Mobilization of Unexploded Ordnance on the Seabed.

Unexploded ordnance devices (UXO) pose a potential threat to human life and material during offshore construction activities. Extensive survey activities are conducted to locate, identify, and clear these objects as necessary. For the period thereafter, it is necessary to investigate whether areas that have already been cleared, or even objects that remain in place, may be affected by mobilization under tidal currents or waves, and could thus have an impact on operation and maintenance during the lifetime of the offshore installation. In this study, model simulations based on fluid mechanics are described to derive the loads on the objects caused by currents and waves and combined with knowledge of the known burial condition of the objects. Within the model, the hydrodynamic and hydrostatic loads on the object caused by waves and currents are balanced with inertia and rolling resistance. Thus, the critical current velocity and critical wave conditions for the mobilization of different objects are calculated and compared with the environmental conditions prevailing in the North Sea. As a result, a recurrence interval for the potential mobilization of objects on the seafloor is given, which can now be used to optimize route surveys and thus help accelerate offshore construction work. It is shown that currents are not able to mobilize the objects investigated in the study in almost all regions of the North Sea. Waves can mobilize certain objects in very shallow and extreme conditions.

'They get the opportunity to say what is important for them': exploring staff's early perceptions of the implementation of a new communicative approach to patients with aphasia.

PURPOSE: This study explored the perceptions of staff members regarding the implementation of a new communicative approach at a multidisciplinary neurorehabilitation centre in Denmark. Communication partner training according to Supported Conversation for Adults with Aphasia (SCATM) was combined with augmentative strategies from the KomHIT programme to increase the influence of patients with aphasia on their own rehabilitation process. METHODS: A qualitative approach was used involving two semi-structured group interviews with multidisciplinary staff in two wards. Three staff members from each ward participated. The recorded interviews were transcribed, and a thematic analysis of the data was conducted. RESULTS: Three main themes emerged from the analysis. Participants reported increased influence of patients with aphasia on their own rehabilitation process, as well as an increased focus on communication with patients with aphasia. Challenges included time restrictions and dilemmas in goal setting. CONCLUSIONS: Increasing staff knowledge of communication support and augmentative strategies seemed to improve the influence of patients with aphasia on their own rehabilitation process. Because the results were based on interviews with a small number of staff, they cannot be generalized and require further investigation that should also include interviews with the patients themselves and their families.IMPLICATIONS FOR REHABILITATIONThe combination of partner training with augmentative strategies may increase staff understanding of all individuals' rights to have their communicative needs met.The combination of partner training with augmentative strategies may support the influence of persons with aphasia on their own rehabilitation.Goal setting discrepancies between staff and patients with aphasia can be brought to light by more successful communication.The implementation of a new communicative approach can be challenged by a number of factors, e.g., time restrictions.The implementation process needs to be supported by actions on a higher organisational level.

Waking Up in Pain: a prospective unselected cohort study of pain in 3702 patients immediately after surgery in the Danish Realm.

BACKGROUND: Acute and persistent pain after surgery is well described. However, no large-scale studies on immediate postoperative pain in the operating room (OR) exist, hindering potential areas of research to improve clinical outcomes. Thus, we aimed to describe the occurrence and severity of immediate postoperative pain in a large, unselected cohort. METHODS: This was a prospective cohort study, encompassing all procedures in 31 public hospitals in the Danish Realm, during a 5-day period including the weekend. Data on procedures and anesthesia were collected and the main outcome was occurrence of moderate or severe pain in the OR. Secondary outcomes included pain, sedation and nausea in the OR or during the first 15 min in the postanesthesia care unit (PACU) including relevant risk factors. Descriptive and logistic regression statistics were used. RESULTS: A total of 3675 procedures were included for analysis (87% inclusion rate). Moderate or severe pain occurred in 7.4% (95% CI 6.5% to 8.3%) of cases in the OR immediately after awakening, rising to 20.2% in the OR and/or PACU. Large intraprocedure and interprocedure variations occurred (0.0%-37.5%), and in 20% of cases with epidural-general anesthesia patients experienced moderate or severe pain. Independent risk factors were female sex, younger age, preoperative pain, daily opioid use and major surgical procedures. CONCLUSION: Moderate or severe pain in the immediate postoperative phase occurred in 20% of all cases with procedure and anesthesiological technique variations, suggesting a need for identification of relevant procedure-specific risk factors and development of preventive treatments. TRIAL REGISTRATION NUMBER: RoPR ID 43191.

