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Er is een relatie tussen vermoeidheid van piloten en (bijna) ongevallen in de luchtvaart. Dit heeft vooral te maken met vliegroosters van de bemanning en vooral van piloten, waardoor men veel uren maakt, met veel onregelmatigheid te maken heeft, tijdzones passeert, en onvoldoende mogelijkheden heeft om te slapen. Hierdoor is er niet alleen sprake van acute effecten van vermoeidheid, maar ook van opbouw van chronische vermoeidheid. Op de korte termijn zijn zowel de gevolgen van acute als van chronische vermoeidheid een gevaar voor de vliegveiligheid. Met name chronische vermoeidheid kan ook ernstige gezondheidsschade opleveren. Maatregelen om de acute gevolgen van vermoeidheid tegen te gaan zijn effectief op de korte termijn, maar zijn onvoldoende om de chronische vermoeidheid tegen te gaan. Hiervoor moet structureel rekening gehouden worden met het gezond plannen van roosters, zodat daadwerkelijk herstel optreedt.

Er is een relatie tussen vermoeidheid van piloten en (bijna) ongevallen in de luchtvaart. Dit heeft vooral te maken met vliegroosters van de bemanning en vooral van piloten, waardoor men veel uren maakt, met veel onregelmatigheid te maken heeft, tijdzones passeert, en onvoldoende mogelijkheden heeft om te slapen. Hierdoor is er niet alleen sprake van acute effecten van vermoeidheid, maar ook van opbouw van chronische vermoeidheid. Op de korte termijn zijn zowel de gevolgen van acute als van chronische vermoeidheid een gevaar voor de vliegveiligheid. Met name chronische vermoeidheid kan ook ernstige gezondheidsschade opleveren. Maatregelen om de acute gevolgen van vermoeidheid tegen te gaan zijn effectief op de korte termijn, maar zijn onvoldoende om de chronische vermoeidheid tegen te gaan. Hiervoor moet structureel rekening gehouden worden met het gezond plannen van roosters, zodat daadwerkelijk herstel optreedt.

In this paper, a conceptual framework is presented to conduct an ex-ante impact assessment for social innovation. The building blocks for an ex-ante impact assessment are goal formulation; developing the relationships between inputs, outputs and outcomes; determining the role of stakeholders to achieve the objectives; calculating the impact; and deciding on the social innovation. These building blocks are sequentially interconnected to each other. In the paper, we present the experience of three cases of social innovation with the framework. The following questions are discussed with results from the three case studies: How can you clarify your social goals and make them more measurable? How can you translate your goals into practical action roadmaps? How do you manage the sponsors and the stakeholders needed in your decision making? What kind of result can you expect from such an ex ante impact assessment? We summarize our lessons for each of these questions. In conclusion, our conceptual framework aims to be a practical guide to both assessor and assessee by structuring the development and decision process. A toolbox has been developed, which consists of a series of steps sprung from our conceptual framework.

In this paper, a conceptual framework is presented to conduct an ex-ante impact assessment for social innovation. The building blocks for an ex-ante impact assessment are goal formulation; developing the relationships between inputs, outputs and outcomes; determining the role of stakeholders to achieve the objectives; calculating the impact; and deciding on the social innovation. These building blocks are sequentially interconnected to each other. In the paper, we present the experience of three cases of social innovation with the framework. The following questions are discussed with results from the three case studies: How can you clarify your social goals and make them more measurable? How can you translate your goals into practical action roadmaps? How do you manage the sponsors and the stakeholders needed in your decision making? What kind of result can you expect from such an ex ante impact assessment? We summarize our lessons for each of these questions. In conclusion, our conceptual framework aims to be a practical guide to both assessor and assessee by structuring the development and decision process. A toolbox has been developed, which consists of a series of steps sprung from our conceptual framework.

