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Background and Objectives: It has been seen that jaw opening is associated with neck extension and jaw closing is associated with neck flexion. This natural association between the jaw and neck can be used as a novel approach to treat chronic non-specific neck pain, although the effects of this concept have never been previously evaluated as a treatment strategy. This article intends to study the effects of integrating jaw opening and closing movements along with active neck exercises versus active neck exercises alone in the management of chronic non-specific neck pain.

Materials and Methods: A total of 80 patients, aged 20 to 50, with chronic non-specific neck pain were included in a double-blind randomized controlled trial, conducted at the Sindh Institute of Physical Medicine and Rehabilitation, Karachi, Pakistan from 2018 to 2022. The patients were divided into two groups: Group A patients were assigned jaw movements with active neck exercises, while Group B patients were assigned only active neck exercises. Both groups were assigned isometric strengthening exercises and self-resisted strengthening exercises for cervical spine muscles as a home plan. The study used various outcome measures, including the numerical pain rating scale (NPRS), neck disability index (NDI), neck flexion endurance (NFE), neck extension endurance (NEE), the neck proprioception error (NPE): neck flexion proprioception error (NFPE), neck extension proprioception error (NEPE), neck right rotation proprioception error (NRRPE), and neck left rotation proprioception error (NLRPE), with measurements taken at week 1 and week 6, respectively; the mean differences between the groups were measured using a two-way repeated ANOVA.

Results: The experimental group showed better improvements compared to the control group, NPRS (73%), NDI (57%), NFE (152%), NEE (83%), NFPE (58%), NEPE (65%), NRRPE (65%), and NLRPE (62%), with a significant difference (p < 0.05). Conclusions: Active neck extension and flexion movements combined with jaw opening and closing are more effective in reducing pain and disability, improving neck muscles endurance and normalizing neck proprioception in patients with chronic neck pain.

The growing recognition of the importance of cultural and creative sectors as sources of creativity and innovation has put emphasis on the development of entrepreneurs within this field. Cultural entrepreneurs are often described as being driven by artistic, rather than entrepreneurial, ambitions, where value creation is based on unique expressions, requiring them to engage in continuous innovation to sustain their activities, as well as facing challenging conditions. However, more understanding is needed on the work of these entrepreneurs and how they deal with challenges. The purpose of this paper is thus to explore the work of cultural entrepreneurs by integrating the current understanding of its challenges and strategies. Through reviewing empirical articles focusing on entrepreneurs in these industries and analyzing how the activities of entrepreneurs are described, we argue that the academic conversation around these entrepreneurs revolves around broad questions: who they are, what they have and where they are. These questions constitute three domains of entrepreneurial activity. We outline the challenges and strategies of cultural entrepreneurs and discuss the dynamics in the interplay between challenges and strategies within and across these domains. In highlighting the interplay between challenges and strategies, we advance the knowledge of entrepreneurship in the cultural and creative sectors and provide avenues for further research.

• Appropriate abiotic stress response is pivotal for plant survival and makes use of multiple signaling molecules and phytohormones to achieve specific and fast molecular adjustments. A multitude of studies has highlighted the role of alternative splicing in response to abiotic stress, including temperature, emphasizing the role of transcriptional regulation for stress response. Here we investigated the role of the core-splicing factor PORCUPINE (PCP) on temperature-dependent root development.
• We used marker lines and transcriptomic analyses to study the expression profiles of meristematic regulators and mitotic markers, and chemical treatments, as well as root hormone profiling to assess the effect of auxin signaling.
• The loss of PCP significantly alters RAM architecture in a temperature-dependent manner. Our results indicate that PCP modulates the expression of central meristematic regulators and is required to maintain appropriate levels of auxin in the RAM.
• We conclude that alternative pre-mRNA splicing is sensitive to moderate temperature fluctuations and contributes to root meristem maintenance, possibly through the regulation of phytohormone homeostasis and meristematic activity.

Introduction: Sepsis is a growing problem worldwide and associated with high mortality and morbidity. The early and accurate diagnosis and effective supportive therapy are critical for combating mortality. The aim of the study was to compare the kinetics of four biomarkers in plasma in patients admitted to ICU including sepsis and during antibiotics treatment.

Methods: The biomarkers evaluated were HBP (Heparin-binding protein), HNL Dimer (Human Neutrophil Lipocalin), HNL Total and PCT (Procalcitonin). Plasma was obtained at admission to ICU and during follow-up at days 2 and 3. Antibiotic treatment was started or reviewed on admission to ICU. The results were compared to SOFA and KDIGO-scores and to survival. 277 patients admitted to ICU were included of which 30% had sepsis. The other groups were categorized as miscellaneous, other medical and trauma.

Results: The plasma concentrations of all four biomarkers were highly elevated with the highest concentrations in sepsis patients. During the follow-up period HNL Dimer decreased already day 2 and further so day 3 (p<0.00001) in contrast to unchanged concentrations of the other three biomarkers. HNL Total showed the strongest relationships to the clinical scores (p<0.0001) and was by multiples regression analysis independently related to these scores.

Conclusion: Our data supports and confirms our earlier findings of HNL Dimer being a novel and potentially useful clinical tool in antibiotic stewardship in sepsis. HNL Total reflects epithelial cell activity in the body and is an interesting biomarker for the management of organ failure in such patients.

In this article, we investigate traces of a news media logic in the Swedish parliamentary speeches from 1920 to 2019. Drawing on theories of mediatisation, we examine two aspects: the length of the speeches and repeated political slogans. Our analysis is based on a complete corpus of parliamentary records with annotated speeches. Speech length was measured based on word count, and the identification of slogans was based on repeated seven-word segments, filtered to exclude generic phrases. While it is difficult to draw any definitive conclusions about the influence of an external media logic, the speech length has dropped by 50 per cent since 1920. This change relates to new parliamentary procedures, and from the 1980s, with the explicit goal to attract the news media. Short and snappy political slogans have increased significantly since the 1990s. This development reflects previous research stating that sound bites are getting shorter.

This study examines geodesics and plurisubharmonic envelopes within the Cegrell classes on bounded hyperconvex domains in Cn. We establish that solutions possessing comparable singularities to the complex Monge–Ampère equation are identical, affirmatively addressing a longstanding open question raised by Cegrell. This achievement furnishes the most general form of the Bedford–Taylor comparison principle within the Cegrell classes. Building on this foundational result, we explore plurisubharmonic geodesics, broadening the criteria for geodesic connectivity among plurisubharmonic functions with connectable boundary values. Our investigation also delves into the notion of rooftop envelopes, revealing that the rooftop equality condition and the idempotency conjecture are valid under substantially weaker conditions than previously established, a finding made possible by our proven uniqueness result. The paper concludes by discussing the core open problems within the Cegrell classes related to the complex Monge–Ampère equation.

Background: A team-based, individualised rehabilitation approach may be required to meet the complex needs of people with dementia. This randomised controlled pilot trial evaluated the feasibility of a person-centred multidimensional interdisciplinary rehabilitation programme for community-dwelling older people with dementia and their informal primary caregivers.

Methods: Participants with dementia were randomised to an intervention group (n = 31, mean age (SD) 78.4 (6.0) years) or usual care (n = 30, mean age 79.0 (7.1)). The rehabilitation programme consisted of a 20-week rehabilitation period containing assessments and interventions based on each individual’s goals, and group-based physical exercise plus social interaction twice a week for 16 weeks at a rehabilitation unit. After 5 and 14 months, the interdisciplinary team followed up participants over two four-week periods. For both groups, dates of deaths and decision to move to nursing home over three years, as well as interventions for the relevant periods, were collected. Blinded assessors measured physical functions, physical activity, activities of daily living, cognitive functions, nutritional status, and neuropsychiatric symptoms at baseline and at 5, 12, 24, and 36 months.

Results: Participants in the intervention group received a mean of 70.7 (20.1) interventions during the 20-week rehabilitation period, delivered by all ten team professions. The corresponding figures for the control group were 5.8 (5.9). In the intervention group, all but one participated in rehabilitation planning, including goal setting, and attendance in the exercise and social interaction groups was 74.8%. None of the adverse events (n = 19) led to any manifest injury or disease. Cox proportional hazard regression showed a non-significant lower relative risk (HR = 0.620, 95% CI 0.27–1.44) in favour of the intervention for moving to nursing home or mortality during the 36-month follow-up period. Linear mixed-effect models showed non-significant but potentially clinically meaningful between-group differences in gait, physical activity, and neuropsychological symptoms in favour of the intervention.

