The feasibility of a multidimensional intervention in lymphoma survivors with chronic fatigue.

PURPOSE: Chronic fatigue (CF) affects 25-30% of lymphoma survivors, but interventions designed to reduce fatigue are lacking. The main aim of this study was to test the feasibility of a multidimensional intervention study in lymphoma survivors with CF. Secondary aims were to describe individual changes in fatigue, quality of life (QoL) and physical performance from pre (T0) to post (T1) intervention. METHODS: This feasibility study was as a one-armed intervention study performed in 2021. Hodgkin or aggressive non-Hodgkin lymphoma survivors received mailed study information and Chalder Fatigue Questionnaire and were asked to respond if they suffered from fatigue. The 12-week intervention included patient education, physical exercise, a cognitive behavioural therapy (CBT)-based group program and nutritional counselling. Feasibility data included patient recruitment, completion of assessments, adherence to the intervention and patient-reported experience measures. Participants responded to questionnaires and underwent physical tests at T0 and T1. RESULTS: Seven lymphoma survivors with CF were included. Of all assessments, 91% and 83% were completed at T0 and T1, respectively. Adherence to the interventional components varied from 69% to 91%. At T1, all participants rated exercise as useful, of whom five rated the CBT-based program and five rated individual nutritional counselling as useful. Five participants reported improved fatigue, QoL and physical performance. CONCLUSION: Lymphoma survivors with CF participating in a multidimensional intervention designed to reduce the level of fatigue showed high assessment completion rate and intervention adherence rate. Most of the participants evaluated the program as useful and improved their level of fatigue, QoL and physical performance after the intervention. TRIAL REGISTRATION: ClinicalTrials.gov, identifier: NCT04931407. Registered 16. April 2021-Retrospectively registered. https://www. CLINICALTRIALS: gov/ct2/show/NCT04931407.

Integrating groundwater stress in life-cycle assessments - An evaluation of water abstraction.

Understanding groundwater abstraction effects is vital for holistic impact assessments in areas depending on groundwater resources. The objective of our study was to modify the state-of-the-art AWaRe (available water remaining), freshwater impact assessment specifically for use in LCAs in areas dependent on groundwater resources. The new method, called "AGWaRe" (available groundwater remaining), reflects groundwater availability, based on a fraction of available groundwater remaining locally relative to a reference. Furthermore, our method increases spatial resolution beyond 1770 km2 grid cells and adjusts demarcations in order to improve the representation of the heterogeneity of groundwater catchments. The applicability of AGWaRe was demonstrated on three groundwater systems producing 5 million m3 water for the city of Copenhagen, namely Advanced Treatment of Groundwater, Simple Treatment of Groundwater and Infiltration of Reclaimed water. Results were normalised to compare with other effects of supplying water to an average Danish person. The normalised impacts for drinking water for one person ranged between 0.1 and 39 PE (person equivalent) for the three systems, which indicates that effects on groundwater resources differ substantially between systems. A comparative LCA of these groundwater systems shows that other impact categories range between 0 and 1 PE/person. Advanced Treatment of Groundwater generally has the lowest effect, for example <50% of the other groundwater systems in Global Warming Potential. The AGWaRe results indicate that freshwater impacts from Simple Treatment of Groundwater are up to 100 times greater than for Infiltration of Reclaimed water. Furthermore, AGWaRe exposes differences between the groundwater systems that AWaRe cannot evaluate, because one AWaRe cell covers two of the systems in question. These improvements are crucial for groundwater managers looking to include sustainability considerations in their analysis and decision-making.

An explorative metabolomic analysis of the endothelium in pulmonary hypertension.