Purpose Sense of coherence (SOC) represents coping and can be considered an essential component of mental health. SOC correlates with mental health and personality, but the background of these associations is poorly understood. We analyzed the role of genetic factors behind the associations of SOC with mental health, self-esteem and personality using genetic twin modeling and polygenic scores (PGS). Methods Information on SOC (13-item Orientation of Life Questionnaire), four mental health indicators, self-esteem and personality (NEO Five Factor Inventory Questionnaire) was collected from 1295 Finnish twins at 20–27 years of age. Results In men and women, SOC correlated negatively with depression, alexithymia, schizotypal personality and overall mental health problems and positively with self-esteem. For personality factors, neuroticism was associated with weaker SOC and extraversion, agreeableness and conscientiousness with stronger SOC. All these psychological traits were influenced by genetic factors with heritability estimates ranging from 19 to 66%. Genetic and environmental factors explained these associations, but the genetic correlations were generally stronger. The PGS of major depressive disorder was associated with weaker, and the PGS of general risk tolerance with stronger SOC in men, whereas in women the PGS of subjective well-being was associated with stronger SOC and the PGSs of depression and neuroticism with weaker SOC. Conclusion Our results indicate that a substantial proportion of genetic variation in SOC is shared with mental health, self-esteem and personality indicators. This suggests that the correlations between these traits reflect a common neurobiological background rather than merely the influence of external stressors.

Studies of quality and safety of organic flour and oils for the development of cookies are considered. The objects of the study are samples of organic spelt, corn and coconut flour; and samples of organic oils (camelina and hemp). The purpose of the study is to substantiate the feasibility of using organic raw materials for the development of new cookie recipes. To determine the quality and safety of organic flour, the nutritional value, physicochemical parameters and safety indicators (content of salts of heavy metals) have been analyzed. To determine the quality of organic oils, the fatty acid composition has been analyzed. Standard methods have been used for the study. The moisture content of the flour has been determined by the drying method. Ash content – by the method of organic matter charring. Atomic absorption and flameless atomic absorption methods have been used to determine the safety indicators of the flour. The fatty acid composition of oils has been determined by gas chromatography. It has been proved, that organic raw materials meet the safety requirements of the Regulation of maximum levels of certain contaminants in food, approved by the Order of the Ministry of Health of Ukraine № 368 of 13.05.2013 and can be used as a promising enrichment for the nutritional value of cookies

Snellen, I.A.G. et al., In this White Paper, which was submitted in response to the European Space Agency (ESA) Voyage 2050 Call, we recommend the ESA plays a proactive role in developing a global collaborative effort to construct a large high-contrast imaging space telescope, e.g. as currently under study by NASA. Such a mission will be needed to characterize a sizable sample of temperate Earth-like planets in the habitable zones of nearby Sun-like stars and to search for extraterrestrial biological activity. We provide an overview of relevant European expertise, and advocate ESA to start a technology development program towards detecting life outside the Solar System., I.S. acknowledges funding from the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation program under grant agreement No 694513. A.L.M. acknowledges the financial support of the F.R.S.-FNRS through a postdoctoral researcher grant. MB acknowledges support from the UK Science and Technology Facilities Council (STFC) research grant ST/S000631/1. I.R. acknowledges support from the Spanish Ministry of Science and Innovation and the European Regional Development Fund through grant PGC2018-098153-B-C33, as well as the support of the Generalitat de Catalunya/CERCA programme. E.P. acknowledges support from the Spanish Ministry of Science through grant PGC2018-098153-B-C31. J.M.D. acknowledges funding from the European Research Council (ERC) under the European Unions Horizon 2020 research and innovation programme (grant agreement no. 679633; Exo-Atmos) Part of this research was carried out at the Jet Propulsion Laboratory, California Institute of Technology, under a contract with the National Aeronautics and Space Administration. We acknowledge financial support from the ASI-INAF agreement n.2018-16-HH.0 We acknowledge financial support from Spanish MCIU SEV-2017-0709 and PID2019-110689RB-I00 awards. We acknowledge financial support from the ASI-INAF agreement n.2018-16-HH.0 AV acknowledges funding from the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme (grant agreement No. 757561). KH acknowledges funding from the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme (grant agreement No. 771620). NJM acknowledges funding from the Leverhulme Trust, and a Science and Technology Facilities Council Consolidated Grant (ST/R000395/1). PdV acknowledges funding from the Netherlands Organisation for Scientific Research NWO (Veni Grant No. 639.041.750). IP acknowledges financial support from the ASI-INAF agreements 2019-29-HH.06-HH.0 and 2015-019-R.1-2018. FS acknowledges funding from the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme (grant agreement no. 678194; FALCONER). MJ acknowledges support from the Knut and Alice Wallenberg foundation (KAW). JLB acknowledges funding from the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation program under grant agreement No 805445. T.H. acknowledges support from the European Research Council under the Horizon 2020 Framework Program via the ERC Advanced Grant Origins 83 24 28. JLG acknowledges ISSI Team 464 for useful discussion.

