes to participatory approaches developed to include vulnerable people in the design of exercise technology and situates participatory design to an exercise location and exercise activities. The results expand the current design space of exercise technology, which is dominated by sports enthusiasts and persuasive strategies. Visions for digital support that mediates local social exercise horizons are presented as a design alternative. The results exemplify that a participatory approach, which includes marginalized people in the design of technology, offers new knowledge for making existing and future applications useful to a broader audience. Specifically, the results point to opportunities for opening up the design space of health-promoting technology to support the cooperation of available health resources among residents in a community with attention to people who are in a vulnerable situation.

Occupational science and therapy scholars have argued that research on inequality in health is needed. Simultaneously, a knowledge gap between how to understand and take action on health inequalities exists in occupational science and therapy.To identify how inequality in health, high-risk areas of health, and engagement in health for low-income adult citizens have been described and conceptualized in contemporary occupational science and therapy literature.A structured literature review of 37 publications in occupational science and therapy literature, published from 2004 to 2014.The review revealed several descriptions and conceptualizations based on environmental, social, cultural, historical, and personal perspectives on occupation and already existing occupational science concepts. However, these descriptions were mainly based on assumptions regarding the relation between occupation and inequality in health, and statements on the need to explore this relation.Basic theory and reasoning, as well as empirical studies, on inequality in health are missing in occupational science and therapy. Based on the findings and theoretical trends, the authors suggest a transactional perspective on occupation is a possible frame for understanding inequality in health and related issues.

The shortage of plant-available nutrients probably constrained prehistoric cereal cropping but there is very little direct evidence relating to the history of ancient manuring. It has been shown that the long-term addition of animal manure elevates the δ15N value of soil and of modern crops grown on the soil. We have examined the δ15N and δ13C values of soil and of the grain and straw fractions of three ancient cereal types grown in unmanured, PK amended and cattle manured plots of the Askov long-term field experiment. Manure increased biomass yields and the δ15N values of soil and of grain and straw fractions of the ancient cereal types; differences in δ15N between unmanured and PK treatments were insignificant. The offset in straw and grain δ15N due to manure averaged 7.9 and 8.8 ‰, respectively, while the soil offset was 1.9 ‰. The soil and biomass δ13C values were not affected by nutrient amendments. Grain weights differed among cereal types but increased in the order: unmanured, PK, and animal manure. The grain and straw total-N concentration was generally not affected by manure addition. Our study suggests that long-term application of manure to permanently cultivated sites would have provided a substantial positive effect on cereals grown in early agriculture and will have left a significant N isotopic imprint on soil, grains and straw. We suggest that the use of animal manure can be identified by the 15N abundance in remains of ancient cereals (e.g. charred grains) from archaeological sites and by growing test plants on freshly exposed palaeosols. Copyright © 2011 John Wiley & Sons, Ltd.

In this article we position user-driven innovation vis-a-vis participatory design and Scandinavian systems In this article we position user-driven innovation vis-a-vis participatory design and Scandinavian systems design by identifying the defining characteristics of user-drive as the relationship between power over interaction, and learning in interaction. A case of design of feedback on electricity consumption for private households based on user-driven innovation serves to exemplify core principles of user involvement and user engagement. By referring to a phenomenological understanding of what it means to be in an innovative state of mind, we explain how letting users take the innovative lead has contributed a positive outcome, and how our approach to user-driven innovation can be regarded as a way to combine classic Scandinavian values of democracy with new economy calls for innovation in systems design. The article stresses the importance of designers taking a genuine interest in learning from users while also giving users the opportunity to learn about design.

The Mesolithic–Neolithic transition in north-west Europe has been described as rapid and uniform, entailing a swift shift from the use of marine and other wild resources to domesticated terrestrial resources. Here, we approach the when, what and how of this transition on a regional level, using empirical data from Öland, an island in the Baltic Sea off the Swedish east coast, and also monitor changes that occurred after the shift. Radiocarbon dating and stable carbon and nitrogen isotope analyses of bones and teeth from 123 human individuals, along with faunal isotope data from 27 species, applying to nine sites on Öland and covering a time span from the Mesolithic to the Roman Period, demonstrate a great diversity in food practices, mainly governed by culture and independent of climatic changes. There was a marked dietary shift during the second half of the third millennium from a mixed marine diet to the use of exclusively terrestrial resources, interpreted as marking the large-scale introduction of farming. Contrary to previous claims, this took place at the end of the Neolithic and not at the onset. Our data also show that culturally induced dietary transitions occurred continuously throughout prehistory. The availability of high-resolution data on various levels, from intra-individual to inter-population, makes stable isotope analysis a powerful tool for studying the evolution of food practices.

