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Mussio I, Chilton S, Duxbury D, Nielsen JS. A risk-risk trade-off assessment of climate-induced mortality risk changes. Risk Anal 2024; 44:536-552. [PMID: 37438942 DOI: 10.1111/risa.14185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 05/30/2023] [Accepted: 06/09/2023] [Indexed: 07/14/2023]
Abstract
The impact of climate change on human health was identified as a priority for the UN COP26 conference. In this article, we consider climate-induced changes to mortality risks and how to incorporate these formally in the policy appraisal process. In the United Kingdom (UK), the Value of Statistical Life (VSL) is used to monetarize the benefits of policies to reduce mortality risks but it remains an open, empirical question as to whether the current VSL (£2.14 million per fatality prevented, December 2021 values) for traffic accidents should be applied in other contexts without any modification and particularly for extreme weather event fatalities. Using a representative sample of the UK population, we aim to estimate and better understand the trade-offs people make when comparing mortality risks, drawing on psychological insights from construal level and regulatory focus theories. We design a stated preference survey using a relative valuation framework with nonmonetary, risk-risk trade-off questions between extreme weather event and traffic accident mortality risks. We find evidence of an extreme weather event risk premium of 1.2-1.6 (implying a climate-related VSL of £2.52-£3.41 million). We also find that participants who are psychologically close to climate change (based on construal level theory), weigh reducing extreme weather event mortality risks almost two times that of reducing traffic accident mortality risks.
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Affiliation(s)
- Irene Mussio
- Newcastle University Business School, Newcastle upon Tyne, UK
| | - Susan Chilton
- Newcastle University Business School, Newcastle upon Tyne, UK
| | - Darren Duxbury
- Newcastle University Business School, Newcastle upon Tyne, UK
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2
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Nielsen JS, Gyrd-Hansen D, Kjaer T. Sample restrictions and the elicitation of a constant willingness to pay per quality adjusted life year. Health Econ 2021; 30:923-931. [PMID: 33569834 DOI: 10.1002/hec.4236] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 01/04/2021] [Accepted: 01/14/2021] [Indexed: 06/12/2023]
Abstract
It is well established that the underlying theoretical assumptions needed to obtain a constant proportional trade-off between a quality adjusted life year (QALY) and willingness to pay (WTP) are restrictive and often empirically violated. In this paper, we set out to investigate whether the proportionality conditions (in terms of scope insensitivity and severity independence) can be satisfied when data is restricted to include only respondents who pass certain consistency criteria. We hypothesize that the more we restrict the data, the better the compliance with the requirement of constant proportional trade-off between WTP and QALY. We revisit the Danish data from the European Value of a QALY survey eliciting individual WTP for a QALY (WTP-Q). Using a "chained approach" respondents were first asked to value a specified health state using the standard gamble (SG) or the time-trade-off (TTO) approach and subsequently asked their WTP for QALY gains of 0.05 and 0.1 (tailored according to the respondent's SG/TTO valuation). Analyzing the impact of the different exclusion criteria on the two proportionality conditions, we find strong evidence against a constant WTP-Q. Restricting our data to include only respondents who pass the most stringent consistency criteria does not impact on the performance of the proportionality conditions for WTP-Q.
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Affiliation(s)
| | - Dorte Gyrd-Hansen
- DaCHE, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Trine Kjaer
- DaCHE, Department of Public Health, University of Southern Denmark, Odense, Denmark
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Gylfadottir SS, Itani M, Krøigård T, Kristensen AG, Christensen DH, Nicolaisen SK, Karlsson P, Callaghan BC, Bennett DL, Andersen H, Tankisi H, Nielsen JS, Andersen NT, Jensen TS, Thomsen RW, Sindrup SH, Finnerup NB. Diagnosis and prevalence of diabetic polyneuropathy: a cross-sectional study of Danish patients with type 2 diabetes. Eur J Neurol 2020; 27:2575-2585. [PMID: 32909392 DOI: 10.1111/ene.14469] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 07/29/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND PURPOSE Diabetic polyneuropathy (DPN) is a common complication of diabetes. Using the Toronto criteria for diabetic polyneuropathy and the grading system for neuropathic pain, the performance of neuropathy scales and questionnaires were assessed by comparing them to a clinical gold standard diagnosis of DPN and painful DPN in a cohort of patients with recently diagnosed type 2 diabetes. METHODS A questionnaire on neuropathy and pain was sent to a cohort of 5514 Danish type 2 diabetes patients. A sample of 389 patients underwent a detailed clinical examination and completed neuropathy questionnaires and scales. RESULTS Of the 389 patients with a median diabetes duration of 5.9 years, 126 had definite DPN (including 53 with painful DPN), 88 had probable DPN and 53 had possible DPN. There were 49 patients with other causes of polyneuropathy, neuropathy symptoms or pain, 10 with subclinical DPN and 63 without DPN. The sensitivity of the Michigan Neuropathy Screening Instrument questionnaire to detect DPN was 25.7% and the specificity 84.6%. The sensitivity of the Toronto Clinical Neuropathy Scoring System, including questionnaire and clinical examination, was 62.9% and the specificity was 74.6%. CONCLUSIONS Diabetic polyneuropathy affects approximately one in five Danish patients with recently diagnosed type 2 diabetes but neuropathic pain is not as common as previously reported. Neuropathy scales with clinical examination perform better compared with questionnaires alone, but better scales are needed for future epidemiological studies.
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Affiliation(s)
- S S Gylfadottir
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - M Itani
- Department of Neurology, Odense University Hospital, Odense, Denmark
| | - T Krøigård
- Department of Neurology, Odense University Hospital, Odense, Denmark
| | - A G Kristensen
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark
| | - D H Christensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - S K Nicolaisen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - P Karlsson
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Core Center for Molecular Morphology, Section for Stereology and Microscopy, Aarhus University, Aarhus, Denmark
| | - B C Callaghan
- Department of Neurology, University of Michigan, Ann Arbor,, MI, USA
| | - D L Bennett
- Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK
| | - H Andersen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - H Tankisi
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark
| | - J S Nielsen
- Danish Centre for Strategic Research in Type 2 Diabetes, Steno Diabetes Center, Odense, Denmark
| | - N T Andersen
- Biostatistics, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - T S Jensen
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - R W Thomsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - S H Sindrup
- Department of Neurology, Odense University Hospital, Odense, Denmark
| | - N B Finnerup
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
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Chilton S, Nielsen JS, Wildman J. Beyond COVID-19: How the 'dismal science' can prepare us for the future. Health Econ 2020; 29:851-853. [PMID: 32488905 PMCID: PMC7300804 DOI: 10.1002/hec.4114] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/13/2020] [Indexed: 05/18/2023]
Affiliation(s)
- Susan Chilton
- Newcastle University Business SchoolNewcastle UniversityNewcastle upon TyneUK
| | | | - John Wildman
- Newcastle University Business SchoolNewcastle UniversityNewcastle upon TyneUK
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5
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Hasific S, Oevrehus KA, Gerke O, Hallas J, Busk M, Lambrechtsen J, Urbonaviciene G, Roennow Sand NP, Nielsen JS, Diederichsen L, Pedersen KB, Mickley H, Rasmussen LM, Lindholt JS, Diederichsen A. 456Risk of arterial calcification by conventional vitamin K antagonist treatment. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Vitamin K antagonists (VKA) are the most frequently prescribed oral anticoagulants worldwide although new oral anticoagulants (NOAC) have become an important alternative. VKA inhibits Vitamin K1 necessary to produce coagulation factors but also Vitamin K2, which is essential in the activation of matrix-Gla protein, thought to be a strong local inhibitor of arterial calcifications.
Purpose
The aim was to investigate, whether VKA treatment is associated with coronary artery calcification (CAC) in a population with no prior cardiovascular disease (CVD).
Methods
We collected data on cardiovascular risk factors and CAC scores from cardiac CT scans performed as part of clinical examinations (n=9,672) or research studies (n=14,166) in the period 2007–2017. Data on use of VKA and NOAC was obtained from the Danish National Health Service Prescription Database. The association between VKA treatment duration and categorized CAC score was investigated by ordered logistic regression while adjusting for covariates. The independent variables included in the model were: age, gender, smoking, body mass index (BMI), diabetes mellitus, hypertension, hypercholesterolemia and/or statin treatment, family history of CVD, estimated glomerular filtration rate, VKA treatment duration and NOAC treatment duration. The categorisation of CAC was: 0, 1–99, 100–399 and ≥400 AU, corresponding to no, mild, moderate and severe atherosclerotic plaque burden, respectively.
Results
The final study population consisted of 17,254 participants (median 67 years old, 75% males) with no prior CVD, of which 1,748 (10%) and 1,144 (7%) had been treated with VKA or NOAC, respectively. A longer duration of VKA treatment was associated with higher CAC categories (Figure). For each cumulative year of VKA treatment, the odds of being in a higher CAC category, i.e. having more severe atherosclerosis, increased (odds ratio (OR)=1.032, 95% CI 1.009–1.057). All traditional cardiovascular risk factors were also associated with CAC. In contrast, NOAC treatment duration was not associated with CAC category (OR=1.004, 95% CI 0.937–1.075). In a sensitivity analysis of patients without statin treatment (n=12,143), the association between VKA treatment and CAC category remained unchanged. There was no significant interaction between VKA treatment duration and age on CAC category.
