Isotopic evidence for primordial molecular cloud material in metal-rich carbonaceous chondrites.

The short-lived (26)Al radionuclide is thought to have been admixed into the initially (26)Al-poor protosolar molecular cloud before or contemporaneously with its collapse. Bulk inner Solar System reservoirs record positively correlated variability in mass-independent (54)Cr and (26)Mg*, the decay product of (26)Al. This correlation is interpreted as reflecting progressive thermal processing of in-falling (26)Al-rich molecular cloud material in the inner Solar System. The thermally unprocessed molecular cloud matter reflecting the nucleosynthetic makeup of the molecular cloud before the last addition of stellar-derived (26)Al has not been identified yet but may be preserved in planetesimals that accreted in the outer Solar System. We show that metal-rich carbonaceous chondrites and their components have a unique isotopic signature extending from an inner Solar System composition toward a (26)Mg*-depleted and (54)Cr-enriched component. This composition is consistent with that expected for thermally unprocessed primordial molecular cloud material before its pollution by stellar-derived (26)Al. The (26)Mg* and (54)Cr compositions of bulk metal-rich chondrites require significant amounts (25-50%) of primordial molecular cloud matter in their precursor material. Given that such high fractions of primordial molecular cloud material are expected to survive only in the outer Solar System, we infer that, similarly to cometary bodies, metal-rich carbonaceous chondrites are samples of planetesimals that accreted beyond the orbits of the gas giants. The lack of evidence for this material in other chondrite groups requires isolation from the outer Solar System, possibly by the opening of disk gaps from the early formation of gas giants.

182Hf-182W age dating of a 26Al-poor inclusion and implications for the origin of short-lived radioisotopes in the early Solar System.

Refractory inclusions [calcium-aluminum-rich inclusions, (CAIs)] represent the oldest Solar System solids and provide information regarding the formation of the Sun and its protoplanetary disk. CAIs contain evidence of now extinct short-lived radioisotopes (e.g., (26)Al, (41)Ca, and (182)Hf) synthesized in one or multiple stars and added to the protosolar molecular cloud before or during its collapse. Understanding how and when short-lived radioisotopes were added to the Solar System is necessary to assess their validity as chronometers and constrain the birthplace of the Sun. Whereas most CAIs formed with the canonical abundance of (26)Al corresponding to (26)Al/(27)Al of ∼5 × 10(-5), rare CAIs with fractionation and unidentified nuclear isotope effects (FUN CAIs) record nucleosynthetic isotopic heterogeneity and (26)Al/(27)Al of <5 × 10(-6), possibly reflecting their formation before canonical CAIs. Thus, FUN CAIs may provide a unique window into the earliest Solar System, including the origin of short-lived radioisotopes. However, their chronology is unknown. Using the (182)Hf-(182)W chronometer, we show that a FUN CAI recording a condensation origin from a solar gas formed coevally with canonical CAIs, but with (26)Al/(27)Al of ∼3 × 10(-6). The decoupling between (182)Hf and (26)Al requires distinct stellar origins: steady-state galactic stellar nucleosynthesis for (182)Hf and late-stage contamination of the protosolar molecular cloud by a massive star(s) for (26)Al. Admixing of stellar-derived (26)Al to the protoplanetary disk occurred during the epoch of CAI formation and, therefore, the (26)Al-(26)Mg systematics of CAIs cannot be used to define their formation interval. In contrast, our results support (182)Hf homogeneity and chronological significance of the (182)Hf-(182)W clock.

Prevalence of IgE sensitization in Danish children with suspected asthma.

