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Non-linear electrical properties of a (biological) tissue can be revealed by non-linear electrical measurements, which means that the applied stimulus itself affects the measurement. If resulting voltage–current plots exhibit pinched hysteresis loops, the underlying tissue may be classified as a memristor, a state dependent resistor. The aloe vera plant and apples have been found to be memristors. However, polarization processes on the electrodes are also non-linear and may affect the measurement. Apples and aloe vera conduct electrical current very well and it is likely that the recordings are actually dominated by the polarization impedance of the electrodes. Here, we study the non-linear properties of aloe vera and apples with two different measurement electrode types. Furthermore, we measured also on the extracted liquids from one aloe vera leaf and one apple, leading to similar results. We concluded, unlike previous studies on these subjects, that the memristive properties originate from electrochemical reactions on the electrodes rather than the apples or aloe vera themselves.

Background: Even though there are multiple studies documenting the outcome of the Charnley low-friction arthroplasty as well as abundant studies on uncemented arthroplasties, there is a dearth of comparative studies of the uncemented acetabular component and a cemented component. In this study we aimed to document the long-term clinical and radiographic outcome as well as component survival in a randomized controlled trial.Materials and Methods: Two hundred fifteen patients (240 hips) were randomly allocated to receive a cemented Charnley cup or uncemented Duraloc 1200 cup. All patients received cemented Charnley stems and were evaluated clinically and radiographically after 6 months, and 2, 5, and 10 years.Results: Harris Hip Scores improved from 48.3 [95% confidence interval (CI) 45.0-51.6] to 90.2 [95% CI 87.9-92.6] in the Charnley group and from 49.3 [95% CI 86.9-91.3] in the Duraloc group at 6 months. After 10 years, the Charnley group's Harris Hip Score was 89.8 [95% confidence interval (CI) 87.0-92.6], and the Duraloc group's score was 87.3 (95% CI 84.1-90.6). In the radiographic analysis after 10 years, there was no statistical difference in the prevalence of radiographic signs of loosening. Nine cups were revised in the Charnley group, and five cups were removed in the Duraloc group. The difference was not statistically significant. There was no statistical difference between the cups when aseptic loosening was the end-point, nor in survival analyses.Conclusions: There is no statistically significant difference in clinical or radiological outcome between the Charnley cup and the Duraloc after 10 years, and no difference in implant survival after 12-14 years. The uncemented Duraloc cup is as good as the cemented Charnley cup after 10 years. [ABSTRACT FROM AUTHOR]

Abstract Background Previously the angiotensin II receptor blocker Irbesartan has been demonstrated to reduce the risk for progression from microalbuminuria to macroalbuminuria in type 2 diabetic patients. The purpose of this study was to evaluate the effect of treatment with Irbesartan in type 2 diabetic patients with microalbuminuria on the urinary proteome. Methods High-resolution capillary-electrophoresis coupled to mass-spectrometry (CE-MS) was used to profile the low-molecular-weight proteome in urine of a subgroup of patients from a two year randomized irbesartan versus placebo therapy trial, which included hypertensive type 2 diabetic patients with microalbuminuria on ongoing antihypertensive medication (IRMA2-substudy). Results We demonstrate that the therapy with 300 mg Irbesartan daily over a period of two years results in significant changes of the urinary proteome. Both, a classifier developed previously that consists of urinary peptides indicative of chronic kidney disease, as well as several individual peptides changed significantly after treatment. These changes were not observed in the placebo-treated individuals. Most prominent are changes of urinary collagen fragments associated with progression of diabetic nephropathy, indicating normalization in urinary peptides. Conclusion CE-MS analysis of urine enabled identification of peptides as potential surrogate markers for renoprotection in microalbuminuric type 2 diabetic patients, which show persistent improvement after longterm treatment with Irbesartan. The results suggest that a major benefit of treatment by Irbesartan may be improvement of collagen turnover, reduction of fibrosis. They further suggest that urinary proteome analysis could be utilized to assess potential benefit of therapeutic intervention, providing statistically significant results even on a small population.

New particle formation (NPF) in the tropical upper troposphere is a globally important source of atmospheric aerosols 1-4 . It is known to occur over the Amazon basin, but the nucleation mechanism and chemical precursors have yet to be identified 2 . Here we present comprehensive in situ aircraft measurements showing that extremely low-volatile oxidation products of isoprene, particularly certain organonitrates, drive NPF in the Amazonian upper troposphere. The organonitrates originate from OH-initiated oxidation of isoprene from forest emissions in the presence of nitrogen oxides from lightning. Nucleation bursts start about 2 h after sunrise in the outflow of nocturnal deep convection, producing high aerosol concentrations of more than 50,000 particles cm - 3 . We report measurements of characteristic diurnal cycles of precursor gases and particles. Our observations show that the interplay between biogenic isoprene, deep tropical convection with associated lightning, oxidation photochemistry and the low ambient temperature uniquely promotes NPF. The particles grow over time, undergo long-range transport and descend through subsidence to the lower troposphere, in which they can serve as cloud condensation nuclei (CCN) that influence the Earth's hydrological cycle, radiation budget and climate 1,4-8 ., Competing Interests: Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Objective: To investigate the longitudinal development of neurofilament light chain (NfL) levels in type 2 diabetes with and without diabetic polyneuropathy (+/-DPN) and to explore the predictive potential of NfL as a biomarker for DPN., Research Design and Methods: We performed retrospective longitudinal case-control analysis of data from 178 participants of the Anglo-Danish-Dutch Study of Intensive Treatment in People with Screen-Detected Diabetes in Primary Care-Denmark (ADDITION-Denmark) cohort of people with screen-detected type 2 diabetes. Biobank samples acquired at the ADDITION-Denmark 5- and 10-year follow-ups were analyzed for serum NfL (s-NfL) using single-molecule array, and the results were compared with established reference material to obtain NfL z-scores. DPN was diagnosed according to Toronto criteria for confirmed DPN at the 10-year follow-up., Results: s-NfL increased over time in +DPN (N = 39) and -DPN participants (N = 139) at levels above normal age-induced s-NfL increase. Longitudinal s-NfL change was greater in +DPN than in -DPN participants (17.4% [95% CI 4.3; 32.2] or 0.31 SD [95% CI 0.03; 0.60] higher s-NfL or NfL z-score increase in +DPN compared with -DPN). s-NfL at the 5-year follow-up was positively associated with nerve conduction studies at the 10-year follow-up (P = 0.02 to <0.001), but not with DPN risk. Areas under the curve (AUCs) for s-NfL were not inferior to AUCs for the Michigan Neuropathy Screening Instrument questionnaire score or vibration detection thresholds. Higher yearly s-NfL increase was associated with higher DPN risk (odds ratio 1.36 [95% CI 1.08; 1.71] per 1 ng/L/year)., Conclusions: Our findings suggest that preceding s-NfL trajectories differ slightly between those with and without DPN and imply a possible biomarker value of s-NfL trajectories in DPN., (© 2024 by the American Diabetes Association.)

Enhanced photolysis of particulate nitrate (pNO 3 ) to form photolabile species, such as gas-phase nitrous acid (HONO), has been proposed as a potential mechanism to recycle nitrogen oxides (NO x ) in the remote boundary layer ("renoxification"). This article presents a series of laboratory experiments aimed at investigating the parameters that control the photolysis of pNO 3 and the efficiency of HONO production. Filters on which artificial or ambient particles had been sampled were exposed to the light of a solar simulator, and the formation of HONO was monitored under controlled laboratory conditions. The results indicate that the photolysis of pNO 3 is enhanced, compared to the photolysis of gas-phase HNO 3 , at low pNO 3 levels, with the enhancement factor reducing at higher pNO 3 levels. The presence of cations (Na + ) and halides (Cl - ) and photosensitive organic compounds (imidazole) also enhance pNO 3 photolysis, but other organic compounds such as oxalate and succinic acid have the opposite effect. The precise role of humidity in pNO 3 photolysis remains unclear. While the efficiency of photolysis is enhanced in deliquescent particles compared to dry particles, some of the experimental results suggest that this may not be the case for supersaturated particles. These experiments suggest that both the composition and the humidity of particles control the enhancement of particulate nitrate photolysis, potentially explaining the variability in results among previous laboratory and field studies. HONO observations in the remote marine boundary layer can be explained by a simple box-model that includes the photolysis of pNO 3 , in line with the results presented here, although more experimental work is needed in order to derive a comprehensive parametrization of this process.

