Public comprehension of medical terminology

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenThe quality of doctor-patient communication is critical for the practice of medicine. Studies show that effective communication results in patient satisfaction and improved compliance. To better understand one aspect of this complex phenomenon we estimated the ability of people to comprehend 11 commonly used medical terms. We used multiple choice questions in a telephone survey of 1167 Icelanders aged 16-75 years. Results (% of participants with correct answers): Gastroesophageal reflux (72), emphysema (25), steroids (40), one tablet twice a day (79), side effects (67), bronchitis (68), white blood cells (56), erythrocyte sedimentation rate (33), diabetes mellitus (72), antibiotics (87), chronic obstructive pulmonary disease (42). Variables associated with better comprehension were: Female gender (better in 7/10 questions), university degree (10/10) and high income (9/10). Decision tree analysis showed that education had the most impact. The youngest participants (age 16-24) had the worst outcome in seven out of 10 questions. The results define certain medical terms that require more careful explanation than others. They also indicate that those of young age, low socioeconomic status and less educated require more help in understanding medical terms. Interestingly, 21% of participants failed to understand a very simple medication order, emphasizing the importance of explaining these in detail. The data may also have implications for informed consent. A larger study exploring the public comprehension of multiple medical terms should be considered.Samskipti lækna og sjúklinga eru afar mikilvæg. Rannsóknir sýna að fræðsla bætir líðan sjúklinga. Einnig er talið að mörg kærumál á hendur heilbrigðisstarfsmönnum byggist á misskilningi. Útskýringar þurfa að vera vandaðar og skilningur góður til að unnt sé að efla fræðslu og forðast misskilning. Til þess að byrja að kanna þetta flókna samspil rannsökuðum við skilning almennings á 11 orðum úr læknisfræði. Við notuðum símakönnun og lögðum fjölvalsspurningar fyrir 1167 Íslendinga á aldrinum 16-75 ára. Niðurstöður (% þátttakenda með rétt svar): Bakflæði (72), lungnaþemba (25), sterar (40), ein tafla tvisvar á dag (79), aukaverkanir (67), berkjubólga (68), hvít blóðkorn (56), sökk (33), sykursýki (87), langvinn lungnateppa (42). Þættir sem bættu árangur í könnuninni voru: Kyn (konur betri í sjö af tíu spurningum), háskólamenntun (10/10), háar tekjur (9/10). Fjölbreytugreining sýndi að menntun vó þyngst af þessum þáttum. Yngstu þátttakendurnir (16-24 ára) stóðu sig verst í sjö spurningum af tíu. Nýta má niðurstöðurnar til þess að útskýra sérstaklega vel þau orð sem illa skiljast og verja meiri tíma til fræðslu ungs fólks, tekjulágra og lítt skólagenginna. Huga þarf sérstaklega vel að lyfjafyrirmælum þar sem 21% fólks skilur ekki einföldustu fyrirmæli af þessu tagi. Niðurstöðurnar geta einnig nýst til þess að bæta upplýst samþykki. Gera þarf viðameiri rannsókn á því hvernig fólki gengur að skilja algeng orð úr læknisfræði

Deep vein thrombosis incidence at Akureyri Hospital, Iceland 1975-1990. Long term prognosis