Conclusion
Adjusted for cardiovascular risk factors, VKA treatment – in contrast to NOAC - is associated with more severe CAC. Additional studies are required to clarify the clinical importance of this association in terms of hard cardiovascular endpoints.
Acknowledgement/Funding
Novo Nordisk Foundation and Independent Research Fund Denmark
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Affiliation(s)
- S Hasific
- Odense University Hospital, Department of Cardiology, Odense, Denmark
| | - K A Oevrehus
- Odense University Hospital, Department of Cardiology, Odense, Denmark
| | - O Gerke
- Odense University Hospital, Department of Nuclear Medicine, Odense, Denmark
| | - J Hallas
- University of Southern Denmark, Clinical Pharmacology and Pharmacy, Odense, Denmark
| | - M Busk
- Lillebaelt Hospital, Department of Cardiology, Vejle, Denmark
| | - J Lambrechtsen
- Svendborg Hospital, Department of Cardiology, Svendborg, Denmark
| | - G Urbonaviciene
- Regional Hospital Central Jutland, Department of Cardiology, Silkeborg, Denmark
| | - N P Roennow Sand
- Sydvestjysk Hospital, Department of Cardiology, Esbjerg, Denmark
| | - J S Nielsen
- Odense University Hospital, DD2, Steno Diabetes Centre Odense, Odense, Denmark
| | - L Diederichsen
- Odense University Hospital, Department of Rheumatology, Odense, Denmark
| | - K B Pedersen
- Odense University Hospital, Department of Cardiology, Odense, Denmark
| | - H Mickley
- Odense University Hospital, Department of Cardiology, Odense, Denmark
| | - L M Rasmussen
- Odense University Hospital, Department of Clinical Biochemistry, Odense, Denmark
| | - J S Lindholt
- Odense University Hospital, Department of Cardiothoracic and Vascular Surgery, Odense, Denmark
| | - A Diederichsen
- Odense University Hospital, Department of Cardiology, Odense, Denmark
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Bo A, Thomsen RW, Nielsen JS, Nicolaisen SK, Beck-Nielsen H, Rungby J, Sørensen HT, Hansen TK, Søndergaard J, Friborg S, Lauritzen T, Maindal HT. Early-onset type 2 diabetes: Age gradient in clinical and behavioural risk factors in 5115 persons with newly diagnosed type 2 diabetes-Results from the DD2 study. Diabetes Metab Res Rev 2018; 34. [PMID: 29172021 DOI: 10.1002/dmrr.2968] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 09/29/2017] [Accepted: 11/05/2017] [Indexed: 11/07/2022]
Abstract
AIM To examine the association between early onset of type 2 diabetes mellitus (DM) and clinical and behavioural risk factors for later complications of diabetes. METHODS We conducted a cross-sectional study of 5115 persons with incident type 2 DM enrolled during 2010-2015 in the Danish Centre for Strategic Research in Type 2 Diabetes-cohort. We compared risk factors at time of diagnosis among those diagnosed at ≤45 years (early onset) with diagnosis age 46 to 55, 56 to 65 (average onset = reference), 66 to 75, and >75 years (late onset). Prevalence ratios (PRs) were computed by using Poisson regression. RESULTS Poor glucose control, ie, HbA1c ≥ 75 mmol/mol (≥9.0%) in the early-, average-, and late-onset groups was observed in 12%, 7%, and 1%, respectively (PR 1.70 [95% confidence intervals (CI) 1.27, 2.28] and PR 0.17 [95% CI 0.06, 0.45]). A similar age gradient was observed for severe obesity (body mass index > 40 kg/m2 : 19% vs. 8% vs. 2%; PR 2.41 [95% CI 1.83, 3.18] and 0.21 (95% CI 0.08, 0.57]), dyslipidemia (90% vs. 79% vs. 68%; PR 1.14 [95% CI 1.10, 1.19] and 0.86 [95% CI 0.79, 0.93]), and low-grade inflammation (C-reactive protein > 3.0 mg/L: 53% vs. 38% vs. 26%; PR 1.41 [95% CI 1.12, 1.78] and 0.68 [95% CI 0.42, 1.11]). Daily smoking was more frequent and meeting physical activity recommendations less likely in persons with early-onset type 2 DM. CONCLUSIONS We found a clear age gradient, with increasing prevalence of clinical and behavioural risk factors the younger the onset age of type 2 DM. Younger persons with early-onset type 2 DM need clinical awareness and support.
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Affiliation(s)
- A Bo
- Danish Diabetes Academy, Odense, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - R W Thomsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - J S Nielsen
- Diabetes Research Centre, Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - S K Nicolaisen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - H Beck-Nielsen
- Diabetes Research Centre, Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - J Rungby
- Department of Biomedicine, Aarhus University Hospital, Aarhus, Denmark
- Center for Diabetes Research, Gentofte University Hospital, Copenhagen, Denmark
| | - H T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - T K Hansen
- Department of Internal Medicine and Endocrinology, Aarhus University Hospital, Aarhus, Denmark
| | - J Søndergaard
- General Practice Research Unit, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - S Friborg
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - T Lauritzen
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - H T Maindal
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Steno Diabetes Centre Copenhagen, Health Promotion, Gentofte, Denmark
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Barron NJ, Kuller M, Yasmin T, Castonguay AC, Copa V, Duncan-Horner E, Gimelli FM, Jamali B, Nielsen JS, Ng K, Novalia W, Shen PF, Conn RJ, Brown RR, Deletic A. Towards water sensitive cities in Asia: an interdisciplinary journey. Water Sci Technol 2017; 76:1150-1157. [PMID: 28876256 DOI: 10.2166/wst.2017.287] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Rapid urbanisation, population growth and the effects of climate change drive the need for sustainable urban water management (SUWM) in Asian cities. The complexity of this challenge calls for the integration of knowledge from different disciplines and collaborative approaches. This paper identifies key issues and sets the stage for interdisciplinary research on SUWM in Asia. It reports on the initial stages of a SUWM research programme being undertaken at Monash University, Australia, and proposes a framework to guide the process of interdisciplinary research in urban water management. Three key themes are identified: (1) Technology and Innovation, (2) Urban Planning and Design, and (3) Governance and Society. Within these themes 12 research projects are being undertaken across Indonesia, China, India and Bangladesh. This outward-looking, interdisciplinary approach guides our research in an effort to transgress single-discipline solutions and contribute on-ground impact to SUWM practices in Asia.
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Affiliation(s)
- N J Barron
- Department of Civil Engineering, Monash University, Clayton, VIC 3800, Australia E-mail:
| | - M Kuller
- Department of Civil Engineering, Monash University, Clayton, VIC 3800, Australia E-mail:
| | - T Yasmin
- School of Social Sciences, Monash University, Clayton, VIC 3800, Australia
| | - A C Castonguay
- Department of Civil Engineering, Monash University, Clayton, VIC 3800, Australia E-mail:
| | - V Copa
- School of Social Sciences, Monash University, Clayton, VIC 3800, Australia
| | - E Duncan-Horner
- School of Social Sciences, Monash University, Clayton, VIC 3800, Australia
| | - F M Gimelli
- School of Social Sciences, Monash University, Clayton, VIC 3800, Australia
| | - B Jamali
- Department of Civil Engineering, Monash University, Clayton, VIC 3800, Australia E-mail:
| | - J S Nielsen
- School of Social Sciences, Monash University, Clayton, VIC 3800, Australia
| | - K Ng
- Department of Civil Engineering, Monash University, Clayton, VIC 3800, Australia E-mail:
| | - W Novalia
- School of Social Sciences, Monash University, Clayton, VIC 3800, Australia
| | - P F Shen
- Department of Civil Engineering, Monash University, Clayton, VIC 3800, Australia E-mail:
| | - R J Conn
- School of Social Sciences, Monash University, Clayton, VIC 3800, Australia
| | - R R Brown
- Monash Sustainable Development Institute, Monash University, Clayton, VIC 3800, Australia
| | - A Deletic
- Department of Civil Engineering, Monash University, Clayton, VIC 3800, Australia E-mail:
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8
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Nielsen JS, Bech M, Christensen K, Kiil A, Hvidt NC. Risk aversion and religious behaviour: Analysis using a sample of Danish twins. Econ Hum Biol 2017; 26:21-29. [PMID: 28214730 DOI: 10.1016/j.ehb.2017.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 01/26/2017] [Accepted: 01/26/2017] [Indexed: 06/06/2023]
Abstract
Economics offers an analytical framework to consider human behaviour including religious behaviour. Within the realm of Expected Utility Theory, religious belief and activity could be interpreted as an insurance both for current life events and for afterlife rewards. Based on that framework, we would expect that risk averse individuals would demand a more generous protection plan which they may do by devoting more effort and resources into religious activities such as church attendance and prayer, which seems to be in accordance with previous empirical results. However, a general concern regards the problems of spurious correlations due to underlying omitted or unobservable characteristics shaping both religious activities and risk attitudes. This paper examines empirically the demand for religion by analysing the association between risk attitudes on the one hand, and church attandance and prayer frequency on the other controlling for unobservable variables using survey data of Danish same-sex twin pairs. We verify the correlation between risk preferences and religion found previously by carrying out cross-sectional analyses. We also show that the association between risk attitudes and religious behaviour is driven by the subgroup of individuals who believe in an afterlife. In addition, when re-analysing our results using panel data analyses which cancel out shared factors among twin pairs, we find that the correlation found between risk aversion and religious behaviour is no longer significant indicating that other factors might explain differences in religious behaviour. Caution is needed in the interpretation of our results as the insignificant association between risk aversion and religious behaviour in the panel data analyses potentially might be due to measurement error causing attenuation bias or lack of variation within twin pairs rather than the actual absence of an association.
