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Summary: Background: Regular audits on nutrition screening, therapy, and dietary intake monitoring are essential for ensuring optimal nutrition practice. This study aimed to investigate the prevalence of nutritional risk, nutritional coverage, and nutrition impact symptoms (NIS) in hospitalized patients. Methods: A cross-sectional study was conducted, including adult patients admitted for ≥5 days on November 1, 2023. Data were collected from medical records to estimate the prevalence of nutritional risk using the NRS-2002 score. Additionally, data on dietary intake and NIS were collected through interviews with patients identified as being at nutritional risk. Results: A total of 104 patients (48% females) were included in the study, with 51% identified as being at nutritional risk. Patients at nutritional risk and those not at risk differed significantly in terms of length of admission (median 9 (IQR: 7–17) vs. 7 days (6–11), P = 0.015) and BMI (median 22.3 (IQR: 20.3–27.7) vs. 25.9 (22.9–29.7), P = 0.015). Patients at nutritional risk had a median energy coverage of 60% (IQR: 38–87) and a median protein coverage of 45% (IQR: 36–82). However, only 42% of them achieved an energy intake of ≥75% of the estimated requirement, while 28% met the same level for protein intake. The most prevalent NIS affecting dietary intake was ‘diarrhea, constipation, or discomfort from the stomach’, reported by 50% of patients. Conclusion: This study highlights the significant prevalence of nutritional risk among hospitalised patients, with one in every two patients identified as being at risk. Despite efforts, nutritional needs were not adequately met, particularly regarding protein intake. Regular audits and interdisciplinary collaboration are necessary for improving nutritional care and outcomes in hospital settings.

Summary: Donor milk obtained from milk banks is a source of infant nutrition for mothers that cannot produce their own milk. Milk banks quality control the milk when donated, testing for the presence of pathogenic bacteria, protein and fat concentrations and total energy content. The macronutrient analysis allows the milk bank to decide if they need to add fortifiers to the milk and whether to continue accepting milk from a specific donor. The data registered is a large knowledge base for understanding how the macronutrient content in human milk changes with e.g. time, maternal health and gestational age. Using information from 331 donated milk samples from 74 different donors, all from Denmark, this paper looks at trends in macronutrient content relative to several parameters. Our results show that there is a statistically significant change in content over time and gestational age, but also that other parameters, not covered by the available data, can have an effect on the quality of donated human milk.

Squamous cell carcinoma (SCC) of the tongue is the most prevalent form of oral cavity cancer, with surgical intervention as the preferred method of treatment. Achieving negative or free resection margins of at least 5 mm is associated with improved local control and prolonged survival. Nonetheless, margins that are close (1–5 mm) or positive (less than 1 mm) are often observed in practice, especially for the deep margins. Ultrasound is a promising tool for assessing the depth of invasion, providing non-invasive, real-time imaging for accurate evaluation. We conducted a clinical trial using a novel portable 3D ultrasound imaging technique to assess ex vivo surgical margin assessment in the operating room. During the operation, resected surgical specimens underwent 3D ultrasound scanning. Four head and neck surgeons measured the surgical margins (deep, medial, and lateral) and tumor area on the 3D ultrasound volume. These results were then compared with the histopathology findings evaluated by two head and neck pathologists. Six patients diagnosed with tongue SCC (three T1 stage and three T2 stage) were enrolled for a consecutive cohort. The margin status was correctly categorized as free by 3D ultrasound in five cases, and one case with a “free” margin status was incorrectly categorized by 3D ultrasound as a “close” margin. The Pearson correlation between ultrasound and histopathology was 0.7 (p < 0.001), 0.6 (p < 0.001), and 0.3 (p < 0.05) for deep, medial, and lateral margin measurements, respectively. Bland–Altman analysis compared the mean difference and 95% limits of agreement (LOA) for deep margin measurement by 3D ultrasound and histopathology, with a mean difference of 0.7 mm (SD 1.15 mm). This clinical trial found that 3D ultrasound is accurate in deep margin measurements. The implementation of intraoperative 3D ultrasound imaging of surgical specimens may improve the number of free margins after tongue cancer treatment.

