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This study investigates how education professionals balance their private and professional lives when using social technologies. Based on boundary theory and interviews with 57 education professionals, we identify which tactics they use to separate or integrate their private and professional life. We identified twice as many segmentation tactics compared to integration tactics and found that the education professionals struggled most with finding segmentation tactics that work. We argue that this is because social technologies are designed to support integration and therefore teachers using these technologies must work harder to separate their private and professional roles. There is a need to further investigate how boundary theory can be used, and segmentation tactics understood, when the object of study is social technology, which is specifically built to integrate time and professional and private spaces. For practice, there is a need to better support teachers in their use of social technologies. [ABSTRACT FROM AUTHOR]

Aim: To describe what registered nurses' experience to be important to job satisfaction in nursing home settings. Design: This is a qualitative study based on data from individual interviews. Methods: Sixteen registered nurses working in nursing homes were interviewed, and their responses were analysed with systematic text condensation. Results: A total of six categories were developed to describe various aspects of job satisfaction among registered nurses at nursing homes: meaningfulness is essential, to possess control and manageability is central, a possibility to balance daily challenges with professional development, supportive leadership is imperative, the nursing team's competence and companionship, and being confident in one's own profession. Conclusion: In the present study, meaningfulness was essential to job satisfaction, and work was experienced to be meaningful and engaging when the demands were manageable, the workload controllable, and when the registered nurses felt supported by management and co‐workers. Conversely, if the demands were too high, the workload was beyond their control and the nurses felt unsupported, then the work felt meaningless and thus unsatisfactory. [ABSTRACT FROM AUTHOR]

Background and purpose: Higher latitude has been associated with increased occurrence of multiple sclerosis (MS) and with more severe disease. The aim was to study the impact of sun exposure habits on MS disease progression and health‐related quality of life. Methods: Patients from a population‐based case–control study were categorized based on sun exposure habits at diagnosis and were followed up to 15 years post‐diagnosis through the Swedish MS registry (n = 3314) with regard to changes in Expanded Disability Status Scale (EDSS). Linear mixed models were used to analyse long‐term changes, while Cox regression models, with 95% confidence intervals, were used to investigate outcomes, including 24‐week confirmed diasability worsening, EDSS3, EDSS4, and physical worsening as measured by the physical component of the Multiple Sclerosis Impact Scale 29. Results: Compared to average sun exposure (median value), low exposure to sunlight was associated with faster EDSS progression, increased risk of confirmed disability worsening (hazard ratio [HR] 1.48, 95% CI 1.21–1.81), increased risk of reaching EDSS 3 (HR 1.35, 95% CI 1.02–1.79), EDSS 4 (HR 1.47, 95% CI 1.01–2.20) and self‐reported physical worsening (HR 1.27, 95% CI 1.00–1.62). Significant trends revealed a lower risk of unfavourable outcomes with increasing sun exposure. Conclusions: Very low levels of sun exposure are associated with worse disease progression and health‐related quality of life in patients with MS. [ABSTRACT FROM AUTHOR]

Background: A significant proportion of individuals with suspicious onset of multiple sclerosis (MS) does not fulfill the diagnostic criteria. Although some receive other diagnoses, many remain undiagnosed and lack healthcare follow‐up. This study aimed to characterize persons with undetermined diagnosis (PwUD) through a questionnaire. Methods: Incident cases with suspected MS were consecutively admitted to a tertiary neurological healthcare center in a prospective cohort study. Those who remained undiagnosed after 40 months (mean, range 31–52) were considered PwUD. They completed a modified questionnaire, previously used in a population‐based case‐control study of incident MS cases. Their responses were compared with two control cohorts, persons with MS (PwMS) and healthy controls, randomly selected from national registries, matched by age, gender, and area of residence. Results: Out of 271 patients with suspected MS onset, 72 (20.3%) were PwUD with a female majority (79%). The response rate was 83% and 39% reported persisting MS‐like symptoms. Compared to controls (n = 548) and PwMS (n = 277), fewer PwUD were currently smoking (p =.4 and p =.03), consumed less alcohol (p =.04 and p =.01), and had children (p =.02 and p =.002). PwUD reported occurrence of other autoimmune disease in 29%, higher compared to PwMS and controls (p <.001 and p <.001). Conclusions: UD is common among persons investigated for suspected MS, in particular among female parents. Our data suggest that PwUD can be characterized as nonsmokers with low alcohol consumption and a higher prevalence of autoimmune disease, in particular thyroid disease. [ABSTRACT FROM AUTHOR]

Diagnosis and treatment of patients with suspected chronic coronary syndrome (CCS) currently relies on the degree of coronary artery stenosis and its significance for myocardial perfusion. However, myocardial perfusion can be affected by factors other than coronary stenosis. The aim of this study was to investigate to what extent sex, age, diabetes, hypertension and smoking affect quantitative myocardial perfusion, beyond the degree of coronary artery stenosis, in patients with suspected or established CCS. Eighty‐six patients [median age 69 (range 46−86) years, 24 females] planned for elective coronary angiography due to suspected or established CCS were included. All patients underwent cardiac 13N‐NH3 positron emission tomography to quantify myocardial perfusion at rest and stress. Lowest myocardial perfusion (perfusionmin) at stress and rest and lowest myocardial perfusion reserve (MPRmin) for all vessel territories was used as dependent variables in a linear mixed model. Independent variables were vessel territory, degree of coronary artery stenosis (as a continuous variable of 0%−100% stenosis), sex, age, diabetes, hypertension and smoking habits. Degree of coronary artery stenosis (p < 0.001), male sex (1.8 ± 0.6 vs. 2.3 ± 0.6 mL/min/g, p < 0.001), increasing age (p = 0.025), diabetes (1.6 ± 0.5 vs. 2.0 ± 0.6 mL/min/g, p = 0.023) and smoking (1.9 ± 0.6 vs. 2.1 ± 0.6 mL/min/g, p = 0.052) were independently associated with myocardial perfusionmin at stress. Degree of coronary artery stenosis (p < 0.001), age (p = 0.040), diabetes (1.8 ± 0.6 vs. 2.3 ± 0.7, p = 0.046) and hypertension (2.2 ± 0.7 vs. 2.5 ± 0.6, p = 0.033) were independently associated with MPRmin. Sex, increasing age, diabetes, hypertension and smoking affect myocardial perfusion independent of coronary artery stenosis in patients with suspected or established CCS. Thus, these factors need to be considered when assessing the significance of reduced quantitative myocardial perfusion of patients with suspected or established CCS. [ABSTRACT FROM AUTHOR]

The banking sectors in the Scandinavian countries are highly concentrated, typically undercapitalised and they have suffered through several crises since the 1990s. This article analyses the systemic risk in Denmark, Norway and Sweden focusing on the co‐dependence in the tails of equity returns of an individual bank and the overall banking system. We use, partly in a new way, conditional cross‐quantilograms (CQs) for this purpose. We find that the CQs are positive and statistically significant in the low and high quantiles indicating that the Scandinavian banks are systemically linked. The low‐quantile dependence is relatively stronger compared with the magnitude of dependence in the other quantiles. These results hold even after controlling for equity market volatility and economic policy uncertainty. We further observe that the systemic risk was insignificant from the early—2000 to the outbreak of the global financial crisis (GFC). However, after the GFC and the euro zone crisis, the systemic risk has increased substantially. Finally, we find that bank size has a positive relationship with systemic risk (low‐quantile dependence) while return on asset and loan to deposit ratio exhibit a negative influence. Furthermore, these relationships are asymmetric across quantiles. [ABSTRACT FROM AUTHOR]

