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Large ruminant production is associated with high greenhouse gas emissions (GHGe) intensity, with the highest in southeast Asia being Laos at 102.9 CO2eq/kg meat produced, compared with average global meat emissions intensity of 33 CO2eq/kg. As recent studies in Laos identified emissions control molasses blocks (ECBs) achieved abatement of 470kg CO2eq/20kg block consumed, a study was conducted with a supplement mix with reported methane reducing properties, containing plant tannins and citral extract, salt, molasses and water. Groups of housed dairy buffalo (n=7) and pasture-fed grazing beef cows (n=11) were randomly selected, body condition scores estimated (BCS:1-5) and baseline nasa-oral methane eructation measured daily for 2 weeks. All animals were offered 300-400g/day of the mix for a month, with buffalo accessing abundant fresh cut forages whereas the grazing cows accessing rice straw and pasture declining in quality and quantity due to severe drought. The buffalo consumed all of the mix and retained their BCS of 3, whereas the cattle consumed between 200-300g/day of the mix and their BCS declined from 1.5 to 1.0 during the trial. Analysis of data points (buffalo n=309; cattle n=378) found average methane concentration (AMP) per animal of both cohorts increased over the 2 week baseline period, then declined during the supplementation period by 36% in the buffalo and 18% in cattle cohorts.

This study explored the function of school leading in the implementation process of education for sustainable development (ESD) in five Swedish schools employing a whole school approach (WSA). A follow-up study design was used, in which schools that had initiated an ESD project in 2016 were subsequently visited twice for interviews with principals during the project and after it was finalized. The theory of practice architectures in combination with the concept of school improvement capacity was used as the theoretical framework in the analysis. The study showed how school leading should be about enhancing the local school’s capacity to improve. It also showed how specific practice architectures prefigured a WSA to ESD and how school leading in this context was about arranging—or orchestrating—practice architectures in ways that enabled such an approach. The issues of time and endurance were pivotal.Based on the empirical results from this study and school improvement theory, guidelines were developed that can be used to drive a WSA to ESD process forward through three different school improvement phases: initiation, implementation, and institutionalization. The limitations and suggestions for further research are also discussed.

Insect decline, i.e. the rapid loss of insect biodiversity and species abundance, is an imminent crisis that mirrors the global loss of biodiversity and biological annihilation. Conservation scientists have therefore called for effective public education on how to mitigate insect decline. In this paper, we develop the framework “Action Competence for Insect Conservation (ACIC)” as a tool for improving education and citizen action for insect biodiversity conservation. The ACIC is an educational framework to develop peoples' abilities to take actions that sustain insect biodiversity, connecting insect conservation science with social science. This framework is applicable in various contexts and settings in both formal (e.g. schools, universities) and informal (e.g. outreach) education. It can be used to design and improve educational approaches, develop social interventions for insect conservation more generally, and develop instruments to assess such interventions. ACIC builds on the educational concept of Action Competence that goes beyond traditional education, which has focused on theoretical knowledge. Instead, the ACIC aims to foster peoples' action-oriented knowledge, confidence in their actions and willingness to take action. This explicit focus on actions contributes to overcoming gaps between knowledge and action implementation. The ACIC covers not only actions in private greenspaces, but also highlights the importance of actions that address other people in the community along with relevant stakeholders. We believe that the ACIC framework can contribute to identifying and developing effective intervention approaches, which have the potential to support transformational change in sustaining insect biodiversity.

The article demonstrates how a questionnaire gauging students' experiences of participation in decision-making at their school can operationalise student participation in a whole school approach (WSA) to education for sustainable development model. Some 902 students in three upper secondary schools participated in the study by giving their answers to Likert-scale items developed to tap into their experience of participation in the decision-making at their school. The students identified four distinct pathways of participation: (i) School and Leadership, (ii) Teaching and Learning, (iii) Community Connections, and (iv) Student Council. The results are discussed in the light of focus group interviews with eleven of the participants. The student WSA participation questionnaire proved to be a reliable and valid instrument that, together with the student WSA participation model, can be used by school leaders wanting to increase student participation, and by researchers investigating student participation throughout the whole school.

