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Aim: Accumulated data suggest that routine use of defunctioning stoma in low anterior resection for rectal cancer may cause kidney injury, bowel dysfunction and a higher risk of permanent stomas. We aim to study whether avoidance of a diverting stoma in selected patients is safe and reduces adverse consequences.

Methods: SELSA is a multicentre international prospective observational study nesting an open-label randomized clinical trial. All patients with primary rectal cancer planned for low anterior resection are eligible. Patients operated with curative intent, aged <80 years, with an American Society of Anaesthesiologists' fitness grade I or II, and a low predicted risk of anastomotic leakage are eligible to 1:1 randomization between no defunctioning stoma (experimental arm) or a defunctioning stoma (control arm). The primary outcome is the composite measure of 2-year stoma-free survival without major low anterior resection syndrome (LARS). Secondary outcomes include anastomotic leakage, postoperative mortality, reinterventions, stoma-related complications, quality of life measures, LARS score, and permanent stoma rate. To be able to state superiority of any study arm regarding the main outcome, with 90% statistical power and assuming 25% attrition, we aim to enrol 212 patients. Patient inclusion will commence in the autumn of 2024.

Conclusion: The SELSA study is investigating a tailored approach to defunctioning stoma use in low anterior resection for rectal cancer in relation to the risk of anastomotic leakage. Our hypothesis is that long-term effects will favour the selective approach, enabling some patients to avoid a defunctioning stoma.

Introduction: Periodontitis is associated with rheumatoid arthritis (RA). One hypothesis posits that this connection arises from the formation of autoantibodies against citrullinated proteins (ACPA) in inflamed gums, possibly triggered by Porphyromonas gingivalis. We previously demonstrated an increased antibody response to P. gingivalis arginine gingipains (anti-Rgp IgG), not only in individuals with severe periodontitis compared to controls, but in RA versus controls, with an association to ACPA. In the present study, we set out to further explore the relationship between anti-Rgp IgG, ACPA and periodontitis, including clinical periodontal parameters, in the large and well-characterized PerioGene North case-control study.

Methods: We measured serum levels of anti-Rgp and ACPA IgG by enzyme-linked immunosorbent assay (ELISA), in 478 patients with periodontitis and 509 periodontally healthy controls within PerioGene North. Subsequently, anti-Rgp IgG levels and ACPA status were analysed in relation to periodontitis and clinical periodontal parameters.

Results: Serum anti-Rgp IgG levels were elevated in cases versus controls (p< 0.001). However, receiver operating characteristic (ROC) curve analysis revealed that anti-Rgp IgG could not efficiently discriminate cases from controls (AUC= 0.63; 95% CI: 0.60 – 0.66). Among cases, increased anti-Rgp IgG levels associated with high periodontal inflammation and advanced alveolar bone loss (p<0.001 for both). An ACPA response was detected in 15 (3.1%) cases and 6 (1.2%) controls (p=0.033), but no association to periodontitis was evident after adjustment for age and smoking and anti-Rgp IgG levels did not differ between ACPA-positive and ACPA-negative individuals.

Conclusion: We show that anti-Rgp IgG identifies a subgroup of periodontitis patients with high degree of periodontal inflammation and advanced alveolar bone loss, but we do not find support for a link between periodontitis or anti-Rgp IgG and ACPA status in PerioGene North. Given the association between anti-Rgp and alveolar bone loss, the mechanistic role of gingipains in bone resorption should be experimentally explored.

AbstraktBakgrund: Trycksår är ett vanligt och allvarligt problem för inneliggande patienter på ett sjukhus. Dessa sår kan leda till betydande komplikationer, förlängd sjukhusvistelse, minskat välbefinnande samt högre vårdkostnader och belastning av sjukvården. Trots att detta är ett väl utforskat område står ungefär elva procent av alla vårdskador för trycksår. 

Syfte: Syftet är att undersöka preventiva interventioner för att förebygga trycksår hos inneliggande patienter på sjukhus. 

Metod: Studiens design är en litteraturöversikt över nio kvantitativa interventionsstudier. Litteratursökning gjordes i databaserna PubMed och CINAHL. De valda artiklarna har genomgått kvalitetsgranskning och en analysprocess där artiklarna delats upp i olika kategorier. 

Resultat: Fem studier visar på en signifikant skillnad i utvecklingen av trycksår mellan kontroll- och interventionsgruppen, till interventionens fördel, och fyra studier visar inte någon signifikant skillnad. 

Konklusion: Slutsatsen av studien är att interventioner som ompositionering, vegetabiliska oljor och krämer, val av madrass, omläggning och en algoritm för att anpassa trycksårsvård kan minska utvecklingen av trycksår. Genom att använda studiens resultat kan fler interventioner användas för att förbättra vården. Däremot behövs det fortsatt mer forskning kring trycksårsprevention för att kunna fylla de kunskapsluckor som finns och få en djupare förståelse för olika interventioners effektivitet

Transcription of human mitochondrial DNA (mtDNA) begins from specific transcription promoters. In strand-asynchronous mtDNA replication, transcripts from the light-strand promoter serve as primers for leading-strand synthesis at the origin of the H-strand replication (O_H). A 7S DNA strand, a presumed aborted replication product, is also synthesized from O_H. Transition from RNA synthesis to DNA synthesis at O_H is crucial for balancing replication with transcription, yet the mechanism remains unclear. Herein, we examine the role of mitochondrial transcription elongation factor (TEFM) in this process. TEFM knockout results in decreased 7S DNA, strand-asynchronous replication intermediates, and mtDNA copy number, all of which are concordant with downregulation of RNA-to-DNA transition at O_H. Conversely, levels of tRNAs encoded near transcription promoters increase, indicating enhanced transcription initiation frequency. Taken together, we propose that, in addition to conferring processivity to the mitochondrial RNA polymerase, TEFM plays a crucial role in maintaining the balance between mitochondrial transcription and replication.

In Sweden, a lack of accessible specialist mental health services places the sole responsibility for caring for people with mental ill-health in rural areas on primary care. Caring for people with severe mental ill-health can pose challenges for district nurses in rural areas. The aim of this study is to describe district nurse’s experiences of encountering people with mental ill-health in rural primary care. Semi-structured interviews were conducted with nine district nurses working in primary care in rural areas in Northern Sweden. Interviews were analyzed with qualitative content analysis. The results describe district nurses’ experiences of encountering people with mental ill-health as a strive for a good relationship. They wanted to understand the core of patients’ needs and adjust their approach based on that. However, organizational obstacles and opportunities affected these encounters, particularly the lack of time and the importance of continuity. Being a primary care nurse in a rural setting provides specific challenges and opportunities when caring for people with mental ill health. District nurses would benefit from organizational support in establishing and maintaining good relationships as a foundation for quality care. Providing district nurses with greater autonomy over their time, along with enhanced support and access to resources would acknowledge and reinforce the critical professional role they play in rural healthcare delivery.

Introduction: Predicting competitive alpine skiing performance using conventional statistical methods has proven challenging. Many studies assessing the relationship between physiological performance and skiing outcomes have employed statistical methods of questionable validity. Furthermore, the reliance on Fédération Internationale de Ski (FIS) points as a performance outcome variable presents additional limitations due to its potential unreliability in reflecting short-term, sport-specific performance. These factors complicate the selection of appropriate tests and the accurate prediction of competitive outcomes.

Method: This study aimed to evaluate the predictive power of a generalized physiological test battery for alpine skiing performance, as measured by FIS points, utilizing multivariable data analysis (MVDA). Physiological test results from a total of twelve (n = 12) world-class female skiers were included in the analysis.

Results: The result on goodness of regression (R2) and goodness of prediction (Q2) in this study indicate that valid Orthogonal Projection to Latent Structures (OPLS) models for both Slalom and Giant Slalom can be generated (R2 = 0.39 to 0.40, Q2 = 0.21 to 0.15), but also that competition performance still cannot be predicted at a group level (low Q2). In contrast, higher predictive power of competitive performance was achieved on an individual level using the same data (R2 = 0.88 to 0.99 and Q2 = 0.64 to 0.96).

Discussion: The findings of this investigation indicate that the selected tests employed in this study exhibit limited generalizability for the assessment of elite alpine skiers, as the predictive value of specific physiological parameters on competitive performance appears to be highly athlete-dependent.