OBJECTIVE: The aim of this article was to estimate the prevalence of IgE sensitization in Danish children with suspected asthma and to characterize the pattern of sensitization. STUDY DESIGN: We performed a cross-sectional study including 1744 children from 0 to 15 yr suspected of asthma who were referred to pediatric outpatient clinics in the region of southern Denmark from 2003 to 2005. The children were subjected to an extensive questionnaire-based interview, clinical examination, and both skin prick testing (SPT) and IgE measurements for 17 allergens. RESULTS: Asthma was confirmed in 1024 of the 1744 children. Among the children in whom the asthma diagnosis was confirmed, sensitization to one or more of the 17 allergens tested was found in 67.5% by either SPT or s-IgE ≥ class 2. Sensitization to any food allergen was found in 31.1%, to any outdoor allergen in 36.2%, and to any indoor allergen in 51.8%. Sensitization to cockroach and latex was rare. We found a weak correlation between SPT and s-IgE among food allergens and a more distinct correlation among inhalant allergens. Surprisingly, 30.1% of children in whom the asthma diagnosis was disproven used inhaled corticosteroids (ICS). On the contrary, 32.5% of the children for whom the asthma diagnosis was verified were not treated with ICS. CONCLUSION: We have found a high prevalence of sensitization among children with verified asthma. Our study supports relevant allergy testing in all children with verified asthma and emphasizes the importance of a thorough asthma diagnosis before prescribing continuous inhaled corticosteroids to children.

The NOAA NCEI marine microplastics database.

Microplastics (<5 mm) pollution is a growing problem affecting coastal communities, marine ecosystems, aquatic life, and human health. The widespread occurrence of marine microplastics, and the need to curb its threats, require expansive, and continuous monitoring. While microplastic research has increased in recent years and generated significant volumes of data, there is a lack of a robust, open access, and long-term aggregation of this data. The National Oceanic and Atmospheric Administration (NOAA) National Centers for Environmental Information (NCEI) now provides a global open access to marine microplastics data on an easily discoverable and accessible GIS web map and data portal ( https://www.ncei.noaa.gov/products/microplastics ). The objective of this data portal is to develop a repository where microplastics data are aggregated, archived, and served in a user friendly, consistent, and reliable manner. This work contributes to NCEI's efforts towards data standardization, integration, harmonization, and interoperability among national and international collaborators for monitoring global marine microplastics. This paper describes the NOAA NCEI global marine microplastics database, its creation, quality control procedures, and future directions.

The Ocean Carbon and Acidification Data System.

The Ocean Carbon and Acidification Data System (OCADS) is a data management system at the National Oceanic and Atmospheric Administration (NOAA) National Centers for Environmental Information (NCEI). It manages a wide range of ocean carbon and acidification data, including chemical, physical, and biological observations collected from research vessels, ships of opportunity, and uncrewed platforms, as well as laboratory experiment results, and model outputs. Additionally, OCADS serves as a repository for related Global Ocean Observing System (GOOS) biogeochemistry Essential Ocean Variables (EOVs), e.g., oxygen, nutrients, transient tracers, and stable isotopes. OCADS endeavors to be one of the world's leading providers of ocean carbon and acidification data, information, products, and services. To provide the best data management services to the ocean carbon and acidification research community, OCADS prioritizes adopting a customer-centric approach and gathering knowledge and expertise from the research community to improve its data management practices. OCADS aims to make all ocean carbon and acidification data accessible via a single portal, and welcomes submissions from around the world: https://www.ncei.noaa.gov/products/ocean-carbon-acidification-data-system/.

'Third wave' cognitive therapy versus mentalization-based therapy for major depressive disorder. A protocol for a randomised clinical trial.

BACKGROUND: Most interventions for depression have shown small or no effects. 'Third wave' cognitive therapy and mentalization-based therapy have both gained some ground as treatments of psychological problems. No randomised trial has compared the effects of these two interventions for patients with major depression. METHODS/DESIGN: We plan a randomised, parallel group, assessor-blinded superiority clinical trial. During two years we will include 84 consecutive adult participants diagnosed with major depressive disorder. The participants will be randomised to either 'third wave' cognitive therapy versus mentalization-based therapy. The primary outcome will be the Hamilton Rating Scale for Depression at cessation of treatment at 18 weeks. Secondary outcomes will be the proportion of patients with remission, Symptom Checklist 90 Revised, Beck's Depression Inventory, and The World Health Organisation-Five Well-being Index 1999. DISCUSSION: Interventions for depression have until now shown relatively small effects. Our trial results will provide knowledge about the effects of two modern psychotherapeutic interventions. TRIAL REGISTRATION: ClinicalTrials: NCT01070134.