Monitoring technology, especially sensor-based technology, is increasingly taken into use in care work. Despite the simplicity of these technologies - aimed to automate what appear as mundane monitoring tasks - recent research has identified major challenges primarily related to the technology's ability to meet the complexity of care work. Understanding intersectional challenges between these care technologies and care work is fundamental to improve design and use of health informatics. In this paper we present an analysis of interaction challenges between a wet-sensor at the task of monitoring wet beds at a nursing home. The analysis identifies the multifaceted nature of monitoring work and the intricacy of integrating sensor technology into the complex knowledge system of monitoring work.

Background and Aims: Microscopic colitis (MC) is a common cause of chronic watery diarrhoea but long-term follow-up data are sparse. Methods: We performed a retrospective review of health records and all pathology reports in a regional cohort of patients with MC to describe the change in pre- and post-diagnostic colon biopsies. Results: MC was diagnosed in 468 patients with collagenous colitis (CC), 361 with lymphocytic colitis (LC) and 226 with incomplete MC (MCi). The 2014 incidence of CC, LC and MCi was 14.5, 14.9 and 5 per 105. Biopsies from both right and left colon were obtained in 237 (51%) patients with CC, 200 (55%) with LC and 107 (47%) with MCi. The diagnostic sensitivities of both left- and right-sided biopsies for MC were high and did not differ. Pre-diagnostic biopsies were obtained in 150 patients and lamina propria inflammation was described in 59, 47 and 43% of patients with a diagnosis of CC, LC and MCi respectively within 1 year, while histology was normal in 16, 13 and 21%. Post-diagnostic biopsies were obtained in 283 patients. MC persisted for up to one year in 77% with CC, 64% with LC and 45% with MCi, of whom 6, 9 and 18% respectively changed to a different MC subgroup. Conclusions: Colonic biopsies obtained prior to the MC diagnosis often revealed increased lamina propria inflammation. The pathological changes of CC and LC are more persistent than those of MCi. Biopsies from the descending or sigmoid colon are sufficient to elucidate whether a patient with chronic watery diarrhoea has MC.

UNLABELLED The high prevalence of chronic debilitating pain in pediatric populations calls for more knowledge regarding the impact of pain on functioning or pain interference. This in turn requires valid and reliable instruments to adequately assess the impact of pain on functioning. Also, adequate measures of pain interference are important in evaluations of behavioral interventions aimed at improving functioning. OBJECTIVE The objectives of this study were to evaluate the statistical properties of the Pain Interference Index (PII), including the factor structure, internal consistency, and concurrent criteria validity of the instrument. METHOD Data were collected from a consecutive sample of children and adolescents referred to a tertiary pain clinic due to chronic pain (n = 163). A principal component analysis was used to investigate the latent factor structure of items. The internal consistency was assessed by Cronbach's alpha. A set of hierarchical regression analyses was conducted to evaluate the ability of instruments to predict levels of depression and functional disability. RESULTS Analyses indicated the adequacy of a 1-factor solution with a total of 6 items. The intercorrelation between items and the scale's reliability was satisfactory. Furthermore, bivariate correlations and hierarchical regression analyses illustrate the concurrent criteria validity of the instrument. CONCLUSION Results support the use of PII as an adequate instrument to assess pain interference in children and adolescents with chronic pain.

BACKGROUND AND OBJECTIVE: Pediatric debilitating chronic pain is a severe health problem, often requiring complex interventions such as intensive interdisciplinary pain treatment (IIPT). Research is lacking regarding the effectiveness of IIPT for children. The objective was to systematically review studies evaluating the effects of IIPT. METHODS: Cochrane, Medline/Ovid, PsycInfo/OVID, PubMed, PubPsych, and Web of Science were searched. Studies were included if (1) treatment was coordinated by ≥3 health professionals, (2) treatment occurred within an inpatient/day hospital setting, (3) patients were RESULTS: One randomized controlled trial and 9 nonrandomized treatment studies were identified and a meta-analysis was conducted separately on pain intensity, disability, and depressive symptoms revealing positive treatment effects. At posttreatment, there were large improvements for disability, and small to moderate improvements for pain intensity and depressive symptoms. The positive effects were maintained at short-term follow-up. Findings demonstrated extreme heterogeneity. CONCLUSIONS: Effects in nonrandomized treatment studies cannot be attributed to IIPT alone. Because of substantial heterogeneity in measures for school functioning and anxiety, meta-analyses could not be computed. There is preliminary evidence for positive treatment effects of IIPT, but the small number of studies and their methodological weaknesses suggest a need for more research on IIPTs for children.

