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This article discusses anonymizing elite interviewees. Based on our experiences with interviewing professional elites and ultra-elites in different research projects, we describe how the types of conflicts involving analysis and publication change when interviewees are not promised anonymity. We discuss how contextualizing the elite positions of anonymized interviewees becomes increasingly difficult in interviews with persons who hold prestigious positions of authority and are interviewed in their official capacity. Masking interviewees can create conflicts with regard to the researcher's presentation of results, the transparency of the research and the ability of interviewees to talk back. We show how working with non-anonymized interviewees -- and even using excerpts from interviews on public radio -- can be an option in qualitative research. However, non-anonymized interviews with elites should be considered only in some instances and may seriously hamper the validity of the material in other cases.

Macrophytes are important structural and biologically active components in many lowland streams. Although the direct and indirect roles of macrophytes on ecosystem structure and function have been assessed, their concurrent influence on whole-stream metabolism and nutrient cycling, particularly during periods of growth and senescence, is less clear. In our study, we sought to quantify the relationships between macrophyte phenology and seasonal patterns in stream structure and function. We measured variables related to biofilm abundance, whole-stream metabolism, and nutrient cycling in a macrophyte-dominated agricultural stream in Denmark on 9 sampling events throughout a year. Seasonal variation in macrophyte abundance and biomass led to concurrent variation in the biomass of epiphytic and benthic biofilms. Regarding ecosystem function, macrophyte biomass was the strongest predictor of NH4+ uptake length (i.e., S w) and was also a predictor of soluble reactive P (SRP) S w and whole-stream metabolism. Furthermore, NH4+ demand was predicted by gross primary production, and SRP uptake was predicted by ecosystem respiration, demonstrating tight coupling between autotrophic production and N cycling and between heterotrophic production and P. Our study adds to the few seasonal studies on the central role of macrophytes on ecosystem function in lowland streams, especially during the growing season via direct metabolic activity and nutrient assimilation as well as indirect effects, such as supporting epiphytic biofilms and enhancing organic matter retention. [ABSTRACT FROM AUTHOR]

Elites often use merit to explain, justify, and make sense of their advantaged positions. But what exactly do they mean by this? In this paper, we draw on 71 interviews with elites in Denmark and the UK to compare self-justifications of meritocratic legitimacy. Our results indicate that while elites in both countries are united by a common concern to frame their merits as spontaneously recognized by others (rather than strategically promoted by themselves), the package of attributes they foreground vary significantly. In the UK, elites tend to be "talent meritocrats" who foreground their unique capacity for ideational creativity or risk taking, innately good judgment, and "natural" aptitude, intelligence, or academic ability. In contrast, in Denmark, elites are more likely to be "hard work meritocrats" who emphasize their unusual work ethic, extensive experience (as a signal of accumulated hard work), and contributions outside of work, particularly in civil society. We tentatively argue that one explanation for this cross-national variation is the role that different channels of elite recruitment play in amplifying legitimate notions of merit. In the UK, for example, elite private schools act to nurture ideas of exceptionalism and natural talent, whereas in Denmark elite employers socialize the connection between hard work and success. These findings suggest that nationally specific understandings of merit can have quite different implications for the legitimation of inequality. [ABSTRACT FROM AUTHOR]

Career narratives among the Danish power elite often include the facilitating presence of an elite superior. We explore the role patrons play in the mobility narratives of the Danish power elite. Drawing from a highly select group identified in the core of elite networks, we interviewed 37 individuals selected for maximal variation in career paths, networks and positions within the power elite. We referenced the concept of patrimonialism to understand the relations between patrons and protégés in building an elite career and develop a typology identifying three kinds of patrimonial relations described by elites, intra-organizational relations to mentors and patriarchs and inter-organizational relations to sponsors. We then empirically explore the three types of patrimonial relations. Finally, we argue that each of these patrimonial relations reinforce elite cohesion, even in the supposedly critical case of good governance in Denmark. Hence, patrimonial relations present a crucial perspective for understanding contemporary power structures. [ABSTRACT FROM AUTHOR]

The prognosis after primary (chemo-)radiotherapy for oropharyngeal squamous cell carcinoma (OPSCC) is affected by Human Papillomavirus (HPV) status, with a better prognosis in HPV-positive OPSCC. HPV-status is routinely assessed by p16 immunohistochemistry (IHC), but additional HPV DNA testing is debated. Also, there are numerous HPV genotypes, which prognostic role may need clarification. The purpose of this study was: (1) to test a custom-made targeted HPV next generation sequencing (NGS) panel in OPSCC, (2) to determine correlation with p16 IHC, and (3) to assess the impact of HPV DNA testing on outcome in the prospectively randomized clinical trial DAHANCA 19. We included 271 patients with OPSCC treated with primary (chemo-)radiotherapy in the DAHANCA 19 trial. Of these, 199 (73%) were p16-positive. HPV-status was determined by targeted HPV next generation sequencing (NGS), using a custom-made HPV genotyping panel. HPV was detected in 194 tumor samples. p16 IHC and NGS HPV status were concordant in 265 (98%) of 271 patients, whereas we did not detect HPV DNA in 5 p16-positive tumors. HPV16 accounted for 169 of 194 HPV-positive cases (87%). HPV genotypes 18, 31, 33, 35, and 59 were also detected. Loco-regional failure and overall survival were similar whether patients were separated by p16 IHC, or HPV DNA status (p < 0.0001 for all) and did not depend on HPV genotype (p = 0.9 and p = 0.7). In the present study, HPV DNA testing or typing in a Danish OPSCC cohort did not add additional information to p16 IHC, the most widely used and accepted prognostic indicator. [ABSTRACT FROM AUTHOR]

The article focuses on the diagnosis of locally recurrent head and neck squamous cell carcinoma (LRC) in Nordic Head and Neck Cancer (HNC) centers and the feasibility of using the Odense-Birmingham definition for uniform diagnosis. Topics discussed include the variation in clinical practice for classifying LRC versus second primary carcinoma (SPC) and the impact of introducing the Odense-Birmingham definition on diagnostic decisions among HNC specialists.

Purpose: The aim of this study is to present incidence, histological subtypes, survival rates, and prognostic factors based on a national cohort of patients with salivary gland carcinoma. Methods: All Danish patients with submandibular gland carcinoma diagnosed from 1990 to 2015 (n = 206) were included and analyzed following histological re-evaluation. Data were collected by the Danish Head and Neck Cancer Group (DAHANCA). Overall, disease-specific and recurrence-free survival were evaluated. Prognostic factors were analyzed with multivariate Cox Hazard Regression. Results: The study population consisted of 109 (53%) men and 97 (47%) women, median age 62 years (range 11–102). Adenoid cystic carcinoma was the most frequent subtype (50%). Tumour classification T1/T2 (75%) and N0 (78%) was most frequent. The mean crude incidence was 0.17/100,000/year. Most patients (n = 194, 94%) were treated with primary surgery, and 130 (67%) received postoperative radiotherapy. The 5- and 10-year survival rates were for overall survival 64% and 41%, disease-specific survival 74% and 61%, and recurrence-free survival 70% and 56%, respectively. Survival rates were higher for adenoid cystic carcinoma compared to other subtypes, but the difference was not significant in multivariate analysis. Recurrence occurred in 69 patients, and 37 (53.6%) of them had recurrence in a distant site. Advanced T-classification and regional lymph-node metastases had significant negative impact on survival rates. Conclusion: The incidence of submandibular gland carcinoma in Denmark was 0.17/100,000/year and stable during the time period. The most frequent subtype was adenoid cystic carcinoma. Half of the recurrences presented in a distant site, and multivariate analysis confirmed that advanced stage was independent negative prognostic factor for recurrence and survival. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate phase IV efficacy, of the PD-1 inhibitor nivolumab among an unselected and unbiased national cohort of recurrent/metastatic Head and Neck Squamous Cell Carcinoma (rmHNSCC) patients. Inclusion criteria included histologically confirmed rmHNSCC and nivolumab as a second-line palliative treatment. Data were collected from patient files at the five Danish head and neck cancer centers and from the DAHANCA database. The iRECIST criteria were used for treatment evaluation. Endpoints were response rate (RR), overall survival (OS), and progression-free survival (PFS), calculated from the start of treatment to the date of event/censoring by the KM-method. Descriptive statistics were used to describe patients and treatment. Analyses were two-sided, with p <.05 considered significant. A total of 146 patients were identified in the period 2017–2020. They had a RR of 14%, median OS of 10.2 months [95% CI: 8.2–12.2] and median PFS of 3.1 months [95% CI: 2.3–4.2]. Patient age (≥ 70 years) or comorbidity did not significantly affect outcome. WHO performance status (PS) =1 was associated with an increased risk of death (HR: 2.1 [95% CI: 1.2–4.0], p =.02) and progression (HR: 1.9 [95% CI: 1.2–3.2], p =.01). Concomitant glucocorticoid-treatment during immunotherapy (≥ 50% of treatment time) appeared important for risk of death (HR: 6.4 [95% CI: 2.3–17.8], p <.001) and risk of progression (HR: 4.8 [95% CI: 1.8–12.5], p =.001). PD-L1 expression ≥ 20% was associated with a lowered risk of progression (HR: 0.5 [95% CI: 0.3–0.7], p =.001), but not lowered risk of death. In this unselected national cohort, outcome of second-line treatment reflects data from the registration studies. Furthermore, the results suggest that immunotherapy should be used with great care in treatment of rmHNSCC in patients with poor performance. [ABSTRACT FROM AUTHOR]

