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To date the final stage in deglaciation of the Greenland shelf, when a contiguous ice sheet margin on the inner shelf transitioned to outlet glaciers in troughs with intervening ice-free areas, we generated cosmogenic 10Be dates from bedrock knobs on six outlying islands along a stretch of 300 km of the southwestern Greenland coast. Despite 10Be inheritance influencing some dates, the ages generally support a Greenland Ice Sheet (GrIS) margin that retreated off the inner shelf during the middle Younger Dryas (YD) period. Published 10Be- and 14C-dated records show that this history of the GrIS margin is seen in other parts of Greenland but with large variations in the extent and speed of retreat, sometimes even between neighbouring areas. Areas with a chronology extending into the Allerød period show no marked ice margin change at the Allerød–YD transition except in northernmost Greenland. In contrast, landforms on the shelf (moraines and grounding zone wedges) have been suggested to indicate YD readvances or long-lasting ice margin stillstands on the middle shelf. However, these features have been dated primarily by correlation with cold periods in the ice core temperature records. Ice margin retreat during the middle and late YD is explained by advection of warm subsurface water at the ice margin and by increased seasonality. Our results therefore point to the complexity of the climate–ice margin relation and to the urgent need for direct dating of the early deglaciation history of Greenland.

Background Morning reports are an essential component of physicians’ daily work. Attending morning reports is prioritized by junior doctors as it provides them with an opportunity to learn diagnostic reasoning through discussion of cases. While teaching formats during morning reports have previously been reported, an in-depth analysis of what learning opportunities exist, e.g., how teaching is enacted during morning reports, is lacking. This qualitative study explores learning opportunities during morning reports. Methods We used an explorative design based on video-recordings of 23 morning reports from two surgical departments, an internal medicine department and an emergency department. We used thematic analysis combined with and inspired by Eraut’s theoretical framework of workplace learning. Results Both formal and informal learning opportunities were identified. Formal learning opportunities had the character of planned teaching activities, and we identified four themes: (1) modes of teaching, (2) structure, (3) presenter role, and (4) participant involvement. Informal learning, on the other hand, was often implicit and reactive, while deliberate learning opportunities were rare. The data showed many missed opportunities for learning. Conclusion Both formal and informal learning opportunities are present during morning reports. However, a prevalent focus on medical topics exists, leaving other important aspects of the medical role under-discussed. Pedagogical methods could be employed more optimally, and harnessing the potential of missed opportunities should be encouraged.

Background In Denmark a national formal advisory program (NFAP) is mandatory in Postgraduate Medical Education (PGME). According to this, an educational advisor is assigned to each doctor in every clinical rotation to guide and oversee the work and learning progress of the trainee. This study explores why newly graduated trainees evaluated the appraisal meetings in the advisory program as either beneficial (successes) or not beneficial (non-successes). Methods Inspired by the Success Case Method, a survey was conducted among all 129 doctors employed in their first six-month clinical rotation of postgraduate medical education (PGY1) in the Central Denmark Region. A cluster analysis resulted in a group with eight successes respectively seven non-successes. Semi-structured interviews were conducted with six successes and five non-successes. Results In contrast to non-successes, the successes had longer appraisal meetings and their advisor introduced them to purpose and process of meetings including use of the personal learning plan. Successes received feedback on clinical skills, overall global performance and career plans. The successes perceived their advisors as prepared, skilled and motivated and the advisor acted as a contact person. To the successes, the appraisal meetings fostered clarification of and reflections on educational goals, progress and career as well as self-confidence and a sense of security. Conclusion Success with appraisal meetings seemed to depend on advisor’s skills and motivation including willingness to prioritize time for this task. The results from this study indicate the importance of faculty development. It also raises the question if all doctors should serve as advisors or if this task should be assigned to the most motivated candidates.

