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BackgroundUnderstanding individual health literacy needs is crucial when designing supportive and effective health care. However, tools assessing health literacy in practice are lacking. The Conversational Health Literacy Assessment Tool (CHAT) was recently developed, but its ability to assess health literacy remains unexplored. We aimed to investigate the implementation and adoption of CHAT, its ability to increase awareness of health literacy among healthcare providers, and if CHAT could assess health literacy needs in patients.MethodsWe performed a qualitative feasibility study of CHAT among healthcare providers (nurses, physiotherapists and occupational therapists) who provide rehabilitation services for patients with noncommunicable diseases in a municipal healthcare centre in Denmark. The study used the RE‐AIM framework (Reach, Effectiveness, Adoption, Implementation and Maintenance) to structure interview guide and analysis. We collected qualitative data from four small focus groups with healthcare providers (n = 11). The data were analysed using a deductive thematic three‐step method for organising and interpreting data. All informants provided written informed consent prior to data collection.ResultsCHAT seems to be a feasible and efficient tool for assessing health literacy needs among individuals with different socio‐demographic characteristics and with different diagnoses. CHAT was easiest implemented and adopted by healthcare providers, who were already familiarly with the concept of health literacy. The informants emphasised that an introduction to CHAT and health literacy as concept was valuable for the adoption. Some of them felt frustrated that they did not have opportunity and options to meet the health literacy needs identified by CHAT.ConclusionsCHAT is a promising tool for assessing individual health literacy needs and increasing awareness of health literacy among healthcare providers. For successfully implementation of CHAT, we recommend developing a structured implementation programme, including an introduction to health literacy and an outline of the options for acting upon CHAT results.

This thesis will provide an analysis of Toni Morrison's The Bluest Eye (1970) and God Help the Child (2015) in light of historical context and gothic literary tropes, with the main focus on shame and the black body, violence and the inheritance of shame in families. I will show how an intertextual gothic reading of characters highlights the structural problems of racism in the shadow of slavery and racist violence. My methodical approach is close reading of passages and characters in the two novels, and I will also draw some parallels to other works by Morrison. My theoretical framework is current gothic and African American literary theory and Morrison’s own academic writing. First, I take a close look at the two narratives separately in light of gothic tropes and internalized shame. Secondly, I analyze inherited shame, representations of violence and the doubling of characters from the two novels. Finally, I look at Morrison’s narrative resistance to systemic racism.

Additional file 1. Fig. S1. Seeding and staining controls for OHCS experiment. a, b) C57BL/6J OHCS injected with sterile PBS (a) or monomeric α-Syn (b) do not show any aggregation either at injection site (DG) or elsewhere at 7 dpi, as detected by conformation-specific MJF-14 (green) and pSer129 (11A5, red). Scale bars = 20 μm (a), 100 μm (b). c) Injection of PFF in α-Syn knockout OHCS does not result in any aggregate pathology at 7 dpi, due to the lack of endogenous α-Syn needed to template aggregation. Conformation-specific MJF-14 (green) was used to detect pathology. Scale bar = 100 μm. Fig. S2. Unilateral intramuscular injection of PFF elicits higher pSer129 insult in the ipsilateral lumbar DRG compared to the contralateral side. Threemonth-old TgM83+/− mice were injected with full-length (1-140) mouse α-Syn PFF (n=4) in the right hindlimb (ipsilateral, in red) or vehicle in the left hindlimb (PBS pH 7.4, contralateral, in blue). a) Proteins from lumbar DRG (L3-L5) homogenates were separated by SDS-PAGE and visualized by immunoblotting with anti-α-Syn antibody, anti-pSer129-α-Syn, anti-b-actin, and anti-b-III tubulin. b) Densitometry quantification of immunoblots as a ratio of pSer129/total α-Syn. Results are shown as mean ± SEM, as determined by one-way ANOVA followed by Tukey’s multiple comparison test. *P < 0.05. Fig. S3. Immunofluorescence detection of astrogliosis in relation to pSer129-α-Syn pathology in lumbar spinal cord, midbrain periaqueductal grey and thalamus of vehicle- injected M83 mice. a) pSer129-α-Syn(in green) co-detection with neuronal nuclei antigen (NeuN, in red) in vehicle-injected mice in dorsal (DH) and ventral (VH) and horn of lumbar spinal cord. b) pSer129-α-Syn (in green) and glial fibrillary acidic protein marker (GFAP, in red) immunoreactivity in DH and VH of lumbar spinal cord, c) midbrain periaqueductual grey (MB-PAG) and d) thalamus. DAPI (blue) was used to stain the nuclei. Scale bar = 100 μm; insets in merge show 63X magnified views. Fig. S4. Immunofluorescence quantification of astrogliosis in lumbar and ventral horn of the spinal cord, midbrain periaqueductal grey (PAG) and thalamus in vehicle and PFF- injected M83 mice. Quantification was performed on 10X views using Zen software (Zeiss). DAPI was used as a cell marker, GFAP quantitation is expressed as GFAP+ cells/mm2 in the indicated regions. Results shown as mean ± SEM as determined by ordinary one-way ANOVA followed by multiple comparison test. ***P < 0.001; ****P < 0.0001. VH, ventral horn, DH, dorsal horn, PAG, periaqueductal grey, thalamus ventroposterior. Fig. S5. Immunofluorescence for pSer129-α-Syn pathology in lumbar spinal cord of PFF- injected M83 mice. pSer129-α-Syn immunoreactivity (in green) in the dorsal (DH) and ventral (VH) horns, and the intermediate grey (IG), with 20X magnified views of grey matter (red rectangles) and white matter (yellow rectangles) as overlayimages at a) at 14 dpi and b) 21 dpi. I-X represent Rexed laminae; CC, central canal. DAPI (blue) was used to stain the nuclei.Scale bar 100 μm.