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenObjective: To evaluate the incidence of deep vein thrombosis (DVT) in a rural area of Iceland and the prevalence of post thrombotic syndrome (PTS) in patients with history of DVT. Material and methods: A retrospective study where all phlebographies (n=177) performed at the department of radiology, Akureyri Hospital, during the period 1975-1990 were re-evaluated. Information on patients with DVT (n=32) were taken both from the Hospital and the Health Center records. All patients alive in December 1997 (n=17), 10.5 years after the diagnosis of DVT were interviewed concerning PTS. Results: The incidence of DVT during the period 1975-1990 was 1/10,000 inhabitants/year, but was 2.3/10,000/ year for the period 1986-1996. The mean age was 60 years and 62% of the patients were males. In 37.5% cases DVT was localized below the popliteal vein, in another 34.4% below the inguinal ligament and 28.1% of the thrombosis extended to the pelvic vein system. Of the patients 23.3% had a history of malignancy and 20% had undergone a major operation or had trauma. Of the patients 46.7% were smokers. At 10.5 years follow-up, 71% of the patients had some problems due to PTS, and these symptoms influenced significantly their quality of daily life. Conclusions: The prevalence of DVT in Iceland seems to be only half of what foreign studies suggest and patients with history of DVT suffer frequently from PTS 10 years after the DVT. These data indicate that it is necessary to improve the long term treatment of patients with history of DVT.Tilgangur: Að kanna tíðni segamyndunar í djúpum bláæðum ganglima (deep vein thrombosis, DVT), staðsetningu þeirra og langtímahorfur þessa sjúklingahóps með tilliti til eftirsegakvilla (post thrombotic syndrome, PTS). Efniviður og aðferðir: Rannsóknin var afturskyggn. Farið var í dagbækur röntgendeildar Fjórðungssjúkrahússins á Akureyri (FSA) og teknar út allar skráðar bláæðamyndatökur (phlebography) frá upphafi og þær endurskoðaðar með tilliti til segamyndunar í ganglimum. Fengnar voru upplýsingar úr sjúkraskrám sjúklinga með staðfesta segamyndun í ganglimum. Einnig voru greiningarskrár allra legudeilda FSA kannaðar og fundnir þeir einstaklingar sem greindust með segamyndun í ganglimum án bláæðamyndatöku. Tekin voru símaviðtöl við alla eftirlifandi sjúklinga og þeir spurðir um einkenni eftirsegakvilla. Dánarorsakir látinna voru fengnar frá Hagstofu Íslands. Niðurstöður: Árin 1975-1990 var heildarfjöldi bláæðamyndataka 177, eða 6,0 rannsóknir á 10.000 íbúa á ári, þar af 128 vegna gruns um segamyndun í ganglimum. Í 32 tilfellum reyndist vera merki um segamyndun hjá 30 einstaklingum. Nýgengi segamyndunar í ganglimum var á tímabilinu 1,0 á 10.000 íbúa á ári, en fyrir tímabilið 1986-1996 var það hærra eða 2,3 á 10.000 íbúa á ári. Meðalaldur var 60 ár. Karlar voru 62%. Frá lyflækningadeild komu 80,1% sjúklinganna. Í 37,5% tilfella reyndist segamyndunin einskorðast við kálfa, hjá 34,4% náði hún upp í læri en hjá 28,1% upp í kviðarhol. Krabbamein höfðu 23,3% sjúklinganna, 13,3% höfðu sögu um nýlegar skurðaðgerðir og 6,7% um áverka. Af sjúklingunum reyktu 46,7%. Nær allir fengu hefðbundna meðferð með blóðþynningu. Rúmum 10 árum eftir greiningu segamyndunar í ganglimum reyndust 71% hafa einhver einkenni um eftirsegakvilla. Í árslok 1997 voru 40% sjúklinganna látnir og var krabbamein algengasta dánarorsökin. Ályktanir: Samkvæmt þessari rannnsókn er tíðni segamyndunar í ganglimum að minnsta kosti helmingi lægri hér á landi en erlendar rannsóknir sýna. Það skýrist aðeins að hluta til af því að á upphafsdögum bláæðamyndataka var enn töluvert um klínískar greiningar. Stór hluti sjúklinganna hafði krabbamein og því aukna áhættu á segamyndun og reyndist krabbamein tíðari dánarorsök hjá þessum sjúklingum en almennt er. Margir hafa veruleg einkenni eftirsegakvilla áratug eftir greiningu segamyndunar í ganglimum sem bendir til að bæta þurfi eftirmeðferð þeirra sem fá sjúkdóminn

Using scale-derived estimates of body size in analyses of Atlantic salmon life-history variation: a cautionary note

Measurements of individual body length at different life stages are critical in understanding fish ecology and evolution. Such data can be obtained via back-calculation from measurements of fish scales or by using the size of the scale as a direct proxy for body length. Using data from Atlantic salmon, we test key assumptions associated with each approach and their implications for investigating how variation in growth earlier in life is associated with age at maturity. The scaling of scale size approximated isometry and was similar among individuals who matured at different ages——validating a key assumption of back-calculation. However, we observed that individuals genetically predisposed to delay maturation have smaller scales for their body size——challenging a key assumption of the “direct scale-size” approach. Depending on the method of body length estimation, the relationship between body length growth earlier in life and age at maturity was observed to differ. Thus, when using scale material to study the relationship between growth and maturation in salmon, we recommend back-calculation and an assumed allometric scaling coefficient. scalimetry, scale reading, scale radius, body size, vgll3, six6publishedVersio