Pulmonary hypertension (PH) is classified into five clinical diagnostic groups, including group 1 [idiopathic pulmonary arterial hypertension (IPAH) and connective tissue disease-associated PAH (CTD-aPAH)] and group 4 (chronic thromboembolic pulmonary hypertension (CTEPH)). PH is a progressive, life-threatening, incurable disease. The pathological mechanisms underlying PH remain elusive; recent evidence has revealed that abnormal metabolic activities in the endothelium may play a crucial role. This research introduces a novel approach for studying PH endothelial function, building on the genome-scale metabolic reconstruction of the endothelial cell (EC) to investigate intracellular metabolism. We demonstrate that the intracellular metabolic activities of ECs in PH patients cluster into four phenotypes independent of the PH diagnosis. Notably, the disease severity differs significantly between the metabolic phenotypes, suggesting their clinical relevance. The significant metabolic differences between the PH phenotypes indicate that they may require different therapeutic interventions. In addition, diagnostic capabilities enabling their identification is warranted to investigate whether this opens a novel avenue of precision medicine.

More is not always better: coping with ambiguity in natural resources management.

Coping with ambiguities in natural resources management has become unavoidable. Ambiguity is a distinct type of uncertainty that results from the simultaneous presence of multiple valid, and sometimes conflicting, ways of framing a problem. As such, it reflects discrepancies in meanings and interpretations. Under the presence of ambiguity it is not clear what problem is to be solved, who should be involved in the decision processes or what is an appropriate course of action. Despite the extensive literature about methodologies and tools to deal with uncertainty, not much has been said about how to handle ambiguities. In this paper, we discuss the notions of framing and ambiguity, and we identify five broad strategies to handle it: rational problem solving, persuasion, dialogical learning, negotiation and opposition. We compare these approaches in terms of their assumptions, mechanisms and outcomes and illustrate each approach with a number of concrete methods.

Viscoelastic haemostatic assay augmented protocols for major trauma haemorrhage (ITACTIC): a randomized, controlled trial.

PURPOSE: Contemporary trauma resuscitation prioritizes control of bleeding and uses major haemorrhage protocols (MHPs) to prevent and treat coagulopathy. We aimed to determine whether augmenting MHPs with Viscoelastic Haemostatic Assays (VHA) would improve outcomes compared to Conventional Coagulation Tests (CCTs). METHODS: This was a multi-centre, randomized controlled trial comparing outcomes in trauma patients who received empiric MHPs, augmented by either VHA or CCT-guided interventions. Primary outcome was the proportion of subjects who, at 24 h after injury, were alive and free of massive transfusion (10 or more red cell transfusions). Secondary outcomes included 28-day mortality. Pre-specified subgroups included patients with severe traumatic brain injury (TBI). RESULTS: Of 396 patients in the intention to treat analysis, 201 were allocated to VHA and 195 to CCT-guided therapy. At 24 h, there was no difference in the proportion of patients who were alive and free of massive transfusion (VHA: 67%, CCT: 64%, OR 1.15, 95% CI 0.76-1.73). 28-day mortality was not different overall (VHA: 25%, CCT: 28%, OR 0.84, 95% CI 0.54-1.31), nor were there differences in other secondary outcomes or serious adverse events. In pre-specified subgroups, there were no differences in primary outcomes. In the pre-specified subgroup of 74 patients with TBI, 64% were alive and free of massive transfusion at 24 h compared to 46% in the CCT arm (OR 2.12, 95% CI 0.84-5.34). CONCLUSION: There was no difference in overall outcomes between VHA- and CCT-augmented-major haemorrhage protocols.

Design of a 20-month comprehensive, multicomponent school-based randomised trial to promote healthy weight development among 11-13 year olds: The HEalth In Adolescents study.