Background This study was designed to investigate how patient-reported shared decision-making relates to other aspects of patient centredness and satisfaction. Methods Questionnaire study with patients. Consecutive patients in primary care responding post visit. Associations are presented as proportions, positive predictive values, with 95% confidence intervals. Results 223 patient questionnaires were included. 62% (95% Confidence interval (CI): 55–69) of the patients indicated the highest possible rating of being involved in the decisions about their ongoing care (self-reported SDM). Self-reported SDM had a positive predictive value (PPV) of between 85% (CI: 77–90) and 95% (CI: 90–98) for five other patient-centred aspects and satisfaction. Conclusion The results suggest that shared decision making is the patient-centred aspect hardest to achieve and that a patient-centred process leading up to the decision-making increases the chance of the patient being involved in the decision-making.

Purpose To evaluate and compare changes in quadriceps and hamstring strength and single-leg-hop (SLH) test performance over the first 24 postoperative months in patients who underwent anterior cruciate ligament reconstruction (ACLR) with bone-patellar tendon-bone (BPTB) or hamstring tendon (HT) autografts and followed either a standard or an accelerated rehabilitation protocol. Methods A total of 160 patients undergoing ACLR were randomised in four groups depending on the graft that was used and the rehabilitation protocol (40 BPTB/standard rehab, 40 BPTB/accelerated rehab, 40 HT/standard rehab, 40 HT/accelerated rehab). Isokinetic concentric quadriceps and hamstring strength at 90°/s and the SLH test performance were assessed preoperatively and 4,6,8,12 and 24 months postoperatively. The results were reported as the limb symmetry index (LSI) at the same time point. Linear mixed models were used to compare the groups at the different time points. Results An average quadriceps strength LSI of 78.4% was found preoperatively. After ACLR, the LSI first decreased at 4 months and then increased from 6 to 24 months, reaching an overall value of 92.7% at the latest follow-up. The BPTB group showed a significantly decreased LSI at 4, 6, 8 and 12 months compared with the HT group. No significant differences between the graft groups were found at 24 months. An average hamstring strength LSI of 84.6% was found preoperatively. After ACLR, the LSI increased from 4 to 24 months in the BTPB group. In the HT group, the LSI first decreased at 4 months and then increased from 6 to 24 months. An LSI of 97.1% and 89.1% was found at the latest follow-up for the BPTB and the HT group, respectively. The HT group showed a significantly decreased LSI at all follow-ups compared with the BPTB group. An average SLH test LSI of 81% was found preoperatively. After ACLR, the LSI increased from 4 to 24 months, reaching 97.6% overall at the latest follow-up. The BPTB group showed a significantly decreased LSI only at 4 months postoperatively compared with the HT group. No significant differences in any of the three tests were found between the standard and accelerated rehabilitation groups for either of the graft groups at any time point. Conclusion Muscle strength and SLH test performance recovered progressively after ACLR overall, but they did not all fully recover, as the injured leg performed on average less than 100% compared with the uninjured leg even 24 months postoperatively. After ACLR, inferior quadriceps strength and a poorer SLH test performance were found at 4, 6, 8 and 12 months and at 4 months, respectively, for the BTPB group compared with the HT group. Persistent, inferior hamstring strength was found at all postoperative follow-ups in the HT group. Rehabilitation, standard or accelerated, had no significant impact on the recovery of muscle strength and SLH test performance after ACLR in any of the graft groups. Level of Evidence Level I.

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This paper presents various educational interventions aimed at promoting environmental citizenship, which were developed in three different European countries (Sweden, Belgium and Spain). The interventions differ in context, target group and educational setting (formal or non-formal) and were evaluated in terms of their impact on participants’ knowledge, attitudes and behaviours. The results show significant differences between pre and post scores, with a positive impact on the behavioural dimension in all of the reported interventions. Finally, the interventions are discussed on the basis of key common pedagogical features aligned with the specialised literature.

Scholarly attention has recently been increasingly focused on the concept of action competence for sustainability and its importance to promote environmental citizenship. Still, knowledge about the effects of sustainability education (SE) as an approach to teaching to foster students’ environmental citizenship in terms of action competence for sustainability, where SE could be defined by holism (the approach to the sustainability content) and pluralism (the approach to teaching). The aim of this study is therefore to contribute new knowledge of effects of SE on young people’s self-perceived action competence for sustainability (SPACS), through a longitudinal design. Our results show that SE as a teaching approach is effective in fostering environmental citizenship in terms of the important aspect of action competence for sustainability.