Large-effect loci mediate rapid adaptation of salmon body size after river regulation

Understanding the potential of natural populations to adapt to altered environments is becoming increasingly relevant in evolutionary research. Currently, our understanding of adaptation to human alteration of the environment is hampered by lack of knowledge on the genetic basis of traits, lack of time series, and little or no information on changes in optimal trait values. Here, we used time series data spanning nearly a century to investigate how the body mass of Atlantic salmon (Salmo salar) adapts to river regulation. We found that the change in body mass followed the change in waterflow, both decreasing to ∼1/3 of their original values. Allele frequency changes at two loci in the regions of vgll3 and six6 predicted more than 80% of the observed body mass reduction. Modeling the adaptive dynamics revealed that the population mean lagged behind its optimum before catching up approximately six salmon generations after the initial waterflow reduction. Our results demonstrate rapid adaptation mediated by large-effect loci and provide insight into the temporal dynamics of evolutionary rescue following human disturbance.publishedVersio

Iteroparity and its contribution to life-history variation in Atlantic salmon

Evolution of iteroparity is shaped by the trade-off between current and future reproduction.We studied variation in iteroparity among 205 050 individual Atlantic salmon caught in 179 rivers spanning 14◦ of latitude. The proportion of repeat spawners (iteroparous individuals) averaged 3.8% and ranged from 0% to 26% across rivers. Females were more often repeat spawners than males and had lower cost of reproduction in terms of lost body mass between spawning events. Proportion of repeat spawners for a given sea age at maturity, and the ratio of alternate to consecutive repeat spawners, increased with increasing population mean sea age at maturity. By combining smolt age, sea age at maturity, and age at additional spawning events, we identified 141 unique life-history types, and repeat spawners contributed 75% of that variation. Our results show that repeat spawners are important for life-history variation and suggest that the association between mean sea age and the frequency of repeat spawning is adaptive rather than a pleiotropic side effect arising from selection on sea age. age at maturity, life-history evolution, local adaptation, repeat spawning, trade-offpublishedVersio

Pixel classification methods for identifying and quantifying leaf surface injury from digital images

Plants exposed to stress due to pollution, disease or nutrient deficiency often develop visible symptoms on leaves such as spots, colour changes and necrotic regions. Early symptom detection is important for precision agriculture, environmental monitoring using bio-indicators and quality assessment of leafy vegetables. Leaf injury is usually assessed by visual inspection, which is labour-intensive and to a consid- erable extent subjective. In this study, methods for classifying individual pixels as healthy or injured from images of clover leaves exposed to the air pollutant ozone were tested and compared. RGB images of the leaves were acquired under controlled conditions in a laboratory using a standard digital SLR camera. Different feature vectors were extracted from the images by including different colour and texture (spa- tial) information. Four approaches to classification were evaluated: (1) Fit to a Pattern Multivariate Image Analysis (FPM) combined with T2 statistics (FPM-T2) or (2) Residual Sum of Squares statistics (FPM-RSS), (3) linear discriminant analysis (LDA) and (4) K-means clustering. The predicted leaf pixel classifications were trained from and compared to manually segmented images to evaluate classification performance. The LDA classifier outperformed the three other approaches in pixel identification with significantly higher accuracy, precision, true positive rate and F-score and significantly lower false positive rate and computation time. A feature vector of single pixel colour channel intensities was sufficient for capturing the information relevant for pixel identification. Including neighbourhood pixel information in the feature vector did not improve performance, but significantly increased the computation time. The LDA classifier was robust with 95% mean accuracy, 83% mean true positive rate and 2% mean false positive rate, indicating that it has potential for real-time applications.Opstad Kruse, OM.; Prats Montalbán, JM.; Indahl, UG.; Kvaal, K.; Ferrer Riquelme, AJ.; Futsaether, CM. (2014). Pixel classification methods for identifying and quantifying leaf surface injury from digital images. Computers and Electronics in Agriculture. 108:155-165. doi:10.1016/j.compag.2014.07.010S15516510

Prognostic Value of Secretoneurin in Critically Ill Patients With Infections.