The study aimed to investigate the pattern of failure and describe compromises in the definition and coverage of the target for patients treated with curatively intended radiotherapy (RT) for sinonasal cancer (SNC). Patients treated with curatively intended RT in 2008–2015 in Denmark for SNC were eligible for the retrospective cohort study. Information regarding diagnosis and treatment was retrieved from the national database of the Danish Head and Neck Cancer Group (DAHANCA). Imaging from the diagnosis of recurrences was collected, and the point of origin (PO) of the recurrent tumour was estimated. All treatment plans were collected and reviewed with the focus on target coverage, manual modifications of target volumes, and dose to organs at risk (OARs) above defined constraints. A total of 184 patients were included in the analysis, and 76 (41%) relapsed. The majority of recurrences involved T-site (76%). Recurrence imaging of 39 patients was evaluated, and PO was established. Twenty-nine POs (74%) were located within the CTV, and the minimum dose to the PO was median 64.1 Gy (3.1–70.7). The criteria for target coverage (V95%) was not met in 89/184 (48%) of the CTV and 131/184 (71%) of the PTV. A total of 24% of CTVs had been manually modified to spare OARs of high-dose irradiation. No difference in target volume modifications was observed between patients who suffered recurrence and patients with lasting remission. The majority of relapses after radical treatment of SNC were located in the T-site (the primary tumour site). Multiple compromises with regards to target coverage and tolerance levels for OARs in the sinonasal region, as defined from RT guidelines, were taken. No common practice in this respect could be derived from the study. [ABSTRACT FROM AUTHOR]

In head and neck cancer, distant metastases may be present at diagnosis (M1) or occur after treatment (DM). It is unknown whether M1 and DM follow the same clinical development and share prognosis, as population-based studies regarding outcomes are scarce. Therefore, we investigated the incidence, location of metastases and overall survival of patients with M1 and DM. Patients diagnosed with squamous cell carcinoma of the pharynx and larynx in Denmark 2008–2017 were identified in the Danish Head and Neck Cancer Group (DAHANCA) database. We identified 7300 patients, of whom 197 (3%) had M1 and 498 (8%) developed DM during follow-up. The 5-year cumulative incidence of DM was 8%. 1- and 2-year overall survival for DM (27% and 13%) vs. M1 (28% and 9%) were equally poor. There was no significant difference in location of metastases for M1 and DM and the most frequently involved organs were lungs, bone, lymph nodes and liver, in descending order. In oropharyngeal squamous cell carcinomas, the location of metastases did not differ by p16-status. For p16-positive patients, 21% of DM occurred later than three years of follow-up compared to 7% of p16-negative patients. Incidence, location of metastases and prognosis of primary metastatic (M1) or post-treatment metastatic (DM) disease in pharyngeal and laryngeal squamous cell carcinoma are similar in this register-based study [ABSTRACT FROM AUTHOR]

In the Nordic countries, as in the rest of the world, particle therapy as a radiotherapy modality, is evolving, albeit the hard evidence for the clinical benefit still is scarce. However, a common goal for the Nordic countries is to include a minimum of 80% of the patients treated with particle therapy into clinical trials. In this paper, we summarize the current status of clinical trials involving particle therapy in the Nordic countries, with an overview of both active and coming trials. So far, one is closed for inclusion and data are being analyzed, seven trials are actively recruiting patients and several more trials are underway. No common Nordic trial has yet been designed, nor is in the planning phase, and the authors will discuss the obstacles as well as the opportunities a common Nordic platform may represent. [ABSTRACT FROM AUTHOR]

Background: The study aimed to evaluate Hyperfractionated, Accelerated Radiotherapy (HART) with nimorazole for patients with head and neck squamous cell carcinoma (HNSCC) using loco-regional failure (LRF), overall survival (OS), early and late morbidity as endpoints. Material and methods: From February 2007 to January 2018, 295 patients with unresected HNSCC, T1-T4, N0-N3, M0, were treated with HART prescribed as 76 Gy in 56 fractions (fx), 10 fx weekly. IMRT was used in >90% of patients. No chemotherapy was given. Patients were prospectively registered in the DAHANCA database. Results: The median age was 64 years, 75% of patients were males. Primary sites were larynx (25%), pharynx (64%) and oral cavity (11%). In total, 59% were stage III-IV (UICC 2002). Of the 150 oropharyngeal cancer (OPC) patients, 42% were p16+. The proportion of patients receiving HART as planned was 97%. The median follow-up time was 66 months. Three-year actuarial LRF was 19% and OS was 66%. LRF was significantly higher for stage III–IV patients compared to stage I–II (25% vs. 11%, HR 2.12 [1.21–3.74]). The site-specific LRF rates were: for larynx 22% [12–32], hypopharynx 30% [16–45], non-p16+ oropharynx 15% [8–23], p16+ oropharynx 7% [1–13] and oral cavity 35% [18–53]. During therapy, 51% reported severe dysphagia and 60% required feeding tubes. The peak incidence of late, severe dysphagia and xerostomia was 21% and 9%, respectively. A comparison to historical data from previous DAHANCA trials showed that tumor control and morbidity are comparable to treatment with acceleration and/or chemo-radiation. Conclusions: HART represents an attractive approach for patients with HNSCC where treatment intensification is indicated. [ABSTRACT FROM AUTHOR]

Introduction: Prediction models using logistic regression may perform poorly in external patient cohorts. However, there is a need to standardize and validate models for clinical use. The purpose of this project was to describe a method for validation of external NTCP models used for patient selection in the randomized trial of protons versus photons in head and neck cancer radiotherapy, DAHANCA 35. Material and methods: Organs at risk of 588 patients treated primarily with IMRT in the randomized controlled DAHANCA19 trial were retrospectively contoured according to recent international recommendations. Dose metrics were extracted using MatLab and all clinical parameters were retrieved from the DAHANCA database. The model proposed by Christianen et al. to predict physician-rated dysphagia was validated through the closed testing, where change of the model intercept, slope and individual beta's were tested for significant prediction improvements. Results: Six months prevalence of dysphagia in the validation cohort was 33%. The closed testing procedure for physician-rated dysphagia showed that the Christianen et al. model needed an intercept refitting for the best match for the Danish patients. The intercept update increased the risk of dysphagia for the validation cohort by 7.9 ± 2.5% point. For the raw model performance, the Brier score (mean squared residual) was 0.467, which improved significantly with a new intercept to 0.415. Conclusions: The previously published Dutch dysphagia model needed an intercept update to match the Danish patient cohort. The implementation of a closed testing procedure on the current validation cohort allows quick and efficient validation of external NTCP models for patient selection in the future. [ABSTRACT FROM AUTHOR]