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Affiliation(s)
- Jytte Seested Nielsen
- Newcastle University Business School, Newcastle University, 5 Barrack Road, NE1 4SE, UK.
| | - Mickael Bech
- KORA-Danish Institute for Local and Regional Government Research, Købmagergade 22, DK-1150 Copenhagen K, Denmark.
| | - Kaare Christensen
- The Danish Twin Registry, Epidemiology, Institute of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9B, DK-5000 Odense C, Denmark.
| | - Astrid Kiil
- KORA-Danish Institute for Local and Regional Government Research, Købmagergade 22, DK-1150 Copenhagen K, Denmark.
| | - Niels Christian Hvidt
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, DK-5000 Odense C, Denmark.
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Taylor M, Chilton S, Ronaldson S, Metcalf H, Nielsen JS. Comparing Increments in Utility of Health: An Individual-based Approach. Value Health 2017; 20:224-229. [PMID: 28237199 DOI: 10.1016/j.jval.2016.12.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 12/09/2016] [Accepted: 12/12/2016] [Indexed: 05/27/2023]
Abstract
BACKGROUND Many economic evaluations of health care changes rely on quality-adjusted life year (QALY) estimates. Notably, though, the QALY approach values health states rather than changes in health states. Hence, a gain in utility of health is only indirectly valued through an ex ante preference elicitation of health states and the subsequent subtraction of health state values from one another, rather than being valued directly. There is therefore an underlying assumption that individuals, from an ex ante perspective ceteris paribus, would be indifferent between equal utility increments from health states with different baseline utilities. OBJECTIVE The aim of this paper is to develop a method that would allow us to measure individual-based preferences over utility increments from different baselines. We elicit our data using face-to-face interviews on a sample of UK individuals. RESULTS Overall, we find that gains of "equal" utility increments from different baselines are not found to be equally preferable by the individual. CONCLUSIONS The results indicate that the subtraction approach could lead to sub-optimal resource allocations and suggest that a new approach which values health changes directly would better reflect individual preferences. This paper provides the foundations for a method to achieve this.
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Affiliation(s)
- Matthew Taylor
- York Health Economics Consortium, University of York, York, North Yorkshire, UK.
| | - Susan Chilton
- Newcastle University, Newcastle-upon-Tyne, Tyne and Wear, UK
| | - Sarah Ronaldson
- York Trials Unit, Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Hugh Metcalf
- Newcastle University, Newcastle-upon-Tyne, Tyne and Wear, UK
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Gyrd-Hansen D, Kjær T, Seested Nielsen J. The value of mortality risk reductions. Pure altruism - a confounder? J Health Econ 2016; 49:184-192. [PMID: 27494571 DOI: 10.1016/j.jhealeco.2016.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 06/28/2016] [Accepted: 07/11/2016] [Indexed: 06/06/2023]
Abstract
This paper examines public valuations of mortality risk reductions. We set up a theoretical framework that allows for altruistic preferences, and subsequently test theoretical predictions through the design of a discrete choice experiment. By varying the tax scenario (uniform versus individual tax), the experimental design allows us to verify whether pure altruistic preferences are present and the underlying causes. We find evidence of negative pure altruism. Under a coercive uniform tax system respondents lower their willingness to pay possibly to ensure that they are not forcing others to pay at a level that corresponds to their own - higher - valuations. This hypothesis is supported by the observation that respondents perceive other individuals' valuations to be lower than their own. Our results suggest that public valuations of mortality risk reductions may underestimate the true societal value because respondents are considering other individuals' welfare, and wrongfully perceive other people's valuations to be low.
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Affiliation(s)
- Dorte Gyrd-Hansen
- COHERE, Department of Business and Economics, University of Southern Denmark, Campusvej 55, DK-5230 Odense M, Denmark; COHERE, Department of Public Health, University of Southern Denmark, Odense, Denmark; Department of Community Medicine, UiT, The Arctic University of Tromsø, Tromsø, Norway.
| | - Trine Kjær
- COHERE, Department of Business and Economics, University of Southern Denmark, Campusvej 55, DK-5230 Odense M, Denmark
| | - Jytte Seested Nielsen
- COHERE, Department of Business and Economics, University of Southern Denmark, Campusvej 55, DK-5230 Odense M, Denmark; Newcastle University Business School, 5 Barrack Road, NE1 4SE Newcastle upon Tyne, United Kingdom
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11
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Mor A, Berencsi K, Svensson E, Rungby J, Nielsen JS, Friborg S, Brandslund I, Christiansen JS, Vaag A, Beck-Nielsen H, Sørensen HT, Thomsen RW. Prescribing practices and clinical predictors of glucose-lowering therapy within the first year in people with newly diagnosed Type 2 diabetes. Diabet Med 2015; 32:1546-54. [PMID: 26032247 DOI: 10.1111/dme.12819] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/27/2015] [Indexed: 11/26/2022]
Abstract
AIM To examine prescribing practices and predictors of glucose-lowering therapy within the first year following diagnosis of Type 2 diabetes mellitus in a clinical care setting. METHODS We followed people enrolled in the Danish Centre for Strategic Research in Type 2 Diabetes (DD2) cohort from outpatient hospital clinics and general practices throughout Denmark in 2010-2013. We used Poisson regression to compute age- and gender-adjusted risk ratios (RRs). RESULTS Among 1158 new Type 2 diabetes mellitus patients, 302 (26%) did not receive glucose-lowering therapy within the first year, 723 (62%) received monotherapy [685 (95%) with metformin], and 133 (12%) received more than one drug. Predictors of receiving any vs. no therapy and combination vs. monotherapy were: age < 40 years [RR: 1.29 (95% CI: 1.16-1.44) and 3.60 (95% CI: 2.36-5.50)]; high Charlson Comorbidity Index [RRs: 1.20 (95% CI: 1.05-1.38) and 2.08 (95% CI: 1.16-3.72)]; central obesity [RRs: 1.23 (95% CI: 1.04-1.44) and 1.93 (95% CI: 0.76-4.94)]; fasting blood glucose of ≥ 7.5 mmol/l [RRs: 1.25 (95% CI: 1.10-1.42) and 1.94 (95% CI: 1.02-3.71)]; and HbA1c ≥ 59 mmol/mol (≥ 7.5%) [RR: 1.26 (95% CI: 1.20-1.32) and 2.86 (95% CI: 1.97-4.14)]. Weight gain ≥ 30 kg since age 20, lack of physical exercise and C-peptide of < 300 pmol/l also predicted therapy. CONCLUSIONS Comorbidity, young age, central obesity and poor baseline glycaemic control are important predictors of therapy one year after Type 2 diabetes mellitus debut.
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Affiliation(s)
- A Mor
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - K Berencsi
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - E Svensson
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - J Rungby
- Department of Biomedicine, Aarhus University Hospital, Aarhus, Denmark
- Center for Diabetes Research, Gentofte University Hospital, Copenhagen, Denmark
| | - J S Nielsen
- Diabetes Research Centre, Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - S Friborg
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - I Brandslund
- Department of Biochemistry, Lillebaelt Hospital, Vejle, Denmark
| | - J S Christiansen
- Department of Internal Medicine and Endocrinology, Aarhus University Hospital, Aarhus, Denmark
| | - A Vaag
- Department of Endocrinology, Rigshospitalet and Copenhagen University, Denmark
| | - H Beck-Nielsen
- Diabetes Research Centre, Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - H T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - R W Thomsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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Nielsen JS, Larsson A, Ledet T, Turina M, Tønnesen E, Krog J. Rough-Form Lipopolysaccharide Increases Apoptosis in Human CD4⁺ and CD8⁺ T Lymphocytes. Scand J Immunol 2015; 75:193-202. [PMID: 21854408 DOI: 10.1111/j.1365-3083.2011.02613.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Immunosuppression induced by lymphocyte apoptosis is considered an important factor in the pathogenesis of sepsis and has been demonstrated in both animal models of lipopolysaccharide (LPS)-induced endotoxemia and septic patients. As rough-form LPS (R-LPS) has recently been shown to elicit a stronger immunological response than regular smooth-form LPS (S-LPS), we aimed to assess the apoptosis-inducing capabilities of R-LPS in different subsets of lymphocytes (CD4(+) T cells, CD8(+) T cell, B cells and NK cells). Using multicolour flow cytometry on human peripheral blood mononuclear cells, we found that R-LPS increased apoptosis in CD4(+) and CD8(+) T cells assessed by annexin V and propidium iodide (AV(+) PI(-)), compared with both S-LPS-stimulated and unstimulated cells. 7-Amino-actinomycin D and staining for intracellular active caspase-3, which are considered later signs of apoptosis, did not reveal the same results. Both forms appeared to inhibit apoptosis in B cells, but no LPS-form-specific effect was seen on B or NK cells. Our results indicate that R-LPS induces a stronger AV(+) PI(-)-assessed apoptotic response in T cells than S-LPS. Our findings emphasize the importance of T cell apoptosis in endotoxemia and advocates for control of LPS form in both endotoxemia research and clinical trials with Gram-negative infections.