"More air-better performance-faster recovery": study protocol for randomised controlled trial of the effect of post-stroke inspiratory muscle training for adults.

BACKGROUND: Stroke results in varying physical, cognitive, emotional and/or social disabilities in the short and long term alike. Motor impairments are important, persistent consequences of stroke and include, among others, decreased respiratory muscle function, decreased ability to expand the thorax and postural dysfunction. These deficits affect the patient's ability to perform daily activities, produce fatigue and reduce endurance and quality of life. Inspiratory muscle training (IMT) aims to improve the strength and endurance of the diaphragm and the external intercostal muscles. The objectives of this study are to investigate the effect of 3 weeks of IMT on (i) maximal inspiratory pressure (MIP) in adults having suffered a stroke, as well as (ii) functional activities and expiratory measurements. METHODS/DESIGN: This is a randomised controlled trial (RCT) comparing IMT with conventional neurorehabilitation (usual practice). The trial will include 80 patients with reduced MIP hospitalised at a specialised neurorehabilitation hospital in Denmark. The intervention group will receive IMT sessions, exercising at 30% of MIP. Patients in the intervention group will perform two daily sessions (one session of IMT with Threshold IMT consisting of two times 15 inspirations at normal breathing rhythm (5-10 min)), 7 days a week for 3 weeks. Training can be with or without physiotherapist supervision. STUDY OUTCOMES: MIP assessed by the Power Breath, Functional Independence Measurement, The 6-min walk test, the Fatigue Severity Scale and average voice volume. Expiratory function will be assessed using spirometry. All assessments will be conducted at baseline and 3 weeks (at termination of the intervention) and 3 months after the intervention has concluded. DISCUSSION: IMT is a promising and partly self-managed tool for rehabilitation to improve respiratory function. The introduction of IMT in combination with traditional physical therapy may enhance faster recovery after stroke and may at the same time demand little personnel resources to increase training intensity. This trial will provide further evidence of IMT to clinicians, patients and health managers. Hereby, this study accepts the call for further research. TRIAL REGISTRATION: ClinicalTrials.gov NCT04686019 . Registered on 28 December 2020.

The Use of Tablet Computers to Reduce Preoperative Anxiety in Children Before Anesthesia: A Randomized Controlled Study.

PURPOSE: Children undergoing surgery and general anesthesia often experience preoperative anxiety (POA) with related negative short-, medium- and long-term consequences. Anxiolytic premedication has negative side effects, and nonpharmacologic interventions are often resource demanding and not always readily available in a busy clinical setting. The use of an age-appropriate game on a tablet computer may reduce POA, postoperative pain, and occurrence of emergence delirium (ED). DESIGN: Children aged 3 to 6 years scheduled to undergo elective minor surgery were randomly assigned to play a game on a tablet computer while in the holding area before anesthesia (n = 30) or prepared as per departmental standard only (n = 30). METHODS: POA, ED, and levels of pain were assessed by the modified Yale Preoperative Anxiety Scale, Pediatric Anesthesia Emergence Delirium, and Face, Legs, Activity, Cry, Consolability scale, respectively. FINDINGS: A total of 60 children were randomized to either the intervention group or the control group. Gender, bodyweight, duration of anesthesia and surgery, and fentanyl dosages were comparable between the two groups. Tablet-gaming children tended to be less anxious than control subjects at the time of anesthesia induction (modified Yale Preoperative Anxiety Scale, 55.7 vs 65.8; 95% confidence interval, -0.63 to 20.8; P = .066). There was no difference in occurrence of ED or pain 20 minutes after arrival in the postanesthesia care unit. CONCLUSIONS: Although not statistically significant, the use of an age-appropriate tablet computer game may reduce the level of anxiety at the anesthetic induction in 3 to 6 years old children undergoing elective day-case surgery. However, the occurrence of ED and levels of pain appeared unaffected. Standardization of nonpharmacologic interventions to reduce perioperative anxiety and pain is required.