Background: A large number of people suffer from psychosocial or physical problems. Adequate strategies to alleviate needs are scarce or lacking. Symptom variation can offer insights into personal profiles of coping and resilience (detailed functional analyses). Hence, diaries are used to report mood and behavior occurring in daily life. To reduce inaccuracies, biases, and noncompliance with paper diaries, a shift to electronic diaries has occurred. Although these diaries are increasingly used in health care, information is lacking about what determines their use.Objective: The aim of this study was to map the existing empirical knowledge and gaps concerning factors that influence the use of electronic diaries, defined as repeated recording of psychosocial or physical data lasting at least one week using a smartphone or a computer, in health care.Methods: A scoping review of the literature published between January 2000 and December 2018 was conducted using queries in PubMed and PsycInfo databases. English or Dutch publications based on empirical data about factors that influence the use of electronic diaries for psychosocial or physical purposes in health care were included. Both databases were screened, and findings were summarized using a directed content analysis organized by the Consolidated Framework for Implementation Research (CFIR).Results: Out of 3170 articles, 22 studies were selected for qualitative synthesis. Eleven themes were determined in the CFIR categories of intervention, user characteristics, and process. No information was found for the CFIR categories inner (eg, organizational resources, innovation climate) and outer (eg, external policies and incentives, pressure from competitors) settings. Reminders, attractive designs, tailored and clear data visualizations (intervention), smartphone experience, and intrinsic motivation to change behavior (user characteristics) could influence the use of electronic diaries. During the implementation process, attention should be paid to both theoretical and practical training.Conclusions: Design aspects, user characteristics, and training and instructions determine the use of electronic diaries in health care. It is remarkable that there were no empirical data about factors related to embedding electronic diaries in daily clinical practice. More research is needed to better understand influencing factors for optimal electronic diary use.

The aim of this paper is to carry out a brief study of the recent Organic Law 3/2021, of March 24, on the regulation of euthanasia (BOE. March 25, 2021) approved in Spain, from a constitutional perspective, highlighting its main aspects. The matter under study is not exempt from controversy because it covers legal, medical and ethical considerations of great complexity.

The COVID-19 pandemic has been a global phenomenon defined by uncertainty, fear and grief which has resulted in record high levels of stress and anxiety in the first half of 2020. It also led to an increased interest in the study of the role of belief, religion, and spirituality as responses to coping with and responding to the pandemic throughout different societal domains. This study explores the impact of anxiety and stress caused by the pandemic on Muslim academics’ subjective well-being. It also explores correlations between coping and spirituality by assessing Muslim academics’ coping strategies in overcoming stress and anxiety. To this end, this study sampled 480 Muslim academics ages 25–60 years residing in Muslim countries. The findings show a negative yet significant correlation between anxiety and well-being while also showing a positive and significant correlation between coping strategies and subjective well-being. The research also points to the role of coping strategies in reducing anxiety and stress, the resulting improvements in well-being for Muslim academics, and the mediating effect of coping strategies between anxiety, stress, and well-being for Muslim academics. Supplementary Information The online version contains supplementary material available at 10.1007/s10943-021-01422-3.

