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Abstract Background Monitoring elite athletes’ body composition (BC) is vital for health and optimizing performance in sports emphasizing leanness, such as athletics. This study aims to investigate and compare sex- and event-specific off-to in-season BC changes in endurance and power event athletics competitors. Methods Elite male and female endurance athletes (> 800 m runners; n = 21) and power event athletes (sprinters, jumpers; n = 32) underwent dual-energy X-ray absorptiometry (DXA) scans for whole and regional lean mass (LM), fat mass (FM), bone mineral content (BMC), and density (BMD) during off-season (September-October) and in-season (April-May). Linear mixed models tested between-group off-season differences in BC, within-group off-season to in-season changes, and between-group differences in change. To assess meaningful or least significant changes (LSC) in BC, DXA precision errors were determined from two consecutive total body scans in a subsample of athletes (n = 30). Results Male athletes (n = 26) gained significantly (p

ABSTRACTRationale The complex nature of student learning in clinical practice calls for a comprehensive pedagogical framework on how to create optimal learning affordances.Purpose The purpose of this study was to describe characteristics of conducted research regarding investigated research questions, distribution of different health care student groups, and employed methodological approaches.Methods A scoping review was chosen to capture the multifaceted characteristics in the field of learning in clinical practice. Funded local projects were analysed to provide significant core concepts for the literature search. A systematic search and review of articles published 2000–2019 in the Nordic countries was conducted according to PRISMA- ScR (23). The search was made in Medline (OVID), SveMed+ and CINAHL and resulted in 3126 articles. After screening of the titles and abstracts 988 articles were included for further review. The abstracts of all these articles were reviewed against established inclusion and exclusion criteria and 391 articles were included. Characteristics of purposes and research questions were analysed with a qualitative content approach resulting in identified subject areas including significant categories. Health care student groups and methodological approaches were also identified.Results Subjects predominating the research were organisation of clinical practice, supervision, and students’ experience followed by interprofessional learning and learning environment. Co-operation, university-clinical setting, and patients’ role were investigated to a small extent. Sparsely occurring subjects were also specific learning outcomes and evidence-based knowledge. Nursing students were involved in 74% of the studies, medical students in 20%, and other professions around 8%. Qualitative approaches were most common.Conclusion Health care students’ learning in clinical practice has been researched to a large extent within the Nordic countries and important subject areas are well represented. The research displays a great potential to extract and describe factors to create a pedagogical framework with significant meaning to support students’ learning.

Abstract Objective Due to communication barriers, people without natural speech who use augmentative and alternative communication (AAC) are rarely interviewed about their healthcare needs, expectations, and experiences. This qualitative interview study aims to investigate how AAC users evaluate a new service delivery (nSD) in AAC care in Germany. Results We conducted 8 semi-structured qualitative interviews with 8 AAC users. The results of the performed qualitative content analysis show a positive evaluation of the nSD among AAC users. Contextual factors were identified that seem to hinder the achievement of the intervention goals. These include caregivers' prejudice and inexperience with AAC and an unfavourable environment in which AAC is used.

Abstract Background People with disabilities and without natural speech often rely on care provided by informal caregivers. The caregiving situation of these informal caregivers has been poorly researched. The objectives of the study are 1) to identify stressors, resources, and coping strategies among informal caregivers of people without natural speech and 2) to examine whether a complex intervention in augmentative and alternative communication (AAC) that is not primarily tailored to the needs of informal caregivers can reduce care-related burden. Methods The main components of the AAC intervention were (1) initial counselling session, (2) 4 AAC training sessions, (3) 20 AAC therapy sessions and (4) accompanying case management. The control group received only the initial counselling session. Within a quasi-experimental intervention study, survey data on self-perceived burden (Burden Scale for Family Caregivers, BSFC-s) from n = 154 informal caregivers of people without natural speech were collected at three time points between June 2018 and April 2021 from a postal survey. Qualitative interviews with n = 16 informal caregivers were conducted. Results Caregivers reported various stressors such as limited communication with the cared-for person and concerns about the living situation in adulthood. Diverse resources and effective coping strategies, which the caregivers refer to when dealing with stressors, could also be identified. Burden was significantly reduced in the intervention group compared to the control group. According to the results of the qualitative study, AAC use led to better communication skills and a reduction in behavioural problems and thus a decreased burden. Conclusions The AAC intervention seems to have a positive impact on self-perceived burden. Linkages between intervention components and burden reduction as well as stressors and coping strategies could be identified and provide an evidence-based foundation for developing future holistic interventions for families with individuals without natural speech. Trial registration German Clinical Trials Register (DRKS); ID: DRKS00013628 (registered on 05/02/2018).

