Do Elevation and Aspect Predict Functional Trait Values in Alpine Plant Populations?

Alpine regions are among the hardest hit by global climate change, experiencing rising temperatures at a faster rate than lowland areas. Such fast rates of warming are predicted to cause rapid changes in alpine plant communities, including shifts in plant functional traits along elevation gradients. To investigate these effects within species, we examined the relationship between elevation, aspect, and functional traits of three common alpine plants in California; the shrub Holodiscus discolor var. microphyllus, the forb Calyptridium umbellatum, and the grass Trisetum spicatum. Functional traits examined included plant height, plant width, and Specific Leaf Area (SLA). These traits were measured across an elevation transect in the Sierra Nevada at multiple populations for each of the three focal species. Our findings indicate that there is no relationship between elevation, aspect, and functional trait values of alpine plants. We infer that there are other factors besides elevation and aspect that are responsible for driving functional trait values of alpine plants, and that elevation may not be a good predictor for future population level change under a warming climate

Helbredsscreening i almen praksis. Et kvalitativt studie om menneskers tanker og erfaringer

Despite the lack of evidence of the actual effects of general health screenings, it is still being discussed whether the screenings should be a public offer. There is a lack of scientific investigations concerning the influence of health screening on individual level over time, especially in relation to the screened people who have been cleared and the people who have declined the screening offer. Only few researchers have conducted detailed investigations regarding the individual’s underlying reasons for declining the screening and how it feels to be declared in or out of risk of illness. In this thesis I have explored understandings and experiences among those who were invited to participate in the Ebeltoft project – a multiphasic health screening, where among other things the participants’ cardiovascular risk score (CRS) was estimated. I have conducted three studies in order to investigate the following three aims 1) How do people with a high CRS identified in the screening, balance health related advice with the life they wish to lead or are able to lead? 2) How do people interpret and act after the screening has shown they are out of risk of a high CRS? 3) Which understandings and experiences can be found among the persons who declined participating in the screening offer? The empirical data are drawn from qualitative semistructured interviews with 14 screened persons, who from the Ebeltoft project were estimated to have a high CRS, 22 screened persons without a high CRS and 18 persons who declined the screening offer. The study is descriptive, analyzed with systematic text condensation and the interpretation is inspired by the Health Belief Model (HBM), Bandura’s theory of self-efficacy and Hollnagel & Malterud’s thoughts on shifting attention from risk factors to health resources. The analysis has demonstrated that a high CRS can give rise to alarm, shock, surprise, and hope (article I). The message of being out of CRS can give reason to relief, feels calming and reduce health worries (article II), while those who did not accept the offer of health screening feared that examinations and results could affect their health and happiness in a negative direction (article III). Among health screened people with a high CRS we found much differentiated conceptions on whether and how the result should have consequences, and several participants made extensive initiatives to change their lifestyle (article I). Participants without a high CRS had attached importance to the confirmation from the experts to their own feelings of being in good health and that their lifestyle therefore was acceptable and could proceed without changes (article II). In time and especially if the quality of life was highly compromised or if difficult circumstances in life arose, the initiated life changes could for those with a high CRS fade into the background (article I), while participants without a high CRS after some time no longer would give much thoughts to the screening results (article II). People who had declined to participate in the health screening, expressed that nevertheless most illness cannot be prevented and that oneself can do several things to prevent illness. They explained how they balanced their own evaluations of being healthy with consideration to the risk of illness caused by heredity or present lifestyle factors and the fear of what screening may give occasion for. Moreover they expressed that a doctor should be for the sick and old people and otherwise only when needed (article III). Practitioners can apply the results from this thesis to 1) be attentive to the emotional reactions that may occur from participating and that these reactions may be connected to the decline of such a screening offer, 2) know that screened persons with a high CRS have decided on the size of the life style changes, that screened people without a high CRS in accordance with the result feel healthy, but some may be unsure of their own body-feeling and lead a worrying lifestyle, that non screened persons attach importance to self-responsibility and 3) that initiatives and attitudes found within health screened people and the people who declined can be perceived as resources by looking at what the participants have succeeded in, focusing on what they can instead of what they lack to do. In general the findings indicate that it may be more important to add – that is to make use of the human beings’ own resources - instead of subtracting by looking for risks or weaknesses

A primer on common statistical errors in clinical ophthalmology

Abstract Although biomedical statistics is part of any scientific curriculum, a review of the current scientific literature indicates that statistical data analysis is an area that frequently needs improvement. To address this, we here cover some of the most common problems in statistical analysis, with an emphasis on an intuitive, tutorial approach rather than a rigorous, proof-based one. The topics covered in this manuscript are whether to enter eyes or patients into the analysis, issues related to multiple testing, pitfalls surrounding the correlation coefficient (causation, insensitivity to patterns, range confounding, unsuitability for method comparisons), and when to use standard deviation (SD) versus standard error of the mean (SEM) ''antennas'' on graphs