It is the purpose of child welfare practices to provide a protective environment for minors. However, welfare practices for children and adolescents have also been linked to a higher risk for maltreatment, trauma, and deprivation. Due to such early-life adversity, affected individuals often report a life course depicted by further trauma, socio-economic disadvantage, mental and physical ill-health. Examination of the long-term health correlates of enforced child welfare practices, as well as potential mediators, have previously been neglected in later life. It was therefore the purpose of these studies to examine the long-term correlates of enforced child welfare practices; the associated maltreatment, trauma, and deprivation; and the physical and mental health outcomes in Swiss older survivors (n=132, MAGE=71 years) and an age-matched control group (n=125). These studies further examined the mediating role of socio-economic factors (e.g., education, income), self-esteem, and self-compassion. Mental health was assessed with a structured clinical interview; physical health, self-esteem, and self-compassion with psychometric instruments. Survivors reported significantly more types and severity of childhood maltreatment, trauma, and deprivation than the control group. They also reported significantly more lifetime and current mental health disorders and more physical illnesses. Socio-economic factors and self-esteem, but not self-compassion, acted as significant mediators. Exposure to maltreatment, trauma, and deprivation in childhood and adolescence is linked to poorer mental and physical health in later life. Potential targets for intervention and health-protective measures include socio-economic factors and self-esteem, which were found to diminish the detrimental long-term impact of early-life adversity and disadvantage into later life.

Objectives: To improve clinical lymph node staging (cN-stage) in oesophageal adenocarcinoma by developing and externally validating three prediction models; one with clinical variables only, one with positron emission tomography (PET) radiomics only, and a combined clinical and radiomics model. Methods: Consecutive patients with fluorodeoxyglucose (FDG) avid tumours treated with neoadjuvant therapy between 2010 and 2016 in two international centres (n = 130 and n = 60, respectively) were included. Four clinical variables (age, gender, clinical T-stage and tumour regression grade) and PET radiomics from the primary tumour were used for model development. Diagnostic accuracy, area under curve (AUC), discrimination and calibration were calculated for each model. The prognostic significance was also assessed. Results: The incidence of lymph node metastases was 58% in both cohorts. The areas under the curve of the clinical, radiomics and combined models were 0.79, 0.69 and 0.82 in the developmental cohort, and 0.65, 0.63 and 0.69 in the external validation cohort, with good calibration demonstrated. The area under the curve of current cN-stage in development and validation cohorts was 0.60 and 0.66, respectively. For overall survival, the combined clinical and radiomics model achieved the best discrimination performance in the external validation cohort (X2 = 6.08, df = 1, p = 0.01). Conclusion: Accurate diagnosis of lymph node metastases is crucial for prognosis and guiding treatment decisions. Despite finding improved predictive performance in the development cohort, the models using PET radiomics derived from the primary tumour were not fully replicated in an external validation cohort. Advances in knowledge: This international study attempted to externally validate a new prediction model for lymph node metastases using PET radiomics. A model combining clinical variables and PET radiomics improved discrimination of lymph node metastases, but these results were not externally replicated.

Background A large number of people suffer from psychosocial or physical problems. Adequate strategies to alleviate needs are scarce or lacking. Symptom variation can offer insights into personal profiles of coping and resilience (detailed functional analyses). Hence, diaries are used to report mood and behavior occurring in daily life. To reduce inaccuracies, biases, and noncompliance with paper diaries, a shift to electronic diaries has occurred. Although these diaries are increasingly used in health care, information is lacking about what determines their use. Objective The aim of this study was to map the existing empirical knowledge and gaps concerning factors that influence the use of electronic diaries, defined as repeated recording of psychosocial or physical data lasting at least one week using a smartphone or a computer, in health care. Methods A scoping review of the literature published between January 2000 and December 2018 was conducted using queries in PubMed and PsycInfo databases. English or Dutch publications based on empirical data about factors that influence the use of electronic diaries for psychosocial or physical purposes in health care were included. Both databases were screened, and findings were summarized using a directed content analysis organized by the Consolidated Framework for Implementation Research (CFIR). Results Out of 3170 articles, 22 studies were selected for qualitative synthesis. Eleven themes were determined in the CFIR categories of intervention, user characteristics, and process. No information was found for the CFIR categories inner (eg, organizational resources, innovation climate) and outer (eg, external policies and incentives, pressure from competitors) settings. Reminders, attractive designs, tailored and clear data visualizations (intervention), smartphone experience, and intrinsic motivation to change behavior (user characteristics) could influence the use of electronic diaries. During the implementation process, attention should be paid to both theoretical and practical training. Conclusions Design aspects, user characteristics, and training and instructions determine the use of electronic diaries in health care. It is remarkable that there were no empirical data about factors related to embedding electronic diaries in daily clinical practice. More research is needed to better understand influencing factors for optimal electronic diary use.