Policy documents across the globe call for citizen engagement to fight climate change emergencies and build more sustainable societies. They also recognize the key role of formal and non-formal education in preparing citizens to address those challenges. However, there is a need to identify appropriate instruments to evaluate the impact of educational interventions on people’s knowledge, attitudes, and behaviors, which are essential components of the action competence required to become environmental citizens and agents of change. The aim of this paper is to investigate the potential of the Sustainability Consciousness Questionnaire (SCQ) to evaluate different educational interventions aimed at increasing environmental citizenship. It presents three sub-studies from Spain, Belgium, and Sweden using the SCQ with varying contexts, duration, and target groups yet sharing common pedagogical features in the interventions. Pre-intervention scores indicate a common pattern of high sustainability knowingness, moderate sustainability attitudes, and lower sustainability behaviors in the three dimensions (environmental, social and economic) of sustainability consciousness, and a positive impact on sustainability behavior after the intervention. These findings are especially significant when compared to previous studies. We therefore conclude that the SCQ is useful for detecting the effects of learning interventions of varying designs and contexts that address environmental citizenship. The results are discussed in terms of key pedagogical features of the educational interventions, and the appropriateness and sensitivity of the instrument in detecting changes in the intended direction. It concludes with implications for research and practice and suggestions for future lines of work.

We present the results of the medical knowledge test after fulfilled internship for Swedish medical authorization during three periods; the years 1995 to 2008, 2009 to the spring of 2015 and from august of 2015 to 2019. During the last period a total of 6089 tests were further analysed. Interns graduated from Swedish universities failed between 0 percent to 5.5 percent of the test subsections. Interns who graduated from countries within the European Union (EU) failed in 22.1 percent and interns graduated from a non-EU country failed in 42.9 percent. A logistic regression showed that the risk of failing the first attempt increases with higher age, education outside of EU or in Poland. Most of the participants passed the test after three or four attempts. Proper measures have to be implemented for doctors graduated from a non-Swedish university to improve the outcome and introduction to the Swedish health care system to secure patient safety.