Additional file of Trans-synaptic spreading of alpha-synuclein pathology through sensory afferents leads to sensory nerve degeneration and neuropathic pain

Background and objectives: Chronic pancreatitis (CP) is a debilitating fibro-inflammatory disease with a profound impact on patients’ quality of life (QOL). We investigated determinants of QOL in a large cohort of CP patients. Methods: This was a multicentre study including 517 patients with CP. All patients fulfilled the EORTC QLQ-C30 questionnaire. Questionnaire responses were compared to results obtained from a general reference population (n = 11,343). Demographic characteristics, risk factors (smoking and alcohol consumption), pain symptoms, disease phenotype (complications) and treatments were recorded. A multivariable regression model was used to identify factors independently associated with QOL scores. Results: Included patients had a mean age of 56.3 ± 12.8 years, 355 (69%) were men and 309 (60%) had alcohol aetiology. Compared to the reference population, patients with CP had lower global health status (50.5 vs. 66.1; p < 0.001) as well as reduced scores for all functional scales (all p < 0.001). Additionally, CP patients reported a higher burden for all symptom items, with pain being the most prominent complaint (all p < 0.001). Constant pain (coefficient −11.3; p = 0.02), opioid based pain treatment (coefficient −19.7; p < 0.001) and alcoholic aetiology (coefficient −5.1; p = 0.03) were independently associated with lowered global health status. The final multivariable model explained 18% of the variance in global health status. Conclusions: Patients with CP have significantly lower QOL compared to a population-based reference population. Factors independently associated with a lowered QOL are constant pain, opioid based pain treatment and alcohol aetiology. However, these factors only explain a fraction of QOL and additional factors need identification.

Supplemental material, sj-pdf-1-ueg-10.1177_2050640620901973 for Multiple risk factors for diabetes mellitus in patients with chronic pancreatitis: A multicentre study of 1117 cases by Søren S Olesen, Jakob L Poulsen, Srdan Novovic, Camilla Nøjgaard, Evangelos Kalaitzakis, Nanna M Jensen, Trond Engjom, Erling Tjora, Anne Waage, Truls Hauge, Stephan L Haas, Miroslav Vujasinovic, Giedrius Barauskas, Aldis Pukitis, Imanta Ozola-Zālīte, Alexey Okhlobystin, Mikael Parhiala, Johanna Laukkarinen and Asbjørn M Drewes in United European Gastroenterology Journal

Supplemental material, sj-pdf-1-ueg-10.1177_2050640620901973 for Multiple risk factors for diabetes mellitus in patients with chronic pancreatitis: A multicentre study of 1117 cases by Søren S Olesen, Jakob L Poulsen, Srdan Novovic, Camilla Nøjgaard, Evangelos Kalaitzakis, Nanna M Jensen, Trond Engjom, Erling Tjora, Anne Waage, Truls Hauge, Stephan L Haas, Miroslav Vujasinovic, Giedrius Barauskas, Aldis Pukitis, Imanta Ozola-Zālīte, Alexey Okhlobystin, Mikael Parhiala, Johanna Laukkarinen and Asbjørn M Drewes in United European Gastroenterology Journal

Additional file 1. SPIRIT Checklist.