Background Previous studies have found that in general, poor health is associated with a lower likelihood of internet use in older adults, but it is not well known how different indicators of health are associated with different types of digital information technology (DIT) use. Moreover, little is known about the relationship between health and the types of DIT use in older ethnic minority and migrant populations. Objective The aim of this study is to examine the associations among depressive symptoms and self-rated health (SRH) with different dimensions of DIT use in older migrants. Methods We analyzed data from the Care, Health and Ageing of Russian-speaking Minority (CHARM) study, which is based on a nationally representative sample of community-dwelling, Russian-speaking adults aged 50 years or older residing permanently in Finland (men: 616/1082, 56.93%; age: mean 63.2 years, SD 8.4 years; response rate: 1082/3000, 36.07%). Data were collected in 2019 using a postal survey. Health was measured using depressive symptoms (measured using the Center for Epidemiologic Studies Depression Scale) and SRH. Binary logistic regression analyses were used to investigate the associations between the two health indicators and the following six outcomes: daily internet use, smartphone ownership, the use of the internet for messages and calls, social media use, the use of the internet for personal health data, and obtaining health information from the internet. A number of sociodemographic and socioeconomic factors were controlled for in the logistic regression regression analysis. Analyses were performed with weights accounting for the survey design and nonresponse. Results After adjusting for sociodemographic and socioeconomic factors, depressive symptoms (odds ratio [OR] 2.68, 95% CI 1.37-5.24; P=.004) and poor SRH (OR 7.90, 95% CI 1.88-33.11; P=.005) were associated with a higher likelihood of not using the internet daily. Depressive symptoms (OR 1.88, 95% CI 1.06-3.35; P=.03) and poor SRH (OR 5.05, 95% CI 1.58-16.19; P=.006) also increased the likelihood of smartphone nonuse. Depressive symptoms were additionally associated with a lower likelihood of social media use, and poor SRH was associated with a lower likelihood of using the internet for messaging and calling. Conclusions Poor SRH and depressive symptoms are associated with a lower likelihood of DIT use in older adults. Longitudinal studies are required to determine the directions of these relationships.

BackgroundAlthough symptomatic remission is considered the optimal outcome in depression, this is not always achieved. Furthermore, symptom indicators do not fully capture patients’ and clinicians’ perspectives on remission. Broader indicators of (partial) remission from depression should be considered.AimsTo investigate relevant outcomes of depression treatment in specialist care from patients’ and clinicians’ perspectives and to investigate whether these perspectives differ from each other.MethodThree focus groups with 11 patients with depression and seven semi-structured interviews with clinicians were conducted exploring their perspectives on remission. All interviews were audio-recorded and transcribed verbatim. We analysed the transcripts thematically using the phenomenologist approach.ResultsIndependently, both patients and clinicians perceived the following outcomes relevant: restoring social functioning and interpersonal relations, regaining quality of life and achieving personal goals. All clinicians emphasised symptom reduction and satisfaction with treatment as relevant outcomes, whereas the former was not an obvious theme in patients. Unlike clinicians, patients made a clear distinction between treatment outcomes in first versus recurrent/chronic depression.ConclusionsClassically defined study outcomes based on symptom resolution only partly reflect issues considered important by patients and clinicians in specialist depression treatment. Incorporating patients’ and clinicians’ perspectives in the development of measurable end-points makes them more suitable for use in trials and subsequent translation to clinical practice. Furthermore, evaluating patients’ perspectives on treatment outcomes helps in the development of tailored interventions according to patients’ needs.

Purpose The purpose was to investigate inequalities in access to care among people with possible depression. Method In this nationwide register-based cohort study of 30,593 persons, we observed the association between socioeconomic position (SEP, education/income) and mental health care use (MHCU) four months before the date of first redeemed antidepressant (Index Date/ID) and 12 months afterwards—and time to contact to psychologist/psychiatrist (PP). Logistic, Poisson, and Cox regression models were used, adjusted for sex, age, cohabitation, and psychiatric comorbidity. Results Before ID, high SEP was associated with less GP contact (general practitioner), higher odds ratios for GP-Mental Health Counseling (GP-MHC), psychologist contact, and admissions to hospital. This disparity decreased the following 12 months for GP-MHC but increased for contact to psychologist; same pattern was seen for rate of visits. However, the low-income group had more contact to private psychiatrist. For the 25,217 individuals with no MHCU before ID, higher educational level was associated with almost twice the rate of contact to PP the following 12 months; for the high-income group, the rate was 40% higher. 10% had contact to PP within 40 days after ID in the group with higher education; whereas, 10% of those with a short education would reach PP by day 120. High-income group had faster access as well. Conclusion Being in high SEP was positively associated with MHCU, before and after ID, and more rapid PP contact, most explicit when measured by education. Co-payment for psychologist may divert care towards private psychiatrist for low-income groups.