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Affiliation(s)
- J S Nielsen
- Department of Anesthesiology and Intensive Care Medicine, Aarhus University Hospital, Aarhus, DenmarkDepartment of Biochemical Pathology, Aarhus University Hospitals, Aarhus, DenmarkDepartment of Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, SwedenDepartment of Surgery, University of Zurich Hospital, Zurich, Switzerland
| | - A Larsson
- Department of Anesthesiology and Intensive Care Medicine, Aarhus University Hospital, Aarhus, DenmarkDepartment of Biochemical Pathology, Aarhus University Hospitals, Aarhus, DenmarkDepartment of Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, SwedenDepartment of Surgery, University of Zurich Hospital, Zurich, Switzerland
| | - T Ledet
- Department of Anesthesiology and Intensive Care Medicine, Aarhus University Hospital, Aarhus, DenmarkDepartment of Biochemical Pathology, Aarhus University Hospitals, Aarhus, DenmarkDepartment of Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, SwedenDepartment of Surgery, University of Zurich Hospital, Zurich, Switzerland
| | - M Turina
- Department of Anesthesiology and Intensive Care Medicine, Aarhus University Hospital, Aarhus, DenmarkDepartment of Biochemical Pathology, Aarhus University Hospitals, Aarhus, DenmarkDepartment of Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, SwedenDepartment of Surgery, University of Zurich Hospital, Zurich, Switzerland
| | - E Tønnesen
- Department of Anesthesiology and Intensive Care Medicine, Aarhus University Hospital, Aarhus, DenmarkDepartment of Biochemical Pathology, Aarhus University Hospitals, Aarhus, DenmarkDepartment of Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, SwedenDepartment of Surgery, University of Zurich Hospital, Zurich, Switzerland
| | - J Krog
- Department of Anesthesiology and Intensive Care Medicine, Aarhus University Hospital, Aarhus, DenmarkDepartment of Biochemical Pathology, Aarhus University Hospitals, Aarhus, DenmarkDepartment of Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, SwedenDepartment of Surgery, University of Zurich Hospital, Zurich, Switzerland
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Kjaergaard AG, Nielsen JS, Tønnesen E, Krog J. Expression of NK cell and monocyte receptors in critically ill patients--potential biomarkers of sepsis. Scand J Immunol 2015; 81:249-58. [PMID: 25619264 DOI: 10.1111/sji.12272] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 01/13/2015] [Indexed: 01/14/2023]
Abstract
UNLABELLED Sepsis is characterized by activation of both the innate and adaptive immune systems as a response to infection. During sepsis, the expression of surface receptors expressed on immune competent cells, such as NKG2D and NKp30 on NK cells and TLR4 and CD14 on monocytes, is partly regulated by pro- and anti-inflammatory mediators. In this observational study, we aimed to explore whether the expression of these receptors could be used as diagnostic and/or prognostic biomarkers in sepsis. Patients with severe sepsis or septic shock (n = 21) were compared with critically ill non-septic patients (n = 15). Healthy volunteers (n = 15) served as controls. To elucidate variations over time, all patients were followed for 4 days. Cell surface expression of NKG2D, NKp30, TLR4 and CD14 and serum levels of IL-1β, IL-6, IFN-γ, TNF-α, IL-4 and IL-10 was estimated by flow cytometry. We found that NK cell expression of NKG2D and monocyte expression of CD14 were lower in the septic patients compared with the non-septic patients, both at ICU admission and during the observation period (P < 0.01 for all comparisons). Both at ICU admission, and during the observation period, levels of IL-6 and IL-10 were higher in the septic patients compared with the non-septic patients (P < 0.001 for all comparisons). CONCLUSION As both NKG2D and CD14 levels appear to distinguish between septic and non-septic patients, both NKG2D and CD14 may be considered potential diagnostic biomarkers of severe sepsis and septic shock.
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Affiliation(s)
- A G Kjaergaard
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus C, Denmark; Department of Anaesthesiology and Intensive Care, Randers Regional Hospital, Randers, Denmark
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Nielsen JS, Gyrd-Hansen D, Kjær T. Valuation of morbidity and mortality risk reductions. Does context matter? Accid Anal Prev 2012; 48:246-253. [PMID: 22664687 DOI: 10.1016/j.aap.2012.01.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Revised: 12/20/2011] [Accepted: 01/15/2012] [Indexed: 06/01/2023]
Abstract
The main research purpose of the present study was to test for any differences in the valuation of morbidity and mortality risk reductions across two contexts; traffic and health. A contingent valuation study on preferences for morbidity and mortality risk was carried out in Denmark in 2007. Respondents were randomised into two different arms: one arm in which the valuation took place in the context of health and another arm in which the context was traffic. In both contexts, the inferior health state was described by way of the standardized EQ-5D descriptive system. We obtained a total sample of 520 respondents from an online database. In the present study we found clear evidence of a context effect on expressed valuations of identical risk reductions. This was true irrespective of whether the adverse outcome in question was death or inferior health. This result suggests that interventions targeting risks of death or risks of ill health should not necessarily be valued equally across sectors. From a welfare economic perspective, the use of the same estimates across contexts - and especially across sectors - could be misleading and in worst case lead to inefficient resource allocations.
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Gyrd-Hansen D, Kjaer T, Nielsen JS. Scope insensitivity in contingent valuation studies of health care services: should we ask twice? Health Econ 2012; 21:101-112. [PMID: 22223555 DOI: 10.1002/hec.1690] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Revised: 09/07/2010] [Accepted: 10/05/2010] [Indexed: 05/31/2023]
Abstract
The main purpose of the present study was to test for outcome scope insensitivity. Respondents were initially asked to value one of two severe health states by way of a time-trade-off (TTO) exercise. Subsequent to the TTO exercise all respondents were asked to value an intervention, which offered a reduction in risk of falling into the health state they had evaluated. All respondents were subsequent to this initial CV exercise asked to value the same risk reduction, but in this case the outcome was death. Although our study passes the internal scope test, there is not a high degree of sensitivity to outcome. As many as 68% of respondents stated an identical maximum WTP in first and second CV valuation exercise implying that they value the interventions equally despite the fact that the health state presented in the initial CV question was deemed far better than death according to the TTO responses given by the same respondents. In contrast, the external scope test (comparison of response to initial CV across study arms) fared much better.
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Affiliation(s)
- D Gyrd-Hansen
- Institute of Public Health, Unit for Health Economics, University of Southern Denmark, Odense, Denmark.
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Abstract
In a retrospective study of patients admitted for acute myocardial infarction (AMI) during six years, sinus node dysfunction (SND) was detected in 20 (1.04%). Twelve had persistent sinus bradycardia, 11 sinotrial block or sinus arrest and six bradytachy syndrome. Symptoms occurred in 17 patients, 12 of whom required temporary pacing for periods up to three weeks. A permanent cardiac pacemaker was implanted in three patients with brady-tachy syndrome. Three patients died during the primary admission and six during the observation period. Follow-up after a mean observation period of 34 months showed continuous signs of SND in 11 out of 19 patients. The arrhythmia caused symptoms in five patients, two of whom had a cardiac pacemaker and two received medical treatment. It is concluded that SND appearing during an AMI persists in a high number of these patients.
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17
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Abstract
A retrospective study covering all admissions during a 6-year period revealed 128 patients with sinus node dysfunction (SND). The patients were grouped according to the ECG criteria chosen: group I 33 patients with sinus bradycardia, group II 37 with sinoatrial block/sinus arrest, group III 58 with brady-tachy syndrome. Additional heart disease, predominantly ischaemic, was found in 56%. The frequency and severity of symptoms increased from group I to group III. Pacemaker treatment was given to 40% of the cases, while medical treatment alone was successful in 17%. A follow-up including 104 patients was carried out after a mean observation period of approximately three years. Sixteen patients had died. The cause of death may have been SND per se in only one case. Five patients died of apoplectic insults or complications to such. In total, nine possible or proven systemic embolic events were found--all occurring in patients with brady-tachy syndrome. A progression of the ECG abnormality from a lower to a higher group took place in nine patients during the observation period. It is concluded that SND is a condition with a broad clinical spectrum and a stationary or slowly progressive course. In general, it carries a good prognosis. A substantial number of deaths of disabilities in patients with brady-tachy syndrome may be ascribed to systemic embolism. Long-term anticoagulant therapy is proposed in this subgroup of patients with SND.