Cerebellar Cognitive Affective Syndrome in Children With Acute Postinfectious Cerebellar Ataxia.

BACKGROUND: Acute postinfectious cerebellar ataxia is the most common cause of acute ataxia in childhood. One previous case study has suggested that cerebellar cognitive affective syndrome may be comorbid with acute postinfectious cerebellar ataxia, but this was not confirmed by formal assessments. METHODS: Children aged three to 15 years with a confirmed diagnosis of acute postinfectious cerebellar ataxia were invited to participate. Three patients were included and assessed by a pediatrician, neuropsychologist, and logopedist at the subacute stage (less than 14 days post-onset) and after six months and one year of follow-up. RESULTS: All three children complied with the diagnostic criteria of cerebellar cognitive affective syndrome. The cognitive and affective symptoms persisted longer than the motor symptoms. Child A (girl, aged three years and eight months) was most severely affected with slow progression of motor cerebellar symptom; the cerebellar cognitive affective symptoms had not entirely remitted at one-year follow-up. Child B (boy, aged four years and four months) had more subtle motor cerebellar symptoms that swiftly remitted within the first week; the cerebellar cognitive affective symptoms were also more subtle. Child C (boy, aged seven years and eleven months) was considerably affected by motor cerebellar symptoms but showed marked improvement within the first month; the cerebellar cognitive affective symptoms had not entirely remitted at one-year follow-up. CONCLUSION: Cognitive affective cerebellar syndrome may be an overlooked complication of acute postinfectious cerebellar ataxia. The severity of cerebellar cognitive affective symptoms seemed to correspond to the severity of the cerebellar motor symptoms, but the improvement was remarkably slower.

Parent perspectives in paediatric SLTs' evidence-based practice / Perspectivas parentales en la práctica basada en la evidencia de logopedas pediátricos

Introduction. Working within the frames of evidence-based practice, paediatric speech and language therapists (SLTs) should attend to parents' values and preferences in order to provide the optimal service to a child and the child's family. However, little is known about how to elicit and include parents' values and preferences in the clinical decision making about speech/language training for their child. Given that background, this study examined how five paediatric SLTs elicited and included parents' values and preferences in clinical decisions about training for their children. Methods. Video recordings of clinical encounters between the SLTs and parents of children with speech/language disorders were transcribed and a broad-brush analysis, drawing on principles of conversation analysis (CA), was carried out. Results. A central finding was that explicit inclusion of the parents' values and preferences in the decision making about the training was only sporadically identified in the encounters. Rather, decisions about whether speech/language training was going to take place, who would perform the training with the child and what should be the focus for the language training appeared to be primarily made by the SLTs, with minimal inclusion of the parents' values and preferences. Discussion/conclusion. Potential impacting factors included the local context, the parents' psychological readiness to contribute to the decision making and a potential discrepancy between SLTs' and parents' focus on outcomes for the child. Further research is needed to establish how parents' values and preferences might be included in the evidence base for interventions for children with speech/language disorders (AU)

Introducción. Desde el marco de la práctica basada en la evidencia, los logopedas pediátricos deberían prestar atención a los valores y las preferencias de los padres para proporcionar un servicio óptimo a los niños y sus familias. Sin embargo, poco se sabe acerca de cómo recabar e incluir los valores y las preferencias de los padres en la toma de decisiones clínicas sobre la intervención logopédica para sus hijos. Con estos antecedentes, este estudio examinó cómo 5 logopedas pediátricos recababan e incluían los valores y las preferencias de los padres en las decisiones clínicas sobre la intervención para sus hijos. Método. Se transcribieron grabaciones de vídeo de encuentros clínicos entre logopedas y padres de niños con trastornos del habla/lenguaje, y se realizó un análisis de carácter general, basado en los principios del análisis conversacional. Resultados. Un resultado principal fue que la inclusión explícita de los valores y las preferencias de los padres en la toma de decisiones sobre la intervención solo se identificó de forma esporádica en estos encuentros. Más bien las decisiones sobre si la intervención del habla/lenguaje tendría lugar, quién la llevaría a cabo y cuál debía ser el foco de la misma fueron principalmente realizadas por los logopedas, con una mínima inclusión de los valores y las preferencias de los padres. Discusión/conclusión. Entre los principales factores influyentes destaca el contexto local, la disposición psicológica de los padres a contribuir en la toma de decisiones y una posible discrepancia entre padres y logopedas en los resultados esperados para el niño. La investigación futura debería establecer cómo podrían incluirse los valores y las preferencias de los padres en la base de la evidencia para las intervenciones dirigidas a niños con trastornos del habla/lenguaje (AU)

Residents in difficulty: a mixed methods study on the prevalence, characteristics, and sociocultural challenges from the perspective of residency program directors.