BACKGROUND AND PURPOSE: The lack of effective school-based interventions for preventing obesity in children has caused a call for longer duration of interventions and better reporting on design and evaluation methodology. The purpose of this paper is to present the development of the intervention, the design of the effectiveness study, and the test-retest reliability of the main outcome measures in the HEalth In Adolescents (HEIA) study. METHODS/DESIGN: The HEIA intervention programme was developed based on literature reviews, a social ecological framework, and focus groups. The intervention aimed to increase total physical activity (PA) and consumption of fruit and vegetables and to decrease screen time and consumption of sugar-sweetened beverages. The intervention programme consisted of a classroom component, including dietary behaviour lessons, computer tailoring, fruit/vegetable and PA breaks, and posters, and an environmental component including active transport campaigns, equipment, suggestions for easy improvements of schoolyards, inspirational courses for teachers (all with regards to PA), and fact sheets to parents. The effect of the intervention programme is evaluated in a cluster randomised controlled trial design (intervention = 12 schools, control = 25 schools) including process evaluation. Main outcomes include anthropometry, PA, screen time, and consumption of fruit, vegetables, and sugar-sweetened beverages. A 2-week test- retest study was conducted among 114 pupils. Determinants of the behaviours were assessed. Similar data were collected from parents. Children's PA was measured objectively by accelerometers. CONCLUSIONS: The HEIA study represents a theoretically informed randomised trial comprising a comprehensive set of multilevel intervention components with a thorough evaluation using reliable outcome measures. The study will contribute to a better understanding of determinants of healthy weight development among young people and how such determinants can be modified.

Understanding the impacts of groundwater abstraction through long-term trends in water quality.

It is vital to understand long-term trends in water quality parameters when assessing the sustainability of groundwater abstraction. Withdrawal-to-availability analysis is still used widely in groundwater management considering quantities and utilization rates based on in- and outflows. In this study, we took a step further than the water balance approach and carried out a detailed investigation of trends in long-term time series of groundwater quality, in order to analyze the sustainability of groundwater abstraction. We assessed trends, links, and patterns in abstraction, potentiometric surface, and water quality parameters for 28 well fields around Copenhagen, Denmark. Groundwater monitoring data from 1900 until 2014 were investigated for each well field. During this period, the well fields experienced a 2-14 m decrease in the nearby potentiometric surface compared to the first-or pre-pumping-potentiometric surface recordings. Sulfate concentrations increased in 25 out of 27 well fields after the maximum abstraction period, compared to the earliest water quality measurements. The results indicate that in the 1980s, when water consumption (abstraction) and drawdown were at their highest, water abstraction caused a steady increase in sulfate and calcium, which we consider unsustainable. In contradiction, the abstraction in 24 well fields show almost steady sulfate levels in the aquifer after decreased water consumption since 1995. Only four well fields showed more than a 20 mg/L increase in sulfate concentration, which indicates that the recent abstraction does not interfere with sulfate levels in the aquifer. Our method and results show how long-term water quality trends can support the management of aquifer exploitation and evaluate sustainability on the well field scale.

Decay kinetics of O2.- studied by direct spectrophotometry. Interaction with catalytic and non-catalytic substances.

The kinetic behaviour of O2.- during spontaneous dismutation and in the presence of Cu,Zn-superoxide dismutase and other compounds, was studied by monitoring the decrease in absorbance (A250nm-A360nm) on a time-scale of > or = 1 min, at pH 9.5. O2.- was generated from KO2, and calculations were performed between 25 and 4 microM of O2.-. An algorithm for the simultaneous calculation of the 1st and 2nd-order rate constants from the decay curve, was evolved. The respective fractions of O2.- which interacted with catalysts or disappeared spontaneously, in various experimental situations, could be estimated. Substances could be classified as inert, catalysts or scavengers. The high assay pH excluded examination of the effect of alkali sensitive substances, e.g., Mn-superoxide dismutase. However, the high pH minimized the interfering effect of trace amounts of Cu(II). Therefore a metal chelator was superfluous and even the effect of metals and metal complexes could be tested. The extremely high sensitivity of the method allowed minute concentrations of reagents to be used, including proteins absorbing in the UV-region. The rate constants found by this simple method, agreed with those obtained by more sophisticated and inaccessible techniques like pulse radiolysis and stopped-flow spectrophotometry.

Pain causes in 200 patients referred to a multidisciplinary cancer pain clinic.

