How digital health documentation transforms professional practices in primary healthcare in Denmark: A WPR document analysis.

Historically, recordkeeping has been an essential task for health professionals. Today, this mandatory task increasingly takes place as digital documentation. This study critically examines problem constructions in practical documents on digital documentation strategies in Danish municipal healthcare and how these problem constructions imply particular solutions. A document analysis based on the approach presented in Bacchi's "What's the problem represented to be?" was applied. Forty practical documents in the form of guidelines, strategies, and quality control documents were included. The analysis uncovered three problem representations: lack of coherence between health services in a complex healthcare system, lack of assessable data for management and political prioritization, and inefficiency in the healthcare system. The proposed solution is a digitalized and standardized practice that transforms recordkeeping in the municipalities. However, municipal healthcare is at risk of being fragmented due to digital documentation's focus on the organizational management of health with task-oriented practices supplied by an anonymous health professional. We find that digital documentation functions as an organizational micromanagement approach that assigns the health professional a subject position as an employee acting according to the organization's framework rather than the profession's normative framework.

Action research as a catalyst for change: Empowered nurses facilitating patient participation in rehabilitation.

Based on action research as a practitioner-involving approach, this article communicates the findings of a two-year study on implementing patient participation as an empowering learning process for both patients and rehabilitation nurses. At a rehabilitation facility for patients who have sustained spinal cord injuries, eight nurses were engaged throughout the process aiming at improving patient participation. The current practice was explored to understand possibilities and obstacles to patient participation. Observations, interviews and logbooks, creative workshops and reflective meetings led to the development and testing of four new rehabilitation initiatives aimed at enhancing patient participation. This study suggests that skills of critical reflection from action research toolbox shed light on both the notion of patient participation and caring in nursing rehabilitation. By actively involving nurses in research, the knowledge development stems from practice and the solutions therefore became practice-oriented. In addition, the personal and professional development experienced by the involved nurses points to a secondary gain in the form of an analytical and reflective approach to complex issues in relation to patient participation, rehabilitation in general and the individual nurses' sense of professional pride.

Ephrin-A1-EphA4 signaling negatively regulates myelination in the central nervous system.

During development of the central nervous system not all axons are myelinated, and axons may have distinct myelination patterns. Furthermore, the number of myelin sheaths formed by each oligodendrocyte is highly variable. However, our current knowledge about the axo-glia communication that regulates the formation of myelin sheaths spatially and temporally is limited. By using axon-mimicking microfibers and a zebrafish model system, we show that axonal ephrin-A1 inhibits myelination. Ephrin-A1 interacts with EphA4 to activate the ephexin1-RhoA-Rock-myosin 2 signaling cascade and causes inhibition of oligodendrocyte process extension. Both in myelinating co-cultures and in zebrafish larvae, activation of EphA4 decreases myelination, whereas myelination is increased by inhibition of EphA4 signaling at different levels of the pathway, or by receptor knockdown. Mechanistically, the enhanced myelination is a result of a higher number of myelin sheaths formed by each oligodendrocyte, not an increased number of mature cells. Thus, we have identified EphA4 and ephrin-A1 as novel negative regulators of myelination. Our data suggest that activation of an EphA4-RhoA pathway in oligodendrocytes by axonal ephrin-A1 inhibits stable axo-glia interaction required for generating a myelin sheath.

Developing a Newborn Resuscitation Telemedicine Program: A Comparison of Two Technologies.

