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Helle Lund,1,2 Mogens Vyberg,1,2 Helle Højmark Eriksen,3 Anni Grove,1 Annette Østergaard Jensen,1 Lone Sunde4,5 1Institute of Pathology, Aalborg University Hospital, Aalborg, Denmark; 2Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; 3Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark; 4Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark; 5Department of Biomedicine, Aarhus University, Aarhus, Denmark Purpose: To examine the validity of registration of hydatidiform mole (HM) in the Danish National Patient Registry (NPR), the Danish Cancer Registry (DCR), and the Danish Pathology Registry (DPR).Patients and methods: We selected women registered with a first-time HM code in NPR, DCR, and DPR from 1999 to 2009. We found most women registered in DPR. For a random sample of women registered in DPR, the coding was validated by comparing with the pathology report. Completeness and positive predictive value (PPV) of registration with an HM code in NPR and DCR were calculated using DPR as the reference. Details of women registered in NPR or DCR, but not in DPR, were scrutinized.Results: In NPR and DPR, 1,520 women were identified in total; 1,057 (70%) were found in both registries, 65 (4%) only in NPR, and 398 (26%) only in DPR. In DCR and DPR, 1,498 women were identified in total; 1,174 (78%) in both registries, 47 (3%) only in DCR, and 277 (19%) only in DPR. For 149/150 randomly selected women registered with an HM code in DPR (99%), the pathology report was consistent with the diagnosis of HM. Completeness of NPR was 73% (95% CI: 70%–75%) and PPV was 94% (95% CI: 93%–95%). Completeness of DCR was 72% (95% CI: 69%–75%) in 1999–2003 and 90% (95% CI: 87%–92%) in 2004–2009. PPV of DCR was 96% (95% CI: 95%–97%) throughout the period.Conclusion: Validation of registry data is important before using these. For research on the number of HMs in Denmark, DPR is the most valid data source. NPR and DCR appear to be equally valid before 2004. However, for research after 2004, DCR should be preferred rather than NPR. Keywords: epidemiology, completeness, positive predictive value, complete hydatidiform mole, partial hydatidiform mole, agreement

Background: Adherence to recommendations for osteoarthritis (OA) care can be measured using quality indicators (QI). In previous research differences related to the study design or the QI items make it challenging to directly compare the results. This EULAR funded study is the first that has applied the same set of QI items across four European countries. Objectives: To assess and compare patient perceived quality of OA management in primary health care in Denmark, Norway, Portugal, and the United Kingdom. Methods: Participants consulting general practitioners with clinical signs and symptoms of knee OA were identified in 30 general practices and invited to complete a cross-sectional survey including 14 QIs for OA care. A QI was considered as eligible if the participant had checked "Yes" or "No", and as achieved if the participant had checked "Yes" to the indicator. The median percentage of eligible QIs achieved by country was determined and compared using negative binomial regression analyses. Achievement of individual QIs by country was determined and compared using logistic regression analyses. Results: A total of 354 participants self-reported QI achievement. For the total sample, the median percentage of QIs achieved (checked 'Yes') was 48% (IQR 28% to 64%; range 0-100%). By country, the median percentage of QIs achieved was relatively similar across three of the countries, but significantly lower in Denmark (23%) compared to Norway (50%) even after adjustment for age, gender, BMI and comorbidity (rate ratio 0.49; 0.39, 0.62). For individual QIs related to different aspects of OA care, significant differences in self-reported achievement rates between the four countries were seen (Table 1). Achievement rates on individual QIs showed a large variation ranging from 0% ("referral to services for losing weight" & "functional assessments" in Denmark) to 83% ("information about the importance of exercise" in Norway). Compared to Norway, the achievement rates were significantly lower for 10 QIs in Denmark, 2 QIs in Portugal and 1 QI in the UK, whereas UK had significantly higher achievement rates than Norway for 5 QIs. Conclusions: The results revealed a potential for improvement in OA care in all four countries, but for somewhat different aspects of OA care. By exploring these differences and comparing health care services across countries, ideas may be generated on how the quality of OA care might be improved. Larger studies are needed to confirm and further explore the findings in this study. (Table Presented).