Edeltraut Garbe,1 Fabian Hoti,2 Tania Schink,1 Kristian Svendsen,3 Haydar Al-Eid,4 Per Arkhammar,5 Marie Carlholm,6 Harald Fjällbrant,6 Stefan Franzén,7,8 Cecilia Hedlund,9 Bianca Kollhorst,10 Atul Kumar,11 Muriel Lobier,2 Vasili Mushnikov,2 Tore Persson,9 Xu Qiao,2 Aaro Salosensaari,12 Wiebke Schäfer,1 Nicholas M Sicignano,13 Gunnar Johansson,14 Eileen O Dareng15 1Department Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany; 2Biostatistics, Scientific Services, Real World Solutions, IQVIA, Espoo, Finland; 3Department of Pharmacy, UiT The Arctic University of Norway, Tromsø, Norway; 4United States Navy, Naval Medical Center, Portsmouth, Virginia, USA; 5Global Patient Safety Biopharma, AstraZeneca, Gothenburg, Sweden; 6Late-Stage Respiratory and Immunology, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden; 7BPM Evidence Statistics, Medical Evidence, BioPharmaceuticals Medical, Gothenburg, Sweden; 8School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; 9Biometrics, Late-stage Respiratory and Immunology, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden; 10Department Biometry and Data Management, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany; 11Global Patient Safety Biopharma, AstraZeneca, Bangalore, India; 12Biostatistics, Scientific Services, Real World Solutions, IQVIA, Turku, Finland; 13Health ResearchTx LLC, Trevose, Pennsylvania, USA; 14Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; 15Safety Epidemiology and Risk Management, AstraZeneca, Cambridge, UKCorrespondence: Eileen O Dareng, AstraZeneca, City House, 126-130 Hills Road, Cambridge, CB2 1RY, United Kingdom, Tel +44 7789447801, Email eileen.dareng@astrazeneca.comPurpose: This study evaluated the long-term safety of roflumilast in patients with chronic obstructive pulmonary disease or chronic bronchitis using electronic healthcare databases from Germany, Norway, Sweden, and the United States (US).Patients and Methods: The study population consisted of patients aged ≥ 40 years who had been exposed to roflumilast and a matched cohort unexposed to roflumilast. The matching was based on sex, age, calendar year of cohort entry date (2010– 2011, 2012, or 2013), and a propensity score that included variables such as demographics, markers of chronic obstructive pulmonary disease (COPD) severity and morbidity, and comorbidities. In comparison to the unexposed matched cohort (never use), three exposure definitions were used for the exposed matched cohort: ever use, use status (current, recent, past use), and cumulative duration of use. The main outcome was 5-year all-cause mortality. Cox regression models were used to estimate crude and adjusted hazard ratios (HRs) and 95% confidence intervals (CI).Results: 112,541 unexposed and 23,239 exposed patients across countries were included. Some variables remained unbalanced after matching, indicating higher COPD disease severity among the exposed patients. Adjusted HRs of 5-year all-cause mortality for “ever use” of roflumilast, compared to “never use”, were 1.12 (95% CI, 1.08– 1.17) in Germany, 1.00 (95% CI, 0.92– 1.08) in Norway, 0.98 (95% CI, 0.92– 1.04) in Sweden, and 1.16 (95% CI, 1.12– 1.20) in the US. Compared to never users, there was a decrease in 5-year mortality risk observed among “current users” in Germany (HR: 0.93, 95% CI: 0.88– 0.98), Norway (HR: 0.77, 95% CI: 0.67– 0.87), and Sweden (HR: 0.80, 95% CI: 0.73– 0.88).Conclusion: There was no observed increase in 5-year mortality risk with the use of roflumilast in Sweden or Norway. A small increase in 5-year mortality risk was observed in Germany and the US in the ever versus never comparison, likely due to residual confounding by indication.Keywords: roflumilast, 5-year all-cause mortality, COPD, electronic healthcare database, propensity score