Late delivery of exotic chromium to the crust of Mars by water-rich carbonaceous asteroids.

The terrestrial planets endured a phase of bombardment following their accretion, but the nature of this late accreted material is debated, preventing a full understanding of the origin of inner solar system volatiles. We report the discovery of nucleosynthetic chromium isotope variability (µ54Cr) in Martian meteorites that represent mantle-derived magmas intruded in the Martian crust. The µ54Cr variability, ranging from -33.1 ± 5.4 to +6.8 ± 1.5 parts per million, correlates with magma chemistry such that samples having assimilated crustal material define a positive µ54Cr endmember. This compositional endmember represents the primordial crust modified by impacting outer solar system bodies of carbonaceous composition. Late delivery of this volatile-rich material to Mars provided an exotic water inventory corresponding to a global water layer >300 meters deep, in addition to the primordial water reservoir from mantle outgassing. This carbonaceous material may also have delivered a source of biologically relevant molecules to early Mars.

Eosinophilic oesophagitis in infants and children in the region of southern Denmark: a prospective study of prevalence and clinical presentation.

OBJECTIVE: Eosinophilic oesophagitis (EE) is a clinical entity characterised by a set of symptoms and eosinophilic infiltration of the oesophageal epithelium. Recent reports indicate that EE is increasingly diagnosed in paediatric patients. We aimed to evaluate the epidemiology of paediatric EE in a European population. DESIGN: Infants and children in the Region of Southern Denmark were prospectively referred for further evaluation of symptoms of gastroesophageal reflux disease (GERD) after treatment failure with a proton pump inhibitor. The evaluation included endoscopy, 24-hour oesophageal pH-metry, histology of oesophageal biopsies, and investigations for food allergy (double-blind, placebo-controlled food challenge, skin prick test, S-IgE antibodies, atopy patch test). RESULTS: Of the 78 referred patients, 28 qualified for a diagnosis of GERD. Six children had >15 eosinophils per high-power field in biopsies from the oesophageal mucosa and qualified for the diagnosis of EE. The median age at diagnosis was 9.6 years. In 4 of the 6 patients, food allergy was confirmed by double-blind, placebo-controlled food challenge. In the Region of Southern Denmark with a paediatric population of 256,164 between 0 and 16 years of age, a yearly incidence of EE of 0.16/10,000 was estimated. CONCLUSION: We report a European prospective study of EE. It was documented in 6 of 78 patients with symptoms of GERD corresponding to an annual incidence of 0.16/10,000 infants and children.

Timing of hip hemiarthroplasty and the influence on prosthetic joint infection.

INTRODUCTION: Previous research suggested that patients have increased risk of infection with increased time from presentation with a femoral neck fracture to treatment with a hip hemiarthroplasty (HHA). The purpose of this study was to determine if rates of prosthetic joint infections within 3 months of surgery was affected by the time from patient presentation with a femoral neck fracture to the time of treatment with HHA. MATERIALS AND METHODS: Acute hip fractures treated with HHA between 2005 and 2017 at three centres in Norway were enrolled in the study. Multi-trauma patients were excluded. Univariable analysis was performed to determine any significant effect of pre-operative waiting time on infection rate. Two pre-planned analyses dichotomizing pre-operative waiting time cut-offs were performed. RESULTS: There were 2300 patients with an average age of 82 (range, 48-100) years included of which 3.4% experienced a prosthetic joint infection within 3 months. The primary analysis found no significant difference in infection rate depending on time to surgery (OR = 1.06 (95% CI 0.94-1.20, p = 0.33)). The secondary analyses showed no significant differences in infection rates when comparing pre-operative waiting time of <24 hours vs ≥24 hours (OR = 0.92 (95% CI 0.58-1.46, p = 0.73)) and <48 hours vs ≥48 hours (OR = 1.39 (95% CI 0.81-2.38, p = 0.23)). CONCLUSION: Based off of a large retrospective Norwegian database of hip fractures there did not appear to be a significant difference in infection rate based on pre-operative wait time to surgery.