BACKGROUND: Early work has demonstrated the feasibility and acceptance of newborn resuscitation telemedicine programs (NRTPs). The technology requirements for providing this type of emergency telemedicine service are unclear. INTRODUCTION: We hypothesized that during NRTP consults, a wired telemedicine cart would provide a more reliable and higher-quality user experience than a consumer-grade wireless tablet. MATERIALS AND METHODS: In this retrospective observational study, six spoke sites used consumer-grade wireless tablets during preintervention and wired coder/decoder (CODEC)-based telemedicine carts during postintervention. Both technologies used the same videoconferencing software. After the telemedicine consult, providers completed surveys assessing connection reliability, user satisfaction, and audio and video quality using a 1-5 Likert scale. RESULTS: Preintervention, users completed 99 consults and 95 surveys. Postintervention, users completed 73 consults and 192 surveys. Successful connection on first attempt was significantly improved with the wired cart compared with the wireless tablet (82.7% vs. 69.5%, p = 0.01), and the percentage of consults complicated by an unplanned disconnection was reduced (6.4% vs. 14.7%, p = 0.02). User satisfaction and video and audio quality ratings were significantly higher for the wired cart. DISCUSSION: The wired telemedicine cart increased connection reliability, which is important given the critical nature and long duration of NRTP consults. Audio-video quality was also improved, allowing for better visualization of the neonate and communication with the care team. CONCLUSIONS: Consumer-grade wireless tablets did not meet the program's technical requirements. Wired telemedicine carts improved reliability, user satisfaction, and audio-video quality. Wired carts may not fully meet NRTP requirements because of cart size and limited mobility.

Transport and translation of MBP mRNA is regulated differently by distinct hnRNP proteins.

In the developing nervous system, abundant synthesis of myelin basic protein (MBP) in oligodendrocytes is required for the formation of compact myelin sheaths around axons. The MBP mRNA is known to be transported into the processes of oligodendrocytes. However, knowledge of the regulatory mechanisms that ensure the tight temporal and spatial control of MBP translation within these processes is limited. Here, we have identified novel regions within the 3'-UTR of the MBP mRNA that are responsible for the regulation of its translation, and we have demonstrated that each of the mRNA-binding proteins heterogeneous nuclear ribonucleoprotein (hnRNP)-A2, hnRNP-K and hnRNP-E1 serve distinct functions to regulate controlled and localized protein synthesis. hnRNP-A2 is responsible for mRNA transport, not for translational inhibition. By contrast, hnRNP-K and hnRNP-E1 play opposing roles in the translational regulation of MBP mRNA. We have identified shared binding sites within the 3'-UTR, and show that translation is promoted by the exchange of inhibitory hnRNP-E1 for stimulatory hnRNP-K. We further show that this molecular switch in the MBP messenger RNA-ribonucleoprotein (mRNP) complex, which regulates the synthesis of MBP, is important for the normal growth and extension of myelin sheets.

A single topical dose of erythropoietin applied on a collagen carrier enhances calvarial bone healing in pigs.

BACKGROUND AND PURPOSE: The osteogenic potency of erythropoietin (EPO) has been documented. However, its efficacy in a large-animal model has not yet been investigated; nor has a clinically safe dosage. The purpose of this study was to overcome such limitations of previous studies and thereby pave the way for possible clinical application. Our hypothesis was that EPO increases calvarial bone healing compared to a saline control in the same subject. METHODS: We used a porcine calvarial defect model. In each of 18 pigs, 6 cylindrical defects (diameter: 1 cm; height: 1 cm) were drilled, allowing 3 pairwise comparisons. Treatment consisted of either 900 IU/mL EPO or an equal volume of saline in combination with either autograft, a collagen carrier, or a polycaprolactone (PCL) scaffold. After an observation time of 5 weeks, the primary outcome (bone volume fraction (BV/TV)) was assessed with high-resolution quantitative computed tomography. Secondary outcome measures were histomorphometry and blood samples. RESULTS: The median BV/TV ratio of the EPO-treated collagen group was 1.06 (CI: 1.02-1.11) relative to the saline-treated collagen group. Histomorphometry showed a similar median effect size, but it did not reach statistical significance. Autograft treatment had excellent healing potential and was able to completely regenerate the bone defect independently of EPO treatment. Bony ingrowth into the PCL scaffold was sparse, both with and without EPO. Neither a substantial systemic effect nor adverse events were observed. The number of blood vessels was similar in EPO-treated defects and saline-treated defects. INTERPRETATION: Topical administration of EPO on a collagen carrier moderately increased bone healing. The dosing regime was safe, and could have possible application in the clinical setting. However, in order to increase the clinical relevance, a more potent but still clinically safe dose should be investigated.