Introduction: The spectrum of diseases on the one hand and limited resources on the other will require greater continuity of care in the future, geared more to patients' needs than to structures. Many patients are currently treated in the inpatient sector, although this could be avoided with appropriate outpatient structures. On the same time, many smaller hospitals in Germany are currently threatened with closure looking for alternative concepts. This situation suggests the development of a care solution in the sense of intersectoral health centers, which as an intermediary structure offer round-the-clock monitoring without a continuous physician presence ("extended outpatient care (EAV)". Aims, Objectives, Theory or Methods: The aim of our project was to investigate which patient groups or cases would be suitable from a medical point of view for such a structure. We conducted 30 semi-structured expert interviews (medical specialists from 16 disciplines distributed between outpatient - inpatient or urban - rural location), nursing staff, nursing scientists, nursing support centers and consultants). Potential diagnoses, services and necessary resources as well as a general view on EAV were interrogated. In an iterative evaluation process, a list of ""EAV-sensitive indication areas"" and scenarios was compiled, to which the services and structures to be provided could then be assigned. Highlights or Results or Key Findings: Specialty-related clinical pictures that could be safely managed in the setting of an EAV could first be classified into ""avoidable life-threatening conditions" of acute diseases and ""exacerbation / decompensation"" in chronic diseases, multimoribidity or geriatric patients. The aforementioned disease states were then assigned to ICD groups to allow for case volume estimation. For patient-specific manageability in the context of an EAV, further criteria showed to be relevant in addition to the diagnosis. These were assigned to four categories: 1. disease-related criteria (diagnostic certainty, manageable complications, conservative therapy option) 2. individual case severity (medical history, prognosis, frailty, etc), 3. sociodemographic criteria (age, need for support, home situation...), 4. structure-related criteria (equipment and available qualifications, etc.). Derived from this we could compile a minimum EAV structure to be provided as well as facultative structures, depending on the regional provider network that would offer additional benefits for patients in the region. [ABSTRACT FROM AUTHOR]

Background: Citrate anticoagulation during apheresis induces transient alterations in calcium homeostasis. It is unknown whether the repeated, transient alterations in calcium homeostasis experienced by repeated apheresis donors affects bone turnover to increase fracture risk. Our aim was to investigate the risk of osteoporotic and nonosteoporotic fracture among voluntary, frequent apheresis donors.Study Design and Methods: All apheresis donors were identified from the Scandinavian Donations and Transfusions database (SCANDAT2), which includes information on over 1.6 million blood donors from Sweden and Denmark from the years 1968 and 1981, respectively. Only data from Sweden were used for these analyses. Information on fractures was obtained by linking SCANDAT2 to hospital registers. Poisson regression was used to compute incidence rate ratios of fractures in relation to the cumulative number of apheresis donations, both overall and in fixed time windows.Results: In total, 140,289 apheresis donors (67,970 women and 72,319 men) were identified from the SCANDAT2 database and were followed for up to 23 years. We observed no association between the frequency of apheresis donation and the risk of fracture either in the overall study period or during fixed-length time windows. The incidence rate ratio of fractures in donors who had made 100 or more cumulative apheresis donations was 0.99 (95% confidence interval, 0.92-1.06) compared with donors who had made from 9 to 24 donations. The results were similar in analyses stratified by sex and restricted to postmenopausal women.Conclusions: The absence of an association between repeated apheresis donation and fracture risk indicates that apheresis collection is safe with regard to bone health. [ABSTRACT FROM AUTHOR]

Background:It is unclear to which degree the services available after end of treatment are sufficient to meet the needs of women treated for breast cancer. The aim of the present study was to identify patient-reported supportive care needs and the prevalence of fear of cancer recurrence (FCR) following end of treatment in women treated for breast cancer. Material and methods:Using a cross-sectional design, women treated for breast cancer (n = 155; mean age 63) completed questionnaires concerning supportive care needs and FCR. Inclusion criteria were: ≥18 years of age and treated for primary breast cancer at Aarhus University Hospital, Aarhus, Denmark and between three months and five years after diagnosis. Associations between demographic characteristics, clinical factors, side effects, late effects and the two dependent variables, unmet needs (examined with linear regression model), and FCR (examined with logistic regression model) were analyzed. Results:The response rate was 79.9%. Almost all (82.6%) women reported at least one unmet need (mean number 9.3; range 0–34). More than half (59.3%) of the unmet needs were rated as strong unmet needs. The most frequent unmet needs were concerned with doctors collaborate to coordinate care; the need for having ongoing dialog with healthcare providers to receive available local health care services, understandable and up-to-date information, to manage side effects and feeling reassured that the best medical care are given. Having unmet needs were associated with young age, short time since primary surgery, and having clinical FCR. FCR was reported by 54.8% of the women and was associated with short time since primary surgery, having chemotherapy, having unmet needs, and moderate to severe muscle and joint pain and fatigue. Conclusions:Breast cancer survivors experience substantial unmet needs years after end of treatment, particularly among younger women and women having clinical FCR. Furthermore, FCR is frequent among women, particularly when closer in time to primary surgery. [ABSTRACT FROM PUBLISHER]

PurposeThe aim of the study was to test the hypothesis that head and neck cancer (HNC) patients benefit from specialized follow-up (FU), as this strategy ensures timely detection of relapses for successful salvage treatment. This was done by evaluation of the pattern of failure, the temporal distribution of recurrences, and the outcome of salvage treatment in a contemporary cohort of HNC patients. MethodsThe study evaluated a cohort of 2062 consecutive patients treated with curative intent at Aarhus University Hospital from 1 January 2000 to 31 December 2013. The database of DAHANCA contained recordings of recurrent disease in 567 patients with primary tumors of the larynx, pharynx, oral cavity, nasal cavity, paranasal sinuses and salivary glands. A review of medical records was performed in order to update and supplement the database. ResultsFailures of the 567 patients were primarily in T-site (65%) followed by N-site (36%) and M-site (22%). The vast majority of the first recurrences occurred within the first years after primary treatment; 62%, 82%, and 91% within the first, second and third year, respectively. Totally, 51% were amenable for salvage treatment, and 44% benefited from salvage in terms of a complete response. Permanent tumor control was observed in 128 patients (23%) after one or two salvage attempts. The highest salvage rate was recorded in patients with primary glottic carcinoma (41%) and the lowest among hypopharyngeal cancers (2%). Asymptomatic recurrence was recorded in 12% of all recurrences and this was found to be a positive prognostic factor for disease-specific survival, as they had significantly better outcome after salvage. ConclusionOur data support the usefulness of specialized FU in terms of early detection of recurrent disease. In particular patients with silent recurrences benefited from early detection, as they had a significantly lower risk ratio of death from primary HNC. [ABSTRACT FROM PUBLISHER]

BackgroundSquamous cell carcinoma of the head and neck (HNSCC) comprises a variety of malignant tumors. Due to the rarity of each individual malignant entity, knowledge of epidemiological changes and trends over time may be derived from data compiled in regional and national registries. This study analyzed the development in incidence rates and mortality in elderly HNSCC patients in Denmark between 1980 and 2012 with specific attention to compliance to radiotherapy, the main treatment modality of HNSCC in Denmark. Material and methodsHNSCC consisting of more than 25 patients per year over the age of 70 years were analyzed. This included cancer of the oral cavity defined as ICD-codes C00.3-4, C02-04, C05.0, C06; oropharynx as C01, C05.1-9, C09-10; and larynx as C32 recorded in the NORDCAN database. Additional data from the DAHANCA database was added to assess differences in compliance to treatment between younger and older patient groups. ResultsHNSCC was predominant in younger patients. Only 17% were older than 70 years. The median age was 60 years. Generally, incidence rates rose for cancer of the oral cavity and oropharynx between 1980 and 2012 and stabilized for laryngeal cancer. Mortality rates had a shallower increase, especially in younger age groups, which translated into improved age-specific survival rates. Compliance to radiotherapy was high for all age groups. Failure to receive at least 60 Gy during radical radiation treatment was 2.3% despite a significant increase in patients with poor WHO performance status over time. ConclusionHNSCC is a rare disease in patients above 70 years accounting for only 17% of all HNSCC patients. Incidence rates increased over time, but age-specific survival rates improved, especially in younger patients. Failure rates to comply with radiation treatment, however, were low in both young and elderly patients. [ABSTRACT FROM PUBLISHER]

The article presents a study which analyses the effectiveness of quality assurance (QA) programs for head and neck cancer patients treated in Danish Head and Neck Cancer Group (DAHANCA) 10 randomized trial. Topics discussed include auditing whether the dose prescriptions and technical components were in accordance with DAHANCA radiation treatment guidelines, formation of a retrospective quality assurance scheme, and documentation of components by patient record notes.