Multidimensional intervention and sickness absence in assistant nursing students.

BACKGROUND: When handling patients, nursing assistant (NA) students and nurse students are frequently exposed to risk factors for low back pain (LBP) including sudden loads and twisting and bending of the spine. Furthermore, LBP is a major cause of sickness absence. AIMS: To ascertain if a multidimensional prevention programme combining physical training, patient transfer technique and stress management prevents sickness absence and LBP in NA students. METHODS: The study was a 14-month cluster randomized controlled study. The participants were NA students from 37 randomly selected classes located at two schools of health and social care in Copenhagen, Denmark. The participants completed a comprehensive questionnaire regarding sickness absence, LBP and psychosocial factors on commencement and after completion of the study. RESULTS: Of 766 female NA students, 668 (87%) completed the baseline questionnaire. Sickness absence during the study period increased in both groups but the increase was significantly lower in the intervention group than the control group, mean (standard deviation) number of days 12 (20) versus 18 (34), P < 0.05. The intervention group reported no change in the mean level of general health perception, energy/fatigue or psychological well-being at follow-up, while the control group reported a decline on those scales. There were no significant differences in the prevalence of LBP at follow-up between the intervention and control group. CONCLUSIONS: Compared to the control group, the intervention group had significantly less sickness absence. The intervention had no preventive effect on LBP prevalence.

Establishing a new falls clinic--conflicting attitudes and inter-sectoral competition affecting the outcome.

Falls clinics are a newer model for falls management among the elderly. Few studies have addressed the impact of the strategy on falls prevention in the healthcare system. The aim of the present study was to describe the social processes that affect the implementation of new strategies in falls management. A newly established falls clinic was chosen as an instrumental case to describe the systematic and comprehensive approach to falls prevention among the elderly. The investigation had a qualitative case study research design with triangulation of sources and methods, including interviews, participant observation and analysis of documents. The study was conducted from January 2006 to June 2007 at a newly established falls clinic at a Danish hospital. Data were analysed qualitatively according to four main themes: The concept of falls, success/failure, competition and expertise. The study showed that the falls clinic was embedded in a context where interests varied at different levels of the organizational hierarchy. In contrast to the political agenda for falls prevention, patients and professionals did not associate falls with chronological age. The biomedical structure of the falls clinic and the hegemonic mode of handling falls prevention may have facilitated falls prevention services and patient trajectories across sectors, but if falls are associated with chronic disease secondary to an unhealthy lifestyle, the individual patient becomes responsible for the falls problem. This may subsequently prevent the patients from seeking timely help from the healthcare system, or patients may drop out of the existing programmes. Future research needs to look at sustainability and dropping out in relation to falls prevention programmes.

Incidence of bullosis diabeticorum--a controversial cause of chronic foot ulceration.

Bullosis diabeticorum (BD) is considered a rare and relatively harmless skin manifestation with tense blisters appearing rapidly and mostly on the feet. Most papers report only a few cases and the cause of the blisters is not known. We have experienced that the lesions are not so rare and may turn into chronic foot ulcers with complications. Retrospective study of 25 consecutive patients with 35 outbreaks and 93 bullae in a population of 5000 people with diabetes treated during a 3-year period. The bullae were deroofed in order to examine the bulla base and treated as foot ulcers including debridement, antibiotics, bandage and protective footwear. The incidence of BD per year in the present diabetic population is 0.16%. In 29 outbreaks, there were hypoglycaemic episodes or highly varying blood glucose. Antibiotics were given in 17 of 35 episodes. Time to healing was as much as median 2.5 months (range 0.5-23 months). Two patients had minor amputations. BD should be well known to all members of diabetic foot care teams. Blood glucose control with special attention to hypoglycaemia at the time of eruption, deroofing of the bullae and foot ulcer care are recommended.

Mini-Mental Status Examination: a short form of MMSE was as accurate as the original MMSE in predicting dementia.