Introduction: Cutibacterium acnes is the most common cause of postoperative infections in orthopaedic shoulder surgery and is hard to eradicate with current measures. Newer strategies focus on reducing bacterial load on the skin before surgery. Several previous studies have used a large number of both described and undescribed sampling techniques. The purpose of this study was to compare three previously described swab techniques to obtain bacterial cultures: Levine's (L) technique, the Z technique and the pencil eraser swab (PES) technique. Methods: Three consecutive skin swabs were collected from the right shoulder, on 15 healthy male volunteers, using Levine's technique, Z technique and PES technique from each participant. To determine the number of living bacteria, serial dilutions were made, and after culturing for 5 d, viable count (VC) was expressed as CFU/mL (with CFU representing colony-forming unit). Results: The PES technique yielded significantly higher VC than the two others. PES: median 3700 CFU/mL, L: 200 CFU/mL and Z: 220 CFU/mL (p=0.003). There was no significant difference between the methods regarding the number of positive cultures. PES: 14/15, L: 11/15 and Z: 12/15. Conclusions: There is a need to harmonise sampling techniques of C. acnes in order to compare the efficacy of different measures to reduce the bacterial load on the skin before and during surgery. Of the three tested methods, the PES technique is simple and produces the highest bacterial counts.

IntroductionMetabolic syndrome (MetS) is a cluster of clinical and metabolic alterations related to the risk of cardiovascular diseases (CVD). Metabolic changes occurring during puberty, especially in children with overweight and obesity, can influence the risk of developing chronic diseases, especially CVD.MethodsLongitudinal study based on the follow-up until puberty of a cohort of 191 prepubertal Spanish boys and girls without congenital, chronic, or inflammatory diseases: undernutrition: or intake of any drug that could alter blood glucose, blood pressure, or lipid metabolism. The following parameters were used to determine the presence of MetS: obesity, hypertension, hyperglycemia, hypertriglyceridemia, and low HDL-c.ResultsA total of 75·5% of participants stayed in the same BMI category from prepuberty to puberty, whereas 6·3% increased by at least one category. The prevalence of MetS was 9·1% (prepubertal stage) and 11·9% (pubertal stage). The risk of presenting alterations in puberty for systolic blood pressure (SBP), plasma triacylglycerols, HDL cholesterol (HDL-c), and HOMA-IR was significantly higher in those participants who had the same alterations in prepuberty. MetS prevalence in puberty was predicted by sex and levels of HOMA-IR, BMI-z, and waist circumference in the prepubertal stage, in the whole sample: in puberty, the predictors were levels of HOMA-IR, BMI-z, and diastolic blood pressure in participants with obesity. Two fast-and-frugal decision trees were built to predict the risk of MetS in puberty based on prepuberty HOMA-IR (cutoff 2·5), SBP (cutoff 106 mm of Hg), and TAG (cutoff 53 mg/dl).DiscussionControlling obesity and cardiometabolic risk factors, especially HOMA-IR and blood pressure, in children during the prepubertal stage appears critical to preventing pubertal MetS effectively.