Purpose. To test the hypothesis that head and neck cancer (HNC) patients are in need of specialized follow-up (FU). This was done by an evaluation of the FU activities in a cohort of patients followed longitudinally for five years with focus on optimal duration and interval of post-therapeutic follow-up. Methods. The study evaluated a cohort consisting of 197 consecutive patients with HNC treated at Aarhus University Hospital from 1 January to 31 December 2009. The inclusion criteria was that patients should be deemed free of disease two months after completed primary curative intended treatment or after primary curative salvage. It left 141 patients available for analysis. Data were collected through a medical chart review and from the Danish Head and Neck Cancer Group (DAHANCA) database. Parameters recorded were: regular or extraordinary visit, alarm symptoms, late morbidity and the consequences of these. Results. The 141 patients underwent 1408 FU visits. Only 15 of the 141 patients had no tumor problems or morbidity issues raised at any FU visit. Suspicion of recurrent disease was observed at 207 of the 1408 FU visits, involving 97 patients and resulted in a total of 370 diagnostic procedures; 170 (82%) visits with suspicion of recurrence occurred within 3½ years after end of treatment. A recurrence was verified in 30 patients. Additionally four new primary head and neck cancer was diagnosed during follow-up. There were 1150 visits (82%) involving 135 patients in which late treatment-related morbidity was recorded. Actions taken related to morbidity happened in 71 patients, but no new problems appeared after three years. Conclusion. The study document the need of specialized FU, as 86% of all HNC survivors have tumor or severe morbidity issues during FU. The data suggest that 3½-year FU after ended therapy may be sufficient for the majority of patients. [ABSTRACT FROM AUTHOR]

Problems related to extensive macrophyte growth are widespread both in modified and man-made canals and streams, and in streams with natural morphology and rich vegetation. The weed cutting is a common management practice in order to reduce flood risk and enhance water conveyance. Although the short- and long-term impacts on the stream physical habitats and biota have been extensively studied, only little information exists on the effects of weed cutting on ecosystem metabolism, especially for larger rivers. This study aims to quantify effects of weed cutting on metabolic rates in a large lowland river in Denmark. We measured Gross Primary Production (GPP), Ecosystem Respiration (ER) and physical parameters (water depth, discharge, water velocity and reaeration rate) one week prior and 2–6 weeks after weed cutting in 2014 and 2020. Physical river conditions changed significantly after the removal of approximately 60% of macrophytic volume, and a significant reduction in water depth and increased water velocity was recorded. We found an immediate 38% and 61% reduction in GPP and 28% and 35% reduction in ER after weed cutting in 2014 and 2020 respectively. We also found that the metabolic rates did not recover to pre-weed cutting levels within 2–6 weeks after weed cutting. The higher decline in GPP compared to that in ER indicates that the heterotrophic contribution to ER was higher compared to the autotrophic contribution. Our results display that even in a large macrophyte-rich river, where only one-third of the channel is managed by weed cutting, GPP and ER can be reduced significantly. The cascade effects of metabolic rates alterations on ecosystem structure and functioning need to be considered in the future management plans, where higher plant biomass and increased flow is anticipated due to the ongoing climate change and thus, the demand for weed cutting might be intensified. • Quantification of changes in metabolic rates in large river caused by weed cutting. • Significant reduction in GPP (38–61%) and ER (28–35%) after weed cutting. • Metabolic rates did not recover 6 weeks after plant removal. • Shift to more heterotrophic conditions after weed cutting. • Cascade effect of ecosystem metabolism reduction requires further consideration. [ABSTRACT FROM AUTHOR]

The aim of this article is to analyse social status differences in alcohol norms and practices seen from the perspective of 'health governance'. Survey data on 1442 employees in a middle-sized, Danish firm are used to construct a Bourdieu-inspired social space, tied to four forms of capital: economic, cultural, inherited and organisational. A range of variables measuring alcohol norms, drinking practices and alcohol-related problems are then inserted into the space. This article identifies status differences in the employees' drinking patterns indicating that respondents with large amounts of economic, cultural and inherited capital are more responsive to alcohol-related health messages than respondents (and especially males) occupying positions low in the social space. This, however, does not mean that respondents from dominant groups have 'safe' drinking habits, as these are defined by the Danish National Health Board. Rather, this article identifies a relatively large group of high-positioned respondents balancing at the limits of risky drinking -- or transgressing them, if measured by international standards. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses various reports within the issue on topics including hypoxia, proliferation and cell density.

Background. The post-treatment follow-up is well-integrated in the oncologic care tradition, based on the risk of developing recurrent disease or new primary tumors in treated patients. Furthermore, follow-up serves as an opportunity to monitor treatment effects and to provide clinical care of side effects. In this study we measured the activity and effectiveness of routine follow-up in head and neck cancer and assessed the value of follow-up from the perspectives of both physicians and the patients. Patients and methods. During a period of six weeks a prospective national cross section cohort of 619 patients attending regular follow-up were enrolled. All patients had received intended curative treatment for head and neck cancer and all were followed according to DAHANCA guidelines. Data were collected by the physician filling in a registration form containing chosen key parameters and patients filling in a validated questionnaire. Results. The majority (91%) of the 619 visits was planned, and 75% of all visits included either tumor or treatment-related problems. Suspicion of recurrent disease led to further diagnostic work-up in 80 visits (13%). A total of 29 recurrences were found, and of these seven (25%) were asymptomatic, i.e. the 'number needed to see' to detect one asymptomatic recurrence was 99. Treatment-related normal-tissue problems were addressed in 72% of all visits, and among these 18% required intervention. Although the majority of problems (either suspicion of recurrent disease or late effects) occurred within a few years after treatment, 39% of patients seen after three years also had problems. The majority of patients (97%) expressed satisfaction with the planned follow-up. Conclusion. Only few relapses are found in asymptomatic patients at routine follow-up, with one silent recurrence detected per 99 visits. However, head and neck cancer survivors have a substantial need for management of sequelae. In this context, a centralized routine follow-up may still be worthwhile. [ABSTRACT FROM AUTHOR]

Aspiration and aspiration pneumonia has been reported with a high incidence in head and neck cancer populations treated with chemo-radiotherapy. The aim of this study was to investigate the incidence and mortality of aspiration pneumonia in an unselected series of head and neck cancer patients treated with curative radiotherapy with or without concurrent weekly cisplatin. Material and methods. A total of 324 consecutive patients treated with curative intended radiotherapy for head and neck cancer in a single Danish referral center in Aarhus from 2006 to 2008 were included and followed for a median of 4.3 years. Data on patient, tumor and treatment characteristics were obtained from the DAHANCA database. Data on hospital admissions were obtained from the National Patient Registry. Data from the National Registry of Causes of Death were obtained on all deaths and causes of death. Results. Severe dysphagia occurred in 32% of the 324 patients included. A total of 18 patients developed aspiration pneumonia, corresponding to an incidence rate of 29 (95% CI 17-46) per 1000 person-years and an incidence proportion of 5.3% (95% CI 3.1-8.3%) in the first year after radiotherapy; significant risk factors included tube feeding, clinical stage, severe dysphagia and incomplete response to treatment. Three of the 18 patients with aspiration pneumonia died from this complication. Conclusion. Dysphagia-related aspiration and aspiration pneumonia are serious and potentially fatal treatment complications to accelerated radiotherapy, but occur less frequent than previously reported. [ABSTRACT FROM AUTHOR]

