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Purpose: Risk assessment of disease recurrence in pT1 colorectal cancer is crucial in order to select the appropriate treatment strategy. The study aimed to develop a prediction model, based on histopathological data, for the probability of disease recurrence and residual disease in patients with pT1 colorectal cancer. Methods: The model dataset consisted of 558 patients with pT1 CRC who had undergone endoscopic resection only (n = 339) or endoscopic resection followed by subsequent bowel resection (n = 219). Tissue blocks and slides were retrieved from Pathology Departments from all regions in Denmark. All original slides were evaluated by one experienced gastrointestinal pathologist (TPK). New sections were cut and stained for haematoxylin and eosin (HE) and immunohistochemical markers. Missing values were multiple imputed. A logistic regression model with backward elimination was used to construct the prediction model. Results: The final prediction model for disease recurrence demonstrated good performance with AUC of 0.75 [95% CI 0.72–0.78], HL chi-squared test of 0.59 and scaled Brier score of 10%. The final prediction model for residual disease demonstrated medium performance with an AUC of 0.68 [0.63–0.72]. Conclusion: We developed a prediction model for the probability of disease recurrence in pT1 CRC with good performance and calibration based on histopathological data. Together with lymphatic and venous invasion, an involved resection margin (0 mm) as opposed to a margin of ≤ 1 mm was an independent risk factor for both disease recurrence and residual disease. [ABSTRACT FROM AUTHOR]

The exploration of factors and processes affecting biodiversity loss is central to nature management and wildlife conservation, but only recently has knowledge about the absence of species been recognized as a valuable asset to understand the current biodiversity crisis. In this paper, we explore the dark diversity (species that belong to a site-specific species pool but that are not locally present) of breeding birds in Denmark assessed through species co-occurrence patterns. We apply a nation-wide atlas survey of breeding birds (with a 5 × 5 km resolution), to investigate how landscape characteristics may influence avian diversity, and whether threatened and near threatened species are more likely to occur in dark diversity than least concern (LC) species. On average, the dark diversity constituted 41% of all species belonging to the site-specific species pools and threatened and near-threatened species had a higher probability of belonging to the dark diversity than least concern species. Habitat heterogeneity was negatively related to dark diversity and the proportional cover of intensive agriculture positively related, implying that homogeneous landscapes dominated by agricultural interests led to more absent avian species. Finally, we found significant effects of human disturbance and distance to the coast, indicating that more breeding bird species were missing when human disturbance was high and in near-coastal areas. Our study provides the first attempt to investigate dark diversity among birds and highlights how important landscape characteristics may shape breeding bird diversity and reveal areas of considerable species impoverishment. [ABSTRACT FROM AUTHOR]

Objective: Good governance of integrated care is key to better health care, but we know little about how professions can help make this happen. Our aim is to introduce a conceptual framework to analyse how professions contribute to the governance of integrated care, and to apply the framework to a secondary analysis of selected case studies from Denmark. Methods: We developed a framework, which identified the what, how and why of the contribution professions make to the governance of integrated care. We included five qualitative Danish studies, using coordination as an indicator of integrated care. We adopted a thematic approach in our analysis, combining deductive and inductive elements. Results: Health professions engage in highly diverse activities, which fall into closely connected clusters of more formal or more informal coordination. Professions apply many different adaptive mechanisms at different levels to fit coordination into local contexts. Professions are driven by interlocking rationales, where a common focus on patients connects organizational and professional concerns. Conclusions: Our analytical framework emerges as a useful tool for analysis. The contribution of professions to the governance of integrated care needs greater attention in health policy implementation as it can promote more effective governance of integrated care. [ABSTRACT FROM AUTHOR]