OBJECTIVES: This study assesses the properties of the Mini-Mental State Examination (MMSE) with the purpose of improving the efficiencies of the methods of screening for cognitive impairment and dementia. A specific purpose was to determine whether an abbreviated version would be as accurate as the original MMSE in predicting dementia. STUDY DESIGN AND SETTING: A population-based post hoc examination of the performance characteristics of the MMSE for detecting dementia in an existing data set of 243 elderly persons. RESULTS: Sensitivity, specificity, and predictive values were computed for the original MMSE as well as new MMSE scale models derived from a Rasch model item analysis. The optimal threshold for the original MMSE screen yielded sensitivity and specificity estimates of 72.5% and 91.3%, respectively. The use of a subscale resulted in a slightly lower sensitivity (71.0%), specificity (88.4%), and positive predictive value (71.0%) but equal area under the receiver operating characteristic curve. Cross-validation on follow-up data confirmed the results. CONCLUSION: A short, valid MMSE, which is as sensitive and specific as the original MMSE for the screening of cognitive impairments and dementia is attractive for research and clinical practice, particularly if predictive power can be enhanced by combining the short MMSE with neuropsychological tests or informant reports.

Mini-Mental Status Examination: mixed Rasch model item analysis derived two different cognitive dimensions of the MMSE.

OBJECTIVES: This study published in two companion papers assesses properties of the Mini-Mental State Examination (MMSE) with the purpose of improving the efficiencies of the methods of screening for cognitive impairment and dementia. STUDY DESIGN AND SETTING: An item analysis by conventional and mixed Rasch models was used to explore empirically derived cognitive dimensions of the MMSE, to assess item bias, and to construct diagnostic cut-points. The scores of 1,189 elderly residents were analyzed. RESULTS: Two dimensions of cognitive function, which are statistically and conceptually different from those obtained in previous studies, were derived. The corresponding sum scales were (1) age-correlated MMSE scale (A-MMSE scale: orientation to time, attention/calculation, naming, repetition, and three-stage command) and (2) non-age-correlated MMSE scale (B-MMSE scale: orientation to place, registration, recall, reading, and copying). The "writing" item was not included due to differential effects of age and sex. The analysis also showed that the study sample consisted of two cognitively different groups of elderly. CONCLUSIONS: The findings indicate that a two-scale solution is a stable and statistically supported framework for interpreting data obtained by means of the MMSE. Supplementary analyses are presented in the companion paper to explore the performance of this item response theory calibration as a screening test for dementia.

Arthrodesis with external fixation in the unstable or misaligned Charcot ankle in patients with diabetes mellitus.

The unstable or misaligned Charcot ankle with or without chronic foot ulceration is a major clinical challenge. When it cannot be accommodated with an ankle foot orthosis, surgical treatment is indicated in order to avoid leg amputation. This requires extensive soft tissue release and bony resection to realign the foot and arthrodesis with internal or external fixation. The guidance in the literature favors internal fixation. This article reports results with external fixation in 11 patients (12 feet) over a period of 12 years. External fixation was chosen as the surgical option because of the presence of foot ulcers with the attendent risk of infection. There were 7 tibio-talar and 5 tibio-calcaneal fusions. Compression was applied for 6 weeks with an external frame according to Charnley, followed by 6 weeks with total-contact cast. Weight bearing with a rigid leather brace was allowed after 12 weeks. In one case, transtibial amputation was required due to loosening of the distal pins from osteopenic disintegrating bone. In 11 cases (92%), the foot was successfully realigned and independent walking with a brace retained during the follow-up of median 48 months (10-102 months). Bony union took place in 5 out of 7 cases with tibio-talar fusion and in 1 out of 5 with tibio-calcaneal fusion. The functional result in cases with fibrous union was, however, satisfactory. Although meaningful comparisons of series are difficult to conduct and interpret from, the limb salvage rate was similar to results with internal fixation. The authors consider the results to be encouraging and to be used to develop a higher level of evidence.

Tiredness in daily activities: a subjective measure for the identification of frailty among non-disabled community-living older adults.