Introduction One third of patients with myelodysplastic syndrome (MDS) will relapse after allogeneic stem cell transplantation (SCT), with a dismal prognosis. Early detection of relapse enables pre-emptive treatment and may potentially reduce relapse risk, but is limited by the lack of sensitive markers for minimal residual disease (MRD). We developed a pipeline where patient-specific mutations, as determined by a myeloid next generation sequencing (NGS) panel are tracked using sensitive digital droplet PCR (ddPCR). Method We designed a prospective Nordic study (NMDSG14B; NCT02872662) enrolling all patients with MDS, mixed MDS / MPN or AML with myelodysplasia related disease and < 30% marrow blasts undergoing SCT in the Nordic region. We hypothesized that personalized MRD detection by ddPCR can predict clinical relapse earlier than conventional methods. Patients were included before SCT and serial bone marrow samples were collected before, and 1 and 3 months post SCT, and thereafter every third month for 2 years or until relapse or death. Blood samples were collected monthly. The MRD results were not available for the treating physicians. MRD positivity was defined based on the background noise of the specific ddPCR-assays and varied between 0.05-0.1% VAF. Results Three-hundred and sixteen patients were screened between 2016 and 2020, of which 19 were excluded due to lack of mutation or disease progression preventing SCT. We here present data of 254 patients followed ≥ 6 months after SCT. Median age was 64 (18-78) years and 59% were male. Most WHO subgroups of MDS (n=166), MDS/MPN (n=39), AML (n=8) and therapy-related disease (n=41), were represented. Risk profile according to IPSS-R was very low (n=13), low (n=32), intermediate (n=46), high (n=60) and very high (n=32). The majority of patients received pre-SCT treatment consisting of HMA (n=159) and / or intensive chemotherapy (n=59) while 60 patients did not receive disease-modifying treatment prior to SCT. The most common mutations were ASXL1 (n=69), TET2 (n=58), SRSF2 (n=57) and TP53 (n=44). No mutation was identified in 10 pts, and NGS data is still pending for 11 patients. After a median follow-up of 436 days, estimated 2 years overall survival and relapse free survival were 72% and 63%, respectively. Cumulative incidence of NRM and relapse at 2 years was 16% and 20%, respectively. Forty-six patients relapsed after a median of 170 (53-733) days, and the estimated median survival following relapse was 197 days. The most common pre-SCT mutations in the relapsed cohort were TP53 (n=19), DNMT3A (n=11) and RUNX1 (n=9). Thirty-seven patients died due to non-relapse mortality (NRM) after a median of 83 (4-754) days. To date, MRD results are available for 64 patients. Relapse was preceded by positive MRD in 14 out of 15 patients a median of 79 (21-173) days before clinical relapse. The 15th patient had an extra-medullary relapse only. Borderline positive MRD samples < 0.2% VAF within 100 days after SCT followed by negative samples were seen in 11 non-relapse patients. Twenty-four of 37 patients in continuous complete remission (CCR) were consistently MRD neg. Six CCR patients had positive MRD after 100 days; two with transient borderline peaks ( 0.1%, which turned negative when the patients developed GVHD; one patient with slowly decreasing MRD which turned negative first after 1 y, and finally one patient with prevailing KIT mutation (>700 days post-SCT) despite negative BCOR and STAG2. Two MRD+ patients died from NRM without showing signs of clinical relapse. Discussion In summary, we show that our pipeline of personalized MRD-assessment, based on patient-specific mutations is feasible with a high sensitivity to predict relapse. An update of study progression will be presented at the meeting. Figure 1 Disclosures Illman: Sanofi-Genzyme: Other: Travel Support; Celgene: Other: Travel Support. Mielke:DNA Prime: Honoraria, Other: received via my institution , Speakers Bureau; KIADIS Pharma: Honoraria, Other: received via my institution , Speakers Bureau; Miltenyi: Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: received via my institution , Speakers Bureau; Kite/Gilead: Honoraria, Other: received via my institution , Speakers Bureau; Bellicum: Honoraria, Other: received via my institution, Speakers Bureau; Novartis: Honoraria, Other: received via my institution, Speakers Bureau; Celgene/BMS: Honoraria, Other: received via my institution , Speakers Bureau. Ebeling:Accord Healthcare: Other: Travel Support; Amgen: Other: Travel Support; Celgene: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: Travel Support; Otsuka Pharma Scandanavia AB: Consultancy, Membership on an entity's Board of Directors or advisory committees.

ObjectivesMigrant physicians (MPs) who wish to practise their profession in a new country often must undergo a recertification process, including a licensing exam. In many cases, this is the same licensing exam used for peers educated within the country; however, the pass rate of MPs is usually lower. This study aimed to explore MPs exam results, focusing on MPs that had participated in a complementary programme (CPP) for physicians with a medical degree from outside the European Union/European Economic Area (EU/EEA), and aspects that may influence these.MethodsMixed methods were applied. The data consisted of 2013 to 2019 licensing exam results of 564 physicians in Sweden that were educated outside of the EU. The data was analysed using linear and logistic regression analysis. Further, 14 interviews with MPs were conducted and thematically analysed.ResultsAn interaction between age and CPP participation was found for both the total score in per cent (p=0.01) and for the proportion failing their first attempt (p=0.04). Age was found to be a very strong predictor for failing on the first attempt, with those 45 and older failing on the first attempt in 72 and 82 per cent for CPP and non-CPP participants, respectively. Interview data was categorised into two themes: preparations and biographical aspects, and the exam and exam situation.ConclusionsAge seems to be an important predictor for failing the first attempt. MPs have had less time to familiarise themselves with the exam type and the language used on the exam. To improve exam results, MPs used different strategies and tools, that is, studying with nationally trained physicians, and using old exams and a web-based study tool consisting of common exam subjects. At the same time, these strategies and tools have also become mediators in the socialisation of MPs into the exam context.

