Nordic Type Research Articles

Empagliflozin Use Is Associated With Lower Risk of All-Cause Mortality, Hospitalization for Heart Failure, and End-Stage Renal Disease Compared to DPP-4i in Nordic Type 2 Diabetes Patients: Results From the EMPRISE (Empagliflozin Comparative Effectiveness and Safety) Study.

Objective: To evaluate the effectiveness of empagliflozin in reducing all-cause mortality (ACM), hospitalization for heart failure (HHF), myocardial infarction (MI), stroke, cardiovascular mortality (CVM), and end-stage renal disease (ESRD) in routine clinical practice in the Nordic countries of the Empagliflozin Comparative Effectiveness and Safety (EMPRISE) study. Methods: This noninterventional, multicountry cohort study used secondary data from four Nordic countries (Denmark, Sweden, Finland, and Norway). Propensity score (PS) matched (1:1) adults with type 2 diabetes (T2D) initiating empagliflozin (a sodium-glucose cotransporter-2 inhibitor) during 2014-2018 who were compared to those initiating a dipeptidyl peptidase-4 inhibitor (DPP-4i). Cox proportional hazards regression modelling was used to assess the risk for ACM, HHF, MI, stroke, CVM, and ESRD. Meta-analyses were conducted and hazard ratios (HRs) with 95% confidence intervals (CIs) from random-effects models were calculated. Results: A total of 43,695 pairs of PS-matched patients were identified. Patients initiating empagliflozin exhibited a 49% significantly lower risk of ACM (HR: 0.51, 95% CI 0.40-0.64) compared to DPP-4i. Additionally, empagliflozin was associated with a 36% significantly lower risk of HHF (HR: 0.64, 95% CI 0.46-0.89), a 52% significantly lower risk of CVM (HR: 0.48, 95% CI 0.37-0.63), and a 66% significantly lower risk of ESRD (HR: 0.34, 95% CI 0.15-0.77) compared to DPP-4i. No significant differences were observed in the risk of stroke and MI between patients initiating empagliflozin compared with those initiating a DPP-4i. Results were generally consistent for subgroups (with/without pre-existing CV disease or congestive heart failure) and in sensitivity analyses. Conclusion: Empagliflozin initiation was associated with a significantly reduced risk of ACM, HHF, CVM, and ESRD compared with initiation of DPP-4i in patients with T2D when examining routine clinical practice data from Nordic countries.

Sakrala ortnamn av förkristen nordisk typ i de nordliga delarna av Norge och Sverige. Ett försök till översikt

In this article, the author seeks to outline an overall picture of the sacral place-names of pre-Christian Nordic (North Germanic) type in the northern parts of Norway and Sweden. She first deals with the theophoric names that appear there and discusses which deities are represented in these names. Furthermore, she addresses names that contain or may contain a word for ‘holy place’ or ‘cult place’. Finally, she discusses names containing a word for ‘holy’ or ‘sanctity’. The overview that the article wants to give is intended to offer comparative material for a discussion of Sami sacral place-names in Scandinavia. However, a summary overview of these is still a desideratum.

Length-weight relationships and condition factors of the sand smelt Atherina boyeri (Risso, 1810) estimated from commercial and experimental catches in Lake Trichonis (Western Greece)

Total length-weight relationships (LWRs) from 3583 individuals of Atherina boyeri (Risso, 1810) caught in Lake Trichonis (Western Greece), using a commercial encircled net and experimental Nordic type benthic and pelagic multi-mesh gillnets, were estimated during 2019-2020. The variation of the parameter b for all seasons combined was significantly allometric, for both encircled towed and gillnets, with a quite robust fit (R^2 equals 0.925 and 0.947, respectively) and values equal to 2.254 and 2.089, respectively. The specimens were significantly lighter in summer than in the other seasons. The slopes of the LWRs significantly differ between seasons and exhibited relatively low values when compared to other ecosystems worldwide and in the same ecosystem in previous periods of time. Τhe estimated values of the Le Cren index were significantly higher than the Allometric and the Fulton ones.