With the postmodernist realignment of our epistemological foundations, contemporary documentary has come to be marked by the idea that problematizing the relationship with the real is inherently good and progressive, and that the core quality of contemporary documentary has come to be its suspicion towards its own relationship to the real (Steyerl 2011; Rangan 2014; Takahashi 2015). In a time, which the assertion of the indiscernibility between fact and fiction has been appropriated by discourses of power I will argue that the facticity of reality needs our attention and care more than our suspicion. Thus, following philosophical proposals for a new empiricism (Latour 2004; Haraway 1988), and a Bazinian ontologization of cinema (Bazin 2005a, 2005b), I will argue for the persistence of observational documentary and a new critical realism set in the vein of contemporary observational documentary practises like Lucien Castaing-Taylor and Véréna Paravel’s Leviathan (2012) and Kevin Jerome Everson’s Tonsler Park (2017)., Diffractions, n. 1 (2019): Suspicion

Through a quantitative content analysis of 4548 comments from the American based online community Reddit, the thesis tries to shed a light on whether or not the users obtain more power over the news process by taking over a series of journalistic core functions, like setting an agenda or intervening in the gatekeeping process. By transferring the content analysis from earlier studies of online media (Milioni et al. 2012) as far as possible; and from the social network Facebook (Eberholst & Hartley 2014), the thesis provides knowledge about how the users of Reddit use the technologies of the internet and the actions of the platform to break with the role as a passive audience. The thesis concludes that the content on Reddit’s front page often times is characterized by having few sources , by being short in format and generally downplaying complexity. This corresponds with one of this thesis’ main theoretical approaches by Poell & van Dijcks and their criticism of how social media insinuate a certain behavior in its users, resulting in an increased priority on less complex news. The content analysis of the comment reel on a selection of posts from the front page of Reddit shows that the users contribute with new information, and often times set an agenda themselves, independently of the articles on which they comment. Doing this the users use the opportunities of web 2.0. The platform provides the audience with the structural possibilities of action to take over a series of the journalistic core functions, from which they were previously cut off. This corresponds with this thesis’ second main theoretical approach by Axel Bruns who agitates for the possibility of users of gate watching sites to approach news like unfinished artefacts or “open news”. Even so, this thesis argues that this “producer”-role is not able to free the users of new types of gate keepers and the knowledge hierarchies that they work in. In this fashion a complex game takes place between the administrations decisions on how to organize and prioritize UGC through algorithms and possible technological actions, and the users own submissions and voting. The users have more power to get involved in the gate keeping processes and set a new agenda, all the while being subjugated by series of twisted structures and choices outside their own influence, affecting their actions.

A general overview is given of the causes of anemia with iron deficiency as well as the pathogenesis of anemia and the para-clinical diagnosis of anemia. Anemia with iron deficiency but without overt GI bleeding is associated with a risk of malignant disease of the gastrointestinal tract; upper gastrointestinal cancer is 1/7 as common as colon cancer. Benign gastrointestinal causes of anemia are iron malabsorption (atrophic gastritis, celiac disease, chronic inflammation, and bariatric surgery) and chronic blood loss due to gastrointestinal ulcerations. The following diagnostic strategy is recommended for unexplained anemia with iron deficiency: conduct serological celiac disease screening with transglutaminase antibody (IgA type) and IgA testing and perform bidirectional endoscopy (gastroscopy and colonoscopy). Bidirectional endoscopy is not required in premenopausal women < 40 years of age. Small intestine investigation (capsule endoscopy, CT, or MRI enterography) is not recommended routinely after negative bidirectional endoscopy but should be conducted if there are red flags indicating malignant or inflammatory small bowel disease (e.g., involuntary weight loss, abdominal pain or increased CRP). Targeted treatment of any cause of anemia with iron deficiency found on diagnostic assessment should be initiated. In addition, iron supplementation should be administered, with the goal of normalizing hemoglobin levels and replenishing iron stores. Oral treatment with a 100-200 mg daily dose of elemental iron is recommended (lower dose if side effects), but 3-6 months of oral iron therapy is often required to achieve therapeutic goals. Intravenous iron therapy is used if oral treatment lacks efficacy or causes side effects or in the presence of intestinal malabsorption or prolonged inflammation. Three algorithms are given for the following conditions: a) the paraclinical diagnosis of anemia with iron deficiency; b) the diagnostic work-up for unexplained anemia with iron deficiency without overt bleeding; and c) how to proceed after negative bidirectional endoscopy of the gastrointestinal tract.

