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In 2014, Trine Syvertsen, Gunn Enli, Ole J. Mjøs, and Hallvard Moe raisedtwo central concerns as to the future of the ideal of the Nordic media welfarestates regarding increasing demographic fragmentation and political polarisation.Using audience data from the Reuters Institute Digital News Report, we offer acomparative longitudinal perspective on how these concerns have played out infour Nordic countries (Denmark, Finland, Norway, and Sweden) from 2016–2022, compared with the US and the UK. We find that despite some fragmentationaccording to age, fragmentation may not be problematic per se if people’s newsdiets draw substantially on quality journalistic news outlets with a guarantee ofrelatively shared news agendas. A moderate degree of political polarisation existsfor some types of Nordic news media, with public service media showing lesspolarisation than some newspapers and digitally born outlets.

Terrestrial orchids are a group of genetically understudied, yet culturally and economically important plants. The Orchidinae tribe contains many species that produce edible tubers that are used for the production of traditional delicacies collectively called ‘salep’. Overexploitation of wild orchids in the Eastern Mediterranean and Western Asia threatens to drive many of these species to extinction, but cost- effective tools for monitoring their trade are currently lacking. Here we present a custom bait kit for target enrichment and sequencing of 205 novel genetic mark- ers that are tailored to phylogenomic applications in Orchidinae s.l. A subset of 31 markers capture genes putatively involved in the production of glucomannan, a water-soluble polysaccharide that gives salep its distinctive properties. We tested the kit on 73 taxa native to the area, demonstrating universally high locus recovery irrespective of species identity, that exceeds the total sequence length obtained with alternative kits currently available. Phylogenetic inference with concatenation and coalescent approaches was robust and showed high levels of support for most clades, including some which were previously unresolved. Resolution for hybridiz- ing and recently radiated lineages remains difficult, but could be further improved by analysing multiple haplotypes and the non-exonic sequences captured by our kit, with the promise to shed new light on the evolution of enigmatic taxa with a complex speciation history. Offering a step-up from traditional barcoding and universal markers, the genome-wide custom loci targeted by Orchidinae-205 are a valuable new resource to study the evolution, systematics and trade of terrestrial orchids.

Conventional smoking is the leading cause of preventable disease and death. Anti- smoking policies and campaigns have been successful in reducing the sales of conven- tional cigarettes, but this has not stopped the tobacco industry from developing a new product which they promote as a better alternative. Namely, e-tobacco. Despite the limited market presence, many studies have shown a correlation between e-tobacco and health, yet the question remains whether the relationship is causal. The objective of this study is to examine the causal short-run effects of e-tobacco on health using data from the Behavioral Risk Factor Surveillance System (BRFSS). We measure health outcomes through self-reported physical health and analyse e-tobacco use among two groups: for- mer conventional tobacco smokers and never smokers. We apply an instrumental variable (IV) approach, using a leave-one-out instrument and exploit variation in the average e- tobacco use of BRFSS respondents’ peers to deal with selection into e-tobacco. We find statistically and economically significant results suggesting that e-tobacco use increases the probability of having a poor physical health. The estimates reveal more pronounced effects among never smokers compared to former smokers. Despite robustness checks re- vealing instrument invalidity, our findings align with existing literature that e-tobacco use correlates with poor health. Since our results are biased due to invalid instruments, future research should explore and focus on finding alternative instruments or other more robust empirical strategies to better understand the health implications of e-tobacco use.

Conventional smoking is the leading cause of preventable disease and death. Anti- smoking policies and campaigns have been successful in reducing the sales of conven- tional cigarettes, but this has not stopped the tobacco industry from developing a new product which they promote as a better alternative. Namely, e-tobacco. Despite the limited market presence, many studies have shown a correlation between e-tobacco and health, yet the question remains whether the relationship is causal. The objective of this study is to examine the causal short-run effects of e-tobacco on health using data from the Behavioral Risk Factor Surveillance System (BRFSS). We measure health outcomes through self-reported physical health and analyse e-tobacco use among two groups: for- mer conventional tobacco smokers and never smokers. We apply an instrumental variable (IV) approach, using a leave-one-out instrument and exploit variation in the average e- tobacco use of BRFSS respondents’ peers to deal with selection into e-tobacco. We find statistically and economically significant results suggesting that e-tobacco use increases the probability of having a poor physical health. The estimates reveal more pronounced effects among never smokers compared to former smokers. Despite robustness checks re- vealing instrument invalidity, our findings align with existing literature that e-tobacco use correlates with poor health. Since our results are biased due to invalid instruments, future research should explore and focus on finding alternative instruments or other more robust empirical strategies to better understand the health implications of e-tobacco use.

In 2014, Trine Syvertsen, Gunn Enli, Ole J. Mjøs, and Hallvard Moe raisedtwo central concerns as to the future of the ideal of the Nordic media welfarestates regarding increasing demographic fragmentation and political polarisation.Using audience data from the Reuters Institute Digital News Report, we offer acomparative longitudinal perspective on how these concerns have played out infour Nordic countries (Denmark, Finland, Norway, and Sweden) from 2016–2022, compared with the US and the UK. We find that despite some fragmentationaccording to age, fragmentation may not be problematic per se if people’s newsdiets draw substantially on quality journalistic news outlets with a guarantee ofrelatively shared news agendas. A moderate degree of political polarisation existsfor some types of Nordic news media, with public service media showing lesspolarisation than some newspapers and digitally born outlets.

Heart disease in birds contributes to premature death and is usually detected postmortem. Echocardiography is a sensitive and noninvasive diagnostic modality but reported standard values for many species of birds, including American flamingos (Phoenicopterus ruber), are unavailable. Echocardiography was opportunistically performed on 30 unsedated American flamingos during their annual routine health examination. Structural heart disease was not found in any of the examined birds. However, 18 birds showed varying degrees of dynamic intraventricular obstruction. Echocardiographic parameters are reported. Benign neurocardiogenic weakness or syncopal events during handling were suspected in three birds. Stress combined with an intraventricular obstruction is believed to have triggered a cascade of parasympathetic innervation and sympathetic inhibition, similar to neurally mediated reflex syncope in humans.

We describe the thecideid brachiopod Praelacazella wetherelli (Morris, 1851) from the lower Maastrichtian Korojon Formation in the Carnarvon Basin, Western Australia. This is the first documented record of Praelacazella wetherelli from the Southern Hemisphere, suggesting that the species was cosmopolitan in distribution during the Late Cretaceous. Three possible long-distance migration routes are discussed.

Objective: The objective of this study is to characterize bladder mucosal trauma associated with intermittent catheterization with conventional eyelet catheters (CECs) and to assess if a microhole zone catheter (MHZC) design concept reduces this adverse effect. Materials and Methods: A porcine model was developed to reflect human catheterization and bladder drainage. Nine pigs were randomized for catheterization with CEC (n = 6) or MHZC (n = 3). The bladder was drained repeatedly 20 times through the catheter. Cystoscopy was performed before and after the procedure, and bladders were analysed by histopathology. Two additional pigs were used for cystoscopy visualization of suction events in vivo. Cystoscopy, gross pathology, histopathological score, leucocyte infiltration, and intracatheter pressure at flow stops during voiding were compared for each group. Results: A significant higher pressure gradient was measured inside the CECs compared with MHZCs during flow stop. Consequently, CECs resulted in suction events inflicting bladder trauma characterized by loss of epithelium, oedema, haemorrhage, and neutrophil tissue infiltration. No significant trauma was identified when using MHZC. Conclusions: Considerable mucosal bladder trauma is inflicted by CECs which may be an overlooked risk factor for urinary tract infection. Catheters can be designed to minimize mucosal suction and reduce associated trauma. This may be a solution to reduce infection frequency and increase user comfort. Furthermore, the study demonstrates the potential of pigs as an attractive animal model for investigating urinary catheter performances.

Objective To investigate the potential associations between functional capacity, muscle strength, body composition, and disease-related measures and quality of life in patients with myositis. Methods Baseline measures of functional capacity (functional index 3 (FI3), 2-minute walk test (2MWT), timed up and go (TUG) and 30-s sit-to-stand (30-STS)), muscle strength (incl. leg and handgrip strength), maximal leg extensor power, body composition (appendicular lean mass, fat percentage/mass) and disease-related measures (disease activity & damage core sets) were examined for their associations with quality of life (physical- and mental component summary scores, Short Form 36 questionnaire (SF-36)) by means of Spearman's correlation analysis. Results A total of 32 patients with myositis were included. Positive correlations between SF-36 physical component summary score (PCS) and FI3, 30-STS, TUG, 2MWT, leg extensor power, leg strength, bench press strength, and handgrip strength were observed. In contrast, fat percentage and fat mass correlated negatively with PCS. In disease-related measures, Extramuscular global assessment, health assessment questionnaire, physician global damage, and patient global damage scores were negatively associated with SF-36 PCS. No correlations to the mental component summary score of SF-36 were observed. Conclusion All measures of functional capacity were positively related to the SF-36 physical component summary score, indicating higher functional capacity positively affects quality of life in patients with myositis. Health assessment questionnaire and patient global damage scores demonstrated the strongest correlations with SF-36 physical component summary scores, further supporting these patient-reported outcomes as viable monitoring tools in patients with myositis., Objective: To investigate the potential associations between functional capacity, muscle strength, body composition, and disease-related measures and quality of life in patients with myositis. Methods: Baseline measures of functional capacity (functional index 3 (FI3), 2-minute walk test (2MWT), timed up and go (TUG) and 30-s sit-to-stand (30-STS)), muscle strength (incl. leg and handgrip strength), maximal leg extensor power, body composition (appendicular lean mass, fat percentage/mass) and disease-related measures (disease activity & damage core sets) were examined for their associations with quality of life (physical- and mental component summary scores, Short Form 36 questionnaire (SF-36)) by means of Spearman's correlation analysis. Results: A total of 32 patients with myositis were included. Positive correlations between SF-36 physical component summary score (PCS) and FI3, 30-STS, TUG, 2MWT, leg extensor power, leg strength, bench press strength, and handgrip strength were observed. In contrast, fat percentage and fat mass correlated negatively with PCS. In disease-related measures, Extramuscular global assessment, health assessment questionnaire, physician global damage, and patient global damage scores were negatively associated with SF-36 PCS. No correlations to the mental component summary score of SF-36 were observed. Conclusion: All measures of functional capacity were positively related to the SF-36 physical component summary score, indicating higher functional capacity positively affects quality of life in patients with myositis. Health assessment questionnaire and patient global damage scores demonstrated the strongest correlations with SF-36 physical component summary scores, further supporting these patient-reported outcomes as viable monitoring tools in patients with myositis.