Working as a physician at an oncology department has some distinctive characteristics that may lead to a stressful work environment. The present study was conducted to provide a nationwide description of the work conditions of all oncologists in Denmark. By comparing the results of the present study with those of a similar study carried out in 2006, the aim was furthermore to elucidate changes in the psychosocial work environment over time. Material and methods. From May to September 2009, 330 physicians employed at six oncology centres and seven community based oncology departments were invited to participate in a survey based on the short version of the COPSOQ II questionnaire. The results were compared with data from a representative section of Danish employees and with data from the 2006 survey. Results. Two hundred and twenty of the 330 invited physicians returned the questionnaire (response rate 67%). Concerning the aspects quantitative demands, work pace, emotional demands, influence, burnout and stress, the oncologists reported worse work conditions than the average Danish employee. However, with regard to possibilities for development, meaning of work and commitment to workplace, the oncologists reported better work conditions. Between 2006 and 2009, substantial improvement was seen concerning several of the assessed work environment aspects within the group of young physicians at the oncology centres. Conclusion. Though substantial improvement of the work conditions has been achieved between 2006 and 2009, certain aspects of the psychosocial work environment at Danish oncology departments still require attention. [ABSTRACT FROM AUTHOR]

Abstract: Two prospective longitudinal studies in 13 postweaning multisystemic wasting syndrome (PMWS)-affected farms from Spain (n =3) and Denmark (n =10) were performed. Blood samples from pigs were longitudinally collected from 1st week until the occurrence of the PMWS outbreak. Wasted and healthy age-matched pigs were euthanized, necropsied and histopathologically characterised. PMWS diagnosis was confirmed by means of lymphoid lesions and detection of porcine circovirus type 2 (PCV2) in these tissues by in situ hybridization or immunohistochemistry. Serological analyses were performed in longitudinally collected serum samples to detect antibodies against, PCV2, porcine reproductive and respiratory syndrome virus (PRRSV), porcine parvovirus (PPV), swine influenza virus (SIV) and Lawsonia intracellularis (law), Mycoplasma hyopneumoniae, Aujeszky’s disease virus (ADV) and Salmonella spp. A Cox proportional hazards model was used to investigate the simultaneous effects of seroconversion and maternal immunity against the studied pathogens. Results showed that high levels of maternal immunity against PCV2 had a protecting effect in farms from both countries. Moreover, for the Danish dataset, seroconversion against law had an overall protecting effect, but for animals with very low levels of maternal antibody levels against this pathogen, the effect appeared neutral or aggravating. Otherwise, for the Spanish dataset, maternal immunity against PPV and PRRSV gave protective and aggravating effects, respectively. In conclusion, the present study reflects the complex interaction among different pathogens and their effects in order to trigger PMWS in PCV2 infected pigs. [Copyright &y& Elsevier]

BACKGROUND: In 1996, a national lookback study was performed in Denmark identifying 1018 patients exposed to hepatitis C virus (HCV) by transfusion before 1991. The objective of this study was to describe morbidity and mortality during extended follow-up among patients in the Danish HCV lookback cohort alive in 1996. STUDY DESIGN AND METHODS: In a retrospective cohort study of 230 patients exposed to HCV by blood transfusion and alive in 1996 we extracted data from national registers and compared these with a matched group of unexposed transfusion recipients. RESULTS: Among 230 HCV-exposed recipients alive in 1996, 124 (53.9%) had chronic hepatitis C, 43 (18.7%) were not infected, and 63 (27.4%) had incomplete HCV data. In 2009, 121 (52.6%) were still alive a median of 21.8 years after transfusion. The mortality rate among the HCV-exposed recipients followed from 1996 was 4.9 per 100 person-years (PY). The incidence of liver cirrhosis and decompensated cirrhosis was 1.0 per 100 PY and 0.4 per 100 PY, respectively; 16.5% had cirrhosis at death. Among HCV-exposed recipients, no difference in all-cause or liver-related mortality was observed between HCV-infected and HCV-uninfected recipients. Further, there was no difference in mortality between HCV-exposed and -unexposed transfusion recipients (mortality rate ratio [MRR], 1.06; 95% confidence interval [CI], 0.96-1.17; p = 0.47), but liver-related mortality was significantly higher among HCV-exposed patients (MRR, 10.0; 95% CI, 7.20-17.7; p < 0.001). CONCLUSION: Two decades after exposure to blood products from HCV-infected donors, only 121(11.8%) of 1018 recipients remained alive. For HCV-exposed recipients no excess all-cause mortality was observed, but liver-related mortality was significantly increased. [ABSTRACT FROM AUTHOR]

- Maribo is a new Danish CM chondrite, which fell on January 17, 2009, at 19:08:28 CET. The fall was observed by many eye witnesses and recorded by a surveillance camera, an all sky camera, a few seismic stations, and by meteor radar observatories in Germany. A single fragment of Maribo with a dry weight of 25.8 g was found on March 4, 2009. The coarse-grained components in Maribo include chondrules, fine-grained olivine aggregates, large isolated lithic clasts, metals, and mineral fragments (often olivine), and rare Ca,Al-rich inclusions. The components are typically rimmed by fine-grained dust mantles. The matrix includes abundant dust rimmed fragments of tochilinite with a layered, fishbone-like texture, tochilinite-cronstedtite intergrowths, sulfides, metals, and carbonates often intergrown with tochilinite. The oxygen isotopic composition: (δ17O = −1.27‰; δ18O = 4.96‰; Δ17O = −3.85‰) plots at the edge of the CM field, close to the CCAM line. The very low Δ17O and the presence of unaltered components suggest that Maribo is among the least altered CM chondrites. The bulk chemistry of Maribo is typical of CM chondrites. Trapped noble gases are similar in abundance and isotopic composition to other CM chondrites, stepwise heating data indicating the presence of gas components hosted by presolar diamond and silicon carbide. The organics in Maribo include components also seen in Murchison as well as nitrogen-rich components unique to Maribo. [ABSTRACT FROM AUTHOR]

Acceleration of diagnosis and initiation of treatment for head and neck cancer requires optimal organization and multidisciplinary collaboration. A project at the Head and Neck Oncology Centre, Aarhus University Hospital aimed at accelerating patient flow. Material and methods. Initiatives were implemented throughout the year 2007. Focus was on optimizing logistics for all patients referred to the center with suspected head and neck cancer. Initiatives included a full-time case manager, pre-booked slots for clinical work-up and weekly tumor-boards. Key-dates were registered and relevant intervals were quantitatively evaluated and compared to a reference-group from 2006. Results. We registered 446 patients. Waiting times for first clinical examination on ENT department were reduced from median eight to median two days through 2007 (p < 0.0001). Time from first clinical examination and until referral for treatment was reduced from median 21 to median nine days (p < 0.0001). Time from referral to treatment and until initiation of treatment was reduced from median 26 to median 15 days (p < 0.001). The net result of these reductions was a reduced overall time from median 57 days ultimo 2006 to median 29 days ultimo 2007 (p < 0.0001). Conclusion. The current project has shown that it is possible to reduce waiting times in head and neck cancer. Through logistic changes, employment of a full-time case manager, strengthening the multidisciplinary tumor board and giving higher priority for head and neck cancer patients, the overall time from first suspicion of cancer until treatment start was reduced from 57 calendar days to 29 calendar days. [ABSTRACT FROM AUTHOR]

Objective. To evaluate the treatment outcome for sino-nasal carcinomas in Denmark from 1995–2004 and compare the results to the previous Danish survey covering 1982–1991. Design. Retrospective follow-up. Materials and methods. In the five Danish head and neck oncology centres, charts of all consecutive patients with sino-nasal carcinomas were reviewed and data extracted to a common database. Altogether 242 patients from the period 1995–2004 were identified. Of these 162 (67%) were male and 80 (33%) female. Histologies included squamous cell carcinoma (55%), adenocarcinoma (28.5%), adenoid-cystic carcinoma (5.0%), undifferentiated carcinoma (4.5%), transitiocellular carcinoma (1.7%), mucoepidermoid carcinoma (0.8%), neuroendocrine carcinoma (2.5%), small cell carcinomas (1.2%) and carcinomas not otherwise specified (0.8%). Treatments included radiotherapy alone 79 (33%), surgery alone 29 (12%), combined surgery and radiotherapy 96 (40%), palliative/no treatment 38 (16%). A total of 204 (86%) patients were treated with curative intent. Results. Of the 204 patients treated with curative intent, 94 (46%) relapsed. Most failures were in T-site (63, 30%). N-site failures were 10 (5%) and M-site failures six (3%). Failure occurring in T+N-site, T+M-site, N+M-site and T+N+M-site were seven (3%), two (1%), one (0.5%) and five (3%) respectively. The 5-year actuarial local, nodal and loco-regional control rates were 55±4%, 86±3%, 49±4%, respectively. The overall 5-year actuarial survival rate for the entire cohort was 47±3%, and the corresponding cancer-specific 5-year actuarial survival rate was 57±3%. Female gender, nasal cavity tumour, adenocarcinoma and low clinical stage were significant positive prognostic factors in univariate analysis. A Cox multivariate analysis showed that only tumour site and clinical stage were independent significant prognostic factors. Conclusion. The current series has confirmed stage and tumour site as independent prognostic factors. Compared to the previous Danish survey covering the period 1982–1991, the overall survival and cancer-specific survival rates have improved significantly. [ABSTRACT FROM AUTHOR]