Deeply fractured rocks of meteorite impact craters are suggested as prime niches for subsurface microbial colonization. Methane can be a product of such microbial communities and seeps of methane from impact craters on Earth are of strong interest as they act as analogs for Mars. Previous studies report signs of ancient microbial methanogenesis in the Devonian Siljan meteorite impact structure in Sweden, but the proportion of microbial methane, metabolic pathways, and potential modern activity remain elusive. In this study, gas composition, hydrochemistry, oil organic geochemistry, and microbial community analyses are reported in 400 m deep fractures of the Siljan impact structure. The results showed a dominantly microbial origin for methane, which was supported by highly negative δ¹³C_CH4 and positive δ¹³C_CO2 values along with multiply substituted isotopologues (Δ¹³CH₃D) that indicated disequilibrium fractionation due to microbial kinetic isotope effects. The presence of C₂ to C₅ hydrocarbons suggested a minor thermogenic input in the gas mix. Characterization of the microbial community via 16S rRNA gene amplicon sequencing and real-time PCR indicated a low abundance of several methanogenic archaeal populations, which is common for settings with active methanogenesis. Evidence of oil biodegradation suggested that secondary microbial hydrocarbon utilization was involved in the methanogenesis. Low sulfate and high alkalinity in the groundwaters also suggested a dominantly microbial methane formation driven by infiltration of freshwater that was coupled to sulfate reduction and secondary utilization of early mature thermogenic hydrocarbons.

Background: Ethiopia has experienced growth in the utilization of family planning services. However, there are reports of relatively low client satisfaction across the country.

Objective: The objective of this study was to assess client and facility level predictors of satisfaction with family planning services in Ethiopia.

Method: A multi-level mixed effects logistic regression analysis was conducted on a national survey obtained from the service provision assessment 2021–22. A total of 2071 clients (level one) and 529 facilities (level two) were included.

Results: Overall, 56% of clients were highly satisfied with the family planning service they received. Findings from the random effects of the multilevel analysis show there is a significant difference in client satisfaction between facilities, with an intra-class correlation of 0.56 in the null model. At the client-level, age above 30, auditory privacy, and discussion on side effects are significantly associated with higher client satisfaction. At the facility level, having a waiting area, facilities with a quality unit and/or committee, a DHIS2 reporting system, operating for more than 20 days a month, privately owned facilities and availability of family planning guidelines are associated with higher odds of being satisfied. On the other hand, at the client level, having a primary or higher education, increasing wait time and clients asking their providers questions are associated with lower odds of being satisfied. At the facility level, having a fixed user fee significantly reduces the odds of client satisfaction.

Conclusions: Human resource and professional development training and health system strengthening is recommended.

Second-home tourism is an important driver and result of rural and urban change. However, the focus for second-home research has typical contextual traits. In a Nordic context, the archetypal image of a second home – in research as well as in the mind’s eye of the public – is that of a detached (single-family) rural housing, such as a cottage or cabin. Much less attention has been paid to other forms of second-home dwellings, like flats, or mobile second homes such as caravans, trailers, and recreational vehicles. In this paper, we expand the horizon of second-home research beyond the detached rural house. Using georeferenced microdata on detached houses and flats, along with survey data on campsites, we explore the prevalence and spatial distribution of different dwelling types in the total second-home stock of a rural region in northern Sweden. The paper contributes to second-home literature by incorporating a wider, inclusive, perspective of the phenomenon, showing that this type of tourism is more widespread than previously thought. Furthermore, the study highlights the relation between these dwelling types and different parts of the tourism supply, with flats and mobile second homes being highly concentrated to urban centres, ski resorts, and nature-based tourism amenities.

The spread of SARS-CoV-2 led to the emergence of several variants of concern (VOCs). The spike glycoprotein, responsible for engaging the viral receptor, exhibits the highest density of mutations, suggesting an ongoing evolution to optimize viral entry. This study characterizes the bond formed by virion mimics carrying the SARS-CoV-2 spike protein and the plasma membrane of host cells in the early stages of virus entry. Contrary to the traditional analysis of isolated ligand-receptor pairs, we utilized well-defined biomimetic models and biochemical and biophysical techniques to characterize the multivalent interaction of VOCs with the complex cell membrane. We observed an overall increase in the binding affinity for newer VOCs. By progressively reducing the system complexity, we identify heparan sulfate (HS) as a main driver of this variation, with a 10-fold increase in affinity for Omicron BA.1 over that of the original strain. These results demonstrate the essential role of coreceptors, particularly HS, in the modulation of SARS-CoV-2 infection and highlight the importance of multiscale biophysical and biochemical assays that account for membrane complexity to fully characterize and understand the role of molecular components and their synergy in viral attachment and entry.

PURPOSE: Defunctioning stoma (DS) has been suggested to mitigate the consequences of anastomotic leak (AL) after low anterior resection. Stoma reversal (SR) is commonly delayed for nonmedical reasons in many healthcare systems. This study investigated the impact of the elapsed time from AR to SR on postoperative 90-day complications. The secondary aim was to explore the independent factors associated with a delayed SR.

M&M: This multicenter retrospective cohort study included rectal cancer patients who underwent anterior resection (AR) and DS between 2014 and 2018. Multivariable logistic regression was used to evaluate the influence of the elapsed time from AR to SR on postoperative complications within 90 days.

RESULTS: Out of 905 patients subjected to AR with DS, 116 (18%) patients experienced at least one postoperative 90-day complication after SR. Multivariable analysis revealed an association between the elapsed time to SR and complications within 90 days from SR (OR 1.02; 95% CI, 1.00-1.04). The association with SR complications was further highlighted in patients who experienced delayed SR > 6 months after AR (OR 1.73; 95% CI, 1.04-2.86). AL after AR and nodal disease were both related to delayed SR.

CONCLUSION: This study demonstrated that postoperative 90-day complications are associated with the time elapsed to SR. These findings emphasize the importance of early SR, preferably within 6 months, to prevent complications.

Humans and wildlife are exposed to a complex mixture of anthropogenic chemicals of which only a few have been subjected to regulations. Chemical risk assessment is currently based on evaluating single chemicals, which is costly, time-consuming, and neglect toxicokinetic and toxicodynamic mixture effects. This study focused on interaction effects on the absorption, distribution, metabolism and excretion (ADME) processes of selected chemicals representing potential modulators of these processes. Adult female zebrafish (Danio rerio) were exposed to selected mixture of 11 chemicals and bioconcentration factors (BCFs) on tissue level were determined for 9 of them: bisphenol A (BPA), bisphenol AF (BPAF), bisphenol Z (BPZ), triclosan, tribromophenol, pentachlorophenol, heptafluorobutyric acid (PFBA), perfluorobutanesulfonic acid (PFBS), and perfluorooctanesulfonic acid (PFOS). Comparison of BCFs of bisphenols obtained from single chemical exposure experiments versus the current study revealed no statistically significant differences (p > 0.05), implying no mixture effects on kinetics of bisphenols at investigated concentrations. The same conclusion was reached using two physiologically based kinetic (PBK) models, developed for individual bisphenols and per- and polyfluoroalkyl substances (PFAS), showing good model fit for BPA, BPZ, BPAF, and PFOS. To simulate exposure scenarios where kinetic interaction effects may occur through competitive protein binding in blood, a new PBK model was developed. Simulations where zebrafish were dosed with BPA and BPZ, individually, and combined with varying levels of PFOS, showed that competitive binding to serum proteins alter tissue levels of bisphenols when levels of PFOS exceeded 1 μg/L. This indicates that chemicals acting in concert could perturb ADME but only at higher levels or in complex mixtures.

Water pollutants such as synthetic dyes can cause significant problems for human health and ecosystems due to their chemical properties and environmental interactions. Contamination of surface and underground water caused by the discharge of synthetic dyes is a widespread problem that arises primarily from industrial activities such as textile manufacturing, leather processing, paper production, and plastics industries. Since adsorption is one of the most efficient and reliable methods to remove pollutants from water, in this work, pine tree logging residues (LR) were used to produce boron/sulfur chemically modified biochars with superior adsorption performance and recyclability. The biochars were produced using a two-step pyrolysis procedure with potassium hydroxide as a chemical activator. The specific surface areas (B.E.T.) of the biochars were 2645 m2 g−1 for the boron-treated biochar (LR-Boron), 2524 m2 g−1 for the sulfur-treated (LR-Sulfur), and 3141 m2 g−1 for the control biochar (LR-Control, without boron or sulfur), respectively. The LR-Boron biochar showed an exceptional degree of graphitization of (ID/IG=0.45), while the LR-Sulfur biochar displayed an ID/IG= 1.02; for comparison, the LR-Control exhibited an ID/IG= 0.81, showing that the sample subjected to boron treatment created carbon-rich in graphitic structures. The three biochars were evaluated as adsorbents for removing reactive black-5 azo dye (RB-5) from water and mixtures of several dyes in synthetic aqueous effluents. The adsorption data showed that all carbons exhibited outstanding RB-5 removal performance. Kinetic measurements were well fitted by the Avrami fractional order model, and the LR-sulfur carbon displayed the fastest adsorption kinetics. Isotherm measurements were well fitted by the Liu model, with a theoretical Qmax of around 1419 mg g−1 (LR-Control), 1586 mg g−1 (LR-Boron), and 1766 mg g−1 (LR-Sulfur) at 316 K. The presence of sulfur-functional groups on the LR-Sulfur biochar surface was probably the reason for the superior adsorption performance of this biochar. Both sulfur and boron-treated biochars exhibited higher regeneration potentials, maintaining around 60–67 % removal capacity after 7 cycles compared to 35 % for the LR-Control biochar. Thermodynamic adsorption studies showed that the adsorption process was endothermic, favorable, and compatible with physical adsorption. All produced biochars were highly efficient for removal of pollutants from concentrated synthetic effluents.