Objective To investigate the effects of adding strength training to neuromuscular control exercises on thigh tissue composition and muscle properties in people with radiographic-symptomatic knee osteoarthritis (KOA). Methods In this exploratory secondary analysis of a randomized controlled trial, using a complete-case approach, participants performed 12 weeks of twice-weekly neuromuscular control exercise and patient education (NEMEX, n = 34) or NEMEX plus quadriceps strength training (NEMEX+ST, n = 29). Outcomes were MRI-measured inter- and intramuscular adipose tissue (InterMAT, IntraMAT), quadriceps muscle cross-sectional area (CSA), knee-extensor strength, specific strength (strength/lean CSA) and 30 s chair-stands. Between-group effects were compared using a mixed model analysis of variance. Results At 12 weeks, responses to NEMEX+ST overlapped with NEMEX for all outcomes. Both groups reduced InterMAT (NEMEX+ST=25 %, NEMEX=21 %); between-group difference: 0.8cm2 (95 % CI: -0.1, 1.7). NEMEX+ST decreased IntraMAT (2 %) and NEMEX increased IntraMAT (4 %); between-group difference 0.1 %-points (-0.3, 0.5). Both groups increased quadriceps CSA and lean CSA (CSA minus IntraMAT), improved knee-extensor strength and specific strength, and improved chair-stand performance with a trend towards greater effects in NEMEX+ST. Conclusion Adding strength training to 12 weeks of neuromuscular control exercises provided largely similar effects to neuromuscular control exercises alone in decreasing InterMAT and IntraMAT, in improving knee-extensor strength, CSA and in improving performance-based function in KOA persons, with a trend towards greater effects with additional strength training. Notably, both groups substantially reduced InterMAT and improved specific strength (an index of muscle quality). Our hypothesis-generating work warrants exploration of the roles played by InterMAT and IntraMAT in exercise effects in KOA., Objective: To investigate the effects of adding strength training to neuromuscular control exercises on thigh tissue composition and muscle properties in people with radiographic-symptomatic knee osteoarthritis (KOA). Methods: In this exploratory secondary analysis of a randomized controlled trial, using a complete-case approach, participants performed 12 weeks of twice-weekly neuromuscular control exercise and patient education (NEMEX, n = 34) or NEMEX plus quadriceps strength training (NEMEX+ST, n = 29). Outcomes were MRI-measured inter- and intramuscular adipose tissue (InterMAT, IntraMAT), quadriceps muscle cross-sectional area (CSA), knee-extensor strength, specific strength (strength/lean CSA) and 30 s chair-stands. Between-group effects were compared using a mixed model analysis of variance. Results: At 12 weeks, responses to NEMEX+ST overlapped with NEMEX for all outcomes. Both groups reduced InterMAT (NEMEX+ST=25 %, NEMEX=21 %); between-group difference: 0.8cm2 (95 % CI: -0.1, 1.7). NEMEX+ST decreased IntraMAT (2 %) and NEMEX increased IntraMAT (4 %); between-group difference 0.1 %-points (-0.3, 0.5). Both groups increased quadriceps CSA and lean CSA (CSA minus IntraMAT), improved knee-extensor strength and specific strength, and improved chair-stand performance with a trend towards greater effects in NEMEX+ST. Conclusion: Adding strength training to 12 weeks of neuromuscular control exercises provided largely similar effects to neuromuscular control exercises alone in decreasing InterMAT and IntraMAT, in improving knee-extensor strength, CSA and in improving performance-based function in KOA persons, with a trend towards greater effects with additional strength training. Notably, both groups substantially reduced InterMAT and improved specific strength (an index of muscle quality). Our hypothesis-generating work warrants exploration of the roles played by InterMAT and IntraMAT in exercise effects in KOA.

The DEXamethasone twice for pain treatment after Total Knee Arthroplasty (DEX-2-TKA) trial showed that adding one and two doses of 24 mg intravenous dexamethasone to paracetamol, ibuprofen and local infiltration analgesia, reduced morphine consumption (primary outcome) within 48 h after TKA. We aimed to explore the differences in the effect of dexamethasone on morphine consumption in different subgroups. Quantile regression adjusted for site was used to test for significant interaction between the predefined dichotomised subgroups and treatment group. The subgroups were defined based on baseline data: sex (male/female), age (≤65 years/>65 years), American Society of Anaesthesiologists (ASA)-score (ASA I + II/III), visual analogue score of preoperative pain at rest (≤30 mm/>30 mm), pain during mobilisation (≤30 mm/>30 mm), type of anaesthesia (spinal anaesthesia/general anaesthesia and spinal converted to general anaesthesia), and prior daily use of analgesics (either paracetamol and/or NSAID/neither). These analyses were supplemented with post hoc multivariate linear regression analyses. Test of interaction comparing sex in the pairwise comparison between DX2 (dexamethasone [24 mg] + dexamethasone [24 mg]) versus placebo (p = .02), showed a larger effect of dexamethasone on morphine consumption in male patients compared to females. Test of interaction comparing age in the pairwise comparison between DX1 (dexamethasone [24 mg] + placebo) versus placebo (p = .04), showed a larger effect of dexamethasone on morphine consumption in younger patients (≤65 years) compared to older. All remaining subgroup analyses showed no evidence of a difference. The supplemental multivariate analyses did not support any significant interaction for sex (p = .256) or age (p = .730) but supported a significant interaction with the type of anaesthesia (p < .001). Our results from the quantile regression analyses indicate that the male sex and younger age (≤65 years) may be assoc, The DEXamethasone twice for pain treatment after Total Knee Arthroplasty (DEX-2-TKA) trial showed that adding one and two doses of 24 mg intravenous dexamethasone to paracetamol, ibuprofen and local infiltration analgesia, reduced morphine consumption (primary outcome) within 48 h after TKA. We aimed to explore the differences in the effect of dexamethasone on morphine consumption in different subgroups. Quantile regression adjusted for site was used to test for significant interaction between the predefined dichotomised subgroups and treatment group. The subgroups were defined based on baseline data: sex (male/female), age (≤65 years/>65 years), American Society of Anaesthesiologists (ASA)-score (ASA I + II/III), visual analogue score of preoperative pain at rest (≤30 mm/>30 mm), pain during mobilisation (≤30 mm/>30 mm), type of anaesthesia (spinal anaesthesia/general anaesthesia and spinal converted to general anaesthesia), and prior daily use of analgesics (either paracetamol and/or NSAID/neither). These analyses were supplemented with post hoc multivariate linear regression analyses. Test of interaction comparing sex in the pairwise comparison between DX2 (dexamethasone [24 mg] + dexamethasone [24 mg]) versus placebo (p =.02), showed a larger effect of dexamethasone on morphine consumption in male patients compared to females. Test of interaction comparing age in the pairwise comparison between DX1 (dexamethasone [24 mg] + placebo) versus placebo (p =.04), showed a larger effect of dexamethasone on morphine consumption in younger patients (≤65 years) compared to older. All remaining subgroup analyses showed no evidence of a difference. The supplemental multivariate analyses did not support any significant interaction for sex (p =.256) or age (p =.730) but supported a significant interaction with the type of anaesthesia (p <.001). Our results from the quantile regression analyses indicate that the male sex and younger age (≤65 years) may be associa

OBJECTIVES: The DEX-2-TKA trial demonstrated that one and two doses of 24 mg intravenous dexamethasone reduced opioid consumption and pain after total knee arthroplasty (TKA). We aimed to investigate the prolonged effects of dexamethasone after the 48-h intervention period.DESIGN: This was a prospective, pre-planned questionnaire follow-up on postoperative days 3-7 of patients in the DEX-2-TKA trial that randomly received: DX1 (dexamethasone 24 mg + placebo), DX2 (dexamethasone 24 mg + dexamethasone 24 mg), and placebo (placebo + placebo) perioperatively and 24 h later.SETTING: A multicenter trial performed at five Danish hospitals.PARTICIPANTS: We analyzed 434 of 485 adult participants enrolled in the DEX-2-TKA trial.OUTCOME MEASURES: Primary outcome was difference between groups in average of all numerical rating scale (NRS) pain scores reported in the morning, at bedtime, and the daily average pain on postoperative days 3-7. Secondary outcomes were sleep quality and patient satisfaction.RESULTS: The median (interquartile range) pain intensity levels for postoperative days 3-7 were: DX2 3.2 (2.1-4.3); DX1 3.3 (2.3-4.1); and placebo 3.3 (2.5-4.7). Hodges-Lehmann median differences between groups were: 0 (95% confidence interval - 0.54 to 0.2), P = 0.38 between DX1 and placebo; 0.1 (-0.47 to 0.33), p = .87 between DX1 and DX2; and 0.1 (-0.6 to 0.13), p = .20 between DX2 and placebo. We found no relevant differences between groups on sleep quality on postoperative days 3-7 nor for patient satisfaction with the analgesic treatment.CONCLUSIONS: We found that neither one nor two doses of 24 mg intravenous dexamethasone demonstrated prolonged effects on overall pain or sleep quality on postoperative days 3-7 after total knee arthroplasty. We also found that dexamethasone had no effect on patient satisfaction.TRIAL REGISTRATION NUMBER: Clinicaltrials.gov NCT03506789 (main result trial).

