Increased use of computed tomography in Denmark: stage shift toward early stage lung cancer through incidental findings.

BACKGROUND: Computed tomography (CT) examinations are increasingly used worldwide and incidental findings are growing likewise. Lung cancer stage at diagnosis is pivotal to survival. The earliest stage of lung cancer, stage IA is in most cases asymptomatic. Potentially, increased use of clinical CTs could induce a stage shift toward earlier lung cancer diagnosis. MATERIALS AND METHODS: Data on the number of CT thorax in Denmark and the stage distribution of Danish lung cancer patients 2013-2020 were acquired from, respectively, the Danish Health Data Authority and the Danish Lung Cancer Registry. Clinical auditing of stage IA lung cancer patients was performed in the period 2019-2021 in a Danish region to assess the reasons for referral. Auditing of stage IV lung cancer patients was done to see whether a CT thorax was performed in a two-year period before diagnosis. RESULTS: All regions showed an increase in CTs per 1000 inhabitants. However, the number of CTs performed in 2013 differed by more than 50% among regions, and the increase per year also differed, from an increase of 1.9 to 3.4 more examinations per year. A significant correlation between CTs and fraction of stage IA lung cancers was seen in four out of the five regions. The audit of stage IA lung cancer cases revealed that 86.8% were incidental findings. Audit of stage IV lung cancer found that 4.3% had a nodule/infiltrate on a previous CT within a 2-year period prior to the diagnosis of lung cancer that was the probable origin of stage IV lung cancer. CONCLUSION: The study found that the vast majority of early-stage lung cancers were incidental findings. It highlights that follow-up algorithms of incidental findings should be used in accordance with guidelines and it should be unequivocally how the CT follow-up of pulmonary infiltrates is managed.

Strong and deep Atlantic meridional overturning circulation during the last glacial cycle.

Extreme, abrupt Northern Hemisphere climate oscillations during the last glacial cycle (140,000 years ago to present) were modulated by changes in ocean circulation and atmospheric forcing. However, the variability of the Atlantic meridional overturning circulation (AMOC), which has a role in controlling heat transport from low to high latitudes and in ocean CO2 storage, is still poorly constrained beyond the Last Glacial Maximum. Here we show that a deep and vigorous overturning circulation mode has persisted for most of the last glacial cycle, dominating ocean circulation in the Atlantic, whereas a shallower glacial mode with southern-sourced waters filling the deep western North Atlantic prevailed during glacial maxima. Our results are based on a reconstruction of both the strength and the direction of the AMOC during the last glacial cycle from a highly resolved marine sedimentary record in the deep western North Atlantic. Parallel measurements of two independent chemical water tracers (the isotope ratios of (231)Pa/(230)Th and (143)Nd/(144)Nd), which are not directly affected by changes in the global cycle, reveal consistent responses of the AMOC during the last two glacial terminations. Any significant deviations from this configuration, resulting in slowdowns of the AMOC, were restricted to centennial-scale excursions during catastrophic iceberg discharges of the Heinrich stadials. Severe and multicentennial weakening of North Atlantic Deep Water formation occurred only during Heinrich stadials close to glacial maxima with increased ice coverage, probably as a result of increased fresh-water input. In contrast, the AMOC was relatively insensitive to submillennial meltwater pulses during warmer climate states, and an active AMOC prevailed during Dansgaard-Oeschger interstadials (Greenland warm periods).

Current-induced membrane discharge.

Possible mechanisms for overlimiting current (OLC) through aqueous ion-exchange membranes (exceeding diffusion limitation) have been debated for half a century. Flows consistent with electro-osmotic instability have recently been observed in microfluidic experiments, but the existing theory neglects chemical effects and remains to be quantitatively tested. Here, we show that charge regulation and water self-ionization can lead to OLC by "current-induced membrane discharge" (CIMD), even in the absence of fluid flow, in ion-exchange membranes much thicker than the local Debye screening length. Salt depletion leads to a large electric field resulting in a local pH shift within the membrane with the effect that the membrane discharges and loses its ion selectivity. Since salt co-ions, H(+) ions, and OH(-) ions contribute to OLC, CIMD interferes with electrodialysis (salt counterion removal) but could be exploited for current-assisted ion exchange and pH control. CIMD also suppresses the extended space charge that leads to electro-osmotic instability, so it should be reconsidered in both models and experiments on OLC.