The morning report is one of the longest surviving hospital practices. Most studies of the morning report focus on the effectiveness of formal medical training, while focus on social and communicative aspects is rarer. This study explores the social interactions and communication in morning reports, examining the ways in which they contribute to the construction of professional identity and socialization into the community of the clinical department. We used a qualitative explorative design with video observations of morning reports. Our data consisted of 43 video-recorded observations (in all, 15.5 hours) from four different hospital departments in Denmark. These were analyzed using the theoretical framework of positioning theory. A key finding was that each department followed its own individual structure. This order was not articulated as such but played out implictly. Two alternative storylines unfolded in the elements of the morning report: 1) being equal members of the specialty and department, and 2) preserving the hierarchical community and its inherent positions. The morning report can be seen as playing an important role in community making. It unfolds as a \"dance\" of repeated elements in a complex collegial space. Within this complexity, the morning report is a space for positioning oneself and others as a collegial \"we\", i.e., equal members of a department and specialty, at the same time as \"having a place\" in a hierarchal community. Thus, morning reports contribute to developing professional identity and socialization into the medical community.

Current three-dimensional (3D) genome modeling platforms are limited by their inability to account for radial placement of loci in the nucleus. We present Chrom3D, a user-friendly whole-genome 3D computational modeling framework that simulates positions of topologically-associated domains (TADs) relative to each other and to the nuclear periphery. Chrom3D integrates chromosome conformation capture (Hi-C) and lamin-associated domain (LAD) datasets to generate structure ensembles that recapitulate radial distributions of TADs detected in single cells. Chrom3D reveals unexpected spatial features of LAD regulation in cells from patients with a laminopathy-causing lamin mutation. Chrom3D is freely available on github.

Background As populations age in the Western world, interventions aiming for ‘aging in place’, such as reablement, have gained prominence. Reablement programs have focused on enabling older people to maintain independence in their home environment. However, while a growing body of research points to the considerable benefits of engaging in outdoor environments, reablement rarely addresses outdoor activities. People living in rural Arctic areas often tend to have strong cultural, social, and emotional attachments to outdoor places, emphasizing the outdoors as a meaningful arena for engagement. Concurrently, rural Arctic communities face unique obstacles in facilitating outdoor activities, such as geographic isolation, limited access to services, harsh climate conditions, and seasonal variations. Recognizing these challenges, our study sought to tailor an outdoor reablement model that is appropriate and feasible for the context of a rural Arctic setting. Methods The study design was inspired by a co-design methodology, incorporating data creation through workshops, focus groups, and individual interviews conducted over an eleven-month period. Three municipalities in rural Arctic Norway were involved, with a total of 35 participants, including older people receiving reablement services and healthcare professionals. A socioecological theory supported the thematic data analysis. Results The study yielded experiences that generated a comprehensive model for implementing outdoor reablement that meet the specific needs that the participants experienced in the rural Arctic setting. The model includes the individual level, accounting for physical and mental functioning; the organizational level, necessitating access to aids and equipment and cross-sectorial collaboration; and the environmental level, adapting to climatic, seasonal, and geographic challenges. Conclusion This study contributes with knowledge that broadens the scope of reablement as an initiative to support aging in place to include outdoor environments. The tailored outdoor reablement model developed in this study addresses the complexity of aging in place in rural Arctic settings. The study underscores the importance of context-specific strategies that support older people in maintaining a healthy and meaningful life through active engagement with the outdoors.

Objectives Whether the elevated risk of lung cancer observed among welders is caused by welding emissions or by confounding from smoking or asbestos exposure is still not resolved. This question was addressed in a cohort with a long follow-up and quantified estimates of individual exposure to welding fume particulates. Methods Male metal workers employed at least 1 year at one or more Danish stainless or mild steel industrial companies from 1964 through 1984 were enrolled in a cohort. Data on occupational and smoking history were obtained by questionnaire in 1986. Welders in the cohort who started welding in 1960 or later (N=4539) were followed from April 1968 until December 2003, when information on cancer diagnosis was obtained from the Danish Cancer Registry. During the follow-up, 75 cases of primary lung cancer were identified. Lifetime accumulated exposure to welding fume particulates was estimated by combining questionnaire information and more than 1000 welding-process-specific measurements of fume particulates in the Danish welding industry. Results The standardized incidence ratio (SIR) for lung cancer was increased among the welders [SIR 1.35, 95% confidence interval (95% CI) 1.06-1.70)]. Among the stainless steel welders, the risk increased significantly with increasing accumulative welding particulate exposure, while no exposure-response relation was found for mild steel welders, even after adjustment for tobacco smoking and asbestos exposure. Conclusions The study corroborates earlier findings that welders have an increased risk of lung cancer. While exposure-response relations indicate carcinogenic effects related to stainless steel welding, it is still unresolved whether the mild steel welding process carries a carcinogenic risk.