The populations of European hedgehog (Erinaceus europaeus) are in decline, and it is essential that research identifies and mitigates the factors causing this. Hedgehogs are increasingly sharing habitats with humans, being exposed to a range of dangers in our backyards. Previous research has documented that some models of robotic lawn mowers can cause harm to hedgehogs. This study explored the personality and behaviour of 50 live hedgehogs when facing an approaching, disarmed robotic lawn mower. By combining a novel arena and novel object test, we found that 27 hedgehogs could be categorised as “shy” and 23 as “bold”, independently of sex and age. The encounter tests with a robotic lawn mower showed that the hedgehogs positioned themselves in seven different ways. Personality did not affect their reactions. Adult hedgehogs tended to react in a shyer manner, and the hedgehogs, generally, acted less boldly during their second encounter with the robotic lawn mower. Additionally, our results show that bold individuals reacted in a more unpredictable way, being more behaviourally unstable compared to the shy individuals. This knowledge will be applied in the design of a standardised hedgehog safety test, eventually serving to produce and approve hedgehog-friendly robotic lawn mowers., The populations of European hedgehog (Erinaceus europaeus) are in decline, and it is essential that research identifies and mitigates the factors causing this. Hedgehogs are increasingly sharing habitats with humans, being exposed to a range of dangers in our backyards. Previous research has documented that some models of robotic lawn mowers can cause harm to hedgehogs. This study explored the personality and behaviour of 50 live hedgehogs when facing an approaching, disarmed robotic lawn mower. By combining a novel arena and novel object test, we found that 27 hedgehogs could be categorised as “shy” and 23 as “bold”, independently of sex and age. The encounter tests with a robotic lawn mower showed that the hedgehogs positioned themselves in seven different ways. Personality did not affect their reactions. Adult hedgehogs tended to react in a shyer manner, and the hedgehogs, generally, acted less boldly during their second encounter with the robotic lawn mower. Additionally, our results show that bold individuals reacted in a more unpredictable way, being more behaviourally unstable compared to the shy individuals. This knowledge will be applied in the design of a standardised hedgehog safety test, eventually serving to produce and approve hedgehog-friendly robotic lawn mowers.

We describe the thecideid brachiopod Praelacazella wetherelli (Morris, 1851) from the lower Maastrichtian Korojon Formation in the Carnarvon Basin, Western Australia. This is the first documented record of Praelacazella wetherelli from the Southern Hemisphere, suggesting that the species was cosmopolitan in distribution during the Late Cretaceous. Three possible long-distance migration routes are discussed.

Objective To investigate the potential associations between functional capacity, muscle strength, body composition, and disease-related measures and quality of life in patients with myositis. Methods Baseline measures of functional capacity (functional index 3 (FI3), 2-minute walk test (2MWT), timed up and go (TUG) and 30-s sit-to-stand (30-STS)), muscle strength (incl. leg and handgrip strength), maximal leg extensor power, body composition (appendicular lean mass, fat percentage/mass) and disease-related measures (disease activity & damage core sets) were examined for their associations with quality of life (physical- and mental component summary scores, Short Form 36 questionnaire (SF-36)) by means of Spearman's correlation analysis. Results A total of 32 patients with myositis were included. Positive correlations between SF-36 physical component summary score (PCS) and FI3, 30-STS, TUG, 2MWT, leg extensor power, leg strength, bench press strength, and handgrip strength were observed. In contrast, fat percentage and fat mass correlated negatively with PCS. In disease-related measures, Extramuscular global assessment, health assessment questionnaire, physician global damage, and patient global damage scores were negatively associated with SF-36 PCS. No correlations to the mental component summary score of SF-36 were observed. Conclusion All measures of functional capacity were positively related to the SF-36 physical component summary score, indicating higher functional capacity positively affects quality of life in patients with myositis. Health assessment questionnaire and patient global damage scores demonstrated the strongest correlations with SF-36 physical component summary scores, further supporting these patient-reported outcomes as viable monitoring tools in patients with myositis., Objective: To investigate the potential associations between functional capacity, muscle strength, body composition, and disease-related measures and quality of life in patients with myositis. Methods: Baseline measures of functional capacity (functional index 3 (FI3), 2-minute walk test (2MWT), timed up and go (TUG) and 30-s sit-to-stand (30-STS)), muscle strength (incl. leg and handgrip strength), maximal leg extensor power, body composition (appendicular lean mass, fat percentage/mass) and disease-related measures (disease activity & damage core sets) were examined for their associations with quality of life (physical- and mental component summary scores, Short Form 36 questionnaire (SF-36)) by means of Spearman's correlation analysis. Results: A total of 32 patients with myositis were included. Positive correlations between SF-36 physical component summary score (PCS) and FI3, 30-STS, TUG, 2MWT, leg extensor power, leg strength, bench press strength, and handgrip strength were observed. In contrast, fat percentage and fat mass correlated negatively with PCS. In disease-related measures, Extramuscular global assessment, health assessment questionnaire, physician global damage, and patient global damage scores were negatively associated with SF-36 PCS. No correlations to the mental component summary score of SF-36 were observed. Conclusion: All measures of functional capacity were positively related to the SF-36 physical component summary score, indicating higher functional capacity positively affects quality of life in patients with myositis. Health assessment questionnaire and patient global damage scores demonstrated the strongest correlations with SF-36 physical component summary scores, further supporting these patient-reported outcomes as viable monitoring tools in patients with myositis.

Objective: The objective of this study is to characterize bladder mucosal trauma associated with intermittent catheterization with conventional eyelet catheters (CECs) and to assess if a microhole zone catheter (MHZC) design concept reduces this adverse effect. Materials and Methods: A porcine model was developed to reflect human catheterization and bladder drainage. Nine pigs were randomized for catheterization with CEC (n = 6) or MHZC (n = 3). The bladder was drained repeatedly 20 times through the catheter. Cystoscopy was performed before and after the procedure, and bladders were analysed by histopathology. Two additional pigs were used for cystoscopy visualization of suction events in vivo. Cystoscopy, gross pathology, histopathological score, leucocyte infiltration, and intracatheter pressure at flow stops during voiding were compared for each group. Results: A significant higher pressure gradient was measured inside the CECs compared with MHZCs during flow stop. Consequently, CECs resulted in suction events inflicting bladder trauma characterized by loss of epithelium, oedema, haemorrhage, and neutrophil tissue infiltration. No significant trauma was identified when using MHZC. Conclusions: Considerable mucosal bladder trauma is inflicted by CECs which may be an overlooked risk factor for urinary tract infection. Catheters can be designed to minimize mucosal suction and reduce associated trauma. This may be a solution to reduce infection frequency and increase user comfort. Furthermore, the study demonstrates the potential of pigs as an attractive animal model for investigating urinary catheter performances.