Wolfenbüttel

Wolfenbüttel

Length‐weight relationships of 6 fish species caught in a Mediterranean lake (Trichonis‐NW Greece)

In the present study the length–weight relationships (LWRs) of 6 fish species which are endemic to Western Greece, caught in the natural Lake Trichonis by experimental gillnets and electrofishing were estimated. Benthic (mesh size 5–55 mm; height 1.5 m; length 30 m) and pelagic (mesh size 6.25–55 mm; height 6 m; length 27.5 m) Nordic type multimesh gillnets were used seasonally, between February 2019 and November 2019, at different depth zones (0-57m). Electrofishing (80 Hz) conducted in the littoral zone of the lake during four samplings (2018, 2019). All the estimated LWRs were highly significant (p < .05) with high correlation coefficient (r2 ≥ 0.962). The estimated b values ranged from 3.058 to 3.344. For five of the studied species (Trichonis spined loach (Cobitis trichonica Stephanidis 1974), Trichonis blenny (Salaria economidisi Kottelat 2004), Trichonis rudd (Scardinius acarnanicus Economidis 1991), Acheloos roach (Leucos panosi (Bogutskaya & Iliadou 2006)) , Hellenic minnowroach (Tropidophoxinellus hellenicus (Stephanidis 1971)) new maximum total body lengths (TL) were recorded, while for two species (T. hellenicus and L. panosi) LWRs are presented for the first time.

The Effects of Needs for Security and Certainty on Economic Beliefs: The Role of Political Engagement and the Welfare State Model

We suggest that the effects of needs for security and certainty (NSC) on economic beliefs result from potentially competing dispositional (political engagement) and contextual (the country-level political narrative around the welfare state) influences. An analysis of data from the 2016 European Social Survey (N = 40,870) showed that at low levels of political engagement, NSC is associated with left-wing beliefs. However, at high levels of political engagement, the NSC effects are conditional on a country’s welfare state model: NSC is related to right-wing beliefs in Liberal, Continental, and Southern types, but the effects are nonsignificant in the Nordic type and the reverse under the Eastern type. Analysis of 2018 round of the same survey (N = 45,575) corroborated the main findings (except the Southern type for which NSC effects were nonsignificant). This study advances knowledge on the psychological roots of economic beliefs and contributes to the understanding of people’s political choices.

Rosacea: Not Curse of the Celts, But of Many More

From what I can remember from my medical studies, a long time ago, when our Professors were naming rosacea as “acne-rosacea”, there was always a mention to its nickname: the “Curse of the Celts”. Hence our formation was including the notion that rosacea was more common among the fair-haired, blue-eyed “Nordic type” [1]. Meanwhile, over the years and with more experience and a deeper knowledge of other continents and populations, I was able to observe that this notion was not exactly and even far from being correct.

Failure domain analysis and uncertainty quantification using surrogate models for steam explosion in a Nordic type BWR

Sever accident mitigation strategy adopted in Nordic Boiling Water Reactors (BWRs) employs a deep water pool below the reactor vessel to fragment and quench core melt and provide long term cooling of the debris. One of the risks associated with this strategy is early containment failure due to ex-vessel steam explosion. Assessment of the risk of steam explosion is subject to significant (i) epistemic uncertainties in modelling and (ii) aleatory uncertainties in scenarios of melt release. For quantification of the uncertainties and the risk a full model (FM) based on TEXAS-V code and a computationally efficient surrogate model (SM) have been previously developed. FM is used to provide a database of solutions that is used for development of a SM, while SM is used in extensive sensitivity and uncertainty analysis. In this work, we compare the risk of containment failure with non-reinforced and reinforced hatch door for metallic and oxidic melt release scenarios. We quantify the error of SM in the approximation of the FM and assess the effect of the approximation uncertainty on risk assessment. We analyze the results and suggest a simplified approach for decision making considering predicted failure probabilities, expected costs, and scenario frequencies.

Viewing Nordic Public Management

How do Nordic states conduct policies in order to bring people closer to the socio-economic realm, in the sense that they, being social capital, tend to be integrated as active and participatory citizens? How do the interventionist and expensive Nordic welfare states survive in the global age, with demanding and ever changing claims to international competitiveness? This paper addresses these questions. Social capital and partnership building are introduced as terms and policy concepts in order to find answers in the framework of intended or unintended strategic taming endeavours. As a critical approach claims a contextual conceptualisation, we shall here view different European social models and administrative traditions in relation to comparative basic contexts in order to arrive at analytical answers. Leaning especially on the Anglo-Saxon model, the traditional Scandinavian universal welfare state model of the post-war Keynesian order has gradually been transformed into the contemporary Nordic model (Veggeland 2007). Contextual regulatory innovations and path-dependent processes have generated the survival of universal welfare state arrangements and collective action but with the mixed use of Market-Type Mechanisms (MTM) in the public sector of Anglo-Saxon origin. In summary, this blending of policies has resulted in the advantageous social capital of what is called flexicurity , social security combined with a flexible participatory labour market. We shall discuss both flexicurity policy and participatory subsidiarity defined downwards as contributions to an explanation of why the expensive welfare states of the Nordic type have not only so far been doing well but have also sustained both democratic and output-side legitimacy.