Many rural areas in southern Europe have long suffered from outward migration but have recently been attracting new types of in-migration. This includes lifestyle migrant entrepreneurs (LMEs) seeking ways of improving their own quality of life and, at the same time, bringing new projects which aim to build on the potential and resources for rural tourism in their chosen destination place. Drawing on data from in-depth research interviews with LMEs and other stakeholders, this article stems from a research project focused on exploring tourism-related entrepreneurial lifestyle migration in the rural Algarve, in southern Portugal. Although this type of migration has often been identified as a potential driver for the sustainable development of both tourism activities and rural areas, this study focuses on the challenges identified, principally by the LMEs themselves, as regards the setting up, operationalisation and continuing activities of tourism-related businesses in rural areas of the Algarve. A variety of challenges were detected, at the micro-, meso- and macro-levels of the entrepreneurial migration process. The most recurrent problem faced is the level of bureaucracy and the difficulties encountered in legal processes. Although this is sometimes due to the language barrier, it is also related to the lack of clear information on procedures and the lack of specialised support. This finding points to the need for a greater level of cooperation and communication among the various stakeholders to ensure a more sustainable development of tourism in these rural areas.

Background & Aims: Biomarkers are needed to identify individuals at elevated risk of inflammatory bowel disease. This study aimed to identify protein signatures predictive of inflammatory bowel disease. Methods: Using large population-based cohorts (n ≥180,000), blood samples were obtained from individuals who later in life were diagnosed with inflammatory bowel disease and compared with age and sex-matched controls, free from inflammatory bowel disease during follow-up. A total of 178 proteins were measured on Olink platforms. We used machine-learning methods to identify protein signatures of preclinical disease in the discovery cohort (n = 312). Their performance was validated in an external preclinical cohort (n = 222) and assessed in an inception cohort (n = 144) and a preclinical twin cohort (n = 102).

Results: In the discovery cohort, a signature of 29 proteins differentiated preclinical Crohn's disease (CD) cases from controls, with an area under the curve (AUC) of 0.85. Its performance was confirmed in the preclinical validation (AUC = 0.87) and the inception cohort (AUC = 1.0). In preclinical samples, downregulated (but not upregulated) proteins related to gut barrier integrity and macrophage functionality correlated with time to diagnosis of CD. The preclinical ulcerative colitis signature had a significant, albeit lower, predictive ability in the discovery (AUC = 0.77), validation (AUC = 0.67), and inception cohorts (AUC = 0.95). The preclinical signature for CD demonstrated an AUC of 0.89 when comparing twins with preclinical CD with matched external healthy twins, but its predictive ability was lower (AUC = 0.58; P = .04) when comparing them with their healthy twin siblings, that is, when accounting for genetic and shared environmental factors.

Conclusion: We identified protein signatures for predicting a future diagnosis of CD and ulcerative colitis, validated across independent cohorts. In the context of CD, the signature offers potential for early prediction.

This paper uses register data and open vacancy data to determine if green industries require different skills than other employers. This is done by focusing on how the entry of the battery producer Northvolt changed the labour demand when establishing in Skellefteå (Sweden). Using data on all vacancies in Sweden 2016–2023 we analyse the skill- and knowledge demand in Northvolt's job ads and compare that to the labour demand at the local, regional and national level. In terms of occupations, we find only minor tendencies towards a higher demand of higher-skilled jobs compared to incumbent local employers, but an increase of service work and a reinforcement of the local manual work specialization. Using language models, we combine the vacancies with a scheme of skills and knowledge from the ESCO-taxonomy. Interestingly, Northvolt deviates in both the skill- and knowledge requirements compared to similar jobs in the rest of the country. This especially concerns a greater emphasis on information, collaboration and communication skills in contrast to other employers who stress manufacturing experience. Despite these skill-specific differences, our experimental approach finds little evidence that the entry spurred a significant diversification and upgrading of the regional labour market.

The local presence and composition of skills is commonly thought to have enormous implications foreconomic development. Yet, skills and the relations between them are notoriously difficult to pinpointand measure. We develop a method that uses information available in Swedish job postings tomeasure the skill-relatedness of jobs and the skill-coherence of local economies. Our skill-relatednessmeasure can be assumed to be exogenous to local economic outcomes such as wages, productivity andlabour mobility. We corroborate some previous research findings and show that workers tend to switchbetween related jobs and that local economies are on average skill-coherent. However, less coherentlocal economies are associated with higher average wages and productivity. Local economies whereworkers switch between related jobs though enjoy higher average wages. In all, this points to thebenefit of local labour market clusters within more diverse regions. We conclude that job postingsprovide a wealth of information on the skill-foundations of local development. A job-level skill-relatedness matrix accompanies the paper.

Aim: In riparian zones along rivers, plant demography is shaped by hydrologic disturbances, the dendritic structure of the river networks, and asymmetric gene flow due to the prevalence of unidirectional dispersal by hydrochory. Downstream-biased dispersal may lead to the accumulation of genetic diversity in populations situated lower within the catchment area—a phenomenon referred to as ‘downstream increase in intraspecific genetic diversity’ (DIGD). Our study aimed to test if the presence of this pattern in riparian plants depends on the species traits, sampling design and ecosystem integrity.

Location: Riparian zones along rivers worldwide.

Time Period: 1978–2023.

Major Taxa Studied: Vascular plants.

Methods: We conducted meta-analysis of population genetic studies on riparian plants to identify the factors linked to the occurrence of the DIGD pattern. We modelled the correlation between position along rivers and population genetic diversity using a dataset consisting of variables extracted from the studies, supplemented by data from plant trait databases.

Results: We found no evidence for a general trend in plant genetic diversity along rivers, but species traits and environmental factors partially explained the patterns. A downstream increase in genetic diversity was more likely to be found in species capable of hydrochoric dispersal and along the unmodified rivers which maintain habitat continuity.

Main Conclusions: Our study highlights that different patterns of genetic diversity can be linked to species traits or different levels of habitat fragmentation. Population genetic studies of riparian plants have frequently investigated patterns of genetic diversity in remnant populations in degraded riparian habitats. Although such investigations are important, more population studies of common plants in well-preserved riparian zones are needed, as these can help understanding the general mechanisms that control natural population dynamics of plant species.

Bacteria often carry multiple genes encoding anti-phage defense systems, clustered in defense islands and phage satellites. Various unrelated anti-phage defense systems target phage-encoded homologous recombinases (HRs) through unclear mechanisms. Here, we show that the phage satellite SaPI2, which does not encode orthodox anti-phage defense systems, provides antiviral immunity mediated by Stl2, the SaPI2-encoded transcriptional repressor. Stl2 targets and inhibits phage-encoded HRs, including Sak and Sak4, two HRs from the Rad52-like and Rad51-like superfamilies. Remarkably, apo Stl2 forms a collar of dimers oligomerizing as closed rings and as filaments, mimicking the quaternary structure of its targets. Stl2 decorates both Sak rings and Sak4 filaments. The oligomerization of Stl2 as a collar of dimers is necessary for its inhibitory activity both in vitro and in vivo. Our results shed light on the mechanisms underlying antiviral immunity against phages carrying divergent HRs.

The aim of the study was to examine physiological and cardiometabolic effects of 12 weeks of walking football (played 2 × 20 min) in physically inactive older adults. Thirty-three volunteers completed the study (men n = 11, women n = 22) were enrolled with a mean age of 74.0 ± 5.7 years. Baseline tests included blood pressure, waist circumference, body composition, blood samples, balance, estimated VO_2max, mobility, grip strength and vertical jump height. Grip strength was significantly higher at the posttest (32.7 ± 7.8 kg vs. 30.7 ± 7.7 kg (p <.005)), and the walking/turning speed was faster making the time to complete the Timed Up and Go test significant shorter at the posttest (6.07 ± 1.0 s vs. 6.87 ± 1.0 s (p <.001)). Waist circumference was lower at the posttest (91.8 ± 13.3 cm vs. 93.9 ± 13.9 cm (p <.001)). HDL-cholesterol was significantly higher at posttest (2.19 ± 1.36 mmol/L vs. 1.98 ± 0.89 mmol/L (p <.005)). HbA1c significantly decreased posttest (39 ± 1.2 mmol/mol vs. 38 ± 5.8 mmol/mol (p <.028)). Walking football for older adults is associated with positive changes in cardiometabolic and physiological variables.