BACKGROUND: The majority of studies on prevalence and characteristics of residents in difficulty have been conducted in English-speaking countries and the existing literature may not reflect the prevalence and characteristics of residents in difficulty in other parts of the world such as the Scandinavian countries, where healthcare systems are slightly different. The aim of this study was to examine prevalence and characteristics of residents in difficulty in one out of three postgraduate medical training regions in Denmark, and to produce both a quantifiable overview and in-depth understanding of the topic. METHODS: We performed a mixed methods study. All regional residency program directors (N = 157) were invited to participate in an e-survey about residents in difficulty. Survey data were combined with database data on demographical characteristics of the background population (N = 2399) of residents, and analyzed statistically (Chi-squared test (Χ (2)) or Fisher's exact test). Secondly, we performed a qualitative interview study involving three focus group interviews with residency program directors. The analysis of the interview data employed qualitative content analysis. RESULTS: 73.2 % of the residency program directors completed the e-survey and 22 participated in the focus group interviews. The prevalence of residents in difficulty was 6.8 %. We found no statistically significant differences in the prevalence of residents in difficulty by gender and type of specialty. The results also showed two important themes related to the workplace culture of the resident in difficulty: 1) belated and inconsistent feedback on the resident's inadequate performance, and 2) the perceived culturally rooted priority of efficient patient care before education in the workplace. These two themes were emphasized by the program directors as the primary underlying causes of the residents' difficulty. CONCLUSIONS: More work is needed in order to clarify the link between, on the one hand, observable markers of residents in difficulty and, on the other hand, immanent processes and logics of practice in a healthcare system. From our perspective, further sociological and pedagogical investigations in educational cultures across settings and specialties could inform our understanding of and knowledge about pitfalls in residents' and doctors' socialization into the healthcare system.

Prevalence of celiac disease autoimmunity in children with type 1 diabetes: regional variations across the Øresund strait between Denmark and southernmost Sweden.

OBJECTIVES: The aim was to determine the prevalence of celiac disease autoimmunity in children with type 1 diabetes (T1D) diagnosed in Denmark and Sweden. METHODS: A total of 662 Swedish children with T1D were matched with 1080 Danish children with T1D and 309 healthy children from Sweden and 283 from Denmark served as controls. Sera were analyzed for the presence of IgA and IgG (IgAG) autoantibodies against deamidated gliadin peptide (DGP) and tissue transglutaminase (tTG) with enzyme-linked immunosorbent assay (ELISA) and IgG-tTG separately in a radioligand binding assay (RBA). Human leukocyte antigen (HLA)-DQB1 and DQA1 genotyping were determined in the T1D cohorts. RESULTS: In the Swedish T1D cohort, 17.2% (114/662) were IgAG-DGP/tTG positive compared with 11.7% (126/1080) in the Danish T1D cohort (p = 0.001) and with 9.4% (29/309) Swedish (p = 0.001) and 5.7% (16/283) Danish (p = 0.003) controls. In the Swedish T1D cohort, both levels of IgAG-DGP/tTG and IgG-tTG were higher compared with the levels in the Danish T1D (p < 0.001). In the control group, 2.8% of the Danish children were positive for both IgAG-DGP/tTG and IgG-tTG, compared to 0.3% of the Swedish. Presence of HLA-DQ2 was equally distributed among 89 children with T1D positive for both IgAG-DGP/tTG and IgG-tTG. CONCLUSION: The discrepancy in levels of IgAG-DGP/tTG and IgG-tTG between Swedish and Danish T1D cohorts was independent of HLA and suggests that regional variations in comorbidity of celiac disease in T1D is caused by difference in exposure to environmental factors.