Conclusions: The rehabilitation programme seems feasible among community-dwelling older people with dementia. The overall results merit proceeding to a future definitive randomised controlled trial, exploring effects and cost-effectiveness. One could consider to conduct the programme earlier in the course of dementia, adding cognitive training and a control attention activity.

Trial registration: The study protocol, ISRCTN59155421, was registered online 4/11/2015.

Background: Complementary and alternativemedicine (CAM) is widely used by patients with cancer. Research indicates that the use of CAM is more prevalent in rural areas compared to urban areas. There is currently a lack of information regarding the scope and specifics of CAM use among patients in Sweden, particularly in rural areas. The aim of this study was to estimate the extent and characteristics of CAM use among cancer patients in the rural areas of Region Gävleborg.

Methods: A total of 631 questionnaires were sent out, and 376 of those were returned, corresponding to a response rate of 59.6%. Oncology patients received questionnaires at their initial appointment for curative care at Gävle Hospital's Department of Oncology. When enrolling in palliative outpatient care in their homes, palliative patients were sought out. Standard descriptive statistics were used to present the characteristics of the respondents. To determine odds ratios and potential factors (age, gender, diagnosis, and education) affecting CAM use after cancer diagnosis, a multivariable logistic model was constructed.

Results: Based on clinical observations, the authors' hypothesis that CAM use is particularly common in small towns in the Hälsingland region was verified in this study. This was particularly pronounced among younger people and residents of small towns in the province of Halsingland. The higher level of CAM use appears to apply to both men and women.

Conclusions: CAM appears to be used more frequently by patients residing in rural areas. It is crucial that care providers enquire about all of the patient's health-seeking activities. Further research is needed on the usage of CAM in rural areas and the potential cultural influences contributing to CAM use. From a sociological standpoint, it is crucial to draw attention to the fact that CAM use may be more prevalent in certain rural areas, particularly in centralized societies where it is more difficult to access healthcare in remote regions.

Proprioception plays a crucial role in motor coordination and self-perception. Muscle spindles are the principal receptors for proprioception. They are believed to encode muscle stretch and signal limb position and velocity. Here, we applied percutaneous pressure to a small area of extensor muscles at the forearm while recording spindle afferent responses, skeletal muscle activity, and hand kinematics. Three levels of sustained pressure were applied on the spindle-bearing muscle when the hand was relaxed and immobile ("isometric" condition) and when the participant's hand moved rhythmically at the wrist. As hypothesized to occur due to compression of the spindle capsule, we show that muscle pressure is an "adequate" stimulus for human spindles in isometric conditions and that pressure enhances spindle responses during stretch. Interestingly, release of sustained pressure in isometric conditions lowered spindle firing below baseline rates. Our findings urge a re-evaluation of muscle proprioception in sensorimotor function and various neuromuscular pathologies.

A necessary condition for the generation of Geomagnetically Induced Currents (GICs) that can pose hazards for technological infrastructure is the occurrence of large, rapid changes in the magnetic field at the surface of the Earth. We investigate the causes of such (Formula presented.) events or “spikes” observed by SuperMAG at auroral latitudes, by comparing with the time-series of different types of geomagnetic activity for the duration of 2010. Spikes are found to occur predominantly in the pre-midnight and dawn sectors. We find that pre-midnight spikes are associated with substorm onsets. Dawn sector spikes are not directly associated with substorms, but with auroral activity occurring within the westward electrojet region. Azimuthally-spaced auroral features drift sunwards, producing Ps6 (10–20 min period) magnetic perturbations on the ground. The magnitude of (Formula presented.) is determined by the flow speed in the convection return flow region, which in turn is related to the strength of solar wind-magnetospheric coupling. Pre-midnight and dawn sector spikes can occur at the same time, as strong coupling favors both substorms and westward electrojet activity; however, the mechanisms that create them seem somewhat independent. The dawn auroral features share some characteristics with omega bands, but can also appear as north-south aligned auroral streamers. We suggest that these two phenomena share a single underlying cause. The associated fluctuations in the westward electrojet produce quasi-periodic negative excursions in the AL index, which can be mis-identified as recurrent substorm intensifications.

Background: Transportation noise has been linked with cardiometabolic outcomes, yet whether it is a risk factor for atrial fibrillation (AF) remains inconclusive. We aimed to assess whether transportation noise was associated with AF in a large, pooled Nordic cohort.

Methods: We pooled data from 11 Nordic cohorts, totaling 161,115 participants. Based on address history from five years before baseline until end of follow-up, road, railway, and aircraft noise was estimated at a residential level. Incident AF was ascertained via linkage to nationwide patient registries. Cox proportional hazards models were utilized to estimate associations between running 5-year time-weighted mean transportation noise (Lden) and AF after adjusting for sociodemographics, lifestyle, and air pollution.

Findings: We identified 18,939 incident AF cases over a median follow-up of 19.6 years. Road traffic noise was associated with AF, with a hazard ratio (HR) and 95% confidence interval (CI) of 1.02 (1.00–1.04) per 10-dB of 5-year mean time-weighted exposure, which changed to 1.03 (1.01–1.06) when implementing a 53-dB cut-off. In effect modification analyses, the association for road traffic noise and AF appeared strongest in women and overweight and obese participants. Compared to exposures ≤40 dB, aircraft noise of 40.1–50 and > 50 dB were associated with HRs of 1.04 (0.93–1.16) and 1.12 (0.98–1.27), respectively. Railway noise was not associated with AF. We found a HR of 1.19 (1.02–1.40) among people exposed to noise from road (≥45 dB), railway (>40 dB), and aircraft (>40 dB) combined.

Interpretation: Road traffic noise, and possibly aircraft noise, may be associated with elevated risk of AF. Funding: NordForsk.

We use optical-optical double-resonance spectroscopy with a continuous wave (CW) pump and a cavity-enhanced frequency comb probe to measure the energy levels of methane in the upper part of the triacontad polyad (P6) with higher rotational quantum numbers than previously assigned. A high-power CW optical parametric oscillator, tunable around 3000 cm-1, is consecutively locked to the P(7, A2), Q(7, A2), R(7, A2), and Q(6, F2) transitions in the ν3 band, and a comb covering the 5800-6100 cm-1 range probes sub-Doppler ladder-type transitions from the pumped levels with J' = 6 to 8, respectively. We report 118 probe transitions in the 3ν3 ← ν3 spectral range with uncertainties down to 300 kHz (1 × 10-5 cm-1), reaching 84 unique final states in the 9070-9370 cm-1 range with rotational quantum numbers J between 5 and 9. We assign these states using combination differences and by comparison with theoretical predictions from a new ab initio-based effective Hamiltonian and dipole moment operator. This is the first line-by-line experimental verification of theoretical predictions for these hot-band transitions, and we find a better agreement of transition wavenumbers with the new calculations compared to the TheoReTS/HITEMP and ExoMol databases. We also compare the relative intensities and find an overall good agreement with all three sets of predictions. Finally, we report the wavenumbers of 27 transitions in the 2ν3 spectral range, observed as V-type transitions from the ground state, and compare them to the new Hamiltonian, HITRAN2020, ExoMol, and the WKMLC line lists.

AI systems, like self-driving cars, healthcare robots, or Autonomous Weapon Systems, already play an increasingly important role in our lives and will do so to an even greater extent in the near future. This raises a fundamental philosophical question: who is morally responsible when such systems cause unjustified harm? In the paper, we argue for the admittedly surprising claim that some of these systems can themselves be morally responsible for their conduct in an important and everyday sense of the term—the attributability sense. More specifically, relying on work by Nomy Arpaly and Timothy Schroeder (In Praise of Desire, OUP 2014), we propose that the behavior of these systems can manifest their ‘quality of will’ and thus be regarded as something they can be blameworthy for. We develop this position in detail, justify some of its crucial presuppositions, and defend it against potential objections.

This workbook originates from the insights and learnings of our work in the field of design for sustainable systemic societal transformation.

More and more organisations are striving to transform their current practices into new ones, that embrace complexity and open-endedness. These new practices do not rush into defining confined (and potentially misleading) problems in the name of efficiency, productivity, and competitiveness. They rather take time to engage in transformation processes, that start by forming collaborations around specific systemic societal challenges. Redefining these challenges into missions that are tackled by a partnership, which evolves in time.

Framing challenges as societal proves to be the first, important hurdle to overcome. Mainstream practices tend to identify and reduce problems to localised interventions that can be solved linearly, by specialised field knowledge.