Background: Chronic non-malignant lung diseases such as chronic obstructive pulmonary disease (COPD) and interstitial lung diseases (ILD) result in reduced quality of life (QoL), a high symptom burden and reduced survival. Patients with chronic non-malignant lung disease often have limited access to palliative care. The symptom burden and the QoL of these patients resembles patients with cancer and the general palliative approach is similar. However, the disease trajectory is often slow and unpredictable, and the palliative effort must be built on accessibility, continuity and professional competences. The Danish Health Authority as well as the WHO recommends that there is access to palliative care for all patients with life-threatening diseases regardless of diagnosis. In 2011, the Danish Health Authority requested that the national medical societies would to formulate guidelines for palliation. Methods: In 2015, a group of members of the Danish Respiratory Society (DRS) was appointed for this purpose. It was composed of experienced ILD and COPD researchers as well as clinicians from different parts of Denmark. A literature review was made, a draft was prepared, and all recommendations were agreed upon unanimously. Results: The Danish version of the position paper was finally submitted for review and accepted by all members of DRS. Conclusion: In this position paper we provide recommendations on the terminology of chronic and terminal lung failure, rehabilitation and palliative care, advanced care planning, informal caregivers and bereavement, symptom management, the imminently dying patient, and organization of palliative care for patients with chronic non-malignant lung diseases.

Epigenetic regulation is a key determinant of adipocyte fate and function, conferring phenotypic plasticity to adipose tissue in response to metabolic and thermal challenges. To understand the spatiotemporal regulation of chromatin during the establishment of a beige thermogenic adipocyte phenotype, we analyzed the transcriptomic, epigenetic, and enhancer connectome dynamics during white and beige adipogenesis. Using a machine learning approach, we find that the white-specific transcriptional program is associated with promoter modulations of H3K2ac levels and chromatin accessibility. In contrast, beige-specific mitochondrial gene expression correlates with promoter changes in H3K4me3 levels. Adipocyte beiging is also mediated by a remodeling of the 3D genome involving the recruitment of short range enhancers targeting fatty acid oxidation and thermogenic genes. These increased promoter-enhancer contacts correlate with increased chromatin opening at sites enriched for C/EBP transcription factor motifs. We notably identify the C/EBP transcription factor NFIL3 as differentially bound between white and beige adipocytes at enhancers regulating PDK4, a key metabolic switch promoting fatty acid oxidation. Our results highlight a multimodal, pathway-specific regulation of the transcriptional program underlying the beige adipocyte phenotype.

A genetic disease in cattle, progressive degenerative myeloencephalopathy (weaver disease), is associated with increased milk production. This association could result from population stratification, from a pleiotropic effect of a single gene, or from linkage disequilibrium between the gene causing weaver disease and a quantitative trait locus (QTL) for milk production. To test these hypotheses, we performed an extensive linkage study in a bovine pedigree segregating for the weaver condition and identified a microsatellite locus (TGLA116) closely linked to the weaver gene (Zmax, 8.15; theta, 0.03). TGLA116 and, by extension, the weaver locus were assigned to bovine synteny group 13. This microsatellite can be used to identify weaver carriers, to select against this genetic defect, and to study the effect of the corresponding chromosomal region on milk production in Brown Swiss and other breeds of cattle.