Social Capital. Viewing Nordic Paths of Management

How do Nordic states conduct policies in order to bring people closer to the socio-economic realm, in the sense that they, being social capital, tend to be integrated as active and participatory citizens? How do the interventionist and expensive Nordic welfare states survive in the global age, with demanding and ever changing claims to international competitiveness? This paper addresses these questions. Social capital and partnership building are introduced as terms and policy concepts in order to find answers in the framework of intended or unintended strategic endeavours. As a critical approach claims a contextual conceptualisation, we shall here view different European social models and administrative traditions in relation to comparative basic contexts in order to arrive at analytical answers. Leaning especially on the Anglo-Saxon model, the traditional Scandinavian universal welfare state model of the post-war Keynesian order has gradually been transformed into the contemporary Nordic model (Veggeland 2007). Contextual regulatory innovations and path-dependent processes have generated the survival of universal welfare state arrangements and collective action but with the mixed use of Market-Type Mechanisms (MTM) in the public sector of Anglo-Saxon origin. In summary, this blending of policies has resulted in the advantageous social capital of what is called flexicurity, social security combined with a flexible participatory labour market. We shall discuss both flexicurity policy and participatory subsidiarity defined downwards as contribution to an explanation of why the expensive welfare states of the Nordic type have not only so far been doing well but have also sustained both democratic and output-side legitimacy.

East Asian welfare regime: obsolete ideal-type or diversified reality

ABSTRACTThe paper asks if East Asian welfare regimes are still productivist and Confucian? And, have they developed public care policies? The literature is split on the first question but (mostly) confirmative on the second. Care has to a large, but insufficient extent, been rolled out in the region. Political science studies tend to conclude that the region has left the old legacies behind and are now welfare states comparable to European states including them either in the conservative type (e.g. Japan), the liberal type (e.g. Korea) or even as a tendency in the Nordic type (e.g. China), while studies focusing on outcomes or causal links tend to suggest that legacies prevail, but there is (nearly) consensus that Confucianism exercises great influence in the whole region.

Development of a surrogate model for analysis of ex-vessel steam explosion in Nordic type BWRs

Severe accident mitigation strategy adopted in Nordic type Boiling Water Reactors (BWRs) employs ex-vessel core melt cooling in a deep pool of water below reactor vessel. Energetic fuel–coolant interaction (steam explosion) can occur during molten core release into water. Dynamic loads can threaten containment integrity increasing the risk of fission products release to the environment. Comprehensive uncertainty analysis is necessary in order to assess the risks. Computational costs of the existing fuel–coolant interaction (FCI) codes is often prohibitive for addressing the uncertainties, including the effect of stochastic triggering time.This paper discusses development of a computationally efficient surrogate model (SM) for prediction of statistical characteristics of steam explosion impulses in Nordic BWRs. The TEXAS-V code was used as the Full Model (FM) for the calculation of explosion impulses. The surrogate model was developed using artificial neural networks (ANNs) and the database of FM solutions. Statistical analysis was employed in order to treat chaotic response of steam explosion impulse to variations in the triggering time. Details of the FM and SM implementation and their verification are discussed in the paper.

Microsatellite diversity of the Nordic type of goats in relation to breed conservation: how relevant is pure ancestry?

In the last decades, several endangered breeds of livestock species have been re-established effectively. However, the successful revival of the Dutch and Danish Landrace goats involved crossing with exotic breeds and the ancestry of the current populations is therefore not clear. We have generated genotypes for 27 FAO-recommended microsatellites of these landraces and three phenotypically similar Nordic-type landraces and compared these breeds with central European, Mediterranean and south-west Asian goats. We found decreasing levels of genetic diversity with increasing distance from the south-west Asian domestication site with a south-east-to-north-west cline that is clearly steeper than the Mediterranean east-to-west cline. In terms of genetic diversity, the Dutch Landrace comes next to the isolated Icelandic breed, which has an extremely low diversity. The Norwegian coastal goat and the Finnish and Icelandic landraces are clearly related. It appears that by a combination of mixed origin and a population bottleneck, the Dutch and Danish Land-races are separated from the other breeds. However, the current Dutch and Danish populations with the multicoloured and long-horned appearance effectively substitute for the original breed, illustrating that for conservation of cultural heritage, the phenotype of a breed is more relevant than pure ancestry and the genetic diversity of the original breed. More in general, we propose that for conservation, the retention of genetic diversity of an original breed and of the visual phenotype by which the breed is recognized and defined needs to be considered separately.

