Preliminary validity testing of the eHealth Literacy Questionnaire (eHLQ): a Confirmatory Factor Analysis (CFA) in Norwegian hospitalized patients.

AIMS: To perform the first psychometric analysis of the Norwegian version of the eHLQ using confirmative factor analysis (CFA) procedures in a population of patients admitted to hospital using a cross-sectional design. The eHLQ consists of 35 items capturing the 7-dimensional eHealth Literacy Framework (eHLF) which describes users' attributes, user's interaction with technologies and user's experience with digital health systems. METHODS: The 7 independent scales of the eHLQ was translated from Danish and culturally adapted into the Norwegian language following a standardised protocol. Assessment of construct validity of the eHLQ was undertaken using data from a cross-sectional survey of 260 patients hospitalized at a Norwegian University Hospital in the Oslo area during a two-week period in June 2021. The analysis included using correlation analysis (Pearsons R), internal consistency (Cronbach's alpha) and confirmatory factor analysis (CFA). RESULTS: All factor loadings were high to acceptable (i.e. > 0.6), except for five items which had somewhat lower loadings. Regarding internal consistency, alpha ranged from 0.73 to 0.90. For optimal CFA fit for the different scale models, correlated residuals were required for five of the seven scales. Overall our analysis shows an intermediate fit of the orginal construct. Scale intercorrelations were all below 0.8, indicating an overall acceptable discriminant validity between the 7 dimensions. CONCLUSIONS: The results from the CFA analysis indicate that for almost all 7 eHLQ scales, an acceptable model fit was achieved. The 260 hospitalized patients included in this study represented a variety of diagnoses, recruited from a geographically limited area. Further studies on psychometric properties of the Norwegian version of eHLQ in larger samples, diverse settings and by using more comprehensive approaches are warranted.

Hysteroscopic resectoscope-directed biopsies and outpatient endometrial sampling for assessment of tumor histology in women with endometrial cancer or atypical hyperplasia.

OBJECTIVE: To evaluate and compare the diagnostic efficiency of outpatient endometrial sampling (OES) and hysteroscopic resectoscope-directed biopsies (HYbiopsy) to distinguish between endometrial cancer (EC) and atypical hyperplasia (AH) and to assess tumor type and grade (histotype) in women with EC. DESIGN: Patients with AH or EC (n = 266) among 1013 patients consecutively referred because of postmenopausal bleeding were included. Identification of EC versus AH, and unfavorable tumor types (endometrioid grade 3 or non-endometrioid tumors) using OES and HYbiopsy was compared to final histopathology at hysterectomy. AH or EC were identified by OES in 184 patients and by HYbiopsy in212. RESULTS: OES had only sufficient tissue samples in 72.7% of intended samples. Even when OES did provide sufficient material, addition of HYbiopsy was a better technique than OES alone to distinguish between EC and AH, with an AUC of 95.9% and 79.8%; sensitivity of 97.4% and 64.6% and a specificity of 94.4% and 95.0%, respectively (p = 0.008). AH was falsely diagnosed with OES in 58 (35.4%) of 164 women with a final diagnose of EC. A final diagnosis of stage 1b or more was seen in 22 of these 58 women, while 5 of 194 patients with EC all stage 1a grade 1 had AH by HYbiopsy. HYbiopsy had higher correlation in assessment of tumor type and grade than OES, but OES and HYbiopsy had comparable AUC of 90.3% and 92.4% for identification of unfavorable tumors when tumor histotype was successfully identified. Regarding identification of unfavorable tumors (n = 57), a successfully assessment of histotype by OES combined with HYbiopsy in women without successfully diagnosed histotype by OES alone had AUC of 91.3%. CONCLUSION: Addition of HYbiopsy may improve diagnosis when preoperative OES identifies AH or is insufficient for explicit diagnosis of tumor type and grade. However, there is limited benefit of the addition of HYbiopsy in the presence of definite diagnosis of grade 1-2 endometrioid tumors by OES.

Identification of endometrial cancers and atypical hyperplasia: Development and validation of a simplified system for ultrasound scoring of endometrial pattern.