Aims: To investigate the relationship between neurofilament light chain (NfL) and the presence and severity of diabetic polyneuropathy (DPN)., Methods: We performed cross-sectional analysis of data from 178 participants of the ADDITION-Denmark cohort of people with screen-detected type 2 diabetes and 32 healthy controls. Biobank serum samples were analyzed for NfL using single-molecule array. DPN was defined by Toronto criteria for confirmed DPN. Original and axonal nerve conduction study (NCS) sum z-scores were used as indicators of the severity of DPN and peripheral nerve damage., Results: 39 (21.9%) participants had DPN. Serum NfL (s-NfL) was significantly higher in participants with DPN (18.8 ng/L [IQR 14.4; 27.9]) than in participants without DPN (15.4 ng/L [IQR 11.7; 20.1]). There were no unadjusted s-NfL differences between controls (17.6 ng/L [IQR 12.7; 19.8]) and participants with or without DPN. Higher original and axonal NCS sum z-scores were associated with 10% higher s-NfL (10.2 and 12.1% [95% CI's 4.0; 16.8 and 6.6; 17.9] per 1 SD). The AUC of s-NfL for DPN was 0.63 (95% CI 0.52; 0.73)., Conclusions: S-NfL is unlikely to be a reliable biomarker for the presence of DPN. S-NfL is however associated tothe severity of the nerve damage underlying DPN., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: L.L.M, C.V.B.H., E.S., H.T., L.B., M.A.K., S.T.A. and T.P. have no conflict of interest to report. M.C. has received speaker/expert testimony honoraria from Novo Nordisk Denmark, Boehringer Ingelheim Denmark and Abbott Rapid Diagnostics. A.S. holds a grant from the Novo Nordisk Foundation (grant number NNF21OC0069462) and has received payment for expert testimony for the Denmark Health Insurance – Health Donations and meeting support from the Novo Nordisk Foundation. A.S. also has a leading role in the “Together about diabetes” project in the Municipality of Aarhus and is part of the Advisory Committee for the Danish Diabetes Association. D.R.W. reports a grant from the European Foundation for the Study of Diabetes and Sanofi, consulting fees from the European Commission and meeting support from the Novo Nordisk Foundation. D.R.W. additionally holds stock in Novo Nordisk A/S and is a member of the external advisory board for the Maastricht Study. T.S.J. is funded by the Novo Nordisk Foundation (grant number NNF14OC0011633) and is part of the Advisory Committee for the Danish Diabetes Association., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)

Objective: Binge-eating disorder (BED) and subthreshold BED (SBED) are prevalent in adults and associated with mental health problems including depression, non-suicidal self-injury, lower quality of life, and suicidality. There is solid evidence that binge-eating behaviors are also prevalent in adolescence, but knowledge about mental health in community adolescents with BED of different frequency thresholds is more limited. We aimed to investigate the prevalence and mental health problems associated with SBED of low frequency and/or limited duration compared with BED in a Danish community sample of adolescents., Methods: We included 2509 adolescents who completed the online survey of the 16-17-year follow-up of the Copenhagen Child Cohort (CCC2000), including items on BED symptoms approximating the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria, and items on mental health and quality of life., Results: The 1-year prevalence of SBED was 2.7% (95% confidence interval [CI]: 2.0%-3.3%) with a male:female ratio of 1:3.7; comparable to previous findings on BED in the same sample. SBED was also comparable to BED concerning cross-sectional associations with overall mental health problems, lower health-related quality of life, depressive symptoms, and suicidal ideation, whereas no associations were seen with non-suicidal self-injury after Holm-Bonferroni correction. In both groups, thoughts and behaviors concerning food and weight interfered significantly with daily life., Discussion: SBED and BED were equally prevalent in this adolescent community sample, and similarly associated with indicators of poor mental health. The findings indicate that community adolescents reporting symptoms approximating clinical criteria of BED need intervention irrespectively of symptom frequency or duration., Public Significance: This study adds knowledge to the field by comparing BED of low frequency and/or limited duration ("subthreshold BED," SBED) with full-syndrome BED in adolescents and showing that SBED in adolescence is both prevalent and associated with poor mental health to a similar extent as that of BED. Findings indicate that self-reported symptoms according to clinical criteria of SBED and BED alike constitute a public health problem and point to youngsters in need of intervention., (© 2023 Wiley Periodicals LLC.)

Particulate nitrate ([Formula: see text]) has long been considered a permanent sink for NO x (NO and NO 2 ), removing a gaseous pollutant that is central to air quality and that influences the global self-cleansing capacity of the atmosphere. Evidence is emerging that photolysis of [Formula: see text] can recycle HONO and NO x back to the gas phase with potentially important implications for tropospheric ozone and OH budgets; however, there are substantial discrepancies in "renoxification" photolysis rate constants. Using aircraft and ground-based HONO observations in the remote Atlantic troposphere, we show evidence for renoxification occurring on mixed marine aerosols with an efficiency that increases with relative humidity and decreases with the concentration of [Formula: see text], thus largely reconciling the very large discrepancies in renoxification photolysis rate constants found across multiple laboratory and field studies. Active release of HONO from aerosol has important implications for atmospheric oxidants such as OH and O 3 in both polluted and clean environments.

Background: Peripheral and central hemodynamic indices are modifiable by lifestyle and medical intervention. We aimed to determine the long-term effect of intensive multifactorial treatment on peripheral and central hemodynamic indices among people with screen-detected diabetes., Methods: Between 2001 and 2006, people with screen-detected type 2 diabetes were included in the Anglo-Danish-Dutch study of Intensive Treatment of Diabetes in Primary Care (ADDITION) trial (NCT00237549, ClinicalTrials.gov). In the Danish arm, participants were invited to a clinical examination in 2015-2016, 13 years after inclusion and 8 years after trial-end. Out of 586 eligible participants who attended the clinical examination, 411 had a valid examination of central and peripheral hemodynamic indices (242 received intensive treatment and 169 received routine care). Carotid-femoral pulse wave velocity (cfPWV), central blood pressure and augmentation index were assessed by applanation tonometry. We used mixed-effect models to examine the intervention effect adjusting for cluster randomization and heart rate., Results: Randomization to intensive treatment during the trial-period was associated with a 0.58 m/s lower cfPWV (95% CI - 1.09 to - 0.06) at follow-up. Adjustment for blood pressure attenuated the association. Differences between intervention groups for central augmentation index were - 1.25% (95% CI: - 3.28 to 0.78), central pulse pressure - 1.74 mmHg (95% CI - 4.79 to 1.31), central systolic blood pressure - 3.06 mmHg (- 7.08 to 0.96), and central diastolic blood pressure - 1.70 mmHg (- 3.74 to 0.34)., Conclusions: Intensive multifactorial treatment of screen-detected type 2 diabetes has a sustained positive effect on aortic stiffness measured by cfPWV. Although all estimates pointed in favor of intensive treatment, we observed no clear beneficial effect on other hemodynamic indices., (© 2022. The Author(s).)

The preschool age seems to be decisive for the development of motor skills and probably the most promising time-window in relation to improvement of motor skills. This trial investigates the effect of an intensive structured intervention to improve motor skills in 3-6-year-old preschool children. A total of 471 Danish preschool children participated in a cluster randomized controlled trial. The intervention was to enhance motor skills, including predefined minimum criteria. Motor skills were measured using the Motor Assessment Battery for Children-2 (MABC-2) (total and three domains) at baseline and 6-, 18-, and 30-months post-intervention. The effect was estimated by multilevel linear regression with preschool and child included as random effects and adjusted for baseline values. Effect estimates were mainly positive at 6 months, but negative at 30 months with very few statistically significant estimates. In preschools with baseline motor skills scores below average, there was a tendency towards a larger improvement in the intervention group. Future interventions and research should focus on clusters with poor motor skills, as there is larger room for improvement. It remains to be seen whether the intervention can influence general well-being, physical activity, and self-perceived competence, both short- and long-term.