Constant pattern of relapse in primary central nervous lymphoma patients treated with high-dose methotrexate combinations. A Finnish retrospective study

Background. Primary central nervous system lymphoma (PCNSL) is a rare brain tumour with a dismal prognosis. Several phase II studies with high-dose methotrexate-based regimens have shown promising early results, but in all hospital-based data published so far, the disease outcome is poor.Material and methods. We performed a hospital-based retrospective analysis to evaluate the long-term results of the Nordic type of Bonn chemotherapy regimen in PCNSL patients. The study included 54 patients with newly diagnosed PCNSL who received chemotherapy with curative intent as their first-line treatment.Results. We found promising response rates, 76% of the patients achieving CR and 22% patients achieving PR, with corresponding two-year EFS 53% and OS 76%. However, with longer follow-up a constant pattern of relapses was observed with only one patient remaining in primary remission after 60 months.Discussion. The finding suggests that basic biological differences exist between PCNSL and systemic diffuse large B-cell lymphoma and there is a need for consolidation or maintenance therapy after achieving a remission in patients with PCNSL.

Cost-effectiveness of dapagliflozin (Forxiga®) added to metformin compared with sulfonylurea added to metformin in type 2 diabetes in the Nordic countries

AimsThe aim of this study was to assess the long-term cost-effectiveness of dapagliflozin (Forxiga®) added to metformin, compared with sulfonylurea (SU) added to metformin, in Nordic Type 2 diabetes mellitus (T2DM) patients inadequately controlled on metformin. MethodsData from a 52-week clinical trial comparing dapagliflozin and SU in combination with metformin was used in a Cardiff simulation model to estimate long term diabetes-related complications in a cohort of T2DM patients. Costs and QALYs were calculated from a healthcare provider perspective and estimated over a patient's lifetime. ResultsCompared with metformin+SU, the cost per QALY gained with dapagliflozin+metformin was €7944 in Denmark, €5424 in Finland, €4769 in Norway, and €6093 in Sweden. Metformin+dapagliflozin was associated with QALY gains ranging from 0.236 in Norway to 0.278 in Sweden and incremental cost ranging from €1125 in Norway to €1962 in Denmark. Results were robust across both one-way and probabilistic sensitivity analyses. Results were driven by weight changes associated with each treatment. ConclusionsResults indicate that metformin+dapagliflozin is associated with gains in QALY compared with metformin+SU in Nordic T2DM patients inadequately controlled on metformin. Dapagliflozin treatment is a cost-effective treatment alternative for Type 2 diabetes in all four Nordic countries.

Agglomeration and size distribution of debris in DEFOR-A experiments with Bi2O3–WO3 corium simulant melt

Flooding of lower drywell has been adopted as a cornerstone of severe accident management strategy in Nordic type Boiling Water Reactors (BWR). It is assumed that the melt ejected into a deep pool of water will fragment, quench and form a porous debris bed coolable by natural circulation. If debris bed is not coolable, then dryout and possibly re-melting of the debris can occur. Melt attack on the containment basemat can threaten containment integrity. Agglomeration of melt debris and formation of solid “cake” regions provide a negative impact on coolability of the porous debris bed. In this work we present results of experimental investigation on the fraction of agglomerated debris obtained in the process of hot binary oxidic melt pouring into a pool of water. The Debris Bed Formation and Agglomeration (DEFOR-A) experiments provide data about the effects of the pool depth and water subcooling, melt jet diameter, and initial melt superheat on the fraction of agglomerated debris. The data presents first systematic study of the debris agglomeration phenomena and facilitates understanding of underlying physics which is necessary for development and validation of computational codes to enable prediction of the debris bed coolability in different scenarios of melt release.

Freedom of Choice through the Promotion of Gender Equality

AbstractThis article argues that policies that promote gender equality actually also increase freedom of choice. Thus, despite the neo‐liberal criticism that welfare policies limit choices and privatization and market solutions increase freedom of choice, this article concludes that market‐liberal welfare regimes offer less choice than the Nordic type of social‐democratic welfare regimes, which have openly striven to promote gender equality. They do so by making it easier for mothers to choose to work (by making day care available and making it easier for fathers to stay at home with children) and by giving fathers the ability to choose to spend more time with children. However, within the realm of such policies, it is still possible to offer more or less freedom of choice, for example, by making parental leaves either extremely flexible or rigid in how they are utilized. Interestingly, it turns out that, in the real world, policies that promote gender equality even offer greater freedom of choice for the group of women considered to be ‘family oriented’ as well as for lesbian and homosexual couples.