Trust-based management is a popular trend in public sector management. After decades of New Public Management-reforms based on distrust between public sector agents, trust is now rediscovered in a functional perspective as a method of reducing transaction costs and increasing social capital. This thesis explores how trust-based management is implemented as a management concept in the municipality of Copenhagen through a case study of a cluster of day-care and afterschool centres that have been exempted from selected parts of the municipal regulation. Based on Scandinavian institutionalism and on methods of interviews and participant observation the case study analyses how trust-based management is translated in the local context and how this reflects back on the concept. The exemption of regulation aims to reduce bureaucracy and paperwork to make room for professional innovation. However the thesis concludes that this goal is not met. Instead the local actors turn the concept to meet their own needs and so existing agendas is ascribed to the concept. The case study shows a risk of ‘projectification’ of trust. Trust-based management is a very flexible and vague concept and as such it is in high risk of undergoing radical transformation in the local translation. The theory of trust-based management is proclaimed to be in opposition of prevalent top-down management concepts, but as the case study shows, an introduction of trust-related projects is no guarantee of increasing trust nor does it necessarily involve a ‘bottom-up’-perspective.

A new reform has come into force in the Danish Folkeskole, which means that a great deal of organizational modifications has to be implemented. This process of implementation, led by the school principal, can mean a radical change for teachers as well as supervisors. Prior to the new reform, the Danish Folkeskole teachers partook in a conflict facilitated by their trade union – a conflict that ultimately resulted in a lockout. This incident has caused severe dissatisfaction among the Danish Folkeskole teachers who believe that the decision was forced upon them. Consequently, considering this background history and adding a reform with a short time period for adaption, this thesis presumes that internal critique in the Danish Folkeskole has unfavourable conditions. This thesis investigates assumptions about critique in interpersonal communication between the teachers and the principal of a school north of Copenhagen. The empiricism of the thesis is constituted of individual interviews with four teachers and one principal from said school. This thesis aims to discuss the role of the critique-assumptions in the school’s organizational development. Already existing research within the field critique in organizations, including possibilities and limitations for having one’s say in a work context as well as critical reflection in organizations, makes up a theoretical point of departure for the thesis’ analysis. The theory section is largely divided into two sections: limitations to and possibilities for critique in organizations. These sections support and facilitate the numerous pages of transcriptions by asking the question: where do the informants express the possibilities of critique and when do they verbalize the limitations of critique in interpersonal communication? Through anecdotes and examples from the informants’ work lives, the analysis proceeds to examine the teachers’ and the principal’s assumptions of critique. The thesis finds that a great amount of limitations of critique are perceived among the interviewees. This can to some extend be ascribed to the fact that the school principal does not regard critique to be progressive and that she does not see potential for development in the critical reflection. As the primary change agent and bearer of cultural values in the organization, the principal risks depicting critique as illegitimate to her employees by setting forth these negative assumptions.

In the upcoming spring semester the e-learning tool ‘Blackboard’ is replacing campusnet as the current e-learning tool at the business administration and economics programme in the course “Information systems for Business’’. There have been several complications with the implementation and use of Blackboard in the “Information system for Business” course in the program Management Marketing and Communication (MMC). This article has identified the possible pitfalls of implementing an e-tool in this specific context, and has found that implementing Blackboard in ISB culture was not successful, due to lack of involving staff in implementation process, communicating the benefits of the tool, and the tool not being compatible with ISB culture.