Despite the fact that eating disorders (EDs) are conditions that are potentially life-threatening, many people decline treatment. The aim of this study was to investigate why women decline specialized ED treatment, including their viewpoints on treatment services. Eighteen semi-structured qualitative interviews were conducted with women who had declined inpatient or outpatient specialized ED treatment. A thematic analysis revealed five main themes: (1) Disagreement on treatment needs, (2) rigid standard procedures, (3) failure to listen, (4) deprivation of identity, and (5) mistrust and fear. The women had declined ED treatment because they believed that treatment was only focused on nutritional rehabilitation and that it failed to address their self-identified needs. From their perspectives treatment was characterized by rigid standard procedures that could not be adapted to their individual situations and preferences. They felt that the therapists failed to listen to them, and they felt deprived of identity and reduced to an ED instead of a real person. This investigation is one of the first of its kind to provide clues as to how treatment could be moderated to better meet the needs of women who decline specialized ED treatment.

Peripheral neuropathy is one of the most common complications of both type 1 and type 2 diabetes. Up to half of patients with diabetes develop neuropathy during the course of their disease, which is accompanied by neuropathic pain in 30-40% of cases. Peripheral nerve injury in diabetes can manifest as progressive distal symmetric polyneuropathy, autonomic neuropathy, radiculo-plexopathies, and mononeuropathies. The most common diabetic neuropathy is distal symmetric polyneuropathy, which we will refer to as DN, with its characteristic glove and stocking like presentation of distal sensory or motor function loss. DN or its painful counterpart, painful DN, are associated with increased mortality and morbidity; thus, early recognition and preventive measures are essential. Nevertheless, it is not easy to diagnose DN or painful DN, particularly in patients with early and mild neuropathy, and there is currently no single established diagnostic gold standard. The most common diagnostic approach in research is a hierarchical system, which combines symptoms, signs, and a series of confirmatory tests. The general lack of long-term prospective studies has limited the evaluation of the sensitivity and specificity of new morphometric and neurophysiological techniques. Thus, the best paradigm for screening DN and painful DN both in research and in clinical practice remains uncertain. Herein, we review the diagnostic challenges from both clinical and research perspectives and their implications for managing patients with DN. There is no established DN treatment, apart from improved glycaemic control, which is more effective in type 1 than in type 2 diabetes, and only symptomatic management is available for painful DN. Currently, less than one-third of patients with painful DN derive sufficient pain relief with existing pharmacotherapies. A more precise and distinct sensory profile from patients with DN and painful DN may help identify responsive patients to one treatment versus another. Detailed sensory profiles will lead to tailored treatment for patient subgroups with painful DN by matching to novel or established DN pathomechanisms and also for improved clinical trials stratification. Large randomized clinical trials are needed to identify the interventions, i.e. pharmacological, physical, cognitive, educational, etc., which lead to the best therapeutic outcomes., (© The Author(s) (2021). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Objective: Symptoms indicative of diabetic polyneuropathy (DPN) early in type 2 diabetes may act as a marker for cardiovascular disease (CVD) and death., Research Design and Methods: We linked data from two Danish type 2 diabetes cohorts, the Anglo-Danish-Dutch Study of Intensive Treatment in People With Screen-Detected Diabetes in Primary Care (ADDITION-Denmark) and the Danish Centre for Strategic Research in Type 2 Diabetes (DD2), to national health care registers. The Michigan Neuropathy Screening Instrument questionnaire (MNSIq) was completed at diabetes diagnosis in ADDITION-Denmark and at a median of 4.6 years after diagnosis of diabetes in DD2. An MNSIq score ≥4 was considered as indicative of DPN. Using Poisson regressions, we computed incidence rate ratios (IRRs) of CVD and all-cause mortality comparing MNSIq scores ≥4 with scores <4. Analyses were adjusted for a range of established CVD risk factors., Results: In total, 1,445 (ADDITION-Denmark) and 5,028 (DD2) individuals were included in the study. Compared with MNSIq scores <4, MNSIq scores ≥4 were associated with higher incidence rate of CVD, with IRRs of 1.79 (95% CI 1.38-2.31) in ADDITION-Denmark, 1.57 (CI 1.27-1.94) in the DD2, and a combined IRR of 1.65 (CI 1.41-1.95) in a fixed-effect meta-analysis. MNSIq scores ≥4 did not associate with mortality; combined mortality rate ratio was 1.11 (CI 0.83-1.48)., Conclusions: The MNSIq may be a tool to identify a subgroup within individuals with newly diagnosed type 2 diabetes with a high incidence rate of subsequent CVD. MNSIq scores ≥4, indicating DPN, were associated with a markedly higher incidence rate of CVD, beyond that conferred by established CVD risk factors., (© 2021 by the American Diabetes Association.)

Objective: The global rise in type 2 diabetes is associated with a concomitant increase in diabetic complications. Diabetic polyneuropathy is the most frequent type 2 diabetes complication and is associated with poor outcomes. The metabolic syndrome has emerged as a major risk factor for diabetic polyneuropathy; however, the metabolites associated with the metabolic syndrome that correlate with diabetic polyneuropathy are unknown., Methods: We conducted a global metabolomics analysis on plasma samples from a subcohort of participants from the Danish arm of Anglo-Danish-Dutch study of Intensive Treatment of Diabetes in Primary Care (ADDITION-Denmark) with and without diabetic polyneuropathy versus lean control participants., Results: Compared to lean controls, type 2 diabetes participants had significantly higher HbA1c (p = 0.0028), BMI (p = 0.0004), and waist circumference (p = 0.0001), but lower total cholesterol (p = 0.0001). Out of 991 total metabolites, we identified 15 plasma metabolites that differed in type 2 diabetes participants by diabetic polyneuropathy status, including metabolites belonging to energy, lipid, and xenobiotic pathways, among others. Additionally, these metabolites correlated with alterations in plasma lipid metabolites in type 2 diabetes participants based on neuropathy status. Further evaluating all plasma lipid metabolites identified a shift in abundance, chain length, and saturation of free fatty acids in type 2 diabetes participants. Importantly, the presence of diabetic polyneuropathy impacted the abundance of plasma complex lipids, including acylcarnitines and sphingolipids., Interpretation: Our explorative study suggests that diabetic polyneuropathy in type 2 diabetes is associated with novel alterations in plasma metabolites related to lipid metabolism., (© 2021 The Authors. Annals of Clinical and Translational Neurology published by Wiley Periodicals LLC on behalf of American Neurological Association.)

We investigated risks and hazard rates of developing chronic ocular graft-versus-host disease (oGVHD) in a large nationwide, single centre study by using the criteria proposed by "The International Chronic oGVHD Consensus Group". This retrospective study included 1407 consecutive adults who underwent allogeneic haematopoietic stem cell transplantation (HSCT). Patients were examined by an ophthalmologist according to the hospital's guidelines: baseline examination before HSCT, annually up to 5 years after HSCT. The 186 (13%) had dry eye disease before HSCT. The 5-year cumulative incidence of oGVHD was 18% (95% CI: 15-21) after myeloablative (MA) and 35% (95% CI: 30-39) after non-myeloablative conditioning (NMA). Factors associated with the rate of oGVHD were assessed separately according to conditioning regimen by using multiple Cox regression analyses. Factors that increased the rate in the MA group: Malignant disease, Schirmer's test≤10 mm/5 min before transplantation, use of female donor, matched unrelated donor, peripheral blood as stem cell source, and grade III-IV acute GVHD. Factors that increased the rate in the NMA group: Schirmer's test≤10 mm/5 min before transplantation and higher recipient age. We recommend a baseline ophthalmological examination before HSCT since many of the patients have signs of dry eyes before transplantation which increased the risk and rate of developing oGVHD.

An investigation of CCl3COCl was conducted with the purpose of using the compound as an alternative Cl atom precursor in laboratory settings. CCl3COCl can be used with or without O2 as a source of Cl atoms and photolysis studies in air and N2 diluent displayed COCl2 and CO as being the major photolysis products. Relative rate studies were performed to determine the Cl atom rate coefficients for reaction with CH3Cl and C2H2 and the results were in agreement with literature values. Cl atom rate coefficients for reaction with n-CH2[double bond, length as m-dash]CH(CH2)3CN and n-CH2[double bond, length as m-dash]CH(CH2)4CN were determined as (2.95 ± 0.58) × 10-10 and (3.73 ± 0.60) × 10-10 cm3 molecule-1 s-1, respectively. CCl3COCl requires UV-C irradiation, so not all molecules are feasible for use in e.g. relative rate studies. Furthermore, it is recommended to perform experiments with O2 present, as this minimizes IR feature disturbance from product formation.