Integration of tradable green certificate markets: What can be expected?

Recently, many countries have introduced systems of tradable green certificates (TGCs) in order to increase the proportion of their electricity supply obtained from renewable sources. The main objective of this paper is to investigate the analytics of a TGC system of the Nordic type when integrated within several countries and to determine what can be expected from the system when applied in a real world setting. Both an analytical and a partial equilibrium version of the model are applied. In particular, we ask whether it is possible to derive analytically clear-cut results with respect to how the system affects generation of electricity from renewable resources, and from carbon emitting resources, in the same way as it is possible for other known policy instruments such as an emission permit system or a plain carbon emission tax. A key result is that TGCs may be an imprecise instrument for regulating the generation of green electricity and that the combination of TGCs with a system of tradable emission permits may yield outcomes contrary to the intended purpose.

Comparative Genomic Hybridization Analysis of Two Predominant Nordic Group I (Proteolytic) Clostridium botulinum Type B Clusters

Comparative genomic hybridization analysis of 32 Nordic group I Clostridium botulinum type B strains isolated from various sources revealed two homogeneous clusters, clusters BI and BII. The type B strains differed from reference strain ATCC 3502 by 413 coding sequence (CDS) probes, sharing 88% of all the ATCC 3502 genes represented on the microarray. The two Nordic type B clusters differed from each other by their response to 145 CDS probes related mainly to transport and binding, adaptive mechanisms, fatty acid biosynthesis, the cell membranes, bacteriophages, and transposon-related elements. The most prominent differences between the two clusters were related to resistance to toxic compounds frequently found in the environment, such as arsenic and cadmium, reflecting different adaptive responses in the evolution of the two clusters. Other relatively variable CDS groups were related to surface structures and the gram-positive cell wall, suggesting that the two clusters possess different antigenic properties. All the type B strains carried CDSs putatively related to capsule formation, which may play a role in adaptation to different environmental and clinical niches. Sequencing showed that representative strains of the two type B clusters both carried subtype B2 neurotoxin genes. As many of the type B strains studied have been isolated from foods or associated with botulism, it is expected that the two group I C. botulinum type B clusters present a public health hazard in Nordic countries. Knowing the genetic and physiological markers of these clusters will assist in targeting control measures against these pathogens.

50 Years Ago in The Journal of Pediatrics: Is There a Rheumatic Constitution?

Diamond EF. J Pediatr 1959;54:341-7 The mystery of widespread occurrence of streptococcal pharyngitis and yet relatively uncommon and unpredictable occurrence of rheumatic fever has intrigued the medical community for a century. Observant clinicians wondered whether gross physical characteristics might distinguish a rheumatic constitution—much as the prematurely gray, blue-eyed Nordic type is known to have a proclivity for pernicious anemia. By the 1950s, numerous authors had reported a preponderance of certain physical characteristics in children with rheumatic fever, spurring Diamond to formally evaluate a roster of Chicago children with rheumatic fever (sample size, 76-204, depending on factor studied). He sought a simple preponderance of certain features and used a formalized control group for assessing other characteristics. Unlike previously reported associations, Diamond found no preponderance in rheumatic children of race, hair or eye color, asthenic or pyknic body build, skin pallor, blood type, or salivary non-secretion of ABO substance (ie, probable secretion of Lewis substance). Diamond found a single significant constitutional factor—hyperextensibility of metacarpophalangeal joints—significantly more frequently in active and inactive rheumatic groups compared with control subjects. Diamond speculated that this finding may be an expression of an underlying biochemical abnormality of connective tissue. In The Journal in 2002, Barron et al (J Pediatr 2002;141:421-5) reported a case-control study performed in children referred to Johns Hopkins Hospital for chronic fatigue and found hyperextensibility of joints 3.5 times more frequently in these patients than in control children referred to the hospital's dermatology clinic. One wonders whether this finding in patients with chronic fatigue and rheumatic fever is merely deconditioning or whether it belies an underlying genetic disorder. Recent geographically confined outbreaks of rheumatic fever and use of modern molecular microbiology have focused attention on rheumatogenic strains of group A streptococcus. Family size, however, also has been a risk factor for rheumatic fever. It seems that the duration of the unsolved mystery alone and evidence from several corners suggest that there is room to consider relevant contributions to rheumatogenicity from the microbe, the host, and the environment.