This study investigates the effects of non-zero IMF By on the magnetotail By and fast earthward ion convection (V⊥ > 200 km/s, "⊥" indicates perpendicular to the magnetic field) in the near-lunar magnetotail plasma sheet using the plasma parameters and magnetic field detected by the ARTEMIS (Acceleration, Reconnection, Turbulence, and Electrodynamics of the Moon’s Interaction with the Sun) P1 satellite during the period 2011–2022. We find that the magnetotail By with in the same direction as IMF By dominates the entire region. The IMF By influence is hemisphere-independent, but shows a dusk-dawn asymmetry with the IMF By effect being weaker in the premidnight region than in the postmidnight region. We also find that the IMF By influence on earthward fast convection results in an interhemispheric flow asymmetry and it is highly correlated with the direction of magnetotail By. The statistical results indicate that occasionally localized dynamics can have a significant effect on magnetotail By and V⊥.

Global climate change has led to notable shifts in the phenology of numerous species, including changes in migration patterns, reproduction timing, and food resource availability. This study investigates the potential effects of climate change on the autumn migration of the northern Bluethroat (Luscinia svecia svecia) in Umeå, Sweden, over the past 15 years. The bluethroat, a migratory bird breeding in Scandinavia and wintering in Pakistan and India, faces challenges as climate change can affect both its migration timing and available food resources at the breeding grounds. Using data collected from bird ringing at the Umedelta's ringing stations Tippen and T-vägen between 2010 and 2024, this study tested three hypotheses: (1) bluethroats have changed their timing of their autumn migration, (2) the total number of ringed bluethroats has decreased over time, and (3) there is a higher number of males than females caught in the nets during migration. The results showed significant differences in the number of ringed birds between different weeks and between males and females over the 15 recorded years. However, no significant change across years in the total number of birds ringed was observed. Migration peak timing was slightly shifted from week 35 to week 36, indicating that bluethroats have delayed their autumn migration, though correlation tests did not reveal a consistent pattern across the years for each week. Despite these findings, the broader trend of declining migratory bird populations, linked to climate change and habitat loss, remains a great concern. The study highlights the complexities of migration patterns and the challenges posed by a changing climate, suggesting that further research covering a longer period and a broader geographical range is needed to understand these trends fully.

Background: Air pollution exposure during pregnancy has been associated with adverse birth outcomes. Uncertainties remain about the effect at very low exposure levels. The aim of this study was to explore the association of maternal exposure to air pollutants during pregnancy at very low exposure levels with birth weight and estimate the health impact.

Methods: The MATEX birth cohort (226,551 singleton births in 2012–2016) was linked with eight modelled air pollutants (PM2.5, PM10, PMcoarse, NO2, NOx, CO, SO2, O3) at home address during pregnancy. Multiple regression was used to estimate the change in birth weight (in g) associated with individual-level mean exposure during pregnancy. We tested different adjustment models and conducted sensitivity analyses. We also estimated the potential number of low birth weight cases attributable to PM2.5 to quantify the public health issues at the prevailing low exposure levels.

Results: PM2.5 was associated with the largest reduction of birth weight (-6.5 g per 1 µg/m3) followed by PMcrs (-4.9 g) and PM10 (-3.0 g). Among the gaseous pollutants the strongest reduction in birth weight was observed for NO2 (-0.8 g), followed by CO (-0.5 g), NOx (-0.4 g) and SO2 (-0.2 g). On the contrary, O3 was associated with a modest increase in birth weight (+ 0.9 g). Effects on births weight were observed also below WHO guideline values. When accounting for the prevailing exposure levels in Finland, CO was associated with the biggest reduction in birth weight. The effect of PM2.5 exposure on birthweight corresponds to a loss of 30 g at mean exposure. Assuming a causal relationship, about 700 cases of low birth weight could be attributable to PM2.5 in Finland during the study period.

Conclusions: No clear evidence on safe exposure level was found in this study. All pollutants were associated with reduced birthweight except ozone. Causality and confounding due to correlations warrant specific attention.

Roads acts as barriers for wildlife and together with wildlife-vehicle collisions (WVC) they can threaten populations size and genetic diversity. Wildlife fences are a common measure to reduce WVC which can increase the barrier. Mitigation measures often used to increase landscape connectivity are fauna passages such as overpasses and underpasses that allow animals to cross the roads. These types of fauna passages are often very expensive and therefore it is of interest to find an alternative for roads that might not have the financial motivation to build such structures. This study examined the behaviour of animals in an at-grade fauna passage with an animal detection system in Sjödiken, Sweden, which was installed in 2019. A previous study of the fauna passage showed that roe deer spent a long time grazing in the entering zone and the road verge of the passage was therefore sanded. The aim of this study was to evaluate how the time in the passage changed after sanding as well as how it affected the crossing success of the animals. Results showed a decrease in time spent in the entering zone for roe deer, red deer and wild boar as well as a decrease in total time in passage for red deer and wild boar. Crossing success increased after sanding for roe deer, and red deer also showed a tendency to increased crossing success. Wild boars crossing success did not change but was high both before and after sand treatment.

Background: Regular physical activity is recommended for all aged 5 years and older, but the health benefits gained might differ across population subgroups. The aim of this study was to examine these benefits in terms of years lived free from major non-communicable diseases in subgroups with varying levels of risk factors.

Methods: Our analysis was based on a multicohort study of initially healthy European adults from the IPD-Work Consortium and initially healthy participants from the UK Biobank study. Self-reported leisure-time physical activity levels at baseline (1986–2010) were categorised as low (no or very little), intermediate (between low and recommended levels), and WHO-recommended (≥2·5 h of moderate or ≥1·25 h of vigorous physical activity per week). We divided the study population into 36 overlapping subgroups based on socioeconomic factors, lifestyle, and mental health at baseline, and assessed disease-free years between ages 40 years and 75 years for both the overall population and subgroups, accounting for coronary heart disease, stroke, type 2 diabetes, cancer, asthma, and chronic obstructive pulmonary disease.

Findings: 14 IPD-Work studies were assessed and six studies were excluded due to missing outcome data and unavailable data for pooling, resulting in the inclusion of eight studies with 124 909 participants. After the exclusion of 7685 participants due to prevalent diseases and 9265 due to missing data, the sample consisted of 107 959 initially healthy European adults (63 567 [58·9%] females and 44 392 [41·1%] males) from the IPD-Work consortium. For the UK Biobank sample, 9 238 453 million individuals were invited, 8 736 094 (94·6%) were non-respondents, and 502 359 participated in the baseline examination. After the exclusion of 73 460 participants, 428 899 participants had data on at least one measure of physical activity. 236 258 (55·1%) were female and 192 641 (44·9%) were male. During 1·6 million person-years at risk, 21 231 IPD-Work participants developed a non-communicable disease, while 101 319 UK Biobank participants developed a non-communicable disease over 4·8 million person-years at risk. Compared with individuals with low physical activity, those meeting the recommended physical activity levels during leisure-time gained an additional 1·1 (95% CI 1·0–1·2) to 2·0 (1·7–2·3) disease-free years, depending on sex and study. In males from the IPD-Work and UK Biobank cohorts, greater gains in disease-free years were observed in current smokers (2·4 [95% CI 2·1–2·8]) versus never smokers (0·7 [0·5–0·9]); those with low education (1·4 [1·1–1·7]) versus high education (0·8 [0·7–1·0]); low socioeconomic status (1·7 [1·5–2·0]) versus high socioeconomic status (0·9 [0·7–1·1]); and those with (1·6 [1·3–1·9]) versus without depressive symptoms (1·0 [0·9–1·1]; p value range <0·0001–0·0008). Similar differences were seen in women for smoking (2·3 [95% CI 1·9–2·7] vs 0·9 [0·7–1·1]), socioeconomic status (1·7 [1·4–2·0] vs 0·8 [0·5–1·0]), depressive symptoms (1·4 [1·1–1·7] vs 1·0 [0·9–1·1]), and for heavy drinkers compared with moderate drinkers (1·4 [1·1–1·6] vs 0·9 [0·7–1·1]; p value range <0·0001–0·010). No differences in physical activity-related health gains were observed between risk groups and non-risk groups by BMI, history of depression, and, in men, alcohol use (p value range 0·11–0·86).

Interpretation: In addition to confirming the association between leisure-time physical activity and increased disease-free years across population subgroups, our findings show that these health benefits are often more pronounced among individuals with pre-existing health risks or disadvantaged backgrounds than in those with more favourable risk factor profiles. This suggests that enhancing population-wide physical activity initiatives could help reduce health disparities, while incorporating physical activity into targeted strategies addressing social disadvantage, unhealthy lifestyles, and depression might enhance their effectiveness.

Funding: Wellcome Trust, UK Medical Research Council, US National Institute on Aging, and Research Council of Finland.