A problem is defined and a technologically driven, incremental innovation is applied to solve that problem. Haraway refers to these kind of attitude as looking for technofixes, which she unapologetically identifies as comic. This bitter humour stems from the awareness that those attempts are dangerously ignoring the necessity to acknowledge the systemic nature of human acts: from the complex life-cycle of products and services that we realise, to the behaviours that we elicit in direct and indirect receivers of such products, services, systems and policies. A shift is urgent: from extractive approaches to regenerative ones, where materials, value and energies are not extracted, but where regenerative practices are established instead.

The resemblance between fallopian tube cells and serous borderline ovarian tumors (BOTs) suggests a potential origin link, with salpingitis proposed as a contributing factor in the pathogenesis of BOT. This study aimed to explore the potential association between pelvic inflammatory disease (PID) and the risk of developing BOT. A national population-based case–control study in Sweden included women with BOT between 1999 and 2020 and 10 matched controls. Data from nationwide registers were analyzed using conditional logistic regression, adjusting for age, residential district, educational level and parity. Among 4782 cases and 45,167 controls, 2.0% of cases and 1.3% of controls had a history of PID. Previous PID was associated with an increased risk of BOT overall (aOR, 1.48; 95% CI, 1.19–1.85). Significant association was observed with serous tumors (aOR, 1.76; 95% CI, 1.36–2.29), while not with mucinous tumors (aOR, 0.95; 95% CI, 0.60–1.49). A dose–response relationship between number of PID episodes and serous BOT risk was noted (Ptrend <.001). This study demonstrates that PID is associated with increased risk of serous BOT, with a dose response relationship. The study highlights the potential serious implications of upper reproductive tract infections and inflammation. This underscores the need for further investigation of biological mechanisms and possible impact of PID on serous BOT development.

Global warming is a worldwide issue that is commonly caused by the emissions of greenhousegases that are released as a consequence of different forms of human activities. One commongreenhouse gas is carbon dioxide which is commonly emitted when burning different fossilfuels, which the transportation sector is still heavily reliant on. Several laws and regulationsare implemented by governmental bodies and organisations like the European Union andUnited Nations, in order to mitigate the increasing emissions in the sector. Many emission-reduction targets put pressure on the logistics sector to reduce their environmental impact. The current literature of the subject highlights a need for a more holistic perspective while exploringthe views and perceptions of companies in the logistics sector to better understand howsustainable initiatives are implemented, and what effect it has on the organisation. Therefore, the purpose of this thesis is to enhance our understanding of sustainable initiatives withinlogistics, which will be done by exploring manager’s perceptions of how sustainable initiativescan be successfully implemented by road freight logistics companies.

To do so, this thesis adopted a qualitative research method, while using semi-structuredinterviews to capture the perceptions and thoughts of managers in logistics companies. A totalof 9 different companies were interviewed, where a total of 10 participants was present andsharing their thoughts of the subject. The collected data was then analysed to find certainpatterns and similarities. Afterwards, the analysed data was compared with the findings fromthe literature review, while following the basis of our conceptual framework that is based onthe Sustainable Supply Chain Management framework. The results of the study were thensummarized in the conclusion section. It was found that sustainability is highly prioritized inmost of the companies that was interviewed. The pressure to implement sustainable initiativescomes primarily from their customers, but also from the government and other stakeholders. This aligns with the different triggers which are outlined in the Sustainable Supply ChainManagement framework. Several sustainable solutions like biofuels, electric vehicles, multi-modal transport was discussed, where most challenges and benefits thereof correspond wellwith existing literature. Additionally, the infrastructure is currently insufficient to support theswitch to many of the sustainable methods, and these methods are almost always more costly.Also, the customers are often not willing to pay for a more sustainable method of transport.However, it was discovered that factors like unfair competition, involvement of finalconsumers, and collaboration between competitors are additional factors that was notdiscovered in the previous literature.Key words: Sustainability, Logisti

Vector control of mosquitoes with insecticides is an important tool for preventing the spread of mosquito-borne diseases including malaria, dengue, chikungunya, and Zika. Development of active ingredients for insecticides are urgently needed because existing agents exhibit off-target toxicity and are subject to increasing resistance. We therefore seek to develop noncovalent inhibitors of the validated insecticidal target acetylcholinesterase 1 (AChE1) from mosquitoes. Here we use molecular dynamics simulations to identify structural properties essential for the potency of reversible inhibitors targeting AChE1 from Anopheles gambiae (AgAChE1), the malaria-transmitting mosquito, and for selectivity relative to the vertebrate Mus musculus AChE (mAChE). We show that the collective motions of apo AgAChE1 and mAChE differ, with AgAChE1 exhibiting less dynamic movement. Opening and closing of the gorge, which regulates access to the catalytic triad, is enabled by different mechanisms in the two species, which could be linked to their differing amino acid sequences. Inhibitor binding reduced the overall magnitude of dynamics of AChE. In particular, more potent inhibitors reduced the flexibility of the Ω loop at the entrance of the gorge. The selectivity of inhibitors for AgAChE1 over mAChE derives from the positioning of the α-helix lining the binding gorge. Our findings emphasize the need to consider dynamics when developing inhibitors targeting this enzyme and highlight factors needed to create potent and selective AgAChE1 inhibitors that could serve as active ingredients to combat disease-transmitting mosquitoes.

A phytoestrogen-rich diet has been suggested to reduce tumor proliferation among men with prostate cancer, and the effect may differ between men with different polymorphisms of the estrogen receptor‐beta gene (ERβ). Patients with low- or intermediate-risk prostate cancer scheduled for radical prostatectomy were randomized to an intervention group (n = 71) provided with soybeans and flaxseeds (∼200 mg phytoestrogens/day) to eat until surgery (approximately 6 wk) or to a control group (n = 69). Tumor proliferation was assessed using Ki-67 indexes, prostate-specific antigen (PSA) concentrations were analyzed in blood, and ERβ polymorphism was genotyped in all subjects. The intervention group had a 13% unit lower risk [95% confidence interval (CI): −28%, 1.8%] of a higher Ki-67 index compared to controls, but the effect was most pronounced among TT carriers of ERβ [risk difference (RD) −19%, 95% CI: −45%, 6.8%]. Subjects with genotype TC/CC had a lower risk (RD −29%, 95% CI: −46%, −1.2%) and TT genotype a higher risk (RD 25%, 95% CI: 8.7%, 42%) of increased PSA concentration, comparing the intervention group to controls. In conclusion, a phytoestrogen-rich diet may cause lower tumor proliferation and concentration of PSA in men with prostate cancer with a specific genetic upset of ERβ.

I denna uppsats undersöks ämnet interpunktion i interlingvistisk översättning. Syftet med denna studie är att utreda på vilket sätt skiljetecken överförs i en litterär översättning från italienska till svenska. I synnerhet jämförs skillnader i användningen av skiljetecken i prototexten Canne al vento av Grazia Deledda, och dess översättning till svenska, metatexten Rö för vinden. Efter undersökningen av divergenserna, i teori och praktik, mellan det italienska och det svenska interpunktionssystemet, presenteras den kvantitativa och kvalitativa analysen av skiljetecknen såväl i proto- som i metatexten. Materialet utgörs av prototexten och metatexten. Förekomsten av fem skiljetecken (kommatecken, punkt, kolon, semikolon, tre punkter) har räknats och jämförts i den italienska respektive den svenska versionen. Därefter har användningen av de ovannämnda skiljetecknen analyserats och kommenterats med utgångspunkt i exempel och utdrag från ett kapitel (II). Resultatet av analysen visar att det finns grundläggande skillnader i användningen av skiljetecken i metatexten jämfört med prototexten. Översättaren tillade huvudsakligen kommatecken samt ersatte semikolon och kolon med kommatecken och punkter; i mindre utsträckning avlägsnade hon även kommatecken som fanns i prototexten. Dessa skillnader är kopplade dels till de olika tendenser inom interpunktion som råder i italienskan respektive svenskan, vilka uppstår i form av anpassningar, dels till översättarens omtolkning av författarens interpunktionsstil.

A profound puzzle lies in how the brain’s information processing gives rise to consciousness. This paper will discuss how and why there can be processes that give rise to subjective experience.Diverging from mainstream media, this paper will first demonstrate that there is no direct correlation between rising intelligence and the ability to gain subjective experience.