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18
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Nielsen JS, Sahlin K, Ørtenblad N. Reduced sarcoplasmic reticulum content of releasable Ca2+ in rat soleus muscle fibres after eccentric contractions. Acta Physiol (Oxf) 2007; 191:217-28. [PMID: 17635412 DOI: 10.1111/j.1748-1716.2007.01732.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM The purpose was to evaluate the effects of fatiguing eccentric contractions (EC) on calcium (Ca2+) handling properties in mammalian type I muscles. We hypothesized that EC reduces both endogenous sarcoplasmic reticulum (SR) content of releasable Ca2+ (eSRCa2+) and myofibrillar Ca2+ sensitivity. METHODS Isolated rat soleus muscles performed 30 EC bouts. Single fibres were isolated from the muscle and after mechanical removal of sarcolemma used to measure eSRCa2+, rate of SR Ca2+ loading and myofibrillar Ca2+ sensitivity. RESULTS Following EC maximal force in whole muscle was reduced by 30% and 16/100 Hz force ratio by 33%. The eSRCa2+ in fibres from non-stimulated muscles was 45 +/- 5% of the maximal loading capacity. After EC, eSRCa2+ per fibre CSA decreased by 38% (P = 0.05), and the maximal capacity of SR Ca2+ loading was depressed by 32%. There were no effects of EC on either myofibrillar Ca2+ sensitivity, maximal Ca2+ activated force per cross-sectional area and rate of SR Ca2+ loading, or in SR vesicle Ca2+ uptake and release. CONCLUSIONS We conclude that EC reduces endogenous SR content of releasable Ca2+ but that myofibrillar Ca2+ sensitivity and SR vesicle Ca2+ kinetics remain unchanged. The present data suggest that the long-lasting fatigue induced by EC, which was more pronounced at low frequencies (low frequency fatigue), is caused by reduced Ca2+ release occurring secondary to reduced SR content of releasable Ca2+.
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Affiliation(s)
- J S Nielsen
- Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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19
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Abstract
AIM We have tested the hypothesis that the altered muscle contractility after lengthening contractions (LC) is caused by altered calcium (Ca2+) kinetics. METHODS Subjects (n = 8) performed 100 drop jumps and muscle contractility was measured pre- and post-exercise by maximal voluntary contraction (MVC) and transcutaneous electrical stimulation (1, 20 and 50 Hz). Muscle biopsies were analysed for muscle metabolites, rates of SR Ca(2+) uptake (CaU) and release (CaR) and myosin heavy chain (MHC) composition. RESULTS The rates of torque relaxation and CaU were positively related to muscle fibre type composition (% MHC II). Muscle creatine (Cr) decreased and the ratio between phosphocreatine (PCr) and Cr increased 3 and 24 h post-exercise (P < 0.05 vs. pre-exercise). LC resulted in reduced MVC (-19%), twitch torque (-41%) and 20/50 Hz torque ratio (-30%) and a faster relaxation rate (P < 0.05). The contractile parameters recovered partially but remained altered 24 h post-exercise (P < 0.05). The average CaR was unchanged after LC (P > 0.05). However, the response varied between subjects and the relative post-exercise CaR was significantly related to the degree of LFF (post/pre 20/50 Hz force ratio) and to the decline in twitch force (post/pre twitch ratio). CaU was lower in seven of eight subjects after LC (P > 0.05). CONCLUSION The decline in torque after LC could not be explained by metabolic factors since PCr/Cr ratio increased. The relation between CaR and fatigue suggests that the mechanism of fatigue in part may be attributed to intrinsic changes in the SR Ca2+ release channel. The faster torque relaxation after LC could not be explained by an increased rate of CaU.
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Affiliation(s)
- J S Nielsen
- Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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20
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Nielsen JS, Jakobsen E, Hølund B, Bertelsen K, Jakobsen A. Prognostic significance of p53, Her-2, and EGFR overexpression in borderline and epithelial ovarian cancer. Int J Gynecol Cancer 2005; 14:1086-96. [PMID: 15571614 DOI: 10.1111/j.1048-891x.2004.14606.x] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The objective of the study was to evaluate the prognostic effect of p53, Her-2, and EGFR in borderline and epithelial ovarian cancer. Tumor tissue from 85 patients with borderline and 783 patients with epithelial ovarian cancer stage I-IV were analyzed immunohistochemically for p53 positivity and over-expression of Her-2 and EGFR. In the ovarian cancer (OC) group 415 patients (53%) had p53-positive tumors, 272 (35%) had tumors with Her-2 over-expression, and 483 (62%) had over-expression of EGFR. In the OC group the classical prognostic factors (older age, higher FIGO stage, and poorer differentiated stage) had significant prognostic value in both uni- and multivariate analyses. Multivariate analyses in the OC group proved p53 positivity to increase mortality significantly depending on the grade of the tumor. Her-2 likewise increased the risk of mortality significantly in this group depending on the grade of the tumor. EGFR on the other hand did not have any additional prognostic effect in the OC group after adjustment for the classical prognostic and molecular factors was made. In the borderline group Her-2 and EGFR over-expression in combination, adjusted for age and p53, significantly improved the prognosis.
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MESH Headings
- Adenocarcinoma, Clear Cell/diagnosis
- Adenocarcinoma, Clear Cell/epidemiology
- Adenocarcinoma, Clear Cell/etiology
- Adenocarcinoma, Clear Cell/metabolism
- Adenocarcinoma, Clear Cell/mortality
- Adenocarcinoma, Clear Cell/pathology
- Adenocarcinoma, Mucinous/diagnosis
- Adenocarcinoma, Mucinous/epidemiology
- Adenocarcinoma, Mucinous/etiology
- Adenocarcinoma, Mucinous/metabolism
- Adenocarcinoma, Mucinous/mortality
- Adenocarcinoma, Mucinous/pathology
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Biomarkers, Tumor/metabolism
- Case-Control Studies
- Cohort Studies
- Cystadenocarcinoma, Serous/diagnosis
- Cystadenocarcinoma, Serous/epidemiology
- Cystadenocarcinoma, Serous/etiology
- Cystadenocarcinoma, Serous/metabolism
- Cystadenocarcinoma, Serous/mortality
- Cystadenocarcinoma, Serous/pathology
- Denmark/epidemiology
- ErbB Receptors/metabolism
- Female
- Gene Expression Regulation, Neoplastic
- Humans
- Immunohistochemistry
- Middle Aged
- Neoplasm Staging
- Ovarian Neoplasms/diagnosis
- Ovarian Neoplasms/epidemiology
- Ovarian Neoplasms/etiology
- Ovarian Neoplasms/metabolism
- Ovarian Neoplasms/mortality
- Ovarian Neoplasms/pathology
- Prognosis
- Receptor, ErbB-2/metabolism
- Registries
- Survival Analysis
- Tumor Suppressor Protein p53/metabolism
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Affiliation(s)
- J S Nielsen
- University of Southern Denmark, Odense, Denmark
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21
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Hansen EA, Andersen JL, Nielsen JS, Sjøgaard G. Muscle fibre type, efficiency, and mechanical optima affect freely chosen pedal rate during cycling. Acta Physiol Scand 2002; 176:185-94. [PMID: 12392498 DOI: 10.1046/j.1365-201x.2002.01032.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
UNLABELLED This study investigated the variation in freely chosen pedal rate between subjects and its possible dependence on percentage myosin heavy chain I (%MHC I) in m. vastus lateralis, maximum leg strength and power, as well as efficiency. Additionally, the hypothesis was tested that a positive correlation exists between percentage MHC I and efficiency at pre-set pedal rates but not at freely chosen pedal rate. Twenty males performed cycling at low and high submaximal power output ( approximately 40 and 70% of the power output at which maximum oxygen uptake (VO(2max)) was attained at 80 r.p.m.) with freely chosen and pre-set pedal rates (61, 88, and 115 r.p.m.). Percentage MHC I as well as leg strength and power were determined. Freely chosen pedal rate varied considerably between subjects: 56-88 r.p.m. at low and 61-102 r.p.m. at high submaximal power output. This variation was only partly explained by percentage MHC I (21-97%) as well as by leg strength and power. Interestingly, %MHC I correlated significantly with the pedal rate at which maximum peak crank power occurred (r = -0.81). As hypothesized, %MHC I and efficiency were unrelated at freely chosen pedal rate, which was in contrast to a significant correlation found at pre-set pedal rates (r = 0.61 and r = 0.57 at low and high power output, respectively). CONCLUSIONS Subjects with high percentage MHC I chose high pedal rates close to the pedal rates at which maximum peak crank power occurred, while subjects with low percentage MHC I tended to choose lower pedal rates, favouring high efficiency. Nevertheless, the considerable variation in freely chosen pedal rate between subjects was neither fully accounted for by percentage MHC I nor by leg strength and power. Previously recognized relationships between percentage Type I ( approximately %MHC I) and efficiency as well as between pedal rate and efficiency were confirmed for pre-set pedal rates, but for freely chosen pedal rate, these variables were unrelated.