A case report of atypical anti-glomerular basement membrane nephritis associated with Mycobacterium Avium.

We present the case of a woman with atypical anti-glomerular basement membrane (anti-GBM) nephritis associated with concurrent pulmonary infection with Mycobacterium avium. A kidney biopsy showed crescentic glomerulonephritis with 50% active crescents and linear IgG staining, but no circulating anti-GBM antibodies were detected, and the patient did not have pulmonary hemorrhage. Despite treatment with a triple-regimen of antibiotics, corticosteroids, and plasmapheresis, the patient did not regain kidney function. One year later she is on maintenance dialysis and has still not cleared the infection with M. avium.

Feasibility of app-based home monitoring after abdominal surgery: A systematic review.

BACKGROUND: Abdominal surgery presents great challenges postoperatively. Considering financial healthcare constraints, the use of mobile applications has received increased interest. This systematic review was conducted to assess and report the feasibility of app-based home monitoring after abdominal surgery. METHODS: MEDLINE, EMBASE, and The Cochrane Library were searched on the October 17, 2023. This systematic review was conducted in accordance with the PRISMA guidelines. RESULTS: Thirty-six articles were included, 17 of these originating from USA or Canada. The response rate varied between 11.9 â€‹% and 100 â€‹%. Bariatric, upper gastrointestinal, and colorectal surgery reported the highest response rates. All included studies had a degree of bias. CONCLUSION: This study found varying response rates. The data indicated that the response rates were high within bariatric surgery, with additional factors potentially affecting this. The degree of bias was generally high, and the quality of the included studies limits the conclusions.

Fragmented care trajectories in municipal healthcare: Local sensemaking of digital documentation.

Objective: Since the 1990s, almost all healthcare organisations have had electronic health records (EHR) to organise and manage treatment, care and work routines. This article aims to understand how healthcare professionals (HCPs) make sense of digital documentation practice. Methods: Based on a case study design, field observations and semi-structured interviews were conducted in a Danish municipality. A systematic analysis based on Karl Weick's sensemaking theory was applied to investigate what cues HCPs extract from timetables in the EHR and how institutional logics frame the enactment of documentation practice. Results: The analysis uncovered three themes: making sense of planning, making sense of tasks and making sense of documentation. The themes illustrate that HCPs make sense of the digital documentation practice as a dominant managerial tool designed to control resources and work routines. This sensemaking leads to a task-oriented practice which centres on delivering fragmented tasks according to a timetable. Conclusion: HCPs mitigate fragmentation by responding to a care professional logic, where they document to share information and carry out invisible work outside of timetables and scheduled tasks. However, HCPs are focused on solving specific tasks by the minute with the possible consequence that continuity and their overview of the service user's care and treatment disappear. In conclusion, the EHR system eliminates a holistic view of care trajectories, leaving it up to HCPs to collaborate in an effort to obtain continuity for the service user.

Design of a randomized controlled trial of a web-based intervention to reduce cardiovascular disease risk factors among remote reservation-dwelling American Indian adults with type 2 diabetes.

We describe a randomized controlled trial, the Lakota Oyate Wicozani Pi Kte (LOWPK) trial, which was designed to determine whether a Web-based diabetes and nutritional intervention can improve risk factors related to cardiovascular disease (CVD) among a group of remote reservation-dwelling adult American Indian men and women with type 2 diabetes who are at high risk for CVD. Enrollment on a rolling basis of 180 planned participants began during 2009; an average 18-month follow-up was completed by June 2011. The primary outcome variable is change in glycosylated hemoglobin level after an average 18-month follow-up period. Secondary outcome variables include changes in low-density lipoprotein cholesterol, systolic blood pressure, body mass index, and smoking status, as well as an evaluation of intervention cost-effectiveness. If effective, the LOWPK trial may serve as a guide for future chronic disease intervention trials in remote, technologically challenged settings.

