Notes

Diabetes type 2 symptoms burden among migrants throughout European countries: unravelling the actual causal pathways.
Outliers are expected to contribute not only to heterogeneity but also to inconsistency, compromising the NMA results. The FS algorithm was applied to real and artificial networks of interventions that include outliers. We developed an R package (NMAoutlier) to allow replication and dissemination of the proposed method. We conclude that the FS algorithm is a visual diagnostic tool that helps to identify studies that are a potential source of heterogeneity and inconsistency.Cancer incidence is increasing, and cancer is a leading cause of death in the Scandinavian countries, and at the same time more efficient but very expensive new treatment options are available. Based on the increasing demand, high expectations and limited resources, crises in public legitimacy of cancer care evolved in the three Scandinavian countries. Similar cancer care reforms were introduced in the period 2007-2015 to address the crisis. In this article we explore processes triggering these reforms in countries with similar and well-developed health care systems. The common objective was the need to reduce time from referral to start treatment, and the tool introduced to accomplish this was integrated care pathways for cancer diagnosis, that is Cancer Patient Pathways. This study investigates the process by drawing on interviews with key actors and public documents. We identified three main logics in play; the economic-administrative, the medical and the patient-related logic and explored how institutional entrepreneurs skillfully aligned these logics. The article contributes by describing the triggering processes on politically initiated similar reforms in the three countries studied and also contributes to a better understanding on the orchestrating of politically initiated health care reforms with the intention to change medical practice in hospitals.
Arterial spin labeling (ASL) is a noninvasive brain perfusion magnetic resonance imaging (MRI) technique that has not been assessed in clinical veterinary medicine.

To test the feasibility of ASL using a 1.5 Tesla scanner and provide recommendations for optimal quantification of cerebral blood flow (CBF) in dogs and cats.

Three hundred fourteen prospectively selected client-owned dogs and cats.

Each animal underwent brain MRI including morphological sequences and ≥1 ASL sequences using different sites of blood labeling and postlabeling delays (PLD). Calculated ASL success rates were compared. The CBF was quantified in animals that had morphologically normal brain MRI results and parameters of ASL optimization were investigated.

Arterial spin labeling was easily implemented with an overall success rate of 95% in animals with normal brain MRI. Technical recommendations included (a) positioning of the imaging slab at the foramen magnum and (b) selected PLD of 1025 ms in cats and dogs <7kg, 1525 ms in dogs 7 to 38 kg, and 2025 ms in dogs >38 kg. In 37 dogs, median optimal CBF in the cortex and thalamic nuclei were 114 and 95 mL/100 g/min, respectively. In 28 cats, median CBF in the cortex and thalamic nuclei were 113 and 114 mL/100 g/min, respectively.

Our survey of brain perfusion ASL-MRI demonstrated the feasibility of ASL at 1.5 Tesla, suggested technical recommendations and provided CBF values that should be helpful in the characterization of various brain diseases in dogs and cats.
Our survey of brain perfusion ASL-MRI demonstrated the feasibility of ASL at 1.5 Tesla, suggested technical recommendations and provided CBF values that should be helpful in the characterization of various brain diseases in dogs and cats.
Phthalates can cause respiratory and immunological disorders. However, little is known about the role of serum periostin and YKL-40 levels in mediating the effects of phthalates. We investigated the mediating role of these biomarkers in the relationship between phthalates and airway dysfunction.

A total of 487 children (aged 10-12years old) were examined. Four high-molecular-weight phthalate (HMWP) [Σ
HMWP] metabolites and 3 low-molecular-weight phthalate (LMWP) [Σ
LMWP] metabolites in urine samples were measured. Serum periostin and YKL-40 levels were measured. Airway function was measured using impulse oscillometry. A mediation model was used to quantify the mediating effects of periostin and YKL-40 on airway dysfunction.

After adjustment for height, gender, BMI z-score, aeroallergen sensitization, secondary smoking, and vitamin D level, the level of urinary Σ
LMWP metabolites was significantly associated with respiratory system resistance at 5Hz (Rrs5; adjusted β 0.020, 95% CI 0.005-0.034; p=.010). The levels of urinary Σ
HMWP and Σ
LMWP metabolites were significantly associated with periostin level, but not with YKL-40 level. learn more In addition, the periostin level was associated with Rrs5 (adjusted β 0.048, 95% CI 0.015-0.081; p=.005) and Rrs20-5 (adjusted β 0.040, 95% CI 0.011-0.069; p=.007). Serum periostin level had a significant effect in mediating the relationship between Σ
LMWP and Rrs5 (13.9%, 95% CI 10.7-77.0; p<.001).

Exposure to LMWPs was significantly associated with airway dysfunction, and this effect was partially attributable to increased serum periostin level.
Exposure to LMWPs was significantly associated with airway dysfunction, and this effect was partially attributable to increased serum periostin level.
Health professions education (HPE) has increasingly turned to qualitative methodology to address a number of the field's difficult research problems. While several different methodologies have been widely accepted and used in HPE research (e.g., Grounded Theory), others remain largely unknown. In this methodology paper, we discuss the value of narrative analysis (NA) as a set of analytic approaches that offer several lenses that can support HPE scholars' research.