Until the 1990’s in Ireland, many children in institutional care experienced abuse and neglect, with lasting negative effects, including trauma symptoms and psychopathology. While trauma disclosure can be important for recovery, findings are inconsistent and often lack consideration of wider social and interpersonal contexts. As survivors of this historical adversity enter later-life stages, research is needed on the long-term impact and to clarify the role of disclosure. Therefore, this study aimed to examine the later-life impact of institutional child abuse on health and well-being, and the role of trauma disclosure and socio-interpersonal contexts in an older adult sample. Qualitative semi-structured interviews (60-120 minutes) were conducted with 17 Irish older adults, aged 50-77 years (mean age=60.7 years), who experienced childhood institutional abuse. Audio-recorded interviews were transcribed and analysed using Framework Analysis. Themes for ‘childhood and related later-life adversity’ included detrimental perceptions and interactions, re-exposure and reminders, failure of system and society, and cycle of abuse. Disclosure themes included successful, unsuccessful, and non-disclosure, as well as evidence of socio-interpersonal interactions (e.g., non-disclosure influenced by shame or fear, compounded by socio-cultural values, (lack of) social acknowledgment, or the power of the church in society). Results suggest that childhood institutional abuse can have long-term negative impacts into later life, including social, psychological, physical health, and socio-economic aspects. Disclosure results emphasize the need to consider the complex social, cultural, and interpersonal contexts within which an individual is embedded. This may enhance understanding and facilitate targeted health and social care services for this older adult population.

Background: Acquiring the theoretical and practical knowhow of conducting patient and public involvement (PPI) in research is not part of the traditional curriculum of researchers. Zuyd University of Applied Sciences and Huis voor de Zorg, a regional umbrella patient organization, therefore started a 1.5-year coaching programme. Objective: To establish a community of practice by developing a PPI coaching programme for senior and junior health services researchers of Zuyd University. The context consisted of research projects conducted by the participants. Methods: A participatory action research methodology. Data were collected from reports of thematic group meetings and individual sessions with participants, field notes and regular reflection meetings with the project team. Data were analysed by reflexive deliberation. Findings: The programme comprised a kick-off meeting (52 attendees), followed by 7 group meetings with 11 junior and 9 senior researchers. The project team constructed a serious game based on the concept of the participation ladder. Questions and concerns differed for junior and senior researchers, and separate tailored meetings were organized for both groups. Between group meetings, participants received individual assignments. Group meetings were accompanied by individual coaching sessions to provide tailor-made feedback. The programme concluded with a combined meeting with all stakeholders. Conclusion: Building a community of PPI practice through action research facilitates the development of a coaching programme that fosters social learning, empowerment and the development of a shared identity concerning PPI. The role and responsibilities of senior researchers should be distinguished from those of junior researchers.

Background: Investigation of the natural history of chronic obstructive pulmonary disease (COPD) has led to the recognition that individuals with higher than normal lung function may have lower risk of developing COPD. We tested the hypothesis that individuals with supernormal lung function have lower risk of COPD. Methods: We followed 108,246 adults from the Copenhagen General Population Study recruited between 2003 and 2015 for clinical COPD outcomes until 2018. A subset of 16,892 attended another examination approximately 10 years later, allowing to investigate lung function decline and COPD development (forced expiratory volume in 1 se (FEV1)/forced vital capacity (FVC)upper limit of normal (ULN). Findings: At baseline, 3944(4%) had supernormal lung function, 91,938(85%) normal lung function, and 12,364(11%) had below normal lung function. Individuals with baseline supernormal versus normal lung function had higher FEV1 decline but did not differ in FEV1/FVC decline. None had COPD at 10 years in those with supernormal lung function, while 3% had in those with normal lung function. Early-life risk factors associated with COPD development and smoking exposure in different stages of life were less common in individuals with supernormal lung function. Compared to individuals with normal lung function, multivariable adjusted hazard ratios in those with supernormal lung function were 0·19(95% confidence interval:0·08–0·46) for acute obstructive lung disease hospitalisations, 0·56(0·45–0·69) for pneumonia hospitalisations, and 0·81(0·72–0·91) for all-cause mortality. Interpretation: Supernormal lung function is associated with lower risk of developing COPD. Funding: Herlev and Gentofte Hospital and Lundbeck Foundation.