Background Chronic pain is a major health problem and more knowledge is needed regarding the interference of pain on behaviors in different life domains. Clinically useful and statistically sound pain interference measures are highly important. Studies on youths have shown that the Pain Interference Index (PII) is a reliable and valid instrument that is sensitive to change following behavioral treatment. This measure may also have utility for adults, but no study has so far evaluated the statistical properties of the PII for long-standing pain in adults. Methods Data were collected from 239 consecutive adults with non-specific chronic pain referred to a tertiary pain clinic. We investigated the factor structure of items using a principal component analysis. Cronbach's alpha was calculated to assess internal consistency. The questionnaire's ability to predict levels of, e.g., disability was analyzed by means of regression analyses. Results Analyses illustrated the adequacy of a one-factor solution with six items. Cronbach's alpha (0.85) suggested a satisfactory internal consistency among items. The PII explained significant amounts of variance in pain disability, physical, and mental health-related quality of life and depression, suggesting concurrent criteria validity. Conclusion The PII is a brief questionnaire with reliable and valid statistical properties to assess pain interference in adults. Other studies support the reliability and validity of PII for use with youths, and now the PII can be used to analyze the influence of pain on behaviors across age groups. Potentially, the PII can also be used as an outcome measure in clinical trials.

Microscopic colitis (MC) is a common cause of chronic watery diarrhea. Traditionally, MC encompasses the 2 subgroups lymphocytic colitis (LC) and collagenous colitis, but recently, an additional subgroup, MC incomplete, has been introduced. Distinguishing between the subgroups relies exclusively on histopathologic evaluation. In the present study, 4 pathologists evaluated 156 archived biopsies originally diagnosed as LC or LC incomplete (LCi). Each pathologist assigned a diagnosis of LC, LCi, or nonspecific inflammation to all cases at 2 independent assessments. At the first assessment, hematoxylin and eosin (HE) stainings were available. At the second assessment, a supplementary CD3 immunohistochemical staining was also available. The aim was to evaluate whether a supplementary CD3 would increase the diagnostic agreement among pathologists, and whether a CD3 stain would change the diagnosis based on HE staining only. After the complete assessment, the cases were divided into 3 groups, that is, full agreement, partial agreement, and disagreement. The CD3 staining increased the number of cases with full agreement from 60 to 78. One hundred thirty-one cases with agreement or partial diagnostic agreement based on HE + CD3 were compared with the HE diagnoses. In 44 (34%) of 131 cases, CD3 changed the diagnosis. Cases assigned to the LCi category based on HE were often changed by a supplementary CD3. Conclusively, it is recommended to use a CD3 before giving the histopathologic diagnosis of LCi.

The paper presents results from a workshop with a group of patients in a Danish General Practice (GP). The workshop facilitated a dialogue on patients' roles and activities in daily health care by using a participatory design inspired method and pointed towards a pluralistic view on patients' participation represented by the terms 'mixed', 'social' and 'fluent participation'. The results challenge future research on Information and Communication Technology to support patient participation in health promoting activities by questioning how to embrace pluralistic opportunities for patient participation, which is especially important to GPs treating a broad group of patients.

Background and aims: The diagnosis of microscopic colitis (MC) rests on a triad of clinical symptoms, a normal endoscopy and characteristic histopathological findings, among which the number of intraepithelial lymphocytes (IELs) is a determining histopathological factor in diagnosing lymphocytic colitis (LC). When the surface epithelium in a HE stained slide shows a largely increased number of IELs, the diagnosis of LC is easy. However, diagnosing incomplete lymphocytic colitis (LCi) may be difficult as mitotic-and/or apoptotic figures can be hard to rule out. The same goes for distinguishing LCi from LC. The purpose of this study was to address such diagnostic challenges by developing software to count immunostained (CD3) T-lymphocytes of colon biopsies in order to facilitate diagnostics of LC and LCi. Methods and results: Software for automated image analysis (AIA) was developed using a training set of 10 colon biopsies (LC, LCi and normal) to match manual scorings of IELs in the surface epithelium. The study set consisted of blinded biopsies from 59 patients with LC or LCi in which four pathologists individually gave a diagnosis of LC, LCi or normal colon. The result of AIA was correlated to the diagnosis provided by the 4 pathologists. The overall agreement between AIA and the manual scoring was 96.6% (Cohen’s Kappa: 0.858). Conclusion: AIA is capable of quantifying CD3 stained lymphocytes in colon biopsies and is applicable as a supplementary diagnostic tool in borderline cases of LC and LCi as well as in research on prospective cohort studies.

The aim of this paper is to identify characteristics of patients' contributions to innovation in health information technology (HIT). The paper outlines a theoretical definition of patient innovation and presents an analysis of four digital prototypes and 22 low-fidelity mock-ups designed by people affected by the chronic illness diabetes mellitus. Seventeen families (a total of 60 people) with one or more diabetic family members participated in design activities in a four-year research project focused on the design of digital support for everyday living with diabetes. Our analysis documented the originality of the analysed patient designs and identified three characteristics of patients' designs: socio-technical networks, objects with associated personal meanings and technology supporting the expression of identity. The paper concludes that patient innovation is defined by what is perceived as new by patients and/or others within the social system of adaptation. The analysed patient designs are original (as distinct from replications of or improvements on known products), and their characteristics are innovative contributions to the social system of everyday living with diabetes (i.e. they are perceived as new to the patients in the research study). The results of the analysis contribute to the credentials of patients as key actors in HIT innovation and call for participatory approaches in health informatics.