Aims: To determine the association between concurrent overall burden of disease, cardiovascular disease, cancer, self-rated health, HbA 1c levels, and attendance at clinical follow-up of the Danish arm of the ADDITION-study., Methods: Logistic regression models were used to study factors proposed being associated with attendance in clinical follow-up. We used data from clinical examinations, questionnaires and national registers at a time-point near the follow-up examination., Results: A total of 1119 participants were eligible for the follow-up conducted a median of 12.8 years (IQR 11.6; 13.4) after type 2 diabetes diagnosis by screening. Concurrent high burden of disease was associated with lower attendance (OR 0.6 (95% CI: 0.4; 0.9) for high-versus no burden of disease). Concurrent cardiovascular disease and cancer showed no statistically significant association with attendance (OR 1.0 (95% CI: 0.7; 1.4)) and (OR 0.8 (95% CI: 0.6; 1.1) for (disease versus no disease). Similarly, self-rated health (OR 0.7 (95% CI: 0.5; 1.0) poor-versus good self-rated health) and HbA 1c levels (OR 1.0 (95% CI: 0.9; 1.2 unit=10mmol/mol)) were not statistically significant associated with attendance., Conclusions: This study showed a lower attendance in clinical follow-up after nearly 13years among individuals with concurrent high burden of disease. No associations were found between concurrent CVD, cancer, self-rated health and Hba 1c levels and attendance., (Copyright © 2019 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.)

Objective: To evaluate whether diabetic polyneuropathy (DPN) follows the hypothesis for the course of nerve fiber damage reflected by symptoms progressing from pure small through mixed to large nerve fiber symptoms with or without symptoms of loss of function of small nerve fibers., Research Design and Methods: Repeated assessments of nerve fiber-specific symptoms were obtained in 518 participants of the ADDITION-Denmark study from the time of a screening-based diagnosis of type 2 diabetes using specific items of the Michigan Neuropathy Screening Instrument questionnaire. DPN was clinically assessed 13 years after inclusion. The course of symptoms reflecting dysfunction of specific nerve fibers was evaluated, and the association between symptoms and DPN was estimated using logistic regression models., Results: An overall stable, yet heterogeneous course of symptoms was seen. According to the hypothesis of symptom progression, 205 (40%) participants remained free of symptoms and 56 (11%) had stable, 114 (23%) progressing, and 132 (26%) improving symptoms. Cross-sectional estimates showed a higher risk of DPN (odds ratios between 2.1 and 4.1) for participants with mixed or large nerve fiber symptoms with or without symptoms of loss of function of small nerve fibers compared with participants without symptoms., Conclusions: There was no evidence for a progressive development of nerve fiber damage in DPN reflected by symptoms going from pure small through mixed to large nerve fiber symptoms with or without symptoms of loss of function of small nerve fibers. Yet overall, neuropathic symptoms were prospectively associated with a higher risk of DPN., (© 2019 by the American Diabetes Association.)

Fourier transform infrared smog chamber techniques were used to study the kinetics and mechanisms of the reactions of Cl atoms and OH radicals with pentafluorophenol (C 6 F 5 OH) in 700 Torr total pressure of air or N 2 diluent at 296 ± 2 K. Rate constants k (OH + C 6 F 5 OH) = (6.88 ± 1.37) × 10 -12 cm 3 molecule -1 s -1 and k (Cl + C 6 F 5 OH) = (2.52 ± 0.31) × 10 -11 cm 3 s -1 molecule -1 in 700 Torr air diluent were determined. In 700 Torr N 2 , the rate constant for the reaction of C 6 F 5 OH with Cl atoms is linearly dependent on the Cl atom concentration. Product studies on this reaction in both 700 Torr air and 700 Torr N 2 diluent show the formation of nonconjugated products. The photolysis constant of C 6 F 5 OH was determined by 254 nm UV irradiation of a C 6 F 5 OH and CH 3 CHO mixture in 700 Torr air or N 2 at 296 ± 2 K and yielded a photolysis rate constant of J (C 6 F 5 OH) = (2.83 ± 0.25) × 10 -3 s -1 . Results are discussed with respect to the atmospheric chemistry of other halogenated aromatic species.

Objective: To systematically review reproductive outcomes of assisted reproductive technology (ART) treatment in women transplanted with frozen-thawed ovarian tissue., Design: Systematic review in accordance with guidelines from Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)., Setting: Not applicable., Patient(s): Women undergoing ovarian tissue transplantation (OTT) and subsequent ART., Intervention(s): Literature search in PubMed and Scopus databases., Main Outcome Measure(s): Time from OTT to initiation of ART, stimulation protocol, and conventional ART outcome measures., Result(s): Twenty studies (including 15 case reports), specifying ART treatments and outcomes of 40 women undergoing OTT were identified. Multiple stimulation protocols were applied, with the modified natural cycle as the most frequently used. In total, 195 ART cycles were performed (4.0 cycles per patient) resulting in 1.5 follicles and 1.0 mature oocyte retrieved per cycle. Empty follicle rates ranged from 23% to 35% in the three largest cohort studies. Twenty-five women (62.5%) had one or more pregnancies, of which 28.6% were lost, resulting in a total of 20 live births (22 children). Overall the pregnancy rates varied from 3.9% to 19.3% and live-birth rates from 3.9% to 14.0% per cycle in the three cohort studies. Fertility treatment was initiated shortly after OTT in some centers, while others awaited natural conception before embarking on ART treatment., Conclusion(s): The reported pregnancy and live-birth rates for women undergoing OTT and ART were considerably lower than those of the general in vitro fertilization (IVF) population, corresponding to patients with poor ovarian reserve. In general, ART outcomes are underreported, and there is a lack of consensus regarding the timing of ART in relation to OTT and the type of ovarian stimulation protocol., (Copyright © 2019 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Diabetic neuropathy (DN) is a common complication of diabetes and can be either painful or non-painful. It is challenging to diagnose this complication, as no biomarker or clear consensus on the clinical definition of either painful or non-painful DN exists. Hence, a hierarchical classification has been developed categorizing the probability of the diagnosis into: possible, probable or definite, based on the clinical presentation of symptoms and signs. Pain is a warning signal of tissue damage, and non-painful DN therefore represents a clinical and diagnostic challenge because it often goes unnoticed until irreversible nerve damage has occurred. Simple clinical tests seem to be the best for evaluation of DN in the general care for diabetes. Screening programs at regular intervals might be the most optimal strategy for early detection and interventions to possibly prevent further neuronal damage and to lower the economic burden of this complication., (© 2019 The Authors. Journal of Diabetes Investigation published by Asian Association for the Study of Diabetes (AASD) and John Wiley & Sons Australia, Ltd.)

Introduction: Young women with a cancer diagnosis often have very little time to decide whether or not to commence fertility-preserving strategies before initiating potentially sterilizing cancer treatment. Minimizing the interval from opting for fertility preservation to completion of the procedure will reduce the potential risk of delaying cancer treatment. In the current study, we have evaluated the period of time from referral to ovarian tissue cryopreservation (OTC) to actual freezing of the tissue in a cohort of Danish women., Material and Methods: The study population comprised 277 consecutive patients with both malignant and nonmalignant diseases referred for OTC from four centers in the Danish network. Statistical analysis was conducted to analyze the impact of age, diagnosis, and referring center on the time from OTC-referral to OTC. A literature search for "random start" protocols for controlled ovarian stimulation (COS) for fertility preservation in cancer patients was performed., Results: The time from OTC-referral to OTC was significantly influenced by diagnosis, age, and referring center. Women with malignant diseases other than breast cancer, such as sarcomas, pelvic cancers, and hematological cancers, experienced a significantly shorter interval to OTC (5 days) than women with breast cancer (7 days) and nonmalignant diseases including systemic, ovarian, and hereditary conditions (13-17.5 days). Women over the age of 30 years experienced a significantly longer time to OTC (P < 0.03), and the diagnosis determined the length of the interval (P < 0.001). According to the literature, fertility preservation by oocyte vitrification requires 13-14 days, as the average time for 1 round of COS was 11 days and oocyte collection can be performed 2 days later., Conclusions: It is in the interest of both cancer patients and clinicians to perform fertility preservation as quickly and safely as possible. In a Danish setting, OTC provides a short interval of around 6 days from the patient choosing this option to completion of the procedure. This is considerably less time than what is needed to perform COS and oocyte vitrification, and therefore OTC might be considered the preferred choice of fertility preservation when urgency is needed., (© 2019 Nordic Federation of Societies of Obstetrics and Gynecology.)