Although age differences in the dopamine system have been suggested to contribute to age-related cognitive decline based on cross-sectional data, recent large-scale cross-sectional studies reported only weak evidence for a correlation among aging, dopamine receptor availability, and cognition. Regardless, longitudinal data remain essential to make robust statements about dopamine losses as a basis for cognitive aging. We present correlations between changes in D2/3 dopamine receptor availability and changes in working memory measured over 5 yr in healthy, older adults (n = 128, ages 64 to 68 yr at baseline). Greater decline in D2/3 dopamine receptor availability in working memory-relevant regions (caudate, middle frontal cortex, hippocampus) was related to greater decline in working memory performance in individuals who exhibited working memory reductions across time (n = 43; caudate: rs = 0.494; middle frontal cortex: rs = 0.506; hippocampus; rs = 0.423), but not in individuals who maintained performance (n = 41; caudate: rs = 0.052; middle frontal cortex: rs = 0.198; hippocampus; rs = 0.076). The dopamine–working memory link in decliners was not observed in the orbitofrontal cortex, which does not belong to the core working memory network. Our longitudinal analyses support the notion that aging-related changes in the dopamine system contribute to working memory decline in aging.

Objective: In this paper, we implement and validate a set of optimization approaches that were applied on ambulance data from the Västerbotten county in Sweden collected 2018, with the objective to find the optimal placement of the ambulance stations (or stand-by positions) in Umeå, a municipality in the county with regards to median of response times for priority 1 alarms, the most urgent type of alarms (MRT1).

Methods: Here, we use data-driven approaches for optimizing the placement of ambulance stations. For a given allocation, i.e. placement of the stations, a large-scale simulation is conducted to estimate the allocation's MRT1. Since the inherent mechanism of the simulation function is very complex, the optimization problem has a black-box nature. We use two methods belonging to important classes for solving the problem of black-box optimization: GPS (smooth-free) and surrogate (smooth-based) methods. Both methods can be used on either local or global data and implemented using a one-by-one approach or an all-together approach. To study the mentioned methods and approaches, we consider several real-world scenarios pertaining to the placement of ambulance stations in Umeå municipality.

Results: Relocating the ambulance stations in Umeå can reduce MRT1 around 80-100 seconds in comparison with the current allocation. Using global data leads to better solutions with lower MRT1-values, although they demand more computational time. The results of GPS and surrogate methods are similar, but the surrogate method is less sensitive to the starting position. One-by-one approach is more effective and less time-consuming than the all-together approach.

Conclusion: The results confirm that relocating ambulance stations can lead to a significant decrease in MRT1 and it also can compensate for the loss of an ambulance resource partially. To reduce the dimensionality and the cost of optimization methods, it can be better to use one-by-one approach than all-together.

This quantitative survey study of 136 randomly selected respondents investigates the degree of verticalintegration in the Swedish commercial printing industry. The results show that vertical integration iscommonly used both by digital printing firms and conventional printing firms. The results of this studyshow that the overall integration in the commercial printing industry in Sweden is high and providingother services than printing is important. In total these complementary integrated services constituteapproximately a quarter of the total revenues. There is no significant difference in how different firmschoose to integrate depending on the size of the firm, which implies that there is a more general need ofbeing vertically integrated within the printing industry. Furthermore, previous research suggests thatvertical integration plays an important roll in success for digital printing and digital printing firms for beingcompetitive in the digital printing industry. This is due to the strategic importance of controlling a largepart of the value system. Nevertheless, this study shows that the level of integration between digitalprinting firms and conventional printing firms did not differ. This lack of difference can be oneexplanation for the hard competition between digital printing firms and conventional printing firms thatthe industry is experiencing.

The objective is to investigate how vertical integration is used to get close customers contactand increase customer relations in the printing industry and to explore the competitiveconsequences with vertical integration towards the customers. The paper is based on aquantitative survey study of the Swedish commercial printing industry and qualitativeinterviews with five printing firms. Results show that it is common to integrate contentcreation in the studied industry. This is primarily done to increase relations with directcustomers and increase profitability, since direct customers are perceived as more loyal andprofitable than customers, such as advertising agencies and print brokers. However,production sold to direct customers still only constitutes a small part of the total production atthe interviewed printing firms. Furthermore, the integration of content creation gives rise to apotentially competitive situation with the advertising agency customer segment. This problemis recognized by printing firms as they try to avoid competition with these customers. Thiscan be done by e.g. performing only simpler jobs that advertising agencies not are interestedin or isolating content creation in a separate firm and consequently both compete withadvertising agencies and still be a printing firm to these customers.

In an interesting article, Dr Zuzana Parusniková claimed: (i) that Semmelweis’ colleagues did not recognise the importance of his animal experiments, (ii) that the resistance to Semmelweis’ hypothesis and results was due mainly to applying mono-causality and (iii) Semmelweis inability to communicate, (iv) that the New Vienna Medical School applied evidence-based medicine, and (v) that the philosophy of Karl Popper is the best interpretation of Semmelweis’ scientific approach. Here, we present some factual aspects of Semmelweis’ text from 1861 and discuss Dr Parusniková’s claims against this backdrop. We conclude that Semmelweis might intentionally have abstained from communicating his hypothesis and results between 1847 and 1849 – including the results from his animal experiments – as he thought that they would eventually be understood and accepted. Semmelweis’ hypothesis was that cadaveric matters and decaying particles were the cause of childbed fever and increased maternal mortality. This hypothesis might have been controversial, but we claim that the major reason for the resistance was eminence-based and induced by the publication of preliminary and suboptimal results, based on a premature version of his hypothesis. If the New Vienna Medical School had been influenced by evidence-based medicine, we believe that Semmelweis’ empirical results would have been accepted - as they were based on an almost randomised controlled trial - and if the results had not been associated with his hypothesis but instead had focused on a black box procedure. We agree that the philosophy of Popper might be appropriate when analysing Semmelweis’ scientific approach when abandoning low-level theories. However, to understand the resistance against Semmelweis’ hypothesis and results, it is not sufficient to refer to a Pickwickian discussion; a Kuhnian framework is more adequate.

BACKGROUND: Harmonizing core outcome domains allows for pooling data, comparing interventions, and streamlining research evaluation. At the same time clinicians require concise and feasible measures for routine practice. Considering the heterogeneity of post-COVID-19 condition, a biopsychosocial approach requires sufficient coverage of the psychosocial dimension with assessments. Previous recommendations for core outcome sets have serious limitations regarding the psychosocial aspects of post-COVID-19 condition. This paper specifically focuses on psychosocial outcomes for adults with post-COVID-19 condition, providing both a comprehensive set of outcome domains for research and a streamlined clinical core set tailored for routine clinical use.

METHODS: In a structured Consensus Development Approach, the European Network to improve diagnostic, treatment, and healthcare for patients with persistent somatic symptoms (EURONET-SOMA) developed psychosocial core outcome domains and assessments regarding post-COVID-19 condition. The experts identified variables and instruments which should be considered in studies on adults suffering from post-COVID-19 condition, and which are feasible in the clinical setting and relevant for research.

RESULTS: We identified three higher-order dimensions with each encompassing several domains: The first higher-order dimension, "outcomes", encompasses (1) the classification/ diagnostics of post-COVID-19 condition, (2) somatic symptoms (including fatigue), (3) the psychopathological status and mental comorbidities, (4) the physical status and somatic comorbidities, (5) neurocognitive symptoms, and (6) illness consequences. The second higher-order domain "mechanisms" encompasses (7) cognitive components, (8) affective components, (9) behavioral components, (10) social components, and (11) psychobiological bridge markers (e.g., neuroimmunological and psychoneuroendocrinological variables). The third higher-order domain, "risk factors", includes factors such as (12) socioeconomic status and sociocultural factors, (13) pre-existing mental and somatic health issues, (14) personality factors (e.g., neuroticism), (15) adverse childhood experiences, (16) ongoing disability or pension claim, and (17) social media use. For each domain, specific instruments are suggested for research purposes and clinical use.

CONCLUSIONS: The recommended core domains help to increase consistency in a biopsychosocial approach to post-COVID-19 condition across investigations, improve synergies, and facilitate decision-making when comparing different interventional approaches. It allows to better identify relevant subgroups in heterogeneous post-COVID-19 condition populations offering practical tools for routine clinical practice through the clinical core set.

The midbrain-hindbrain boundary (MHB), also known as the isthmic organizer (IsO), plays a critical role in the developmental patterning of the posterior midbrain and anterior hindbrain. Understanding the wiring of this organizer's deeply conserved gene regulatory network is of significant interest for both evolutionary and neurodevelopmental biology. Various secreted signalling molecules and transcription factors have been identified as being important components for the formation and function of the MHB. Among these, FGF8 is considered a primary mediator of IsO activity; it directs anterior-posterior patterning and promotes the specification and maintenance of the MHB. While the core gene regulatory network governing MHB development is well-characterized, the direct interactions between key regulatory genes and the cis-regulatory elements that control their spatiotemporal expression remain poorly understood. This review summarizes the current knowledge of the gene regulatory network underlying the formation of the vertebrate midbrain-hindbrain boundary. We focus in particular on Fgf8 and its regulatory landscape from an evolutionary perspective.