Medicine donation programmes supporting the global drive to end the burden of neglected tropical diseases.

Neglected tropical diseases (NTDs) are targeted for global control or elimination. Recognising that the populations most in need of medicines to target NTDs are those least able to support and sustain them financially, the pharmaceutical industry created mechanisms for donating medicines and expertise to affected countries through partnerships with the WHO, development agencies, non-governmental organisations and philanthropic donors. In the last 30 y, companies have established programmes to donate 17 different medicines to overcome the burden of NTDs. Billions of tablets, capsules, intravenous and oral solutions have been donated, along with the manufacturing, supply chains and research necessary to support these efforts. Industry engagement has stimulated other donors to support NTDs with funds and oversight so that the 'heath benefit' return on investment in these programmes is truly a 'best value in public health'. Many current donations are 'open-ended', promising support as long as necessary to achieve defined health targets. Extraordinary global health advances have been made in filariasis, onchocerciasis, trachoma, trypanosomiasis, leishmaniasis, schistosomiasis, intestinal parasites and others; and these advances are taking place in the context of strengthening health systems and meeting the global development goals espoused by the WHO. The pharmaceutical manufacturers, already strong collaborators in initiating or supporting these disease-targeted programmes, have committed to continuing their partnership roles in striving to meet the targets of the WHO's new NTD roadmap to 2030.

Evolutionary history of the extinct Sardinian dhole.

The Sardinian dhole (Cynotherium sardous)1 was an iconic and unique canid species that was endemic to Sardinia and Corsica until it became extinct at the end of the Late Pleistocene.2-5 Given its peculiar dental morphology, small body size, and high level of endemism, several extant canids have been proposed as possible relatives of the Sardinian dhole, including the Asian dhole and African hunting dog ancestor.3,6-9 Morphometric analyses3,6,8-12 have failed to clarify the evolutionary relationship with other canids.We sequenced the genome of a ca-21,100-year-old Sardinian dhole in order to understand its genomic history and clarify its phylogenetic position. We found that it represents a separate taxon from all other living canids from Eurasia, Africa, and North America, and that the Sardinian dhole lineage diverged from the Asian dhole ca 885 ka. We additionally detected historical gene flow between the Sardinian and Asian dhole lineages, which ended approximately 500-300 ka, when the land bridge between Sardinia and mainland Italy was already broken, severing their population connectivity. Our sample showed low genome-wide diversity compared to other extant canids-probably a result of the long-term isolation-that could have contributed to the subsequent extinction of the Sardinian dhole.

Comparison of natural humic substances and synthetic ethylenediaminetetraacetic acid and nitrilotriacetic acid as washing agents of a heavy metal-polluted soil.

Ethylenediaminetetraacetic acid (EDTA), nitrilotriacetic acid (NTA), and other synthetic polycarboxylic acids have been shown to possess substantial capacity as washing agents of heavy metal-polluted soils, but they are environmentally problematic. Therefore, a sample of natural soluble humic substances (HS) was tested as a possible substitute. The efficiency of HS to extract cadmium (Cd), copper (Cu), and lead (Pb) from a strongly polluted calcareous urban soil was compared with that of EDTA and NTA. The influence of extractant concentration (25-100 mmol L(-1) C), solution/soil ratio (5-100 L kg(-1)), and single-step vs. multistep extraction on heavy metal removal from the soil was investigated. The extracted pools were assessed by sequential extraction. Ethylenediaminetetraacetic acid and NTA extracted up to 86, 77, and 30% of total soil Cd, Cu, and Pb, respectively, whereas HS extracted 44, 53, and 4%. Extracted amounts of Cd, Cu, and Pb increased with increasing extractant concentration and solution/soil ratio in the range 5 to 100 L kg(-1). Single-step extraction removed about the same amounts of the three metals as multiple-step extraction. The metal-extracted pools of the soil depended on the metal and on the extractant. The overall conclusion is that soluble HS can replace synthetic EDTA and NTA as washing agents for Cd- and Cu-polluted soils, whereas HS is not a promising substitute of EDTA or NTA for cleaning Pb-polluted, calcareous soils.