Helbredsscreening i almen praksis. Et kvalitativt studie om menneskers tanker og erfaringer

Despite the lack of evidence of the actual effects of general health screenings, it is still being discussed whether the screenings should be a public offer. There is a lack of scientific investigations concerning the influence of health screening on individual level over time, especially in relation to the screened people who have been cleared and the people who have declined the screening offer. Only few researchers have conducted detailed investigations regarding the individual’s underlying reasons for declining the screening and how it feels to be declared in or out of risk of illness. In this thesis I have explored understandings and experiences among those who were invited to participate in the Ebeltoft project – a multiphasic health screening, where among other things the participants’ cardiovascular risk score (CRS) was estimated. I have conducted three studies in order to investigate the following three aims 1) How do people with a high CRS identified in the screening, balance health related advice with the life they wish to lead or are able to lead? 2) How do people interpret and act after the screening has shown they are out of risk of a high CRS? 3) Which understandings and experiences can be found among the persons who declined participating in the screening offer? The empirical data are drawn from qualitative semistructured interviews with 14 screened persons, who from the Ebeltoft project were estimated to have a high CRS, 22 screened persons without a high CRS and 18 persons who declined the screening offer. The study is descriptive, analyzed with systematic text condensation and the interpretation is inspired by the Health Belief Model (HBM), Bandura’s theory of self-efficacy and Hollnagel & Malterud’s thoughts on shifting attention from risk factors to health resources. The analysis has demonstrated that a high CRS can give rise to alarm, shock, surprise, and hope (article I). The message of being out of CRS can give reason to relief, feels calming and reduce health worries (article II), while those who did not accept the offer of health screening feared that examinations and results could affect their health and happiness in a negative direction (article III). Among health screened people with a high CRS we found much differentiated conceptions on whether and how the result should have consequences, and several participants made extensive initiatives to change their lifestyle (article I). Participants without a high CRS had attached importance to the confirmation from the experts to their own feelings of being in good health and that their lifestyle therefore was acceptable and could proceed without changes (article II). In time and especially if the quality of life was highly compromised or if difficult circumstances in life arose, the initiated life changes could for those with a high CRS fade into the background (article I), while participants without a high CRS after some time no longer would give much thoughts to the screening results (article II). People who had declined to participate in the health screening, expressed that nevertheless most illness cannot be prevented and that oneself can do several things to prevent illness. They explained how they balanced their own evaluations of being healthy with consideration to the risk of illness caused by heredity or present lifestyle factors and the fear of what screening may give occasion for. Moreover they expressed that a doctor should be for the sick and old people and otherwise only when needed (article III). Practitioners can apply the results from this thesis to 1) be attentive to the emotional reactions that may occur from participating and that these reactions may be connected to the decline of such a screening offer, 2) know that screened persons with a high CRS have decided on the size of the life style changes, that screened people without a high CRS in accordance with the result feel healthy, but some may be unsure of their own body-feeling and lead a worrying lifestyle, that non screened persons attach importance to self-responsibility and 3) that initiatives and attitudes found within health screened people and the people who declined can be perceived as resources by looking at what the participants have succeeded in, focusing on what they can instead of what they lack to do. In general the findings indicate that it may be more important to add – that is to make use of the human beings’ own resources - instead of subtracting by looking for risks or weaknesses

The Importance of Feasibility Assessment in the Design of ctDNA Guided Trials – Results From the OPTIPAL II Study

Introduction: Both quantitative and molecular changes in ctDNA can hold important information when treating metastatic colorectal cancer (mCRC), but its clinical utility is yet to be established. Before conducting a large-scale randomized trial, it is essential to test feasibility. This study investigates whether ctDNA is feasible for detecting patients who will benefit from treatment with epidermal growth factor receptor inhibitors and the prognostic value of circulating tumor DNA (ctDNA) response. Materials and methods: Patients with mCRC, who were considered for systemic palliative treatment and were eligible for ctDNA analysis. Mutational testing on cell-free DNA (cfDNA) was done by ddPCR. ctDNA response from baseline to the third treatment cycle was evaluated in patients with detectable ctDNA at baseline. ctDNA maximum response was defined as undetectable ctDNA at the third treatment cycle, ctDNA partial response as any decrease in the ctDNA level, and ctDNA progression as any increase in the ctDNA level. Results: Forty-nine patients were included. The time to test results for mutational testing on cfDNA was significantly shorter than on tumor tissue (p &lt; .001). Progression-free survival were 11.2 months (reference group), 7.5 months (HR = 10.7, p= .02), and 4.6 months (HR = 11.4, p= .02) in patients with ctDNA maximum response, partial response, and progression, respectively. Overall survival was 31.2 months (reference group), 15.2 months (HR = 4.1, p= .03), and 9.0 months (HR = 2.6, p= .03) in patients with ctDNA maximum response, partial response, and progression, respectively. Conclusion: Pretreatment mutational testing on cfDNA in daily clinic is feasible and can be applied in randomized clinical trials evaluating the clinical utility of ctDNA. Early dynamics in ctDNA during systemic treatment hold prognostic value.</p