Background. A retrospective nationwide study of cancer of the nasal vestibule was conducted to evaluate classification systems and prognostic factors for treatment outcome. Methods. Patients treated between 1993 and 2002 at head and neck oncology centers in Denmark were included. Results. The 5-year results were locoregional control 67%, overall survival 50%, cancer-specific survival 74%. Cancer-specific survival according to Wang classification was 83%, 63%, and 39% for T1, T2, T3, respectively (p < .000). Regarding T1 tumors, 5-year locoregional control for surgery, surgery + radiotherapy (RT), or RT was 94%, 87%, or 61%, respectively (p < .000). Fifty-four Gray in 18 fractions was found comparable with 66 Gy in 33 fractions regarding T1 tumors. Conclusion. This national survey is the largest series of nasal vestibule cancer ever published. Wang classification is more prognostic and easier to use than the Union Internationale Contre le Cancer 2002. Surgery or hypofractionated RT can be used for T1 lesions, whereas larger lesions should be treated with combined approach. © 2009 Wiley Periodicals, Inc. Head Neck, 2009 [ABSTRACT FROM AUTHOR]

Abstract: Longitudinal case–control studies were performed in post-weaning multisystemic wasting syndrome (PMWS) affected farms from Denmark and Spain using similar designs. Fourteen independent batches of 100–154 pigs per batch were monitored from birth to PMWS outbreak occurrence. Pigs displaying PMWS-like signs and matched healthy cohorts were euthanized during the clinical outbreak. PMWS was diagnosed according to internationally accepted criteria and pigs were classified as: (i) PMWS cases, (ii) wasted non-PMWS cases and (iii) healthy pigs. Porcine circovirus type 2 (PCV2) quantitative PCR (qPCR) and serology techniques were applied to analyse longitudinally collected sera and/or nasal and rectal swabs. Results showed that PCV2 load increased in parallel to waning maternal antibody levels, reaching the maximum viral load concurrent with development of clinical signs. PMWS affected pigs had higher PCV2 prevalence and/or viral load than healthy pigs in all collected samples at necropsy (p <0.0001–0.05) and even in sera and nasal swabs at the sampling prior to PMWS outbreak (p <0.01–0.05). Danish farms had a higher PCV2 prevalence in young piglets as well as an earlier PMWS presentation compared to Spanish farms. PMWS diagnoses were confirmed by laboratory tests in only half of pigs clinically suspected to suffer from PMWS. Positive and significant correlations were found among PCV2 viral loads present in sera, nasal swabs, rectal swabs and lymphoid tissues (R =0.289–0.827, p <0.0001–0.01), which indicates that nasal and rectal swabs were suitable indicators of PCV2 excretion. Sensitivity and/or specificity values observed from both tests used separately or combined suggested that qPCR and/or serology tests are not apparently able to substitute histopathology plus detection of PCV2 in tissues for the individual PMWS diagnosis within PMWS affected farms. However, qPCR appears to be a potential reliable technique to diagnose PMWS on a population basis. [Copyright &y& Elsevier]

The article discusses highlights of the 6th Acta Oncologica Symposium held in Aarhus, Denmark, on June 5-7, 2008, that was dedicated to image-guided radiotherapy (IGRT). The symposium aims to evaluate the current knowledge in the field of IGRT, which offers promise to improve the clinical outcome of cancer treatment. Clinical sessions covered tumor sites in the pelvis, thorax, head-and-neck and brain.

This paper describes the procedure of changing from 2D to 3D treatment planning guidelines for post-mastectomy radiotherapy in Denmark. The aim of introducing 3D planning for post-mastectomy radiotherapy was to optimize the target coverage and minimize the dose to the normal tissues. Initially, it was investigated whether it was possible to find a treatment technique alternative to the one recommended by the Danish Breast Cancer Cooperative Group (DBCG). A dosimetric comparison of a combined photon/electron 3-field technique (3F) and a partial wide tangent technique (PWT) was carried out on individual planning CT-scans from seven patients selected to represent a wide range of sizes and shapes of chest walls. The heart dose was lower for PWT than for 3F, however, for both techniques the dose was within the accepted constraints. The lung dose was higher but acceptable for six of the seven patients with PWT. The dose to the internal mammary nodes (IMN) was not satisfactory for five of the seven patients for 3F, whereas only two of the seven patients had a minimum dose lower than 95% of the prescribed dose with PWT. Finally, the dose to the contralateral breast was increased when using PWT compared to 3F. It was concluded that PWT was an appropriate choice of technique for future radiation treatment of post-mastectomy patients. A working group was formed and guidelines for 3D planning were developed during a series of workshops where radiation oncologists and physicists from all radiotherapy centres participated. This work also included a definition of the tissue structures needed to be outlined on the planning CT-scan. The work was initiated in 2003 and the guidelines were approved by the DBCG Radiotherapy Committee in 2006. The first of January 2007 the 3D guidelines had been fully implemented in five of the seven radiotherapy centres. [ABSTRACT FROM AUTHOR]

In Denmark, a general impression of prolonged pretreatment delay for patients with head and neck cancer led to a nationwide study of time spans from symptom debut over first health care contact to start of treatment. Charts of consecutive new patients with squamous cell carcinoma of the pharynx and larynx, seen at the five Danish oncology centers in January–April 1992 and 2002, respectively, were reviewed. Of the 288 patients identified, definitive treatment was radiotherapy in 264 cases, surgery in one case. Twenty-three patients had neither surgery nor radiotherapy. Total time from first health care contact to start of definitive treatment was significantly longer in 2002 than in 1992 (median 70 versus 50 days, p? [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate the outcome of primary treatment and treatment of recurrences in patients with nasopharyngeal carcinoma. The material included 149 consecutive patients seen at the Aarhus University Hospital from 1963 to 1991 (49 females and 100 males). The stage distribution was: Stage I –9%, II–3%, III–28%, and IV–60%. Primary treatment was delivered with curative intent in 145 patients (97%). Persistent or recurrent disease after primary radical treatment was observed in 82 of the patients; 54% at the T-level, 40% at the N-level, and 33% at the M-level. A curative salvage attempt was carried out in 14 patients only, all with nodal recurrence: surgery in 8 patients (4 controlled) and radiotherapy in 6 patients (2 controlled). The 5-year local tumour control, locoregional tumour control, disease-specific survival rate and the overall survival rate for the patients treated with curative intent were 66%, 53%, 50% and 43%, respectively. Most of the patients (88%) had poorly differentiated tumours and these patients had the best prognosis. A major complication in three patients was radiation-induced myelopathy due to high-dose radiation delivered to the brain stem. Significant positive prognostic factors for treatment outcome in univariate analyses were early T-classification, small clinical stage, poor differentiation and low age. The Cox multivariate analysis showed that early T-categories, low N-categories and poor differentiation were independent, positive prognostic factors. Nasopharyngeal carcinoma is curable with primary radiotherapy; patients with poorly differentiated tumours have the best prognosis. Only a few patients were salvaged after recurrence. The factor most essential for success is primary control of the disease at the T- and N-levels. [ABSTRACT FROM AUTHOR]