Purpose: To ultimately make accurate and precise fetal noninvasive oxygen saturation (sO2) measurements by T2‐prepared bSSFP more widely available by systematically assessing error sources in order to potentially reduce perinatal mortality in cardiovascular malformations and fetal growth restriction. Methods: T2‐prepared bSSFP data were acquired in phantoms; in flowing blood in adults in the superior sagittal sinus, ascending and descending aorta, and main pulmonary artery; and in the fetal descending aorta and umbilical vein. T2 was assessed in relation to T2 two‐ or three‐parameter curve‐fitting techniques, SSFP readout, refocusing time delay (τ), constant and pulsatile blood flow, and impact of T1 recovery. Further, fetal T2 and sO2 variability were quantified in the descending aorta and umbilical vein in healthy fetuses and fetuses with cardiovascular malformation (gestational weeks 32–38). Results: In phantoms, three‐parameter fitting was accurate irrespective of phase FOV (<4 ms; i.e., <2%), and T2 was overestimated (up to 23 ms/10%; p = 0.001) beyond ±30 Hz off‐resonance. In the adult aorta, T2 was underestimated during higher blood flow velocities and pulsatility for τ = 16 ms (−41 ms/−17%; p = 0.008). In fetuses, two‐parameter fitting overestimated T2 compared with three‐parameter fitting (+33 ms/+18%; p = 0.03). T2 variability was 18 ms/15% in the fetal descending aorta and 28 ms/14% in the umbilical vein. The resulting estimated sO2 variability was ∼10% (15% of sO2 value) in the fetal descending aorta. Conclusions: Errors due to T2‐fitting techniques, off‐resonance, flow velocity, and insufficient T1 recovery between image acquisitions could be mitigated by using three‐parameter fitting with included saturation‐prepared images approximating infinite T2‐preparation time, adequate shimming covering the fetus and placenta, and by modifying acquisition parameters. Variability in fetal blood T2 and sO2, however, indicate that it is currently not feasible to use these methods for prediction of disease. [ABSTRACT FROM AUTHOR]

Objective: Inconclusive findings have been reported regarding the influence of smoking on disease outcomes in established rheumatoid arthritis (RA). This study was undertaken to investigate the influence of smoking habits on disease activity and health‐related quality of life (HRQoL) in RA patients. Methods: Patients with newly diagnosed RA (n = 1,531) from the population‐based case–control Epidemiological Investigation of Rheumatoid Arthritis study were followed up for up to 3 years after recruitment. Using logistic regression models, the risks of unfavorable outcomes in patients with different smoking habits were compared using self‐reported swollen and tender joint counts, the Short Form 36 health survey, the Health Assessment Questionnaire, and the Hospital Anxiety and Depression Scale by calculating odds ratios with 95% confidence intervals. Results: At 1‐year and 3‐year follow‐up, current smokers reported higher disease activity and lower HRQoL life compared to non‐smokers, regarding both physical and mental aspects. Patients who stopped smoking within 1‐year post‐baseline had less disease activity measured as swollen joint counts at 1‐year follow‐up compared to those who continued smoking. Patients who stopped smoking after the 1‐year follow‐up had higher disease activity and lower HRQoL at baseline than smokers who did not quit, and late smoking cessation was not associated with more favorable outcomes compared to continued smoking. Conclusion: Current smoking is associated with increased disease activity and lower HRQoL among RA patients. Smoking cessation within the first year after baseline appears to have a favorable effect on disease activity. [ABSTRACT FROM AUTHOR]

Objective: Multiple studies have found a relationship between alcohol consumption and disease activity in rheumatoid arthritis (RA), although reverse causation has been suggested to explain the association. We aimed to study the relationship between alcohol consumption and disease activity, disease progression, and health‐related quality of life in patients with RA. Methods: We followed up 1,228 patients with newly diagnosed RA from a population‐based case–control study, Epidemiological Investigation of Rheumatoid Arthritis (EIRA). Drinkers and non‐drinkers were compared to evaluate risk of unfavorable outcomes regarding disease activity and health‐related quality of life. Odds ratios with 95% confidence intervals were calculated using logistic regression models. Results: Non‐drinkers at baseline had higher disease activity and estimated their pain as more severe compared to drinkers. At 1 year of follow‐up, non‐drinkers reported higher swollen and tender joint counts and experienced more pain and fatigue, lower global health scores, and lower health‐related quality of life. The inverse relationship between alcohol consumption and RA‐specific outcomes was also observed when comparing drinkers and non‐drinkers who had not changed their alcohol consumption habits at or after the year of disease onset. Those who stopped drinking postbaseline experienced higher disease activity, more pain, and lower health‐related quality of life at 1 year of follow‐up, compared to drinkers, although there was no difference in disease activity at baseline between drinkers who continued versus discontinued drinking. Our findings argue against bias due to reverse causation. Conclusion: Alcohol consumption was associated with lower disease activity and higher health‐related quality of life in RA patients in a dose‐dependent manner. [ABSTRACT FROM AUTHOR]

Background and purpose: The association between socioeconomic status (SES) and the risk of multiple sclerosis (MS) is unclear. The aim was to study whether a potential association between indicators of SES and MS risk in Sweden is explained by lifestyle/environmental factors. Methods: Using the Swedish MS registry and the Swedish patient registries, a register study was performed comprising all cases diagnosed with MS in Sweden between 1990 and 2018 (N = 24,729) and five randomly selected controls per case, matched by year and age at disease onset, sex and residential area at disease onset. Data from two matched case–control studies combined comprising data on environment/lifestyle factors (7193 cases, 9609 controls, inclusion period 2005–2018) were also utilized. For all participants, information regarding ancestry, formal education (available 1990–2018) and family income (available 1998–2018) was retrieved from the National Board of Health and Welfare. Results: The registry study revealed no association between education and MS risk, whereas an income exceeding the upper quartile was associated with lower MS risk compared to having an income in the lowest quartile (odds ratio 0.86, 95% confidence interval 0.82–0.90). These findings were replicated in the crude analyses of the case–control study. However, after adjustment for confounding, no association was observed between income and risk of MS. Conclusions: Education and income were not associated with occurrence of MS after adjustment for a few lifestyle‐related factors (smoking, alcohol consumption, body mass index and sun exposure habits), indicating that SES has no influence on MS risk besides its association with these lifestyle factors in the Swedish context. [ABSTRACT FROM AUTHOR]

Purpose: To explore a fetal 3D cardiovascular cine acquisition using a radial image acquisition and compressed‐sensing reconstruction and compare image quality and scan time with conventional multislice 2D imaging. Methods: Volumetric fetal cardiac data were acquired in 26 volunteers using a radial 3D balanced SSFP pulse sequence. Cardiac gating was performed using a Doppler ultrasound device. Images were reconstructed using a parallel‐imaging and compressed‐sensing algorithm. Multiplanar reformatting to standard cardiac views was performed before image analysis. Clinical 2D images were used for comparison. Qualitative and quantitative image evaluation were performed by two experienced observers (scale: 1–4). Volumes, mass, and function were assessed. Results: Average scan time for the 3D imaging was 6 min, including one localizer. A 2D imaging stack covering the entire heart including localizer sequences took at least 6.5 min, depending on planning complexity. The 3D acquisition was successful in 7 of 26 subjects (27%). Overall image contrast and perceived resolution were lower in the 3D images. Nonetheless, the 3D images had, on average, a moderate cardiac diagnostic quality (median [range]: 3 [1–4]). Standard clinical 2D acquisitions had a high cardiac diagnostic quality (median [range]: 4 [3, 4]). Cardiac measurements were not different between 2D and 3D images (all p > 0.16). Conclusion: The presented free‐breathing whole‐heart fetal 3D radial cine MRI acquisition and reconstruction method enables retrospective visualization of all cardiac views while keeping examination times short. This proof‐of‐concept work produced images with diagnostic quality, while at the same time reducing the planning complexity to a single localizer. [ABSTRACT FROM AUTHOR]