Arctic food systems blend Traditional Ecological Knowledge with modern, often energy-intensive influences, triggered by colonization. Food systems’ future depends on alignment of tradition with innovation, facilitation of resilience and a heritage-driven interaction with the global economy – at a pace determined by local communities.

Formative assessment has been suggested as a means of supporting studentmotivation. However, empirical studies have shown mixed effects of formativeassessment interventions on students’ motivation, making it necessary to understandthe mechanisms underlying these effects. We analyzed a formative classroompractice implemented by a 10th-grade first-language teacher during 7 months.Teacher logs, classroom observations and a teacher interview were used to collectdata for characterizing the formative assessment practice. Changes in students’satisfaction regarding the basic psychological needs of perceived autonomy,competence and relatedness, as well as changes in student motivation manifestingas engagement in learning activities and autonomous types of motivation, weremeasured by pre- and post-questionnaires in the intervention class and fourcomparison classes. Since the intraclass correlation values ICC(1) and ICC(2)were low, we treated the comparison classes as one group and t-tests were usedin the significance testing of the differences in changes in psychological needssatisfaction and motivation between the intervention class and the comparisonclasses. Path analysis was conducted to investigate whether a possible influenceof the intervention on autonomous motivation and behavioral engagementwould be mediated by basic psychological needs satisfaction. The analysis ofthe classroom practice in the intervention class identifies that both teacher andstudents were proactive agents in formative assessment processes. The analysisof the quantitative data shows that students’ psychological needs satisfactionincreased more in the intervention class than in the comparison classes, and thatthis needs satisfaction mediated an effect on students’ behavioral engagementand autonomous motivation.

Motivated by the Swedish Betula study, we consider the joint modeling of longitudinal memory assessments and the hazard of dementia. In the Betula data, the time-to-dementia onset or its absence is available for all participants, while some memory measurements are missing. In longitudinal studies of aging, one cannot rule out the possibility of dropout due to health issues resulting in missing not at random longitudinal measurements. We, therefore, propose a pattern-mixture sensitivity analysis for missing not-at-random data in the joint modeling framework. The sensitivity analysis is implemented via multiple imputation as follows: (i) multiply impute missing not at random longitudinal measurements under a set of plausible pattern-mixture imputation models that allow for acceleration of memory decline after dropout, (ii) fit the joint model to each imputed longitudinal memory and time-to-dementia dataset, and (iii) combine the results of step (ii). Our work illustrates that sensitivity analyses via multiple imputations are an accessible, pragmatic method to evaluate the consequences of missing not at-random data on inference and prediction. This flexible approach can accommodate a range of models for the longitudinal and event-time processes. In particular, the pattern-mixture modeling approach provides an accessible way to frame plausible missing not at random assumptions for different missing data patterns. Applying our approach to the Betula study shows that worse memory levels and steeper memory decline were associated with a higher risk of dementia for all considered scenarios.

Recently family firms seen a delicate renewed interest in regional science, regional studies and economic geography and similarly, spatial and regional contexts have been addressed in family business studies. Those strands are driven by interest in the heterogeneity of family firms as the most common type of organization all over the world (family spatialities) and the heterogeneity of spatial and regional context as a significant selection filter for the behavior and performance of family firms (spatial familiness). This editorial addresses these unique settings of family firms and the nature of spatial/regional contexts in a greater depth, by providing a concise literature overview on contextualizing research, by presenting a star shaped model to systemize research around spatial and regional contexts, and by suggesting further research directions. Our proposed star-shaped model frames a holistic view on spatial and regional contexts though a scientific agenda that differentiates between theoretical explanations and modelling (spatial concepts), empirical descriptions and analyses (spatial factors, spatial structures, spatial settings), and policy recommendations (spatial policies). These elements are shaped by scalar (spatial frames) and temporal frames (spatial processes). Most of these spatial building blocks and their interplay are explored by the articles in this special issue.

Introduction: The need for innovative technology in healthcare is apparent due to challenges posed by the lack of resources. This study investigates the adoption of AI-based systems, specifically within the postanesthesia care unit (PACU). The aim of the study was to explore staff needs and expectations concerning the development and implementation of a digital patient flow system based on ML predictions.

Methods: A qualitative approach was employed, gathering insights through interviews with 20 healthcare professionals, including nurse managers and staff involved in planning patient flows and patient care. The interview data were analyzed using reflexive thematic analysis, following steps of data familiarization, coding, and theme generation. The resulting themes were then assessed for their alignment with the modified technology acceptance model (TAM2).

Results: The respondents discussed the benefits and drawbacks of the proposed ML system versus current manual planning. They emphasized the need for controlling PACU throughput and expected the ML system to improve the length of stay predictions and provide a comprehensive patient flow overview for staff. Prioritizing the patient was deemed important, with the ML system potentially allowing for more patient interaction time. However, concerns were raised regarding potential breaches of patient confidentiality in the new ML system. The respondents suggested new communication strategies might emerge with effective digital information use, possibly freeing up time for more human interaction. While most respondents were optimistic about adapting to the new technology, they recognized not all colleagues might be as convinced.

Conclusion: This study showed that respondents were largely favorable toward implementing the proposed ML system, highlighting the critical role of nurse managers in patient workflow and safety, and noting that digitization could offer substantial assistance. Furthermore, the findings underscore the importance of strong leadership and effective communication as key factors for the successful implementation of such systems.

Background: Suicide is a public health problem. For every suicide committed, there are an estimated 20 suicide attempts. In Sweden, suicide leads to 1200 deaths annually. Ambulance cases relating to mental illness, where there is a risk of suicide, have recently increased.     

Motive: Despite the fact that suicidal patients constitute a significant patient group for the ambulance service, there is a perception that ambulance nurses feel a lack of knowledge to deal with this patient group. More knowledge is therefore needed about ambulance nurses experience of interactions with suicidal patients.   

Aim: To describe how ambulance nurses experience interactions with a suicidal patient.   

Methods: Semi-structured interviews have been conducted with ambulance nurses in the middle north region of Sweden. The interviews were analysed by a qualitative content analysis.    

Result: The analysis resulted in three categories. “Emotional impact”, “External circumstances”, “Personal circumstances”.   

Conclusions: The study reveals several aspects that affect the ambulance nurses' interaction with the patient. The interaction in turn, could then affect the ambulance nurse emotionally. More training, reflections of the interaction, as well as supportive measures to manage emotional impact, can improve the treatment of patients and the ambulance nurse's well-being. 

Aims: This study examined the association between educational attainment and the risk of deaths of despair among individuals assessed for substance use severity at municipal social services in Sweden. It aimed to determine whether the protective association between education and despair-related mortality risk, commonly observed in broader population studies, also applies to this high-risk, treatment-seeking population.

Methods: We linked data from municipal Addiction Severity Index (ASI) assessments to various population registers. The study population included adults aged 25 years or older who were assessed for substance use severity between 1999 and 2019. Fine–Gray competing risk regression models were employed to examine the association between educational attainment and despair-related mortality, both overall and by subtype (alcohol-related, drug use-related, suicide).

Results: Tertiary education was unexpectedly associated with increased risks of overall despair-related mortality, alcohol-related and drug use-related mortality, after controlling for demographic characteristics, ASI composite scores and substance use onset age. No significant associations were found between education and suicide.

Conclusions: The counterintuitive finding that tertiary education is linked to a greater risk of despair-related mortality among social service users may be attributed to differences between the treatment-seeking population and the general population. Highly educated individuals who seek treatment from municipal social services might have severe substance use and complex psychosocial problems and/or contact social services after exhausting other treatment options. Further research is necessary to understand how educational and socioeconomic factors influence treatment pathways for individuals with severe substance use problems in Sweden and how these different pathways impact health-related outcomes.

This research explores the potential of abundant biopolymers, specifically chitin and lignin, found in biomass byproducts to address environmental and energy challenges.

Chitin, commonly found in crustacean shells, can be deacetylated to produce chitosan, a versatile material with various industrial applications. Traditional chitosan production is energy-intensive and uses corrosive reagents.  In order to improve the process, Paper I introduces a ‘greener’ method, using the ionic liquid [Emim][OAc] for chitin pretreatment, followed by microwave-assisted deacetylation in aqueous NaOH or [TBA][OH] solutions. The pretreatment effectively reduces the chitin crystallinity, improving its reactivity for achieving up to 85% deacetylation in 1-2 hours. Both [Emim][OAc] and [TBA][OH] are regenerated (97% and 83%, respectively), offering a more sustainable chitosan production method, which can serve as a substrate for e.g. catalysts in industry. Paper II investigates the adsorption and catalytic reduction of phenol red dye using Ag-loaded chitosan catalysts. These catalysts display excellent activity across a broad pH range (4–11), with efficient adsorption at near-neutral pH (6.4) and room temperature. After five recycling cycles, the catalysts maintain structural stability, with only a 0.2% loss of Ag, demonstrating their potential for wastewater treatment.