In the core of the paper, a speculative idea is brought forward: the ability to filter noise is what gives a being the ability to develop subjective experience. This could mean a system that can take all of the information and pick out the relevant parts. Every other sensory input that is seemingly unnecessary will be part of the experience, offering a unique point of view. It is like something to be conscious, and the argument is that all of this seemingly unnecessary information is part of that, giving the conclusion that this could be how subjective experience emerges.

Further speculation suggests that a developing component answers why consciousness emerges from a system that is only filtering noise. This would mean a system constantly refining its ability to filter noise and interact with the world. This ongoing refinement, this journey of sorting order from chaos, is integral to the development of subjective experience.

In Western Europe, rightwing populist parties and their supporters frequently deny the realities of climate change and oppose climate policies. Meanwhile, public opinion research has tied ideological orientations associated with rightwing populism to climate change denial/ skepticism and climate policy opposition. Yet, comprehensive studies assessing the relative importance of various rightwing populist orientations across national contexts are lacking. Using European Social Survey data (Round 8) from 15 Western European countries, we systematically investigate the relationships between a large set of orientations related to rightwing populism and public views about climate change. The results show that nationalism and nativism, that is, orientations associated with the thick ideology of rightwing populism, appear to be comparably strong and consistent predictors, especially regarding opposition to climate change mitigation policies. However, the relative importance of different orientations varies across Western European countries, and depend on whether the focus is on policy attitudes or climate change beliefs. Researchers studying single countries and/or specific attitudinal outcomes should therefore be cautious when generalizing about these relationships cross-nationally.

Introduction: In Sweden, youth clinics (YCs) address, among other things, issues related to the mental well-being among young people. However, YCs´ impact on their mental health have not been assessed. This study aimed to: i) analyse trends in mental health outcomes (stress, anxiety and psychological distress) among young people in Sweden according to the municipal availability of YCs; and ii) assess the impact on mental health outcomes of the presence of YCs with a first-line mental health (FLMH) assignment and YCs without this assignment, as compared to municipalities without YCs.

Methods: An ecological controlled interrupted time series design was applied. Annual data over 18 years (2004-2021) on self-reported stress, anxiety and psychological distress of individuals aged 16-25 were used. Thus, the mental health outcome trends in municipalities with YCs and those without YCs were compared. The prevalence ratio and their 95% confidence intervals were estimated.

Results: In total, 17,174 young people aged 16–25 participated in the study. A decrease in the reporting of stress, anxiety and psychological distress was observed from 2004 to 2010, followed by an increase in all three outcomes during the period 2011–2021. Trends were not statistically significant different in municipalities with or without YCs (even among YCs with the FLMH assignment). 

Conclusion: The prevalence of mental ill-health has been increasing among young people in Sweden since 2011. While YCs play an important role in the prevention of mental illness, their impact on these trends could not be determined. We recommend that structural factors such as education and the labour market for youth, which are outside the scope of YCs, should be addressed to curb these trends. 

Introduction: Compliance with long-term secondary prevention guidelines in primary care settings is hampered, in part, by a shortage of health professionals in rural areas. Telemedicine has shown promise in supporting preventive care without requiring the physical relocation of professionals to underserved regions. Although many studies have shown positive outcomes with telemedicine, more evidence is needed. The aim of this study was to compare the effect of telemedicine on compliance to guidelines for blood pressure and lipid control in primary care in patients with ischaemic cardiovascular disease compared with traditional care in rural Sweden. In addition, the study investigated the effect of five years of telemedicine follow-up on improvements in blood pressure and lipid levels compared with a control health centre.

Methods: Two rural health centres in northern Sweden were included. The intervention group received regularly scheduled online video consultations between a cardiologist and the local nurses, while the control group received conventional centre-based monitoring. Patient-based registry information was collected for the period 2016-2020. Data included available measurements of systolic and diastolic blood pressure, LDL, HDL, total cholesterol and triglycerides. Compliance with the guidelines was assessed by recording the number of available blood pressure and lipid measurements from the list of eligible patients. Those with one or no measurements were considered non-compliant. Means of blood pressure and lipid measurements at two time points were estimated, followed by difference-in-difference analysis.

Results: The intervention group showed increased compliance to guideline recommendations. However, there were no statistically significant differences in blood pressure and lipid measurements over time compared with the control group.

Conclusion: The results highlight the potential of telemedicine to improve compliance to secondary cardiovascular prevention guidelines in rural primary care. This study serves as a successful model for integrating telemedicine into real-world health care and highlights the need for continued research and evaluation.

Introduction: Soccer is an intense sport characterized by intermittent high-intensity bursts interspersed with lower-intensity periods. Recent advancements in technology reveal the physical demands of soccer, highlighting the importance of short sprints (10-30 meters) and their impact on game-changing moments. Strength, power and body composition play crucial roles in soccer performance. The force and velocity relationship, combining maximum force and velocity, supports maximal power and athletic performance. The purpose of this study was to compare power training and hypertrophy training on various performance variables. Method: Twelve highly trained youth male soccer players were randomly assigned to either a hypertrophy group or a power group. The study employed a randomized control trial design, with assessment conducted before and after the training intervention. Sprint performance, maximal force, maximal speed and maximal power. 

Results: The result showed non-significant difference between pre and post intervention for the power group and the hypertrophy group in sprint times 5,10 and 20 meters as well as maximum force, maximum speed, maximum power, Wingate test and comparing the two against each other. 

Discussion: The volume and frequency of the sessions in the intervention might have been too low to achieve any significant effect. The duration of the separate sessions was a consequence of the coaches limitations and might have affected the training.The relatively low loads (60% of 1RM) imposed by the coaches limitations in the power group might have hindered the optimal strength adaptations. An individualized approach for the training program could have optimized the training effect for the participants and therefore the results obtained. 

Conclusion: While our study did not reveal any significant results, it highlights the importance of factors such as volume, frequency, intensity and individualisation. Additionally, the sample size is too small to draw any solid conclusions from the results. 

This article explores the personal names given to Icelandic and Norwegian individuals in 23 of the Old Norse literary íslendingaflættir. The aim is to establish if differences between Norway and Iceland, and innovations and archaisms in personal names from the different time periods accessible through the íslendingaflættir, are visible in literary sources. The findings of the analysis of the personal names in the íslendingaflættir are supplemented with results of previous research and non-literary sources. Despite the limited source material, the personal names of Icelandic and Norwegian individuals found in 23 íslendingaflættir exhibit noticeable differences such as preferences for specific names or name components.

As service members transition from deployment to civilian life, they are also expected to reintegrate into society. An important part of this process is to “soften up” veteran or warrior identities and open up the self for both existing and new identities, mindsets, and ways of life. Past research has shown that the warrior mindset, in particular, can have negative health implications in the long run. The mindset can be costly, not only for the individual and their loved ones, but also for the healthcare services and other agencies. This article draws from a recent interview study with 24 deployed Swedish veterans suffering from deteriorating mental health without receiving a clinical diagnosis. Purposeful sampling was conducted with the support of the medical staff at the Veterans’ Clinic at Uppsala University Hospital. Participants had been screened for posttraumatic stress disorder (PTSD) but had not received a clinical diagnosis. This constitutes a large and understudied patient group in the clinic. The medical staff selected patients based on the following criteria: deteriorating mental health, increased suffering related to PTSD symptoms, and issues related to moral issues, existential concerns, and identity. The sample included veterans from both the Swedish Armed Forces and other deploying agencies. Of the 24 interviewees, 19 were from the Swedish Armed Forces (16 men and three women), and five (four women and one man) were deployed by other agencies. The number of overseas deployments varied widely, with some interviewees having completed 1–2 deployments, while others had completed 3–8. Additionally, some interviewees had interrupted planned or ongoing deployments for various reasons. At the time of the interviews, none were serving full-time in the armed forces; all were veterans. The interviews took place during an intense wave of COVID-19 infections in Sweden in early 2022, so the majority were conducted via videoconference. The participants’ veteran identities were abductively analyzed through the mask of secrecy, the stoic mask, and the mask of denial, which are elements of the “Mask of the Warrior.” This mask functions to safeguard mission focus, to endure, to execute tasks in extremely stressful situations, and to solve operational tasks during deployments and combat operations. The analysis of the interviews suggests that certain elements in these powerful veteran identities can serve as breeding grounds for suffering later in life. The veterans in the study tended to be stoic about their deteriorating mental health, kept the suffering to themselves, and denied the harmful aspects of their deployments. Thus, the Mask of the Warrior played a counterproductive role for the individual, their friends and family, and life in the aftermath of deployments. Another implication of secrecy and denial occurred on the societal or macro and system levels due to the absence of sufficient insight, knowledge, and understanding of veterans among personnel within the healthcare system and other agencies. This made it difficult for the healthcare system, and other relevant agencies, to offer adequate care and to understand the participants’ health issues during sick leave. The perceived absence of societal and organizational rewards and benefits for veterans who risk their mental health and lives during deployment can be seen as a failing implicit work contract. This lack of recognition may lead to the corrosion of character.