Thirty-three students used their personal mobile devices to access digital media in a paper-based textbook containing Quick Response (QR) codes. The students worked in small groups with minimal intervention from the course instructor to participate in activities and complete assignments. Information regarding student satisfaction with the course, as well as their perceptions of the benefits and disadvantages of the instructional method employed, were gathered through a questionnaire and a reflective writing activity. The results indicated that overall satisfaction was high (M = 3.38), especially regarding the role of the instructor (M = 3.35) and interaction (M = 3.35). However, participants indicated a lower level of satisfaction with the materials (M = 2.89). Further inquiry revealed that dissatisfaction with the course materials was due to the lack of a stable Wi-Fi connection at the university rather than the design or content of the textbooks.

Summary Background Amino acid availability is a regulatory factor of protein anabolism and is partly dependent on enteral amino acid uptake. During continuous enteral feeding, enteral amino acid uptake may vary considerably, but this has not been documented systematically. Methods In this pragmatic study, we investigated patients in the intensive care unit (n = 10) and healthy adults (n = 10). The time course of essential amino acid concentrations in arterial plasma and the uptake of dietary phenylalanine were recorded during 12 hours of continuous enteral feeding, using a 13C-labeled phenylalanine tracer. Results Plasma essential amino acid concentrations and 13C-phenylalanine enrichment reached a tentative steady state after no more than 4.5 h from start of tracer infusion. There was a large intra- and inter-individual variability in both cohorts. No periodicity could be detected in the temporal variation. Conclusion During continuous enteral feeding, uptake of amino acids shows large intra- and inter-individual variation. A tentative steady state of 13C-phenylalanine uptake is eventually reached. Trial registration Registered at Australian New Zealand Clinical Trials Registry, trial ID ACTRN12616000593437.

In this paper, the concept of sustainability consciousness, an individual's experience and awareness of sustainable development, is introduced. Based on UNESCO's definition of sustainable development, a sustainability consciousness questionnaire (SCQ) is theoretically and empirically developed. Using the data of 638 respondents from Sweden aged 18-19 years old, the scale is developed in two versions. The long version (SCQ-L) can be used to measure individuals' environmental, social and economic knowingness, attitudes and behaviour (nine valid and reliable subscales), in addition to the second order constructs of sustainability knowingness, sustainability attitudes and sustainability behaviour, as well as the third order construct, sustainability consciousness. For the short version (SCQ-S) 27 items were identified that can be used to measure the second and third order constructs. Both versions of the scale present excellent psychometric quality. Possible applications of the questionnaire instruments in the context of evaluation of sustainability policies, practices and stakeholder engagement are discussed.

Background Previous studies showed that disability pensioners have a higher risk of premature death than others, but residual confounding has been suggested. The aim was to assess the degree of residual confounding of the association between disability pension (DP) and risk of premature death. Methods Prospective cohort study of everyone aged 19-64 years, living in Sweden 31 December 2004 (n = 5 406 469), followed up through 2010. Mortality hazard rates over time were estimated for three groups; incident disability pensioners during 2005 from start of DP (February-December 2005), prevalent disability pensioners (January 2005 or since before), and individuals not on DP in January 2005, after standardizing populations to characteristics of the incident disability pensioners, stratified by previous hospitalization or not. If DP has no immediate effect on mortality, incident disability pensioners and those not on DP should initially have similar hazard rates, thereby, allowing assessment of the degree of residual confounding. Results For those not previously hospitalized, the mortality hazard rate on the first DP day was: 3.07 (95% CI 2.21, 4.36), 2.09 (1.78, 2.48) and 0.78 (0.73, 0.84) per thousand person-years for incident, prevalent, and non DP, respectively. Among previously hospitalized these figures were: 21.67 (17.73, 26.24), 17.00 (15.76, 18.51) and 18.88 (18.14, 19.64) respectively. Hazard ratios were 1.15 (0.94, 1.40) in the strata with and 3.94 (2.78, 5.57) in the strata without, previous hospitalization comparing incident DP with non-DP. Conclusions Substantial residual confounding was found in the association between DP and premature death among those not previously hospitalized.