Screening for urinary tract cancer with urine cytology in Lynch syndrome and familial colorectal cancer.

AIM: The aim of this study was to evaluate if Urine Cytology (UC) is an appropriate screening procedure for detecting urinary tract neoplasia at an early stage in persons at risk in Hereditary Non-Polyposis Colorectal Cancer families. METHOD: In the National Danish HNPCC-register persons at risk were identified in three categories of HNPCC-families (1) families harbouring a disease causing mutation in a Mismatch repair gene (MMR), (2) families fulfilling the Amsterdam I or II criteria and (3) families suspected of HNPCC. In total 3,411 persons were identified and traced in Patobank-the National Danish Pathology database. All UC and UTC (Urinary Tract Tumours) were listed and evaluated. RESULTS: 977 persons had a total of 1,868 screening procedures performed. Two of these procedures (0.1%) lead to diagnosis of an asymptomatic urothelial tumour. In ten times as many procedures (22 persons) UC lead to a false positive screening diagnosis. During the study period fourteen persons (1.4%) developed a UTC and five of these were interval tumours. The sensitivity of UC in diagnosing asymptomatic UTC in HNPCC patients was 29%. Twelve of the tumours were found in persons from families with a proven MMR-mutation and eleven out of these were MSH2 mutations (92%, 95% cl 62-100%). DISCUSSION: UC is not a proper method of screening for UTC in HNPCC. However, the study can not reveal if screening for UTC in special families ought to be recommended. Consequently, further studies needs to be performed in order to evaluate an appropriate screening programme.

Comparison of structure and activities of peroxidases from Coprinus cinereus, Coprinus macrorhizus and Arthromyces ramosus.

Initial structural and kinetic data suggested that peroxidases from Coprinus cinereus, Coprinus macrorhizus and Arthromyces ramosus were similar. Therefore they were characterized more fully. The three peroxidases were purified to RZ 2.5 and showed immunochemical identity as well as an identical M(r) of 38,000, pI about 3.5 and similar amino acid compositions. The N-termini were blocked for amino acid sequencing. The peroxidases had similar retention volumes by anion-exchange and gel-filtration chromatography. All peroxidases showed multiple peaks by Concanavalin A-Sepharose chromatography. The Concanavalin A-Sepharose profiles were different and depended furthermore on a fermentation batch. Tryptic peptide maps were very similar except for one peptide. This peptide contained an N-linked glycan composed of varying ratios of glucosamine and mannose for the three peroxidases. Rate constants and their pH dependence were the same for the three peroxidases using guaiacol or iodide as reducing substrates. We conclude that peroxidases from Coprinus cinereus, Coprinus macrorhizus and Arthromyces ramosus are most likely identical in their amino acid sequences, but deviate in glycosylation which, apparently, has no influence on the reaction rates of the enzyme. We suggest, that the Coprinus fungi express one peroxidase only in contrast to the lignin-degrading white-rot Basidiomycetes, which produce multiple peroxidase isozymes.

Work-related stressors, depression and quality of life in Danish managers.

BACKGROUND: By use of valid questionnaires to investigate work-related stress and distress in Danish managers. METHODS: The survey focused on members of the Danish Association of Managers and Executives who no longer were active (former managers' group). Acting managers (active managers' group) served as controls. Questionnaires measuring stressors at work and general life events were used. For the measurement of distress, scales for depression and quality of life were used. RESULTS: The Mokken analysis proved the validity of the questionnaires, i.e. their summed-up total scores were sufficient statistics. No differences were found between former (n = 1,256) and active managers (n = 942) as to life events. Approximately 20% of former managers were at risk of depression and 12% had developed major depression. Among the specific work-related stressors were role overload, lack of team spirit and lack of social support. The percentage of active managers at risk of or suffering from major depression did not differ significantly from the Danish general population. Approximately 37% of the former managers had a decreased well-being. Alcohol use was found to be significantly associated with depression. CONCLUSION: The study identified specific work-related stressors in managers, 12% of whom developed a major depression.

Postischemic hyperactivity in the Mongolian gerbil correlates with loss of hippocampal neurons.