Background: Neonates with critical congenital heart disease require early intervention. Four‐dimensional (4D) flow may facilitate surgical planning and improve outcome, but accuracy and precision in neonates are unknown. Purpose: To 1) validate two‐dimensional (2D) and 4D flow MRI in a phantom and investigate the effect of spatial and temporal resolution; 2) investigate accuracy and precision of 4D flow and internal consistency of 2D and 4D flow in neonates; and 3) compare scan time of 4D flow to multiple 2D flows. Study Type: Phantom and prospective patients. Population: A total of 17 neonates with surgically corrected aortic coarctation (age 18 days [IQR 11–20]) and a three‐dimensional printed neonatal aorta phantom. Field Strength/Sequence: 1.5T, 2D flow and 4D flow. Assessment: In the phantom, 2D and 4D flow volumes (ascending and descending aorta, and aortic arch vessels) with different resolutions were compared to high‐resolution reference 2D flow. In neonates, 4D flow was compared to 2D flow volumes at each vessel. Internal consistency was computed as the flow volume in the ascending aorta minus the sum of flow volumes in the aortic arch vessels and descending aorta, divided by ascending aortic flow. Statistical tests: Bland–Altman plots, Pearson correlation coefficient (r), and Student's t‐tests. Results: In the phantom, 2D flow differed by 0.01 ± 0.02 liter/min with 1.5 mm spatial resolution and −0.01 ± 0.02 liter/min with 0.8 mm resolution; 4D flow differed by −0.05 ± 0.02 liter/min with 2.4 mm spatial and 42 msec temporal resolution, −0.01 ± 0.02 liter/min with 1.5 mm, 42 msec resolution and −0.01 ± 0.02 liter/min with 1.5 mm, 21 msec resolution. In patients, 4D flow and 2D flow differed by −0.06 ± 0.08 liter/min. Internal consistency in patients was −11% ± 17% for 2D flow and 5% ± 13% for 4D flow. Scan time was 17.1 minutes [IQR 15.5–18.5] for 2D flow and 6.2 minutes [IQR 5.3–6.9] for 4D flow, P < 0.0001. Data Conclusion: Neonatal 4D flow MRI is time efficient and can be acquired with good internal consistency without contrast agents or general anesthesia, thus potentially expanding 4D flow use to the youngest and smallest patients. Evidence Level: 1 Technical Efficacy: Stage 2 [ABSTRACT FROM AUTHOR]

Background: Nonalcoholic fatty liver disease (NAFLD) is rapidly increasing worldwide. It is subdivided into nonalcoholic fatty liver (NAFL) and the more aggressive form, nonalcoholic steatohepatitis (NASH), which carries a higher risk of developing fibrosis and cirrhosis. There is currently no reliable non‐invasive method for differentiating NASH from NAFL. Purpose: To investigate the ability of magnetic resonance imaging (MRI)‐based imaging biomarkers to diagnose NASH and moderate fibrosis as well as assess their repeatability. Study Type: Prospective. Subjects: Sixty‐eight participants (41% women) with biopsy‐proven NAFLD (53 NASH and 15 NAFL). Thirty participants underwent a second MRI in order to assess repeatability. Field Strength/Sequence: 3.0 T; MR elastography (MRE) (a spin‐echo echo‐planar imaging [SE‐EPI] sequence with motion‐encoding gradients), MR proton density fat fraction (PDFF) and R2* mapping (a multi‐echo three‐dimensional gradient‐echo sequence), T1 mapping (a single‐point saturation‐recovery technique), and diffusion‐weighted imaging (SE‐EPI sequence). Assessment: Quantitative MRI measurements were obtained and assessed alone and in combination with biochemical markers (cytokeratin‐18 [CK18] M30, alanine transaminase [ALT], and aspartate transaminase [AST]) using logistic regression models. Models that could differentiate between NASH and NAFL and between moderate to advanced fibrosis (F2–4) and no or mild fibrosis (F0–1), based on the histopathological results, were identified. Statistical Tests: Independent samples t‐test, Pearson's chi‐squared test, area under the receiver operating characteristic curve (AUROC), Spearman's correlation, intra‐individual coefficient of variation, and intraclass correlation coefficient (ICC). Statistical significance was set at P < 0.05. Results: There was a significant difference between the NASH and NAFL groups with liver stiffness assessed with MRE, CK18 M30, and ALT, with an AUROC of 0.74, 0.76, and 0.70, respectively. Both MRE and PDFF contributed significantly to a bivariate model for diagnosing NASH (AUROC = 0.84). MRE could significantly differentiate between F2–4 and F0–1 (AUROC = 0.74). A model combining MRE with AST improved the diagnosis of F2–4 (AUROC = 0.83). The ICC for repeatability was 0.94 and 0.99 for MRE and PDFF, respectively. Data Conclusion: MRE can potentially diagnose NASH and differentiate between fibrosis stages. Combining MRE with PDFF improves the diagnosis of NASH. Level of Evidence: 2 Technical Efficacy: Stage 2 [ABSTRACT FROM AUTHOR]

Background: Fetal cardiac magnetic resonance imaging (MRI) improves the diagnosis of congenital heart defects, but is sensitive to fetal motion due to long image acquisition time. This may be overcome with faster image acquisition with low resolution, followed by image enhancement to provide clinically useful images. Purpose: To combine phase‐encoding undersampling with super‐resolution neural networks to achieve high‐resolution fetal cine cardiac MR images with short acquisition time. Study Type: Prospective. Subjects: Twenty‐eight fetuses (gestational week 36 [interquartile range 33–38 weeks]). Field Strength/Sequence: 1.5 T, balanced steady‐state free precession (bSSFP) cine sequence. Assessment: Images were acquired using fully sampled Doppler ultrasound‐gated clinical bSSFP cine as reference, with equivalent cine sequences with decreased phase‐encoding resolution (25%, 33%, and 50% of clinical standard). Two super‐resolution methods based on convolutional neural networks were proposed and evaluated (phasrGAN and phasrresnet). Data were partitioned into training (36 cine slices), validation (3 cine slices), and test sets (67 cine slices) without overlap. Conventional reconstruction methods using bicubic interpolation and k‐space zeropadding were used for comparison. Three blinded observers scored image quality between 1 and 10. Statistical Tests: Image scores are reported as median [interquartile range] and were compared using Mann–Whitney's nonparametric test with P < 0.05 showing statistically significant differences. Results: Both proposed methods showed no significant difference in image quality compared to clinical images (8 [7–8.5]) down to 33% (phasrGAN 8 [6.5–8]; phasrresnet 8 [7–8], all P ≥ 0.19) phase‐encoding resolution, i.e., up to three times faster image acquisition, whereas bicubic interpolation and k‐space zeropadding showed significantly lower quality for 33% phase‐encoding resolution (both 7 [6–8]). Data Conclusion: Super‐resolution enhancement can be used for fetal cine cardiac MRI to reduce image acquisition time while maintaining image quality. This may lead to an improved success rate for fetal cine MR imaging, as the impact of fetal motion is lessened by shortened acquisitions. Level of Evidence: 1 Technical Efficacy: Stage 2 [ABSTRACT FROM AUTHOR]