This study examines the mobility experiences of Swedish for Immigrants (SFI)

students in Umeå, focusing on how these experiences have evolved in response

to technological advancements and Umeå's environmental initiatives.

The research explores various dimensions of mobility, including access to

public transportation, cycling habits, and the influence of gender on mobility

patterns.

The study draws on key theoretical frameworks, such as the New

Mobilities Paradigm, Time-Space Compression, and Transnationalism, to

provide a deeper understanding of how mobility shapes and is shaped by social

and technological changes.

By comparing current experiences with those documented in a 2006 study,

this paper illuminates the impact of recent technological progress and municipal

sustainability efforts on the daily lives of sfi students.

Additionally, the study investigates the students' awareness of and

engagement with Umeå municipality's environmental goals, identifying potential

areas for improvement in mobility and communication strategies.

Through a combination of surveys and interviews, the research offers a

comprehensive analysis of the challenges and opportunities immigrant students

face in adapting to Umeå's evolving mobility landscape.

This study investigated the population viability of Sotalia guianensis in the Cananéia Estuarine-Lagoon Complex, considering current and potential future scenarios. Simulations, using VORTEX software v. 10.5.5.0, spanned 100 years and were iterated 1000 times. Scenarios encompassed adjustments to demographic and environmental factors, evaluating population trajectories (baseline; increase fisheries; increase tourism; and increase harbour activity scenarios). Findings revealed a potential stochastic growth rate and population stabilization in baseline and increase tourism scenarios when major threats were absent. Conversely, increase fishing and harbour activity scenarios exhibited population decline, leading to eventual extinction within 100 years. Projected growth rates for all Scenarios were 0.0298 (SD=0.0424), −0.2650 (SD=0.2825), 0.0294 (SD=0.0654), and −0.0334 (SD=0.1145) respectively, with extinction probabilities of 0.0 for baseline and increase tourism scenarios, 1.0 for increase fishing scenario with mean estimated extinction time at 14 years, and 0.4430 for increase harbour activity scenario with mean estimated extinction time at 80.1 years. Sensitivity testing identified the percentage of adult females breeding and female mortality as the parameters most significantly impacting population trends. The simulations provided important insights into the primary factors impacting the viability of Sotalia guianensis and lay the groundwork for future population assessments and conservation plans.

Oncogenic signaling through the MAPK/ERK pathway drives tumor progression in many cancers. Although targeted MAPK/ERK pathway inhibitors improve survival in selected patients, most tumors are resistant. New drugs could be identified in small-animal models that, unlike in vitro models, can address oral uptake, compound bioavailability, and toxicity. This requires pharmacologic conformity between human and model MAPK/ERK pathways and available phenotypic assays. In this study, we test if the conserved MAPK/ERK pathway in Caenorhabditis elegans could serve as a model for pharmacological inhibition and develop in vivo pipelines for high-throughput compound screens. Using fluorescencebased image analysis of vulva development as a readout for MAPK/ERK activity, we obtained excellent assay Z-scores for the MEK inhibitors trametinib (Z = 0.95), mirdametinib (Z = 0.93), and AZD8330 (Z = 0.87), as well as the ERK inhibitor temuterkib (Z = 0.86). The throughput was 800 wells per hour, with an average seed density of 25.5 animals per well. Readouts included drug efficacy, toxicity, and pathway specificity, which was tested against pathway activating upstream (lin-15)- and downstream (lin-1) mutants. To validate the model in a high-throughput setting, we screened a blinded library of 433 anticancer compounds and identified four MEK inhibitors among seven positive hits. Our results highlight a high degree of pharmacological conformity between C. elegans and human MAPK/ERK pathways, and the presented high-throughput pipeline may discover and characterize novel inhibitors in vivo.

Background: Nutri-Score is a scientifically validated 5-color front-of-pack nutrition label reflecting the nutrient profile of foods. It has been implemented in several European countries on a voluntary basis, pending the revision of the European labeling regulation. Hence, scientific evidence is needed regarding the ability of the nutrient profile underlying the Nutri-Score (uNS-NPS, 2023-updated version) to characterize healthier foods. Our objective was therefore to study the prospective association between the nutritional quality of diet characterized by the uNS-NPS and the risk of cardiovascular diseases in a large European population.

Methods: Our analyses included 345,533 participants from the European Prospective Investigation into Cancer and Nutrition study (EPIC, 1992–2010, 7 European countries). Food intakes were assessed at baseline using country-specific dietary questionnaires. The uNS-NPS was calculated as a continuous scale for each food, based on its 100 g content of energy, sugars, saturated fatty acids, salt, fibre, and protein and percentage content of fruit, vegetables, and pulses. A dietary index was derived at the individual level (uNS-NPS DI: energy-weighted mean of uNS-NPS scores of all foods consumed by a participant). Cardiovascular events during follow-up were retrieved using country-specific methods (self-report, registry data). Multi-adjusted Cox models were computed.

Findings: Overall, 16,214 first cardiovascular events were reported (median follow-up: 12.3 years; 4,103,133 person-years). The consumption of foods with a higher uNS-NPS score (reflecting a lower overall nutritional quality of diet) was associated with higher risks of total cardiovascular events (Hazards Ratio (HR) for an increment of 1 standard deviation: 1.03 (95% Confidence Interval 1.01–1.05)), especially myocardial infarction (HR = 1.03 (1.01–1.07)), and stroke (HR = 1.04 (1.01–1.07)).

Interpretation: In this large prospective study among European adults, a higher risk of cardiovascular diseases (total and several subtypes) was observed in individuals consuming a diet with a lower nutritional value, as graded by the uNS-NPS score. This brings new evidence on the relevance of the updated nutrient profile underlying the Nutri-Score to characterize foods with a healthier nutrient profile.

Funding: EPIC-CVD was supported by EU FP7, ERC, UK MRC, British Heart Foundation, and UK NIHR.

Human CD81 and CD9 are members of the tetraspanin family of proteins characterized by a canonical structure of four transmembrane domains and two extracellular loop domains. Tetraspanins are known as molecular facilitators, which assemble and organize cell surface receptors and partner molecules forming clusters known as tetraspanin-enriched microdomains. They have been implicated to play various biological roles including an involvement in infections with microbial pathogens. Here, we demonstrate an important role of CD81 for the invasion of epithelial cells by Salmonella enterica. We show that the overexpression of CD81 in HepG2 cells enhances invasion of various typhoidal and non-typhoidal Salmonella serovars. Deletion of CD81 by CRISPR/Cas9 in intestinal epithelial cells (C2BBe1 and HT29-MTX-E12) reduces S. Typhimurium invasion. In addition, the effect of human CD81 is species-specific as only human but not rat CD81 facilitates Salmonella invasion. Finally, immunofluorescence microscopy and proximity ligation assay revealed that both human tetraspanins CD81 and CD9 are recruited to the entry site of S. Typhimurium during invasion but not during adhesion to the host cell surface. Overall, we demonstrate that the human tetraspanin CD81 facilitates Salmonella invasion into epithelial host cells.

Objective: Ultrasound (US) images during a muscle contraction can be decoded into individual motor unit (MU) activity, i.e., trains of neural discharges from the spinal cord. However, current decoding algorithms assume a stationary mixing matrix, i.e. equal mechanical twitches at each discharge. This study aimed to investigate the accuracy of these approaches in non-ideal conditions when the mechanical twitches in response to neural discharges vary over time and are partially fused in tetanic contractions.

Methods: We performed an in silico experiment to study the decomposition accuracy for changes in simulation parameters, including the twitch waveforms, spatial territories, and motoneuron-driven activity. Then, we explored the consistency of the in silico findings with an in vivo experiment on the tibialis anterior muscle at varying contraction forces.

Results: A large population of MU spike trains across different excitatory drives, and noise levels could be identified. The identified MUs with varying twitch waveforms resulted in varying amplitudes of the estimated sources correlated with the ground truth twitch amplitudes. The identified spike trains had a wide range of firing rates, and the later recruited MUs with larger twitch amplitudes were easier to identify than those with small amplitudes. Finally, the in silico and in vivo results were consistent, and the method could identify MU spike trains in US images at least up to 40% of the maximal voluntary contraction force.