Objective To investigate the effects of adding strength training to neuromuscular control exercises on thigh tissue composition and muscle properties in people with radiographic-symptomatic knee osteoarthritis (KOA). Methods In this exploratory secondary analysis of a randomized controlled trial, using a complete-case approach, participants performed 12 weeks of twice-weekly neuromuscular control exercise and patient education (NEMEX, n = 34) or NEMEX plus quadriceps strength training (NEMEX+ST, n = 29). Outcomes were MRI-measured inter- and intramuscular adipose tissue (InterMAT, IntraMAT), quadriceps muscle cross-sectional area (CSA), knee-extensor strength, specific strength (strength/lean CSA) and 30 s chair-stands. Between-group effects were compared using a mixed model analysis of variance. Results At 12 weeks, responses to NEMEX+ST overlapped with NEMEX for all outcomes. Both groups reduced InterMAT (NEMEX+ST=25 %, NEMEX=21 %); between-group difference: 0.8cm2 (95 % CI: -0.1, 1.7). NEMEX+ST decreased IntraMAT (2 %) and NEMEX increased IntraMAT (4 %); between-group difference 0.1 %-points (-0.3, 0.5). Both groups increased quadriceps CSA and lean CSA (CSA minus IntraMAT), improved knee-extensor strength and specific strength, and improved chair-stand performance with a trend towards greater effects in NEMEX+ST. Conclusion Adding strength training to 12 weeks of neuromuscular control exercises provided largely similar effects to neuromuscular control exercises alone in decreasing InterMAT and IntraMAT, in improving knee-extensor strength, CSA and in improving performance-based function in KOA persons, with a trend towards greater effects with additional strength training. Notably, both groups substantially reduced InterMAT and improved specific strength (an index of muscle quality). Our hypothesis-generating work warrants exploration of the roles played by InterMAT and IntraMAT in exercise effects in KOA., Objective: To investigate the effects of adding strength training to neuromuscular control exercises on thigh tissue composition and muscle properties in people with radiographic-symptomatic knee osteoarthritis (KOA). Methods: In this exploratory secondary analysis of a randomized controlled trial, using a complete-case approach, participants performed 12 weeks of twice-weekly neuromuscular control exercise and patient education (NEMEX, n = 34) or NEMEX plus quadriceps strength training (NEMEX+ST, n = 29). Outcomes were MRI-measured inter- and intramuscular adipose tissue (InterMAT, IntraMAT), quadriceps muscle cross-sectional area (CSA), knee-extensor strength, specific strength (strength/lean CSA) and 30 s chair-stands. Between-group effects were compared using a mixed model analysis of variance. Results: At 12 weeks, responses to NEMEX+ST overlapped with NEMEX for all outcomes. Both groups reduced InterMAT (NEMEX+ST=25 %, NEMEX=21 %); between-group difference: 0.8cm2 (95 % CI: -0.1, 1.7). NEMEX+ST decreased IntraMAT (2 %) and NEMEX increased IntraMAT (4 %); between-group difference 0.1 %-points (-0.3, 0.5). Both groups increased quadriceps CSA and lean CSA (CSA minus IntraMAT), improved knee-extensor strength and specific strength, and improved chair-stand performance with a trend towards greater effects in NEMEX+ST. Conclusion: Adding strength training to 12 weeks of neuromuscular control exercises provided largely similar effects to neuromuscular control exercises alone in decreasing InterMAT and IntraMAT, in improving knee-extensor strength, CSA and in improving performance-based function in KOA persons, with a trend towards greater effects with additional strength training. Notably, both groups substantially reduced InterMAT and improved specific strength (an index of muscle quality). Our hypothesis-generating work warrants exploration of the roles played by InterMAT and IntraMAT in exercise effects in KOA.

The DEXamethasone twice for pain treatment after Total Knee Arthroplasty (DEX-2-TKA) trial showed that adding one and two doses of 24 mg intravenous dexamethasone to paracetamol, ibuprofen and local infiltration analgesia, reduced morphine consumption (primary outcome) within 48 h after TKA. We aimed to explore the differences in the effect of dexamethasone on morphine consumption in different subgroups. Quantile regression adjusted for site was used to test for significant interaction between the predefined dichotomised subgroups and treatment group. The subgroups were defined based on baseline data: sex (male/female), age (≤65 years/>65 years), American Society of Anaesthesiologists (ASA)-score (ASA I + II/III), visual analogue score of preoperative pain at rest (≤30 mm/>30 mm), pain during mobilisation (≤30 mm/>30 mm), type of anaesthesia (spinal anaesthesia/general anaesthesia and spinal converted to general anaesthesia), and prior daily use of analgesics (either paracetamol and/or NSAID/neither). These analyses were supplemented with post hoc multivariate linear regression analyses. Test of interaction comparing sex in the pairwise comparison between DX2 (dexamethasone [24 mg] + dexamethasone [24 mg]) versus placebo (p = .02), showed a larger effect of dexamethasone on morphine consumption in male patients compared to females. Test of interaction comparing age in the pairwise comparison between DX1 (dexamethasone [24 mg] + placebo) versus placebo (p = .04), showed a larger effect of dexamethasone on morphine consumption in younger patients (≤65 years) compared to older. All remaining subgroup analyses showed no evidence of a difference. The supplemental multivariate analyses did not support any significant interaction for sex (p = .256) or age (p = .730) but supported a significant interaction with the type of anaesthesia (p < .001). Our results from the quantile regression analyses indicate that the male sex and younger age (≤65 years) may be assoc, The DEXamethasone twice for pain treatment after Total Knee Arthroplasty (DEX-2-TKA) trial showed that adding one and two doses of 24 mg intravenous dexamethasone to paracetamol, ibuprofen and local infiltration analgesia, reduced morphine consumption (primary outcome) within 48 h after TKA. We aimed to explore the differences in the effect of dexamethasone on morphine consumption in different subgroups. Quantile regression adjusted for site was used to test for significant interaction between the predefined dichotomised subgroups and treatment group. The subgroups were defined based on baseline data: sex (male/female), age (≤65 years/>65 years), American Society of Anaesthesiologists (ASA)-score (ASA I + II/III), visual analogue score of preoperative pain at rest (≤30 mm/>30 mm), pain during mobilisation (≤30 mm/>30 mm), type of anaesthesia (spinal anaesthesia/general anaesthesia and spinal converted to general anaesthesia), and prior daily use of analgesics (either paracetamol and/or NSAID/neither). These analyses were supplemented with post hoc multivariate linear regression analyses. Test of interaction comparing sex in the pairwise comparison between DX2 (dexamethasone [24 mg] + dexamethasone [24 mg]) versus placebo (p =.02), showed a larger effect of dexamethasone on morphine consumption in male patients compared to females. Test of interaction comparing age in the pairwise comparison between DX1 (dexamethasone [24 mg] + placebo) versus placebo (p =.04), showed a larger effect of dexamethasone on morphine consumption in younger patients (≤65 years) compared to older. All remaining subgroup analyses showed no evidence of a difference. The supplemental multivariate analyses did not support any significant interaction for sex (p =.256) or age (p =.730) but supported a significant interaction with the type of anaesthesia (p <.001). Our results from the quantile regression analyses indicate that the male sex and younger age (≤65 years) may be associa

The populations of European hedgehog (Erinaceus europaeus) are in decline, and it is essential that research identifies and mitigates the factors causing this. Hedgehogs are increasingly sharing habitats with humans, being exposed to a range of dangers in our backyards. Previous research has documented that some models of robotic lawn mowers can cause harm to hedgehogs. This study explored the personality and behaviour of 50 live hedgehogs when facing an approaching, disarmed robotic lawn mower. By combining a novel arena and novel object test, we found that 27 hedgehogs could be categorised as “shy” and 23 as “bold”, independently of sex and age. The encounter tests with a robotic lawn mower showed that the hedgehogs positioned themselves in seven different ways. Personality did not affect their reactions. Adult hedgehogs tended to react in a shyer manner, and the hedgehogs, generally, acted less boldly during their second encounter with the robotic lawn mower. Additionally, our results show that bold individuals reacted in a more unpredictable way, being more behaviourally unstable compared to the shy individuals. This knowledge will be applied in the design of a standardised hedgehog safety test, eventually serving to produce and approve hedgehog-friendly robotic lawn mowers., The populations of European hedgehog (Erinaceus europaeus) are in decline, and it is essential that research identifies and mitigates the factors causing this. Hedgehogs are increasingly sharing habitats with humans, being exposed to a range of dangers in our backyards. Previous research has documented that some models of robotic lawn mowers can cause harm to hedgehogs. This study explored the personality and behaviour of 50 live hedgehogs when facing an approaching, disarmed robotic lawn mower. By combining a novel arena and novel object test, we found that 27 hedgehogs could be categorised as “shy” and 23 as “bold”, independently of sex and age. The encounter tests with a robotic lawn mower showed that the hedgehogs positioned themselves in seven different ways. Personality did not affect their reactions. Adult hedgehogs tended to react in a shyer manner, and the hedgehogs, generally, acted less boldly during their second encounter with the robotic lawn mower. Additionally, our results show that bold individuals reacted in a more unpredictable way, being more behaviourally unstable compared to the shy individuals. This knowledge will be applied in the design of a standardised hedgehog safety test, eventually serving to produce and approve hedgehog-friendly robotic lawn mowers.

OBJECTIVES: The DEX-2-TKA trial demonstrated that one and two doses of 24 mg intravenous dexamethasone reduced opioid consumption and pain after total knee arthroplasty (TKA). We aimed to investigate the prolonged effects of dexamethasone after the 48-h intervention period.DESIGN: This was a prospective, pre-planned questionnaire follow-up on postoperative days 3-7 of patients in the DEX-2-TKA trial that randomly received: DX1 (dexamethasone 24 mg + placebo), DX2 (dexamethasone 24 mg + dexamethasone 24 mg), and placebo (placebo + placebo) perioperatively and 24 h later.SETTING: A multicenter trial performed at five Danish hospitals.PARTICIPANTS: We analyzed 434 of 485 adult participants enrolled in the DEX-2-TKA trial.OUTCOME MEASURES: Primary outcome was difference between groups in average of all numerical rating scale (NRS) pain scores reported in the morning, at bedtime, and the daily average pain on postoperative days 3-7. Secondary outcomes were sleep quality and patient satisfaction.RESULTS: The median (interquartile range) pain intensity levels for postoperative days 3-7 were: DX2 3.2 (2.1-4.3); DX1 3.3 (2.3-4.1); and placebo 3.3 (2.5-4.7). Hodges-Lehmann median differences between groups were: 0 (95% confidence interval - 0.54 to 0.2), P = 0.38 between DX1 and placebo; 0.1 (-0.47 to 0.33), p = .87 between DX1 and DX2; and 0.1 (-0.6 to 0.13), p = .20 between DX2 and placebo. We found no relevant differences between groups on sleep quality on postoperative days 3-7 nor for patient satisfaction with the analgesic treatment.CONCLUSIONS: We found that neither one nor two doses of 24 mg intravenous dexamethasone demonstrated prolonged effects on overall pain or sleep quality on postoperative days 3-7 after total knee arthroplasty. We also found that dexamethasone had no effect on patient satisfaction.TRIAL REGISTRATION NUMBER: Clinicaltrials.gov NCT03506789 (main result trial).