We investigate the importance of adult children and/or cohabitation with a partner for older hip fracture patients' probability of independent living, public home care use and hospital readmission. Data from 35,066 Swedish hip fracture patients between 2012 and 2017, aged 65 years, and living at home at the time of the fracture in the Swedish Registry for Hip Fracture Patients and Treatment were linked with national registers. We applied adjusted logistic regression models and Cox proportional hazard models. In total, 959 (4.0%) women and 817 (7.3%) men had no adult children, 13,384 (56.0%) women and 3,623 (32.5%) men had no cohabiting partner and 2,780 (11.6%) women and 1,389 (12.5%) men neither had a cohabiting partner nor adult children. In comparison with women and men who had both a cohabiting partner and adult children, those without a cohabiting partner (i.e. only adult children) and those who neither had a cohabiting partner nor adult children had significantly lower probabilities of returning home (at discharge and after 4 months). They also had a greater probability of both receiving home care and having an increase in the amount of home care they receive. Having a close next of kin and hospital readmission were not associated. In conclusion, absence of a close next of kin, specifically a cohabiting partner, reduces the chance of return to independent living and increases the use of home care after a hip fracture hospitalisation. The findings highlight the importance of family support for older adults living situation after a hip fracture. [ABSTRACT FROM AUTHOR]

Background: Among multiple sclerosis (MS) patients, an association has been observed between low levels of vitamin D and high Epstein‐Barr nuclear antigen 1 (EBNA‐1) antibody levels. However, whether sun exposure/vitamin D moderates the role of Epstein‐Barr virus (EBV) infection in MS etiology is unclear. We aimed to investigate potential synergistic effects between low sun exposure and elevated EBNA‐1 antibody levels regarding MS risk. Methods: We used a population‐based case−control study involving 2017 incident cases of MS and 2443 matched controls. We used logistic regression models to calculate the odds ratios of MS with 95% confidence intervals (CIs) in subjects with different sun exposure habits and EBNA‐1 status. Potential interaction on the additive scale was evaluated by calculating the attributable proportion due to interaction (AP). Results: Low sun exposure acted synergistically with high EBNA‐1 antibody levels (AP 0.2, 95% CI 0.03–0.3) in its association to increased MS risk. The interaction was present regardless of HLA‐DRB1*15:01 status. Conclusions: Low sun exposure may either directly, or indirectly by affecting vitamin D levels, synergistically reinforce pathogenic mechanisms, such as aspects of the adaptive immune response, related to MS risk conveyed by EBV infection. [ABSTRACT FROM AUTHOR]

Helplessness and hopelessness are transdiagnostic and aggravating factors of mental ill health, but their relation with somatization is not well documented. The main objectives were to identify somatic symptoms that are particularly associated with helplessness, referred to as somatic symptoms of helplessness (SS‐He), and hopelessness, referred to as somatic symptoms of hopelessness (SS‐Ho), determine increased risk of helplessness and hopelessness if having these symptoms and a certain number of these symptoms, and determine sensitivity and specificity in identifying helplessness and hopelessness based on number of these symptoms in a general Swedish sample. Population‐based data from validated questionnaire instruments were used from 3,210 participants who constituted case groups of helplessness and hopelessness, and corresponding reference groups. Among 15 common somatic symptoms, five SS‐He (e.g., feeling tired/having low energy) and five SS‐Ho (e.g., dizziness) were identified, showing increased risk of helplessness and hopelessness that ranged from the factor 1.73 to 2.58 and from 1.44 to 1.92, respectively, which decreased considerably when controlled for depression and anxiety. The risk of helplessness increased by the factor 1.49 for each additional SS‐He, and by 1.38 for each SS‐Ho. A cutoff of two/three or more SS‐He showed a sensitivity of 81.7/63.7% and a specificity of 40.6/61.4% in identifying helplessness, and 77.4/54.6% and 40.4/66.1%, respectively, in identifying hopelessness based on two/three or more SS‐Ho. Primary care clinicians may consider further investigation of helplessness and hopelessness as well as depression and anxiety if presenting with these symptoms. [ABSTRACT FROM AUTHOR]

Summary: Routine follow‐up for diffuse large B‐cell lymphoma have been shortened to 2 years when event‐free survival at 24 months (EFS24) emerged as a new milestone. In the present study, we aimed to determine whether the achievement of this milestone affected overall survival (OS). We compared OS to that of an age‐ and sex‐matched population, analysed other factors governing OS, and reviewed the causes of death. Data were collected from the Swedish Cancer Registry and from individual patient's records. We included 1169 adult patients from five counties between the years 2001 and 2014. The median (range) age was 64·6 (18–91) years, 56·6% were men and the median follow‐up was 82·3 months. For early stages, the achievement of EFS12 did not improve OS. More than two‐thirds of the patients (n = 837, 71·6%) achieved EFS24, of which 190 (22·7%) died during follow‐up. Lymphoma (20%), cardiovascular disease (22·4%) and malignancies (16%) contributed to causes of death. Patients aged <60 years had an OS that matched the standard population. In multivariate analysis, only age >60 years significantly affected OS after EFS24 compared with the standard population. We concluded that follow‐up beyond EFS24 should be considered for patients aged >60 years. [ABSTRACT FROM AUTHOR]

Introduction: Both echocardiography and CMR imaging are used to quantify longitudinal function. Inter‐method variability for mitral (MAPSE) and tricuspid (TAPSE) annular plane systolic excursion, and variability between directly measured MAPSE and TAPSE and as based on atrioventricular plane displacement (AVPD) analysis by CMR, are, however, not known. This study, therefore, assessed inter‐method variability and variability between annular plane systolic excursion and AVPD‐based values in a healthy adult population. Methods: Echocardiography and CMR were performed in 111 adults (35 [32–38] years). Method comparisons were assessed with Deming regression, Bland–Altman analysis and coefficient of variation. Observer reproducibility was assessed by the concordance correlation coefficient. Results: Echocardiography and semi‐automatic CMR agreed on MAPSE (17 ± 2 mm vs. 17 ± 2 mm, p = 0.1) and TAPSE (25 ± 3 mm vs. 25 ± 3 mm, p = 0.5), correlated highly between methods (fitted‐slope 1.22 [95% CI 1.07–1.38] and 1.12 [95% CI 0.95–1.29]) and showed low bias (0.42 [95% CI − 2.05 to 2.88] and − 0.18 [95% CI − 4.78 to 4.43]). Intra‐/inter‐observer reproducibility was high for both methods for both MAPSE (echocardiography 0.96/0.86; CMR 0.87/0.85) and TAPSE (echocardiography 0.96/0.95; CMR 0.97/0.96). MAPSE (16 ± 2 mm vs. 17 ± 2 mm; p < 0.001) and TAPSE (24 ± 3 vs. 25 ± 3 mm; p < 0.001) based on AVPD were similar but statistically different compared with semi‐automatic CMR. Conclusions: Echocardiography and semi‐automatic CMR have low variability and provide similar values for MAPSE and TAPSE and are thus interchangeable for follow‐up studies. Lateral values based on tracked data from AVPD analysis are not clinically significantly different and could be used as a representation of annular displacement. [ABSTRACT FROM AUTHOR]

The cause of obesity in narcolepsy type 1 (NT1) patients is not fully understood. The present study investigated if a reduced physical activity could explain weight gain in NT1. Seventy‐nine patients were included in this retrospective study and divided into an NT1 group (n = 56) and a non‐NT1 group (n = 23), including NT2 and idiopathic hypersomnia (IH). Accelerometry‐derived measures of physical activity, total energy expenditure and skin temperature were collected from patients during seven consecutive days without medication. In addition, results from multiple sleep latency tests and the Epworth Sleepiness Scale questionnaire, body weight, height and CSF orexin/hypocretin were acquired. Three measurements of physical activity, including metabolic equivalent of task (MET), the average time of physical activity and step count, were compared without differences between groups. Neither could we find a significant difference in total energy expenditure or skin temperature. Thus, by analysing accelerometric data, we could not find any differences in the amount of physical activity or total energy expenditure explaining overweight in NT1. [ABSTRACT FROM AUTHOR]