Personality characteristics in surgery seeking and non-surgery seeking obese individuals compared to non-obese controls.

It is currently unknown what makes some obese individuals opt for bariatric surgery whereas others choose not to. The aim of this study was to examine whether personality characteristics differed between obese individuals signed up for Roux-en-Y gastric bypass (RYGB) (N=30) and obese individuals not seeking RYGB (N=30) compared to non-obese controls (N=30). All participants completed the NEO Personality Inventory-Revised. The obese RYGB group displayed higher levels of Neuroticism and borderline lower levels of Extraversion compared to the obese non-RYGB and the non-obese group, while the two latter groups did not differ in terms of personality. The Neuroticism domain and possibly the Extraversion domain may therefore be worthwhile to consider in future studies investigating the outcome of bariatric surgery.

Phantom breast sensations are frequent after mastectomy.

INTRODUCTION: Phantom breast sensation (PBS) following mastectomy has been recognized for many years. PBS is a feeling that the removed breast is still there. The reported prevalence and risk factors have not been established in large well-defined patient series. The purpose of this study was to examine the prevalence of PBS following mastectomy and associated risk factors. MATERIAL AND METHODS: This study was part of a nationwide cross-sectional questionnaire study of women aged 18-70 years treated for primary unilateral breast cancer in Denmark between 1 January 2005 and 31 December 2006. A detailed questionnaire was mailed to respondents between January and April 2008. Only questionnaires from mastectomised women were analyzed. The main outcome measures were prevalence of PBS in mastectomized Danish women and adjusted odds ratio (OR) of PBS with respect to age, pain in the breast area, surgical technique, chemotherapy and radiotherapy. RESULTS: A total of 1,131 women (84%) answered the questionnaire. A total of 26% experienced PBS, viz. the proportion ranged from 18% to 35% within the six well defined treatment groups, but only young age was a risk factor for PBS (OR 1.030 per year; 95% CI 1.010-1.050; p = 0.0026). CONCLUSION: The prevalence of PBS during the first 1-3 years after mastectomy is about 25% and it is related to young age.

Peripheral benzodiazepine receptors in the brain of cirrhosis patients with manifest hepatic encephalopathy.

PURPOSE: It has been suggested that ammonia-induced enhancement of peripheral benzodiazepine receptors (PBRs) in the brain is involved in the development of hepatic encephalopathy (HE). This hypothesis is based on animal experiments and studies of post-mortem human brains using radiolabelled PK11195, a specific ligand for PBR, but to our knowledge has not been tested in living patients. The aim of the present study was to test this hypothesis by measuring the number of cerebral PBRs in specific brain regions in cirrhotic patients with an acute episode of clinically manifest HE and healthy subjects using dynamic (11)C-PK11195 brain PET. METHODS: Eight cirrhotic patients with an acute episode of clinically manifest HE (mean arterial ammonia 81 micromol/l) and five healthy subjects (22 micromol/l) underwent dynamic (11)C-PK11195 and (15)O-H(2)O PET, co-registered with MR images. Brain regions (putamen, cerebellum, cortex and thalamus) were delineated on co-registered (15)O-H(2) (15)O and MR images and copied to the dynamic (15)O-H(2)O and (11)C-PK11195 images. Regional cerebral blood flow (CBF) ((15)O-H(2)O scan) and the volume of distribution of PK11195 ((11)C-PK11195 scan) were calculated by kinetic analysis. RESULTS: There were regional differences in the CBF, with lowest values in the cortex and highest values in the putamen in both groups of subjects (p<0.05), but no significant differences between the groups. There were no significant differences in the volume of distribution of PK11195 (V (d)) between regions or between the two groups of subjects. Mean values of V (d) ranged from 1.0 to 1.1 in both groups of subjects. CONCLUSION: The results do not confirm the hypothesis of an increased number of PBRs in patients with HE.

Cancer incidence in parents who lost a child: a nationwide study in Denmark.