This article is dedicated to the WHO International Year of Health and Care Workers in 2021 in recognition of their commitment during the COVID-19 pandemic. The study aims to strengthen health workforce preparedness, protection and ultimately resilience during a pandemic. We argue for a health system approach and introduce a tool for rapid comparative assessment based on integrated multi-level governance. We draw on secondary sources and expert information, including material from Denmark, Germany, Portugal and Romania. The results reveal similar developments across countries: action has been taken to improve physical protection, digitalization and prioritization of healthcare worker vaccination, whereas social and mental health support programmes were weak or missing. Developments were more diverse in relation to occupational and organizational preparedness: some ad-hoc transformations of work routines and tasks were observed in all countries, yet skill-mix innovation and collaboration were strongest in Demark and weak in Portugal and Romania. Major governance gaps exist in relation to education and health integration, surveillance, social and mental health support programmes, gendered issues of health workforce capacity and integration of migrant healthcare workers (HCW). There is a need to step up efforts and make health systems more accountable to the needs of HCW during global public health emergencies. [ABSTRACT FROM AUTHOR]

In recent years, considerable efforts have been made to restore turbid, phytoplankton‐dominated shallow lakes to a clear‐water state with high coverage of submerged macrophytes. Various dynamic lake models with simplified physical representations of vertical gradients, such as PCLake, have been used to predict external nutrient load thresholds for such nonlinear regime shifts. However, recent observational studies have questioned the concept of regime shifts by emphasizing that gradual changes are more common than sudden shifts. We investigated if regime shifts would be more gradual if the models account for depth‐dependent heterogeneity of the system by including the possibility of vertical gradients in the water column and sediment layers for the entire depth. Hence, bifurcation analysis was undertaken using the 1D hydrodynamic model GOTM, accounting for vertical gradients, coupled to the aquatic ecosystem model PCLake, which is implemented in the framework for aquatic biogeochemical modeling (FABM). First, the model was calibrated and validated against a comprehensive data set covering two consecutive 7‐yr periods from Lake Hinge, a shallow, eutrophic Danish lake. The autocalibration program Auto‐Calibration Python (ACPy) was applied to achieve a more comprehensive adjustment of model parameters. The model simulations showed excellent agreement with observed data for water temperature, total nitrogen, and nitrate and good agreement for ammonium, total phosphorus, phosphate, and chlorophyll a concentrations. Zooplankton and macrophyte coverage were adequately simulated for the purpose of this study, and in general the GOTM‐FABM‐PCLake model simulations performed well compared with other model studies. In contrast to previous model studies ignoring depth heterogeneity, our bifurcation analysis revealed that the spatial extent and depth limitation of macrophytes as well as phytoplankton chlorophyll‐a responded more gradually over time to a reduction in the external phosphorus load, albeit some hysteresis effects still appeared. In a management perspective, our study emphasizes the need to include depth heterogeneity in the model structure to more correctly determine at which external nutrient load a given lake changes ecosystem state to a clear‐water condition. [ABSTRACT FROM AUTHOR]

Background: Patient-centred care based on needs has been gaining momentum in health policy and the workforce. This creates new demand for interprofessional teams and redefining roles and tasks of professionals, yet little is known on how to implement new health policies more effectively. Our aim was to analyse the role and capacity of health professions in driving organisational change in interprofessional working and patient-centred care.Methods: A case study of the introduction of interprofessional, early discharge teams in stroke rehabilitation in Denmark was conducted with focus on day-to-day coordination of care tasks and the professional groups' interests and strategies. The study included 5 stroke teams and 17 interviews with different health professionals conducted in 2015.Results: Professional groups expressed highly positive professional interest in reorganised stroke rehabilitation concerning patients, professional practice and intersectoral relations; individual professional and collective interprofessional interests strongly coincided. The corresponding strategies were driven by a shared goal of providing needs-based care for patients. Individual professionals worked independently and on behalf of the team. There was also a degree of skills transfer as individual team members screened patients on behalf of other professional groups.Conclusions: The study identified supportive factors and contexts of patient-centred care. This highlights capacity to improve health workforce governance through professional participation, which should be explored more systematically in a wider range of healthcare services. [ABSTRACT FROM AUTHOR]