Potential long‐term consequences of hypnotics remain controversial. We used the prospective Swedish National March Cohort, a study based on 41,695 participants with a mean follow‐up duration of 18.9 years. Logistic regression models and Cox proportional hazards models with attained age as timescale were used to assess associations of hypnotic use with short‐ and long‐term mortality. The proportion of subjects who initiated or discontinued hypnotic use during follow‐up was substantial. All groups of hypnotics were associated with increased mortality within 2 years after a first prescription, with an overall OR of 2.38 (95% CI, 2.13–2.66). The association was more pronounced among subjects younger than 60 years (OR, 6.16; 95% CI, 3.98–9.52). There was no association between hypnotic use and long‐term mortality. The association between hypnotic use and increased mortality was thus restricted to a relatively short period after treatment initiation, and may be explained in terms of confounding by indication. [ABSTRACT FROM AUTHOR]

Aims: Improved risk stratification is of value for decision making in pulmonary arterial hypertension (PAH). Right heart catheterization combined with quantitative tricuspid regurgitation (TR) by cardiovascular magnetic resonance (CMR) may provide this. The aims were to study: (i) to what extent quantitative TR is associated with event‐free survival; (ii) how quantitative TR is related to known prognostic markers in PAH; and (iii) to what extent quantitative TR and right atrial pressure determine right atrial dilation. Methods and results: Fifty patients (63 ± 17 years) with PAH referred for CMR were included. Volumes and pulmonary artery flow by CMR and pressure and vascular resistance by right heart catheterization were obtained. Composite outcome was lung transplantation or death. Four transplantations and 27 deaths occurred over a median of 2.7 years. A trend towards higher hazard ratio was shown for TR volume (TRV; 2.1, 95% CI 1.0–4.4) and TR fraction (TR%; 1.6, 95% CI 0.8–3.3) above median. TRV and TR% correlated with right ventricular (RV) end‐diastolic (TRV r = 0.50; TR% r = 0.39) and end‐systolic (TRV r = 0.35; TR% r = 0.30) volumes, pulmonary vascular resistance (TRV r = 0.28; TR% r = 0.43), N terminal pro brain natriuretic peptide (TRV r = 0.65; TR% r = 0.68), cardiac index (TRV r = −0.32; TR% r = −0.54), pulmonary artery stroke volume (TRV r = −0.32; TR% r = −0.58) and effective RV ejection fraction by pulmonary artery quantitative flow (TRV r = −0.56; TR% r = −0.69), but not RVEF. Both TR% and right atrial pressure determined right atrial volumes (r2 = 0.38; r2 = 0.48). Conclusions: A clear trend towards worse outcome with larger TRV or TR% was shown; however, the number of events was insufficient for significant outcome differences. Prognostic value of quantitative TR should be investigated in a larger multicentre cohort. Effective RV ejection fraction may be considered an improved measure of RV function in PAH. [ABSTRACT FROM AUTHOR]

Considering the widespread contaminations of food products with mycotoxins, it is important to develop, robust, time‐ and cost‐effective detection methods. We developed and optimized an immunoassay using a continuous flow system for the detection of zearalenone (ZEN). The assay was performed in a flow mode using an automated sequential injection system. Time for an assay cycle was 18 Min. Under optimal conditions, the limit for quantification for ZEN was 0.40 µg L−1 with a linear dependency between concentration and signal amplitude between 0.10 and 10 µg L−1. The assay proved to be robust and reliable with 13% relative standard deviation between measurements. By dissociating the antigen–antibody complex using a regeneration solution, we showed 50 times reusability of the immobilized antibodies without affecting the antigen‐binding properties. [ABSTRACT FROM AUTHOR]

Purpose: To develop and assess a technique for self-gated fetal cardiac cine magnetic resonance imaging (MRI) using tiny golden angle radial sampling combined with iGRASP (iterative Golden-angle RAdial Sparse Parallel) for accelerated acquisition based on parallel imaging and compressed sensing.Materials and Methods: Fetal cardiac data were acquired from five volunteers in gestational week 29-37 at 1.5T using tiny golden angles for eddy currents reduction. The acquired multicoil radial projections were input to a principal component analysis-based compression stage. The cardiac self-gating (CSG) signal for cardiac gating was extracted from the acquired radial projections and the iGRASP reconstruction procedure was applied. In all acquisitions, a total of 4000 radial spokes were acquired within a breath-hold of less than 15 seconds using a balanced steady-state free precession pulse sequence. The images were qualitatively compared by two independent observers (on a scale of 1-4) to a single midventricular cine image from metric optimized gating (MOG) and real-time acquisitions.Results: For iGRASP and MOG images, good overall image quality (2.8 ± 0.4 and 2.6 ± 1.3, respectively, for observer 1; 3.6 ± 0.5 and 3.4 ± 0.9, respectively, for observer 2) and cardiac diagnostic quality (3.8 ± 0.4 and 3.4 ± 0.9, respectively, for observer 1; 3.6 ± 0.5 and 3.6 ± 0.9, respectively, for observer 2) were obtained, with visualized myocardial thickening over the cardiac cycle and well-defined myocardial borders to ventricular lumen and liver/lung tissue. For iGRASP, MOG, and real time, left ventricular lumen diameter (14.1 ± 2.2 mm, 14.2 ± 1.9 mm, 14.7 ± 1.1 mm, respectively) and wall thickness (2.7 ± 0.3 mm, 2.6 ± 0.3 mm, 3.0 ± 0.4, respectively) showed agreement and no statistically significant difference was found (all P > 0.05). Images with iGRASP tended to have higher overall image quality scores compared with MOG and particularly real-time images, albeit not statistically significant in this feasibility study (P > 0.99 and P = 0.12, respectively).Conclusion: Fetal cardiac cine MRI can be performed with iGRASP using tiny golden angles and CSG. Comparison with other fetal cardiac cine MRI methods showed that the proposed method produces high-quality fetal cardiac reconstructions.Level Of Evidence: 2 Technical Efficacy: Stage 1 J. MAGN. RESON. IMAGING 2017;46:207-217. [ABSTRACT FROM AUTHOR]

Background: Fetal cardiovascular MRI complements ultrasound to assess fetal cardiovascular pathophysiology.Purpose: To develop a free-breathing method for retrospective fetal cine MRI using Doppler ultrasound (DUS) cardiac gating and tiny golden angle radial sampling (tyGRASP) for accelerated acquisition capable of detecting fetal movements for motion compensation.Study Type: Feasibility study.Subjects: Nine volunteers (gestational week 34-40). Short-axis and four-chamber views were acquired during maternal free-breathing and breath-hold.Field Strength/sequence: 1.5T cine balanced steady-state free precession.Assessment: A self-gated reconstruction method was improved for clinical application by using 1) retrospective DUS gating, and 2) motion detection and rejection/correction algorithms for compensating for fetal motion. The free-breathing reconstructions were qualitatively and quantitatively assessed, and DUS-gating was compared with self-gating in breath-hold reconstructions. A scoring of 1-4 for overall image quality, cardiac, and extracardiac diagnostic quality was used.Statistical Tests: Friedman's test was used to assess differences in qualitative scoring between observers. A Wilcoxon matched-pairs signed rank test was used to assess differences between breath-hold and free-breathing acquisitions and between observers' quantitative measurements.Results: In all cases, 111 free-breathing and 145 breath-hold acquisitions, the automatically calculated DUS-based cardiac gating signal provided reconstructions of diagnostic quality (median score 4, range 1-4). Free-breathing did not affect the DUS-based cardiac gated retrospective radial reconstruction with respect to image or diagnostic quality (all P > 0.06). Motion detection with rejection/correction in k-space produced high-quality free-breathing DUS-based reconstructions [median 3, range (2-4)], whereas free-breathing self-gated methods failed in 80 out of 88 cases to produce a stable gating signal.Data Conclusion: Free-breathing fetal cine cardiac MRI based on DUS gating and tyGRASP with motion compensation yields diagnostic images. This simplifies acquisition for the pregnant woman and thus could help increase fetal cardiac MRI acceptance in the clinic.Level Of Evidence: 2 Technical Efficacy Stage: 1 J. Magn. Reson. Imaging 2020;51:260-272. [ABSTRACT FROM AUTHOR]