The present study was designed to determine the contribution of the cross-sectional area of the ski poles (Sp) to the total aerodynamic drag during alpine skiing. At three different wind speeds in a wind tunnel, 10 skiers assumed typical alpine skiing postures (high, middle, and tuck), and their frontal aerodynamic drag was assessed with a force plate and their cross-sectional area, along with that of their ski poles, determined by interactive image segmentation. The data collected were utilized to examine intra-subject variation in Sp, the effects of Sp on the coefficient of aerodynamic drag (Cd), and the product of Cd and total cross-sectional area (Cd∙S. The major findings were as follows: (i) Sp ranged from 0.0067 (tuck position) to 0.0262 m2 (middle position), contributing 2.2–4.8% of the total cross-sectional area, respectively; (ii) Sp was dependent on wind speed in the high and middle positions; (iii) intra-subject variations ranged from 0.0018 m2 (27.6%) in the tuck position to 0.0072 m2 (30.5%) in the high position; (iv) Sp exerted a likely effect on Cd and Cd∙S. The extensive intra- and inter-skier variability in Sp can account for as much as ~5% of the total frontal cross-sectional area and future investigations on how elite skiers optimize their positioning of the poles in a manner that reduces aerodynamic drag are warranted.

Several studies have demonstrated that medical students and doctors rank specialties differently in terms of perceived status and prestige. At the same time some of the specialties have problems with recruiting and retaining staff. This study aimed to understand what constitutes status and prestige in the medical field and how it influences medical doctors' choice of specialty. By using a sociological perspective and applying Bourdieu's theoretical concepts of field, symbolic capital and perceived status, we analysed young doctors' journeys towards their chosen specialty. We conducted 15 in-depth semi-structured interviews. The data was analysed using content analysis. The findings suggest that medical specialties carry different social status. In the field of power, surgery is seen as the most prestigious of all specialties. However, in the future it might be a less attractive choice when young doctors tend to view their profession less as an identity and more like a job. For specialties perceived as low status, the challenge is to raise popularity by better describing to young doctors the characteristics and advantages of these specialties.

The aim of this study was to explore challenging encounters experienced by registered nurses (RN) during their first year in the emergency medical service by using the social learning theory of communities of practice. During the first year in a new professional practice, a new RN experiences a transition during which the new professional identity is being formed. This is a challenging and demanding period of time. According to the learning theory of communities of practice by Lave and Wenger, individuals' learning and development in a new professional practice occurs through participation in social activity and is influenced by context. This study is based on the qualitative data from semi-structured interviews. Thirty-two RNs working in the Swedish emergency medical service were interviewed via telephone during the spring of 2017. A qualitative content analysis with deductive reasoning of the interviews was used. The analysis process generated the main category; "New RNs participation is challenged by unpredictability and uncertainty in practice." The main category was based on three generic categories; "Loneliness in an unpredictable context," "Uncertainty about the team," and "Uncertainty in action." The challenges new RNs encounter during the first year relate to all three dimensions of a community of practice; mutual engagement, joint enterprise and shared repertoire. The encountered challenges also relate to the EMS context. Taking into account all these aspects when designing support models for RN's professional development may be advantageous for creating positive development for RNs new to the EMS and/or similar practices.

In basketball, game-related statistics are the most common measure of performance. However, the literature assessing their reliability is scarce. Purpose: Analyze the number of games required to obtain a good relative and absolute reliability of teams' game-related statistics. Method: A total of 884 games from the 2015-2016 to 2017-2018 seasons of the Spanish men's professional league were analyzed using all games and clustered by scoring difference. Intra-class correlation coefficient (ICC) was calculated for each variable. The number of games required to detect a change and to achieve good relative reliability was calculated using minimal detectable change and Spearman-Brown prophecy formula respectively. Results: Using all games, the results showed that the minimal number of games required in each group was 30 to detect a medium change (d > 0.5), 187 for a small change (d > 0.2), and 100 for good relative reliability (ICC = 0.75). Using balanced and unbalanced games, the minimal number of games required in each group was respectively 31 and 30 to detect a medium change (d > 0.5), 190 and 188 for a small change (d > 0.2), and 191 and 121 for good relative reliability (ICC = 0.75). Conclusions: The sample needs to consist of at least 30 games in each group to detect a medium size change, and at least 190 games to detect a small size change. To be able to rank teams with good reliability, at least 100 games are required when including both balanced and unbalanced games.