OBJECTIVES: To derive and validate a practical scoring system for identification of endometrial cancer (EC) or atypical hyperplasia (AH) using transvaginal ultrasonography (TVS) and gel infusion sonography (GIS) in women with postmenopausal bleeding (PMB). STUDY DESIGN: Endometrial pattern was correlated with endometrial pathology in consecutive women with PMB in both a derivation study (N = 164) and a validation study (N = 711). Logistic regression was used to derive and validate two scoring systems (A and B) for prediction of EC/AH: scoring system A was Doppler score + interrupted endo-myometrial junction (IEJ) (2 points); and scoring system B was Doppler score + IEJ (1 point) + Irregular Endometrial Outline (IESO) by GIS (1 point); the Doppler score was based on the presence of more than one single or double vessel (1 point) + multiple vessels (1 point) + large vessels (1 point). OUTCOME MEASURES: Diagnostic performance and calibration curves for identification of EC/AH. RESULTS: Both scoring systems had good observer agreement. VALIDATION DATA: Scoring was most effective with endometrial thickness (ET) ≥ 8 mm. Both scoring systems were well calibrated and performed satisfactorily in women with ET ≥ 8 mm. The sensitivity and specificity of a score of ≥ 2 points in system A were 92% and 84%; the respective values were 89% and 88% in system B. CONCLUSIONS: Scoring was highly efficient in identifying EC/AH. Four risk groups of EC/AH may guide the management of women with PMB: very low (ET < 4 mm), low (ET 4-7.9 mm), intermediate (ET ≥ 8 mm and score < 2 points) and high risk (ET ≥ 8 mm and score ≥ 2 points).

Structure and clinical correlates of obsessive-compulsive symptoms in a large sample of children and adolescents: a factor analytic study across five nations.

The underlying structure of obsessive-compulsive disorder (OCD) remains to be confirmed in child and adolescent populations. In this paper we report the first factor analytic study of individual OCD items from Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS). OCD symptoms were assessed using the CY-BOCS symptom checklist in a sample of 854 patients with OCD (7-18 years of age) recruited from clinics in five countries. Pooled data were subjected to exploratory and confirmatory factor analysis (CFA) to identify the optimal factor structure. Various models were tested for age and gender subgroups. Also, the invariance of the solution across age and gender was tested and associations with demographic and clinical factors were explored. A three-factor model provided the best-fit solution. It consisted of the following factors: (1) harm/sexual, (2) symmetry/hoarding, (3) contamination/cleaning. The factor structure was invariant for age and gender across subgroups. Factor one was significantly correlated with anxiety, and factor two with depression and anxiety. Factor three was negatively correlated with tic disorder and attention-deficit/hyperactivity disorder (ADHD). Females had higher scores on factor two than males. The OCD symptom structure in children and adolescents is consistent across age and gender and similar to results from recent child and adolescents although hoarding may not be a separate factor. Our three-factor structure is almost identical to that seen in early studies on adults. Common mental disorders had specific patterns of associations with the different factors.

Genetic diversity of the NE Atlantic sea urchin Strongylocentrotus droebachiensis unveils chaotic genetic patchiness possibly linked to local selective pressure.

We compared the genetic differentiation in the green sea urchin Strongylocentrotus droebachiensis from discrete populations on the NE Atlantic coast. By using eight recently developed microsatellite markers, genetic structure was compared between populations from the Danish Strait in the south to the Barents Sea in the north (56-79°N). Urchins are spread by pelagic larvae and may be transported long distances by northwards-going ocean currents. Two main superimposed patterns were identified. The first showed a subtle but significant genetic differentiation from the southernmost to the northernmost of the studied populations and could be explained by an isolation by distance model. The second pattern included two coastal populations in mid-Norway (65°N), NH and NS, as well as the northernmost population of continental Norway (71°N) FV. They showed a high degree of differentiation from all other populations. The explanation to the second pattern is most likely chaotic genetic patchiness caused by introgression from another species, S. pallidus, into S. droebachiensis resulting from selective pressure. Ongoing sea urchin collapse and kelp forests recovery are observed in the area of NH, NS and FV populations. High gene flow between populations spanning more than 22° in latitude suggests a high risk of new grazing events to occur rapidly in the future if conditions for sea urchins are favourable. On the other hand, the possibility of hybridization in association with collapsing populations may be used as an early warning indicator for monitoring purposes.