Background Activity pacing is a recommended non-pharmacological intervention for the management of rheumatic and musculoskeletal diseases in international clinical guidelines. In clinical practice, activity pacing aims at adapting daily activities, and is often an important component of self-management programs. However, despite its wide endorsement in clinical practice, to date activity pacing is still a poorly understood concept. \ud Objectives To achieve consensus by means of an international Delphi exercise on the most important aspects of activity pacing as an intervention within non-pharmacological rheumatology care. \ud Methods An international, multidisciplinary expert panel comprising 60 clinicians and/or healthcare providers experienced with activity pacing across 12 different countries participated in a Delphi survey. Over four Delphi rounds, the panelists identified and ranked the most important goals of activity pacing, behaviours of activity pacing (the actions people take to meet the goal of activity pacing), strategies to change behaviour in activity pacing (for example goal setting) and contextual factors that should be acknowledged when instructing activity pacing. Besides, topics for future research on activity pacing were formulated and prioritized. \ud Results Of the 60 panelists, nearly two third (63%) completed all four Delphi rounds. The panel prioritized 9 goals, 11 behaviours, 9 strategies to change behaviour and 10 contextual factors of activity pacing. These items were integrated into a consensual list containing the most important aspects of activity pacing interventions in non-pharmacological rheumatology care. Furthermore, the Delphi panel prioritized 9 topics for future research on activity pacing which were included in a research agenda. This agenda highlights that future research should focus on the effectiveness of activity pacing interventions and on appropriate outcome measures to assess its effectiveness, as selected by 64% and 82% of the panelists, respectively. \ud Conclusions The diversity and number of items included in the consensual list developed in the current study reflect the heterogeneity of the concept of activity pacing. This study is an important first step to achieve better transparency and homogeneity within the concept of activity pacing for clinical practice and research.

Estimates of forest area vary according to source and definition. How forest is defined can influence how deforestation, reforestation and afforestation can be interpreted. This paper, for example, illustrates some of the difference for estimates of forest land in Turkey and the Food and Agriculture Organization (FAO) of the United Nations and how different definitions of forest may be interpreted for deforestation, reforestation, and afforestation. Lastly I provide some suggestions for developing clearer definitions. Forest, deforestation, reforestation, afforestation, Turkey., Orman alanına ilişkin tahminler çeşitli kaynaklarda değişik tanımlara göre farklılık arzeder. Ormanın nasıl tanımlandığı ormansızlaşma, tekrar ormanlaştırma ve ormanlaştırmanın nasıl yorumlanabileceğini de etkileyebilir. İşte bu makale, Türkiye’de orman sahalarına ilişkin tahminlerin FAO’dan farklılıklarını ve ormanın farklı tanımlarının ormansızlaşma, tekrar ormanlaştırma ve ormanlaştırma açısından nasıl yorumlanabileceğini örneklendirmektedir. Ardından, daha açık tanımlar geliştirmeye yönelik bazı öneriler ortaya koyuyorum. Keywords:Orman, ormansızlaşma, tekrar (yeniden) ormanlaştırma, ormanlaştırma, Türkiye.

OBJECTIVE: To identify the optimal exercise program, characterized by type and intensity of exercise, length of program, duration of individual supervised sessions, and number of sessions per week, for reducing pain and patient-reported disability in knee osteoarthritis (OA).METHODS: A systematic review and meta-analysis of randomized controlled trials were performed. Standardized mean differences (SMDs) were combined using a random-effects model. Study-level covariates were applied in meta-regression analyses in order to reduce between-study heterogeneity.RESULTS: Forty-eight trials were included. Similar effects in reducing pain were found for aerobic, resistance, and performance exercise (SMD 0.67, 0.62, and 0.48, respectively; P = 0.733). These single-type exercise programs were more efficacious than programs that included different exercise types (SMD 0.61 versus 0.16; P < 0.001). The effect of aerobic exercise on pain relief increased with an increased number of supervised sessions (slope 0.022 [95% confidence interval 0.002, 0.043]). More pain reduction occurred with quadriceps-specific exercise than with lower limb exercise (SMD 0.85 versus 0.39; P = 0.005) and when supervised exercise was performed at least 3 times a week (SMD 0.68 versus 0.41; P = 0.017). No impact of intensity, duration of individual sessions, or patient characteristics was found. Similar results were found for the effect on patient-reported disability.CONCLUSION: Optimal exercise programs for knee OA should have one aim and focus on improving aerobic capacity, quadriceps muscle strength, or lower extremity performance. For best results, the program should be supervised and carried out 3 times a week. Such programs have a similar effect regardless of patient characteristics, including radiographic severity and baseline pain.