Abstract Background Interprofessional Education (IPE) is now included in curricula in universities worldwide. It is known that there are differences in attitudes towards IPE among students, but less is known regarding how students’ personalities and learnings styles correspond with those attitudes. The aim of this study was to investigate whether personality traits and learning styles have any impact on medical students’ attitudes towards IPE. Methods Seventy nine medical students in their 9th term (63% females, mean age 29 years) were questioned regarding their attitudes towards IPE according to the Interdisciplinary Education Perception Scale questionnaire, the Kolb’s learning style and Big Five Inventory questionnaires. For all three instruments we used the Swedish translated versions. Results When investigated with a logistic regression, adjusting for age and gender, there were no significant associations between Big Five inventory, Kolb’s learning style and IEPS, except for the Reflective-Pragmatic learning style that was moderately associated with a higher IEPS score. Conclusion There was no clear correlation between personality, learning style and attitude towards IPE as measured by the IEPS among medical students in our study population. Further investigations would benefit from a combination of qualitative and quantitative design.

Objective To examine interrelations between care-related burden on informal caregivers and their proxy assessments of outcomes in people without natural speech.Design A cross-sectional survey.Setting Data were collected in January 2019 from a postal survey of informal caregivers of people without natural speech who are insured by a large regional health insurance company in the German federal state of Lower Saxony.Participants n=714 informal caregivers of people without natural speech of all ages and with various underlying disabilities were identified and contacted via the health insurance company. Data from n=165 informal caregivers (26.4%) were obtained.Main outcome measures Caregiver burden (self-reported, Burden Scale for Family Caregivers), pragmatic communication skills of people without natural speech (proxy report, self-developed), health-related quality of life of people without natural speech (proxy report, DISABKIDS Chronic Generic Measure - DCGM-12) and functioning of people without natural speech (proxy report, WHO Disability Assessment Schedule 2.0).Results The analyses revealed significant associations between caregiver burden on the one hand and both proxy-reported health-related quality of life (b=−0.422; p≤0.001) and functioning (b=0.521; p≤0.001) on the other. Adding caregiver burden to the regression model leads to a substantial increase in explained variance in functioning (R² Model 1=0.349; R² Model 2=0.575) as well as in health-related quality of life (R² Model 1=0.292; R² Model 2=0.460).Conclusions Caregiver burden should be considered an important determinant when informal caregivers report outcomes on behalf of people without natural speech. Longitudinal studies are recommended to better understand the burdens experienced by caregivers when supporting people without natural speech.Trial registration number DRKS00013628.

An object-based method for automatic iceberg detection has been applied to Advanced Synthetic Aperture Radar images in the Amundsen Sea Embayment (ASE), Antarctica. The images were acquired between 1 January 2006 and 8 April 2012 under varying meteorological, oceanographic and sea-ice conditions. During this time period, the icebergs were counted (average 1370 ± 50) and their surface area was estimated (average 1537.5 km2). The average surface area was about 2.5 times larger than the annual calved area (620 km2), indicating that the average iceberg age in the ASE is about 2.5 years, which was confirmed by observed residence times based on drift tracks. Most of the ASE icebergs were less than 1500 m long, and almost 90% of them were smaller than 2 km2. The proportion of small- and medium-sized icebergs (84.4%) was significantly higher than in the open ocean, where large icebergs (>10 km2) account for nearly the whole iceberg surface area. The opposite was true for the freshly calved icebergs in the ASE. The data indicate that the creation of icebergs in the ASE is dominated by steady small- to medium-scale calving from ice shelves fringing the embayment. In addition, rare calving events of giant icebergs occur on a decadal timescale. There is also some import of icebergs from the Bellingshausen Sea further east along the coast, in particular after large calving events there.

Reducing browsing damages from cervids (Cervidae) on economically valuable tree species is a challenging task in many countries. Apart from cervid abundance, landscape characteristics, such as forest composition, land use, forage availability and climatic conditions, may affect the degree of browsing through both direct and indirect effects. A better understanding of basic mechanisms in this complex system is needed to design efficient and convincing management strategies. Focusing on Sweden as a case, which has been widely studied using regression analyses only, we applied path analysis to test the validity of a model on the indirect and direct links between landscape characteristics, cervid populations, and browsing damages on Scots pine (Pinus sylvestris). Our results validated the tested model in which moose (Alces alces) density and pine availability directly influence browsing damages. Increasing amounts of pine forests, preferred deciduous trees, and young forest had positive direct effects on moose densities and thereby indirectly contributed to increased browsing damages. The density of smaller deer species showed no direct effect on browsing damages on pine. Path analysis corroborated our attempt to disentangle direct and indirect potential causal drivers of browsing damages and shows that the choice of statistical method may alter the understanding of mechanistic driving forces.

