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Hensikten med denne bacheloroppgaven var å få oversikt over hvordan forskjellige faktorer kan påvirke Webex Meetings plattformen og skape dårlig nettkvalitet. Oppgaven består av tre forskjellige scenarioer som omhandler forsinkelse og interferens, og disse ble sammenlignet med et datasett bestående av optimale testdata. Vår analyse fastslo hvorvidt de forskjellige nettverkskonseptene som denne oppgaven omhandler påvirker en dårlig nettforbindelse, samt hvordan de forskjellige videometrikkene i Webex Meetings-klienten ble påvirket av disse. The purpose of this thesis was to gain insight into what happens to the Webex Meetings platform when it is affected by a poor network connection. Three different test scenarios containing a variable degree of network interference and latency were conducted, and these were correlated between using a baseline data set. Our analysis determined which networking concepts within this thesis become a contributing factor when conditions become subpar, and how they affect different video metrics within the Webex Meetings client.

Background and aimsNo prior randomized controlled trial (RCT) has reported patient outcomes of large over-the-scope clip (OTSC) compared to standard hemostasis as initial endoscopic treatment of severe NVUGIB. This was our study aim.MethodsPatients with bleeding ulcers or Dieulafoy's lesions and major stigmata of hemorrhage - SRH (active spurting bleeding, visible vessel, or clot) - or lesser SRH (oozing bleeding or flat spots - with arterial blood flow by Doppler probe) were randomized to OTSC or standard endoscopic hemostasis (with hemoclips or multipolar electrocoagulation - MPEC). Patients and their healthcare providers were blinded to treatments and made all post-randomization management decisions. Ulcer patients received high dose intravenous infusions of proton pump inhibitors (PPI) for 3 days, then 27 days of oral PPI. 30 day outcomes were prospectively recorded; data management was with SAS; and data analysis was by a statistician.Results53 patients (25 OTSC, 28 Standard) were randomized, with similar baseline risk factors. However, there were significant differences in OTSC vs. Standard groups in rates of rebleeding (4% vs. 28.6%; p= .017; relative risk 0.10, 95% confidence intervals 0.01, 0.91; number needed to treat 4); severe complications (0 % vs. 14.3%); and post-randomization units of red cell transfusions (0.04 vs. 0.68). All rebleeds occurred in patients with major SRH and none with lesser SRH.Conclusion1. OTSC significantly reduced rates of rebleeding, severe complications, and post-randomization red cell transfusions. 2. Patients with major stigmata benefited significantly from hemostasis with OTSC, but those with lesser stigmata did not. (ClinicalTrials.gov, Number: NCT03065465).

Hayley Lewthwaite,1,2 Dennis Jensen,3– 5 Magnus Ekström6 1School of Environmental & Life Sciences, College of Engineering, Science and Environment, University of Newcastle, Ourimbah, Australia; 2UniSA: Allied Health and Human Performance, Innovation, Implementation and Clinical Translation in Health, University of South Australia, Adelaide, Australia; 3Department of Kinesiology and Physical Education, McGill University, Montréal, Québec, Canada; 4Research Institute of the McGill University Health Centre, Faculty of Medicine, McGill University, Montréal, Québec, Canada; 5Research Centre for Physical Activity and Health, Faculty of Education, McGill University, Montréal, Canada; 6Faculty of Medicine, Department of Clinical Sciences Lund, Respiratory Medicine and Allergology, Lund University, Lund, SwedenCorrespondence: Hayley LewthwaiteSchool of Environmental & Life Sciences, College of Engineering, Science and Environment, University of Newcastle, Ourimbah, AustraliaTel +612 498 54582Email Hayley.Lewthwaite@newcastle.edu.auAbstract: Activity-related breathlessness is the most problematic symptom of chronic obstructive pulmonary disease (COPD), arising from complex interactions between peripheral pathophysiology (both pulmonary and non-pulmonary) and central perceptual processing. To capture information on the breathlessness experienced by people with COPD, many different instruments exist, which vary in applicability depending on the purpose and context of assessment. We reviewed common breathlessness assessment instruments, providing recommendations around how to assess the severity of, or change in, breathlessness in people with COPD in daily life or in response to exercise provocation. A summary of 14 instruments for the assessment of breathlessness severity in daily life is presented, with 11/14 (79%) instruments having established minimal clinically importance differences (MCIDs) to assess and interpret breathlessness change. Instruments varied in their scope of assessment (functional impact of breathlessness or the severity of breathlessness during different activities, focal periods, or alongside other common COPD symptoms), dimensions of breathlessness assessed (uni-/multidimensional), rating scale properties and intended method of administration (self-administered versus interviewer led). Assessing breathlessness in response to an acute exercise provocation overcomes some limitations of daily life assessment, such as recall bias and lack of standardized exertional stimulus. To assess the severity of breathlessness in response to an acute exercise provocation, unidimensional or multidimensional instruments are available. Borg’s 0– 10 category rating scale is the most widely used instrument and has estimates for a MCID during exercise. When assessing the severity of breathlessness during exercise, measures should be taken at a standardized submaximal point, whether during laboratory-based tests like cardiopulmonary exercise testing or field-based tests, such as the 3-min constant rate stair stepping or shuttle walking tests. Recommendations are provided around which instruments to use for breathlessness assessment in daily life and in relation to exertion in people with COPD.Keywords: dyspnea, dyspnoea, measurement, COPD