Gerbils show a postischemic increase in locomotor activity that correlates to the extent of neuron loss in the hippocampal CA1 subfield. It has been suggested that this hyperactivity is predictive of neuron loss in the CA1. In this study the correlation between postischemic hyperactivity and neuron loss in several hippocampal subfields was investigated, and the theory that the hyperactivity is due to a reduced ability for spatial navigation was evaluated. Significant correlations were found between hyperactivity and neuron loss in several hippocampal subfields; the correlation was stronger for the CA3 than for the CA1 subfield, suggesting that postischemic hyperactivity can be used as a predictor of neuron loss in the CA3 rather than in the CA1. From observations of the pattern of hyperactivity within the test arenas and during the test period, this study challenges the spatial mapping theory of postischemic hyperactivity.

Direct comparison of visual cortex activation in human and non-human primates using functional magnetic resonance imaging.

We report a technique for functional magnetic resonance imaging (fMRI) in an awake, co-operative, rhesus macaque (Macaca mulatta) in a conventional 1.5T clinical MR scanner, thus accomplishing the first direct comparison of activation in visual cortex between humans and non-human primates with fMRI. Activation was seen in multiple areas of striate and extra-striate visual cortex and in areas for motion, object and face recognition in the monkey and in homologous visual areas in a human volunteer. This article describes T1, T2 and T2* values for macaque cortex, suitable MR imaging sequences, a training schedule, stimulus delivery apparatus and restraining hardware for monkey fMRI using a conventional 19 cm knee coil. Much of our understanding of the functional organization of the primate brain comes from physiological studies in monkeys. Direct comparison between species using fMRI such as those described here will help us to relate the wealth of existing knowledge on the functional organization of the non-human primate brain to human fMRI.

Impairment of working memory in the T-maze after transient global cerebral ischemia in the Mongolian gerbil.

Using a T-maze, the influence of transient global cerebral ischemia on working memory in gerbils was investigated. Furthermore, it was examined whether a correlation exists between impairment in choice accuracy in the T-maze and neuron loss in the hippocampus. In two experiments, male Mongolian gerbils were tested in a previously learned delayed alternation T-maze task 1 week after a 4 min occlusion of the common carotid arteries. In both experiments memory was significantly impaired and in the second experiment, where the design allowed a separation between working and reference memory deficits, a selective impairment in working memory was seen. The results suggest that ischemia-induced disruption of delayed alternation in the T-maze in gerbils is a model which is relevant to the clinical manifestations of vascular dementia.

Transient cerebral ischemia inhibits juvenile recognition in the Mongolian gerbil.

This study introduces a social recognition test for Mongolian gerbils and describes the effect of transient global cerebral ischemia in this model. Adult male gerbils were exposed to an unfamiliar juvenile stimulus animal in two successive trials. The difference between the first and second exposures in duration of social investigation of the stimulus animal was used as a measure of social recognition. Recognition of the stimulus animal was seen after interexposure intervals (IEI) of 5 and 30 min, but not after 120 min. This is in concordance with data obtained in rats in a similar model. The capacity for social recognition was subsequently investigated in gerbils 1 week after 0 (sham), 4, or 8 min of bilateral occlusion of the common carotid arteries. An IEI of 30 min was used, as this IEI was within the time limit for recognition of the stimulus animal. Social recognition was impaired in both occlusion groups. The results suggest that the juvenile recognition test is a suitable model for testing amnesia in gerbils and that social olfactory memory is impaired by global cerebral ischemia.

Specific behavioral effects related to age and cerebral ischemia in rats.

Rats at 4, 14, and 20 months of age were subjected to permanent occlusion of the left middle cerebral artery (MCAO) and the effects of age and ischemia assessed in tests for spatial learning (Morris' water maze), social behavior, olfactory learning, exploratory behavior, and motor function. Furthermore, the extent of ischemic damage to the brain of rats of 5 and 19 months of age was studied. An age-related decline in water-maze performance was observed, and aged rats were less agile, less explorative, and less frequently engaged in social interactions than young rats. After ischemia, mild memory impairment was observed in old rats, while changes in some exploratory behaviors were observed in young rats. Neuropathological analyses revealed a variable and limited degree of infarction in the piriform cortex and the insular cortex with no difference between age groups. In conclusion, the present study confirmed and extended current data on behavioral differences between young and old rats. MCAO had limited influence on the tested behaviors.

Discrimination between artefacts and contractions in pressure signals from the gastrointestinal tract by pattern recognition method.