OBJECTIVES Secretoneurin is produced in neuroendocrine cells, and the myocardium and circulating secretoneurin levels provide incremental prognostic information to established risk indices in cardiovascular disease. As myocardial dysfunction contributes to poor outcome in critically ill patients, we wanted to assess the prognostic value of secretoneurin in two cohorts of critically ill patients with infections. DESIGN Two prospective, observational studies. SETTING Twenty-four and twenty-five ICUs in Finland. PATIENTS A total of 232 patients with severe sepsis (cohort #1) and 94 patients with infections and respiratory failure (cohort #2). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We measured secretoneurin levels by radioimmunoassay in samples obtained early after ICU admission and compared secretoneurin with other risk indices. In patients with severe sepsis, admission secretoneurin levels (logarithmically transformed) were associated with hospital mortality (odds ratio, 3.17 [95% CI, 1.12-9.00]; p = 0.030) and shock during the hospitalization (odds ratio, 2.17 [1.06-4.46]; p = 0.034) in analyses that adjusted for other risk factors available on ICU admission. Adding secretoneurin levels to age, which was also associated with hospital mortality in the multivariate model, improved the risk prediction as assessed by the category-free net reclassification index: 0.35 (95% CI, 0.06-0.64) (p = 0.02). In contrast, N-terminal pro-B-type natriuretic peptide levels were not associated with mortality in the multivariate model that included secretoneurin measurements, and N-terminal pro-B-type natriuretic peptide did not improve patient classification on top of age. Secretoneurin levels were also associated with hospital mortality after adjusting for other risk factors and improved patient classification in cohort #2. In both cohorts, the optimal cutoff for secretoneurin levels at ICU admission to predict hospital mortality was ≈ 175 pmol/L, and higher levels were associated with mortality also when adjusting for Simplified Acute Physiology Score II and Sequential Organ Failure Assessment scores. CONCLUSIONS Secretoneurin levels provide incremental information to established risk indices for the prediction of mortality and shock in critically ill patients with severe infections

Expanding the Versatility of Phage Display II: Improved Affinity Selection of Folded Domains on Protein VII and IX of the Filamentous Phage

Background: Phage display is a leading technology for selection of binders with affinity for specific target molecules. Polypeptides are normally displayed as fusions to the major coat protein VIII (pVIII) or the minor coat protein III (pIII). Whereas pVIII display suffers from drawbacks such as heterogeneity in display levels and polypeptide fusion size limitations, toxicity and infection interference effects have been described for pIII display. Thus, display on other coat proteins such as pVII or pIX might be more attractive. Neither pVII nor pIX display have gained widespread use or been characterized in detail like pIII and pVIII display. Methodology/Principal Findings: Here we present a side-by-side comparison of display on pIII with display on pVII and pIX. Polypeptides of interest (POIs) are fused to pVII or pIX. The N-terminal periplasmic signal sequence, which is required for phage integration of pIII and pVIII and that has been added to pVII and pIX in earlier studies, is omitted altogether. Although the POI display level on pIII is higher than on pVII and pIX, affinity selection with pVII and pIX display libraries is shown to be particularly efficient. Conclusions/Significance: Display through pVII and/or pIX represent platforms with characteristics that differ from those of the pIII platform. We have explored this to increase the performance and expand the use of phage display. In the paper, we describe effective affinity selection of folded domains displayed on pVII or pIX. This makes both platforms more attractive alternatives to conventional pIII and pVIII display than they were before. © 2011 Wälchli et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

Redningsaksjon for Vossolaksen 2010-2020 -status per 2021

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Redningsaksjon for Vossolaksen 2010-2020 -status per 2021