Hintergrund Ein beeinträchtigter Gang ist von großer Bedeutung für die Lebensqualität von Patienten mit Huntington Erkrankung (HD). Objektive gemessene Gangparameter dienen einer unabhängigen Beurteilung motorischer Defizite, um Diagnosestellung und Therapieevaluation zu unterstützen und als potentieller Endpunkt zukünftiger klinischer Studien zu fungieren. Zielsetzung Identifizieren charakteristischer Gangeigenschaften von Patienten mit HD durch mobile, sensorbasierte Ganganalyse. Die Gangparameter wurden unter anderem mit den etablierten klinischen Skalen Unified Huntington´s Disease Rating Scale Total Motor Score (UHDRS TMS) und Total Functional Capacity (TFC) korreliert. Methoden Patienten mit manifester HD (n = 43) wurden an zwei deutschen Zentren eingeschlossen und im Zuge ihrer jährlichen ENROLL-HD Visite klinisch untersucht. Ein Timed Up-and-Go Test (TUG) und eine Falls Efficiacy Scale wurden erhoben, um funktionale Mobilität und Selbstwahrnehmung des Sturzrisikos zu erfassen. Zudem absolvierten Patienten und Kontrollprobanden (n = 43) definierte Gangaufgaben (inkl. 4 x 10 m Gehstrecke). Sensoren an der Ferse beider Schuhe zeichneten dabei Schrittmuster auf. Mithilfe von Algorithmen maschinellen Lernens wurden spatio-temporale Gangparameter errechnet. Die Gangvariabilität wurde als Variabilitätskoeffizient ausgegeben. Ergebnisse Während Schrittlänge, Ganggeschwindigkeit und Schwungzeit reduziert waren, waren Schritt- und Standzeit der Patienten mit HD erhöht. Überdies war die Gangvariabilität gesteigert und zeigte signifikante Korrelationen zu TMS und TFC. Die objektiven Gangdaten korrelierten mit dem Krankheitsstadium nach TFC und der funktionalen Mobilität gemäß TUG. Sturzangst stand in Zusammenhang mit ausgeprägten Beeinträchtigungen des Ganges. Verlaufsmessungen der Gangparameter spiegelten den Progress der HD gemäß der TFC tendenziell wider. Fazit Von Sensoren abgeleitete Parameter der Gangvariabilität wurden als klinisch relevanteste digitale Biomarker für Beeinträchtigungen des Ganges bei der HD identifiziert. Eine veränderte Gangvariabilität repräsentiert die charakteristische Irregularität im Gang der HD und reflektiert deren Schweregrad entsprechend klinischen und funktionalen Messungen. Background Impaired gait plays an important role for quality of life in patients with Huntington’s disease (HD). Measuring objective gait parameters in HD might provide an unbiased assessment of motor deficits in order to support diagnosis and therapy monitoring and may serve as potential outcome measure in future clinical trials. Objective To objectively identify characteristic features of gait in HD patients using mobile sensor-based gait analysis. Gait parameters were correlated to the well-established clinical rating scales such as the Unified Huntington’s Disease Rating Scale Total Motor Score (UHDRS TMS) and Total Functional Capacity (TFC). Methods Patients with manifest HD (n = 43) at two German sites were included and clinically assessed during their annual ENROLL-HD visit. Timed Up-and-Go test (TUG) and Falls Efficiacy Scale were carried out to evaluate functional mobility and perceived risk of falling. In addition, patients with HD and a cohort of age- and gender-matched controls (n = 43) performed defined gait tests (incl. 4 x 10 m walk). Gait patterns were recorded by inertial sensors laterally attached to the heels of both shoes. Machine learning algorithms were applied to calculate spatio-temporal gait parameters and gait variability expressed as coefficient of variance. Results While stride length, gait velocity and swing time were reduced, stride and stance time were increased in patients with HD. Moreover, parameters reflecting gait variability were substantially altered in HD patients and showed strong correlations to TMS and TFC. Objective gait parameters correlated with disease stage based upon TFC and functional mobility as estimated by the TUG. Fear of falling correlated with pronounced gait impairment. Longitudinal gait measurements tended to mirror disease progression according to TFC. Conclusions Gait variability was identified as clinically most relevant digital biomarker for gait impairment in HD. Altered gait variability represents the characteristic irregularity of gait in HD and reflects disease severity in conjunction with clinical and functional measurements.