Importance Young children often fall ill, leading to concern among their caregivers and urgent contact with health care services. Objective To assess the effectiveness and safety of video tutorials to empower caregivers in caring for acutely ill children. Design, Setting, and Participants Caregivers calling the out-of-hours Medical Helpline 1813 (MH1813), Emergency Medical Services Capital Region, Denmark, and their children aged 0.5 to 11.9 years were randomized to video tutorials (intervention) or telephone triage by a nurse or physician (control) from October 2020 to December 2021 and followed up for 72 hours blinded to the intervention. Data were analyzed from March to July 2022. Intervention The intervention group had the call disconnected before telephone triage and received video tutorials on managing common symptoms in acutely ill children and when to seek medical help. Caregivers could subsequently call MH1813 for telephone triage. Main outcomes and measures The primary outcome was caregivers’ self-efficacy, reported in an electronic survey the following day. Secondary outcomes were satisfaction, child status, assessment by a general practitioner or physician at the hospital, telephone triage, and adverse events during the 72-hour follow-up period. Results In total, 4686 caregivers and children were randomized to intervention (2307 participants) or control (2379 participants), with a median (IQR) child age of 2.3 (1.3-5.1) years and 53% male distribution in both groups (2493 participants). Significantly more caregivers in the intervention group reported high self-efficacy (80% vs 76%; crude odds ratio [OR], 1.30; 95% CI, 1.01-1.67; P = .04). The intervention group received fewer telephone triages during follow-up (887 vs 2374 in the control group). Intention-to-treat analysis showed no difference in secondary outcomes, but per-protocol subanalysis showed fewer hospital assessments when caregivers watched video tu, Importance: Young children often fall ill, leading to concern among their caregivers and urgent contact with health care services. Objective: To assess the effectiveness and safety of video tutorials to empower caregivers in caring for acutely ill children. Design, Setting, and Participants: Caregivers calling the out-of-hours Medical Helpline 1813 (MH1813), Emergency Medical Services Capital Region, Denmark, and their children aged 0.5 to 11.9 years were randomized to video tutorials (intervention) or telephone triage by a nurse or physician (control) from October 2020 to December 2021 and followed up for 72 hours blinded to the intervention. Data were analyzed from March to July 2022. Intervention: The intervention group had the call disconnected before telephone triage and received video tutorials on managing common symptoms in acutely ill children and when to seek medical help. Caregivers could subsequently call MH1813 for telephone triage. Main outcomes and measures: The primary outcome was caregivers' self-efficacy, reported in an electronic survey the following day. Secondary outcomes were satisfaction, child status, assessment by a general practitioner or physician at the hospital, telephone triage, and adverse events during the 72-hour follow-up period. Results: In total, 4686 caregivers and children were randomized to intervention (2307 participants) or control (2379 participants), with a median (IQR) child age of 2.3 (1.3-5.1) years and 53% male distribution in both groups (2493 participants). Significantly more caregivers in the intervention group reported high self-efficacy (80% vs 76%; crude odds ratio [OR], 1.30; 95% CI, 1.01-1.67; P =.04). The intervention group received fewer telephone triages during follow-up (887 vs 2374 in the control group). Intention-to-treat analysis showed no difference in secondary outcomes, but per-protocol subanalysis showed fewer hospital assessments when caregivers watched video tutorials (27% vs 35%; adjusted OR, 0.6

Background It is unknown if patients are relieved of pain after knee arthroplasty revision for unexplained pain. The aim of this cross-sectional case-control study was to compare patient-reported outcome measures (PROMs) and satisfaction 1 to 3 years after revision of total knee arthroplasties (TKAs) for the indications of unexplained pain versus aseptic loosening. Methods We included 384 patients undergoing TKA revision for the indications of unexplained pain and aseptic loosening from January 1, 2018 to December 31, 2020 from the Danish Knee Arthroplasty Register. A total of 81 patients were revised for unexplained pain and 303 for aseptic loosening. Questionnaires including PROMs (Oxford Knee Score, EQ-5D-5L, and Forgotten Joint Score) and satisfaction with the surgery on a 0-100 scale (100 = not satisfied; 0 = very satisfied) were sent to digitally secured mailboxes. Time from revision to data collection was a median 3.1 years (range, 1.4-4.4 years). Results Median Oxford Knee Score was 25 (interquartile range [IQR] 15) versus 31 (IQR 18) 1-3 years after revisions for unexplained pain versus aseptic loosening, P = .009. Median EQ-5D-5L was 0.6 (IQR 0.4) versus 0.8 (IQR 0.3) for unexplained pain versus aseptic loosening, P = .009. Median Forgotten Joint Score was 50 (IQR 7) versus 50 (IQR 16) for unexplained pain versus aseptic loosening, P = .905. Satisfaction was 75 (IQR 38) for unexplained pain and 50 (IQR 73) for aseptic loosening, P < .001. Conclusion Patients undergoing TKA revision for the indication of unexplained pain had worse results on PROMs than those revised for aseptic loosening. Likewise, patients revised for unexplained pain were less satisfied compared to patients revised for aseptic loosening. This information is valuable to both surgeons and patients when candidates for revision surgery are selected, to obtain the best possible outcomes., Background: It is unknown if patients are relieved of pain after knee arthroplasty revision for unexplained pain. The aim of this cross-sectional case-control study was to compare patient-reported outcome measures (PROMs) and satisfaction 1 to 3 years after revision of total knee arthroplasties (TKAs) for the indications of unexplained pain versus aseptic loosening. Methods: We included 384 patients undergoing TKA revision for the indications of unexplained pain and aseptic loosening from January 1, 2018 to December 31, 2020 from the Danish Knee Arthroplasty Register. A total of 81 patients were revised for unexplained pain and 303 for aseptic loosening. Questionnaires including PROMs (Oxford Knee Score, EQ-5D-5L, and Forgotten Joint Score) and satisfaction with the surgery on a 0-100 scale (100 = not satisfied; 0 = very satisfied) were sent to digitally secured mailboxes. Time from revision to data collection was a median 3.1 years (range, 1.4-4.4 years). Results: Median Oxford Knee Score was 25 (interquartile range [IQR] 15) versus 31 (IQR 18) 1-3 years after revisions for unexplained pain versus aseptic loosening, P = .009. Median EQ-5D-5L was 0.6 (IQR 0.4) versus 0.8 (IQR 0.3) for unexplained pain versus aseptic loosening, P = .009. Median Forgotten Joint Score was 50 (IQR 7) versus 50 (IQR 16) for unexplained pain versus aseptic loosening, P = .905. Satisfaction was 75 (IQR 38) for unexplained pain and 50 (IQR 73) for aseptic loosening, P < .001. Conclusion: Patients undergoing TKA revision for the indication of unexplained pain had worse results on PROMs than those revised for aseptic loosening. Likewise, patients revised for unexplained pain were less satisfied compared to patients revised for aseptic loosening. This information is valuable to both surgeons and patients when candidates for revision surgery are selected, to obtain the best possible outcomes.

Aortic-to-right ventricle fistula is a rare complication after transcatheter aortic valve implantation (TAVI). In this case report, an 87-year-old male was admitted with signs of congestion six weeks after TAVI. Two days later, he developed severe epigastric and back pain, elevated D-dimer, lactic acidosis and renal failure. Transthoracic echocardiography revealed a progressing aortic-to-right ventricle fistula which in retrospect had been present since the TAVI-procedure. The patient died despite supportive treatment.

Introduction: Candidemia is a severe condition associated with high mortality, and fungi are often not covered by empiric antimicrobial regimes for sepsis. Therefore, the shortest possible time to detection of yeast in the blood is of the essence. Materials and methods: We performed a cohort study of blood culture flasks drawn from patients aged 18 or older in the capital region of Denmark. In 2018 a blood cultures set consisted of two aerobic and two anaerobic flasks. This was changed in 2020 to two aerobic, one anaerobic, and one mycosis flask. We used time-to-event statistics to model time to positivity and compared 2018 with 2020; further, we stratified analyses on the blood culture system used (BacTAlert™ vs. BACTEC™) and high-risk vs. low-risk departments. Results: We included 175,416 blood culture sets and 107,077 unique patients. We found an absolute difference in the likelihood of identifying fungi in a blood culture set of 1.2 (95% CI: 0.72; 1.6) pr. 1.000 blood culture sets corresponding to the number needed to treat 853 (617; 1382). In high-risk departments, the absolute difference was profound, whereas it was negligible and statistically non-significant in low-risk departments 5.2 (95% CI: 3.4; 7.1) vs. 0.16 (−0.17; 0.48) pr. 1.000 blood culture sets. Conclusions: We found that including a mycosis flask in a blood culture set increases the likelihood of identifying candidemia. The effect was mainly seen in high-risk departments.