A pattern recognition algorithm has been developed to discriminate between artefacts and contractions in interdigestive motility recorded by a pressure catheter with four channels from the human duodenum. A learning and a test set, both containing natural and induced artefacts, such as respiration and body movement, are obtained from five volunteers. The event classes were phase I, II and III contractions of the interdigestive motility complex and artefacts from respiration, cough, calibration signals and movements. Length, area, amplitude, inter-event interval, up- and downstroke, and correlation to other pressure channels and to respiration, are applied to classify the events. The sensitivity of the computer scoring increases with the number of applied features. When all the features are applied, the sensitivity of the Bayes' classifier against the visually scored contractions and artefacts is 0.96 with a specificity of 0.69.

What exercise and sport scientists don't understand.

The power of research design in studies published in the Australian Journal of Science and Medicine in Sport (AJSMS: now the Journal of Science and Medicine in Sport) for the years 1996 and 1997 were analysed for their ability to detect small, medium, and large effects according to Cohen's (1988) conventions. Also examined were the reporting and interpreting of effect sizes and the control for experiment-wise (EW) Type I error rates. From the two years of articles, 29 studies were analysed, and power was computed on 108 different tests of significance. The median power of the studies to detect small, medium, and large effects were .14, .65 and .97, respectively. These results suggest that exercise and sport science research, at least as represented in AJSMS, is probably underpowered and may be limited in detecting small effects, has a better, but still underpowered, chance of detecting medium effects, and has adequate power principally for detecting large effects. The reporting of effect sizes was rare, and adequate interpretation of them was even rarer. The mean EW Type I error rate for all studies was .49. The analyses conducted suggest that much research in exercise science may have substantial Type I and Type II errors. An appeal is made for exercise scientists to conduct power analyses, control for EW error, exercise caution in the interpretation of nonsignificant results, and examine, report, and interpret effect sizes rather than solely rely on p values to determine whether significant changes occurred or significant relationships exist.

Physiotherapists' and male professional athletes' views on psychological skills for rehabilitation.

In the literature on the psychological aspects of rehabilitation from athletic injury, several studies in North America have focused on athletic trainers' roles as physical and psychological caregivers for injured athletes. Wiese, Weiss, and Yukelson (1991) examined the views of athletic trainers on the psychological characteristics that distinguished athletes who coped well, versus those who coped poorly with rehabilitation, and also sought athletic trainers opinions on the role of psychological skills in injury rehabilitation. This study replicated the Wiese et al. (1991) study with Australian physiotherapists and extended it to include the viewpoints of professional basketball players. The results indicated the importance attached to communication and motivation by both physiotherapists and athletes in the rehabilitation process. Both athletes and physiotherapists did not, however, think psychological skills such as relaxation or imagery techniques to be particularly useful tools in the recovery process.

The ethical beliefs and behaviours of Victorian fitness professionals.

A survey based on those employed by Petitpas, Brewer, Rivera, and Van Raalte (1994), Pope, Tabachnick, and Keith-Spiegel (1987), Pope and Vetter (1992), and Tabachnick, Keith-Spiegel, and Pope (1991) was used to investigate the ethical beliefs and behaviours of Victorian fitness professionals. Although there is evidence that Victorian fitness professionals are knowledgeable about some general ethical principles, the results of this study suggest that there is some lack of consensus among Victorian fitness professionals about the ethical appropriateness of a number of complex issues relating to business practices, confidentiality, dual relationships, and personal and professional boundaries. The findings suggest there is a need to improve the professional and ethical education of fitness professionals and to develop comprehensive ethical principles and a code of conduct that is relevant to the individuals working in the Australian fitness profession.

Psychosocial influences on central and peripheral vision and reaction time during demanding tasks.

We examined perceptual deficits hypothesized in a model of stress and injury relationships. An ophthalmologic perimeter was used to measure peripheral and central vision during baseline and demanding task situations for 201 intercollegiate athletes from 10 sports. We conducted analyses of covariance with the stress measures as dependent variables and their appropriate baseline measures as covariates. Performance under demanding tasks deteriorated significantly on all the perceptual variables. Individuals with high negative life events scores experienced greater peripheral narrowing and slower central vision reaction time during stress than did those with life events scores that were low. Men with low social support had more failures to detect cues, and men with high negative life events, low social support, and low coping skills had the lowest perceptual sensitivity. Women with high negative life events and low coping skills had more failures to detect cues. We discuss the findings in terms of how stress responsivity may influence injury risk through changes in perception and attention.

Effects of life-event stress on anxiety and peripheral narrowing.