Cellular uptake of coumarin-6 under microfluidic conditions into HCE-T cells from nanoscale formulations.

UNLABELLED: In vitro studies of ocular bioavailability of active pharmaceutical ingredients (API) from colloidal drug delivery systems do not consider physiological shear stress generated by eyelid wiping and tear flow. The present study introduces a live cell imaging approach which enables the investigation of model drug uptake from various formulations under shear stress by using custom-made microchannels for the cultivation of human corneal epithelial cells (HCE-T). Coumarin-6 (C-6) was used as a model API incorporated into solid lipid nanoparticles and liposomes, and as an aqueous crystalline suspension. Confocal laser scanning microscopy visualized C-6 uptake into HCE-T cells in a time-resolved manner with an applied shear stress of 0.1 Pa. Static conditions were also studied for comparative purposes. Additionally, solid lipid nanoparticles (SLN) were labeled with a fluorescent phospholipid to check whether C-6 uptake was associated with SLN incorporation into the cells. RESULTS: Intact SLN were not incorporated into the cells, i.e., C-6 was passively redistributed from SLN to lipophilic cellular compartments. C-6 was enriched up to a given limit in HCE-T cells within 5 min of contact with the dispersions both under static and under flow conditions. The C-6 delivery rate from liposomes was superior to that from SLN whereby the suspension exhibited the lowest rate. C-6 release rates were comparable for static and flow conditions. Alternate flushing with formulations and buffer revealed that cells accumulated C-6. The results suggest that combining microfluidics with live cell imaging provides a valuable option for in vitro studies of ocular drug delivery.

Characterization of the gut microbiota in leptin deficient obese mice - Correlation to inflammatory and diabetic parameters.

Gut microbiota have been implicated as a relevant factor in the development of type 2 diabetes mellitus (T2DM), and its diversity might be a cause of variation in animal models of T2DM. In this study, we aimed to characterise the gut microbiota of a T2DM mouse model with a long term vision of being able to target the gut microbiota to reduce the number of animals used in experiments. Male B6.V-Lep(ob)/J mice were characterized according to a number of characteristics related to T2DM, inflammation and gut microbiota. All findings were thereafter correlated to one another in a linear regression model. The total gut microbiota profile correlated to glycated haemoglobin, and high proportions of Prevotellaceae and Lachnospiraceae correlated to impaired or improved glucose intolerance, respectively. In addition, Akkermansia muciniphila disappeared with age as glucose intolerance worsened. A high proportion of regulatory T cells correlated to the gut microbiota and improved glucose tolerance. Furthermore, high levels of IL-10, IL-12 and TNF-α correlated to impaired glucose tolerance, blood glucose or glycated haemoglobin. The findings indicate that gut microbiota may contribute to variation in various disease read-outs in the B6.V-Lep(ob)/J model and considering them in both quality assurance and data evaluation for the B6.V-Lep(ob)/J model may have a reducing impact on the inter-individual variation.

Localizing and extracting filament distributions from microscopy images.

Detailed quantitative measurements of biological filament networks represent a crucial step in understanding architecture and structure of cells and tissues, which in turn explain important biological events such as wound healing and cancer metastases. Confocal microscope images of biological specimens marked for different structural proteins constitute an important source for observing and measuring meaningful parameters of biological networks. Unfortunately, current efforts at quantitative estimation of architecture and orientation of biological filament networks from microscopy images are predominantly limited to visual estimation and indirect experimental inference. Here we describe a new method for localizing and extracting filament distributions from 2D confocal microscopy images. The method combines a filter-based detection of pixels likely to contain a filament with a constrained reverse diffusion-based approach for localizing the filaments centrelines. We show with qualitative and quantitative experiments, using both simulated and real data, that the new method can provide more accurate centreline estimates of filament in comparison to other approaches currently available. In addition, we show the algorithm is more robust with respect to variations in the initial filter-based filament detection step often used. We demonstrate the application of the method in extracting quantitative parameters from an experiment that seeks to quantify the effects of carbon nanotubes on actin cytoskeleton in live HeLa cells. We show that their presence can disrupt the overall actin cytoskeletal organization in such cells.

Does oral health matter in people's daily life? Oral health-related quality of life in adults 35-47 years of age in Norway.