This study compares the structure of eelgrass (Zostera marina L.) meadows and associated food webs in two eelgrass habitats in Denmark, differing in exposure, connection to the open sea, nutrient enrichment and water transparency. Meadow structure strongly reflected the environmental conditions in each habitat. The eutrophicated, protected site had higher biomass of filamentous algae, lower eelgrass biomass and shoot density, longer and narrower leaves, and higher above to below ground biomass ratio compared to the less nutrient-enriched and more exposed site. The faunal community composition and food web structure also differed markedly between sites with the eutrophicated, enclosed site having higher biomass of consumers and less complex food web. These relationships resulted in a column shaped biomass distribution of the consumers at the eutrophicated site whereas the less nutrient-rich site showed a pyramidal biomass distribution of consumers coupled with a more diverse consumer community. The differences in meadow and food web structure of the two seagrass habitats, suggest how physical setting may shape ecosystem response and resilience to anthropogenic pressure. We encourage larger, replicated studies to further disentangle the effects of different environmental variables on seagrass food web structure. [ABSTRACT FROM AUTHOR]

We investigated the ability of the process-based, 1-dimensional hydrodynamic-ecosystem lake model GOTM-WET to reproduce the fluctuating dynamics and shifts between turbid and clear water states following restoration in temperate, shallow Lake Arreskov, Denmark. The lake model was calibrated on a comprehensive 12-year dataset with a multiple single-model ensemble approach to address model parameter and performance metric uncertainty. Compared to earlier modelling attempts on this lake, the GOTM-WET model, which enables simulation of water column hydrodynamics such as stratification events and two zooplankton groups, improved the simulation of the maximum chlorophyll a concentrations during cyanobacteria blooms and zooplankton dynamics. However, the timing of shifts between phytoplankton and submerged macrophytes dominance following fish removal was not well reproduced, although both states were simulated. We discuss potential improvements of the model to enhance the ability to simulate the effects of restoration on the food web and ecological states in this and similar lakes. • We tested the ability of a new lake model to simulate effects of restoration. • The 1D GOTM-WET model was used and represented by multiple single-model ensembles. • The model reproduced short-term stratification events and surface algae blooms. • Timing of shifts in ecological states following fish removal was not captured well. [ABSTRACT FROM AUTHOR]

Coastal seagrasses are declining at increasing rates worldwide, forcing herbivores previously reliant on these habitats to abandon them in search of alternative ways to fulfil their daily energy budgets. After two decades of declining seagrass abundance in Mariager Fjord, Denmark, the Svalbard breeding population of Light-bellied Brent Geese Branta bernicla hrota has experienced substantial changes in habitat use at this traditional autumn staging area. Declines in seagrasses have caused birds to depend increasingly on Sea Lettuce Ulva lactuca in recent years, and forced birds into terrestrial habitats such as saltmarsh and winter wheat. In contrast to those birds exploiting aquatic habitats, birds relying on these new habitats showed higher energy expenditure and failed to balance their energy budget. Eelgrass ( Zostera) was energetically superior to other food resources, with marine Ulva being second best. Predicted body mass development under two different scenarios indicate that present habitat use resulted in a midwinter body mass around 122 g lower than just 20 years ago, equivalent to c. 9.4% of Brent Goose body weight. Even after controlling for inter-annual differences in thermoregulatory costs, the effect of changes in habitat use translated into a body mass reduction of c. 56 g, which could adversely affect survival and future reproduction. Flyway-wide declines in Zostera abundance and further reductions in traditional habitats due to climate change give cause to reassess projected population trends and consequent management implications for the East Atlantic flyway population of Light-bellied Brent Geese. [ABSTRACT FROM AUTHOR]

This article discusses the "lost paradox" of Denis Diderot in Danish theatre. It mentions that the theatrical notion of paradox of the 18th century developed from the writings of Diderot, editor of the French "Encyclopédie." The author discusses the idea of bourgeois drama, the double narrative of the drama, and the theatrical reaction to the ideals of classicism. An analysis of the human relations within Diderot's plays, such as "Le fils naturel" and "Jacques le fataliste," is provided, along with a discussion of acting methodology and means of expression.