This study examined one of the mechanisms proposed to be behind the relationship between life stress and injury. Past researchers have identified a correlation between high life stress and athletic injury for contact and noncontact sports and for male and female athletes, but they did not investigate why athletes who experienced stress from life events were more prone to injury than those whose lives were low in stressful events. The authors tested the hypothesis that recreational athletes with high life-event stress would, when placed in a stressful, dual-task laboratory situation, experience greater narrowing of peripheral vision and state anxiety than recreational athletes with low life-event stress. ANOVA and regression results offered support for peripheral vision deficits as a potential mechanism in the life stress-injury relationship and very minimal support the effect of elevated state anxiety. The great variability in peripheral vision changes for the groups with high life stress suggests that, for certain subjects, some unmeasured variable may be buffering the adverse impact of high life-event stress. The authors recommend that future researchers examine potential moderating variables, such as coping resources, and assess the relative contributions of psychosocial variables, stress history variables, and mediating mechanisms in predicting actual injuries.

Exercise and multiple sclerosis: physiological, psychological, and quality of life issues.

The case for the benefits of physical activity has been well documented in healthy individuals, and the potential for reducing the risk of mental and physical ill health is substantial. Yet, individuals with multiple sclerosis (MS) have long been advised to avoid participation in exercise in order to minimise the risk of exacerbations and symptoms of fatigue. There is, however, increasing interest in how acute and chronic exercise affect physiological and psychological functioning in MS. Much of the research has examined physiological tolerance to exercise and focused on responses in terms of heart rate, blood pressure, cardiorespiratory fitness, muscle function, and symptom stability. Little research has focused on understanding how exercise affects psychosocial functioning and brings about changes in depression, affect, mood, well-being, and quality of life. This paper provides a summary of the research exploring the efficacy of physical activity for people with MS. In addition, the key issues that face clinical practice are examined, and considerations for research are discussed.

Heart rate-perceived exertion relationship during training and taper.

BACKGROUND: Examine the heart rate-perceived exertion (HR-RPE) relationship under conditions of high-intensity training and taper. METHODS: Experimental design and participants: prospective with collegiate cyclists (n=11) completed six weeks of high-intensity interval training, followed by a one-week taper. INTERVENTIONS: participants completed a high-intensity training regimen along with graded exercise tests (GXT) throughout the training and the taper. MEASURES: heart rates (HR) and ratings of perceived exertion (RPE) were recorded following each stage of the GXTs. Scores on GXTs were also recorded. RESULTS: . The HR-RPE relationship during GXTs changed over the course of the training with greater RPEs for a given HR at the end of the training compared to the beginning. The most powerful predictors of the performance response to the taper were training induced changes in the HR-RPE relationship and decreases in HR for a given power output. Those individuals who reported higher RPEs for lower HRs were more likely to have better performance responses to taper (r=0.72) as were those who had larger changes in the HR-power output relationship (r=0.76). CONCLUSIONS: These results indicate that changes in the HR-RPE relationship during high-intensity training may be used to monitor the magnitude of overreaching that is necessary for a positive response to a taper. For coaches and athletes, the HR-RPE ratio may be a practical measure for monitoring an aspect of fatigue associated with high-intensity training.

Student and supervisor perceptions of the quality of supervision in athletic training education.

OBJECTIVE: To assess the perceptions of the quality of athletic training supervision via the internship route to certification and the NATA-approved/CAAHEP programs. DESIGN AND SETTING: A questionnaire was mailed to head athletic trainers or NATA/CAAHEP program directors and athletic training students in 40 programs nationwide (stratified random sample). SUBJECTS: Head athletic trainers (20), NATA-approved or CAAHEP-accredited program directors (20), and athletic training students in those educational programs (149). MEASUREMENTS: The Athletic Training Supervisory Skills Inventory (ATSSI) was adapted from the Supervisory Evaluation Form (SEF) and athletic training literature. The ATSSI was reviewed by 30 certified athletic trainers, and their feedback was incorporated into the final version of the questionnaire. The ATSSI contains 46 questions that cover six major domains of athletic training supervisor behavior. RESULTS: Overall, there were no differences in how internship route supervisors and NATA/CAAHEP program directors rated their own supervisory skills. Also, there were few differences in how students in those two types of athletic training education programs rated their supervisors. CONCLUSIONS: This exploratory study's limitations included a one-time assessment approach and a small sample of supervisors. Future studies in supervision should take a longitudinal approach and include a larger sample size.