App-delivered self-management intervention trial selfBACK for people with low back pain: protocol for implementation and process evaluation

Background: Implementation and process evaluation is vital for understanding how interventions function in different settings, including if and why interventions have different effects or do not work at all. Objective: This paper presents the protocol for an implementation and process evaluation embedded in a multicenter randomized controlled trial conducted in Denmark and Norway (the selfBACK project). selfBACK is a data-driven decision support system that provides participants with weekly self-management plans for low back pain. These plans are delivered through a smartphone app and tailored to individual participants by using case-based reasoning methodology. In the trial, we compare selfBACK in addition to usual care with usual care alone. Methods: The aim of this study is to conduct a convergent mixed-methods implementation and process evaluation of the selfBACK app by following the reach, effectiveness, adoption, implementation, and maintenance framework. We will evaluate the process of implementing selfBACK and investigate how participants use the intervention in daily life. The evaluation will also cover the reach of the intervention, health care provider willingness to adopt it, and participant satisfaction with the intervention. We will gather quantitative measures by questionnaires and measures of data analytics on app use and perform a qualitative exploration of the implementation using semistructured interviews theoretically informed by normalization process theory. Data collection will be conducted between March 2019 and October 2020. Results: The trial opened for recruitment in February 2019. This mixed-methods implementation and evaluation study is embedded in the randomized controlled trial and will be collecting data from March 2019 to October 2020; dissemination of trial results is planned thereafter. The results from the process evaluation are expected 2021-2022. Conclusions: This study will provide a detailed understanding of how self-management of low back pain can be improved and how a digital health intervention can be used as an add-on to usual care to support patients to self-manage their low back pain. We will provide knowledge that can be used to explore the possibilities of extending the generic components of the selfBACK system and key drivers that could be of use in other conditions and diseases where self-management is an essential prevention or treatment strategy. Trial Registration: ClinicalTrials.gov NCT03798288; https://www.clinicaltrials.gov/ct2/show/NCT03798288 International Registered Report Identifier (IRRID): DERR1-10.2196/20308

Eruptive Melanocytic Nevi in the Setting of Encorafenib, Cetuximab, and Binimetinib Combination Therapy: A Case Report

Introduction: The development of new and changing melanocytic lesions has been increasingly reported as an adverse dermatologic toxicity of BRAF inhibitor therapy. Melanocytic lesions and melanomas induced by BRAF inhibitor therapy that lack BRAF V600E expression have been less commonly described. One mechanism that has been proposed for the development of BRAF inhibitor-induced melanocytic lesions, including those lacking BRAF V600E expression, is the paradoxical activation of the MAPK signaling pathway in BRAF wild-type (BRAFWT) cells. Case Presentation: Herein, we report a rare case of a 39-year-old woman who developed numerous BRAF V600E-negative eruptive melanocytic nevi following encorafenib, cetuximab, and binimetinib combination therapy, the current standard of care for the treatment of BRAF-mutant metastatic colorectal cancer. Conclusion: Patients treated with BRAF inhibitors, with or without related combination therapies, who develop BRAFWT melanocytic lesions are at risk for developing both dysplastic nevi and melanoma, thereby warranting baseline dermatoscopic evaluation prior to the initiation of therapy as well as regular follow-up during and after treatment

Mobilising community-based research on zoonotic infections: A case study of longitudinal cohorts in Vietnam

We initiated the Vietnam Initiative on Zoonotic Infections (VIZIONS) research program to better understand the epidemiology of disease transmission at the human–animal interface in Vietnamese rural communities and to integrate One Health approaches to disease surveillance. We established a longitudinal community cohort study of individuals with occupational exposure to animals, which involves concurrent targeted sampling from domestic livestock species and follow-up monitoring of human clinical cases. The project was implemented by government agencies at the provincial and district levels of the public health and animal health sectors in Vietnam. Engaging with rural communities builds response capacity at the grassroots level, and has improved dialogue between local stakeholders responsible for monitoring human and animal health. Here we describe the process of initiating participatory research and cohort field implementation over the first year in two study sites in Vietnam.Keywords: Vietnam, participatory research, zoonoses, field epidemiolog