Background There is extensive documentation on skeletal muscle protein depletion during the initial phase of critical illness. However, for intensive care unit (ICU) long-stayers, objective data are very limited. In this study, we examined skeletal muscle protein and amino acid turnover in patients with a prolonged ICU stay. Methods Patients (n = 20) were studied serially every 8–12 days between days 10 and 40 of their ICU stay as long as patients stayed in the ICU. Leg muscle protein turnover was assessed by measurements of phenylalanine kinetics, for which we employed a stable isotope-labeled phenylalanine together with two-pool and three-pool models for calculations, and results were expressed per 100 ml of leg volume. In addition, leg muscle amino acid flux was studied. Results The negative leg muscle protein net balance seen on days 10–20 of the ICU stay disappeared by days 30–40 (p = 0.012). This was attributable mainly to an increase in the de novo protein synthesis rate (p = 0.007). It was accompanied by an attenuated efflux of free amino acids from the leg. Leg muscle protein breakdown rates stayed unaltered (p = 0.48), as did the efflux of 3-methylhistidine. The arterial plasma concentrations of free amino acids did not change over the course of the study. Conclusions In critically ill patients with sustained organ failure and in need of a prolonged ICU stay, the initial high rate of skeletal muscle protein depletion was attenuated over time. The distinction between the acute phase and a more prolonged and more stable phase concerning skeletal muscle protein turnover must be considered in study protocols as well as in clinical practice. Trial registration Australian New Zealand Trial Registry, ACTRN12616001012460. Retrospectively registered on 1 August 2016. Electronic supplementary material The online version of this article (10.1186/s13054-017-1932-6) contains supplementary material, which is available to authorized users.

Education for sustainable development (ESD) is promoted as one important component in the endeavor toward sustainable development. Goal 4 in the Sustainable Development Goals (UN in Sustainable development goals—17 goals to transform our world, 2017) in particular targets the role of ESD in this respect. The importance of cultural specificity in ESD is emphasized in numerous international policy documents, but there are few cross-cultural studies that focus on the broad context of sustainable development and ESD. The current study investigates the sustainability consciousness of grade 12 students (age 18–19) in Taiwan (N = 617) and Sweden (N = 583) and discusses the implications for ESD policy and practice. The findings indicate that significant differences exist between the two samples, both with respect to their sustainability consciousness and within the three sub-constructs of knowingness, attitudes and self-reported behaviors. The differences are considered in light of the cultural value orientations of the East Asian and Western European regions. Implications for ESD are discussed from the perspective of cultural specificity.

The concept of Action Competence (AC) has been interpreted in different ways in various domains of the educational sciences. Given the rising scholarly attention to AC, these diverse interpretations are problematic because they hinder a common understanding of the concept among scholars. We unravel the interpretation of AC as a competence of people versus that of an educational approach. We call the latter education for sustainable development (ESD), and discuss the approach as predominantly being a subjectification model of education. Furthermore, we offer an updated and refined generic definition of action competence as a competence of people. To this end, we develop an ecology of psychological concepts that underpin AC. We present a theoretical perspective based on the concepts of “action” and “competence”, for stronger consideration of AC as a competence of people. We relate this generic concept of AC to concepts such as commitment, passion, knowledge, and self-efficacy for solving controversial problems. Finally, we introduce the specific concept of “Action Competence in Sustainable Development” (ACiSD) to articulate the competence of people to engage in solving sustainability issues.

This study contributes to an operationalization of the concept of action competence for sustainability through the theoretical development and empirical validation of a new 12-item Likert-scale questionnaire: the Self-Perceived Action Competence for Sustainability Questionnaire, SPACS-Q. Other scales in environmental and sustainability education (ESE) typically measure concepts such as pro-environmental and sustainability attitudes and behaviors, and therefore do not fully cover the concept of action competence for sustainability. An action differs from a ‘mere’ behavior in that it is voluntary and targeted at bringing about change, which is the overarching goal of ESE. We define action competence as a latent capacity among individuals to act sustainably. We introduce a novel scale measuring this seminal concept. Totally, 614 Swedish adolescents aged 12-19 participated in this study. The scale includes three latent subconstructs: i) knowledge of action possibilities, ii) confidence in one’s own influence, and iii) the willingness to act. Confirmatory factor analyses, reliability measures and investigation of convergent validity reveal a questionnaire instrument with excellent psychometric quality. We put forward that the SPACS-Q is a novel and theory-driven, empirically reliable and valid, instrument, and encourage fellow researchers to use the SPACS-Q when investigating people’s action competence for sustainability in various contexts.