Repeated blood sampling is required in certain clinical and research settings, which is currently performed by drawing blood from venous catheters requiring manual handling of each sample at the time of collection. A novel body-worn device for repeated serial samples, Fluispotter®, with automated extraction, collection, and storage of up to 20 venous dried blood spot samples over the course of 20 h may overcome problems with current methods for serial sampling. The purpose of this study was to assess the performance and safety of Fluispotter for the first time in healthy subjects. Fluispotter consists of a cartridge with tubing, a reservoir for flushing solution, pumps and filterpaper, and a multi-lumen catheter placed in the brachial vein. We recruited healthy subjects for testing in an in-hospital setting. Fluispotter was attached by an anesthesiologist to 22 healthy subjects of which 9/22 (40.9%) participants had all 20 samples taken, which was lower than the goal of complete sampling in 80% of the subjects (P = 0.02). The main reason for sample failure was clogging of blood flow which was observed in 11/22 (50%) of the participants. No serious adverse events occurred, and the participants rated the pain from the insertion and the removal of catheter as very low. A cortisol profile showed nadir values at midnight and highest values at 05:00 h. Although full sampling was not successful in all participants, the Fluispotter technology proved safe and highly acceptable to the participants producing the expected cortisol profile without the requirement of staff during sample collection., Repeated blood sampling is required in certain clinical and research settings, which is currently performed by drawing blood from venous catheters requiring manual handling of each sample at the time of collection. A novel body-worn device for repeated serial samples, Fluispotter®, with automated extraction, collection, and storage of up to 20 venous dried blood spot samples over the course of 20 h may overcome problems with current methods for serial sampling. The purpose of this study was to assess the performance and safety of Fluispotter for the first time in healthy subjects. Fluispotter consists of a cartridge with tubinga reservoir for flushing solution, pumps and filter paper, and a multi-lumen catheter placed in the brachial vein. We recruited healthy subjects for testing in an in-hospital setting. Fluispottewas attached by an anesthesiologist to 22 healthy subjects of which 9/22 (40.9%) participants had all 20 samples taken, which was lower than the goal of complete sampling in 80% of the subjects (P = 0.02). The main reason for sample failure was clogging of blood flow which was observed in 11/22 (50%) of the participants. No serious adverse events occurred, and the participants rated the pain from the insertion and the removal of catheter as very low. A cortisol profile showed nadir values at midnight and highest values at 05:00 h. Although full sampling was not successful in all participants, the Fluispotter technology proved safe and highly acceptable to the participants producing the expected cortisol profile without the requirement of staff during sample collection.

Aim Children often fall sick, which causes concern among parents. Online health information can be confusing and difficult to understand. We aimed to produce simple, informative video tutorials on the symptoms ill children present. Methods We used a modified Delphi method to produce video tutorials on the symptoms of fever, vomiting and diarrhoea, abdominal pain, breathing difficulties, sore throat, red eyes, earache and rash. We identified the most common symptoms in acutely ill children. During the first consensus round, experts rated statements on out-of-hospital management from existing health information. Video tutorials were produced from statements rated to be included. The second consensus round involved video showings and editing. Two videos were evaluated in focus groups by parents. Results During the first round, experts rated a median of 79 (40–154) statements for each symptom. Panels consisted of a median of seven (6–11) experts, primarily. Panels reached a consensus on inclusion, neutrality or exclusion in 83% of statements. The second round led to adjustments to the videos and final approval by experts. Most parents evaluated the videos as ‘informative, easy to understand and calming’. Conclusion We produced video tutorials on the common symptoms ill children present using a modified Delphi method. Feedback from parents in focus groups was positive., Aim: Children often fall sick, which causes concern among parents. Online health information can be confusing and difficult to understand. We aimed to produce simple, informative video tutorials on the symptoms ill children present. Methods: We used a modified Delphi method to produce video tutorials on the symptoms of fever, vomiting and diarrhoea, abdominal pain, breathing difficulties, sore throat, red eyes, earache and rash. We identified the most common symptoms in acutely ill children. During the first consensus round, experts rated statements on out-of-hospital management from existing health information. Video tutorials were produced from statements rated to be included. The second consensus round involved video showings and editing. Two videos were evaluated in focus groups by parents. Results: During the first round, experts rated a median of 79 (40–154) statements for each symptom. Panels consisted of a median of seven (6–11) experts, primarily. Panels reached a consensus on inclusion, neutrality or exclusion in 83% of statements. The second round led to adjustments to the videos and final approval by experts. Most parents evaluated the videos as ‘informative, easy to understand and calming’. Conclusion: We produced video tutorials on the common symptoms ill children present using a modified Delphi method. Feedback from parents in focus groups was positive.

Multi-criteria decision-making (MCDM) tools are essentially methods to enable a decision maker to achieve a more objective approach to a given decision scenario using quantitative methods. One such complex decision scenario is the underutilization of side-streams in the seafood industry, which is brought about by a combination of complex decision challenges related to processing methods, storage methods, logistics, technical viability, status quo mindset, and the attitude of the decision maker. However, the influence and identification of cognitive biases (e.g., loss aversion bias) in MCDM tools are rarely accounted for and may result in a less objective decision process due to subjective influences, which can influence the valorization and utilization of seafood side-streams in a company. To enable a more objective approach where the influence of these cognitive biases is corrected, in this paper, we propose a debiasing method based on the UN’s 14 SDGs, cognitive mapping (CM), and attribute substitution (AS) as an extension of MCDM tools and the modeling of seafood processing. The results of the case-specific implementation show that the proposed method can identify cognitive biases and correct these by enabling the implementation of relevant debiasing techniques that can aid a decision marker in choosing the best alternative when it comes to decisions on reducing wasted side-streams and increasing the sustainability of their food processing. It was found that the debiasing application provided a correction of the user ranking for the best-evaluated alternative within a side-stream scenario to be in line with the experts’ ranking for the same scenario in terms of environmentally and economically efficient production. This is a novel approach combining existing theories and methods into a single bias identification and debiasing method, which is designed to be generic and can be implemented in other sectors and industries using MCDM tools in their decision process.

Dækfrøede planter, også kaldet angiospermer, har en utrolig divers morfologi, og størstedelen af dem afhænger af dyr for at blive bestøvet og reproducere sig. Pollenspredning gennem dyr er grundstenen inden for mutualistiske forhold, planter og bestøvere imellem, og anses for at være en af de vigtigste økologiske interaktioner indenfor biologien. Dette gælder specielt i tropiske økosystemer, hvor langt størstedelen af bestøvning faciliteres gennem dyre-plante interaktioner. Det mutualistiske forhold mellem to arter af Heliconia planter og deres kolibri-bestøver, granatstruben (Eulampis jugularis), er længe blevet brugt som et eksempel på meget specialiserede artsforhold i De små Antiller. Heliconia bihai og Heliconia caribaeas blomster er lange og buede, og reflekterer størrelsen og bøjningen af E. jugularis’ næb. Hunnerne har lange buede næb og anses for at være den eneste effektive bestøver af H. bihai, mens H. caribaea bestøves af både hunnerne og hannerne med de kortere, lige næb. I 2017 blev Antillerne ramt a den tropiske orkan, Maria, som ødelagde størstedelen af Dominicas vegetation. Orkanen er siden blevet kendt for at havde ændret forhold mellem planter og bestøvere på øen. Feltarbejdet til dette projekt, blev udført på øen Dominica i De små Antiller. Målet med studiet var at undersøge om E. jugularis stadig kan anses for at være den primære bestøver af H. bihai og H. caribaea, eller om flere arter er begyndt at udnytte Heliconia planterne for deres rige nektar. Jeg målte besøgsrater på blomster og talte pollenkorn afsat på blomsternes stigma, efter besøg af besøgende fugle. I denne afhandling diskuterer jeg også om forholdet mellem E. jugularis og de to Heliconia arter har ændret sig siden orkanen Maria ramte Dominica i 2017. I modsætning til tidligere studier af dette artsforhold, viser mine resultater at banansmutten (Coereba flaveola), en lille spurvefugl, havde den højeste besøgsrate af alle besøgende fugle. C. flaveola stod for over 50% af alle besøg, Angiosperms are unbelievably diverse in morphology, and the majority of them rely on animal pollination for reproduction. Pollen dispersal by animals is the building blocks of mutualistic relationships between plants and pollinators and is considered one of the most important ecological interactions, especially in tropical ecosystems, where the vast majority of pollination is facilitated by animal-interactions. A mutualistic relationship between two species of Heliconia plants and their hummingbird-pollinator, the purple-throated carib (Eulampis jugularis), have been used as a prime example of highly specialized species associations across the Lesser Antilles. The flowers of Heliconia bihai and Heliconia caribaea are long and curved and have been shown to reflect the size and curvature of the bill of E. jugularis. In Dominica, the females of E. jugularis have long and curved bills and are considered the primary pollinators of H. bihai, while H. caribaea is pollinated by both the females and the shorter, straighter-billed males. In 2017, the Antilles were impacted by the tropical hurricane Maria, which destroyed the canopy and understory vegetation, affecting the entire elevational gradient in Dominica. The hurricane has since been known to have broken down plant-pollinator associations among plants and pollinators in Dominica. This project was carried out on the island of Dominica in the Lesser Antilles, with the goal to investigate whether E. jugularis could still be considered the main pollinator of H. bihai and H. caribaea, or whether other animals have started exploring the rich nectar resource offered by these Heliconias. I measured visitation rates on flowers and counted pollen grains deposited on floral stigmas after visits of avian pollinators. In this thesis, I also discuss if the relationship between E. jugularis and the two Heliconias has changed, since hurricane Maria hit Dominica in 2017. Contradicting previous studies, my results show that the bananaqu