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Affiliation(s)
- E A Hansen
- Institute of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark
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22
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Nielsen JS, Joner EJ, Declerck S, Olsson S, Jakobsen I. Phospho-imaging as a tool for visualization and noninvasive measurement of P transport dynamics in arbuscular mycorrhizas. New Phytol 2002; 154:809-819. [PMID: 33873457 DOI: 10.1046/j.1469-8137.2002.00412.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
• A new method is described for monitoring hyphal 32 P transport in compartmented, monoxenic mycorrhizal root cultures. Nondestructive time-course measurements of P transport in hyphae were obtained by capturing digital autoradiograms on P-imaging screens, and comparing with growth observed by optical scanning. 32 P distribution measured by densitometry on the day of harvest closely agreed with values obtained by liquid scintillation counting after destructive harvest. • Virtually all labeled PO4 was absorbed by arbuscular mycorrhizal (AM) hyphae, but transfer to the roots appeared to be incomplete. P transport was not unidirectional towards the roots, as 32 P was also transported from the root compartment to the hyphal compartment. Net P flux rates were calculated for hyphae crossing between compartments, taking bidirectional flow into account. • Amounts of transported P were poorly correlated with extra-radical hyphal length and root d. wt, but highly correlated with the number of hyphae crossing the barrier separating the two compartments. Such correlations were highest when only hyphae with detectable protoplasmic streaming were considered. • The method was tested using radiolabeled P sources, H2 PO4 - and cytidine triphosphate (CTP), and the AM fungi, Glomus intraradices and G. proliferum. Fungal transport of 32 P from CTP was much slower than from PO4 for both fungi.
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Affiliation(s)
- J S Nielsen
- Risø National Laboratory, DK-4000 Roskilde, Denmark
| | - E J Joner
- Centre de Pedologique Biologique - CNRS, F-54501 Vandoeuvre-les-Nancy, France
| | - S Declerck
- Universite Catholique de Louvain, 1348 Louvain-La-Neuve, Belgium
| | - S Olsson
- The Royal Veterinary and Agricultural University, DK-1870 Frederiksberg, Denmark
| | - I Jakobsen
- Risø National Laboratory, DK-4000 Roskilde, Denmark
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Madsen N, Bowe P, Nielsen JS, Siegfried LE, Hangst JS. Low-current, vertical blowup in a stored laser-cooled ion beam. Phys Rev Lett 2001; 87:274801. [PMID: 11800884 DOI: 10.1103/physrevlett.87.274801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2001] [Indexed: 05/23/2023]
Abstract
Using a novel technique for real-time transverse beam profile diagnostics of a stored ion beam, we have observed the transverse size of a stored laser-cooled ion beam. Earlier we observed that the density of the beam is independent of the beam current. At very low currents, we observe an abrupt change in this behavior: The vertical beam size increases suddenly by about an order of magnitude. This observation implies a sudden change in the indirect vertical cooling mediated by intrabeam scattering. Our results have serious implications for the ultimate beam quality attainable by laser cooling.
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Nielsen JS. [The pathographic tradition and method]. Dan Medicinhist Arbog 2001; 12:91-104. [PMID: 11629297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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Nielsen JS, Gesser H. Effects of high extracellular [K+] and adrenaline on force development, relaxation and membrane potential in cardiac muscle from freshwater turtle and rainbow trout. J Exp Biol 2001; 204:261-8. [PMID: 11136612 DOI: 10.1242/jeb.204.2.261] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Increases in extracellular K(+) concentrations reduced the twitch force amplitude of heart muscle from the freshwater turtle (Trachemys scripta elegans) and rainbow trout (Oncorhynchus mykiss). Adrenaline augmented twitch force amplitude and reduced the relative influence of [K(+)]. In the absence of adrenaline, high [K(+)] had less effect in reducing twitch force in turtle than in trout, whereas the reverse was true in the presence of adrenaline. Under anoxic conditions, twitch force was lower in 10 mmol l(−1) than in 2.5 mmol l(−1) K(+) in both preparations, but adrenaline removed this difference. A further analysis of turtle myocardium showed that action potential duration was shorter and resting potential more positive in high [K(+)] than in low [K(+)]. Adrenaline restored the duration of the action potential, but did not affect the depolarisation, which may attenuate Na(+)/Ca(2+) exchange, participating in excitation/contraction coupling. The contractile responses in the presence of adrenaline were, however, similar in both high and low K(+) concentrations when increases in extracellular Ca(2+) were applied to increase the demand on excitation/contraction coupling. The possibilities that adrenaline counteracts the effects of high [K(+)] via the sarcoplasmic reticulum or sarcolemmal Na(+)/K(+)-ATPase were examined by inhibiting the sarcoplasmic reticulum with ryanodine (10 micromol l(−1)) or Na(+)/K(+)-ATPase with ouabain (0.25 or 3 mmol l(−)). No evidence to support either of these possibilities was found. Adrenaline did not protect all aspects of excitation/contraction coupling because the maximal frequency giving regular twitches was lower at 10 mmol l(−1) K(+) than at 2.5 mmol l(−1) K(+).
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Affiliation(s)
- J S Nielsen
- Department of Zoophysiology, Institute of Biological Sciences, University of Aarhus, DK-8000 Aarhus C, Denmark
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26
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Nielsen JS, Møller BL. Cloning and expression of cytochrome P450 enzymes catalyzing the conversion of tyrosine to p-hydroxyphenylacetaldoxime in the biosynthesis of cyanogenic glucosides in Triglochin maritima. Plant Physiol 2000; 122:1311-21. [PMID: 10759528 PMCID: PMC58967 DOI: 10.1104/pp.122.4.1311] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/1999] [Accepted: 12/28/1999] [Indexed: 05/22/2023]
Abstract
Two cDNA clones encoding cytochrome P450 enzymes belonging to the CYP79 family have been isolated from Triglochin maritima. The two proteins show 94% sequence identity and have been designated CYP79E1 and CYP79E2. Heterologous expression of the native and the truncated forms of the two clones in Escherichia coli demonstrated that both encode multifunctional N-hydroxylases catalyzing the conversion of tyrosine to p-hydroxyphenylacetaldoxime in the biosynthesis of the two cyanogenic glucosides taxiphyllin and triglochinin in T. maritima. This renders CYP79E functionally identical to CYP79A1 from Sorghum bicolor, and unambiguously demonstrates that cyanogenic glucoside biosynthesis in T. maritima and S. bicolor is catalyzed by analogous enzyme systems with p-hydroxyphenylacetaldoxime as a free intermediate. This is in contrast to earlier reports stipulating p-hydroxyphenylacetonitrile as the only free intermediate in T. maritima. L-3,4-Dihydroxyphenyl[3-(14)C]Ala (DOPA) was not metabolized by CYP79E1, indicating that hydroxylation of the phenol ring at the meta position, as required for triglochinin formation, takes place at a later stage. In S. bicolor, CYP71E1 catalyzes the subsequent conversion of p-hydroxyphenylacetaldoxime to p-hydroxymandelonitrile. When CYP79E1 from T. maritima was reconstituted with CYP71E1 and NADPH-cytochrome P450 oxidoreductase from S. bicolor, efficient conversion of tyrosine to p-hydroxymandelonitrile was observed.
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Affiliation(s)
- J S Nielsen
- Plant Biochemistry Laboratory, Department of Plant Biology and Center for Molecular Plant Physiology (PlaCe), The Royal Veterinary and Agricultural University, 40 Thorvaldsensvej, DK-1871 Frederiksberg C, Copenhagen, Denmark
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27
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Gehr NR, Lund O, Alstrup P, Nielsen JS, Villadsen AB, Bartholdy NJ. Recurrence of uterine intravenous leiomyomatosis with intracardiac extension. Diagnostic considerations and surgical removal. SCAND CARDIOVASC J 1999; 33:312-4. [PMID: 10540923 DOI: 10.1080/14017439950141597] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A 28-year-old woman (gravida 2, para 2) was admitted 20 months after a hysterectomy because of fibromyoma. The hysterectomy specimen had shown intravenous leiomyomatosis. The patient presented with unspecific abdominal symptoms, serologic signs of hepatic and renal failure and clinical right-sided heart failure. Progression despite treatment with a gonadotropin-releasing hormone analogue promoted transferral to the present centre. Abdominal ultrasonography, phlebography and transoesophageal echocardiography showed a left pelvic mass and a seemingly free-floating tumour extending from the left main iliac vein via the inferior caval vein to the right ventricle. During a combined cardiac and distal caval approach using extracorporeal circulation, a 45 cm massive leiomyoma was removed successfully. Seven weeks later the left pelvic tumour was removed radically together with left oophorectomy. At control 12 months later the patient was well and without any remaining symptoms.