There is limited knowledge of the talent selection strategies used by national sporting organizations to identify and develop talented players in basketball. Therefore, we aimed to explore differences in selection strategies between European youth basketball national team (NT) programs, and how they relate to the program’s success. Specifically, we examined differences in the number of youth NT players and within-country variance in the 1988–1999 generations between 38 countries (n men = 38, women = 32). Further, we tested if the number of youth NT players and within-country variance was related to the NTs senior ranking, youth ranking, and youth-to-senior player promotion, using generalized Bayesian multilevel models. We further checked the moderating effect of the amount of licensed basketball players in each country. On average, 15.6 ± 2.0 male and 12.4 ± 1.8 female players were selected per generation. Over a third of the NTs consistently selected a higher or lower number of players than the average, with a difference of 8.1 players (95% CI [5.8, 10.8]) for men and 7.6 players (95% CI [5.4, 10.0]) for women between the countries with the highest and lowest average. When licensed players were used as moderator, the differences decreased but did not disappear, in both genders. There was an above 99.3% probability that a higher number of players was positively related to higher men’s senior and youth rankings, and women’s youth ranking. Within countries, generations with a higher number of youth players generated more senior players, with a probability of 98.4% on the men’s, and 97.3% on the women’s side. When licensed players were used as moderator, the probabilities for these relationships remained largely unaffected, apart from women’s youth ranking, which sank to 80.5%. In conclusion, the selection strategy in basketball NT programs varies between European countries and selecting a higher number of players possibly relates to better long-term performance and more players promoted to the senior NTs. These findings show that talent development programs should make conscious decisions about their selection strategies as it can affect their success.

Abstract Background Working in the emergency medical service (EMS) can be extremely varying and sometimes physically and psychologically demanding. Being new in this context can be a great challenge. This study aim to describe what ambulance nurses consider to be important support during the first year in the EMS. Methods Three hundred and eighty-nine eligible participants that had graduated from the prehospital emergency care program were identified via university registrations office in Sweden. The eligible participants received a study specific questionnaire via mail consisting of 70 statements about support during the first year. The perceived importance of each statement were graded on a 7-point Likert scale. The gradings were analysed using descriptive statistics and frequencies, mean and SD were calculated. Results Two hundred and thirty questionnaires were returned fully completed, giving a response rate of 59%. Fourteen statements regarding desirable support were rated with mean values > 6.00 and SD

I simulated selective harvest strategies of moose (Alces alces) using antler point restrictions and protection of cows with calves to assess the impact of these strategies on population age structure and potential harvest efficiency (proportion of allowed shooting opportunities). The post-hunt, adult bull:cow ratio was held constant throughout the simulations, but age structure of the bull cohort was allowed to vary. The simulation showed that protecting bulls with few antler points (

Abstract Background New and inexperienced emergency medical service (EMS) professionals lack important experience. To prevent medical errors and improve retention there is an urgent need to identify ways to support new professionals during their first year in the EMS. Methods A purposeful sample and snowball technique was used and generated a panel of 32 registered nurses with 12–48 months of EMS experience. A Delphi technique in four rounds was used. Telephone interviews were undertaken in round one to identify what desirable support professionals new to the EMS desire during their first year. Content analysis of the transcribed interviews yielded items which were developed into a questionnaire. The experts graded each item in terms of perceived importance on a 5-graded likert scale. Consensus level was set at 75%. Items which reached consensus were removed from questionnaires used in subsequent rounds. Results Desirable support was categorized into eight areas: Support from practical skills exercises, support from theoretical knowledge, support from experiences based knowledge, theoretical support, support from an introduction period, support from colleagues and work environment, support from management and organization and other support. The experts agree on the level of importance on 64 of a total of 70 items regarding desirable support. One item was considered not important, graded 1 or 2, 63 items were considered important, graded 4 or 5. Conclusion Even with extensive formal competence the EMS context poses challenges where a wide variety of desirable forms of support is needed. Support structures should address both personal and professional levels and be EMS context oriented.