Screening for prostate cancer has been advocated by a number of organisations largely because there is good evidence that administration of the test for prostate specific antigen (PSA) results in the detection of cancers at an early stage. However, the mere fact that a cancer can be detected earlier in its natural history by screening is no guarantee that benefit will follow. Further, screening for prostate cancer can substantially impair the quality of life of those with detected and treated cancer, that would not otherwise have reduced life expectancy. The only established mechanism to evaluate the efficacy of screening is the randomised controlled trial. In this paper we review the trials contributing to our collaboration, the advantages that will flow from them, and the reasons why decisions on the introduction of population-based screening for prostate cancer cannot be made before these trials have come to fruition.

This Special issue deals with the Energy Systems Engineering as a part Computer Aided Process Engineering. In this editorial introduction, the editors are highlighting the individual articles presented and discussed in this issue. Main areas of this issue can be summarised as follows: Process Integration including Total Sites, exergy, distributed energy production and consumption, energy production and generation control and energy related environmental impact.

The emerging concepts regarding bioproducts from lignocellulosics are very suitable for existing pulp manufacturing facilities, to take advantage of infrastructure and process integration. The LignoDeco project is a partnership among 5 countries (Brazil, Finland, Denmark, Spain and France – Fig. 1), promoted by the EC FP7 programme. It focus on the development of pre-treatments for deconstruction of high productivity and fast-growing Brazilian eucalypt clones and elephant grass, aiming at production of special pulps and bioproducts, using modern analytical techniques for in-depth identification of the changes produced in the main plant polymers. The project is now on the 30th month and resulted 3 patents, 12 peer-reviewed papers, 28 oral/visual presentations, and many other dissemination activities., Proceedings of the 20th European Biomass Conference and Exhibition, 18-22 June 2012, Milan, Italy, pp. 1211-1215

The routine use of CT in 51 consecutive patients with squamous cell carcinoma of the larynx revealed cartilage involvement or extra-laryngeal tumor growth consistent with a T4 tumor which made 14 patients candidates for laryngectomy. Only 5 of these had a T4 classification by clinical examination while 8 cases were upstaged from T3. Except for one supraglottic tumor upstaged from T2 to T4, CT did not change the classification for T1 and T2 tumors, Whose localization was mainly glottic, and there were 2 false-negative examinations. It is concluded that CT is mandatory only in advanced tumors of the glottic region or when the anterior commissure is involved. However, in suspected malignancies of the sub- or supraglottic regions CT should always be carried out because these patients are at an increased risk of unexpected deep tumor growth.

IEEE Computer Society Press.

Cambridge, MA: MIT press

The problem of the validity of simulation is particularly relevant for methodologies that use machine learning techniques to develop control systems for autonomous robots, as, for instance, the artificial life approach known as evolutionary robotics. In fact, although it has been demonstrated that training or evolving robots in real environments is possible, the number of trials needed to test the system discourages the use of physical robots during the training period. By evolving neural controllers for a Khepera robot in computer simulations and then transferring the agents obtained to the real environment we show that (a) an accurate model of a particular robot-environment dynamics can be built by sampling the real world through the sensors and the actuators of the robot; (b) the performance gap between the obtained behaviors in simulated and real environments may be significantly reduced by introducing a “conservative” form of noise; (c) if a decrease in performance is observed when the system is transferred to a real environment, successful and robust results can be obtained by continuing the evolutionary process in the real environment for a few generations.