Background: A rising trend for incidence of multiple sclerosis (MS) has been observed during the recent years in Iran. Several factors have been investigated as the reason, but socioeconomic determinants have been neglected. The present study aimed to investigate the relationship between Human Development Index (HDI), income and education and MS prevalence in the provinces of Iran. Methods: The data used in this study were obtained from three sources: (a) National Registry of MS for MS prevalence data from 2006 to 2013, (b) Statistical Centre of Iran for demographic, income, and percentage of educated people data, and (c) some previous studies for HDI data. Results: The findings showed high prevalence of MS in the provinces of Iran. Most patients were residents of provinces with a higher socioeconomic level. Significant relationships were found between the prevalence of MS and HDI, income and educational level (P = .002, P = .006, and P = .001, respectively). Conclusion: Socioeconomic determinants in Iran are different from those in many other countries. It seems that Iranian provinces with a higher socioeconomic level have higher prevalence of MS. Further studies in smaller scale are needed to better understand the relationship between socioeconomic determinants and MS prevalence in the provinces of Iran. [ABSTRACT FROM AUTHOR]

Summary: Blood flow measurements in the ascending aorta and pulmonary artery from phase‐contrast magnetic resonance images require accurate time‐resolved vessel segmentation over the cardiac cycle. Current semi‐automatic segmentation methods often involve time‐consuming manual correction, relying on user experience for accurate results. The purpose of this study was to develop a semi‐automatic vessel segmentation algorithm with shape constraints based on manual vessel delineations for robust segmentation of the ascending aorta and pulmonary artery, to evaluate the proposed method in healthy volunteers and patients with heart failure and congenital heart disease, to validate the method in a pulsatile flow phantom experiment, and to make the method freely available for research purposes. Algorithm shape constraints were extracted from manual reference delineations of the ascending aorta (n = 20) and pulmonary artery (n = 20) and were included in a semi‐automatic segmentation method only requiring manual delineation in one image. Bias and variability (bias ± SD) for flow volume of the proposed algorithm versus manual reference delineations were 0·0 ± 1·9 ml in the ascending aorta (n = 151; seven healthy volunteers; 144 heart failure patients) and −1·7 ± 2·9 ml in the pulmonary artery (n = 40; 25 healthy volunteers; 15 patients with atrial septal defect). Interobserver bias and variability were lower (P = 0·008) for the proposed semi‐automatic method (−0·1 ± 0·9 ml) compared to manual reference delineations (1·5 ± 5·1 ml). Phantom validation showed good agreement between the proposed method and timer‐and‐beaker flow volumes (0·4 ± 2·7 ml). In conclusion, the proposed semi‐automatic vessel segmentation algorithm can be used for efficient analysis of flow and shunt volumes in the aorta and pulmonary artery. [ABSTRACT FROM AUTHOR]

Objective: Smoking is associated with an increased risk of rheumatoid arthritis (RA) in subsets of patients defined according to the presence or absence of anti–citrullinated protein antibodies (ACPAs) and rheumatoid factors (RFs). Moreover, an interaction between smoking and the HLA–DRB1 shared epitope (SE) has been demonstrated to be a risk factor for seropositive RA. The aim of this study was to investigate the interplay between smoking and the HLA–DRB1 SE with regard to risk of RA in different patient subsets based on ACPA and RF status. Methods: Incident cases of RA (3,645 cases, 5,883 matched controls) were divided into 4 subgroups based on the presence or absence of RF and anti–cyclic citrullinated peptide 2 (anti‐CCP2) antibodies. The influence of smoking on the risk of disease was determined in each RA subgroup, using logistic regression models with calculation of odds ratios and 95% confidence intervals (95% CIs). The potential interaction between smoking and HLA–DRB1 SE genes was evaluated by calculating the attributable proportion due to interaction (AP). Results: In the RF+/anti‐CCP2+ subset of RA patients, both smoking and the presence of the HLA–DRB1 SE conferred independent disease risks, and there was a strong interaction between the 2 risk factors (AP 0.4, 95% CI 0.3, 0.5). In the RF−/anti‐CCP2+ patient subset, the HLA–DRB1 SE conferred an increased risk of RA, whereas the independent influence of smoking was limited. However, there was a significant interaction between the HLA–DRB1 SE and smoking (AP 0.2, 95% CI 0.02, 0.5). In the RF+/anti‐CCP2− patient subset, there was an increased risk of disease among smokers, which was only marginally affected by the presence of the HLA–DRB1 SE, and no interaction between the 2 factors was observed (AP 0.002, 95% CI −0.3, 0.3). In the RF−/anti‐CCP2− patient subset, neither smoking nor the presence of the HLA–DRB1 SE conferred an increased risk of RA. Conclusion: These findings demonstrate different effects of smoking and HLA–DRB1 in the 4 serologically defined RA subsets. [ABSTRACT FROM AUTHOR]

Summary: Limited visualization of the fetal heart and vessels by fetal ultrasound due to suboptimal fetal position, patient habitus and skeletal calcification may lead to missed diagnosis, overdiagnosis and parental uncertainty. Counselling and delivery planning may in those cases also be tentative. The recent fetal cardiac magnetic resonance (CMR) reconstruction method utilizing tiny golden‐angle iGRASP (iterative Golden‐angle RAdial Sparse Parallel MRI) allows for cine imaging of the fetal heart for use in clinical practice. This case describes an unbalanced common atrioventricular canal where limited ultrasound image quality and visibility of the aortic arch precluded confirming or ruling out presence of a ventricular septal defect. Need of prostaglandins or neonatal intervention was thus uncertain. Cardiovascular magnetic resonance imaging confirmed ultrasound findings and added value by ruling out a significant ventricular septal defect and diagnosing arch hypoplasia. This confirmed the need of patient relocation for delivery at a paediatric cardiothoracic surgery centre and prostaglandins could be initiated before the standard postnatal ultrasound. The applied CMR method can thus improve diagnosis of complicated fetal cardiac malformation and has direct clinical impact. [ABSTRACT FROM AUTHOR]