Purpose — We wanted to examine the potential of the Scandinavian Sarcoma Group (SSG) Central Register, and evaluate referral and treatment practice for soft-tissue sarcomas in the extremities and trunk wall (STS) in the Nordic countries. Background — Based on incidence rates from the literature, 8,150 (7,000–9,300) cases of STS of the extremity and trunk wall should have been diagnosed in Norway, Finland, Iceland, and Sweden from 1987 through 2011. The SSG Register has 6,027 cases registered from this period, with 5,837 having complete registration of key variables. 10 centers have been reporting to the Register. The 5 centers that consistently report treat approximately 90% of the cases in their respective regions. The remaining centers have reported all the patients who were treated during certain time periods, but not for the entire 25-year period. Results — 59% of patients were referred to a sarcoma center untouched, i.e. before any attempt at open biopsy. There was an improvement from 52% during the first 5 years to 70% during the last 5 years. 50% had wide or better margins at surgery. Wide margins are now achieved less often than 20 years ago, in parallel with an increase in the use of radiotherapy. For the centers that consistently report, 97% of surviving patients are followed for more than 4 years. Metastasis-free survival (MFS) increased from 67% to 73% during the 25-year period. Interpretation — The Register is considered to be representative of extremity and trunk wall sarcoma disease in the population of Scandinavia, treated at the reporting centers. There were no clinically significant differences in treatment results at these centers.

IntroductionThe current practice of service delivery in Germany for people with complex communication needs (CCN) who are in need of augmentative and alternative communication (AAC) is characterised by diverse problems, including a lack of clarity in the responsibilities of the service providers involved. To address these issues a new service delivery model has been put in place, implemented in three AAC counselling centres for patients with a particular health insurance across Germany. The implementation of a new service delivery model aims to improve individualised service delivery. The model goes beyond standard care by adding case management, counselling, AAC training and, if needed, AAC therapy. This study aims to evaluate the effectiveness of this complex intervention.Methods and analysisIn consideration of the complexity of the new service delivery model, formative and summative evaluation will be conducted. The formative evaluation will provide data based on qualitative and quantitative assessments of the competences and perspectives of all involved stakeholders, including a proxy measurement of persons with CCN. The summative evaluation will include a controlled study design as the new service delivery model will be compared against the service delivery in an existing contract and against data gathered from caregivers of AAC users provided with standard care. With the exception of the individual interviews the data will be collected from proxies—that is, informal and formal caregivers.Ethics and disseminationData collection, storage and evaluation meet the currently valid data protection regulations. Consultation by the responsible data protection officer of the Oldenburg Medical School and a positive vote from its Ethics Committee were obtained prior to the start of the study. Dissemination strategies include the presentation of the obtained data and results in the form of publications and at conferences.Trial registration numberDRKS00013628.

The aims of the current study were to analyze the evolution of players’ age in the UEFA Champions League since the start of its modern-day format in 1992–1993 up until 2017–2018 and to determine how the players’ age relates to their market value. The sample consisted of all players participating in the UEFA Champions League from the 1992–1993 to 2017–2018 seasons (n = 16062). The following variables were used in this study: players’ age, number of seasons in the club, number of Champions Leagues won, team performance, and market value of the player in the season. Data were examined using a one-way ANOVA and a linear regression. The main finding of the current study is that an aging trend has occurred in the last three decades in the Champions League. A significant increase in average players’ age (>1.6 years) was observed, rising from an age of 24.9 to 26.5 years. Goalkeepers and Center Backs tend to peak later than attackers, and their peak performance can last until an age of about 31 years. Finally, an inverted-U curve defines the association between market value and age, with peak value appearing in the 26–30 age range. These results provide useful information regarding at which age soccer players are likely to perform at the highest level, as well as the age they are likely to have the highest market value.