Conclusion: The decoding method was accurate irrespective of the varying twitch-like shapes or the degree of twitch fusion, indicating robustness, important for neural interfacing applications.

Objective: To investigate whether high-intensity lower extremity constraint-induced movement therapy can improve balance, leg strength, and dual-task ability.

Design: A longitudinal cohort study in a real-world outpatient clinic.

Patients: 147 community-dwelling participants in the subacute and chronic poststroke phases.

Methods: Participants received lower extremity constraint-induced movement therapy for 6 hours/day during 2 consecutive weeks, including balance, strength, and functional training. The Berg Balance Scale (BBS), Single-Leg-Stance (SLS) bilaterally, one Repetition Maximum (1RM) in a leg press, symmetry of leg strength (Diff-1RM), Timed Up and Go (TUG), and the TUG Manual test were assessed before, after, and 3 months after lower extremity constraint-induced movement therapy.

Results: Compared with preintervention data, statistically significant improvements after lower extremity constraint-induced movement therapy (p < 0.001) were demonstrated for balance with an absolute value in BBS at 1.9 points (effect size 0.38) and SLS at 2.4 s (effect size 0.24), and for leg strength at 10.2 kg (effect size 0.54) for the affected leg. Diff 1RM decreased significantly at 5.8 kg (effect size 0.39) and improvements on dual-task ability at 2.7 s were significant (effect size 0.14). The effects persisted at the 3-month follow-up.

Conclusions: High-intensity lower extremity constraint-induced movement therapy may be a feasible treatment option for middle-aged stroke patients to affect balance, leg strength, and dual-task ability positively in an out-patient clinical setting.

In the world of linear algebra computation, a well-established standard exists called BLAS(Basic Linear Algebra Subprograms). This standard has been crucial for the development of software using linear algebra operations. Its benefits include portability with efficiency and mitigation of suboptimal re-implementations of linear algebra operations. Multilinear algebra is an extension of linear algebra in which the central objects are tensors, which are generalizations of vectors and matrices. Though tensor operations are becoming more common, they do not have a standard like BLAS. Such standardization would be beneficial and decrease the now-visible replication of work, as many libraries nowadays use their own implementations. This master thesis aims to work towards such a standard by discovering whether or not a BLAS-like interface is possible for the operation binary tensor contraction. To answer this, an interface has been developed in the programming language C together with an implementation and tested to see if it would be sufficient. The interface developed is:

xGETT(RANKA, EXTA, INCA, A, RANKB, EXTB, INCB, B, CONTS, CONTA, CONTB, PERM, INCC, C)

with the implementation and tests, it has been deemed sufficient as a BLAS-like interface for binary tensor contractions and possible to use in a BLAS-like standardization for tensor operations.

The worldwide pandemic caused by SARS-CoV-2 had a tremendously negative impact on society and human health. An infection can lead toCOVID-19, a severe disease resulting from a dysregulated inflammatory response, causing severe organ damage and possible death. Vaccination induces B cells to produce pathogen-specific antibodies and differentiate into memory B cells, offering long-term protection against severe disease. However, individuals with conditions such as multiple sclerosis (MS), organ transplantation, or B-cell lymphoma, are treated with immunosuppressants and are at a higher risk for infection. In these individuals vaccines generally exhibit lower efficacy and offer limited protection. Therefore, a coordinated administration of vaccine doses during immunosuppressing medication is recommended. In some cases even a deliberate vaccination does not protect individuals from infection and persistent viremia. For this, different virus-neutralizing agents like intravenous immunoglobulins (IVIGs) collected from healthy virus-experienced individuals show treatment potential.

This thesis focuses on the reaction of the innate immune system to SARSCoV-2 during acute disease, and the clinical impact of vaccination and lastly viremia treatment with IVIGs in different immunocompromised cohorts. First, we found an elevation of pro-inflammatory cytokines during acute disease, with a sex-specific IL-18 increase in men with severe disease. This correlated with a higher inflammatory neutrophil activity in these individuals. Second, we assessed the protective ability of vaccination in MS patients during B-cell depletion therapy interruption. We could show higher levels of virus-neutralizing antibodies in a high-responding subset of patients after three doses. These antibody levels remained high in blood even after recommencing B cell depleting medication. Finally, immunocompromised individuals with persistent SARS-CoV-2 viremia were treated with IVIG collected from virus-experienced individuals. These antibodies efficiently neutralized several SARS-CoV-2 variants and facilitated patient recovery. In summary, this thesis contributes to the understanding of sex-specific acute COVID-19, and the vaccination and treatment of immunocompromised individuals against SARS-CoV-2.

Background: Tracheal extubation is a critical risk phase for patients undergoing general anesthesia and is related to complications for the patient. In Sweden, registered nurse anesthetists and anesthesiologists perform extubations and share responsibility for the patient. While there is research regarding the medical and technical aspects of when to extubate, there is a lack of research regarding the experience of registered nurse anesthetists (RNAs) and anesthesiologists (ANs) and their reasons for deciding when to perform extubation. Clinical judgment is applied in making crucial decisions, and non-technical skills are essential in clinical practice.

Aim: To describe and explore registered nurse anesthetists’ and anesthesiologists’ experiences of tracheal extubation in the anesthesia setting.

Methods: This thesis was based on interviews with registered nurse anesthetists and anesthesiologists. In Study I, focus group interviews were performed with RNAs (n=20). Individual interviews were conducted with ANs (n=17) in Study II. Both studies employed qualitative content analysis to analyze data. In Study III, individual interviews were conducted with RNAs (n=20) to determine their main concerns during the extubation process. Observation and individual interviews were performed, and data were analyzed using grounded theory. In Study IV, the focus group interviews (Study I) with RNAs (n=20) and individual (Study II) interviews with ANs (n=17), were analyzed using reflexive thematic analysis, with Tanner’s model of clinical judgment as a lens.

Findings: The results showed that RNAs (Study I) and ANs (Study II) described extubation as a process that begins when preparing for the anesthesia procedure and meeting the patient. From then, they continuously assessed and prepared the patient for extubation and assembled a unique extubation plan to prevent extubation failure. At extubations, they acted upon recognizable patterns and relied on experience and intuition. The RNAs and ANs protected the patient by speaking for them and keeping them safe during the vulnerable situation of extubation. They shared the responsibility for the patient, but their roles differed. The RNA felt lonely during extubations despite other professionals being in the operating room. Conversely, ANs felt like a member of the team when entering the operating room during extubations. In Study III, the RNAs’ main concern was safeguarding the patient in a highly technological environment. This they managed by maintaining adaptability while moving between challenges and facilitators. In Study IV, the RNAs’ and ANs’ extubation process comprised putting the pieces together when holding responsibility for the patient. They noticed patient reactions and recognizable situations during extubations, which they interpreted and made sense of by using clinical reasoning. They responded to these interpretations based on clinical experience and intuition. They reflected during and after extubation, evaluating their actions and contemplating improvement.

Conclusion: In the extubation process, RNAs and ANs combine theoretical knowledge, clinical experience, and intuition with each patient’s uniqueness to make decisions on extubations. However, extubation decision-making does not rely solely on what is visible on the monitors or a prescribed technique. Instead, it involves professional skills, critical thinking, and clinical reasoning. At the point of extubation, there is a need for improvement in the working environment for theprofessionals who perform this critical task. The patient is in a  vulnerable phase, and the professionals need to be able to focus in order to safeguard the patient.

Background: Regular physical exercise can counteract age-relatedphysiological and cognitive decline, reduce the risk of disease, andimprove quality of life. Even so, a considerable proportion of older adultsare insufficiently physically active. Supramaximal high-intensity intervaltraining (HIT) is a potential time-efficient, effective, and appealingalternative to longer duration moderate-intensity training (MIT).Research also indicates promising effects from supramaximal HIT forolder adults, but the interpretation of these results is limited to a fewsmall studies, highlighting a need for larger, high-quality randomizedcontrolled trials (RCT) for this population. The aims of this thesis wereto investigate motivational aspects of physical exercise, and controlledsupramaximal HIT in particular; and to examine the applicability andeffects of controlled supramaximal HIT in comparison to aerobic MIT,among older adults not engaged in regular physical exercise.