This thesis was scanned from the print manuscript for digital preservation and is copyright the author. Researchers can access this thesis by asking their local university, institution or public library to make a request on their behalf. Monash staff and postgraduate students can use the link in the References field.

BACKGROUND: The 3-minute constant-rate stair stepping (3-min CRSST) and constant-speed shuttle tests (3-min CSST) were developed to assess breathlessness in response to a standardized exercise stimulus. Estimating the rate of oxygen consumption (V’O(2)) during these tests would assist clinicians to relate the stepping/shuttle speeds that elicit breathlessness to daily physical activities with a similar metabolic demand. This study: (I) developed equations to estimate the V’O(2) of these tests in people with chronic obstructive pulmonary disease (COPD); and (II) compared the newly developed and American College of Sports Medicine (ACSM) metabolic equations for estimating the V’O(2) of these tests. METHODS: This study was a retrospective analysis of people with COPD who completed a 3-min CRSST (n=98) or 3-min CSST (n=69). Multivariate linear regression estimated predictors (alpha

Background:Impaired gait plays an important role for quality of life in patients with Huntington’s disease (HD). Measuring objective gait parameters in HD might provide an unbiased assessment of motor deficits in order to determine potential beneficial effects of future treatments. Objective:To objectively identify characteristic features of gait in HD patients using sensor-based gait analysis. Particularly, gait parameters were correlated to the Unified Huntington’s Disease Rating Scale, total motor score (TMS), and total functional capacity (TFC). Methods: Patients with manifest HD at two German sites (n = 43) were included and clinically assessed during their annual ENROLL-HD visit. In addition, patients with HD and a cohort of age- and gender-matched controls performed a defined gait test (4 × 10m walk). Gait patterns were recorded by inertial sensors attached to both shoes. Machine learning algorithms were applied to calculate spatio-temporal gait parameters and gait variability expressed as coefficient of variance (CV). Results:Stride length (− 15%) and gait velocity (− 19%) were reduced, while stride (+ 7%) and stance time (+ 2%) were increased in patients with HD. However, parameters reflecting gait variability were substantially altered in HD patients (+ 17% stride length CV up to + 41% stride time CV with largest effect size) and showed strong correlations to TMS and TFC (0.416 ≤ rSp ≤ 0.690). Objective gait variability parameters correlated with disease stage based upon TFC. Conclusions:Sensor-based gait variability parameters were identified as clinically most relevant digital biomarker for gait impairment in HD. Altered gait variability represents characteristic irregularity of gait in HD and reflects disease severity. This work was supported by the Mobilise-D project that has received funding from the Innovative Medicines Initiative 2 Joint Undertaking under grant agreement No. 820820. This Joint Undertaking receives support from the European Union's Horizon 2020 research and innovation program and the European Federation of Pharmaceutical Industries and Associations (EFPIA). Content in this publication reflects the authors’ view and neither IMI nor the European Union, EFPIA, or any Associated Partners are responsible for any use that may be made of the information contained herein.