OBJECTIVE: The aim of this study was to assess the effect of oral health on aspects of daily life measured by the Dental Impact Profile (DIP) in 35- to 47-year-old individuals in Norway, and to study associations between reported effects and demographic variables, subjectively assessed oral health, general health, oral health behaviour and clinical oral health. MATERIAL AND METHODS: A stratified randomized sample of 249 individuals received a questionnaire regarding demographic questions, dental visits, oral hygiene behaviour, self-rated oral health and general health and satisfaction with oral health. The DIP measured the effects of oral health on daily life. Teeth present and caries experience were registered by clinical examination. Bi- and multivariate analyses and factor analysis were used. RESULTS: Items most frequently reported to be positively or negatively influenced by oral health were chewing and biting, eating, smiling and laughing, feeling comfortable and appearance. Only 1% reported no effects of oral health. Individuals with fewer than two decayed teeth, individuals who rated their oral health as good or practised good oral health habits reported more positive effects than others on oral quality of life (P ≤ 0.05). When the variables were included in multivariate analysis, none was statistically significant. The subscales of the DIP were somewhat different from the originally suggested subscales. CONCLUSIONS: This study showed that most adults reported oral health to be important for masticatory functions and confirmed that oral health also had impacts on other aspects of life.

Oral health-related quality of life among adults 68-77 years old in Nord-Trøndelag, Norway.

Dental health has mostly been measured by dental staff disregarding patient's experiences. However, clinical conditions alone do not fully indicate how people feel affected by their oral status. The aim of this study was to investigate how clinical recorded dental health, self-rated dental health, satisfaction with dental health were related to oral health-related quality of life (OHRQoL) assessed by Oral Health Impact Profile (OHIP-14) in 68-77 years old. A total of 151 individuals completed a questionnaire on self-rated dental health, satisfaction with dental health and the short form of OHIP-14. Clinical examination was performed registering number of teeth and dental caries. In total 63% of the individuals rated their dental health as good, and 59% were satisfied with their dental health. Using the OHIP-14 42% reported no problems or oral discomfort at all. The proportion of individuals reporting problems or discomfort varied between 13% and 43% according to the dimensions of OHIP-14. The most frequently reported problems were physical pain (43%), psychological discomfort (28%) and psychological disability (28%). Individuals who rated their dental health as poor and those who were dissatisfied with their dental health had significantly lower OHRQoL than other individuals. The study showed relationship between self-evaluations of dental health and OHRQoL in 68-77 years old. Individuals with few teeth reported lower OHRQoL than others, but no association between clinical caries status and OHRQoL could be found.

First-trimester Down syndrome screening: pregnant women's knowledge.

OBJECTIVES: The primary aim of this study was to assess pregnant women's knowledge of first-trimester combined Down syndrome screening in a setting of required informed consent. As the secondary aim, we wanted to identify relevant differences in knowledge level among subgroups of pregnant women, including those informed in different ways about prenatal examinations. METHODS: Data stem from a population-based cross-sectional questionnaire study including 15 multiple-choice questions assessing knowledge of different aspects of screening. Included were 6427 first-trimester pregnant women from three Danish obstetric departments offering prenatal screening free of charge. Both participants and non-participants in the screening program were included. The results are based on 4095 responders (64%). Differences between subgroups were examined using chi-squared tests and logistic regression analysis. Estimates are stated with 95% CI. RESULTS: The majority of the participants (87.6 (86.6-88.6)% to 92.6 (91.7-93.3)%) correctly identified the test concept and the main condition being screened for. Fewer participants (16.4 (15.3-17.6)% to 43.3 (41.8-44.8)%) correctly recognized test accuracy and the potential risk of adverse findings other than Down syndrome. Knowledge level was positively associated with length of education (adjusted ORs 1.0 (0.8-1.4) to 3.9 (2.4-6.4)) and participation in the screening program (adjusted OR 0.9 (0.6-1.3) to 5.9 (3.9-8.8)). Participation in an individual information session was weakly associated with more knowledge. CONCLUSION: The majority of the pregnant women correctly identified the test concept and the main condition being screened for. The pregnant women were found less knowledgeable on test accuracy and drawbacks.

Knowledge of prenatal screening and psychological management of test decisions.