Målet for redningsaksjonen er å reetablere Vossolaksen som en selvreproduserende og høstbar bestand som ikke er genetisk påvirket av rømt oppdrettslaks. Med grunnlag i en omfattende dokumentasjon av bestandssituasjon og trusselfaktorer tok miljøforvaltningen i 2010 initiativ til en redningsaksjon for Vossolaksen i perioden 2010-2020. Prosjektet har vært gjennomført som et samarbeid mellom forskning, forvaltning, lokale interessenter og flere næringsaktører, spesielt fiskeoppdrettsnæringen gjennom Vossolauget og kraftprodusenten Eviny (BKK). Et første tiltak var å bygge opp gytebestanden ved å sette ut smolt produsert ved Voss klekkeri med opphav fra genbanken. Dette fungerte forutsatt at smolten ble slept ut fjordene i en tank eller merd før slipp. Laks som returnerte fra disse slepene sikret at gytebestandsmålet ble nådd i minst 8 av årene i perioden 2011-2021. Dette har ført til økt gyting, økte tettheter av ungfisk og økt antall utvandrende smolt fra og med årene 2014/2015. Det viktigste målet for redningsaksjonen var at gytebestandsmålet skulle nås med naturlig rekruttert laks innen 2020 dvs. uten bruk av bidrag fra kultivert smolt slept ut fjordene. Resultatene tilsier at ca. 25 til 50 % av denne målsettingen er oppnådd de siste fem årene (2017-2021). Gytebestandsmålet for naturlig rekruttert laks er derfor ikke nådd. Kraftproduksjon og andre inngrep i vassdraget påvirker bestanden. De bidrar til redusert produksjon av laksesmolt, men ser ikke ut til å ha et omfang som kan være til hinder for å reetablere laksestammen. Estimatene tilsier at det årlig vandrer ut minst 30000 smolt fra Vossovassdraget. En forholdsvis lav sjøoverlevelse på cirka 3 prosent ville være nok til å sikre gytebestandsmålet. Resultatene viser imidlertid at den reelle sjøoverlevelsen for smolt som vandrer ut fra Vossovassdraget er unormalt lav, dvs. rundt 1 % eller lavere. Lav sjøoverlevelse er også dokumentert for naboelvene Daleelva, Ekso og Modalselva. Mye smolt blir spist av annen fisk under smoltutvandringen i vassdraget og særlig i innsjøene (Vangsvatnet og Evangervatnet), men også på strekningen Bolstadfjorden-Straume. I hvor stor grad denne predasjonen avviker fra en naturlig tilstand er usikkert. Predasjon er en velkjent og naturlig årsak til tap av laksesmolt. Denne problemstillingen vil bli nærmere belyst i et pågående prosjekt finansiert av Norges Forskningsråd. Når smolten har forlatt vassdraget venter en stor utfordring i form av en kompleks fjordvandring med mulig samvirkende effekter av predasjon, aluminium (forsuring) og lakselus. En langtidsserie basert på 88 forsøksgrupper i årene 2000-2019 viser at laksesmolt som gis fôr som beskytter mot lakselus har en større gjenfangst som voksne laks, men at denne effekten har blitt svakere over tid. Dette skyldes mest sannsynlig resistensutvikling hos lusen. Samtidig har man siden 2009 funnet en klar sammenheng mellom lusetrykk målt som antall lus på sjøaure ved Herdla og hvor mange voksne laks som gjenfanges fra forsøksgruppene. Samlet peker disse forsøkene på et klart behov for å redusere lusemengden i smoltens utvandringsrute for å lykkes med reetableringsarbeidet. Etter at slepene som planlagt opphørte fra og med 2020 vil bidraget fra klekkerismolt fases ut. Dette er nødvendig for å reetablere en naturlig gytende laksebestand. Målet er at Vossolaksen vil tilpasses de naturgitte forholdene ved naturlig seleksjon gjennom hele livssyklusen og er vanlig framgangsmåte når en laksestamme skal reetableres i naturen. For at strategien skal lykkes viser resultatene et klart behov for mer effektive tiltak rettet mot lakselus. Genetiske undersøkninger viser at laksebestanden i Vossovassdraget og omkringliggende bestander er sterkt påvirket av innkrysning av rømt oppdrettslaks. For å sikre en sterk og levedyktig bestand vil det være viktig å forhindre ytterligere påvirkning fra rømt oppdrettslaks. Tiltak for å unngå rømming og å ta ut rømt oppdrettslaks fra bestanden vil være viktig. Laksebestandene i regionen er genetisk forskjellige, men både innkrysning av rømt oppdrettslaks og utsetting av kultivert fisk kan føre til unaturlig stor genetisk utveksling og bryte ned lokal genetisk tilpasning. I senere år har det blitt benyttet molekylærgenetiske metoder for å estimere effektivt antall gytelaks i Vossovassdraget og denne metoden sammen med estimat av innkrysning av rømt oppdrettslaks vil være nyttige verktøy for å overvåke bestandsutviklingen. I tillegg til å redusere effektene av lakselus og rømt fisk, er det behov for tiltak både i vassdraget og i fjordene som kan øke antallet smolt som forlater vassdraget, og klarer vandringen ut til beiteområdene i havet. Foreliggende kunnskapsstatus gir et godt faglig grunnlag for prioriteringer og gjennomføring av tiltak for å sikre Vossolaksen.publishedVersio