This study described the participation in daily and social activities and the perceived barriers and facilitators to participation of individuals with chronic obstructive pulmonary disease (COPD). Individuals, recruited from outpatient clinics, responded to a survey on their participation in, and barriers and facilitators towards, 26 daily and social activities, divided into 3 categories: (1) physical activity and movement (PAM); (2) self-care; and (3) social engagement. For each activity, chi-square analyses were used to examine participation differences by individuals’: quartiles of airflow obstruction [percent predicted forced expiratory volume in 1 second (FEV1%predicted)] and breathlessness burden and exacerbation risk. Of the 200 participants (47% women; mean ± standard deviation age = 68 ± 9 years), most wanted to increase their participation in PAM activities (range 21–75%) and significant differences were found in 5/10 PAM activities for individuals’ breathlessness burden and exacerbation risk (e.g., more individuals than expected in group A (modified Medical Research Council breathlessness score participated in regular exercise as much as they wanted (χ(9) 2=20.43, Cramer’s V=.23)). Regardless of the degree of airflow obstruction or breathlessness burden and exacerbation risk, the most common barrier to participation was breathlessness (p2 p=.86) and the most common facilitator was engaging as part of their routine (p2 p=.75). Individuals with COPD want to increase their participation in daily and social activities but are limited by breathlessness. Strategies to alleviate breathlessness should be identified/prioritized and incorporated into individuals’ daily routines to meet their self-reported participation objectives in daily and social activities.

Supplemental material, Reviewer_1_v.1 for Relieving exertional dyspnea during the 3-min constant speed shuttle test in patients with COPD with indacaterol/glycopyrronium versus tiotropium: the RED trial by Jessie Beaulieu, Dennis Jensen, Denis E. O’Donnell, Cynthia Brouillard, Lauren Tracey, Sandra Vincent, Éric Nadreau, Emmanuelle Bernard, Sarah Bernard and François Maltais in Therapeutic Advances in Respiratory Disease

Supplemental material, Reviewer_2_v.1 for Relieving exertional dyspnea during the 3-min constant speed shuttle test in patients with COPD with indacaterol/glycopyrronium versus tiotropium: the RED trial by Jessie Beaulieu, Dennis Jensen, Denis E. O’Donnell, Cynthia Brouillard, Lauren Tracey, Sandra Vincent, Éric Nadreau, Emmanuelle Bernard, Sarah Bernard and François Maltais in Therapeutic Advances in Respiratory Disease

Objective The objective of this review was to summarize the current best evidence for the effectiveness, feasibility, user compliance and safety of exercise-based games (EBGs), including virtual reality and interactive video game interventions, for the rehabilitation of individuals with neurological disorders at home. Material and methods We identified randomized controlled trials (RCT) evaluating the effects of EBGs in neurological patients in home settings by searching 3 electronic databases (MEDLINE, SCOPUS, CENTRAL Library) from inception to March 2018. All data pertaining to participants, interventions, outcomes, supervision and cost-effectiveness were independently extracted by 2 reviewers. Risk of bias was independently assessed by 2 reviewers. Results Reports of 11 RCT studies with heterogeneous populations (i.e., stroke, Parkinson disease and multiple sclerosis) were included in the review. The treatment of experimental groups included EBGs (i.e., commercially available games such as Nintendo Wii or Dance Dance Revolution or custom-designed devices), and control groups received a controlled (i.e., conventional therapy) or uncontrolled (i.e., usual care) intervention. Across studies, EBGs at home tended to have limited effects on upper and lower limbs. We demonstrated an increased risk of participants dropping out of the program or discontinuing training in experimental groups (n = 51 participants) as compared with controls (n = 23 participants). Few adverse events (2 of 6 studies), such as minor musculoskeletal pain, were reported in balance training. Conclusions This systematic review reveals that EBGs seem a relevant alternative for rehabilitation at home because the effectiveness of these interventions was at least equivalent to conventional therapy or usual care. We give recommendations for the development of new EBG therapies.