Methods: This thesis comprises four research papers, totaling 117participants (64-79 years old, 56% women). Paper I used cross-sectionaldata from 49 participants to investigate a neurobiological link betweendopamine and exercise-related motivation. Papers II-IV used data fromthe Umeå HIT Study, an RCT with 68 participants, to examineapplicability and effects from 3 months of twice-weekly controlledsupramaximal HIT (10×6-sec intervals, 20 minutes in total) compared toMIT (3×8-min intervals, 40 minutes in total). Both groups exercised onstationary bicycles in a group setting. All participants in the Umeå HITstudy received medical clearance before the training started. Paper IIdescribed the applicability of controlled supramaximal HIT and its effecton exercise-related motivation. Paper III examined the effects onphysiological and cognitive functions, such as cardiorespiratory fitnessand global cognitive function. Paper IV used data from 42 participantson structural and functional magnetic resonance imaging (MRI) toinvestigate the effects of the exercise on the hippocampus and episodicmemory.

Results: Paper I indicated a positive association between self-reportedexercise motivation and dopamine D2-receptor availability in the frontalparts of the brain. Paper II showed that non-exercising, but otherwiserelatively healthy older adults were able to exercise at supramaximaltraining intensities without compromising their physical and mentalwell-being during the training, or their exercise motivation. Theparticipation was high, and no serious adverse events occurred. Notably,the participants performing supramaximal HIT reported more positiveivand fewer negative exercise-related events compared to the participantsperforming MIT. The results from Paper III showed that three months ofcontrolled supramaximal HIT resulted in similar but also additionaleffects compared to MIT, despite the total training time being halved.Both groups improved fitness and cardiovascular function, and in favorof supramaximal HIT there was an improvement in muscular function.Neither group showed an effect on global cognitive function, but apotential improvement in working memory was observed in favor ofsupramaximal HIT. While the effects on episodic memory were mixed,Paper IV observed associations between change in cardiorespiratoryfitness and change in hippocampus function for the CA4/DG subfieldduring pattern completion, which in turn was associated with episodicmemory improvements in pattern completion.

Conclusion: Overall, this thesis supports controlled supramaximal HIT as an effective and appealing training method for older adults, which canmake meaningful contributions to their independence in daily lifeactivities. Although the connection between motivation, dopamine, andaging requires further research, an interesting observation in this thesiswas that, contrary to previous concerns, controlled supramaximal HIThad no negative impact on the participants' motivation. Controlledsupramaximal HIT can be a meaningful addition to the exerciseprograms commonly available for older adults, as providing moretailored and individualized training may contribute to promotingphysical exercise for health and well-being. The cognitive effects ofsupramaximal HIT were mixed, and future studies should aim for longerinterventions and more pronounced physiological changes. Further,research should evaluate controlled supramaximal HIT in a broaderpopulation, including individuals with chronic conditions and diseases,and explore how this form of exercise can be effectively implemented ineveryday settings.

This thesis makes contributions within the area of causal inference, domain adaptation, and studies of health inequalities. The common theme is using asymptotic statistics, where estimators and predictors are shown to be asymptotically unbiased, normally distributed, and reach the asymptotic efficiency bound. Furthermore, due to the robustness of the solutions, the usage of flexible machine learning models like neural networks is justified.

The first work studies the necessary growth rate for convolutional neural network architectures, where asymptotically efficient estimation of causal effect estimators is aimed at, and convolutional neural networks are used to fit nuisance models. The proposed method is also applied to Swedish registry data in order to study the effects of early retirement on health outcomes.

The second article proposes an asymptotically efficient estimator for a novel causal parameter. The parameter of interest is the effect of an intervention on a counterfactual version of the concentration index, which is an index that represents socioeconomic-related health inequality. The real data application of this paper is the study of the effect of education on different health-related inequalities in a cohort of Swedes.

The third paper solves a problem in the field of domain adaptation in machine learning, where the training set is observed but it is not possible to assume that test and training sets follow the same distribution. A weaker assumption is instead considered, referred to as a generalized label shift. This paper proposes a robust and asymptotically efficient predictor under the generalized label shift assumption.

The last article is a vignette on the software developed to perform the analysis in the first paper. It is possible to utilize the software in a broader manner than what is described in the first paper. Several examples and more practical details are presented in this article in order to demonstrate how neural networks can be used in order to fit nuisance functions when the average treatment effect or the average treatment effect on the treated is the parameter of interest.

Background: Indigenous populations in Latin America are often at the crossroads of traditional and Western healthcare systems. Despite the cultural significance of traditional medicine, integration into Western healthcare practices remains challenging. Ecuador has been at the forefront of embracing intercultural health, aiming to merge these distinct medical paradigms effectively. This study sought to systematize the experience of integrating Indigenous traditional birth attendants (TBAs) into the Western healthcare system in the Amazon region of Ecuador, identifying the enabling factors and challenges of such an integration to enhance healthcare access and quality for Indigenous communities.

Methods: Employing a qualitative case study design, the research involved conducting key informant interviews with 15 participants, comprising TBAs and midwives, in the province of Orellana, Ecuador. Thematic analysis was utilized to interpret the data, focusing on the participants' experiences, perceptions, and the operational dynamics of the integration process.

Results: The study revealed initial scepticism towards integration, which was gradually overcome through mutual learning and adaptation processes, highlighting the importance of cultural sensitivity and bidirectional knowledge exchange. Integration seemed to have facilitated healthcare access, with TBAs playing a pivotal role in bridging cultural and linguistic gaps, thus enhancing Indigenous women's comfort and trust in healthcare services. Despite these advances, TBAs faced significant challenges, including financial constraints and logistical difficulties, underscoring the need for continued support and sustainable integration strategies.

Conclusion: Integrating TBAs into the Western healthcare system in the Ecuadorian Amazon has shown promise in improving healthcare access for Indigenous women by fostering an environment of mutual respect and cultural sensitivity. However, to ensure the sustainability and effectiveness of such integrative health models, it is imperative to address the identified challenges and support the continuous development of TBAs and healthcare professionals alike. Future research should aim to quantitatively evaluate the health outcomes of this integration and explore its scalability to other regions.

Disabled refugee women can experience a lack of possibilities for social participation in their new country, which can impact their health and well-being. Intersectional approaches that acknowledge the participatory needs of disabled refugees are missing in policies and regulations. This study highlights the capabilities that disabled refugee women use to construct their everyday lives and to experience social participation. For more than one year, interviews and participant observation were carried out with three disabled refugee women. Various qualitative methods have been used to understand the women's everyday lives in an urban area of Sweden. Through an intersectional lens, unequal conditions that affect social participation and access to the health and social care systems were identified, as were individual resources that women use to overcome barriers that would keep them from participating in the new society.

Background: Randomized trials have shown that axillary clearance (AC) can safely be omitted in patients with sentinel lymph node-positive breast cancer. At the same time, de-escalation of chemotherapy in postmenopausal patients with ER+HER2− breast cancer may depend on detailed axillary nodal stage. The aim of this pre-specified secondary analysis of the SENOMAC trial was to investigate whether the choice of axillary staging affected the proportion of patients receiving adjuvant chemotherapy, and recurrence-free survival (RFS).

Methods: Proportion receiving adjuvant chemotherapy was calculated according to AC or sentinel lymph node biopsy (SLNB) only, menopausal status, and region of inclusion, for 2168 patients with clinically node-negative ER+HER2− breast cancer and 1–2 sentinel lymph node macrometastases included in the SENOMAC trial.

Findings: In premenopausal patients, 514 out of 615 patients (83.6%) received adjuvant chemotherapy with no significant difference between randomization arms. In postmenopausal patients, the proportion receiving chemotherapy varied considerably by region and country (36.0–82.4%). In Denmark, where 194 out of 539 postmenopausal patients (36.0%) received adjuvant chemotherapy, rates differed significantly between the AC and the SLNB only arm (41.3% vs 31.4%, p = 0.019). After a median follow-up of 44.88 months for Danish postmenopausal patients, no significant difference was seen in 5-year RFS, which was 91% (85.6%–96.6%) for the SLNB only and 90.9% (86.3%–95.6%) for the AC arm (p = 0.42).

Interpretation: When omitting axillary clearance, and thus reducing the risk of long-term arm morbidity, potential under-treatment of postmenopausal patients with ER+HER2− breast cancer may require the development of new predictive and imaging tools.