BACKGROUND: It has been debated whether psychological stress causes cancer, but the scientific evidence remains contradictory. The objective of this study was to investigate whether the death of a child is related to cancer risk in bereaved parents. METHODS: The authors undertook a follow-up study based on national registers. All 21,062 parents who lost a child from 1980 to 1996 were recruited for the exposed cohort together with 293,745 randomly selected, unexposed parents. Cox proportional hazards regression models were used to evaluate the relative risk of cancer incidence up to 18 years after the bereavement. The main outcomes of interest were all incident cancers, breast carcinoma, smoking-related malignancies (International Classification of Diseases [ICD] 7 codes 140, 141, 143-149, 150, 157, 160-162, 180, and 181), alcohol-related malignancies (ICD7 codes 141, 143-146, 148-150, 155, and 161), virus/immune-related malignancies (ICD7 codes 155, 171, 191, 200-202, and 204), lymphatic/hematopoietic malignancies (ICD7 codes 200-205), and hormone related malignancies (ICD7 codes 170, 172, 175, and 177). RESULTS: The authors observed a slightly increased overall cancer risk in bereaved mothers (relative risk [RR], 1.18; 95% confidence interval [95%CI], 1.01-1.37; P = 0.028) at 7-18 years of follow-up. There was an increased risk for smoking-related malignancies (RR, 1.65; 95%CI, 1.05-2.59; P = 0.010) among bereaved mothers during the 7-18 years of follow-up. The authors observed no significantly increased relative risk of breast carcinoma, alcohol-related malignancies, virus/immune-related malignancies, or hormone-related malignancies. CONCLUSIONS: The current data suggest that the death of a child was associated with a slightly increased overall cancer risk in mothers and that the increase may be related to stress-induced adverse life styles.

Myocardial infarction in parents who lost a child: a nationwide prospective cohort study in Denmark.

BACKGROUND: The association between psychological stress and coronary heart disease remains unclear. We conducted a prospective follow-up study based on national registers to investigate if the death of a child, one of the most severe stressors, increases the risk of myocardial infarction (MI) in parents. METHODS AND RESULTS: From 1980 to 1996, 19 361 parents who lost a child (<18 years of age) in Denmark were recruited to the exposed cohort, and 295 540 parents matched on family structure were selected for the unexposed cohort. The Cox proportional hazards model was used to evaluate the relative risk (RR) of myocardial infarction (MI). The average RRs for a fatal MI and any first MI among the exposed were 1.36 (95% CI, 0.98 to 1.88) and 1.28 (95% CI, 1.08 to 1.51), respectively. The two cohorts had similar MI risk during the first 6 years of follow-up. From the 7th to the 17th year of follow-up, the exposed cohort had a RR of 1.58 (95% CI, 1.08 to 2.30) for fatal MI and a RR of 1.31 (95% CI, 1.09 to 1.57) for first MI. Parents who lost a child unexpectedly, especially from sudden infant death syndrome, experienced higher RRs. CONCLUSIONS: The death of a child was associated with an increased risk of MI in bereaved parents.

An observational study of slimming behavior in Denmark in 1992 and 1998.

OBJECTIVE: To elucidate how frequent weight-loss attempts are made, the methods used to achieve weight loss, and the extent to which the outcome is positive. RESEARCH METHODS AND PROCEDURES: Two independent interviews were conducted in 1992 and in 1998, each with 1200 randomly selected adult subjects. Each survey was designed to ensure an equal distribution of age, gender, and geographical regions in Denmark. RESULTS: The proportion of subjects having attempted weight loss did not change from 1992 to 1998, although the prevalence of overweight and obesity increased from 1992 (overweight, 30%; obesity, 6%) to 1998 (overweight, 35%; obesity, 8%). Almost twice as many women (61%) than men (32%) had attempted weight loss (p < 0.0001). Slimming occurred more often in subjects <50 years (51%) than >50 years (39%) (p < 0.0001), although overweight and obesity were more frequent in the elderly. Over-the-counter diet pills or meal replacements were associated with a negative outcome of slimming treatment (p < 0.0001). DISCUSSION: Approximately half of all adult Danes have attempted weight loss, particularly women and individuals <50 years. This finding is inconsistent with the fact that overweight and obesity are more prevalent in men and in individuals >50 years. Changes in habitual diet and increased physical activity are the most prevalent modes of slimming, whereas the use of over-the-counter diet pills or meal replacements has decreased from 1992 to 1998. This development may have a positive impact on future body- weight-management strategies.