Non-variceal upper gastrointestinal bleeding remains an important emergency condition, leading to significant morbidity and mortality. As endoscopic therapy is the 'gold standard' of management, treatment of these patients can be considered in three stages: pre-endoscopic treatment, endoscopic haemostasis and post-endoscopic management. Since publication of the Asia-Pacific consensus on non-variceal upper gastrointestinal bleeding (NVUGIB) 7 years ago, there have been significant advancements in the clinical management of patients in all three stages. These include pre-endoscopy risk stratification scores, blood and platelet transfusion, use of proton pump inhibitors; during endoscopy new haemostasis techniques (haemostatic powder spray and over-the-scope clips); and post-endoscopy management by second-look endoscopy and medication strategies. Emerging techniques, including capsule endoscopy and Doppler endoscopic probe in assessing adequacy of endoscopic therapy, and the pre-emptive use of angiographic embolisation, are attracting new attention. An emerging problem is the increasing use of dual antiplatelet agents and direct oral anticoagulants in patients with cardiac and cerebrovascular diseases. Guidelines on the discontinuation and then resumption of these agents in patients presenting with NVUGIB are very much needed. The Asia-Pacific Working Group examined recent evidence and recommends practical management guidelines in this updated consensus statement.

Bidraget har som sit overordnede formål at tilvejebringe en vurdering af, om tiden er moden til at indføre en generel omgåelsesklausul i dansk skattelovgivning. Ved diskussion heraf tages der udgangspunkt i den iagttagelse, at det generelle EU-retlige misbrugsprincip på både et skrevet og uskrevet grundlag nu har vundet indpas i enkelte dele af dansk skatteret. Bidragets analyser fordrer derfor også en overordnet principiel redegørelse for karakteren af dette misbrugsprincip samt indplacering af princippet i en teoretisk kontekst i forhold til de øvrige retsfigurer, der potentielt kan bringes i anvendelse til imødegåelse af aggressiv skatteplanlægning.

Background and aimsFor more than 4 decades endoscopists have relied on ulcer stigmata for risk stratification and as a guide to hemostasis. None used arterial blood flow underneath stigmata to predict outcomes. For patients with severe peptic ulcer bleeding (PUB), we used a Doppler endoscopic probe (DEP) for (1) detection of blood flow underlying stigmata of recent hemorrhage (SRH), (2) quantitating rates of residual arterial blood flow under SRH after visually directed standard endoscopic treatment, and (3) comparing risks of rebleeding and actual 30-day rebleed rates for spurting arterial bleeding (Forrest [F] IA) and oozing bleeding (F IB).MethodsProspective cohort study of 163 consecutive patients with severe PUB and different SRH.ResultsAll blood flow detected by the DEP was arterial. Detection rates were 87.4% in major SRH-spurting arterial bleeding (F IA), non-bleeding visible vessel (F IIA), clot (F IIB)-and were significantly lower at 42.3% (P < .0001) for an intermediate group of oozing bleeding (F IB) or flat spot (F IIC). For spurting bleeding (F IA) versus oozing (F IB), baseline DEP arterial flow was 100% versus 46.7%, residual blood flow detected after endoscopic hemostasis was 35.7% versus 0%, and 30-day rebleed rates were 28.6% versus 0% (all P < .05).Conclusions(1) For major SRH versus oozing or spot, the arterial blood flow detection rate by the DEP was significantly higher, indicating a higher rebleed risk. (2) Before and after endoscopic treatment, spurting (F IA) PUB had significantly higher rates of blood flow detection than oozing (F IB) PUB and a significantly higher 30-day rebleed rate. (3) The DEP is recommended as a new endoscopic guide with SRH to improve risk stratification and potentially definitive hemostasis for PUB.

It follows explicitly from the EC VAT Directive that the deduction of input VAT depends on a positive link between on the one hand the incurred expenses and on the other hand the planned or actually completed taxed output transactions. In theory and in practice the deeper nature of this link, however, constantly gives rise to uncertainty, and thus also uncertainty in relation to the necessary distinction between direct costs and overhead costs. The purpose of this article is to analyse the recent case-law of the Court of Justice of the European Union (ECJ) with a view to assessing the status of the relevant test used when establishing the link between a taxable person´s different input and output transactions.