After briefly discussing the 'narrative turn' in research, we highlight five NA lenses holistic, situated, linguistic, agentive and sequential. We explore what each lens can offer HPE scholars-highlighting certain aspects of the data-and how each lens is limited-obscuring other aspects. To support these observations, we offer an example of each lens from contemporary HPE scholarship. The manuscript also describes methods that can be employed in NA research and offers two different typologies of NA methods that can be used to access these lenses.

We conclude with a discussion of how different analytic methods can be used to harness each of the lenses. We urge the deliberate selection and use of NA methods and point to the inherent partiality of any NA approach. Reflecting on our position as narrative scholars, we acknowledge how our own lenses illuminate some areas and conceal others as we tell the story of NA. In conclusion, we invite other researchers to benefit from the potential NA promises.
We conclude with a discussion of how different analytic methods can be used to harness each of the lenses. We urge the deliberate selection and use of NA methods and point to the inherent partiality of any NA approach. Reflecting on our position as narrative scholars, we acknowledge how our own lenses illuminate some areas and conceal others as we tell the story of NA. In conclusion, we invite other researchers to benefit from the potential NA promises.
The once-weekly administered glucagon-like peptide 1 (GLP-1) receptor agonist (GLP-1RA) semaglutide, has, in clinical trials, demonstrated significant reductions in glycated haemoglobin A
(HbA
) and body weight in persons with type 2 diabetes. We evaluated the real-world clinical effects of semaglutide once weekly in a hospital-based diabetes out-patient clinic.

This retrospective observational cohort study included persons with type 2 diabetes (n=119) on a broad range of antidiabetic medicine GLP-1RA naïve persons (n=37) and GLP-1RA-experienced persons (n=82). Person characteristics at inclusion age [median (quartiles)] 65 (57, 72) years; body weight 99 (86, 118) kg; body mass index (BMI) 33 (29, 38) kg/m²; HbA
61 (54, 69) mmol/mol/(7.7 (7.1, 8.5) %). Data were collected at baseline and after 3, 6 and 12months of semaglutide treatment. Data were analysed using a general linear mixed model for repeated measurements.

After 12months, the reductions in HbA
were (mean [95% confidence interval] GLP-1RA naïve -12.8 [-17.0, -8.5] mmol/mol/ -1.2 [-1.6, -0.8]% (p<0.01) and GLP-1RA experienced -6.4 [-9.0, -3.8] mmol/mol/ -0.6 [-0.8, -0.4]% (p<0.01), respectively. Body weight reductions in GLP-1RA naïve -5 [-6.9, -3.1] kg (p<0.01) and GLP-1RA experienced -3.2 [-4.4, -2.0] kg (p<0.01), respectively. Seventy-five percent received 1mg QW semaglutide.

We observed effects of semaglutide once weekly on HbA
and body weight comparable with the effects observed in clinical studies with fewer persons in our cohort receiving maximum dose of semaglutide.
We observed effects of semaglutide once weekly on HbA1c and body weight comparable with the effects observed in clinical studies with fewer persons in our cohort receiving maximum dose of semaglutide.Pulmonary angiosarcoma (PAS) is a malignant tumor of the vascular wall of mesenchymal origin. PAS is rare and has unknown etiology and poor prognosis. Depending on the location, angiosarcoma can lead to serious obstructive and embolic complications, as well as severe pulmonary hypertension and right ventricular heart failure. Patients with PAS are often mistakenly diagnosed with pulmonary embolism, chronic thromboembolic pulmonary hypertension, or lung tumors. Here, we present a clinical case of combined treatment of PAS.
Persons with dementia spend most time of their day not engaging in activities or social interactions. A care concept of a dementia special care unit that promotes activities and social interaction through a household-like design and individualised stimuli is studied.

To evaluate the main outcomes of the care concept of a dementia special care unit, namely, engagement in activities and social interactions.

We conducted an observational study as part of a theory-driven evaluation. The Maastricht Daily Life Observation Tool was used to collect momentary assessments multiple times per participant, including engagement in activity, type of activity, engagement in social interaction, interaction partners, location, agitation and mood. Thirty-three residents of the dementia special care units that implemented the care concept and 54 residents with dementia of two traditional nursing homes participated in the study, resulting in 2989momentary assessments.

Residents of both settings did not engage in activities or social interaction in approximately half of the observations. Compared to residents of traditional nursing homes, residents of special care units had a significantly higher chance for engagement in activities and social interaction in the afternoon but not in the morning or evening.

The care concept of the special care unit facilitated engagement but had its limitations. Further research is needed to develop and evaluate appropriate interventions to enhance engagement of persons with dementia.
The care concept of the special care unit facilitated engagement but had its limitations. Further research is needed to develop and evaluate appropriate interventions to enhance engagement of persons with dementia.
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