Medical and nursing students’ co-learning in digitalized health care eco-system

The demographic change in Finnish population has forced us to develop digital solutions to meet health care requirements. To respond to the need, we designed and piloted a one-day Multidisciplinary Digital Clinic (MDC) education for medical and nursing students. In this report, we describe our project of the one-day MDC education of digital solutions in primary care for medical and nursing students, and their learning experiences. Additionally, we describe the realization of the intended learning outcomes. The MDC education was conducted by flipped learning method with pre-studying materials. The MDC day was divided into three topical workshops: Remote Care, Digital Symptoms and Health care assessment, and Assessment of Need for care. Students formed three multidisciplinary teams. The students (N=108) valued the opportunity to train with modern technological equipment. Learning in the multidisciplinary teams enabled their knowledge and expertise sharing beyond study field limits, and provided a unique opportunity to discuss together, and thus, helped generate future-proof cooperation skills. The MDC training improved students' understanding of digitally enhanced health care services and increased their understanding of the automated digitalized service pathways, and the continuity of care. In conclusion, the students described MDC as a unique opportunity, and future oriented education. The MDC encouraged students to get involved in the digitally and technologically enhanced health care eco-system in their professional careers

A comparison of European surveillance programs for Campylobacter in broilers

Campylobacter is an important foodborne pathogen as it is associated with significant disease burden across Europe. Among various sources, Campylobacter infections in humans are often related to the consumption of undercooked poultry meat or improper handling of poultry meat. Many European countries have implemented measures to reduce human exposure to Campylobacter from broiler meat. In this paper, surveillance programs implemented in some European countries is summarized. Our findings reveal that many European countries test neck skin samples for Campylobacter as per the Process Hygiene Criterion (PHC) set by the European Regulation. Variations to the legal plan are seen in some countries, as in Norway and Iceland, where weekly sampling is performed during infection peak periods only, or in Iceland, where the Campylobacter limit is set at 500 CFU/g instead of 1000 CFU/g. Furthermore, northern European countries have implemented national Campylobacter surveillance plans. Denmark tests cloaca and leg skin samples at the slaughterhouses and meat samples at the retail, while Finland, Norway, and Sweden test caeca at slaughterhouses. In contrast, Iceland tests feces on farms. Iceland and Norway test flocks close to the slaughter date and when a farm tests positive, competent authority implement measures such as logistic slaughter, heat treatment or freeze the meat from these flocks. In Iceland, frozen meat is further processed prior to being put on the market. While the incidence of campylobacteriosis has declined in all European countries except France since the introduction of PHC in 2018, it is uncertain whether this decrease is due to prevalence reduction or underreporting during the COVID-19 pandemic. Future investigations with more comprehensive data, devoid of potential confounding factors, are necessary to validate this potential trend. However, it is evident that the implementation of national action plans can be successful in reducing the incidence of human campylobacteriosis, as demonstrated by Iceland

Asparaginase-Associated Pancreatitis in Acute Lymphoblastic Leukemia : Results From the NOPHO ALL2008 Treatment of Patients 1-45 Years of Age

PURPOSE Asparaginase-associated pancreatitis (AAP) is common in patients with acute lymphoblastic leukemia (ALL), but risk differences across age groups both in relation to first-time AAP and after asparaginase re-exposure have not been explored. PATIENTS AND METHODS We prospectively registered AAP (n = 168) during treatment of 2,448 consecutive ALL patients aged 1.0-45.9 years diagnosed from July 2008 to October 2018 and treated according to the Nordic Society of Pediatric Hematology and Oncology (NOPHO) ALL2008 protocol. RESULTS Compared with patients aged 1.0-9.9 years, adjusted AAP hazard ratios (HRa) were associated with higher age with almost identical HRa (1.6; 95% CI, 1.1 to 2.3; P = .02) for adolescents (10.0-17.9 years) and adults (18.0-45.9 years). The day 280 cumulative incidences of AAP were 7.0% for children (1.0-9.9 years: 95% CI, 5.4 to 8.6), 10.1% for adolescents (10.0 to 17.9 years: 95% CI, 7.0 to 13.3), and 11.0% for adults (18.0-45.9 years: 95% CI, 7.1 to 14.9; P = .03). Adolescents had increased odds of both acute (odds ratio [OR], 5.2; 95% CI, 2.1 to 13.2; P = .0005) and persisting complications (OR, 6.7; 95% CI, 2.4 to 18.4; P = .0002) compared with children (1.0-9.9 years), whereas adults had increased odds of only persisting complications (OR, 4.1; 95% CI, 1.4 to 11.8; P = .01). Fifteen of 34 asparaginase-rechallenged patients developed a second AAP. Asparaginase was truncated in 17/21 patients with AAP who subsequently developed leukemic relapse, but neither AAP nor the asparaginase truncation was associated with increased risk of relapse. CONCLUSION Older children and adults had similar AAP risk, whereas morbidity was most pronounced among adolescents. Asparaginase re-exposure should be considered only for patients with an anticipated high risk of leukemic relapse, because multiple studies strongly indicate that reduction of asparaginase treatment intensity increases the risk of relapse. (C) 2019 by American Society of Clinical OncologyPeer reviewe

