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The purpose of the study was to investigate if differences in levels of knowledge existed between Danish and English training and specialist psychiatrists. This is important in the context of the free (and growing) movement of the medical workforce across European Union (EU) countries’ borders.
A complete balanced two-way factorial study design was used. Ten training and ten specialist psychiatrists were recruited in each country from reputable, university hospitals. They answered 50 multiple choice questions (MCQs), translated into the appropriate language, consisting of four subcategories of questions: psychology (15 MCQs), psychopharmacology (10 MCQs), neuroscience (five MCQs) and psychopathology (20 MCQs). No memory or other types of aids were allowed at the knowledge test. A two-way analysis of variance was used to analyse the total knowledge score (number of correct answers) and the component subscores. Levene’s test of equality of error variances was used to test for variance homogeneity.
There were significant differences in total knowledge and psychology knowledge by country and level of training. UK doctors scored 3.10 points higher than Danish doctors, with 95% confidence interval (0.97, 5.23). The knowledge of the specialists was also significantly superior to that of the training psychiatrists, with 2.30 higher score, 95% confidence interval (0.17, 4.43). In the sub-categories only the scores in the psychology section were significantly different. UK doctors scored 2.30 higher than Danish doctors, with 95% confidence interval (1.15, 3.45). Specialists scored 1.20 higher than non-specialists with 95% confidence interval (0.05, 2.35).
The results indicate that there is a significant difference in level of knowledge between psychiatrists in these two EU-countries, England and Denmark. This difference seemed to be chiefly the result of different knowledge of psychology. The disparity could be a result of the fundamentally different post-graduate training system in psychiatry in the two countries. Surprisingly, the differences in total knowledge and psychology knowledge between countries were larger than the differences between levels of training. The difference in knowledge is worrying taking into consideration that there is free movement of the workforce, including doctors, across the EU. The results here need further confirmation in future studies with greater numbers, more countries involved and perhaps additional measurements to MCQs.
The impact of cream processing on milk fat globule membrane (MFGM) was assessed in an industrial setting for the first time. Three creams and their derived MFGM fractions from different stages of the pasteurization procedure at a butter dairy were investigated and compared to a native control as well as a commercial MFGM fraction. The extent of cross-linking of serum proteins to MFGM proteins increased progressively with each consecutive pasteurization step. Unresolved high molecular weight aggregates were found to consist of both indigenous MFGM proteins and β-lactoglobulin as well as αs1- and β-casein. With regards to fat globule stability and in terms of resistance towards coalescence and flocculation after cream washing, single-pasteurized cream exhibited reduced sensitivity to cream washing compared to non- and double-pasteurized creams. Inactivation of the agglutination mechanism and the increased presence of non-MFGM proteins may determine this balance between stable and non-stable fat globules.
A wealth of clinical studies have identified objective biomarkers, which separate schizophrenia patients from healthy controls on a group level, but current diagnostic systems solely include clinical symptoms. In this study, we investigate if machine learning algorithms on multimodal data can serve as a framework for clinical translation.
Forty-six antipsychotic-naïve, first-episode schizophrenia patients and 58 controls underwent neurocognitive tests, electrophysiology, and magnetic resonance imaging (MRI). Patients underwent clinical assessments before and after 6 weeks of antipsychotic monotherapy with amisulpride. Nine configurations of different supervised machine learning algorithms were applied to first estimate the unimodal diagnostic accuracy, and next to estimate the multimodal diagnostic accuracy. Finally, we explored the predictability of symptom remission.
Cognitive data significantly classified patients from controls (accuracies = 60–69%; p values = 0.0001–0.009). Accuracies of electrophysiology, structural MRI, and diffusion tensor imaging did not exceed chance level. Multimodal analyses with cognition plus any combination of one or more of the remaining three modalities did not outperform cognition alone. None of the modalities predicted symptom remission.