Abstract Background The delivery of safe drinking water has high public health relevance, as reflected in the Sustainable Development Goals (SDG6). Several precautionary actions have reduced the burden associated with infectious diseases in high-income countries; however, pollution in source waters, inadequate disinfection, and premise plumbing, along with an increased awareness that intrusion in the drinking water distribution system, represents risk factors for gastrointestinal illness linked to consume of drinking water. Sporadic cases of waterborne infections are expected to be underreported since a sick person is less likely to seek healthcare for a self-limiting gastrointestinal infection. Hence, knowledge on the true burden of waterborne diseases is scarce. The primary aim with the present study was to estimate the risk of gastrointestinal illness associated with drinking tap water in Norway. Methods We conducted a 12-month prospective cohort study where participants were recruited by telephone interview after invitation based on randomised selection. A start up e-survey were followed by 12 monthly SMS questionnaires to gather information on participants characteristics and drinking tap water (number of 0.2L glasses per day), incidence, duration and symptoms associated with gastrointestinal illness. Associations between the exposure of drinking tap water and the outcome of risk of acute gastrointestinal illness (AGI) were analysed with linear mixed effects models. Age, sex, education level and size of the drinking water supply were identified as potential confounders and included in the adjusted model. Results In total, 9,946 persons participated in this cohort study, accounting for 11.5% of all invited participants. According to the data per person and month (99,446 monthly submissions), AGI was reported for 5,508 person-months (5.5 per 100 person-months). Severe AGI was reported in 819 person-months (0.8 per 100 person-months). Our study estimates that 2–4% of AGI in Norway is attributable to drinking tap water. Conclusions This is the largest cohort study in Norway estimating the burden of self-reported gastrointestinal infections linked to the amount of tap water drunk in Norway. The data indicate that waterborne AGI is not currently a burden in Norway, but the findings need to be used with caution. The importance of continued efforts and investments in the maintenance of drinking water supplies in Norway to address the low burden of sporadic waterborne cases and to prevent future outbreaks needs to be emphasised.

Abstract Laser-driven compact particle accelerators can provide ultrashort pulses of broadband X-rays, well suited for undertaking X-ray absorption spectroscopy measurements on a femtosecond timescale. Here the Extended X-ray Absorption Fine Structure (EXAFS) features of the K-edge of a copper sample have been observed over a 250 eV window in a single shot using a laser wakefield accelerator, providing information on both the electronic and ionic structure simultaneously. This capability will allow the investigation of ultrafast processes, and in particular, probing high-energy-density matter and physics far-from-equilibrium where the sample refresh rate is slow and shot number is limited. For example, states that replicate the tremendous pressures and temperatures of planetary bodies or the conditions inside nuclear fusion reactions. Using high-power lasers to pump these samples also has the advantage of being inherently synchronised to the laser-driven X-ray probe. A perspective on the additional strengths of a laboratory-based ultrafast X-ray absorption source is presented.

Abstract Greenhouse whitefly (Trialeurodes vaporariorum) is a major global pest, causing direct damage to plants and transmitting viral plant diseases. Management of T. vaporariorum is problematic because of widespread pesticide resistance, and many greenhouse growers rely on biological control agents to regulate T. vaporariorum populations. However, these are often slow and vary in efficacy, leading to subsequent application of chemical insecticides when pest populations exceed threshold levels. Combining chemical and biological pesticides has great potential but can result in different outcomes, from positive to negative interactions. In this study, we evaluated co-applications of the entomopathogenic fungi (EPF) Beauveria bassiana and Cordyceps farinosa and the chemical insecticide spiromesifen in laboratory bioassays. Complex interactions between the EPFs and insecticide were described using an ecotoxicological mixtures model, the MixTox analysis. Depending on the EPF and chemical concentrations applied, mixtures resulted in additivity, synergism, or antagonism in terms of total whitefly mortality. Combinations of B. bassiana and spiromesifen, compared to single treatments, increased the rate of kill by 5 days. Results indicate the potential for combined applications of EPF and spiromesifen as an effective integrated pest management strategy and demonstrate the applicability of the MixTox model to describe complex mixture interactions.

This case study focused on students' experiences with gradeless formative assessment at a center for gifted students. Twenty-two students attending one of the six talent centers in Norway participated. A questionnaire with open- and close-ended questions were used to collect data. Qualitative data analysis was performed. Findings indicated that the students experience gradeless formative assessment positively. They highlighted less stressful and more motivating learning situations at the talent center compared to their experiences at school. Gradeless formative assessment allowed the students to focus on the learning process rather than the learning product.

Purpose: The article unpacks potentials of and resistance towards facilitating meetings between refugee and non-refugee youth in global citizenship education. Design/methodology/approach: The analyses are based on participant observation in a school-based intervention in three locations, developed on the principles of design-based research [DBR]. Findings: The article exposes both how meetings between students could be deeply educational and how teachers prevent meaningful interaction between students out of concern for refugee students. Research limitations/implications: More research is needed on how students care for themselves and others in transformational learning contexts. Practical implications: Privileged teachers' concern for retraumatising students can veil unconscious protection of the privileged self against students' trauma and should therefore be subject to critical reflection.