The 3'UTRs of Myelin Basic Protein mRNAs Regulate Transport, Local Translation and Sensitivity to Neuronal Activity in Zebrafish.

Formation of functional myelin sheaths within the central nervous system depends on expression of myelin basic protein (MBP). Following process extension and wrapping around axonal segments, this highly basic protein is required for compaction of the multi-layered membrane sheath produced by oligodendrocytes. MBP is hypothesized to be targeted to the membrane sheath by mRNA transport and local translation, which ensures that its expression is temporally and spatially restricted. The mechanistic details of how this might be regulated are still largely unknown, in particular because a model system that allows this process to be studied in vivo is lacking. We here show that the expression of the zebrafish MBP orthologs, mbpa and mbpb, is developmentally regulated, and that expression of specific mbpa isoforms is restricted to the peripheral nervous system. By analysis of transgenic zebrafish, which express a fluorescent reporter protein specifically in myelinating oligodendrocytes, we demonstrate that both mbpa and mbpb include a 3'UTR sequence, by which mRNA transport and translation is regulated in vivo. Further functional analysis suggests that: (1) the 3'UTRs delay the onset of protein expression; and that (2) several regulatory elements contribute to targeting of the mbp mRNA to the myelin sheath. Finally, we show that a pharmacological compound known to enhance neuronal activity stimulates the translation of Mbp in zebrafish in a 3'UTR-dependent manner. A similar effect was obtained following stimulation with a TrkB receptor agonist, and cell-based assays further confirmed that the receptor ligand, BDNF, in combination with other signals reversed the inhibitory effect of the 3'UTR on translation.

Chemical fingerprinting of hydrocarbon-contamination in soil.

Chemical fingerprinting analyses of 29 hydrocarbon-contaminated soils were performed to assess the soil quality and determine the main contaminant sources. The results were compared to an assessment based on concentrations of the 16 priority polycyclic aromatic hydrocarbons pointed out by the U.S. Environmental Protection Agency (EPAPAH16) and total petroleum hydrocarbon (TPH). The chemical fingerprinting strategy proposed in this study included four tiers: (i) qualitative analysis of GC-FID chromatograms, (ii) comparison of the chemical composition of both un-substituted and alkyl-substituted polycyclic aromatic compounds (PACs), (iii) diagnostic ratios of selected PACs, and (iv) multivariate data analysis of sum-normalized PAC concentrations. The assessment criteria included quantitative analysis of 19 PACs and C1-C4 alkyl-substituted homologues of naphthalene, fluorene, dibenzothiophene, phenanthrene, pyrene, and chrysene; and 13 oxygenated polycyclic aromatic compounds (O-PACs). The chemical composition of un-substituted and alkyl-substituted PACs and visual interpretation of GC-FID chromatograms were in combination successful in differentiating pyrogenic and petrogenic hydrocarbon sources and in assessing weathering trends of hydrocarbon contamination in the soils. Multivariate data analysis of sum-normalized concentrations could as a stand-alone tool distinguish between hydrocarbon sources of petrogenic and pyrogenic origin, differentiate within petrogenic sources, and detect weathering trends. Diagnostic ratios of PACs were not successful for source identification of the heavily weathered hydrocarbon sources in the soils. The fingerprinting of contaminated soils revealed an underestimation of PACs in petrogenic contaminated soils when the assessment was based solely on EPAPAH16. As alkyl-substituted PACs are dominant in petrogenic sources, the evaluation of the total load of PACs based on EPAPAH16 was not representative. Likewise, the O-PACs are not represented in soil quality assessments based on EPAPAH16 and TPH. The ∑O-PACs ranged between

Depressive symptom experiences among older women: a comparison of alternative measurement approaches.