Neonicotinoids (NN), first introduced in 1991, are found on environmental surfaces where they undergo photolytic degradation. Photolysis studies of thin films of NN were performed using two approaches: (1) transmission FTIR, in which solid films of NN and the gas-phase products were analyzed simultaneously, and (2) attenuated-total-reflectance FTIR combined with transmission FTIR, in which solid films of NN and the gas-phase products were probed in the same experiment but not at the same time. Photolysis quantum yields using broadband irradiation centered at 313 nm were (2.2 ± 0.9) × 10 -3 for clothianidin (CLD), (3.9 ± 0.3) × 10 -3 for thiamethoxam (TMX), and (3.3 ± 0.5) × 10 -3 for dinotefuran (DNF), with all errors being ±1 s. At 254 nm, which was used to gain insight into the wavelength dependence, quantum yields were in the range of (0.8-20) × 10 -3 for all NNs, including acetamiprid (ACM) and thiacloprid (TCD). Nitrous oxide (N 2 O), a potent greenhouse gas, was the only gas-phase product detected for the photolysis of nitroguanidines, with yields of ΔN 2 O/ΔNN > 0.5 in air at both 313 and 254 nm. The atmospheric lifetimes with respect to photolysis for CLD, TMX, and DNF, which absorb light in the actinic region, are estimated to be 15, 10, and 11 h, respectively, at a solar zenith angle of 35° and 12, 8, and 10 h at a solar zenith angle of 15°.

Introduction: Rapid and accessible methods for diagnosing diabetic polyneuropathy (DPN) have been developed, but not validated, in large cohorts of people with diabetes., Methods: The performance of a point-of-care device (POCD) was studied in 168 patients with type 2 diabetes, estimating the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) compared with conventional sural nerve conduction studies (NCS)., Results: A POCD amplitude limit of 6 µV increased the sensitivity (96%) and NPV (98%), but decreased the specificity (71%) and PPV (54%) compared with the 4-µV limit, which had values of 78%, 92%, 89%, and 71%, respectively. POCD on both legs showed better performance than on 1 leg. POCD amplitudes and conduction velocities correlated significantly with conventional sural NCS, but POCD values were underestimated compared with NCS., Discussion: The POCD may be used as a suitable screening tool for detection of DPN. Patients with abnormal and borderline results should undergo conventional NCS. Muscle Nerve 59:187-193, 2019., (© 2018 Wiley Periodicals, Inc.)

Objective: To examine the course of cardiovascular autonomic neuropathy (CAN) and related cardiometabolic risk factors in patients with type 2 diabetes., Research Design and Methods: CAN and cardiometabolic risk factors were assessed in the Danish arm of the Anglo-Danish-Dutch Study of Intensive Treatment in People With Screen-Detected Diabetes in Primary Care (ADDITION-Denmark) at 6-year ( n = 777) and 13-year ( n = 443) follow-up examinations. Cardiovascular autonomic reflex tests (CARTs)-that is, lying to standing, deep breathing, and the Valsalva maneuver-and 2-min resting heart rate variability (HRV) indices were obtained as the main measures of CAN. Risk factors related to CAN status, as determined by CARTs, were studied by using multivariate logistic regressions. The effects of risk factors on continuous CARTs and HRV indices, and their changes over time, were estimated in linear mixed models., Results: A progressive yet heterogeneous course of CAN occurred between the 6- and 13-year follow-ups. Higher HbA 1c , weight, BMI, and triglycerides were associated with prevalent CAN. No significant effect of risk factors on CARTs was found when they were analyzed as continuous variables. CART indices decreased over time, and a trend of decreasing HRV indices was seen. Higher HbA 1c and BMI were associated with lower HRV index values, but these differences diminished over time., Conclusions: These data confirm that hyperglycemia, obesity, and hypertriglyceridemia are negatively related to indices of CAN, although these effects diminish over time. The observed heterogeneous course of CAN may challenge the present clinical approach of categorically classifying CARTs to diagnose CAN and the notion of CAN being irreversible., (© 2018 by the American Diabetes Association.)

Aims: In this cross-sectional study, we explored the utility of corneal confocal microscopy (CCM) measures for detecting diabetic polyneuropathy (DPN) and their association with clinical variables, in a cohort with type 2 diabetes., Methods: CCM, nerve conduction studies, and assessment of symptoms and clinical deficits of DPN were undertaken in 144 participants with type 2 diabetes and 25 controls. DPN was defined according to the Toronto criteria for confirmed DPN., Results: Corneal nerve fiber density (CNFD) was lower both in participants with confirmed DPN (n = 27) and in participants without confirmed DPN (n = 117) compared with controls (P = 0.04 and P = 0.01, respectively). No differences were observed for CNFD (P = 0.98) between participants with and without DPN. There were no differences in CNFL and CNBD between groups (P = 0.06 and P = 0.29, respectively). CNFD was associated with age, height, total- and LDL cholesterol., Conclusions: CCM could not distinguish patients with and without neuropathy, but CNFD was lower in patients with type 2 diabetes compared to controls. Age may influence the level of CCM measures., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Photochemical reactors were used to study the kinetics and mechanisms of reactions of Cl atoms and OH radicals with hexa- and penta-fluorobenzene (C6F6, C6F5H) in 700 Torr total pressure of N2, air, or O2 diluent at 296 ± 2 K. C6F6 and C6F5H undergo ring-opening following 254 nm UV irradiation, but with small quantum yields (φ < 0.03). Reaction of Cl atoms with C6F6 proceeds via adduct formation, while the reaction of Cl atoms with C6F5H proceeds via hydrogen abstraction and adduct formation. C6F6-Cl and C6F5H-Cl adducts decompose rapidly (k ∼ 105-106 s-1) reforming the reactants, and react with Cl atoms to form products. The fraction of adduct reacting with Cl atoms increases with steady state Cl atom concentration, resulting in an increasing apparent effective Cl atom rate constant. The rate constant for the H-abstraction channel for Cl + C6F5H is estimated at (7.3 ± 5.7) × 10-16 cm3 molecule-1 s-1. Establishment of the equilibrium between the adducts and the aromatic reactant + Cl occurs rapidly with equilibrium constants of K([adduct]/[aromatic][Cl]) = (1.96 ± 0.11) × 10-16 and (9.28 ± 0.11) × 10-17 cm3 molecule-1 for C6F6 and C6F5H, respectively. Reaction of the adducts with O2 occurs slowly with estimated rate constants of <7 and <4 × 10-18 cm3 molecule-1 s-1 for C6F6-Cl and C6F5H-Cl, respectively. The rate constants for reaction of OH radicals with C6F6 and C6F5H were determined to be (2.27 ± 0.49) × 10-13 and (2.56 ± 0.62) × 10-13 cm3 molecule-1 s-1, respectively. UV and IR spectra of C6F6 and C6F5H at 296 ± 1 K were collected and calibrated. Results are discussed in the context of available literature data for reactions of Cl atoms and OH radicals with halogenated aromatic compounds.

Objective: To study cardiometabolic risk-factor trajectories (in terms of levels and changes over time) preceding diabetic polyneuropathy (DPN) 13 years after a screen-detected diagnosis of type 2 diabetes., Research Design and Methods: We clinically diagnosed DPN in a nested case-control study of 452 people in the Danish arm of the Anglo-Danish-Dutch Study of Intensive Treatment in People with Screen-Detected Diabetes in Primary Care (ADDITION). By linear regression models, we estimated preceding risk-factor trajectories during 13 years. Risk of DPN was estimated by multivariate logistic regression models of each individual's risk-factor trajectory intercept and slope adjusting for sex, age, diabetes duration, height, and trial randomization group., Results: Higher baseline levels of HbA 1c (odds ratio [OR] 1.76 [95% CI 1.37; 2.27] and OR 1.68 [95% CI 1.33; 2.12] per 1% and 10 mmol/mol, respectively) and steeper increases in HbA 1c over time (OR 1.66 [95% CI 1.21; 2.28] and OR 1.59 [95% CI 1.19; 2.12] per 1% and 10 mmol/mol increase during 10 years, respectively) were associated with DPN. Higher baseline levels of weight, waist circumference, and BMI were associated with DPN (OR 1.20 [95% CI 1.10; 1.31] per 5 kg, OR 1.27 [95% CI 1.13; 1.43] per 5 cm, and OR 1.24 [95% CI 1.12; 1.38] per 2 kg/m 2 , respectively)., Conclusions: Both higher levels and slopes of HbA 1c trajectories were associated with DPN after 13 years. Our findings indicate that the rate of HbA 1c increase affects the development of DPN over and above the effect of the HbA 1c level. Furthermore, this study supports obesity as a risk factor for DPN., (© 2018 by the American Diabetes Association.)