Although many recent studies describe the emergence and prevalence of “clonal hematopoiesis of indeterminate potential” in aged human populations, a systematic analysis of the numbers of clones supporting steady-state hematopoiesis throughout mammalian life is lacking. Previous efforts relied on transplantation of “barcoded” hematopoietic stem cells (HSCs) to track the contribution of HSC clones to reconstituted blood. However, ex vivo manipulation and transplantation alter HSC function and thus may not reflect the biology of steady-state hematopoiesis. Using a noninvasive in vivo color-labeling system, we report the first comprehensive analysis of the changing global clonal complexity of steady-state hematopoiesis during the natural murine lifespan. We observed that the number of clones (ie, clonal complexity) supporting the major blood and bone marrow hematopoietic compartments decline with age by ∼30% and ∼60%, respectively. Aging dramatically reduced HSC in vivo–repopulating activity and lymphoid potential while increasing functional heterogeneity. Continuous challenge of the hematopoietic system by serial transplantation provoked the clonal collapse of both young and aged hematopoietic systems. Whole-exome sequencing of serially transplanted aged and young hematopoietic clones confirmed oligoclonal hematopoiesis and revealed mutations in at least 27 genes, including nonsense, missense, and deletion mutations in Bcl11b, Hist1h2ac, Npy2r, Notch3, Ptprr, and Top2b.

Spiders (Arachnida: Araneae) are widespread in subterranean ecosystems worldwide and represent an important component of subterranean trophic webs. Yet, global-scale diversity patterns of subterranean spiders are still mostly unknown. In the frame of the CAWEB project, a European joint network of cave arachnologists, we collected data on cave-dwelling spider communities across Europe in order to explore their continental diversity patterns. Two main datasets were compiled: one listing all subterranean spider species recorded in numerous subterranean localities across Europe and another with high resolution data about the subterranean habitat in which they were collected. From these two datasets, we further generated a third dataset with individual geo-referenced occurrence records for all these species. Data from 475 geo-referenced subterranean localities (caves, mines and other artificial subterranean sites, interstitial habitats) are herein made available. For each subterranean locality, information about the composition of the spider community is provided, along with local geomorphological and habitat features. Altogether, these communities account for > 300 unique taxonomic entities and 2,091 unique geo-referenced occurrence records, that are made available via the Global Biodiversity Information Facility (GBIF) (Mammola and Cardoso 2019). This dataset is unique in that it covers both a large geographic extent (from 35° south to 67° north) and contains high-resolution local data on geomorphological and habitat features. Given that this kind of high-resolution data are rarely associated with broad-scale datasets used in macroecology, this dataset has high potential for helping researchers in tackling a range of biogeographical and macroecological questions, not necessarily uniquely related to arachnology or subterranean biology.

BACKGROUND: Telecoaching approaches can enhance physical activity (PA) in patients with chronic obstructive pulmonary disease (COPD). However, their effectiveness is likely to be influenced by intervention-specific characteristics. OBJECTIVE: This study aimed to assess the acceptability, actual usage, and feasibility of a complex PA telecoaching intervention from both patient and coach perspectives and link these to the effectiveness of the intervention. METHODS: We conducted a mixed-methods study based on the completers of the intervention group (N=159) included in an (effective) 12-week PA telecoaching intervention. This semiautomated telecoaching intervention consisted of a step counter and a smartphone app. Data from a project-tailored questionnaire (quantitative data) were combined with data from patient interviews and a coach focus group (qualitative data) to investigate patient and coach acceptability, actual usage, and feasibility of the intervention. The degree of actual usage of the smartphone and step counter was also derived from app data. Both actual usage and perception of feasibility were linked to objectively measured change in PA. RESULTS: The intervention was well accepted and perceived as feasible by all coaches present in the focus group as well by patients, with 89.3% (142/159) of patients indicating that they enjoyed taking part. Only a minority of patients (8.2%; 13/159) reported that they found it difficult to use the smartphone. Actual usage of the step counter was excellent, with patients wearing it for a median (25th-75th percentiles) of 6.3 (5.8-6.8) days per week, which did not change over time (P=.98). The smartphone interface was used less frequently and actual usage of all daily tasks decreased significantly over time (P