In this multivariate and multimodal study in antipsychotic-naïve patients, only cognition significantly discriminated patients from controls, and no modality appeared to predict short-term symptom remission. Overall, these findings add to the increasing call for cognition to be included in the definition of schizophrenia. To bring about the full potential of machine learning algorithms in first-episode, antipsychotic-naïve schizophrenia patients, careful a priori variable selection based on independent data as well as inclusion of other modalities may be required.
The process of agglutination causes firm cream layers in bovine milk, and a functioning agglutination mechanism is paramount to the quality of non-homogenized milks. The phenomenon is not well-described, but it is believed to occur due to interactions between immunoglobulins (Ig) and milk fat globules. For the first time, this paper demonstrates how the process of agglutination can be visualized using confocal laser scanning microscopy, rhodamine red and a fluoresceinisothiocynat-conjugated immunoglobulin M antibody. The method was used to illustrate the effect on agglutination of storage temperature and pasteurization temperature. Storage at 5 °C resulted in clearly visible agglutination which, however, was markedly reduced at 15 °C. Increasing storage temperature to 20 or 37 °C cancelled any detectable interaction between IgM and milk fat globules, whereby the occurrence of cold agglutination was documented. Increasing 20 s pasteurization temperatures from 69 °C to 71 °C and further to 73 °C lead to progressively higher inactivation of IgM and, hence, reduction of agglutination. Furthermore, 2-dimensional sodium dodecyl sulfate polyacrylamide gel electrophoresis showed that changes in storage temperature caused a redistribution of Ig-related proteins in milk fat globule membrane isolates. Poly-immunoglobulin G receptor was present in milk fat globule preparations stored at cold (4 °C) conditions, but absent at storage at higher temperature (25 °C). The findings provide valuable knowledge to dairy producers of non-homogenized milk in deciding the right pasteurization temperature to retain the crucial agglutination mechanism.
The illegal killing and taking of wild birds remains a major threat on a global scale. However, there are few quantitative data on the species affected and countries involved. We quantified the scale and scope of this issue in Northern and Central Europe and the Caucasus, using a diverse range of data sources and incorporating expert knowledge. The issue was reported to be widespread across the region and affects almost all countries/territories assessed. We estimated that 0.4–2.1 million birds per year may be killed/taken illegally in the region. The highest estimate of illegal killing in the region was for Azerbaijan (0.2-1.0 million birds per year). Out of the 20 worst locations identified, 13 were located in the Caucasus. Birds were reported to be illegally killed/taken primarily for sport and food in the Caucasus and for sport and predator/pest control in both Northern and Central Europe. All of the 28 countries assessed are parties to the Bern Convention and 19 are also European Union Member States. There are specific initiatives under both these policy instruments to tackle this threat, yet our data showed that illegal killing and taking is still occurring and is not restricted to Mediterranean European countries. Markedly increased effort is required to ensure that existing legislation is adequately implemented and complied with/enforced on the ground. Our study also highlighted the paucity of data on illegal killing and taking of birds in the region. It is a priority, identified by relevant initiatives under the Bern Convention and the European Union, to implement systematic monitoring of illegal killing and taking and to collate robust data, allowing stakeholders to set priorities, track trends and monitor the effectiveness of responses.
Ice algae are a key component in polar marine food webs and have an active role in large-scale biogeochemical cycles. They remain extremely under-sampled due to the coarse nature of traditional point sampling methods compounded by the general logistical limitations of surveying in polar regions. This study provides a first assessment of hyperspectral imaging as an under-ice remote-sensing method to capture sea-ice algae biomass spatial variability at the ice/water interface. Ice-algal cultures were inoculated in a unique inverted sea-ice simulation tank at increasing concentrations over designated cylinder enclosures and sparsely across the ice/water interface. Hyperspectral images of the sea ice were acquired with a pushbroom sensor attaining 0.9 mm square pixel spatial resolution for three different spectral resolutions (1.7, 3.4, 6.7 nm). Image analysis revealed biomass distribution matching the inoculated chlorophyll a concentrations within each cylinder. While spectral resolutions >6 nm hindered biomass differentiation, 1.7 and 3.4 nm were able to resolve spatial variation in ice algal biomass implying a coherent sensor selection. The inverted ice tank provided a suitable sea-ice analogue platform for testing key parameters of the methodology. The results highlight the potential of hyperspectral imaging to capture sea-ice algal biomass variability at unprecedented scales in a non-invasive way.