Smog chamber/Fourier transform infrared (FTIR) techniques were used to measure the kinetics of the reaction of n-CH 2 ═CH(CH 2 ) x CN ( x = 0-4) with Cl atoms, OH radicals, and O 3 : k(CH 2 ═CHCN + Cl) = (1.03 ± 0.13) × 10 -10 , k(CH 2 ═CHCH 2 CN + Cl) = (2.02 ± 0.35) × 10 -10 , k(CH 2 ═CH(CH 2 ) 2 CN + Cl) = (2.75 ± 0.45) × 10 -10 , k(CH 2 ═CHCN + OH) = (4.21 ± 0.95) × 10 -12 , k(CH 2 ═CHCH 2 CN + OH) = (1.55 ± 0.34) × 10 -11 , k(CH 2 ═CH(CH 2 ) 2 CN + OH) = (2.98 ± 0.64) × 10 -11 , k(CH 2 ═CH(CH 2 ) 3 CN + OH) = (3.34 ± 0.64) × 10 -11 , k(CH 2 ═CH(CH 2 ) 4 CN + OH) = (3.61 ± 0.85) × 10 -11 , k(CH 2 ═CHCN + O 3 ) = (2.55 ± 0.28) × 10 -20 , k(CH 2 ═CHCH 2 CN + O 3 ) = (1.17 ± 0.24) × 10 -18 , k(CH 2 ═CH(CH 2 ) 2 CN + O 3 ) = (3.35 ± 0.69) × 10 -18 , k(CH 2 ═CH(CH 2 ) 3 CN + O 3 ) = (4.07 ± 0.82) × 10 -18 , and k(CH 2 ═CH(CH 2 ) 4 CN + O 3 ) = (7.13 ± 1.49) × 10 -18 cm 3 molecule -1 s -1 at a total pressure of 700 Torr of air or N 2 diluents at 296 ± 2 K. CH 2 ClC(O)CN, HC(O)CN, HC(O)Cl, HCN, NCC(O)OONO 2 , and ClC(O)OONO 2 were identified as products from the Cl initiated oxidation of CH 2 ═CHCN. The product spectra were compared to experimental and theoretically calculated IR spectra. No products could be determined from the oxidation of n-CH 2 ═CH(CH 2 ) x CN ( x = 1-4). With the determined OH rate constants, the atmospheric lifetimes for n-CH 2 ═CH(CH 2 ) x CN ( x = 0-4) were estimated to be 66, 18, 9.3, 8.3, and 7.7 h, respectively. It was found that these unsaturated nitriles have no significant atmospheric environmental impact.

Objective: To study incident diabetic polyneuropathy (DPN) prospectively during the first 13 years after a screening-based diagnosis of type 2 diabetes and determine the associated risk factors for the development of DPN., Research Design and Methods: We assessed DPN longitudinally in the Danish arm of the Anglo-Danish-Dutch study of Intensive Treatment of Diabetes in Primary Care (ADDITION) using the Michigan Neuropathy Screening Instrument questionnaire (MNSIQ), defining DPN with scores ≥4. Risk factors present at the diabetes diagnosis associated with the risk of incident DPN were estimated using Cox proportional hazard models adjusted for trial randomization group, sex, and age., Results: Of the total cohort of 1,533 people, 1,445 completed the MNSIQ at baseline and 189 (13.1%) had DPN at baseline. The remaining 1,256 without DPN entered this study (median age 60.8 years [interquartile range 55.6; 65.6], 59% of whom were men). The cumulative incidence of DPN was 10% during 13 years of diabetes. Age (hazard ratio [HR] 1.03 [95% CI 1.00; 1.07]) (unit = 1 year), weight (HR 1.09 [95% CI 1.03; 1.16]) (unit = 5 kg), waist circumference (HR 1.14 [95% CI 1.05; 1.24]) (unit = 5 cm), BMI (HR 1.14 [95% CI 1.06; 1.23]) (unit = 2 kg/m 2 ), log 2 methylglyoxal (HR 1.45 [95% CI 1.12; 1.89]) (unit = doubling), HDL cholesterol (HR 0.82 [95% CI 0.69; 0.99]) (unit = 0.25 mmol/L), and LDL cholesterol (HR 0.92 [95% CI 0.86; 0.98]) (unit = 0.25 mmol/L) at baseline were significantly associated with the risk of incident DPN., Conclusions: This study provides further epidemiological evidence for obesity as a risk factor for DPN. Moreover, low HDL cholesterol levels and higher levels of methylglyoxal, a marker of dicarbonyl stress, are identified as risk factors for the development of DPN., (© 2018 by the American Diabetes Association.)

Background: Good motor skills are considered important for children's physical, social, and psychological development, but the relationship is still poorly understood. Preschool age seems to be decisive for the development of motor skills and probably the most promising time-window in relation to preventive strategies based on improved motor skills. This research program has four overall aims: (1) investigation of the effect of a structured program aimed at improving motor skills in 3-6-year-old children on current and future motor skills, health, cognition, and wellbeing; (2) establish reference data on motor skills in 3-6-year-olds; (3) description of early development of musculoskeletal problems; and (4) establishment of a population-based cohort of 3-6-year-olds., Methods: Over a four-year period, all preschools in a Danish municipality, Svendborg, will implement a new program aimed at optimizing children's motor skills. By introducing the program into a subset of the preschools at onset and comparing these children to another subset (control) that will not receive the intervention the first three years, it is possible to document a potential effect of the intervention. At the same time, a cohort will be established including all children attending preschools in the municipality with extensive baseline data collection: gross and fine motor skills; movement patterns; musculoskeletal complaints; physical activity; anthropometry; general wellbeing; cognitive abilities; language status; medical history; demographic background; and more. The children are aged 3-6 years at baseline. A total of 1461 children have been invited into the cohort, 368 to the intervention arm and 359 to the control arm. Follow-up time for the trial is 2.5 years. The cohort is planned to run at least until the children leave school at age 15-16 years. Longer follow-up will depend on future funding., Discussion: If the results of the trial are positive, the intervention can be implemented in other similar settings with reasonable ease and at a relatively low initial cost. This is due to the extensive end-user involvement, the broad population base, and the pragmatic nature of the intervention. The cohort will provide important information about the influence of early motor skills on children's development across many domains and the potential interactions between these domains., Trial Registration: ISRCTN registry, ISRCTN23701994 . Registered on 13 October 2016.

FTIR/smog chamber experiments and ab initio quantum calculations were performed to investigate the atmospheric chemistry of (CF 3 ) 2 CFCN, a proposed replacement compound for the industrially important sulfur hexafluoride, SF 6 . The present study determined k(Cl + (CF 3 ) 2 CFCN) = (2.33 ± 0.87) × 10 -17 , k(OH + (CF 3 ) 2 CFCN) = (1.45 ± 0.25) × 10 -15 , and k(O 3 + (CF 3 ) 2 CFCN) ≤ 6 × 10 -24 cm 3 molecule -1 s -1 , respectively, in 700 Torr of N 2 or air diluent at 296 ± 2 K. The main atmospheric sink for (CF 3 ) 2 CFCN was determined to be reaction with OH radicals. Quantum chemistry calculations, supported by experimental evidence, shows that the (CF 3 ) 2 CFCN + OH reaction proceeds via OH addition to -C(≡N), followed by O 2 addition to -C(OH)═N·, internal H-shift, and OH regeneration. The sole atmospheric degradation products of (CF 3 ) 2 CFCN appear to be NO, COF 2 , and CF 3 C(O)F. The atmospheric lifetime of (CF 3 ) 2 CFCN is approximately 22 years. The integrated cross section (650-1500 cm -1 ) for (CF 3 ) 2 CFCN is (2.22 ± 0.11) × 10 -16 cm 2 molecule -1 cm -1 which results in a radiative efficiency of 0.217 W m -2 ppb -1 . The 100-year Global Warming Potential (GWP) for (CF 3 ) 2 CFCN was calculated as 1490, a factor of 15 less than that of SF 6 .