Lessons from biomass planning at national and regional level in the EU

Abstract: Action plans are an important tool for meeting the EU renewable energy targets. Planning of biomass at national level has recently shifted from biomass action plans to renewable energy action plans; the latter still assigning special attention to biomass. A number of regions have also developed or are developing biomass plans. However, even though such plans are to assist the delivery of bioenergy development, the processes leading to successful implementation are not well documented. Little is known of the roles and function of these plans. This paper examines factors underlying plans and draws lessons from the planning processes that appear to support successful bioenergy development. The work presents views of actors involved in biomass planning in eleven countries and nine regions in Europe with an analytical framework employed to condense and present interview content. The analysis shows that while planning processes at both national and regional levels have encountered barriers – most of them common to policy implementation in general, but some specifi c to bioenergy policy – the national level appears to have better dealt with such barriers. Stakeholder commitment, continuity of policy, and fl exibility of planning guidelines and processes were found as some of the keys to successful implementation. While biomass plans were demonstrated to serve several roles, approaches looking beyond energy use are still limited. The work concludes that coordination of planning between jurisdictional levels needs to be strengthened and regional stimuli recognized at higher levels in order for biomass policy and planning to better achieve goals. © 2012 Society of Chemical Industry and John Wiley & Sons, LtdJRC.F.7-Renewable Energ

Pathways to deep decarbonisation in 2050: How Australia can prosper in a low carbon world

The 2014 report and the associated Technical Report elaborate on the work undertaken to prepare the Australian chapter of the DDPP 2014 report. They provide additional Australian context and technical detail about the modelling and analysis. The accompanying Technical Report provides more information on the modelling framework, assumptions and results of the sectoral analysis. The analysis presents an illustrative deep decarbonisation pathway for Australia; just one of many possible pathways, and has been developed using a combination of well-established modelling tools with a prominent role for least cost economic modelling methodologyThis report was commisioned by ClimateWorks Australi

Pathways to deep decarbonization

This report stated the key concepts of decarbonization of 15 leading economies aiming at limiting global warming by 2 degrees Celsius. The report was presented to UN Secretary-General Ban Ki-moon in support of the UN Climate Leaders' Summit in New York on September 23, 2014 and the UNFCCC COP21, where the historic Paris Climate Agreement was signed in December 2015.Don

Impact of body mass index on outcome and treatment-related toxicity in young adults with acute lymphoblastic leukemia

Background: Data on outcome for patients in different body mass index (BMI) categories in young adults with acute lymphoblastic leukemia (ALL) are scarce. We explored survival and toxicities in different BMI categories in young adults with ALL. Material and methods: Patients aged 18–45 years, diagnosed with ALL between July 2008 and June 2022 in the Nordic countries, Estonia, or Lithuania, and treated according to the NOPHO ALL2008 protocol, were retrospectively enrolled and classified into different BMI categories. Endpoints were overall survival (OS), event-free survival (EFS) and cumulative incidence of relapse as well as incidence rate ratio (IRR) of severe predefined toxic events, and treatment delays. Results: The group comprised 416 patients, of whom 234 (56%) were stratified to non-high-risk (non-HR) treatment. In the non-HR group, patients with severe obesity, BMI ≥35 kg/m2 had worse EFS due to relapses but there was no effect on toxicity or treatment delays compared with the healthy-weight patients. There was no association between BMI category and OS, overall toxicity, or treatment delays in the patients with high-risk treatment. Conclusion: Severe obesity is associated with worse EFS in young adults treated according to the non-HR arms of the NOPHO ALL2008 protocol. Poorer outcome is explained with a higher risk of relapse, possibly due to under treatment, and not caused by excess therapy-related mortality