Lignin, an abundant but underutilized polymer in wood biomass, is typically burned for heat. Recent interest has focused on converting lignin into valuable products like jet-fuel range hydrocarbons and fine chemicals. The challenge is selectively breaking C–O and C–C bonds in lignin while maintaining catalyst stability. Paper III explores C–O cleavage in lignin models using multifunctional Ru/NbOPO₄/TiO₂ catalysts, achieving high yields of hydrocarbons (86.9–100%) under mild conditions. Paper IV investigates both C–O and C–C cleavage with Ru/NbOPO₄ catalysts, producing >99% conversion in model compounds with high yield of hydrocarbons. The catalysts’ performance is driven by the tunable synergy between Lewis and Brønsted acid sites of niobium phosphate and the hydrogen activation role of Ru.

This interdisciplinary research advances biopolymer chemistry and catalysis, offering sustainable solutions for environmental and energy challenges by maximizing biomass byproducts and providing eco-friendly alternatives in wastewater treatment and renewable energy.

This thesis examines how changes in school equipment relate to changes in teaching ideals in the Swedish school system between 1865 and 2010. Three cases of changes in school equipment are examined in three sub-studies. The first sub-study explores how national guidelines for school desks covering the period 1865–1981 implicitly expressed specific teaching ideals. The second sub-study examines equipment requirements that arose in connection with changes in teaching ideals during the Swedish comprehensive school reform of 1949–1972. The third sub-study analyses how teaching ideals changed in conjunction with the introduction of new media technology in schools during the 1980s and in 2010. The thesis’s overarching research question addresses the significance of the origin and direction of change initiatives when school equipment and teaching ideals change. The source materials used in these studies consist of archival material from schools and authorities, printed official documents, teacher magazines, the local daily press, and teacher interviews. The thesis’s theoretical framework is based on a socio-material perspective whereby schools are studied as socio-material networks, and teaching ideals and school equipment shape each other. Additionally, concepts such as ‘historical path dependency’, ‘the grammar of schooling’, and ‘horizontal and vertical change initiatives’ also contribute to the analysis. Methodologically, the study follows a source-pluralistic and source-critical approach, which is supplemented by discourse analysis (in one sub-study). The results indicate that school equipment should not be seen merely as passive or neutral proposals for teaching. Historically, equipment has supported specific teaching ideals and has hindered or concealed others. While many teaching ideals have clearly changed during the period of investigation, older ideals have been reproduced over time because of ‘the path-dependent use of equipment’. However, school equipment has also changed based on how it is used or the ideals it is inter-related with. The results also indicate that the significance of the origin and direction of the change initiative shifts in character if such initiatives are vertical or horizontal to the school. Vertical change initiatives tend to function primarily as boundary setters for internal change within the school. Horizontal change initiatives, on the other hand, appear to take on great significance as trendsetters for the direction these changes take.

Economic crises and instability are inherent to capitalist economies, often having profound effects on regional economies and individual livelihoods. As a result, understanding how to achieve resilient regional economies has become a central focus of research in economic geography. In the wake of the 2007–2008 financial crisis, economic geographers have concentrated on how regions are impacted and what macro-level factors drive recovery, reorganization, or stagnation. While these macro-scale dynamics are important, they often overlook a crucial question: how do individuals and communities adapt to, and cope with economic shocks? This thesis shifts the focus to the lived experiences of those affected by crisis, examining how people cope with the losses brought on by economic upheaval in their daily lives, and how this reshapes their spatial relationships. Empirically, this research draws on the experiences of Danish mink farmers who lost their farms in 2020 due to the political decisions following COVID-19 pandemic. Through qualitative interviews, the study highlights how everyday practices—often neglected in macro- and meso-level analyses—not only help sustain livelihoods during crises but also challenge the structural inequalities of geographically peripheral regions. Beyond policy measures and economic structures, resilience in geographically peripheral regions is deeply embedded in social reproduction, cross-scalar networks, everyday familiarity, and the rhythms of socio-natural life. 

Through three articles analysing how people cope with economic crises using different theoretical frameworks, this study offers a micro-scale perspective on regional economic resilience. Empirically it highlights the crucial role of cross-scalar networks—both formal and informal—that people rely on to manage economic and social challenges. These networks are essential for counteracting uneven spatial power dynamics, supporting economic activities, and sustaining daily life (Paper 1). Furthermore, this thesis shows that economic crises are not only structural disruptions but also deeply personal and emotional experiences. Beyond the loss of employment, individuals often feel stranded—not just because their skillsets become redundant, but also due to their emotional attachment to their professions and ways of life (Paper 2). Finally, the research shows how the dismantling of industries disrupts the socio-natural rhythms that structure agricultural work, profoundly affecting individuals' relationships with both their environment and their livelihoods (Paper 3). This disruption extends beyond technical expertise, fundamentally altering how people engage with their surroundings. 

On a broader level, the findings emphasize that regional economic resilience is not solely about macro-scale economic production. It is deeply intertwined with social reproduction—the everyday, often invisible labor that sustains households, communities, and local economies. The contributions of family members, community groups, and local support networks are essential for maintaining livelihoods and ensuring social stability. Moreover, resilient regional economies are not just those that sustain economic production but also those that invest in and uphold resilient public services. Resilience, therefore, is not just an economic outcome but a collective process, shaped by relationships, interdependence, and the institutions that support everyday life. 

It is very challenging for policymakers and other decision makers to make any kind of decision on a new policy, as the reaction of a person to that policy (policy as one form of a norm) in a given situation is highly individual and based on their own subjective perspective. This becomes even more challenging in environments with a high degree of uncertainty (as is usually the case for policymakers).

Social simulations are a powerful tool for policymakers and other decision makers to support them in their decision-making process. To build agent-based social simulations that provide this support two main challenges exist: norm (policy) realistic behavior and the usability of the simulation.

Norm realistic behavior includes differentiated norm engagement as well as seeing norms as more than just restrictions on behavior. Situated norm engagement means that people react differently to norms and focus only on the parts that are relevant for them. Seeing norms as more than just restrictions on behavior means that people can also violate norms and be motivated to circumvent norms. To address these two parts, we formalize different perspectives on norms and develop a novel agent deliberation architecture, called the Perspective-Based Agent Deliberation Architecture (PBADA) that can represent different perspectives on norms. Another key element of our agent deliberation architecture is that norms are explicit objects.

Having norms as explicit objects is crucial for addressing the challenge of usability of the simulation. It allows policymakers to modify them interactively in the simulation. In general, we see usability as empowering the policy maker to use the simulation in a - for them - meaningful way. Policymakers need to understand how a norm (policy) is influencing the behavior of the agents and in what way. Furthermore, policymakers need to be able to modify existing norms and add new ones on the fly. This requires interaction tools and visualization capabilities necessary to support them in this process. To address this challenge, we present preliminary work on such an interaction tool. 

Abstract Background Ways of working play a central role in student engagement and learning, where variation and adaptation to subject content are crucial to meet students’ diverse needs. Objective The purpose of the study was to investigate what perceptions there were among students in Year 9, regarding work forms in Home and Consumer Studies, focusing on which work forms they preferred and why. Method The study was based on a quantitative method, through a web-based survey in Office Forms 365, which enabled the collection of comprehensive data from Year 9 students. The survey consisted of both closed and open-ended questions and ensured anonymity and privacy of the respondents. Results The majority of the respondents preferred the 'working in groups' approach. Most of the respondents felt that working in groups increased engagement and promoted learning in the best way. Variation in working methods was considered important for learning.  Conclusion The study shows that students prefer working in groups as a form of work in HKK teaching, where learning and commitment are promoted. Furthermore, variation in teaching methods promotes different learning styles, which in turn is important for meeting students' diverse educational needs and preferences. Keywords Engagement, learning styles and learning. 

Bakgrund Intresset för växtbaserad kost har ökat markant, bland annat motiverat av faktorer som etiska- och miljömässiga aspekter samt en rad hälsofördelar. Trots de hälsofördelar som växtbaserad kost kan medföra, riskerar vissa personer att utveckla brist på specifika näringsämnen om kosten inte är välplanerad och baseras på tillräcklig kunskap.

Syfte Syftet med studien var att undersöka uppskattad konsumtionsfrekvens av olika livsmedel med fokus på näringsämnen som vitamin B12, vitamin D, omega-3, järn, zink och kalcium hos vuxna personer som äter växtbaserad kost i Sverige. Studien syftade också till att undersöka användandet av kosttillskott samt kartlägga uppfattning om pålitligheten hos olika informationskällor för växtbaserad kost.