OBJECTIVES: To study associations between pregnant women's knowledge of prenatal screening and decisional conflict in deciding whether to participate in first-trimester screening for Down syndrome in a setting of required informed consent, and to study associations between knowledge and personal wellbeing, and worries in pregnancy. METHODS: A population-based cross-sectional study with 6427 pregnant women consecutively included before the time of a nuchal translucency scan. Participants were recruited from three Danish obstetric departments offering prenatal screening free of charge. The results presented are based on 4111 pregnant women (64%). Knowledge was measured using 15 questions. The primary outcomes were measured using pre-existing validated scales, i.e. The Decisional Conflict Scale, the WHO Well-Being Index and the Cambridge Worry Scale. Associations were analyzed by multivariate logistic and linear regression analyses. RESULTS: A higher level of knowledge was associated with less decisional conflict when deciding whether to participate in first-trimester Down syndrome screening (adjusted odds ratio 1.31 (95% CI, 1.26-1.37)). An increased level of knowledge was also associated with higher levels of wellbeing (adjusted linear coefficient 0.51 (95% CI, 0.26-0.75), P < 0.001). Knowledge was not associated with worries, either in general or specifically about something being wrong with the baby. CONCLUSION: The results of this study indicate the importance of ensuring a high level of knowledge for pregnant women making choices about participation in prenatal screening for Down syndrome in order to improve the psychological management of test decisions.

The nucleus as a central structure in defining the mechanical properties of stem cells.

Manipulation of stem cells is one of the highest goals within biological sciences for the development of devices for the regeneration of injured tissues. In general, the mechanical properties of cells are nowadays recognized to play a role in many cellular phenotypes, including mobility though tissues, survival to mechanical loading and differentiation. Here we present a study where the mechanics of bone marrow CD34+ hematopoietic stem cells (CD34+ cells) and bone marrow stromal cells (BMSCs) is investigated through micropipette aspiration. The objective was to address the role of the nucleus as a central mechanoactive structure in stem cells. Stem cell nuclei occupy most of the cell volume and present different properties from what is known for somatic cells. Mechanics revealed to be highly dependent on the nucleus, where CD34+ cells revealed to be stiffer than BMSCs for short times under loading assuming elastic behavior and highly viscoelastic for longer times under loading, which present a higher nuclear volume per cell volume ratio. Mechanics was also evaluated for agglomerates of stem cells by aspirating spheres of neural progenitor cells (NSC-Ss). Relatively to single cells, NSC-Ss presented higher deformability, which seems to be more dependent on intracellular connectivity than on cell mechanics. The general character of the reported conclusions is being investigated with other types of stem cells.

Comparison of prostate set-up accuracy and margins with off-line bony anatomy corrections and online implanted fiducial-based corrections.

The aim of the study was to determine prostate set-up accuracy and set-up margins with off-line bony anatomy-based imaging protocols, compared with online implanted fiducial marker-based imaging with daily corrections. Eleven patients were treated with implanted prostate fiducial markers and online set-up corrections. Pretreatment orthogonal electronic portal images were acquired to determine couch shifts and verification images were acquired during treatment to measure residual set-up error. The prostate set-up errors that would result from skin marker set-up, off-line bony anatomy-based protocols and online fiducial marker-based corrections were determined. Set-up margins were calculated for each set-up technique using the percentage of encompassed isocentres and a margin recipe. The prostate systematic set-up errors in the medial-lateral, superior-inferior and anterior-posterior directions for skin marker set-up were 2.2, 3.6 and 4.5 mm (1 standard deviation). For our bony anatomy-based off-line protocol the prostate systematic set-up errors were 1.6, 2.5 and 4.4 mm. For the online fiducial based set-up the results were 0.5, 1.4 and 1.4 mm. A prostate systematic error of 10.2 mm was uncorrected by the off-line bone protocol in one patient. Set-up margins calculated to encompass 98% of prostate set-up shifts were 11-14 mm with bone off-line set-up and 4-7 mm with online fiducial markers. Margins from the van Herk margin recipe were generally 1-2 mm smaller. Bony anatomy-based set-up protocols improve the group prostate set-up error compared with skin marks; however, large prostate systematic errors can remain undetected or systematic errors increased for individual patients. The margin required for set-up errors was found to be 10-15 mm unless implanted fiducial markers are available for treatment guidance.