Background: In a previous effectiveness study (Havnen et al., 2014), 35 obsessive compulsive disorder (OCD) patients underwent Concentrated Exposure Treatment (cET), which is a newly developed group treatment format delivered over four consecutive days. Aims: The primary aims of the present study were to evaluate the treatment results for a new sample of OCD patients receiving the cET treatment approach and to replicate the effectiveness study described in Havnen et al. (2014). Method: Forty-two OCD patients underwent cET treatment. Treatment was delivered by different therapists than in Havnen et al. (2014), except for two groups led by the developers of the treatment. Assessments of OCD symptom severity, treatment satisfaction, and occupational impairment were included. Results: The results showed a significant reduction in Yale-Brown Obsessive Compulsive Scale scores from pre-treatment to post-treatment, which was maintained at 6-month follow-up. At post-treatment, 74% of the sample was remitted; at 6-month follow-up, 60% were recovered. The sample showed a very high degree of overall treatment satisfaction. The results from the present study were statistically compared with those obtained in the previous study. The analyses showed that the study samples had comparable demographic data and equal application of treatment. The outcome of the present and original study did not differ significantly on primary and secondary outcome measures. Conclusions: This study shows that cET was successfully replicated in a new patient sample treated by different therapists than the original study. The results indicate that cET is well accepted by the patients, and the potential for dissemination is discussed.
This study investigates the determinants of the fertility transition in the United States from 1850 to the end of the 20th century. We find a robust negative relation between years of schooling and fertility. The magnitude of our baseline estimate suggests that the rise in schooling accounts for about 60% of the US fertility decline. In contrast, we find no evidence of a robust relation between income per capita and fertility. This pattern corroborates theories stressing the importance of human capital investments in generating a transition from high to low fertility.
DHA from diet or endogenous synthesis has been proposed to affect infant development, however, results are inconclusive. In this study, we aim to verify previously observed fatty acid desaturase gene cluster (FADS) SNP-specific associations with erythrocyte DHA status in 9-month-old children and sex-specific association with developmental outcomes. The study was performed in 166 children (55 % boys) of obese mothers. Erythrocyte fatty acid composition was analysed in blood-samples obtained at 9 months of age, and developmental outcomes assessed by the Ages and Stages Questionnaire at 3 years. Erythrocyte DHA level ranged from 4·4 to 9·9 % of fatty acids, but did not show any association with FADS SNP or other potential determinants. Regression analysis showed associations between erythrocyte DHA and scores for personal–social skills (β 1·8 (95 % CI 0·3, 3·3), P=0·019) and problem solving (β 3·4 (95 % CI 1·2, 5·6), P=0·003). A tendency was observed for an association in opposite direction between minor alleles (G-variant) of rs1535 and rs174575 and personal–social skills (P=0·062 and 0·068, respectively), which became significant when the SNP were combined based on their previously observed effect on erythrocyte DHA at 9 months of age (β 2·6 (95 % CI 0·01, 5·1), P=0·011). Sex–SNP interaction was indicated for rs174575 genotype on fine motor scores (P=0·016), due to higher scores among minor allele carrying girls (P=0·043), whereas no effect was seen among boys. In conclusion, DHA-increasing FADS SNP and erythrocyte DHA status were consistently associated with improved personal–social skills in this small cohort of children of obese mothers irrespective of sex, but the sample was too small to verify potential sex-specific effects.