Mols Bjerge National Park was established in 2009 as one out of three national parks in Denmark, soo far. Most of the surface of the the park is landbased, and 80% of this is privately owned. The landscape of the park has been shaped by several glacial advances during the last ice‐age, and consists of coastal cliffs, flat plains and lateral moraine, among others. The areas have been cultivated since the middleage, but around the year 1700, intensive land use was abandoned on the most washed out and sandy soils. Some of these areas have been used for grazing, and today they harbour the naturetype grasslands. The town of Ebeltoft is situated within the limits of the park; and a cultural environment in the shape of an old maltfactory lies within the town. This report seeks to investigate the objectives concerning culture and nature listed in the basis for Mols Bjerge National Park, and try to uncover how differences in interests and views on nature affect the fulfillment of these objectives. We have chosen to take our starting point in two cultural environments, the maltfactory in Ebeltoft, and the grasslands in the core‐area of Mols Bjerge National Park. The investigation is based on theory of views on Side 2 af 81 nature, geografical observation in the two cultural environments as well as interviews with three key persons i relation to the maltfactory and the grasslands. The report discusses the weighting between use and conservation of nature and cultural management within the park.

Serotonin 2C receptors are G protein-coupled receptors expressed by GABAergic, glutamatergic, and dopaminergic neurons. Anatomically, they are present in various brain regions, including cortical areas, hippocampus, ventral midbrain, striatum, nucleus accumbens, hypothalamus, and amygdala. A large body of evidence supports a critical role of serotonin 2C receptors in mediating the interaction between serotonergic and dopaminergic systems, which is at the basis of their proposed involvement in the regulation of mood, affective behavior, and memory. In addition, their expression in specific neuronal populations in the hypothalamus would be critical for their role in the regulation of feeding behavior. Modulation of these receptors has therefore been proposed to be of interest in the search for novel pharmacological strategies for the treatment of various pathological conditions, including schizophrenia and mood disorders, as well as obesity. More precisely, blockade of serotonin 2C receptors has been suggested to provide antidepressant and anxiolytic benefit, while stimulation of these receptors may offer therapeutic benefit for the treatment of psychotic symptoms in schizophrenia and obesity. In addition, modulation of serotonin 2C receptors may offer cognitive-enhancing potential, albeit still a matter of debate. In the present review, the most compelling evidence from the literature is presented and tentative hypotheses with respect to existing controversies are outlined.

Specialet undersøger, hvordan køn konstrueres blandt unge trænere i dansk elitesport. Til undersøgelsen er der udviklet et brætspil, som i specialet fungerer som interviewmetode.

Aggregated α-synuclein (α-syn) accumulates in the neuronal Lewy body (LB) inclusions in Parkinson's disease (PD) and LB dementia. Yet, under nonpathological conditions, monomeric α-syn is hypothesized to exist in an equilibrium between disordered cytosolic- and partially α-helical lipid-bound states: a feature presumably important in synaptic vesicle release machinery. The exact underlying role of α-syn in these processes, and the mechanisms regulating membrane-binding of α-syn remains poorly understood. Herein we demonstrate that Protein kinase R (PKR) can phosphorylate α-syn at several Ser/Thr residues located in the membrane-binding region that is essential for α-syn's vesicle-interactions. α-Syn phosphorylated by PKR or α-syn isolated from PKR overexpressing cells, exhibit decreased binding to lipid membranes. Phosphorylation of Thr64 and Thr72 appears as the major contributor to this effect, as the phosphomimetic Thr64Glu/Thr72Glu-α-syn mutant displays reduced overall attachment to brain vesicles due to a decrease in vesicle-affinity of the last two thirds of α-syn's membrane binding region. This allows enhancement of the “double-anchor” vesicle-binding mechanism that tethers two vesicles and thus promote the clustering of presynaptic vesicles in vitro. Furthermore, phosphomimetic Thr64Glu/Thr72Glu-α-syn inhibits α-syn oligomerization and completely abolishes nucleation, elongation, and seeding of α-syn fibrillation in vitro and in cells, and prevents trans-synaptic spreading of aggregated α-syn pathology in organotypic hippocampal slice cultures. Overall, our findings demonstrate that normal and abnormal functions of α-syn, like membrane-binding, synaptic vesicle clustering and aggregation can be regulated by phosphorylation, e.g., via PKR. Mechanisms that could potentially be modulated for the benefit of patients suffering from α-syn aggregate-related diseases.