Dækfrøede planter, også kaldet angiospermer, har en utrolig divers morfologi, og størstedelen af dem afhænger af dyr for at blive bestøvet og reproducere sig. Pollenspredning gennem dyr er grundstenen inden for mutualistiske forhold, planter og bestøvere imellem, og anses for at være en af de vigtigste økologiske interaktioner indenfor biologien. Dette gælder specielt i tropiske økosystemer, hvor langt størstedelen af bestøvning faciliteres gennem dyre-plante interaktioner. Det mutualistiske forhold mellem to arter af Heliconia planter og deres kolibri-bestøver, granatstruben (Eulampis jugularis), er længe blevet brugt som et eksempel på meget specialiserede artsforhold i De små Antiller. Heliconia bihai og Heliconia caribaeas blomster er lange og buede, og reflekterer størrelsen og bøjningen af E. jugularis’ næb. Hunnerne har lange buede næb og anses for at være den eneste effektive bestøver af H. bihai, mens H. caribaea bestøves af både hunnerne og hannerne med de kortere, lige næb. I 2017 blev Antillerne ramt a den tropiske orkan, Maria, som ødelagde størstedelen af Dominicas vegetation. Orkanen er siden blevet kendt for at havde ændret forhold mellem planter og bestøvere på øen. Feltarbejdet til dette projekt, blev udført på øen Dominica i De små Antiller. Målet med studiet var at undersøge om E. jugularis stadig kan anses for at være den primære bestøver af H. bihai og H. caribaea, eller om flere arter er begyndt at udnytte Heliconia planterne for deres rige nektar. Jeg målte besøgsrater på blomster og talte pollenkorn afsat på blomsternes stigma, efter besøg af besøgende fugle. I denne afhandling diskuterer jeg også om forholdet mellem E. jugularis og de to Heliconia arter har ændret sig siden orkanen Maria ramte Dominica i 2017. I modsætning til tidligere studier af dette artsforhold, viser mine resultater at banansmutten (Coereba flaveola), en lille spurvefugl, havde den højeste besøgsrate af alle besøgende fugle. C. flaveola stod for over 50% af alle besøg, Angiosperms are unbelievably diverse in morphology, and the majority of them rely on animal pollination for reproduction. Pollen dispersal by animals is the building blocks of mutualistic relationships between plants and pollinators and is considered one of the most important ecological interactions, especially in tropical ecosystems, where the vast majority of pollination is facilitated by animal-interactions. A mutualistic relationship between two species of Heliconia plants and their hummingbird-pollinator, the purple-throated carib (Eulampis jugularis), have been used as a prime example of highly specialized species associations across the Lesser Antilles. The flowers of Heliconia bihai and Heliconia caribaea are long and curved and have been shown to reflect the size and curvature of the bill of E. jugularis. In Dominica, the females of E. jugularis have long and curved bills and are considered the primary pollinators of H. bihai, while H. caribaea is pollinated by both the females and the shorter, straighter-billed males. In 2017, the Antilles were impacted by the tropical hurricane Maria, which destroyed the canopy and understory vegetation, affecting the entire elevational gradient in Dominica. The hurricane has since been known to have broken down plant-pollinator associations among plants and pollinators in Dominica. This project was carried out on the island of Dominica in the Lesser Antilles, with the goal to investigate whether E. jugularis could still be considered the main pollinator of H. bihai and H. caribaea, or whether other animals have started exploring the rich nectar resource offered by these Heliconias. I measured visitation rates on flowers and counted pollen grains deposited on floral stigmas after visits of avian pollinators. In this thesis, I also discuss if the relationship between E. jugularis and the two Heliconias has changed, since hurricane Maria hit Dominica in 2017. Contradicting previous studies, my results show that the bananaqu

Dirofilarosis is spreading among dogs and humans in Europe with infections being established in many countries. Here, we describe the first molecular biologically confirmed case of D. repens infection in an imported dog in Denmark and highlight the potential zoonotic aspects from this emerging zoonotic parasite in central and northern Europe as at least one to two generations of Dirofilaria spp. can occur per year in Denmark.

Play is a non-invasive, safe, and inexpensive intervention that can help children and adolescents better manage difficult aspects of hospitalisation. Play has existed in hospitals for decades but is emerging as an interdisciplinary scientific field. The field concerns all medical specialties and healthcare professionals working with children. In this review, we describe play within different clinical contexts and recommend that directed and non-directed play activities should be prioritised in future paediatric departments. We also emphasise the need for professionalisation and research in the area.

A new genus and species of stromateiform fish, Butyrumichthys henricii gen. et sp. nov., from the Eocene Fur Formation of Denmark is described. The description is based on six well-preserved, almost complete articulated skeletons plus a well-preserved head. All the specimens originate from the carbonate concretion horizons of the Fur Formation. The fossils were investigated also through element-mapping of strontium and phosphorus using a micro-XRF spectrometer in order to expose and enhance the skeletal anatomy. Butyrumichthys gen. nov. exhibits a unique combination of characters that support its recognition as a new stromateoiform genus, including jaws with uniserially arranged, small conical teeth, preopercle with at least 15 prominent spines, 37–38 (17–18 + 20) vertebrae, dorsal fin with 5–6 weak spines and 27–28 soft rays, and anal fin with two spines and 19–20 soft rays. The new fossil stromateoid described herein shows several morphological similarities to certain species of the genus Schedophilus Cocco, 1839, especially S. pemarco (Poll, 1959) and S. medusophagus (Cocco, 1839), and is tentatively referred to the family Centrolophidae. The exceptionally preserved fossil fishes of the Fur Formation increase our knowledge of the diversity of Paleogene marine teleosts, also providing some of the earliest occurrences of modern lineages based on articulated skeletal remains, including that of the stromateiforms.

Nonverbal kommunikation består af to begreber: Det nonverbale henviser til betydningsdannelse skabt via alt andet end ord, og kommunikation henviser til, at ikke kun talere, men også modtagere er involveret i den samlede meningsskabelse. Mennesker skaber hele tiden mening gennem mange forskellige (multi-modale) handlinger i konkrete situationer og tillægger disse handlinger og situationer betydning (Due 2017: 9). Så snart andre mennesker er til stede som en del af kommunikative situationer (fysisk og/eller digitalt), kommunikerer vores blotte kropslige tilstedeværelse (eller digitalt medierede repræsentation), og der kan opstå betydningsdannelse helt uden anvendelse af det verbalt sproglige.

The earliest Eocene (Ypresian) Fur Formation (Denmark) is globally renowned for its exceptionally well-preserved fossils, including birds, sea turtles, insects, plants, and fishes. Fishes, albeit abundant and diverse, however, are only superficially known and very few detailed, taxonomic studies have been realized to date. A new polymixiiform fish, Polyspinatus fluere gen. et sp. nov., from the Fur Formation is described based on seven well-preserved, nearly complete specimens. All the specimens were studied by traditional stereomicroscopy, and by micro-X-ray fluorescence-element mapping. Digital 2D-element images of strontium-, phosphorus-, and calcium distributions of each specimen were directly applied for the taxonomic descriptions presented herein. Polyspinatus fluere gen. et sp. nov. is the first known Eocene record of the family Polymixiidae based on articulated skeletal remains. Polyspinatus gen. nov. exhibits a unique combination of characters that support its recognition as a new genus of the Polymixiidae. Its specialized hyoid apparatus with the first and second branchiostegal rays being sinuous and parallel to each other, and the third being wide and plate-like, followed by four saber-like elements, is strikingly similar to that of Polymixia, supporting a possible sister-group relationship with extant beardfishes.

Dirofilarosis is spreading among dogs and humans in Europe with infections being established in many countries. Here, we describe the first molecular biologically confirmed case of D. repens infection in an imported dog in Denmark and highlight the potential zoonotic aspects from this emerging zoonotic parasite in central and northern Europe as at least one to two generations of Dirofilaria spp. can occur per year in Denmark.

Play is a non-invasive, safe, and inexpensive intervention that can help children and adolescents better manage difficult aspects of hospitalisation. Play has existed in hospitals for decades but is emerging as an interdisciplinary scientific field. The field concerns all medical specialties and healthcare professionals working with children. In this review, we describe play within different clinical contexts and recommend that directed and non-directed play activities should be prioritised in future paediatric departments. We also emphasise the need for professionalisation and research in the area.