ObjectiveTo determine what kappa free light chain (KFLC) metric has the highest capacity to separate healthy patients from patients with MS, we evaluated the sensitivity, specificity, and the overall diagnostic accuracy of 4 different KFLC metrics. To assess the usefulness of KFLC in the diagnostics of MS, we compared the different KFLC metrics with oligoclonal bands (OCBs), the current gold standard biochemical method to demonstrate intrathecal antibody production.MethodsCSF and plasma were collected from patients with confirmed or suspected MS, other neurological diseases, as well as symptomatic and healthy controls between May 2017 and May 2018 (n = 335) at the Department of Neurology, Karolinska University Hospital, as part of routine diagnostic workup. KFLC analysis and isoelectric focusing for the detection of oligoclonal bands (OCB) were determined and correlated with diagnosis. Receiver operating characteristic (ROC) curve analysis was used to determine accuracy.ResultsOCBs yielded a sensitivity of 87% and a specificity of 100%. All KFLC metrics showed a high sensitivity (89%–95%) and specificity (95%–100%). Using the optimal cutoff according to the Youden Index resulted for the KFLC intrathecal fraction in a cutoff of −0.41 with a sensitivity of 95% and a specificity of 97% and for CSF KFLC/CSF albumin with a cutoff of 1.93 × 10−3 with a sensitivity of 94% and specificity of 100%.ConclusionAll evaluated KFLC metrics have excellent accuracy, and both KFLC intrathecal fraction and CSF KFLC/CSF albumin are at least as good as OCB in separating patients with MS from a control group.Classification of evidenceThis study provides Class III evidence that CSF KFLC accurately distinguishes patients with MS from healthy controls.

In recent decades, the Taiwanese government has worked actively to implement the concept of a sustainable Taiwan. As an important step in their strategy, the Ministry of Education has decided to promote the Green School Partnership Project in Taiwan (GPPT). However, academic research and critical reflection on the effects of this environmental and sustainability education initiative are lacking. Therefore, this study focuses on filling this gap by means of a nationwide generalizable effect study. The sampling allowed comparisons between the sixth, ninth, and twelfth grades in GPPT and non-GPPT schools and considered the geographic location (north, center, and south of Taiwan) as well as socio-economic area of the schools. A total of 1741 students participated, answering a questionnaire that focused on student sustainability consciousness (SC) and its components (i.e., knowingness, attitudes, and behaviors in relation to sustainability). Data were analyzed through structural equation modeling. Our findings make an important empirical contribution, indicating that GPPT schools and non-GPPT schools have a similar effect on the SC of students, i.e. schools engaged in the GPPT do not enhance student SC. In addition, the gender gap regarding SC increased consistently with each increasing grade level, yielding higher mean values for the girls than for the boys. Furthermore, an adolescent dip occurred in the student SC, especially with regard to student sustainability behavior. Given these findings, implications for developing GPPT are discussed; this research could provide valuable information about the educational transformation process to enhance environmental and sustainability behavior among students in Taiwan.

Background We designed this observational study to investigate the level of patients’ and doctors’ ratings of patient-centred aspects of the primary care consultation. Methods Questionnaire study with patients and doctors. Consecutive patients in a primary care setting and 16 doctors responding post visit. Results are presented as proportions with 95% confidence intervals. Results 411 questionnaires, 223 from patients and 188 from doctors, covered 251 consultations. Both patients and doctors gave the highest possible estimations on the aspects of patient-centred communication and satisfaction less frequently when the patient had other reasons for visit than purely somatic. Unlike the doctors’ estimations, the frequency of highest possible estimations in patient responses dropped if the patients had two to six reasons for visit rather than one. Among the six patient-centred aspects, both patients and doctors gave the highest possible estimation least frequently on the aspect of shared decision-making. Conclusion The results suggest that the nature of the reason, as well as the number of reasons for visit, interferes with the doctors’ level of patient-centred communication. Our results furthermore confirm the findings of previous studies that doctors insufficiently involve patients in their care. Electronic supplementary material The online version of this article (10.1186/s12875-019-0959-y) contains supplementary material, which is available to authorized users.