Background and Objectives. Approximately one in five ex-smokers reduces or maintains weight after smoking cessation but little is known about who succeeds to avoid weight gain. The purpose of this study was to identify predictors of weight reduction after long-term smoking cessation in a general population. Methods. Data was obtained from two Danish population-based cohorts (the Inter99 and the Helbred2006 study). Anthropometric measurements were performed by trained research staff. Out of 3.577 daily smokers at baseline 317 participants had quit smoking at the five-year follow-up for at least one year. Multiple logistic regression analysis was performed to determine predictors of weight reduction. Results. Thirteen percent reduced weight by at least 1 kg and 4% maintained their weight. Quitters with obesity had more than seven times higher odds than normal weight quitters to lose weight (OR 7.13 (95% CI 2.76–19.71)), and they had the largest median weight loss of 4.45 kg. The only other significant predictor of weight reduction was low tobacco consumption at baseline. Conclusions. Predictors of weight reduction after smoking cessation were high body mass index and low tobacco consumption at baseline. This study might motivate smokers with obesity to quit smoking and health professionals to give them support. [ABSTRACT FROM AUTHOR]

Soils are a crucial link between the atmosphere, biosphere, and geosphere. Any disturbance to the health of soils will severely impact plants as well as a multitude of organisms living in or on soils, such as fungi, bacteria, and insects. Catastrophic soil loss is thought to have played a pivotal role during mass-extinction events as a result of major deforestation, but the exact feedbacks remain elusive. Here, we assess the role of soil loss during the end-Triassic mass-extinction event based on proxy data obtained from four sediment sections recovered from France, Germany, and Denmark. Clay mineral and palynological data indicate a strong increase in erosion during the latest Rhaetian with the influx of kaolinite and abundantly reworked Palaeozoic and Neoproterozoic organic matter. Based on a new timeline, these changes were coeval with intense volcanic activity in the Central Atlantic Magmatic Province (CAMP). In addition to vegetation dieback, repeated forest fires, as well as widespread seismic activity related to CAMP emplacement led to landscape destruction triggering removal of soils. The biological degradation of fern spore walls by fungi and bacteria, a process coupled to organic matter decay in soils, strongly decreased across the T/J boundary. We interpret this counter-intuitive result as evidence for rapid and widespread removal of soils. Taken together, CAMP induced environmental changes led to profound changes in erosion and removal of soils, while soil resilience during the Hettangian appears to have proceeded hand in hand with recovery in Jurassic seas. [ABSTRACT FROM AUTHOR]

Purpose: Knowledge of the underlying mechanisms behind progression of chronic pancreatitis (CP) is needed to identify targets for new mechanism-based treatments. There is an urgent need for imaging biomarkers that can detect early morphological and functional pancreatic damage in order to initiate intervention and reduce the progression of CP at an early stage. The aim of our study was to assess and explore the potential role of structural magnetic resonance imaging (MRI) biomarkers for characterisation of disease progression in a CP patient cohort over a 4-year period.Methods: This longitudinal MRI study included twenty-five patients with definitive CP. Assessments of morphological imaging parameters at baseline and after 4 years included pancreatic gland volume, apparent diffusion coefficient (ADC) values, fat signal fraction (FSF) and main pancreatic duct (MPD) diameter. Patients were classified according to the modified Cambridge classification.Results: CP patients developed significantly reduced pancreatic gland volume, which decreased from mean 50.3 ± 19.6 ml at baseline to 43.5 ± 20.8 ml at follow-up (P < 0.001), decreased ADC values, meaning a higher degree of fibrosis (P < 0.001), increased FSF, meaning more fat infiltration (P < 0.001) and higher Cambridge classification scores (P = 0.033). The MPD diameter in the pancreatic head, body and tail did not change significantly over time (all P > 0.05). Only few, but no clear and systematic, associations were found between the progressions of the individual MRI measures.Conclusions: Morphological progression in patients with established CP seems to be primarily parenchymal-related. The different parenchymal changes were mostly unrelated and probably reflect diverse pathophysiological processes. [ABSTRACT FROM AUTHOR]