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Affiliation(s)
- N R Gehr
- Department of Cardio-Thoracic Surgery, Aalborg Hospital, Denmark
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28
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Walker CS, Steel D, Jacobsen RB, Lirazan MB, Cruz LJ, Hooper D, Shetty R, DelaCruz RC, Nielsen JS, Zhou LM, Bandyopadhyay P, Craig AG, Olivera BM. The T-superfamily of conotoxins. J Biol Chem 1999; 274:30664-71. [PMID: 10521453 DOI: 10.1074/jbc.274.43.30664] [Citation(s) in RCA: 110] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We report the discovery and initial characterization of the T-superfamily of conotoxins. Eight different T-superfamily peptides from five Conus species were identified; they share a consensus signal sequence, and a conserved arrangement of cysteine residues (- -CC- -CC-). T-superfamily peptides were found expressed in venom ducts of all major feeding types of Conus; the results suggest that the T-superfamily will be a large and diverse group of peptides, widely distributed in the 500 different Conus species. These peptides are likely to be functionally diverse; although the peptides are small (11-17 amino acids), their sequences are strikingly divergent, with different peptides of the superfamily exhibiting varying extents of post-translational modification. Of the three peptides tested for in vivo biological activity, only one was active on mice but all three had effects on fish. The peptides that have been extensively characterized are as follows: p5a, GCCPKQMRCCTL*; tx5a, gammaCCgammaDGW(+)CCT( section sign)AAO; and au5a, FCCPFIRYCCW (where gamma = gamma-carboxyglutamate, W(+) = bromotryptophan, O = hydroxyproline, T( section sign) = glycosylated threonine, and * = COOH-terminal amidation). We also demonstrate that the precursor of tx5a contains a functional gamma-carboxylation recognition signal in the -1 to -20 propeptide region, consistent with the presence of gamma-carboxyglutamate residues in this peptide.
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Affiliation(s)
- C S Walker
- Department of Biology, University of Utah, Salt Lake City, Utah 84112, USA
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29
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Abstract
The biosynthesis of the two cyanogenic glucosides, taxiphyllin and triglochinin, in Triglochin maritima (seaside arrow grass) has been studied using undialyzed microsomal preparations from flowers and fruits. Tyrosine was converted to p-hydroxymandelonitrile with V(max) and K(m) values of 36 nmol mg(-1) g(-1) fresh weight and 0.14 mM, respectively. p-Hydroxyphenylacetaldoxime and p-hydroxyphenylacetonitrile accumulated as intermediates in the reaction mixtures. Using radiolabeled tyrosine as substrate, the radiolabel was easily trapped in p-hydroxyphenylacetaldoxime and p-hydroxyphenylacetonitrile when these were added as unlabeled compounds. p-Hydroxyphenylacetaldoxime was the only product obtained using microsomes prepared from green leaves or dialyzed microsomes prepared from flowers and fruits. These data contrast earlier reports (Hösel and Nahrstedt, Arch. Biochem. Biophys. 203, 753-757, 1980; and Cutler et al., J. Biol. Chem. 256, 4253-4258, 1981) where p-hydroxyphenylacetaldoxime was found not to accumulate. All steps in the conversion of tyrosine to p-hydroxymandelonitrile were found to be catalyzed by cytochrome P450 enzymes as documented by photoreversible carbon monoxide inhibition, inhibition by antibodies toward NADPH-cytochrome P450 oxidoreductase, and by cytochrome P450 inhibitors. We hypothesize that cyanogenic glucoside synthesis in T. maritima is catalyzed by multifunctional cytochrome P450 enzymes similar to CYP79A1 and CYP71E1 in Sorghum bicolor except that the homolog to CYP71E1 in T. maritima exhibits a less tight binding of p-hydroxyphenylacetonitrile, thus permitting the release of this intermediate and its conversion into triglochinin.
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Affiliation(s)
- J S Nielsen
- Department of Plant Biology, Center for Molecular Plant Physiology (PlaCe), The Royal Veterinary and Agricultural University, 40 Thorvaldsensvej, Copenhagen, Frederiksberg C, DK-1871, Denmark
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Affiliation(s)
- K P Chang
- Department of Microbiology/Immunology, University of Health Sciences/Chicago Medical School, Illinois 60064, USA.
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31
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Gregersen H, Nielsen JS, Peterslund NA. [Acute porphyria and multiple organ failure during treatment with lamotrigine]. Ugeskr Laeger 1996; 158:4091-4092. [PMID: 8701527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
A 38-year-old female suffered from an acute porphyric attack, multi-organ failure and disseminated intravascular coagulation (DIC) within two weeks of starting lamotrigine, a new antiepileptic drug. The porphyric attack was characterized by excess urinary excretion of aminolevulinic acid (ALA), porphobilinogen (PBG) and coproporphyrin III, a pattern similar to that seen in hereditary coproporphyria, however the diagnostic criteria for this specific porphyria were not fulfilled. We suggest that the observed clinical picture represents a rare adverse reaction to lamotrigine.
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Affiliation(s)
- H Gregersen
- Medicinsk-haematologisk afdeling, Arhus Amtssygehus
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32
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Lebedev VA, Hangst JS, Nielsen JS. Schottky noise in a laser-cooled ion beam. Phys Rev E Stat Phys Plasmas Fluids Relat Interdiscip Topics 1995; 52:4345-4353. [PMID: 9963906 DOI: 10.1103/physreve.52.4345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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33
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Hangst JS, Nielsen JS, Poulsen O, Shi P, Schiffer JP. Laser cooling of a bunched beam in a synchrotron storage ring. Phys Rev Lett 1995; 74:4432-4435. [PMID: 10058505 DOI: 10.1103/physrevlett.74.4432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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34
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Nielsen JS. Generation of 90-mW continuous-wave tunable laser light at 280 nm by frequency doubling in a KDP crystal. Opt Lett 1995; 20:840-842. [PMID: 19859347 DOI: 10.1364/ol.20.000840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Laser light at a wavelength of 560 nm from a commercial ring dye laser has been frequency doubled in an external enhancement cavity with a KDP crystal. The cavity employs a new design consisting of only three mirrors, permitting a shorter cavity length as well as compensation for astigmatism and coma. With an input power of ~950 mW of green light, ~90 mW of UV light has been produced. The wavelength of the UV light can be tuned corresponding to +/-3 nm by angle tuning of the crystal, and the optical frequency can be scanned electronically up to +/-10 GHz.
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35
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Hangst JS, Labrador A, Lebedev V, Madsen N, Nielsen JS, Poulsen O, Shi P, Schiffer JP. Anomalous Schottky signals from a laser-cooled ion beam. Phys Rev Lett 1995; 74:86-89. [PMID: 10057705 DOI: 10.1103/physrevlett.74.86] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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36
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Nissen H, Nielsen PF, Frederiksen M, Helleberg C, Nielsen JS. [Endocarditis--clinical picture of native valve infection]. Ugeskr Laeger 1994; 156:4576-9. [PMID: 7992392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
In a population of 930,000 inhabitants all records of native valve infective endocarditis diagnosed in the decade 1980-89 were reviewed. One hundred and thirty-two cases were found, of whom 23 were not diagnosed until postmortem. Median prehospital duration of symptoms was 20 days (range 0-180) and median in-hospital diagnostic delay five days (range 0-54). Known cardiac disease was found in 42%, possible portal of entry in 33%, but in 36% no predisposing factors were found. During the clinical course 55% experienced cardiac failure and 17% embolic episodes. Surgery was required in 19 patients. Of 111 culture positive cases, streptococci were found in 61 and staphylococci in 45 cases. Overall mortality was 33% with a mortality of clinically diagnosed cases of 18%. Native valve endocarditis is thus associated with a significant mortality in part due to significant diagnostic delays and a large number of post-mortem diagnosed cases. Only by securing a high level of alertness towards endocarditis can we expect a reduced mortality.
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Affiliation(s)
- H Nissen
- Odense Universitetshospital, kardiologisk afdeling B
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37
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Abstract
We report a rare case of a bronchogenic adenocarcinoma metastatic to the lower gingiva as the first clinical sign of metastatic disease. The following safe approach is recommended: a tumor in the oral cavity should be regarded as malignant or as a metastasis until the hypothesis can be abandoned.