Objective To describe 1) the proportion of patients with knee osteoarthritis (OA) undergoing guideline-adherent core treatments until six months after primary referral to an orthopaedic surgeon, 2) which specific treatment pathways these patients undertake and 3) the characteristics of patients choosing different treatment pathways. Design This prospective cohort study consecutively invited patients referred to an orthopaedic surgeon due to knee OA at two Danish hospitals from October 2018 to December 2020. Before and six months after consulting the surgeon, patients answered a questionnaire reporting which treatments they had received for knee OA. The proportion receiving the combination of guideline-adherent treatments (i.e., exercise, education, and dietary weight management if needed) was determined. We evaluated the specific treatment usage before and until six months after the consultation and investigated characteristics of patients undertaking different pathways. Results Out of 5251 eligible patients, 2574 (49%) had complete data and were included in analyses. 23% received guideline-adherent treatments, 10% had no treatment. Patients underwent 1143 unique treatment pathways, 62% including treatments not recommended/recommended against. Those who underwent guideline-adherent pathways had similar characteristics to those who did not but tended to be females, retired, had longer-lasting knee problems, have comorbidities, and higher education levels. Conclusions Only one in four patients with knee OA received treatment adhering to clinical guidelines before and six months after consulting the surgeon. Patients used many different treatment pathways. There is a need for a structured effort to increase the use of guideline-adherent core treatments., Objective: To describe 1) the proportion of patients with knee osteoarthritis (OA) undergoing guideline-adherent core treatments until six months after primary referral to an orthopaedic surgeon, 2) which specific treatment pathways these patients undertake and 3) the characteristics of patients choosing different treatment pathways. Design: This prospective cohort study consecutively invited patients referred to an orthopaedic surgeon due to knee OA at two Danish hospitals from October 2018 to December 2020. Before and six months after consulting the surgeon, patients answered a questionnaire reporting which treatments they had received for knee OA. The proportion receiving the combination of guideline-adherent treatments (i.e., exercise, education, and dietary weight management if needed) was determined. We evaluated the specific treatment usage before and until six months after the consultation and investigated characteristics of patients undertaking different pathways. Results: Out of 5251 eligible patients, 2574 (49%) had complete data and were included in analyses. 23% received guideline-adherent treatments, 10% had no treatment. Patients underwent 1143 unique treatment pathways, 62% including treatments not recommended/recommended against. Those who underwent guideline-adherent pathways had similar characteristics to those who did not but tended to be females, retired, had longer-lasting knee problems, have comorbidities, and higher education levels. Conclusions: Only one in four patients with knee OA received treatment adhering to clinical guidelines before and six months after consulting the surgeon. Patients used many different treatment pathways. There is a need for a structured effort to increase the use of guideline-adherent core treatments. Trial Identifiers: Registration: NCT03746184, Protocol: PMID: 34233992.

Importance Young children often fall ill, leading to concern among their caregivers and urgent contact with health care services. Objective To assess the effectiveness and safety of video tutorials to empower caregivers in caring for acutely ill children. Design, Setting, and Participants Caregivers calling the out-of-hours Medical Helpline 1813 (MH1813), Emergency Medical Services Capital Region, Denmark, and their children aged 0.5 to 11.9 years were randomized to video tutorials (intervention) or telephone triage by a nurse or physician (control) from October 2020 to December 2021 and followed up for 72 hours blinded to the intervention. Data were analyzed from March to July 2022. Intervention The intervention group had the call disconnected before telephone triage and received video tutorials on managing common symptoms in acutely ill children and when to seek medical help. Caregivers could subsequently call MH1813 for telephone triage. Main outcomes and measures The primary outcome was caregivers’ self-efficacy, reported in an electronic survey the following day. Secondary outcomes were satisfaction, child status, assessment by a general practitioner or physician at the hospital, telephone triage, and adverse events during the 72-hour follow-up period. Results In total, 4686 caregivers and children were randomized to intervention (2307 participants) or control (2379 participants), with a median (IQR) child age of 2.3 (1.3-5.1) years and 53% male distribution in both groups (2493 participants). Significantly more caregivers in the intervention group reported high self-efficacy (80% vs 76%; crude odds ratio [OR], 1.30; 95% CI, 1.01-1.67; P = .04). The intervention group received fewer telephone triages during follow-up (887 vs 2374 in the control group). Intention-to-treat analysis showed no difference in secondary outcomes, but per-protocol subanalysis showed fewer hospital assessments when caregivers watched video tu, Importance: Young children often fall ill, leading to concern among their caregivers and urgent contact with health care services. Objective: To assess the effectiveness and safety of video tutorials to empower caregivers in caring for acutely ill children. Design, Setting, and Participants: Caregivers calling the out-of-hours Medical Helpline 1813 (MH1813), Emergency Medical Services Capital Region, Denmark, and their children aged 0.5 to 11.9 years were randomized to video tutorials (intervention) or telephone triage by a nurse or physician (control) from October 2020 to December 2021 and followed up for 72 hours blinded to the intervention. Data were analyzed from March to July 2022. Intervention: The intervention group had the call disconnected before telephone triage and received video tutorials on managing common symptoms in acutely ill children and when to seek medical help. Caregivers could subsequently call MH1813 for telephone triage. Main outcomes and measures: The primary outcome was caregivers' self-efficacy, reported in an electronic survey the following day. Secondary outcomes were satisfaction, child status, assessment by a general practitioner or physician at the hospital, telephone triage, and adverse events during the 72-hour follow-up period. Results: In total, 4686 caregivers and children were randomized to intervention (2307 participants) or control (2379 participants), with a median (IQR) child age of 2.3 (1.3-5.1) years and 53% male distribution in both groups (2493 participants). Significantly more caregivers in the intervention group reported high self-efficacy (80% vs 76%; crude odds ratio [OR], 1.30; 95% CI, 1.01-1.67; P =.04). The intervention group received fewer telephone triages during follow-up (887 vs 2374 in the control group). Intention-to-treat analysis showed no difference in secondary outcomes, but per-protocol subanalysis showed fewer hospital assessments when caregivers watched video tutorials (27% vs 35%; adjusted OR, 0.6

Background It is unknown if patients are relieved of pain after knee arthroplasty revision for unexplained pain. The aim of this cross-sectional case-control study was to compare patient-reported outcome measures (PROMs) and satisfaction 1 to 3 years after revision of total knee arthroplasties (TKAs) for the indications of unexplained pain versus aseptic loosening. Methods We included 384 patients undergoing TKA revision for the indications of unexplained pain and aseptic loosening from January 1, 2018 to December 31, 2020 from the Danish Knee Arthroplasty Register. A total of 81 patients were revised for unexplained pain and 303 for aseptic loosening. Questionnaires including PROMs (Oxford Knee Score, EQ-5D-5L, and Forgotten Joint Score) and satisfaction with the surgery on a 0-100 scale (100 = not satisfied; 0 = very satisfied) were sent to digitally secured mailboxes. Time from revision to data collection was a median 3.1 years (range, 1.4-4.4 years). Results Median Oxford Knee Score was 25 (interquartile range [IQR] 15) versus 31 (IQR 18) 1-3 years after revisions for unexplained pain versus aseptic loosening, P = .009. Median EQ-5D-5L was 0.6 (IQR 0.4) versus 0.8 (IQR 0.3) for unexplained pain versus aseptic loosening, P = .009. Median Forgotten Joint Score was 50 (IQR 7) versus 50 (IQR 16) for unexplained pain versus aseptic loosening, P = .905. Satisfaction was 75 (IQR 38) for unexplained pain and 50 (IQR 73) for aseptic loosening, P < .001. Conclusion Patients undergoing TKA revision for the indication of unexplained pain had worse results on PROMs than those revised for aseptic loosening. Likewise, patients revised for unexplained pain were less satisfied compared to patients revised for aseptic loosening. This information is valuable to both surgeons and patients when candidates for revision surgery are selected, to obtain the best possible outcomes., Background: It is unknown if patients are relieved of pain after knee arthroplasty revision for unexplained pain. The aim of this cross-sectional case-control study was to compare patient-reported outcome measures (PROMs) and satisfaction 1 to 3 years after revision of total knee arthroplasties (TKAs) for the indications of unexplained pain versus aseptic loosening. Methods: We included 384 patients undergoing TKA revision for the indications of unexplained pain and aseptic loosening from January 1, 2018 to December 31, 2020 from the Danish Knee Arthroplasty Register. A total of 81 patients were revised for unexplained pain and 303 for aseptic loosening. Questionnaires including PROMs (Oxford Knee Score, EQ-5D-5L, and Forgotten Joint Score) and satisfaction with the surgery on a 0-100 scale (100 = not satisfied; 0 = very satisfied) were sent to digitally secured mailboxes. Time from revision to data collection was a median 3.1 years (range, 1.4-4.4 years). Results: Median Oxford Knee Score was 25 (interquartile range [IQR] 15) versus 31 (IQR 18) 1-3 years after revisions for unexplained pain versus aseptic loosening, P = .009. Median EQ-5D-5L was 0.6 (IQR 0.4) versus 0.8 (IQR 0.3) for unexplained pain versus aseptic loosening, P = .009. Median Forgotten Joint Score was 50 (IQR 7) versus 50 (IQR 16) for unexplained pain versus aseptic loosening, P = .905. Satisfaction was 75 (IQR 38) for unexplained pain and 50 (IQR 73) for aseptic loosening, P < .001. Conclusion: Patients undergoing TKA revision for the indication of unexplained pain had worse results on PROMs than those revised for aseptic loosening. Likewise, patients revised for unexplained pain were less satisfied compared to patients revised for aseptic loosening. This information is valuable to both surgeons and patients when candidates for revision surgery are selected, to obtain the best possible outcomes.