The atmospheric fates of Z- and E-CF 3 CH[double bond, length as m-dash]CHCF 3 have been studied, investigating the kinetics and the products of the reactions of the two compounds with Cl atoms, OH radicals, OD radicals, and O 3 . FTIR smog chamber experiments measured: k(Cl + Z-CF 3 CH[double bond, length as m-dash]CHCF 3 ) = (2.59 ± 0.47) × 10 -11 , k(Cl + E-CF 3 CH[double bond, length as m-dash]CHCF 3 ) = (1.36 ± 0.27) × 10 -11 , k(OH + Z-CF 3 CH[double bond, length as m-dash]CHCF 3 ) = (4.21 ± 0.62) × 10 -13 , k(OH + E-CF 3 CH[double bond, length as m-dash]CHCF 3 ) = (1.72 ± 0.42) × 10 -13 , k(OD + Z-CF 3 CH[double bond, length as m-dash]CHCF 3 ) = (6.94 ± 1.25) × 10 -13 , k(OD + E-CF 3 CH[double bond, length as m-dash]CHCF 3 ) = (5.61 ± 0.98) × 10 -13 , k(O 3 + Z-CF 3 CH[double bond, length as m-dash]CHCF 3 ) = (6.25 ± 0.70) × 10 -22 , and k(O 3 + E-CF 3 CH[double bond, length as m-dash]CHCF 3 ) = (4.14 ± 0.42) × 10 -22 cm 3 molecule -1 s -1 in 700 Torr of air/N 2 /O 2 diluents at 296 ± 2 K. E-CF 3 CH[double bond, length as m-dash]CHCF 3 reacts with Cl atoms to give CF 3 CHClC(O)CF 3 in a yield indistinguishable from 100%. Z-CF 3 CH[double bond, length as m-dash]CHCF 3 reacts with Cl atoms to give (95 ± 10)% CF 3 CHClC(O)CF 3 and (7 ± 1)% E-CF 3 CH[double bond, length as m-dash]CHCF 3 . CF 3 CHClC(O)CF 3 reacts with Cl atoms to give the secondary product CF 3 C(O)Cl in a yield indistinguishable from 100%, with the observed co-products C(O)F 2 and CF 3 O 3 CF 3 . The main atmospheric fate for Z- and E-CF 3 CH[double bond, length as m-dash]CHCF 3 is reaction with OH radicals. The atmospheric lifetimes of Z- and E-CF 3 CH[double bond, length as m-dash]CHCF 3 are estimated as 27 and 67 days, respectively. IR absorption cross sections are reported and the global warming potentials (GWPs) of Z- and E-CF 3 CH[double bond, length as m-dash]CHCF 3 for the 100 year time horizon are calculated to be GWP 100 = 2 and 7, respectively. This study provides a comprehensive description of the atmospheric fate and impact of Z- and E-CF 3 CH[double bond, length as m-dash]CHCF 3 .

Quantitative microbial risk assessments (QMRAs) often lack data on water quality leading to great uncertainty in the QMRA because of the many assumptions. The quantity of waste water contamination was estimated and included in a QMRA on an extreme rain event leading to combined sewer overflow (CSO) to bathing water where an ironman competition later took place. Two dynamic models, (1) a drainage model and (2) a 3D hydrodynamic model, estimated the dilution of waste water from source to recipient. The drainage model estimated that 2.6% of waste water was left in the system before CSO and the hydrodynamic model estimated that 4.8% of the recipient bathing water came from the CSO, so on average there was 0.13% of waste water in the bathing water during the ironman competition. The total estimated incidence rate from a conservative estimate of the pathogenic load of five reference pathogens was 42%, comparable to 55% in an epidemiological study of the case. The combination of applying dynamic models and exposure data led to an improved QMRA that included an estimate of the dilution factor. This approach has not been described previously.

A total of 397 hips were randomised to receive Metasul metal-on-metal (MoM), metal-on-conventional polyethylene (MoP) or ceramic-on-polyethylene (CoP) bearings using a cemented triple-tapered polished femoral component (MS-30). There were 129 MoM hips in 123 patients (39 male and 84 female, mean age 63.3 years (40.7 to 72.9)), 137 MoP hips in 127 patients (39 male and 88 female, mean age 62.8 years (24.5 to 72.7)) and 131 CoP hips in 124 patients (51 male and 73 female, mean age 63.9 years (30.6 to 73.8)). All acetabular components were cemented Weber polyethylene components with the appropriate inlay for the MoM articulation. Clinical evaluation was undertaken using the Harris hip score (HHS) and radiological assessments were made at two, five and seven years. The HHS and radiological analysis were available for 341 hips after seven years. The MoM group had the lowest mean HHS (p = 0.124), a higher rate of revision (p < 0.001) and a higher incidence of radiolucent lines in unrevised hips (p < 0.001). In all, 12 revisions had been performed in 12 patients: eight in the MoM group (four for infection, four for aseptic loosening, three in the MoP group (one each of infection, dislocation and pain) and one in the CoP group (infection). Our findings reveal no advantage to the MoM bearing and identified a higher revision rate and a greater incidence of radiolucent lines than with the other articulations. We recommend that patients with a 28 mm Metasul MoM bearing be followed carefully.

Background: We aimed to investigate whether fluid therapy with a goal of near-maximal stroke volume (SV) guided by oesophageal Doppler (ED) monitoring result in a better outcome than that with a goal of maintaining bodyweight (BW) and zero fluid balance in patients undergoing colorectal surgery., Methods: In a double-blinded clinical multicentre trial, 150 patients undergoing elective colorectal surgery were randomized to receive fluid therapy after either the goal of near-maximal SV guided by ED (Doppler, D group) or the goal of zero balance and normal BW (Zero balance, Z group). Stratification for laparoscopic and open surgery was performed. The postoperative fluid therapy was similar in the two groups. The primary endpoint was postoperative complications defined and divided into subgroups by protocol. Analysis was performed by intention-to-treat. The follow-up was 30 days. The trial had 85% power to show a difference between the groups., Results: The number of patients undergoing laparoscopic or open surgery and the patient characteristics were similar between the groups. No significant differences between the groups were found for overall, major, minor, cardiopulmonary, or tissue-healing complications (P-values: 0.79; 0.62; 0.97; 0.48; and 0.48, respectively). One patient died in each group. No significant difference was found for the length of hospital stay [median (range) Z: 5.00 (1-61) vs D: 5.00 (2-41); P=0.206]., Conclusions: Goal-directed fluid therapy to near-maximal SV guided by ED adds no extra value to the fluid therapy using zero balance and normal BW in patients undergoing elective colorectal surgery.

The paper addresses an ICT-based, user-driven innovation process in the health sector in rural areas in Norway. The empirical base is the introduction of a new model for psychiatric health provision. This model is supported by a technical solution based on mobile phones that is aimed to help the communication between professional health personnel and patients. This innovation was made possible through the use of standard mobile technology rather than more sophisticated systems. The users were heavily involved in the development work. Our analysis shows that by thinking simple and small-scale solutions, including to take the user's needs and premises as a point of departure rather than focusing on advanced technology, the implementation process was made possible. We show that by combining theory on information infrastructures, user-oriented system development, and innovation in a three-layered analytical framework, we can explain the interrelationship between technical, organizational, and health professional factors that made this innovation a success.