Assessment of a daily online implanted fiducial marker-guided prostate radiotherapy process.

The aims of this study were to investigate whether intrafraction prostate motion can affect the accuracy of online prostate positioning using implanted fiducial markers and to determine the effect of prostate rotations on the accuracy of the software-predicted set-up correction shifts. Eleven patients were treated with implanted prostate fiducial markers and online set-up corrections. Orthogonal electronic portal images were acquired to determine couch shifts before treatment. Verification images were also acquired during treatment to assess whether intrafraction motion had occurred. A limitation of the online image registration software is that it does not allow for in-plane prostate rotations (evident on lateral portal images) when aligning marker positions. The accuracy of couch shifts was assessed by repeating the registration measurements with separate software that incorporates full in-plane prostate rotations. Additional treatment time required for online positioning was also measured. For the patient group, the overall postalignment systematic prostate errors were less than 1.5 mm (1 standard deviation) in all directions (range 0.2-3.9 mm). The random prostate errors ranged from 0.8 to 3.3 mm (1 standard deviation). One patient exhibited intrafraction prostate motion, resulting in a postalignment prostate set-up error of more than 10 mm for one fraction. In 14 of 35 fractions, the postalignment prostate set-up error was greater than 5 mm in the anterior-posterior direction for this patient. Maximum prostate rotations measured from the lateral images varied from 2 degrees to 20 degrees for the patients. The differences between set-up shifts determined by the online software without in-plane rotations to align markers, and with rotations applied, was less than 1 mm (root mean square), with a maximum difference of 4.1 mm. Intrafraction prostate motion was found to reduce the effectiveness of the online set-up for one of the patients. A larger study is required to determine the magnitude of this problem for the patient population. The inability in the current software to incorporate in-plane prostate rotations is a limitation that should not introduce large errors, provided that the treatment isocentre is positioned near the centre of the prostate.

Grey-scale conversion X-ray mapping by EDS of multielement and multiphase layered microstructures.

A procedure for grey-scale conversion of energy dispersive spectroscopy X-ray maps has been developed, which is particularly useful for the plotting of line composition profiles across modified layered engineering surfaces. The method involves (a) the collection of grey-scale elemental maps, (b) the calculation of mean grey-scale levels along strips parallel to the layered microstructure and (c) the conversion of grey-scale line profiles into composition line profiles. As an example of the grey-scale conversion method and its advantages for multielement and multiphase layered microstructures, the procedure has been applied to a layered microstructure that results from a plasma-sprayed metallic MCrAlY coating onto a nickel-superalloy turbine blade. As a further demonstration of the accuracy and amount of compositional data that can be obtained with this procedure, measured compositional profiles have been obtained for several long-term isothermal heat treatments in which significant interdiffusion has taken place. The resulting composition profiles have greatly improved counting statistics compared to traditional point-by-point scans for the same scanning electron microscope time and may be considered as a rapid alternative to energy dispersive spectroscopy spectrum imaging. The composition profiles obtained may be conveniently compared with results of multicomponent thermodynamic modelling of interdiffusion.

Sentinel node lymphocytes: tumour reactive lymphocytes identified intraoperatively for the use in immunotherapy of colon cancer.

The sentinel node is the first lymph node to receive lymphatic drainage from a tumour and is usually the first site of metastases. Today, the sentinel node is used for tumour staging. Here, we focus on its immunological role and investigate lymphocytic function in sentinel nodes, identified intraoperatively by peritumoural dye injection, from 15 patients with colon cancer. Tumour infiltrating lymphocytes, sentinel and nonsentinel lymph node cells and peripheral blood leukocytes were studied by flow cytometry, proliferation assays and interferon-gamma secretion after activation with autologous tumour homogenate. Whereas tumour-infiltrating lymphocytes were nonresponsive in the proliferation assays, lymphocytes from sentinel nodes proliferated dose dependently and secreted interferon-gamma upon stimulation with tumour homogenate. The responses were of varying magnitude and tended to be weaker in metastatic sentinel nodes. Sentinel node lymphocytes represents an enriched source of tumour reactive lymphocytes, and may be useful in future trials of adoptive immunotherapy.