Causes of pain were analysed in 200 patients referred to a specialized cancer pain clinic. Pain caused by tumour growth was found in 158 patients, pain secondary to cancer or its treatment in 116 patients and pain unrelated to cancer in 33 patients. Visceral involvement (74 cases), bone metastases (68 cases), soft tissue invasion (56 cases) and nerve/plexus pressure or infiltration (39 cases) were the most frequent causes of pain due to tumour growth. Myogenic pain (68 cases) was the most frequent cause of secondary pain. The patients presented with a multitude of different combinations of causes of pain, the majority having at least two separate causes. Since pain treatment in cancer patients should be determined by its aetiology, a detailed analysis of the pain condition in each patient should form the basis for a rational therapy.

Placenta percreta--two cases and review of the literature.

Two cases of placenta pecreta confirmed histologically were treated conservatively with retention of the uterus. Both later went on to have successful pregnancies.

The influence of geological factors on indoor radon concentrations in Norway.

Indoor radon levels in 1618 Norwegian dwellings located in different geological settings are compared with geological information. The results show a significant correlation between indoor radon levels and geological factors. Radium content and permeability of the building ground have been found to be useful indicators of indoor radon concentrations. Based on easily accessible geological data, an assessment of the radon potential of an area can be given. Areas of high radon risk in Norway include: (a) exposed bedrock with elevated levels of radium; and (b) highly permeable unconsolidated sediments derived from all rock types and moderately permeable sediments derived from rock types rich in radium. A comparison of indoor radon with house construction characteristics and ventilation habits suggests that radon concentrations in Norwegian dwellings are also influenced by ventilation system, aeration habits and floor level of the room where the measurements were carried out. The significant correlation between indoor radon levels and geological factors observed in the present investigation indicates that it is possible to outline areas of high radon risk in Norway based on geological information.

Bilateral ovarian lipid cell hyperplasia in a young hirsute patient.

Virilizing lipid cell ovarian hyperplasia occurred in a 24-year-old woman referred with secondary amenorrhea, hirsutism, and weight gain. Hormone analyses revealed abnormal androgen production shown in a suppression test to be autonomic and of ovarian origin. Ovarian vein catheterization revealed abnormally increased androgen levels in the left ovarian vein and in the caval vein where it was entered by the right ovarian vein. As the patient wanted to become pregnant, three-quarters of her ovarian tissue was resected. Menstruation and ovulation returned. Two years after the operation the patient conceived. Histopathological and electron microscopic examinations revealed bilateral lipid cell hyperplasia.

[Intrauterine contraception (IUD) and uterine perforation]. / Intrauterint placeret kontraception (IUD) og uterusperforation.

PIP: Perforation of the uterus was reported in 6 IUD users. In only 1 case was there definite indications of perforation. It is important to determine the position and size of the uterus before IUD insertion. Menostasis due to pregnancy is often the first symptom of IUD perforation. The position of the IUD can be determined by X-ray or ultrasonic examinations on 2 planes, supplemented by hysterosalpingography. If the IUD is in an extrauteral position, it should be removed to avoid possible complications.^ieng

[Extrauterine pregnancy and intrauterine contraception]. / Ekstrauterin graviditet og intrauterin antikonception.

PIP: Of a group of 93 cases of extrauterine pregnancy, 10 women, aged 20-40, had IUDs at the point of conception. None of these patients had had an ectopic pregnancy before. 6 of the women had copper IUDs. Although none of the patients had had IUD related symptoms before, the pain and bleeding which occurred were diagnosed in most cases as IUD side effects. All patients eventually underwent unilateral salpingectomy. As side effects of IUD use can also be symptoms of ectopic pregnancy, care must be taken in diagnosis.^ieng

[Pelvic inflammation associated with the use of an intrauterine device]. / Baekkeninflammation i forbindelse med anvendelse af intrauterin kontraception.