Momslovens kapitel 3, som omfatter §§ 4-13, omhandler afgrænsningen af de afgiftspligtige transaktioner. Der er tre typer af afgiftspligtige transaktioner. Først og fremmest de almindelige leveringer mod vederlag her i landet i henhold til § 4. Herudover er der to særlige typer af afgiftspligtige transaktioner, som begge angår køb af varer fra udlandet. For det første afgiftspligtig erhvervelse af varer fra andre EU-lande i henhold til § 11, og for det andet afgiftspligtig indførsel af varer fra lande, som ligger uden for EU (tredjelande), i henhold til § 12. I kapitel 3 findes der desuden regler, som statuerer momspligt i et videre omfang end efter de almindelige regler. Det gør sig bl.a. gældende ved byggeri for egen regning, overførsel af varer til andre EU-lande samt udtagning af varer og ydelser til bl.a. privatforbrug. Sådanne transaktioner sidestilles efter omstændighederne med levering mod vederlag og bliver dermed omfattet af afgiftspligten i henhold til ML § 4. Endelig indeholder kapitel 3 en lang række specifikke momsfritagelser i § 13. Såfremt en afgiftspligtig transaktion er omfattet af en af disse fritagelser, vil transaktionen alligevel ikke medføre momspligt.

I Momskommentarens kapitel 3 gennemføres en analyse af momslovens § 13, der indeholder en lang række komplekse momsfritagelser. I den forbindelse redegøres der for sammenhængen mellem momssystemdirektivet og momsloven.

Momslovens kapitel 3, som omfatter §§ 4-13, omhandler afgrænsningen af de afgiftspligtige transaktioner. Der er tre typer af afgiftspligtige transaktioner. Først og fremmest de almindelige leveringer mod vederlag her i landet i henhold til § 4. Herudover er der to særlige typer af afgiftspligtige transaktioner, som begge angår køb af varer fra udlandet. For det første afgiftspligtig erhvervelse af varer fra andre EU-lande i henhold til § 11, og for det andet afgiftspligtig indførsel af varer fra lande, som ligger uden for EU (tredjelande), i henhold til § 12. I kapitel 3 findes der desuden regler, som statuerer momspligt i et videre omfang end efter de almindelige regler. Det gør sig bl.a. gældende ved byggeri for egen regning, overførsel af varer til andre EU-lande samt udtagning af varer og ydelser til bl.a. privatforbrug. Sådanne transaktioner sidestilles efter omstændighederne med levering mod vederlag og bliver dermed omfattet af afgiftspligten i henhold til ML § 4. Endelig indeholder kapitel 3 en lang række specifikke momsfritagelser i § 13. Såfremt en afgiftspligtig transaktion er omfattet af en af disse fritagelser, vil transaktionen alligevel ikke medføre momspligt.

I den momsretlige regulering gives der mulighed for at sektoropdele diversificerede virksomheder med henblik på at sikre en mere retvisende grad af fradragsret. Selvom sektoropdelingsinstituttet siden de oprindelige EU-direktivers vedtagelse i 1967 på fakultativt grundlag har været en del af det fælleseuropæiske momssystem, har instituttet imidlertid ikke hidtil været genstand for megen opmærksomhed fra hverken EU-Domstolens eller nationale domstoles side. Der kan heller ikke i den foreliggende retslitteratur findes nogen nærmere analyse af sektoropdelingsinstituttets potentielle anvendelsesområde og øvrige problemfelter. I de senere års nationale administrative praksis kan der dog spores en stigende interesse for muligheden for at sektoropdele virksomheder; dette gælder ikke mindst i relation til den finansielle sektor. Nærværende artikel har i forlængelse heraf og med udgangspunkt i grundlæggende momsretlige principper til formål at analysere dels sektorbegrebet og dels begrebet "sektorspecifikke udgifter" med henblik på mere præcist at fastlægge de principielle karakteristika, der kendetegner virksomheder, hvor sektoropdeling kan og bør finde anvendelse. Som et naturligt modstykke hertil vil analysen også klargøre, hvornår sektoropdeling ikke bør appliceres.