A comparison of European surveillance programs for <i>campylobacter </i>in broilers

Campylobacter is an important foodborne pathogen as it is associated with significant disease burden across Europe. Among various sources, Campylobacter infections in humans are often related to the consumption of undercooked poultry meat or improper handling of poultry meat. Many European countries have implemented measures to reduce human exposure to Campylobacter from broiler meat. In this paper, surveillance programs implemented in some European countries is summarized. Our findings reveal that many European countries test neck skin samples for Campylobacter as per the Process Hygiene Criteria (PHC) set by the European Regulation. Variations to the legal plan are seen in some countries, as in Norway and Iceland, where weekly sampling is performed during infection peak periods only, or in Iceland, where the Campylobacter limit is set at 500 CFU/g instead of 1000 CFU/g. Furthermore, northern European countries have implemented national Campylobacter surveillance plans. Denmark tests cloaca samples at slaughterhouses and meat samples at retail, while Finland, Norway, and Sweden test ceca at slaughterhouses. In contrast, Iceland tests feces on farms. Iceland and Norway test flocks close to the slaughter date and when a farm tests positive, competent authority implement measures such as logistic slaughter, heat treatment or freeze the meat from these flocks. In Iceland, frozen meat is further processed prior to being put on the market. While the incidence of campylobacteriosis has declined in all European countries except France since the introduction of PHC in 2018, it is uncertain whether this decrease is due to prevalence reduction or underreporting during the COVID-19 pandemic. Future investigations with more comprehensive data, devoid of potential confounding factors, are necessary to validate this potential trend. However, it is evident that the implementation of national action plans can be successful in reducing the incidence of human campylobacteriosis, as demonstrated by Iceland

Thromboembolism in acute lymphoblastic leukemia: results of NOPHO ALL2008 protocol treatment in patients aged 1 to 45 years

To access publisher's full text version of this article click on the hyperlink belowThromboembolism frequently occurs during acute lymphoblastic leukemia (ALL) therapy. We prospectively registered thromboembolic events during the treatment of 1772 consecutive Nordic/Baltic patients with ALL aged 1 to 45 years who were treated according to the Nordic Society of Pediatric Hematology and Oncology ALL2008 protocol (July 2008-April 2017). The 2.5-year cumulative incidence of thromboembolism (N = 137) was 7.9% (95% confidence interval [CI], 6.6-9.1); it was higher in patients aged at least 10 years (P < .0001). Adjusted hazard ratios (HRas) were associated with greater age (range, 10.0-17.9 years: HRa, 4.9 [95% CI, 3.1-7.8; P < .0001]; 18.0-45.9 years: HRa, 6.06 [95% CI, 3.65-10.1; P < .0001]) and mediastinal mass at ALL diagnosis (HRa, 2.1; 95% CI, 1.0-4.3; P = .04). In a multiple absolute risk regression model addressing 3 thromboembolism risk factors, age at least 10 years had the largest absolute risk ratio (RRage, 4.7 [95% CI, 3.1-7.1]; RRenlarged (lymph nodes), 2.0 [95% CI, 1.2-3.1]; RRmediastinal mass, 1.6 [95% CI, 1.0-2.6]). Patients aged 18.0 to 45.9 years had an increased hazard of pulmonary embolism (HRa, 11.6; 95% CI, 4.02-33.7; P < .0001), and patients aged 10.0 to 17.9 years had an increased hazard of cerebral sinus venous thrombosis (HRa, 3.3; 95% CI, 1.5-7.3; P = .003) compared with children younger than 10.0 years. Asparaginase was truncated in 38/128 patients with thromboembolism, whereas thromboembolism diagnosis was unassociated with increased hazard of relapse (P = .6). Five deaths were attributable to thromboembolism, and patients younger than 18.0 years with thromboembolism had increased hazard of dying compared with same-aged patients without thromboembolism (both P <= .01). In conclusion, patients aged at least 10 years could be candidates for preemptive antithrombotic prophylaxis. However, the predictive value of age 10 years or older, enlarged lymph nodes, and mediastinal mass remain to be validated in another cohort.Research Foundation of Rigshospitalet (University of Copenhagen) King Christian the 10th Foundation Danish Acute Leukemia Group Krista and Viggo Petersen's Foundation Danish Childhood Cancer Foundation Danish Cancer Societ