PIP: Of 381 patients who were treated for pelvic inflammations over a 2 year period, 102 were IUD users. Slight inflammations were diagnosed in 84 of the IUD users; 18 patients had serious inflammation with unilateral abscess formation. 3 patients were operated on for actue perforation peritonitis.^ieng

[High-dose epidural opioid treatment of malignant pain]. / Højdosis epidural opioidbehandling af maligne smerter.

A retrospective investigation was undertaken of 48 cancer patients receiving long-term treatment with high dosages of epidural opioids. Prior to introduction of the epidural catheter, the patients were in stable oral opioid treatment (median dose: 300 mg morphine/24 hours, range 40-1,360). The effect of stable epidural opioid treatment (median dose: 90 mg morphine/24 hours, range 16-600) in the first catheter was assessed as good in 20, reasonable in 14 and poor in 13. The effect could not be assessed in one patient. Twenty-nine patients could be assessed on pure and stable epidural opioid treatment. The effect was good in 14, reasonable in seven and poor in eight. If the patients were subdivided according to the type of pain, 16 had somatic and/or visceral types of pain while 13 had neurogenic pain. Epidural opioid treatment of neurogenic pain was found to produce statistically significantly poorer results than in the case of somatic/visceral pain (p less than 0.05). At the time of assessment, no statistically significant difference was present in the epidural opioid dosage between the groups. The patients were subdivided into a low dosage group and a high dosage group. The low dosage group comprised patients who had received oral opioid treatment with less than 300 mg morphine/24 hours and the high dosage group comprised patients who received equal or greater than 300 mg morphine/24 hours. Epidural opioid treatment was found to provide statistically significantly better results in the low dosage group (p less than 0.05). In this group, a tendency to better relief of neurogenic pain was observed as compared with the high dosage group. At the time of assessment, no statistically significant difference was present in the epidural opioid dosage between the high dosage and low dosage groups.(ABSTRACT TRUNCATED AT 250 WORDS)

[Causes of pain and treatment effect in patients with cancer referred to a multidisciplinary pain clinic]. / Smerteårsager og behandlingseffekt hos cancerpatienter henvist til en tvaerfaglig smerteklinik.

The causes of pain were analysed in 200 patients referred to a multidisciplinary pain clinic for cancer patients. In 158 patients, pain caused directly by tumour growth was found, 116 patients had pain secondary to the cancer disease or treatment while 33 patients had pain caused by factors unrelated to the cancer disease. The patients had many different combinations of causes of pain and the majority had more than one cause of pain. At the first contact and after treatment for 1-2 weeks, the patients were asked whether they had pain on movement, at rest or pain which interrupted sleep. After treatment for 1-2 weeks and after treatment for more than two weeks, the patients assessed the relief of pain obtained (none, slight, moderate, considerable, complete). The majority of patients achieved relief of pain at rest and during sleep while movement was still accompanied by pain in a number of patients. The majority of patients considered that the relief of pain obtained was moderate or considerable. Treatment consisted of adjustment of medication, blockades and epidural opioids supplemented by psychological intervention and help from social workers in selected patients.

[Distress symptoms in hospice patients]. / Belastende symptomer hos patienter i hospice.

A number of symptoms cause physical or mental distress and suffering in the terminal and dying patient. In this prospective study of 117 patients (96% with a cancer diagnosis) in a Danish hospice all symptoms causing distress were assessed daily in three degrees of severity. The ten most frequently recorded symptoms were: fatigue, pain, weakness, dyspnoea, immobility/paresis, anorexia, general malaise, nausea/vomiting, oedema and amnesia. Fatigue was registered on 60.9% of the admission days, pain on 27.3%, dyspnoea on 19.2% and nausea/vomiting on 8.5%. The prevalence of pain, dyspnoea, nausea/vomiting, thirst and anxiety did not increase during the last seven days of life. Unconsciousness occurred in 23% of the patients during the last 24 hours and in 5% on the day before.