Metod Deltagarna rekryterades via olika organisationer och plattformar som Facebook- och Instagram, samt via informationsblad med QR-kod som anslogs på Umeå universitet och runt om Umeå stad. Webbenkäten innehöll frågor som berörde uppskattad konsumtion av livsmedel, kosttillskott och valet av informationskällor. Chi-två-test användes för att analysera skillnader i intag och frekvens av kosttillskott mellan olika grupper.

Resultat Totalt rekryterades 444 deltagare. Den rapporterade konsumtionen och frekvensen av utvalda livsmedel visade att baljväxter, fullkornsprodukter och växtbaserade mejerisubstitut ofta konsumerades av deltagarna. Medan alger och kantareller konsumerades i lägre utsträckning. De livsmedel som konsumerades störst mängd av vid varje måltid var linser, tofu/tempeh, fullkornspasta, fullkornsris och havregryn. Majoriteten av deltagarna (91%) rapporterade att de använde kosttillskott, där vitamin B12 var det vanligaste. Sociala medier var den mest använda informationskällan, men ansågs också som minst pålitlig när det gällde information om växtbaserad kost. Högst pålitlighet hade vetenskapliga artiklar och myndigheter.

Slutsats Det fanns en kunskap bland deltagarna om näringsämnen som är specifikt centrala i en växtbaserad kost. Däremot kan en ökad medvetenhet om varierat och regelbundet livsmedelsintag vara fördelaktigt för att möta näringsbehov. Det fanns även en efterfrågan av mer tillförlitlig information och förbättrad informationskvalitet inom hälso- och sjukvård, offentliga verksamheter samt på sociala medier. 

Bakgrund De svenska kostråden bygger på de Nordiska Näringsrekommendationerna.Följsamheten till svenska kostråd är generellt låg. Tidigare forskning visar samband mellanhög utbildning och konsumtion av hälsosamma livsmedel. Studier visar även att kvinnorkonsumerar mindre mängder rött kött än män. Kunskapen avseende människors inställningtill kostråden är begränsad.Syfte Undersöka matvanor och inställning till svenska kostråd bland vuxna i Sverige.Metod Kvantitativ metod med en webbaserad enkätstudie. Enkäten fanns tillgänglig att svarapå under en vecka i september 2024. Analys av data genomfördes i Microsoft Excel där blandannat fyra olika chi-2-test genomfördes.Resultat Totalt deltog 282 personer i studien. Majoriteten av deltagarna var kvinnor och deflesta hade en utbildning vid universitet eller högskola. De flesta deltagarna åt mindre mängdfrukt och grönsaker än vad som rekommenderas enligt kostråden, däremot tyckte de attmängderna i kostrådet var lagom. Ungefär hälften av deltagarna åt mindre än 500 gram röttkött i veckan. Något mindre än hälften (41,8%) tyckte att mängden max 500 gram rött kött varlagom. Män åt mer rött kött än kvinnor (p <0,001). De flesta män tyckte att mängden ikostrådet var för lite medan kvinnor i högre utsträckning tyckte att mängden var lagom ellerför mycket. Analys av grönsaksintag och inställning till kostrådet om grönsaker kopplat tillutbildningsnivå visade inga statistiskt signifikanta skillnader.Slutsats Majoriteten av deltagarna åt inte enligt Livsmedelsverkets kostråd vilket stämmeröverens med tidigare forskning. Samtidigt tyckte de flesta av deltagarna att mängderna ikostråden var lagom. För att öka följsamheten till kostråden och därmed förebygga ohälsa påbefolkningsnivå behövs fler undersökningar kring varför följsamheten är låg, samt insatser föratt öka följsamheten till kostråden.

Bakgrund: Sociala medier används flitigt globalt, där svenska användare i genomsnitt spenderar över två timmar per dag. Influencers på Instagram skapar relationer med sina följare genom kontinuerliga inlägg, medan algoritmer anpassar innehållet utifrån intressen. Hälsotrenden "fitnessinspiration" förmedlar ideal om vältränade kroppar och sunda vanor, vilket formar en fitnesskultur där kost, träning och kroppsideal sprids online.

Syfte: Syftet med studien var att utforska möjliga motiv bakom kostrelaterade inlägg som delats av åtta fitnessinfluencers med #highprotein på Instagram 

Metod: Genom en netnografisk observationsstudie undersöktes inlägg från fitnessinfluencers konton publicerat under perioden juni 2024 till september 2024. Kontona inhämtades genom sökning av #highprotein och data insamlades genom arkivdata och fältanteckningar. Data genomgick tematisk analys. 

Resultat: De teman som noterades innefattar utöka sin tillväxt på Instagram och generera ekonomisk vinst, vara en kunskapskälla och frambringa gemenskap genom sitt konto. Influencerna använde sig av marknadsföring både för olika produkter samt andra hemsidor eller applikationer. Det framgick att de skapade tilltalande innehåll för att behålla följares intresse. Genom att dela råd och kunskaper kring kost och hälsa skapade de en trovärdighet och tillit gentemot sina följare. Influencerna skapade en samhörighetskänsla genom att dela med sig av sin vardag och romantisera sina levnadsvanor. 

Slutsats: Influencerna tolkades att med olika tillvägagångssätt dela sina kunskaper för ekonomisk vinning, men även utifrån ett ärligt intresse och för att skapa relationer till sina följare. Ur ett samhällsperspektiv beskriver uppsatsen hur fitnessinfluencers kan medföra ett kroppsideal som kan vara svåruppnåeligt samtidigt som det kan inspirera deras följare för att fatta hälsosamma val. Uppsatsen ger även förslag på hur denna forskning kan vara till grund för framtida forskning.

This thesis explores experiences, challenges and achievements of Greek women IT professionals in both the digital industry and education. Thematic analysis of 8 interviews with IT experts revealed key factors that shaped their study and career choices. These themes illustrate the complex interplay between gender dynamics, career aspirations, personal motivations, family responsibilities, socio-cultural circumstances and strong societal norms that influence women's IT professionals career in Greece. The study underscores the importance of holistic approaches to gender diversity in IT, addressing not only changes in quotas and skills but also in socio-cultural context and work environments. Empowerment,confidence, positive role models, and advisors drive women’s pursuit of IT careers.Transitioning to the IT private sector necessitates labor market transformation, addressing work-life balance and working conditions. Societal norms regarding women's careers and priorities also need to change in order to create inclusive and equitable opportunities forGreek women IT professionals.

Bakgrund: Övervikt och obesitas blir allt vanligare i dagens samhälle. År 2022 hade 51% av befolkningen mellan 16–84 år en övervikt. Den effektivaste behandlingsmetoden vid obesitas är bariatrisk kirurgi, vilket innebär en minskning av magsäckens storlek.  Behandlingsmetoden minskar risken för följdsjukdomar relaterat till obesitas och är kostnadseffektiv för sjukvården. För en optimal behandling är det nödvändigt med ett multidisciplinärt vårdteam. Dietistens roll i teamet är bland annat att ge generella och individanpassade kostråd, både före och efter operationen. 

Syfte: Syftet med studien var att undersöka dietisters upplevelser och erfarenheter av att ge kostbehandling vid bariatrisk kirurgi med specifikt fokus på patienters inställning och motivation samt vilka kostrelaterade utmaningar som framkommer under samtalet både pre-och postoperativt. 

Metod: Syftet besvarades genom sju semistrukturerade digitala intervjuer med legitimerade dietister som är verksamma inom bariatrisk kirurgi, som rekryterades via mejl och två Facebookgrupper med dietister. Intervjuerna spelades in, transkriberades och analyserades genom en kvalitativ innehållsanalys. 

Resultat: Analysen identifierade fyra kategorier med elva subkategorier. Resultatet visade att bariatrisk kirurgi ofta är ett genomtänkt beslut från patientens sida och att de flesta patienter genomför bariatrisk kirurgi för att uppnå bättre hälsa. Under vårdprocessen ges information från olika vårdprofessioner om operationen och dess behandling. Respondenterna lyfte vikten av individanpassade kostråd för ökad följsamhet till behandlingen. Respondenterna beskrev även att patientens personlighet kunde påverka följsamheten till kostråden och att patientens motivation hade betydelse för behandlingens resultat. Ett respektfullt bemötande från det multidisciplinära vårdteamet beskrevs också som viktigt för patientens vårdprocess och följsamhet, eftersom en stor del av patientgruppen tidigare har upplevt dåligt bemötande från vården. För optimal behandling under hela vårdförloppet är de olika professionerna viktiga, dock lyfte vissa respondenter att antalet dietistresurser inte räcker till inom flera regioner. 

Slutsats: Respondenterna i studien beskrev en individuell motivation som förändras över tid hos patienter som genomgått bariatrisk kirurgi. Patienters följsamhet till behandlingens kostråd beskrevs som hög men att det finns en del patienter som av olika anledningar har svårt att följa kostråden. Resultatet stödjer att det är viktigt med ett personcentrerat arbetssätt, ge individanpassad vård och att patienterna möts med respekt av vårdpersonalen.