Bilið brúað milli bráðadeildar og hefðbundinnar göngudeildar þjónust: reynslan af sérhæfðri endurhæfingardeild (D28)

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn Skoða/Opna(view/open)Endurhæfing einstaklinga með alvarlega geðfötlun er flókið og margbreytilegt ferli sem tekur á öllum þáttum meðferðar. Hún krefst þolinmæði og fagmennsku margra meðferðaraðila. Frá upphafi verður að gera ráð fyrir löngu bataferli (1) Ýmis áföll og sjúkdómar geta orðið til þess að skjólstæðingur getur ekki nýtt hæfileika sína og getu til þess að sjá sér farborða og staðist kröfur samfélagsins. Heilsa og heilsuleysi er oft sett fram sem andstæður en í raun er heilsuleysi oft einskonar ferli, veikleiki á einhverju sviði sem birtist og þróast við vissar aðstæður og á þetta ekki síst við um marga geðsjúkdóma (1). Í þessum tilvikum er sjúkdómurinn hluti af lífi þessa fólks. Ljóst er að þegar sjúkdómurinn hindrar virka þátttöku einstaklinga í samfélaginu, er árangursrík meðferð og endurhæfing ásamt eftirfylgni forsenda þess að þeir geti aðlagast samfélaginu að nýju. Þannig má segja að endurhæfing feli í sér tvo megin þætti. Annars vegar meðferð sjúkdómsins sem hindrar sjúklinginn í þátttöku í eðlilegu lífi og hins vegar vinnu sjúklingsins að eigin aðlögun að samfélaginu og ábyrgð á eigin lífi. Einnig er mikilvægt að tekið sé tillit til þjóðfélagslegra aðstæðna. Áríðandi er að læknismeðferð og vinna þverfaglegra hópa meðferðaraðila sé stunduð samhliða, í nánu samstarfi við skjólstæðinginn og aukin áhersla sé lögð á reglulega eftirfylgni (2). Nú í dag eru til fjölmargar aðferðir og áætlanir fyrir endurhæfingu. Margar grundvallarreglur og einstakir þættir þeirra eru hluti af flestum áætlunum og hér á eftir eru settar fram nokkrar grunnreglur og hugtök úr ólíkum meðferðaráætlunum sem hafa mótað starfið á deild 28 (3). Allt fólk hefur getu til að þroskast og þeir sem búa við hindranir vegna sjúkdómseinkenna, geta bætt líkamlega og tilfinningalega hæfni sína

Intracellular Fas ligand in normal and malignant breast epithelium does not induce apoptosis in Fas-sensitive cells

Fas ligand (FasL) is expressed on some cancers and may play a role in the immune evasion of the tumour. We used immuno-histochemistry to study the expression of Fas and FasL in tissue samples from breast cancer patients, as well as normal breast tissue. Our results show that Fas and FasL are co-expressed both in normal tissue and in breast tumours. Fas and FasL mRNA were expressed in fresh normal and malignant breast tissue, as well as cultured breast epithelium and breast cancer cell lines. Flow cytometry analysis of live cells failed to detect FasL on the surface of normal or malignant breast cells; however, both stained positive for FasL after permeabilization. Fas was detected on the surface of normal breast cells and T47D and MCF-10A cell lines but only intracellularly in other breast cell lines tested. Neither normal breast epithelium nor breast cell lines induced Fas-dependent apoptosis in Jurkat cells. Finally, 20 tumour samples were stained for apoptosis. Few apoptotic cells were detected and there was no increase in apoptotic cells on the borders between tumour cells and lymphocytes. We conclude that FasL is expressed intracellularly in both normal and malignant breast epithelium and unlikely to be important for the immune evasion of breast tumours. © 2000 Cancer Research Campaign http://www.bjcancer.co

Prediction-Coherent LSTM-based Recurrent Neural Network for Safer Glucose Predictions in Diabetic People