Arterial vasodilation is dependent on nitric oxide synthesized from L-arginine by endothelial nitric oxide synthase. Triathletes are reported to display altered serum concentrations of nitric oxide metabolites such as L-arginine, asymmetric dimethyl arginine (ADMA) and symmetric dimethyl arginine (SDMA) shortly after completing long-distance triathlon races. In other populations, similar changes to nitric oxide metabolites are established risk markers of cardiovascular disease. The objective of this study was to assess serum concentrations of metabolites for endothelial nitric oxide synthesis in triathletes one week following a long-distance triathlon race. In this prospective observational study, we used high-performance liquid chromatography to measure circulating concentrations of L-arginine, ADMA, and SDMA in triathletes. Venous blood samples were collected before, immediately after, day one, and one week following the triathlon race. Serum concentrations and L-arginine/ADMA ratio were determined for each time-point and compared to baseline. L-arginine/ADMA ratio was reduced on day one (147 ± 32 vs 163 ± 40, p < 0.02). ADMA was reduced immediately after and increased at day one and remained elevated at one week (0.29 ± 0.05 μM, p < 0.001, 0.44 ± 0.08 μM, p < 0.001 and 0.42 ± 0.07 μM, p = 0.04, respectively vs 0.40 ± 0.05 μM). SDMA was increased at all time-points when compared to baseline (0.48 ± 0.10 μM, p < 0.001, 0.53 ± 0.11 μM, p < 0.001 and 0.42 ± 0.08 μM, p = 0.048 vs 0.38 ± 0.05 μM). L-arginine was only decreased immediately after (46.0 ± 9.3 μM vs. 64.6 ± 16.1 μM, p < 0.001). Long-distance triathlon racing induces altered levels of metabolites for endothelial nitric oxide production that mostly normalizes within one week following racing. The clinical relevance of these transient changes has yet to be elucidated in the athletic population.

The environmental conditions of the ocean are rapidly deteriorating in many locations, largely due to anthropogenic activities. Previous studies have indicated both negative and positive impacts on marine biodiversity during the construction and operation of OWFs, but the impacts of decommissioning remain largely unknown. Assessments of marine biodiversity impacts are now needed to support science-based decisions as the first OWFs are approaching decommissioning. Life Cycle Impact Assessment (LCIA) offers a quantitative and transparent approach to impact assessment but does currently not adequately cover marine biodiversity impacts. As a first step in developing an LCIA method, we conducted a systematic literature review to identify the links between offshore infrastructure decommissioning activities and their impacts on marine biodiversity. Links were delineated as impact pathways, providing the foundational framework for future LCIA development. We extended the scope of our study to oil and gas (O&G) platforms, given the similarities between the two types of offshore infrastructure and decommissioning activities. Our study identifies numerous impact pathways through which OWF decommissioning affects marine biodiversity. We found many similarities between impacts from the decommissioning of OWFs and O&G, but generally, more pathways were identified for O&G decommissioning. As the structures resemble each other, this study suggests that much knowledge can be brought from O&G decommissioning to OWF. We identified habitat change as particularly important when investigating impacts associated with offshore decommissioning, as several pressures may affect habitat change. The study also identified implications for developing a comprehensive LCIA method, including a scarcity of quantitative studies and empirical data, baseline definitions, as well as inconsistency in biodiversity metrics applied across reviewed studies. Importantly, the identified impact pathways provide the first step toward integrating marine biodiversity into LCIA in the context of the decommissioning of offshore structures.

Introduction: Students in pharmacy are positive towards integrating artificial intelligence and ChatGPT into their practice. The aim of this study was to investigate the direct short-term learning effect of using Chat GPT by pharmacy students. Methods: This was an experimental randomized study. Students were allocated into two groups; the intervention group (n = 15) used all study tools and ChatGPT, while the control group (n = 16) used all study tools, except ChatGPT. Differences between groups was measured by how well they performed on a knowledge test before and after a short study period. Results: No significant difference was found between the intervention and control groups in level of competence in the pretest score (p = 0.28). There was also no significant effect of using ChatGPT, with a mean adjusted difference of 0.5 points on a 12-point scale. However there was a trend towards a higher proportion of ChatGPT participants having a large (at least four point) increase in score (4 out of 15) vs control group (1 out of 16). Conclusion: There is a potential for positive effects of ChatGPT on learning outcomes in pharmacy students, however the current study was underpowered to measure a statistically significant effect of ChatGPT on short term learning.