Data centers are complex systems that require sophisticated operational management approaches to provide the availability of digital services against the backdrop of cost and energy efficiency. To achieve this, data center telemetry data is required since, as is commonly said it is not possible to manage what cannot be measured. This paper details how it is possible to construct the key data center infrastructure management (DCIM) elements of monitoring and measuring by a combination of available opensource software tools that permit both scalability and an environment where analytics can be employed on the data center operation, which can offer relevant insight into energy efficient operational practices.

Previous research has shown that interest in and concern about environmental issues tends to decrease in adolescence, but less is known about adolescents' broader consciousness of sustainable devel ...

Background Previous studies have found that sickness absentees have an excess risk of premature death. Most of the studies compared sickness absentees with non-sickness absentees, with 1 report including the total population. However, no study to date has investigated in detail how the risk of premature death varies over the time course of a sick-leave spell. Methods A population-based cohort of all 5.6 million people aged 16–64 years was followed up for 6 years. Hazard rates with 95% CI for mortality in the total population, sickness absentees with sick-leave spells exceeding 30 days and non-sickness absentees, were estimated over time and were standardised so that the distribution of background variables in all 3 groups was as close as possible to that in the total population. Results The standardised hazard rate of premature death at the first day under risk for the sickness absentees was 13.58 (95% CI 13.26 to 13.95) deaths per 1000 person-years, 2.29 (2.24 to 2.35) in the total population and 0.90 (0.87 to 0.94) among non-sickness absentees. The standardised hazard rates of premature death at 6 years was 3.42 (3.22 to 3.62) among sickness absentees, 3.48 (3.43 to 3.52) in the total population and 2.61 (2.57 to 2.66) among the non-sickness absentees. The hazard rates varied greatly across sick-leave diagnoses. Conclusions Right after start of a sick-leave spell exceeding 30 days, sickness absentees were at higher risk of premature death than the total population. The difference in risk, however, decreased over time and vanished completely after 6 years of follow-up.

Objective To investigate the risk of acute kidney injury (AKI) associated with antibiotic prophylaxis with teicoplanin in cardiac surgery. Design Observational cohort study. Data were gathered from patient charts and national registers. Setting University hospital. Participants All adult patients who underwent cardiac surgery at the authors’ institution between January 1, 2010 and July 31, 2013 were eligible for the study. Interventions The risk for AKI associated with teicoplanin prophylaxis was estimated by multivariate logistic regression. Measurements and Main Results The primary endpoint, AKI, was defined according to the Acute Kidney Injury Network criteria stage 1, as an increase of postoperative serum creatinine by≥26 μmol/L (≥0.3 mg/dL) or a relative increase of≥50% compared to the preoperative value. The authors included 2,809 patients, and 1,056 (38%) received a combination of teicoplanin and cloxacillin for antibiotic prophylaxis. The remaining 1,753 (62%) patients received only cloxacillin and constituted the control group. AKI occurred in 32% (n = 343) in the teicoplanin group compared to 29% (n = 517) in the control group. There was a significant association between antibiotic prophylaxis with teicoplanin and AKI; multivariate adjusted odds ratio (OR): 1.41 (95% confidence interval [CI] 1.18-1.70). There was a dose-dependent relationship; 600 mg OR: 1.48 (95% CI 1.17-1.87), and 400 mg OR: 1.34 (95% CI 1.06-1.71). The findings were confirmed in several subgroup analyses; men (OR: 1.27; 95% CI 1.03-1.56); women (OR: 1.90; 95% CI 1.30-2.80); normal renal function (OR: 1.31; 95% CI 1.07-1.60), and reduced renal function (OR: 1.80; 95% CI 1.13-2.85). Conclusions Antibiotic prophylaxis with teicoplanin was associated with an increased risk of AKI after cardiac surgery. The relative risk of AKI was higher in women and in patients with impaired renal function.

During the past decade, numerous schools in Sweden have implemented education for sustainable development (ESD) as an explicit guiding approach in teaching. In this paper, we investigate the effect ...