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Affiliation(s)
- N H Staalsen
- Department of Thoracic and Cardiovascular Surgery, Skejby Hospital, University Hospital of Aarhus, Denmark
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38
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Kristensen M, Hangst JS, Jessen PS, Nielsen JS, Poulsen O, Shi P. Laser-rf double-resonance spectroscopy in a storage ring. Phys Rev A 1992; 46:4100-4109. [PMID: 9908608 DOI: 10.1103/physreva.46.4100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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39
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Nissen H, Nielsen PF, Frederiksen M, Helleberg C, Nielsen JS. Native valve infective endocarditis in the general population: a 10-year survey of the clinical picture during the 1980s. Eur Heart J 1992; 13:872-7. [PMID: 1644074 DOI: 10.1093/oxfordjournals.eurheartj.a060285] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
In a population of 930,000 inhabitants all records of native valve infective endocarditis diagnosed in the decade 1980-89 were reviewed. Using strict case definitions 132 clinically well-defined or post-mortem diagnosed cases were found. Included were cases referred to the local department of cardiology, as well as cases treated in non-specialized departments. Of 132 cases found 23 were only diagnosed post mortem. The male/female ratio was 71/61. The median prehospital duration of symptoms was 20 days (range 0-180 days) and the median in-hospital diagnostic delay was 5 days (range 0-54 days). Known cardiac disease was found in 42% of cases, a possible portal of entry was found in 33%, but in 36% there were no predisposing factors. Remarkably, only two patients had known rheumatic heart disease and none had a known dental focus. During the clinical course 55% experienced cardiac failure and 17% embolic episodes. In 19 patients surgery was required. Of 111 culture-positive cases streptococci were found in 61 and staphylococci in 45 cases. Echocardiography was performed in 95 cases with echocardiographic signs of endocarditis in 65 patients. Overall mortality was 33% with a mortality in clinically diagnosed cases of 18%. Of 14 cases needing immediate surgical intervention, two died.
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Affiliation(s)
- H Nissen
- Cardiology Department, Odense University Hospital, Denmark
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40
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Andersen C, Clemensen SE, Henneberg SW, Hansen HS, Nielsen JS, Hole P. [Incapacitating angina pectoris treated with electric stimulation of the spinal cord]. Ugeskr Laeger 1992; 154:1176-9. [PMID: 1604745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Thirty patients who had severe incapacitating angina pectoris which had not reacted to the conventional therapeutic measures and which required massive daily opioid consumption were treated with electrical spinal cord stimulation (SCS) by means of a completely implantable stimulation system. The therapeutic effect was good in 87% of the patients who experienced considerably reduced frequency of attacks and markedly reduced opioid consumption (p less than 0.00005). Nine of the patients could reduce opioid consumption and 14 out of 27 could cease their otherwise daily opioid consumption. In four patients, the therapeutic effect was unsatisfactory. In the first 22 patients in whom a unipolar electrode was introduced, displacement of the electrode and subsequent reoperation was a frequent problem. This problem disappeared after change to multipolar electrodes as slight changes in placing of the electrode could easily be compensated for via the external programming equipment. This investigation reveals that SCS is a good therapeutic alternative for this selected patient category.
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Affiliation(s)
- C Andersen
- Odense Sygehus, Anaestesiologisk/intensiv afdeling V og medicinsk afdeling B
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41
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Guldager B, Jelnes R, Jørgensen SJ, Nielsen JS, Klaerke A, Mogensen K, Larsen KE, Reimer E, Holm J, Ottesen S. EDTA treatment of intermittent claudication--a double-blind, placebo-controlled study. J Intern Med 1992; 231:261-7. [PMID: 1556523 DOI: 10.1111/j.1365-2796.1992.tb00533.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A double-blind, randomized multicentre study was undertaken to evaluate the possible effect of chelation treatment with ethylenediamine-tetraacetic acid (EDTA) in patients with severe intermittent claudication. A total of 153 patients received 20 intravenous infusions of either 3 g Na2EDTA or placebo during a period of 5-9 weeks. Vitamin, mineral and trace element supplements were administered orally. The changes observed in the pain-free and maximal walking distances, measured on a treadmill, were similar in the two groups. During the 3-month (n = 149) and 6-month (n = 123) follow-up period, no long-term therapeutic effect of EDTA could be demonstrated. The ankle-brachial blood pressure index remained unchanged throughout the study period. This study failed to demonstrate any effect of EDTA chelation treatment in intermittent claudication.
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Affiliation(s)
- B Guldager
- Department of Surgery, Central Hospital Hillerød, Denmark
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Abstract
The occurrence of a new congenital defect of the appendicular skeleton in Mohair goats is described. The malformation is peromelia and occurs in a familiar pattern. The defect seems to have an autosomal recessive mode of inheritance with variation in the expressivity of the genotype. The pathological abnormalities were described in 8 cases, all characterized by agenesia of the phalanges and parts of the metacarpus or metatarsus affecting one or more limbs. In some cases additional skeletal defects were found. Furthermore, 5 cases were reported by the owners with a description of the limb affected and 1 case was examined clinically. Predisposition for pelvic limbs to be affected was observed. The defect, which does not seem to have been described in goats previously, is phenotypically similar to and possibly also genetically homologous to a defect described in sheep.
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Affiliation(s)
- J S Nielsen
- Department of Pathology and Epidemiology, National Veterinary Laboratory, Copenhapen, Denmark
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43
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Hørlyck A, Nielsen JS. [Residual metastases from testicular cancer. CT as a diagnostic and strategic adjuvant]. Ugeskr Laeger 1991; 153:2485-7. [PMID: 1926601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Forty-nine young males with advanced testicular cancer treated between March 1982 and June 1989 comprised a 49/588 (8%) subgroup with distant metastases to the retroperitoneum, mediastinum and lungs, and required mandatory surgery on basis of the risk for reactivation of "slumbering" malignant components in tumor tissue temporarily inactivated by chemotherapy and/or radiotherapy. Preoperative CAT-scan was carried out with the intention of mapping regional pathology related to the size, number, burden of the tumor tissue, and the occasional and prognostic ominous invasion of the great vessels. Regarding radical surgery, the positive predictive value of CAT-scan was found to be 33/34 (97%). The negative predictive value was 5/15 (33%) and was interpreted as an expression of the radiologist's cautious assessment. 14/49 (29%) died before March 1990. Poor prognosis was related to invasion of major vessels and was found in 14 patients of whom eight died. It seems established that CAT-scan presents an extremely valuable preoperative investigation when it comes to planning of surgical strategy in a patient population with testicular cancer metastases with difficult access.
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Affiliation(s)
- A Hørlyck
- Røntgendiagnostisk afdeling R, Arhus Kommunehospital
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44
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Hangst JS, Kristensen M, Nielsen JS, Poulsen O, Schiffer JP, Shi P. Laser cooling of a stored ion beam to 1 mK. Phys Rev Lett 1991; 67:1238-1241. [PMID: 10044095 DOI: 10.1103/physrevlett.67.1238] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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45
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Thomsen PD, Nielsen JS. PCR screening for carriers of hereditary citrullinaemia in Danish Holstein-Friesian bulls. Acta Vet Scand 1991; 32:279-82. [PMID: 1803940 PMCID: PMC8127890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- P D Thomsen
- Department of Animal Science and Animal Health, Royal Veterinary and Agricultural University, Copenhagen, Denmark
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46
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Nielsen JS, Andresen E, Basse A, Christensen LG, Lykke T, Nielsen US. Inheritance of bovine spinal muscular atrophy. Acta Vet Scand 1990; 31:253-5. [PMID: 2260520 PMCID: PMC8133198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- J S Nielsen
- National Veterinary Laboratory, Copenhagen, Denmark
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47
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Strate M, Nielsen JS. [Infectious endocarditis. A retrospective analysis of 34 cases]. Ugeskr Laeger 1987; 149:3031-3. [PMID: 3433500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Abstract
Heart rate responses to stepwise and periodic changes in lung volume were studied in seven young healthy males. Stepwise inspiration and expiration both resulted in an increase in heart rate followed by a rapid decrease in heart rate. The fastest heart rate was reached in 1.6 +/- 0.5 s and in 3.6 +/- 1.4 s in response to inspiration and expiration, respectively (P less than 0.01). The slowest heart rate was reached in 4.8 +/- 1.0 s and in 7.6 +/- 1.9 s in response to inspiration and expiration, respectively (P less than 0.01). Following this biphasic change the heart rate returned to a steady level. The difference between the fastest and the slowest heart rates was significantly larger in response to inspiration (21.7 +/- 7.3 beats per minute) than in response to expiration (12.0 +/- 7.3 beats per minute; P less than 0.01). Periodic changes in lung volume were performed with frequencies from 3.0 to 12.0 respirations per minute (r.p.m.). The changes in heart rate showed a constant amplitude in the frequency range below 5.5 r.p.m. Maximal heart rate changes were found at frequencies of 5.5 to 7.0 r.p.m. Changes in heart rate decreased in a linear manner on a log-log scale in the frequency range above 7.0 r.p.m. The relation between frequency and changes in heart rate is explained by interference between the transient changes in heart rate induced both by inspiration and by expiration. It is concluded that if heart rate changes in response to periodic changes in lung volume are to be used as a measure of vagal function a number of factors have to be taken into consideration and to simplify the analysis of heart rate responses to breathing we recommend, instead, the use of the transient changes in heart rate induced by stepwise changes in lung volume.
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Nielsen JS, Hrudey SE, Cantwell FF. Role of the free metal ion species in soluble nickel removal by activated sludge. Environ Sci Technol 1984; 18:883-886. [PMID: 22283220 DOI: 10.1021/es00129a013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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50
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Nielsen JS, Jørgensen LB, Siem-Jørgensen P. [Double gallbladder. With a single concretion of the cranial anlage]. Ugeskr Laeger 1984; 146:433-4. [PMID: 6702004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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