Purpose: An approach for the automated segmentation of visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) in multicenter water–fat MRI scans of the abdomen was investigated, using 2 different neural network architectures. Methods: The 2 fully convolutional network architectures U‐Net and V‐Net were trained, evaluated, and compared using the water–fat MRI data. Data of the study Tellus with 90 scans from a single center was used for a 10‐fold cross‐validation in which the most successful configuration for both networks was determined. These configurations were then tested on 20 scans of the multicenter study beta‐cell function in JUvenile Diabetes and Obesity (BetaJudo), which involved a different study population and scanning device. Results: The U‐Net outperformed the used implementation of the V‐Net in both cross‐validation and testing. In cross‐validation, the U‐Net reached average dice scores of 0.988 (VAT) and 0.992 (SAT). The average of the absolute quantification errors amount to 0.67% (VAT) and 0.39% (SAT). On the multicenter test data, the U‐Net performs only slightly worse, with average dice scores of 0.970 (VAT) and 0.987 (SAT) and quantification errors of 2.80% (VAT) and 1.65% (SAT). Conclusion: The segmentations generated by the U‐Net allow for reliable quantification and could therefore be viable for high‐quality automated measurements of VAT and SAT in large‐scale studies with minimal need for human intervention. The high performance on the multicenter test data furthermore shows the robustness of this approach for data of different patient demographics and imaging centers, as long as a consistent imaging protocol is used. [ABSTRACT FROM AUTHOR]

Productivity and trophic structure of aquatic ecosystems result from a complex interplay of bottom‐up and top‐down forces that operate across benthic and pelagic food web compartments. Projected global changes urge the question how this interplay will be affected by browning (increasing input of terrestrial dissolved organic matter), nutrient enrichment and warming. We explored this with a process‐based model of a shallow lake food web consisting of benthic and pelagic components (abiotic resources, primary producers, grazers, carnivores), and compared model expectations with the results of a browning and warming experiment in nutrient‐poor ponds harboring a boreal lake community. Under low nutrient conditions, the model makes three major predictions. (a) Browning reduces light and increases nutrient supply; this decreases benthic and increases pelagic production, gradually shifting productivity from the benthic to the pelagic habitat. (b) Because of active habitat choice, fish exert top‐down control on grazers and benefit primary producers primarily in the more productive of the two habitats. (c) Warming relaxes top‐down control of grazers by fish and decreases primary producer biomass, but effects of warming are generally small compared to effects of browning and nutrient supply. Experimental results were consistent with most model predictions for browning: light penetration, benthic algal production, and zoobenthos biomass decreased, and pelagic nutrients and pelagic algal production increased with browning. Also consistent with expectations, warming had negative effects on benthic and pelagic algal biomass and weak effects on algal production and zoobenthos and zooplankton biomass. Inconsistent with expectations, browning had no effect on zooplankton and warming effects on fish depended on browning. The model is applicable also to nutrient‐rich systems, and we propose that it is a useful tool for the exploration of the consequences of different climate change scenarios for productivity and food web dynamics in shallow lakes, the worldwide most common lake type. Productivity and trophic structure of aquatic ecosystems result from the interplay of bottom‐up and top‐down forces across benthic and pelagic food web compartments. Using a process‐based model, we investigated how shallow lake ecosystems respond to browning (terrestrial dissolved organic matter), nutrient enrichment and warming. The model predicts that browning and nutrient enrichment shift productivity from the benthic to the pelagic habitat, whereas warming relaxes control of grazers by fish, thus decreasing primary producer biomass. Predicted warming effects are, however, small compared to effects of browning and nutrient enrichment. A pond‐scale manipulation of browning and warming corroborated many of these expectations. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the ganglion cell complex (GCC) thickness using the Iowa Reference Segmentation Algorithm in individuals with chronic Leber hereditary optic neuropathy (LHON) and to assess its relation to visual acuity, visual field sensitivity, and Estermann score. Methods: In this study, a total of 17 patients (34 eyes) aged 16–72 with chronic LHON were enrolled. Visual acuity, visual fields, and Optic coherence tomography (OCT) were performed. Visual fields was evaluated with Estermann and a custom central 30‐degree test, both performed monocularly with the Octopus 900 Haag‐Streit Diagnostics. OCT imaging was performed using a Canon OCT HS‐100 to measure the retinal ganglion cell complex (GCC) thickness. The raw OCT images were exported to IOWA Reference Algorithm and the GCC segmentation was rechecked and manually recorrected if needed. The thickness obtained from the Iowa Reference Algorithms was analysed and compared against the automated segmentation provided by the OCT's inbuilt segmentation algorithm. The correlation between the GCC thickness from 9 ETDRS sectors and the visual function were analysed. Results: On average the automated segmentation overestimated GCC thickness by 23.8 μm for all sectors. Macular central GCC correlated significantly with both visual field sensitivity and Estermann points missed (r = −0.486 and −0.396 respectively). Macular middle sector GCC thickness correlated significantly with visual acuity and visual field sensitivity (r = −0.586 and −0.396 respectively). GCC thickness in outer macular sector correlated significantly only with visual acuity (r = −0.471). Conclusions: In patients with chronic LHON, GCC thickness in central and middle sectors of macula correlates well with the visual function. OCT imaging and precise ganglion cell thickness evaluations in the macula can provide useful information about the structural damage and level of visual impairment in chronic LHON patients. [ABSTRACT FROM AUTHOR]

Objective: The main aim was to investigate the development of health-related quality of life (HRQOL) and symptoms of anxiety and depression in a cohort diagnosed with cancer during adolescence from shortly after up to 10 years after diagnosis.Methods: Participants (n = 61) completed the SF-36 and the HADS shortly; six, 12, and 18 months; and two, three, four, and 10 years (n = 28) after diagnosis. Polynomial change trajectories were used to model development.Results: Polynomial change trajectories showed an initial increase which abated over time into a decrease which abated over time for the SF-36 subscales Mental Health and Vitality; an initial decline which abated over time into an increase for HADS anxiety; and an initial decline which abated over time into an increase which abated over time for HADS depression. The SF-36 mental component summary showed no change from two to 10 years after diagnosis whereas the SF-36 physical component summary showed an increase from two years after diagnosis which declined over time. Ten years after diagnosis 29% reported possible anxiety.Conclusions: Development of HRQOL and symptoms of anxiety and depression appears to be non-linear among persons diagnosed with cancer during adolescence. Well into permanent survivorship an increase in symptoms of anxiety is shown and approximately a third of the participants report possible anxiety. The findings indicate the need for: studies designed to pinpoint the times of highest psychological risk, clinical follow-up focusing on psychological problems, and development of effective psychological interventions for survivors of adolescent cancer. © 2015 The Authors. Psycho-Oncology published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Purpose: To validate metric optimized gating phase‐contrast MR (MOG PC‐MR) flow measurements for a range of fetal flow velocities in phantom experiments. 2) To investigate intra‐ and interobserver variability for fetal flow measurements at an imaging center other than the original site. Methods: MOG PC‐MR was compared to timer/beaker measurements in a pulsatile flow phantom using a heart rate (∼145 bpm), nozzle diameter (∼6 mm), and flow range (∼130–700 mL/min) similar to fetal imaging. Fifteen healthy fetuses were included for intra‐ and interobserver variability in the fetal descending aorta and umbilical vein. Results: Phantom MOG PC‐MR flow bias and variability was 2% ± 23%. Accuracy of MOG PC‐MR was degraded for flow profiles with low velocity‐to‐noise ratio. Intra‐ and interobserver coefficients of variation were 6% and 19%, respectively, for fetal descending aorta; and 10% and 17%, respectively, for the umbilical vein. Conclusion: Phantom validation showed good agreement between MOG and conventionally gated PC‐MR, except for cases with low velocity‐to‐noise ratio, which resulted in MOG misgating and underestimated peak velocities and warranted optimization of sequence parameters to individual fetal vessels. Inter‐ and intraobserver variability for fetal MOG PC‐MR imaging were comparable to previously reported values. [ABSTRACT FROM AUTHOR]