Carbon emission from Arctic rivers constitutes a positive feedback between the climate warming and C cycle. However, in case of rivers with extensive floodplains, the impacts of temporary water bodies and secondary channels on CO₂ exchange with atmosphere, compared to the main stem and tributaries, remain strongly understudied. In order to quantify the relative role of various water bodies of the Arctic river basin in the C cycle, the hydrochemical variables and greenhouse gases GHG concentrations and fluxes were measured within the floodplain of the largest Arctic River, Ob, in its low reaches located in the permafrost zone. These included the main stem, secondary channels, tributaries and floodplain lakes sampled over a 900 km north-south transect (25,736 km² of the main stem and adjacent floodplain area; 7893 km² water surface) during peak of spring flood (May 2023). In addition to main stem and tributaries, providing less than a half of overall C flux, floodplain lakes and secondary channels acted as important factor of C emission from the floodplain water surfaces. Multi-parametric statistical treatment of the data suggested two main processes of C emission from the Ob River floodplain waters: terrestrial organic matter-rich flooded wetlands (fens) provided elevated pCO₂, whereas the sites of possible groundwater discharge in the secondary channels decreased the CO₂ fluxes due to more alkaline environments, rich in labile metals and anionic elements. Based on available high-resolution Landsat-8 images, which matched the period of field work, it was found that the total water coverage of the floodplain during spring 2023 was 30 % of overall territory, compared to 18 % during the baseflow. Based on chamber-measured CO₂ fluxes (1.56 ± 0.47 g C-CO2 m−2 d−1), overall CO₂ emissions during 2 months of the spring flood from the entire Lower Ob River floodplain water surfaces including the main stem amounted to 0.73 ± 0.25 Tg C. Diffuse CH4 flux represented <1 % of total C flux. The main stem of the Ob River accounted for 34 % and 18 % of CO₂ and CH₄ emissions, respectively, whereas the floodplain lakes provided 59 % and 50 % of CO₂ and CH₄ emission, respectively. Considering that the low reaches of the Ob River represent >70 % of total river basin floodplain, and that during some years, the entire floodplain can be covered by water, emissions from the river – if assessed solely from summer (July–August) measurements – can be at least 3 times underestimated. It is therefore important to account for extended water surface during high water levels on Arctic rivers when assessing global riverine C emissions.

When a region is at war or in a conflict, that region gains a lot of attention worldwide. The attention levels drop drastically when the region or country proceeds out of the conflict. Regions that enter post-conflict eras are more forgotten, especially from a business perspective. On the other hand, scholars have recently elaborated on emerging markets, as opportunities and risks have been analyzed and discussed frequently in the literature. The comparability between specific emerging markets and post-conflict countries and regions is apparent, with numerous similarities. However, the difference in literature that upholds opportunities and risks in post-conflict states is substantially scarce in research on emerging markets. Therefore, this study sets out to fill this gap and generate data that enhances business in post-conflict settings. This study aims to understand better the opportunities and risks associated with conducting business in post-conflict countries and to foster valuable knowledge for global companies when internationalizing. The researchers chose a qualitative study approach to fulfill the purpose at hand. After gathering data from the literature, four respondents were selected for deep and insightful interviews. All four respondents had significant roles as executives or managers in global companies and shared their experiences of operating within post-conflict states. Four countries affected by different conflicts were chosen based on the respondents' working experience. The respondents had various roles in their companies' operations in Russia, Ukraine, Bulgaria, and Vietnam. This multiple-case study collected empirical data from these countries and respondents and conducted a thematic data analysis. We examined and presented those based on two main themes: opportunities and risks. As the data was analyzed, it concluded that the opportunities mentioned in the literature are apparent across various post-conflict countries. The post-conflict areas studied revealed opportunities such as workforce opportunities, natural resource opportunities, social stability opportunities, funding from organizations, and new customers. All opportunities associated with post-conflict business environments derived from the empirical data could be categorized under the above subheadings. The literature and empirical findings showed distinctive interconnections. The literature derived political risk, corruption risk, institutional risk, abuse of human rights, and reoccurring conflict as significant risks. The research and data concluded the same results, corresponding to the respondents' experiences. Outlying data such as Sanctions and Currency risk were found. However, they were parallel to the opportunities categorical endeavor, and they could be structured under the significant risks listed previously.  

Bakgrund: Förstoppningsproblematik hos barn är orsaken till många besök i primärvården. Studier visar att förstoppning är ett återkommande och långvarigt problem. För en effektiv behandling av förstoppningen är det viktigt att tidigt komma i kontakt med vården för råd och behandling. Barnets livskvalité påverkas negativ av förstoppningsproblematiken.Motiv: Att få mer kunskap om föräldrars erfarenhet av vårdkontakter när deras barn är förstoppat.Syfte: Syftet med studien var att belysa föräldrars erfarenheter av vårdkontakter vid sitt barns förstoppningsbesvär och hur livet påverkas av förstoppningen.Metod: Studiens design var kvalitativ där data samlades in med hjälp av fjorton semistrukturerade intervjuer. Intervjuerna analyserades med kvalitativ innehållsanalys. Deltagarna var föräldrar till barn med förstoppningsbesvär som hade kontakt med specialistvården. Totalt deltog fjorton föräldrar i studien. Data samlades in under februarioch mars månad under 2019. Resultat: Studiens resultat presenteras utifrån två kategorier med sex underkategorier. Att söka hjälp från vårdgivare innefattande fyra underkategorier: Bemötande i vården, Söka orsak till förstoppning, Rådgivning till att utföra egenvård, Vikten av information. Påverkan på socialt liv innefattande två underkategorier: Förskolan och skolan, Familj och vardag. Diskussion: Sjuksköterskan har en viktig uppgift att fylla när det gäller information ochrådgivning om behandling av förstoppade barn. Insatser i tidigt skede är betydelsefullt för att minska påverkan på barnets och familjens sociala liv.Slutsats: Studien visade att föräldrarna upplevde att de inte blivit tagna på allvar när de sökte vård för sitt barn med förstoppningsbesvär. När de fått råd och hjälp saknade de relevant information och de påtalade att de råd de fått inte alltid varit lätta att utföra i hemmet. Föräldrarna belyste vikten av att vården följde upp de råd som givits. Förstoppningen i sig och behandlingsåtgärderna påverkade familjens och barnets sociala liv negativt.Nyckelord: Förstoppning, föräldrar, barn, erfarenhet, vårdkontakt

BACKGROUND: Breast reconstruction after mastectomy helps women with breast cancer feel better about their bodies and lives. There is debate about the best time and type of reconstruction (immediate versus delayed, and using own tissue versus implants). Long-term studies are rare.

AIM: This study looked at long-term results of different breast reconstruction methods and timings in Swedish women who had mastectomies in 2000, 2005 or 2010. It focused on how satisfied the women were with their surgeries and their quality of life.

METHOD: The study included 5853 women from the Swedish National Breast Cancer Registry who had mastectomies in 2000, 2005 or 2010. Of these, 2904 women answered the survey, and 895 had breast reconstruction. Satisfaction and quality of life were measured using two surveys: EORTC QLQ-BRECON23 and BREAST-Q. RESULTS: Of the women who answered the survey, 895 (31%) had breast reconstruction. Of these, 176 (20%) had immediate reconstruction, and 719 (80%) had delayed reconstruction; 58% had implant-based reconstructions, 31% had reconstructions using their own tissue, 2% had both types and 9% did not report the type of reconstruction. There were no major differences in satisfaction between immediate and delayed reconstruction. Women who used their own tissue were more satisfied with their results and breast appearance than those with implants.

CONCLUSION: Autologous reconstruction leads to better satisfaction and outcomes than implants. The timing of reconstruction (immediate versus delayed) was less of an influence on quality of life.

The increasing prevalence of threats and violence against ambulance clinicians is a critical issue that has not been adequately studied. These incidents pose significant challenges to the provision of prehospital emergency care, affecting both the safety and well-being of the clinicians involved. This study aimed to explore the experiences of Swedish ambulance clinicians when encountering threats and violence during their work. A qualitative approach was used, involving semi-structured interviews with 11 ambulance clinicians from various regions of Sweden. The participants were selected to ensure diversity in gender, age, and educational background. The data were collected over three weeks in 2021 and analyzed using qualitative content analysis. The analysis revealed three key categories related to the challenges faced by ambulance clinicians: Police cooperation challenges, Strategies for a safe care environment, and Impact during and relief after stressful events. These categories highlight the complexities of managing threats and violence in the field. This study sheds light on the multifaceted challenges that ambulance clinicians face due to threats and violence. It underscores the urgent need for comprehensive training, effective communication, and clear role allocation in complex situations. Furthermore, it emphasizes the importance of organized support systems to help clinicians cope with the aftermath of stressful events.