Vaasa, Finlandia: University Press

INTRODUCTION:The aim of the study was to evaluate the incidence of recurrence of local cancer, distant metastases and survival after conventional low anterior resection for cure in patients with rectal carcinoma, on the basis of the poor prognosis after colorectal cancer in Denmark.MATERIAL AND METHODS:Consecutive patients operated on in the nine Danish departments of surgical gastroenterology in 1992-1993. Retrospective collection of data on recurrence of local cancer, distant metastases, and over-all survival at the end of 1996.RESULTS:Of 268 patients, 77 (29%) developed recurrent local cancer and/or distant metastases. Forty-eight (18%) had local recurrence with a cumulative 5-year rate of 39%. Distant metastases were seen in 54 (20%). The local recurrence rate increased with increasing Dukes' tumour stage and was higher after operation by a non-specialist (30%) than by a consultant, another specialist, or a surgeon under training and supervised by a consultant (15-17%) (p = 0.04). Multiple regression showed that the recurrence rate was independent of tumour localisation, blood loss, transfusion, anastomotic leakage, and status of the surgeon. The cumulative crude 5-year survival was 50% and independent of the status of the surgeon.DISCUSSION:Our relatively high local recurrence rate and the results in the literature after total mesorectal excision (TME) indicate that the conventional technique should be replaced by TME, which has become the recommended method in recent years. Furthermore, we propose a changed strategy in the treatment of rectal cancer. The patients should be treated in fewer departments with established teams of rectal cancer specialists taking part in all operations for rectal cancer. INTRODUCTION: The aim of the study was to evaluate the incidence of recurrence of local cancer, distant metastases and survival after conventional low anterior resection for cure in patients with rectal carcinoma, on the basis of the poor prognosis after colorectal cancer in Denmark.MATERIAL AND METHODS: Consecutive patients operated on in the nine Danish departments of surgical gastroenterology in 1992-1993. Retrospective collection of data on recurrence of local cancer, distant metastases, and over-all survival at the end of 1996.RESULTS: Of 268 patients, 77 (29%) developed recurrent local cancer and/or distant metastases. Forty-eight (18%) had local recurrence with a cumulative 5-year rate of 39%. Distant metastases were seen in 54 (20%). The local recurrence rate increased with increasing Dukes' tumour stage and was higher after operation by a non-specialist (30%) than by a consultant, another specialist, or a surgeon under training and supervised by a consultant (15-17%) (p = 0.04). Multiple regression showed that the recurrence rate was independent of tumour localisation, blood loss, transfusion, anastomotic leakage, and status of the surgeon. The cumulative crude 5-year survival was 50% and independent of the status of the surgeon.DISCUSSION: Our relatively high local recurrence rate and the results in the literature after total mesorectal excision (TME) indicate that the conventional technique should be replaced by TME, which has become the recommended method in recent years. Furthermore, we propose a changed strategy in the treatment of rectal cancer. The patients should be treated in fewer departments with established teams of rectal cancer specialists taking part in all operations for rectal cancer.

CD-ROM with databases and software included CD-Rom avec bases de données et logiciels inclus; International audience

CD-ROM with databases and software included; CD-Rom avec bases de données et logiciels inclus; International audience

This randomized, double-blind, double-dummy parallel study compared the anti-emetic efficacy and tolerability of the serotonin antagonist granisetron with prednisolone plus the dopamine D2 antagonist metopimazine during nine cycles of moderately emetogenic chemotherapy. Chemotherapy naive women with stage I or II breast cancer scheduled to intravenous cyclophosphamide, fluorouracil and methotrexate or cyclophosphamide, epirubicin and fluorouracil every 3 weeks were included. Patients received a single intravenous dose of granisetron 3 mg or a 3-day oral treatment with prednisolone 25 mg once a day plus metopimazine 30 mg four times a day. A total of 223 women were enrolled and 218 patients (97.8%) were evaluable for efficacy. Granisetron (n = 109) was superior to prednisolone plus metopimazine (n = 109) in the prophylaxis of acute nausea and vomiting during the first cycle of chemotherapy (P < 0.001) and prednisolone plus metopimazine was superior on days 2–5 (P = 0.002). Overall, granisetron was superior on days 1–5 (P = 0.009). The median number of cycles completed with granisetron was five (95% confidence interval 4–6) compared with two (95% confidence interval 2–2) for prednisolone plus metopimazine (P = 0.0019). Constipation and rash were reported more frequently with granisetron (P < 0.001 and P = 0.043 respectively) and palpitations more frequently with prednisolone plus metopimazine (P = 0.015). In conclusion, the number of cycles completed with granisetron was significantly higher than the number completed with prednisolone plus metopimazine, but the anti-emetic efficacy of both treatments declined during multiple cycles of moderately emetogenic chemotherapy. © 1999 Cancer Research Campaign