Cancer of the nasal cavity and paranasal sinuses is a rare disease. The many different histologies and sites make the management of this disease a challenge. The current report from the Danish Society for Head and Neck Oncology comprises a joint analysis of five retrospective series covering the entire country, with 315 patients seen in the 10-year period from 1 January 1982 to 31 December 1991. Tumour sites were nasal cavity (n=156), maxillary sinus (n=139), ethmoid sinus (n=14), sphenoid sinus (n=5) and frontal sinus (one case). The most common histologies included squamous cell carcinoma (126 cases), adenocarcinoma (41 cases), malignant melanoma (38 cases) and malignant lymphoma (34 cases). A total of 284 patients (90%) received treatment with curative intent; most of these patients were treated with radiotherapy, either alone (120 patients) or in combination with surgery (111 patients). There was no significant difference between the five centres in disease specific survival and overall survival. The results showed that histology, localization and nodal involvement were significant prognostic factors for locoregional control and survival. Patients with squamous cell carcinoma had a significantly poorer prognosis compared with patients with adenocarcinoma. However, a Cox multivariate analysis revealed that this was likely the result of tumour localization, as most adenocarcinomas were in the nasal cavity. The experience from this data collection has inspired the Danish Society for Head and Neck Oncology to arrange common data registration of several other clinical head and neck series. In the future, the Society plans to expand this activity further. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the results of the initial and salvage treatment for hypopharyngeal carcinoma. The study was conducted in 1963 to 1991and included 138 patients (38 females (28%) and 100 males (73%)). Most of the tumours originated in the piriform sinus (86%). Tumour stage distribution was T1: 20%, T2: 27%, T3: 37% and T4: 17% and nodal stage distribution was N0: 45%, N1: 25%, N2: 10%, and N3: 20%. Primary treatment was delivered with curative intent in 124 out of 138 cases (90%). Treatment failure was noted in 98 patients, with 55% recurrence in T-position, 39% in N-position, and 14% at distant metastases sites. Salvage surgery was successful in 9 out of 32 patients. The overall 5-year locoregional tumour control, cause-specific and overall survival rates were 20%, 25% and 19%, respectively. Univariate actuarial analysis showed that T- and N-stage, clinical stage, tumour size and well-differentiated tumours were significant prognostic parameters. A Cox multivariate analysis showed that only the T- and N-stages were independent prognostic factors. In conclusion, the prognosis for advanced hypopharyngeal carcinoma is extremely poor and the meagre results with conventional radiotherapy alone indicate that other treatment modalities should be introduced in the management of this disease. [ABSTRACT FROM AUTHOR]

Metals sequestered in coastal sediments are normally considered to be stable, but this investigation shows – somewhat surprisingly – that mercury concentrations in a previously contaminated area, Harboøre Tange, Denmark, have decreased since the 1980s. Mercury concentrations were determined in sediment and benthic biota and present values were compared to values in the 1980s and values from areas without known; history of mercury contamination. Concentrations in both the upper 20 cm of the sediments and; biota are considerably lower now compared to latest monitoring (1980s). Sediment. concentrations at most locations have decreased from the 100–300 ng Hg g−1 dry weight (dw) level to levels below the Background Concentration (BC) of 50 ng Hg g−1 dw defined by Oslo-Paris Convention for the Protection of the Marine Environment of the North-East Atlantic; some stations are at the 2–10 ng Hg g−1 dw level characteristic of Danish coastal sediments with no known history of mercury contamination. Concentrations of mercury in the benthic biota along Harboøre Tange have also decreased since the 1980s but despite the lowered mercury concentrations in the sediments, concentrations in most samples of benthic invertebrate fauna still exceed those in uncontaminated coastal areas and also the Environmental Quality Standard (EQS) of 20 ng Hg g−1 wet weight (≈100 ng Hg g−1 dry weight) defined by the European Union's Water Framework Directive. Concentration ranges in selected organisms are: (Harboøre Tange l980s / Harboøre Tange now / uncontaminated areas - given in ng Hg g−1 dw): Periwinkles Littorina littorea 9000 / 150–450 / 55-77, blue mussels Mytilus edulis up to 9000 / 300–500 / 40–170, cockles Cerastoderma edule up to 8000 / 400–1200 / 200, brown shrimp Crangon crangon 700–2200 / 150-450 / 47, eelgrass Zostera marina up to 330 / 25–70 / 12. The present results - together with a literature review - show that a simple and straight forward relationship between the concentrations of mercury in sediment and benthic organisms does not necessarily exist. Image 1 • Mercury concentrations were determined in a previously contaminated coastal area. • Hg concentrations in sediment and biota have decreased since the 1980s. • Sediment concentrations are now below OSPAR's BC & BAC at most stations. • However, Hg in biota still exceeds the Water Framework Directive's EQS. Although Hg concentrations in a previously contaminated sediment have decreased to below OSPAR BAC values, Hg concentrations in the benthic biota still exceed EQS values. [ABSTRACT FROM AUTHOR]

Primary radiotherapy treatment is preferred for squamous cell carcinomas in the head and neck region (HNSCC) owing to the preservation of anatomical structures and function. The delineation of treatment volumes, particularly the expansion from the gross tumour volume (GTV) to the high-dose clinical target volume (CTV1), is critical in radiotherapy planning. Historically, the choice of margin size for GTV-CTV1 has varied between different treatment centres in Denmark from zero to over 10 millimetres or could encompass the whole organ (volume) where the tumour is located. Therefore, the first DAHANCA IMRT guidelines could be referred to as volumetric-based. In 2013, national consensus guidelines were introduced by the Danish Head and Neck Cancer Group (DAHANCA), recommending an isotropic margin of five millimetres corrected only for air or natural anatomical barriers resulting in a more uniform geometrical margin. With over a decade of experience in applying geometrically-based GTV-CTV1 guidelines, the primary aim of this study was to assess whether the implementation of the guidelines in 2013 led to improved consistency in CTV1 volumes across different treatment centres. Additionally, we analysed whether changes in GTV-CTV1 margins moving from volumetric to geometric guidelines impacted 3-year local tumour control and local recurrence pattern in patients treated three years before and three years after implementation of the geometrical guidelines. The cohort consisted of 1,948 patients diagnosed with oro-/hypopharyngeal and laryngeal squamous cell carcinomas across three national treatment centres. The patients underwent definitive intensity-modulated radiotherapy (IMRT) in 2010-2012 when volumetric guidelines were used, and in 2013-2015, when geometric guidelines were adopted. The GTV-CTV1 margins were quantitatively assessed by calculating the median surface distance from the primary GTV to CTV1. Three-year local control (LC) rates were determined, and local recurrence patterns were examined (Figure 1) using a centre of mass (COM) analysis. Hazard ratios and corresponding 90% CIs were calculated using the Cox proportional hazard model to identify factors that influenced local tumour control. [Display omitted] The transition from volumetric to geometric guidelines substantially reduced median GTV-CTV1 margins, declining from a median of 9.0 mm (IQR 0.0-9.7) to 4.7 mm (IQR 4.0-5.5). Importantly, adopting geometric guidelines led to increased consistency in CTV1 volumes between treatment centres. Median CTV1 changed from 76 to 61 cm3 for Centre1, from 28 to 53 cm3 for Centre2, and from 42 to 62 cm3 for Centre3 for the periods 2010-2012 and 2013-2015, respectively. The three-year LC rates exhibited a notable trend towards improvement, increasing from 0.84 to 0.87, although statistical significance was not reached (p=0.06). Cox regression analysis indicated that factors such as sex (female), tumour site (HPV p16+ oropharyngeal), T stage (T1-2), treatment schedule (6 or 10 fractions per week), and the administration of nimorazole and chemotherapy were associated with superior three-year LC. At the same time, GTV-CTV1 margin size did not appear to influence local control significantly (Figure 2). [Display omitted] Out of 146 radiology-verified local recurrences (LR), 102 (70%) were inside the CTV1. 45 (63%) and 57 (76%) LRs were inside CTV1 in 2010-2012 and 2013-2015, respectively. The LRs were covered by the 95% isodose in 75% in 2010-2012 and 91% in 2013-2015. The implementation of geometrically-based GTV-CTV1 margins resulted in reduced variation in treatment volumes across 3 different centres. Although our analysis did not demonstrate a direct impact of GTV-CTV1 margin size on local tumour control, a promising trend towards improved local control was observed in the newest cohort. Most recurrences occurred within CTV1 and were encompassed by the prescribed dose. A relevant next step could involve randomised trials comparing standard radiotherapy protocols with reduced margins and escalated doses to CTV1, further exploring the potential benefits of geometrically-based treatment strategies. [ABSTRACT FROM AUTHOR]