Contains fulltext : 190875.pdf (Publisher’s version ) (Open Access) BACKGROUND: To meet the challenge of multimorbidity in decision making, a switch from a disease-oriented to a goal-oriented approach could be beneficial for patients and clinicians. More insight about the concept and the implementation of this approach in clinical practice is needed. OBJECTIVE: This study aimed to develop conceptual descriptions of goal-oriented care by examining the perspectives of general practitioners (GPs) and clinical geriatricians (CGs), and how the concept relates to collaborative communication and shared decision making with elderly patients with multimorbidity. METHOD: Qualitative interviews with GPs and CGs were conducted and analyzed using thematic analysis. RESULTS: Clinicians distinguished disease- or symptom-specific goals, functional goals and a new type of goals, which we labelled as fundamental goals. "Fundamental goals" are goals specifying patient's priorities in life, related to their values and core relationships. These fundamental goals can be considered implicitly or explicitly in decision making or can be ignored. Reasons to explicate goals are the potential mismatch between medical standards and patient preferences and the need to know individual patient values in case of multimorbidity, including the management in acute situations. CONCLUSION: Based on the perspectives of clinicians, we expanded the concept of goal-oriented care by identifying a three-level goal hierarchy. This model could facilitate collaborative goal-setting for patients with multiple long-term conditions in clinical practice. Future research is needed to refine and validate this model and to provide specific guidance for medical training and practice.

Room‐temperature Na–S batteries are facing one of the most serious challenges of charge/discharge with long cycling stability due to the severe shuttle effect and volume expansion. Herein, a sodium polysulfides defense system is presented by designing and constructing the cathode‐separator double barriers. In this strategy, the hollow carbon spheres are decorated with MoS2 (HCS/MoS2) as the S carrier (S@HCS/MoS2). Meanwhile, the HCS/MoS2 composite is uniformly coated on the surface of the glass fiber as the separator. During the discharge process, the MoS2 can adsorb soluble polysulfides (NaPSs) intermediates and the hollow carbon spheres can improve the conductivity of S as well as act as the reservoir for electrolyte and NaPSs, inhibiting them from entering the anode to make Na deteriorate. As a result, the cathode‐separator group applied to room‐temperature Na–S battery can enable a capacity of ≈1309 mAh g−1 at 0.1 C and long cycling life up to 1000 cycles at 1 C. This study provides a novel and effective way to develop durable room‐temperature Na–S batteries., An efficient polysulfides defense system in which the cathode‐separator is constructed by HCS/MoS2 composite is proposed and designed. Benefiting from the structural and compositional advantages, the S@HCS/MoS2 composite cathode shows excellent electrochemical performance.

Purpose: The aim of this study was to describe and gain more knowledge about the phenomenon of the inner child in relation to health and well-being reflected in events during childhood experienced by adults. Method: In this hermeneutical phenomenological study, 20 adults, 10 men and 10 women aged 22–68, were interviewed. Results: The analysis of the data illuminated the phenomenon of the inner child in one theme: Gaining useful life lessons through childhood experiences, made up by four sub-themes: Sharing relationships, playing to heal, being strong or frail and supporting the next generation. Conclusion: The participants’ experiences of events during childhood were illuminating the phenomenon of the inner child as promoting or hindering health and well-being and impact human adaptation throughout life. Our findings indicate that the participants learned useful life lessons suggesting that experiences during childhood can help us to adapt across the life span and over generations, and this is the essence of the inner child. Our findings also contribute to the health literacy discussion and detail how knowledge and action competency is developed in mental, social and existential dimensions of health and well-being.