Age differences in depressive symptom experiences were investigated in a community sample of women (N = 287, ages 55-95 years). The purpose of the analysis was to compare the age-depression relation using 3 different measurement approaches: (a) a standard screening scale, (b) a clinical diagnostic, and (c) a latent variable measurement approach. The analysis, which uses structural equation modeling procedures, extends earlier confirmatory factor analyses of the Symptom Checklist-90--Revised Depression and Additional Symptoms scales conducted by Newmann, Engel, & Jensen (1990, 1991a, 1991b). Findings show that each measurement approach leads to different conclusions about the age-depression relation, with only the latent variable measurement showing a significant increase in depressive symptoms with advancing age. Implications of these findings for future research on aging depression are discussed.

Sleep-wake transition in narcolepsy and healthy controls using a support vector machine.

Narcolepsy is characterized by abnormal sleep-wake regulation, causing sleep episodes during the day and nocturnal sleep disruptions. The transitions between sleep and wakefulness can be identified by manual scorings of a polysomnographic recording. The aim of this study was to develop an automatic classifier capable of separating sleep epochs from epochs of wakefulness by using EEG measurements from one channel. Features from frequency bands α (0-4 Hz), ß (4-8 Hz), δ (8-12 Hz), θ (12-16 Hz), 16 to 24 Hz, 24 to 32 Hz, 32 to 40 Hz, and 40 to 48 Hz were extracted from data by use of a wavelet packet transformation and were given as input to a support vector machine classifier. The classification algorithm was assessed by hold-out validation and 10-fold cross-validation. The data used to validate the classifier were derived from polysomnographic recordings of 47 narcoleptic patients (33 with cataplexy and 14 without cataplexy) and 15 healthy controls. Compared with manual scorings, an accuracy of 90% was achieved in the hold-out validation, and the area under the receiver operating characteristic curve was 95%. Sensitivity and specificity were 90% and 88%, respectively. The 10-fold cross-validation procedure yielded an accuracy of 88%, an area under the receiver operating characteristic curve of 92%, a sensitivity of 87%, and a specificity of 87%. Narcolepsy with cataplexy patients experienced significantly more sleep-wake transitions during night than did narcolepsy without cataplexy patients (P = 0.0199) and healthy subjects (P = 0.0265). In addition, the sleep-wake transitions were elevated in hypocretin-deficient patients. It is concluded that the classifier shows high validity for identifying the sleep-wake transition. Narcolepsy with cataplexy patients have more sleep-wake transitions during night, suggesting instability in the sleep-wake regulatory system.

The potential of willow for remediation of heavy metal polluted calcareous urban soils.

Growth performance and heavy metal uptake by willow (Salix viminalis) from strongly and moderately polluted calcareous soils were investigated in field and growth chamber trials to assess the suitability of willow for phytoremediation. Field uptakes were 2-10 times higher than growth chamber uptakes. Despite high concentrations of cadmium (>/=80 mg/kg) and zinc (>/=3000 mg/kg) in leaves of willow grown on strongly polluted soil with up to 18 mgCd/kg, 1400 mgCu/kg, 500 mgPb/kg and 3300 mgZn/kg, it is unsuited on strongly polluted soils because of poor growth. However, willow proved promising on moderately polluted soils (2.5 mgCd/kg and 400 mgZn/kg), where it extracted 0.13% of total Cd and 0.29% of the total Zn per year probably representing the most mobile fraction. Cu and Pb are strongly fixed in calcareous soils.