Background: The Charnley stem provides good outcome for 10 years, but several studies find deteriorating results thereafter. However, study populations, techniques and data analysis vary widely. We have studied 240 Charnley stems in a homogeneous group of patients providing clinical, radiological and survival data after 11-14 years., Hypothesis: The clinical and radiological outcome of the Charnley stem is not as good than previously thought., Patients and Methods: Five surgeons implanted 240 femoral stems in a community hospital in Norway using antibiotic impregnated cement and third generation cementing techniques. The Charnley stems were implanted with a Charnley cup in 120 cases and an uncemented hemispherical cup (Duraloc) in 120 cases. The mean age of the patients was 65.5 years and the mean Body Mass Index (BMI) was 26.8. All patients received low molecular weight heparin and antibiotic prophylaxis. Patients were assessed after 10 years by means of Harris Hip Score (HHS)and radiographic evaluation. Implant survival studies were performed after 11-14 years., Results: One hundred and fifty-eight patients were available for clinical and radiographic evaluation after 10 years. HHS improved from 48.4 (95% CI: 46.6-50,2) preoperatively to 87.9 (95%CI: 86.6-89.3) after 6 months and 87.6 (95% CI: 85.3-89.8) at 10 years. Thirty-one stems had been revised, the reasons for revision were loosening (21), infection (five), instability (four) and late perisprosthetic fracture (one). Forty-one stems had one or more signs of loosening.Stem survival was 83.6% using any revisions as end point, and mean estimated stem survival was 12.7 years (12.2-13.3 years)., Discussion: Other studies report survival at mid-term from 83-96%. Our results are in the low-end. Even though our rate of infection was high (2%), the main cause of the poor results is aseptic loosening. We do not know the reason for this high-rate of loosening. As we believe that our technique is adequate and patient population average, we suspect that this rate of loosening is a characteristic of the implant. Results from this prospective cohort study add to the evidence that the Charnley stem should not be used hip arthroplasty unless patient life expectancy is less than 10 years., (Copyright 2010. Published by Elsevier Masson SAS.)

Background: The major fuel for exercising muscle at low exercise intensities is fat., Objective: To investigate the role of fat metabolism in McArdle disease (also known as glycogen storage disease type V), an inborn error of muscle glycogenolysis, by manipulating free fatty acid availability for oxidation during exercise., Design: Randomized, placebo-controlled, crossover trial., Setting: Hospitalized care., Patients: Ten patients (8 men and 2 women) with McArdle disease., Interventions: Patients cycled at a constant workload corresponding to 70% of their maximum oxygen consumption. In random order and on separate days, patients received nicotinic acid (a known blocker of lipolysis) to decrease the availability of free fatty acids or 20% Intralipid infusion to increase free fatty acid availability during exercise. Results were compared with placebo (isotonic sodium chloride solution infusion) and glucose infusion trials., Main Outcome Measures: Exercise tolerance was assessed by heart rate response to exercise during different infusions., Results: Free fatty acid levels more than tripled by Intralipid infusion and were halved by nicotinic acid administration. Heart rate was significantly higher during exercise in the Intralipid infusion and nicotinic acid trials compared with the placebo and glucose infusion trials, an effect that was observed before and after the patients had experienced the second wind phenomenon., Conclusions: Lipids are an important source of fuel for exercising muscle in McArdle disease, but maximal rates of fat oxidation seem limited and cannot be increased above physiologically normal rates during exercise. This limitation is probably caused by a metabolic bottleneck in the tricarboxylic acid cycle due to impaired glycolytic flux in McArdle disease. Therapies aimed at enhancing fat use in McArdle disease should be combined with interventions targeting expansion of the tricarboxylic acid cycle.

Objective: It is known that muscle phosphorylase deficiency restricts carbohydrate utilization, but the implications for muscle fat metabolism have not been studied. We questioned whether patients with McArdle disease can compensate for the blocked muscle glycogen breakdown by enhancing fat oxidation during exercise., Methods: We studied total fat oxidation by indirect calorimetry and palmitate turnover by stable isotope methodology in 11 patients with McArdle disease and 11 healthy controls. Cycle exercise at a constant workload of 50% to 60% of maximal oxygen uptake capacity was used to evaluate fatty acid oxidation (FAO) in the patients. Healthy controls were exercised at the same absolute workload., Results: We found that palmitate oxidation and disposal, total fat oxidation, and plasma levels of palmitate and total free fatty acids (FFAs) were significantly higher, whereas total carbohydrate oxidation was lower, during exercise in patients with McArdle disease vs healthy controls. We found augmented fat oxidation with the onset of a second wind, but further increases in FFA availability, as exercise continued, did not result in further increases in FAO., Conclusion: These results indicate that patients with McArdle disease have exaggerated fat oxidation during prolonged, low-intensity exercise and that increased fat oxidation may be an important mechanism of the spontaneous second wind. The fact that increasing availability of free fatty acids with more prolonged exercise did not increase fatty acid oxidation suggests that blocked glycogenolysis may limit the capacity of fat oxidation to compensate for the energy deficit in McArdle disease.

Background: Two single case studies suggest that a protein-rich diet may be beneficial for patients with McArdle disease, based on improvements in either endurance or muscle energetics, as assessed by phosphorous MR spectroscopy. In healthy subjects, proteins contribute very little to energy metabolism during exercise, which questions the effect of protein in McArdle disease., Methods: In a crossover, open design, we studied seven patients with McArdle disease, who were randomised to follow either a carbohydrate- or protein-rich diet for 3 days before testing. Calorific intake on each diet was identical, and was adjusted to the subject's weight, age and sex. After each diet, exercise tolerance and maximal work capacity were tested on a bicycle ergometer, using a constant workload for 15 minutes followed by an incremental workload to exhaustion., Results: During the constant workload, heart rate and perceived exertion were consistently lower (p<0.0005) on the carbohydrate- versus protein-rich diet. Patients also had a 25% improvement in maximal oxidative work capacity on the carbohydrate versus the protein diet., Conclusions: This study shows that patients with McArdle disease can improve their maximal work capacity and exercise tolerance to submaximal workloads by maintaining a diet high in carbohydrate instead of protein. The carbohydrate diet not only improves tolerance to everyday activities, but will probably also help to prevent exercise-induced episodes of muscle injury in McArdle disease.

Background: Oral sucrose (75 g) ingested 40 minutes before exercise improves exercise tolerance in McArdle disease., Objective: To determine whether a lower dose of sucrose administered closer in time to exercise could have a similar beneficial effect on exercise capacity in patients with McArdle disease., Design: Placebo-controlled crossover., Setting: Neuromuscular Research Unit at the Department of Neurology, Rigshospitalet, Copenhagen, Denmark., Patients: Six patients with biochemically and genetically diagnosed McArdle disease., Interventions: On separate days, the patients were tested after ingestion of either 75 g of sucrose or a placebo 40 minutes before exercise, or 37 g of sucrose or a placebo 5 minutes before exercise. Patients were blinded to test substances., Main Outcome Measures: Treatment effectiveness was assessed by monitoring heart rate and perceived exertion during exercise., Results: Both sucrose treatments dramatically improved exercise tolerance, compared with the placebo. The low-dose, 5-minute sucrose trial had a more sustained effect on exercise capacity than the 40-minute trial. The more sustained effect was probably related to more continuous glucose uptake from the intestine and correspondingly higher circulating glucose levels later during exercise., Conclusions: This study shows that 37 g of sucrose ingested shortly before exercise has a marked and prolonged effect on exercise tolerance in patients with McArdle disease. This treatment is more convenient for the patients and saves more calories than the currently recommended sucrose treatment.

Objective: It is unclear to what extent muscle phosphorylase b kinase (PHK) deficiency is associated with exercise-related symptoms and impaired muscle metabolism, because 1) only four patients have been characterized at the molecular level, 2) reported symptoms have been nonspecific, and 3) lactate responses to ischemic handgrip exercise have been normal., Methods: We studied a 50-year-old man with X-linked PHK deficiency using ischemic forearm and cycle ergometry exercise tests to define the derangement of muscle metabolism. We compared our findings with those in patients with McArdle disease and in healthy subjects., Results: Sequencing of PHKA1 showed a novel pathogenic mutation (c.831G>A) in exon 7. There was a normal increase of plasma lactate during forearm ischemic exercise, but lactate did not change during dynamic, submaximal exercise in contrast to the fourfold increase in healthy subjects. Constant workload elicited a second wind in all patients with McArdle disease, but not in the patient with PHK deficiency. IV glucose administration appeared to improve exercise tolerance in the patient with PHK deficiency, but not to the same extent as in the patients with McArdle disease. Lipolysis was higher in the patient with PHK deficiency than in controls., Conclusion: These findings demonstrate that X-linked PHK deficiency causes a mild metabolic myopathy with blunted muscle glycogen breakdown and impaired lactate production during dynamic exercise, which impairs oxidative capacity only marginally. The different response of lactate to submaximal and maximal exercise is likely related to differential activation mechanisms for myophosphorylase.