Previous studies have suggested that the intake of trans-fatty acids (TFA) plays a role in the development of obesity. The proportions of adipose tissue fatty acids not synthesised endogenously in humans, such as TFA, usually correlate well with the dietary intake. Hence, the use of these biomarkers may provide a more accurate measure of habitual TFA intake than that obtained with dietary questionnaires. The objective of the present study was to investigate the associations between the proportions of specific TFA in adipose tissue and subsequent changes in weight and waist circumference (WC). The relative content of fatty acids in adipose tissue biopsies from a random sample of 996 men and women aged 50–64 years drawn from a Danish cohort study was determined by GC. Baseline data on weight, WC and potential confounders were available together with information on weight and WC 5 years after enrolment. The exposure measures were total trans-octadecenoic acids (18 : 1t), 18 : 1 Δ6-10t, vaccenic acid (18 : 1 Δ11t) and rumenic acid (18 : 2 Δ9c, 11t). Data were analysed using multiple regression with cubic spline modelling. The median proportion of total adipose tissue 18 : 1t was 1·52 % (90 % central range 0·98, 2·19) in men and 1·47 % (1·01, 2·19) in women. No significant associations were observed between the proportions of total 18 : 1t, 18 : 1 Δ6-10t, vaccenic acid or rumenic acid and changes in weight or WC. The present study suggests that the proportions of specific TFA in adipose tissue are not associated with subsequent changes in weight or WC within the exposure range observed in this population.
This essay will highlight the position, capabilities and options of married women, according to Norwegian medieval law, regarding their control of property. Women's control and disposal of property during marriage were conditioned and influenced by a long series of factors - pertaining not only to legal regulations of different kinds but also to a broad field of interests, involving several actors and relations, such as the relationship between spouses themselves, the relationship to direct, lineal descendants, and the relationship between the conjugal couple and their kin groups on both sides. In order to evaluate the capabilities of married women in controlling property, and the possible strategies they employed, this wider ‘space of action’ must be taken into consideration.
The position of married women in controlling property will be discussed on the basis of the legal situation drawn up by the first nation-wide law codex encompassing the whole medieval Norwegian monarchy, which was established by king Magnus the lawmender in 1274. In contrast to the former provincial laws, this National Law Code introduced new principles for women's access to inheritance, thus influencing greatly women's options for acquiring control over property. However, as many of the regulations in this law related to principles that had been introduced into the provincial laws during the two preceding centuries, a short overview of previous developments is needed. This concerns above all the principles and conditions for contracting a valid marriage, the introduction and successive curtailment of marriage prohibitions according to canon law, and the rules regulating property transactions and exchange of gifts by contracting marriage.
There has been a tendency in scholarship on premodern women and the law to see married women as hidden from view, obscured by their husbands in legal records. This volume provides a corrective view, arguing that the extent to which the legal principle of 'coverture' applied has been over-emphasized. In particular, it points up differences between the English common law position, which gave husbands guardianship over their wives and their wives' property, and the position elsewhere in northwest Europe, where wives' property became part of a community of property. Detailed studies of legal material from medieval and early modern England, Wales, Scotland, Ireland, Ghent, Sweden, Norway and Germany enable a better sense of how, when, and where the legal principle of 'coverture' was applied and what effect this had on the lives of married women. Key threads running through the book are married women's rights regarding the possession of moveable and immovable property, marital property at the dissolution of marriage, married women's capacity to act as agents of their husbands and households in transacting business, and married women's interactions with the courts. Cordelia Beattie is Senior Lecturer in Medieval History at the University of Edinburgh; Matthew Frank Stevens is Lecturer in Medieval History at Swansea University. Contributors: Lars Ivar Hansen, Shennan Hutton, Lizabeth Johnson, Gillian Kenny, Mia Korpiola, Miriam Muller, S. C. Ogilvie, Alexandra Shepard, Cathryn Spence.