De momsretlige konsekvenser af overdragelse af aktier og andele har til stadighed givet anledning til betydelig usikkerhed. EU-domstolens seneste præjudicielle afgørelse i sag C-29/08, AB SKF om dette emne har desværre ikke reduceret denne usikkerhed, men synes blot at føje et nyt kapitel til sagaen. Nærværende artikel har imidlertid ikke til formål at analysere AB SKF sagen, men blot at undersøge, hvilke implikationer dommen har haft for den danske retsanvendelse i relation til salg af aktier og andele.

In revealing the conditions for the deduction of input VAT, the essential questions concern the nature of the so-called ‘direct and immediate link’ test and thus also the criteria for the important distinction between direct costs and general costs. The ‘direct and immediate link’ test is of general importance to all types of costs, but judged from the case law of the ECJ it has especially materialised itself when it comes to costs related to the acquisition, holding or sales of shares. The purpose of this article is therefore twofold. On the one hand it deals with the difficult question of distinguishing between direct and general costs. On the other hand the aim is to describe and analyse the law as it stands regarding the treatment of shares in the EU VAT system, with a special focus on the right to deduct input VAT on costs re-lating to transactions in shares. As a part of this analysis the aim is also to pinpoint questions regarding transactions in shares that are still unanswered by the ECJ.

Although frequently reported, it is unknown whether pathological reports of ischemia obtained from gastroduodenal biopsies suggest a diagnosis, prognosis or a requirement for additional evaluation. The aim of this study was to review the natural history, clinical presentation, endoscopic appearance, treatments, and major clinical outcomes of patients with gastroduodenal ischemia. A case series of 14 patients with variable etiologies (seven gastric and seven duodenal) was obtained from a search of our endoscopic pathological database for reports of histological ischemia. The results were as follows. The most common presentation was upper gastrointestinal bleeding (71 %). Half of the endoscopic lesions appeared very severe (large or circumferential lesions, exudative, pseudomembranous, black or pale mucosa). There were six cases of rebleeding (43 %) and four deaths (29 %). Computed tomography scanning was frequently used (12 cases, 86 %), but led to an underlying diagnosis in only three cases. In our series, patients with underlying vascular pathology have substantial 6-month mortality (29 %).

The main part of the article is devoted to a critical analysis of the optional transfer pricing provisions in the EC VAT Directive in the light of the principle of fiscal neutrality. As an integrated part of this analysis, the VAT transfer pricing regime is considered in the light of the well-known principles for transfer pricing in the area of income tax law, as set out in Art. 9 of the OECD Model Tax Convention. The last part of the article contains a brief discussion of to which extent it is desirable to harmonize the two tax systems´ transfer pricing rules.

I bidraget præsenteres først en analyse af mulighederne for tilsidesættelse af skattearrangementer baseret på realitetsbetragtninger. I naturlig forlængelse heraf undersøges mulighederne for tilsidesættelse baseret på det EU-retlige misbrugsprincip. Herefter redegøres der for konsekvenserne af tilsidesættelse ud fra henholdsvis realitets- og misbrugsbetragtninger. Afslutningsvist diskuteres det, i hvilket omfang det EU-retlige misbrugsprincip kan finde anvendelse på national lovgivning, der er udtryk for implementering af EU-direktiver.

Den 21. juni afsagde Højesteret dom i SKM2010.396.HR. Sagen omhandler en dansk virksomhed, der havde benyttet sig af et såkaldt grænsehandelskoncept i forbindelse med salg af jet-både til danske kunder. I modsætning til Landsskatteretten og Vestre Landsret når Højesteret frem til, at der skal svares dansk moms i forbindelse med salget af jet-bådene og ikke tysk moms, som det ellers var forudsat af de involverede aktører. Nærværende artikel sigter primært på at analysere højesteretsdommen, men indeholder herudover også en kritisk analyse af en nyere kendelse fra Landsskatteretten, der ligeledes omhandler den momsretlige behandling af grænsehandelskoncepter.