• Functional Resonance Analysis Method and LEAN methods can be used synergistically in practice to support organisational changes. • Functional Resonance Analysis Method provides an in-depth understanding of work-as-done of the referral process in a hospital. • Value Stream Method provides baseline data such as processing time and lead time and quantifies value added and non-valued added activities. • One third of internal referrals can be averted by focusing on organsiational factors. Although LEAN and Resilience Engineering (RE) are distinct process improvement approaches, recent research evidence suggests that these two approaches have some similarities and can be used jointly for process optimisation. This study aimed to understand and improve the referral process between internal medicine outpatient clinics at the University Hospital of Southern Denmark, Hospital Sønderjylland, using RE and LEAN principles. The referral process was mapped from the RE perspective using Functional Resonance Analysis Method (FRAM) and from the LEAN perspective using Value Stream Mapping (VSM). The FRAM and VSM outputs were also compared to identify learning opportunities and to understand how these two methods complement each other in practice. The study drew on sources of data from interviews, observations, a VSM workshop and registry data on referrals from the hospital's electronic patient journal system. The FRAM analysis showed that organisational structure, time constraints, interruptions and lack of a standard for referral may explain the inefficient referral process. The VSM showed that long processing times may explain bottlenecks in the referral flow: while the processing time of a referral took between 6 and 17 min in the outpatient clinics, the actual time was longer, taking between 22 h 42 min and 5 days 14 h 25 min. By using FRAM and VSM methodologies synergistically, we identified potential quality improvement initiatives to improve the referral process. Our findings may guide healthcare or other industries in how to use FRAM and VSM in practice for process optimisation. [ABSTRACT FROM AUTHOR]

Presents data collected from all five oncology centers in Denmark on cervical lymph node metastases from unknown tumors. Citation of treatment policy of all centers during the study; Determination of the optimal strategy in terms loco=regional control.

Abstract Introduction The aim was to analyze position of CT-verified local recurrences (LR) and local control (LC) among three centers that used different GTV to CTV1 margins. Materials and methods In total, 1576 patients completing radical primary IMRT for larynx, pharynx, oral cavity HNSCC in three centers in Denmark between 2006 and 2012 were included. CT-verified LRs were analyzed as possible points of recurrence origin and compared between groups of small (0–2.5 mm), larger (>2.5 mm), and anatomical GTV-CTV1 margins. The recurrence point's position relative to the GTV and 95% prescription dose was evaluated. Overall local control rate was evaluated using Cox uni- and multi-variate analysis. Results After a median follow-up of 41 months, 272 patients had local failure. Median GTV-CTV1 margin in Center1, 2 and 3 was 0.0, 3.7 and 9.7 mm, respectively. 51% of local recurrences were inside the GTV. No difference in distribution of LRs in relation to GTV surface (p = 0.4) or the dose to LRs (p = 0.2) was detected between the groups. A difference in LC was found univariate between the centers (p = 0.03), but not in multivariate analysis (p = 0.4). Conclusions No relation was found between the recurrences' distributions as function of the margins used at three centers. In multivariate analysis, local control was not influenced by the centers. [ABSTRACT FROM AUTHOR]

• Late toxicity is substantial in all examined organs at risk. • Associations between dose to the optic nerve and ocular toxicity was present. • Across all examinations, 74% had late toxicity in more than one organ. • The severity of toxicity increased with increasing number of organs affected. To evaluate the occurrence of late toxicity after curatively intended intensity modulated radiotherapy (IMRT) for sinonasal cancer and assess dose–response associations. Patients treated with IMRT in 2008–2016 were included. Cross sectional examinations of toxicity from the optic pathway, the brain, the pituitary gland and the nose were performed along with quality of life – (QoL) and dose–response analyses. Twenty-seven patients were enrolled; median age was 67 years (range 47–83). Five patients (19%) had radiation-related ocular toxicity. The risk of visual acuity impairment increased with increasing dose (grade 2 odds ration (OR) 1.12, p = 0.01; grade 3 OR 1.14, p = 0.02) and dose constraint violations (grade 2, OR = 21, p < 0.01; grade 3, OR = 41, p < 0.01). Six patients (22%) exhibited evidence of radiation-related hypopituitarism, but no dose–response association was detected. Seventeen patients (63%) had impaired olfactory function. The risk of olfactory impairment increased with higher stage (OR = 3.32, p = 0.03). Three patients (11%) had structural abnormalities in irradiated areas of the brain, and impaired cognitive function was present in 17 patients (63%). Cognitive, physical, role functioning as well as fatigue and insomnia were affected the most in QOL analyses. Fifteen patients (56%) had grade 2 radiation-related impairment in at least one organ. Grade 3 toxicity was only present in patients with toxicities in >3 organs and in patients initially treated for T4 tumours. Three patients (11%) had radiation-related impaired function in all examined OARs. Late toxicity after radiotherapy was substantial in all examined organs, with dose–response associations between visual acuity impairment and the optic nerve. The results have led to changed praxis for follow-up examinations in Denmark. [ABSTRACT FROM AUTHOR]

Macrophytes provide essential ecosystem services in lowland streams, including nutrient uptake that can reduce downstream transport to vulnerable coastal areas. Despite that, to ensure water conveyance and effective run off from agricultural fields, aquatic plant biomass is removed regularly in many European streams (i.e. weed cutting practices). However, the impacts of weed cutting on stream ecosystem processes are not yet well documented. Here, we studied the effect of weed cutting on nutrient retention and ecosystem metabolism in three lowland streams with contrasting dominant vegetation communities (submergent and emergent plants) during summer in Denmark. Our results showed a decrease in nutrient retention; uptake velocity of ammonium decreased 34–77 % and of phosphate decreased 50–77 %. Ecosystem metabolic rates also decreased after weed cutting, both in gross primary production (9 %, 60 % and 85 %) and respiration (47 %, 69 % and 76 %). The effects of weed cutting on these ecosystem processes prevailed three weeks after the cutting occurred. Understanding the effects of weed cutting on stream ecosystem functioning can improve nature-based management strategies to control eutrophication of downstream coastal areas. [Display omitted] • Stream gross primary production and respiration decreased after weed cutting. • Nutrient retention decreased after weed cutting, but only partially attributed to weed cutting. • The effects of weed cutting prevailed after three weeks. [ABSTRACT FROM AUTHOR]

Abstract: Background and aim: Significant tumour progression was observed during waiting time for treatment of head and neck cancer. To reduce waiting times, a Danish national policy of fast track accelerated clinical pathways was introduced in 2007. This study describes changes in waiting time and the potential influence of fast track by comparing waiting times in 2010 to 2002 and 1992. Methods: Charts of all new patients diagnosed with squamous cell carcinoma of the oral cavity, pharynx and larynx at the five Danish head and neck oncology centres from January to April 2010 (n =253) were reviewed and compared to similar data from 2002 (n =211) and 1992 (n =168). Results: The median time to diagnosis was 13 days (2010) versus 17 days (2002; p <0.001) and 20 days (1992; p <0.001). Median days from diagnosis to treatment start were 25 (2010) versus 47 (2002; p <0.001) and 31 (1992; p <0.001). Total pre-treatment time was median 41 days in 2010 versus 69 days (2002) (p <0.001) and 50 days (1992; p <0.001). Significantly more diagnostic imaging was done in 2010 compared to 2002 and 1992. When compared to current fast track standards the adherence to diagnosis improved slightly from 47% (1992) to 51% (2002) and 64% (2010); waiting time for radiotherapy was within standards for 7%, 1% and 22% of cases, respectively; waiting time for surgery was within standards for 17%, 22% and 48%, respectively. Conclusion: The study showed a significant reduction in delay of diagnosis and treatment of head and neck cancer in 2010, but still less than half of all patients start treatment within the current standards. [Copyright &y& Elsevier]