In the context of time-series forecasting, we propose a LSTM-based recurrent neural network architecture and loss function that enhance the stability of the predictions. In particular, the loss function penalizes the model, not only on the prediction error (mean-squared error), but also on the predicted variation error. We apply this idea to the prediction of future glucose values in diabetes, which is a delicate task as unstable predictions can leave the patient in doubt and make him/her take the wrong action, threatening his/her life. The study is conducted on type 1 and type 2 diabetic people, with a focus on predictions made 30-minutes ahead of time. First, we confirm the superiority, in the context of glucose prediction, of the LSTM model by comparing it to other state-of-the-art models (Extreme Learning Machine, Gaussian Process regressor, Support Vector Regressor). Then, we show the importance of making stable predictions by smoothing the predictions made by the models, resulting in an overall improvement of the clinical acceptability of the models at the cost in a slight loss in prediction accuracy. Finally, we show that the proposed approach, outperforms all baseline results. More precisely, it trades a loss of 4.3\% in the prediction accuracy for an improvement of the clinical acceptability of 27.1\%. When compared to the moving average post-processing method, we show that the trade-off is more efficient with our approach

Inter-comparison of salt effect correction for δ 18 O and δ 2 H measurements in seawater by CRDS and IRMS using the gas-H 2 O equilibration method

The isotope composition of seawater is an efficient method for detecting mixing between water masses. To measure long term or large scale hydrological processes at the ocean surface, it is necessary to be able to precisely compare datasets produced by different laboratories. The oxygen and hydrogen isotope (δ18O and δ2H) composition of marine waters can be measured using isotope ratio mass spectrometry (IRMS) and near-infrared laser absorption spectroscopy (LS) techniques. The IRMS and equilibration method is thought to provide results on the activity scale, while LS provides results on the concentration scale. However, the effect of dissolved seawater salts on the measurement is not sufficiently assessed and seems sometimes contradictory in the literature. For this purpose, we made artificial seawater and a pure NaCl solution from a freshwater of known isotope composition. The solutions were measured by four different laboratories allowing us to compare the two techniques. We show that minor corrections are necessary to correct seawater measurements for the salt effect and report them on the concentration scale. Interestingly, seawater measurements using LS (type Picarro) coupled to a liner are not on the concentration scale and require a correction of ~ 0.09‰ for δ18O, while the correction is relatively less significant for δ2H (~ 0.13‰). Moreover, we found for IRMS measurements that the salt effect can differ between different laboratories but seems reproducible for a given laboratory. A natural sea water sample was then analyzed by the different laboratories participating in the study. We found that applying the corrections increases the reproducibility of the isotope measurement significantly, with inter-laboratory standard deviation decreasing from 0.06 to 0.02‰ and 0.55 to 0.23‰ for δ18O and δ2H, respectively. Thus, comparing sea water datasets produced in different laboratories requires that each laboratory carries out its own calibration with artificial seawater and presents measurements on the concentration scale

Modeling Historic Rangeland Management and Grazing Pressures in Landscapes of Settlement

Defining historic grazing pressures and rangeland management is vital if early landscape threshold crossing and long–term trajectories of landscape change are to be properly understood. In this paper we use a new environmental simulation model, Búmodel, to assess two contrasting historical grazing landscapes in Mývatnssveit Iceland for two key periods—the colonization period (ca. Landnám, A.D. 872–1000) and the early eighteenth century A.D. Results suggest that there were spatial and temporal variations in productivity and grazing pressure within and between historic grazing areas and indicate that land degradation was not an inevitable consequence of the livestock grazing introduced with settlement. The results also demonstrate the significance of grazing and livestock management strategies in preventing overgrazing, particularly under cooler climatic conditions. The model enables detailed consideration of historic grazing management scenarios and their associated landscape pressures