The effects of Co, Ni together with W addition on the precipitation sequence, amount, and composition of carbides and FCC matrix in Fe–C–V–Cr–Mo based alloys are investigated with the help of Partial Equilibrium (PE) approximation and thermodynamic calculations as well as differential scanning calorimetry (DSC) and electron backscatter diffraction (EBSD) ‐ energy dispersive spectrometer (EDS) analyses. Results show that, individually, Co and Ni elements strengthen the matrix by their great solubility in FCC matrix; W element enlarges the hardness of the alloy through benefiting the formation of M6C carbide. Mutually, the addition of Co and Ni together with W increases the precipitation temperature of the eutectic carbides, although the addition of Co and Ni itself exerts little influence on the nature (type, amount, and composition) of the carbides. These predictions combined with the experimental verifications provide potentials for the alloy design and the property control in high speed steels. [ABSTRACT FROM AUTHOR]

Background: Platelet microparticles (PMPs) are subcellular procoagulant vesicles released upon platelet activation. In people with clinical diseases, alterations in PMP concentrations have been extensively investigated, but few canine studies exist. Objectives: This study aims to validate a canine flow cytometric protocol for PMP quantification and to assess the influence of calcium on PMP concentrations. Methods: Microparticles (MP) were quantified in citrated whole blood (WB) and platelet‐poor plasma (PPP) using flow cytometry. Anti‐CD61 antibody and Annexin V (AnV) were used to detect platelets and phosphatidylserine, respectively. In 13 healthy dogs, CD61+/AnV− concentrations were analyzed with/without a calcium buffer. CD61+/AnV−, CD61+/AnV+, and CD61−/AnV+ MP quantification were validated in 10 healthy dogs. The coefficient of variation (CV) for duplicate (intra‐assay) and parallel (inter‐assay) analyses and detection limits (DLs) were calculated. Results: CD61+/AnV− concentrations were higher in calcium buffer; 841,800 MP/μL (526,000‐1,666,200) vs without; 474,200 MP/μL (278,800‐997,500), P < .05. In WB, PMP were above DLs and demonstrated acceptable (<20%) intra‐assay and inter‐assay CVs in 9/10 dogs: 1.7% (0.5‐8.9) and 9.0% (0.9‐11.9), respectively, for CD61+/AnV− and 2.4% (0.2‐8.7) and 7.8% (0.0‐12.8), respectively, for CD61+/AnV+. Acceptable CVs were not seen for the CD61−/AnV+ MP. In PPP, quantifications were challenged by high inter‐assay CV, overlapping DLs and hemolysis and lipemia interfered with quantification in 5/10 dogs. Conclusions: Calcium induced higher in vitro PMP concentrations, likely due to platelet activation. PMP concentrations were reliably quantified in WB, indicating the potential for clinical applications. PPP analyses were unreliable due to high inter‐CV and DL overlap, and not obtainable due to hemolysis and lipemia interference. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To identify temporal patterns of patient‐reported trismus during the first year post‐radiotherapy, and to study their associations with maximal interincisal opening distances (MIOs). Design: Single institution case series. Setting: University hospital ENT clinic. Participants: One hundred and ninety‐six subjects who received radiotherapy (RT) for head and neck cancer (HNC) with or without chemotherapy in 2007‐2012 to a total dose of 64.6/68 Gy in 38/34 fractions, respectively. All subjects were prospectively assessed for mouth‐opening ability (Gothenburg Trismus Questionnaire (GTQ), European Organization for Research and Treatment of Cancer quality of life Questionnaire (EORTC QLQ‐H&N35), and MIO) pre‐RT and at 3, 6 and 12 months after RT. Main outcome measures: Correlations between temporally robust GTQ symptoms and MIO as given by Pearson's correlation coefficients (Pr); temporally robust GTQ‐symptom domains as given by factor analysis; rates of trismus with respect to baseline by risk ratios (RRs). Results: Four temporally robust domains were identified: Eating (3‐7 symptoms), Jaw (3‐7), Pain (2‐5) and Quality of Life (QoL, 2‐5), and included 2‐3 persistent symptoms across all post‐RT assessments. The median RR for a moderate/severe (>2/>3) cut‐off was the highest for Jaw (3.7/3.6) and QoL (3.2/2.9). The median Pr between temporally robust symptoms and MIO post‐radiotherapy was 0.25‐0.35/0.34‐0.43/0.24‐0.31/0.34‐0.50 for Eating/Jaw/Pain/QoL, respectively. Conclusions: Mouth‐opening distances in patients with HNC post‐RT can be understood in terms of associated patient‐reported outcomes on trismus‐related difficulties. Our data suggest that a reduction in MIO can be expected as patients communicate their mouth‐opening status to interfere with private/social life, a clinical warning signal for emerging or worsening trismus as patients are being followed after RT. [ABSTRACT FROM AUTHOR]

Main-group complexes are shown to be viable electrocatalysts for the H2-evolution reaction (HER) from acid. A series of antimony porphyrins with varying axial ligands were synthesized for electrocatalysis applications. The proton-reduction catalytic properties of TPSb(OH)2 (TP=5,10,15,20-tetra( p-tolyl)porphyrin) with two axial hydroxy ligands were studied in detail, demonstrating catalytic H2 production. Experiments, in conjunction with quantum chemistry calculations, show that the catalytic cycle is driven via the redox activity of both the porphyrin ligand and the Sb center. This study brings insight into main group catalysis and the role of redox-active ligands during catalysis. [ABSTRACT FROM AUTHOR]

Purpose To validate ironload T2* by automatic inline Maximum Likelihood Estimate ( MLE) with k-space Rician noise correction, against the manual and automated truncation, as well as offset methods, in phantoms and in heart and liver in patients. Methods Twenty-five patients and an iron-oxide phantom were scanned at 1.5T using 2 multi-echo gradient-echo sequences. All parameters were identical (voxel 2-3 × 2-3 × 10 mm3, 10 echoes, TR = 26 ms, FA = 20°, BW = 833 Hz, SENSE = 2) except for TE (cardiac: TE1 = 2·5 ms, Δ TE = 2·5 ms; liver: TE1 = 1·2 ms, Δ TE = 1·5 ms). Phantoms were scanned at 1 and 32 signal averages ( NSA), with NSA32 representing low-noise reference. Results Phantoms: MLE showed low variability between NSA1 and NSA32 (0·02 ± 0·29 ms, CI ±0·21 ms). Between methods, no difference was shown ( MLE versus all: <0·31 ms, CI < ±0·35 ms). Patients: No differences were found between methods in heart ( MLE versus all: <−0·22 ms, CI < ±0·75 ms) or liver ( MLE versus all: <0·12 ms, CI < ±0·26 ms). Conclusions The automatic inline MLE method is comparable to the general reference standards for determining cardiac and liver T2* for ironload in man. An automatic inline method may simplify ironload assessment, particularly in centres seeing fewer cases. [ABSTRACT FROM AUTHOR]

Objective To describe general practitioners' experiences of being the principal physician responsible for a nursing home. Method Fifteen general practitioners assigned to a nursing home participated in semi-structured qualitative interviews. Data were analysed using systematic text condensation. Result Medical assessment is the main duty of general practitioners. Advance care planning together with residents and family members facilitates future decisions on medical treatment and end-of-life care. Registered Nurses' continuity and competence are perceived as crucial to the quality of care, but inadequate staffing, lack of medical equipment and less-than-optimal IT systems for electronic healthcare records are impediments to patient safety. Conclusion The study highlights the importance of advance care planning together with residents and family members in facilitating future decisions on medical treatment and end-of-life care. To meet the increasing demands for more complex medical treatment at nursing homes and to provide high-quality palliative care, there would seem to be a need to increase Registered Nurses' staffing and acquire more advanced medical equipment, as well as to create better possibilities for Registered Nurses and general practitioners to access each other's healthcare record systems. [ABSTRACT FROM AUTHOR]