The objective of this study was to determine whether the responses to questions about tiredness in daily activities is an early subjective sign of frailty indicating older community-living adults at increased risk for disability and mortality. Tiredness in daily activities as measured by the Mob-T Scale, maximal power in sustained work, and comorbid diseases were assessed together with sociodemographic variables in a sample of 705 non-disabled, 70-year old men and women surveyed in 1984. Vital status of members was determined prospectively over the next 15 years. Onset of disability was measured at 5-, 10-, and 15-year follow-up. Onset of disability among non-disabled 70-year old men and women was strongly related to tiredness in daily activities at 5- and 10-year follow-up. Scores on the Mob-T Scale were significantly associated with mortality during the aggregate 15-year follow-up period. Multiple stepwise regression analyses not only indicated that tiredness in daily activities is a strong independent predictor of both disability and mortality, but also that tiredness mediates the effects of comorbidity and maximal power in sustained work on disability/mortality. Self-reported tiredness in daily activities is suggested as a basis for identifying vulnerable frail subsets of older adults requiring targeted strategies for prevention.

Religion and survival in a secular region. A twenty year follow-up of 734 Danish adults born in 1914.

The aim of the study was to analyse associations of religiosity and mortality in a secular region. The sample consisted of 734 Danish, community dwelling elderly persons, living in a secular culture, and all aged 70 when primary data were collected. Secondary data consisted of a 20 year follow-up on vital status or exact age of death. The study was designed to be highly comparable to studies conducted in more religious environments in order to compare results. Three variables of religion were investigated in relation to survival: importance of affiliation, church attendance and listening to religious media. Relative hazards (RH) of dying were controlled in models including gender, education, medical and mental health, social relations, help given and received, and health behaviour. The results showed significant and positive associations between claiming religious affiliation important and survival (relative hazard of dying=RH .70; 95% CI .58-.85) and church attendance and survival (RH .73; 95% CI .64-.87). Results decreased and only stayed significant regarding church attendance when controlled for covariates. Nearly all significant effects were seen in women, but not in men. The effect size of the full sample is less than in more religious environments in United States samples. Although the positive overall RHs are comparable to those of other studies, the mediating variables and pathways of effects seem dissimilar in this sample from a secular environment. Receiving and especially giving help to others are suggested as variables of explanatory value.

Sculpting with people--An experiential learning technique.

At Department of Nursing, University College Lillebaelt in Denmark we use an experiential technique called sculpting in our simulation program. Sculpting is a kind of non-verbal role play in which participants are given a certain character and create a 'sculpture' by arranging family members, social circles and professionals in ways which reflect the quality of the relationships of the people involved. The aim of this study is to further describe the sculpting exercise and present a small scale evaluation study using a qualitative descriptive design. An evaluation sheet was formulated by the authors and filled out by 114 Danish third-year nursing students. The results show that sculpting is experienced as emotionally demanding, but in a good way. It is experienced as an eye-opener that helps to identify the possible complex and emotional dynamics in a family experiencing critical illness and impending death. Sculpting seems to increase nursing students' personal knowing related to palliative care. An experiential learning technique like sculpting can be introduced in other parts of nursing education to raise students' awareness of what they themselves bring into a situation and how this may affect their clinical judgments.

Stroke rehabilitation: assistive technology devices and environmental modifications following primary rehabilitation in hospital--a therapeutic perspective.

The aim of this article is to describe the need for assistive devices and environmental modifications among long-living stroke survivors and to investigate if the need is continued and growing over time. The study sample of 155 consecutive stroke patients with stroke-related impairment, discharged home from three hospitals in Copenhagen from 1996 through 1998, constituted 20% of the total population of stroke survivors in this area. The results showed that 75% of these patients were provided with assistive devices and/or environmental modifications at discharge. Six months after discharge the proportion was 81%. The aids most frequently prescribed were bath seats, aids for mobility, grab bars, and removal of door thresholds. At follow-up 3-5 years later, 74% of the survivors were seen (76 patients). Almost all of the survivors were dependent on assistive devices and/or environmental modifications, most frequently wheelchairs and aids for walking and bathing. In addition there was a significant increase in aids for cooking/eating and reading/hearing/writing adaptations. Of those devices abandoned, most were aids for the household. These findings suggest that home visits by therapists should be required in order to target stroke survivors' changing needs for assistive devices and environmental modifications.