Glyphosate and AMPA in human urine of HBM4EU-aligned studies: part B adults

Within HBM4EU, human biomonitoring (HBM) studies measuring glyphosate (Gly) and aminomethylphosphonic acid (AMPA) in urine samples from the general adult population were aligned and quality-controlled/assured. Data from four studies (ESB Germany (2015-2020); Swiss HBM4EU study (2020); DIET-HBM Iceland (2019-2020); ESTEBAN France (2014-2016)) were included representing Northern and Western Europe. Overall, median values were below the reported quantification limits (LOQs) (0.05-0.1 microg/L). The 95th percentiles (P95) ranged between 0.24 and 0.37 microg/L urine for Gly and between 0.21 and 0.38 microg/L for AMPA. Lower values were observed in adults compared to children. Indications exist for autonomous sources of AMPA in the environment. As for children, reversed dosimetry calculations based on HBM data in adults did not lead to exceedances of the ADI (proposed acceptable daily intake of EFSA for Gly 0.1 mg/kg bw/day based on histopathological findings in the salivary gland of rats) indicating no human health risks in the studied populations at the moment. However, the controversy on carcinogenicity, potential endocrine effects and the absence of a group ADI for Gly and AMPA induce uncertainty to the risk assessment. Exposure determinant analysis showed few significant associations. More data on specific subgroups, such as those occupationally exposed or living close to agricultural fields or with certain consumption patterns (vegetarian, vegan, organic food, high cereal consumer), are needed to evaluate major exposure sources

The Iceland–Faroe warm-water flow towards the Arctic estimated from satellite altimetry and in situ observations

The inflow of warm and saline Atlantic water to the Arctic Mediterranean (Nordic Seas and Arctic Ocean) between Iceland and the Faroes (IF inflow) is the strongest Atlantic inflow branch in terms of volume transport and is associated with a large transport of heat towards the Arctic. The IF inflow is monitored in a section east of the Iceland–Faroe Ridge (IFR) by use of sea level anomaly (SLA) data from satellite altimetry, a method that has been calibrated by in situ observations gathered over 2 decades. Monthly averaged surface velocity anomalies calculated from SLA data were strongly correlated with anomalies measured by moored acoustic Doppler current profilers (ADCPs) with consistently higher correlations when using the reprocessed SLA data released in December 2021 rather than the earlier version. In contrast to the earlier version, the reprocessed data also had the correct conversion factor between sea level slope and surface velocity required by geostrophy. Our results show that the IF inflow crosses the IFR in two separate branches. The Icelandic branch is a jet over the Icelandic slope with average surface speed exceeding 20 cm s−1, but it is narrow and shallow with an average volume transport of less than 1 Sv (106 m3 s−1). Most of the Atlantic water crosses the IFR close to its southernmost end in the Faroese branch. Between these two branches, water from the Icelandic branch turns back onto the ridge in a retroflection with a recirculation over the northernmost bank on the IFR. Combining multi-sensor in situ observations with satellite SLA data, monthly mean volume transport of the IF inflow has been determined from January 1993 to December 2021. The IF inflow is part of the Atlantic Meridional Overturning Circulation (AMOC), which is expected to weaken under continued global warming. Our results show no weakening of the IF inflow. Annually averaged volume transport of Atlantic water through the monitoring section had a statistically significant (95 % confidence level) increasing trend of (0.12±0.10) Sv per decade. Combined with increasing temperature, this caused an increase of 13 % in the heat transport, relative to 0 ∘C, towards the Arctic of the IF inflow over the 29 years of monitoring. The near-bottom layer over most of the IFR is dominated by cold water of Arctic origin that may contribute to the overflow across the ridge. Our observations confirm a dynamic link between the overflow and the Atlantic water flow above. The results also provide support for a previously posed hypothesis that this link may explain the difficulties in reproducing observed transport variations in the IF inflow in numerical ocean models, with consequences for its predictability under climate change.</p

Adolescent Learning of Academic Vocabulary in Iceland

The fields of vocabulary instruction, literacy professional development, and global language issues framed this research. Situated in Iceland, the intervention consisted of professional development for 10th‐grade teachers focused on academic words in various subject materials, increasing the learners’ proficiency in using explicit strategies to detect word meanings, and offering learners multimodal ways of working with the vocabulary. There were no significant differences between the participants in the experimental schools (n = 157) and in the control schools (n = 88). There were gains from pretest to posttest in vocabulary and in comprehension, and there were some promising trends that distinguished the experimental group from the control group on the reading comprehension test. The nature, intensity, and length of the professional development offered to the high school teachers and the relatively short time of measurement of student outcomes are suggested explanations of the results.Fulbright Foundation/U.S. State DepartmentPre-prin

Setting the stage for health: Salutogenesis in midwifery professional knowledge in three European countries

There is a lack of systematic evidence concerning health orientation in maternity practice in the current climate of risk avoidance. The midwifery professional project is orientated toward the preservation of normal physiological processes during the maternity episode. This study investigates accounts of midwives who were working in health-orientated birth settings, to examine if and how they frame a health orientation in professional practice. Twenty-seven narrative interviews were conducted with midwives working in pre-, peri-, and postnatal care in different maternity care settings in Switzerland, Austria, and Germany. In-depth and comparative pattern data analyses were conducted. The distinct practice orientation of the participants was revealed in three main concepts, underpinned by a common framework mirroring the three parameters of the Sense of Coherence (comprehensibility, manageability, and meaningfulness) described in Aaron Antonovsky's salutogenic theory. The midwives’ implicit salutogenic knowledge shaped their reported actions in supporting mothers, fathers, and families to have health-promoting experiences in maternity care. These results suggest that an implicit health orientation in maternity care practice can be prefered through examination of the practice reports of midwives working in settings that have a health-promoting philosophy. Implications for midwifery practice and research are discussed. Consideration is given to the relevance of the results for debates about avoiding overtreatment and for the operationalization of salutogenic theory in health care practice

Variations in Multiple Birth Rates and Impact on Perinatal Outcomes in Europe

Objective Infants from multiple pregnancies have higher rates of preterm birth, stillbirth and neonatal death and differences in multiple birth rates (MBR) exist between countries. We aimed to describe differences in MBR in Europe and to investigate the impact of these differences on adverse perinatal outcomes at a population level. Methods We used national aggregate birth data on multiple pregnancies, maternal age, gestational age (GA), stillbirth and neonatal death collected in the Euro-Peristat project (29 countries in 2010, N = 5 074 643 births). We also used European Society of Human Reproduction and Embryology (ESHRE) data on assisted conception and single embryo transfer (SET). The impact of MBR on outcomes was studied using meta-analysis techniques with random-effects models to derive pooled risk ratios (pRR) overall and for four groups of country defined by their MBR. We computed population attributable risks (PAR) for these groups. Results In 2010, the average MBR was 16.8 per 1000 women giving birth, ranging from 9.1 (Romania) to 26.5 (Cyprus). Compared to singletons, multiples had a nine-fold increased risk (pRR 9.4, 95% Cl 9.1–9.8) of preterm birth (<37 weeks GA), an almost 12-fold increased risk (pRR 11.7, 95% CI 11.0–12.4) of very preterm birth (<32 weeks GA). Pooled RR were 2.4 (95% Cl 1.5–3.6) for fetal mortality at or after 28 weeks GA and 7.0 (95% Cl 6.1–8.0) for neonatal mortality. PAR of neonatal death and very preterm birth were higher in countries with high MBR compared to low MBR (17.1% (95% CI 13.8–20.2) versus 9.8% (95% Cl 9.6–11.0) for neonatal death and 29.6% (96% CI 28.5–30.6) versus 17.5% (95% CI 15.7–18.3) for very preterm births, respectively). Conclusions Wide variations in MBR and their impact on population outcomes imply that efforts by countries to reduce MBR could improve perinatal outcomes, enabling better long-term child health