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Recosal prošeavtta ulbmil lea doarjut ovttasbargohálddašeami máŋggabealat atlántalaš luossamáddodat kompleaksa hálddašeami ektui stuorra Deanubivdoguovllus (Teno suomagillii, Tana darogillii ja Deatnu sámegillii) davimus Fennoskandias. Álggahit ovttasbarggu Living Lab geavaheddjiid servodaga hárrái Prošeakta ovttastahttá máhtolašvuođabuvttadeami luossahálddašemiin, mas earenoamážit deattuhit ovdánahttit álbmogii guoski, ulbmillaš árvvoštallamiid genehtalaččat máŋggabealat luossaveahkadagain máŋggakultuvrralaš birrasis mas árvvut leat Álgoálbmot ja Báikkálaš máhtolašvuohta (ILK) ja vuoigatvuođat. RecoSal galgá fállat fágaidrasttideaddji rávvagiid hábmet ja čađahit beaktilis ja sosiálalaččat nana stivren- ja jođihanvugiid maid ulbmilin lea seailluhit ekologalaččat ja váldit atnui goariduvvon biodiversitehta.

Objectives: Recent studies have shown gender-based disparities in surgical outcomes, with women physicians achieving better postoperative results. However, the mechanisms underlying these differences remain poorly understood. This complex, underexplored phenomenon lacks perspectives from key stakeholders such as patients, staff, and surgeons. Surgical residents inhabit a unique position, balancing the roles of learners and healthcare providers and offering valuable insights into these disparities. Our objective was to explore resident surgeons' perceptions of the mechanisms underlying the differences observed in postoperative outcomes through interviews.

Methods: We conducted a qualitative study using semi-structured interviews with men and women residents, analyzed through qualitative content analysis. Participants included 17 surgical residents from 10 ACGME-accredited orthopedic and general surgery programs across four U.S. regions.

Results: Key findings were: (1) Women surgical residents experienced gender biases during training; (2) Men and women surgeons differed in their approaches to patient care and surgical practice. Residents of both genders noted that women surgeons encounter biases stemming from prevailing norms, beliefs, and expectations related to gender. These biases manifest as double standards and pressure to conform to men-dominated environments. The absence of comparable pressure on men surgeons to adapt to interactions with women colleagues or patients may lead to challenges in meeting the expectations of women patients. Participants of both genders reported that women surgeons tend to adopt a more holistic approach to patient care.

Conclusions: Our findings suggest that the unique challenges faced by women surgeons may contribute to the development of refined interpersonal and surgical skills, which could be associated with improved postoperative outcomes. Raising awareness of gender-based differences in surgical practice is essential to addressing the disparities observed in postoperative results.

Practical Implications: Residency programs may benefit from incorporating gender-aware training to address implicit biases, foster equitable learning environments, and optimize skill development for all trainees.

Ecological and geomorphic theory assume longitudinal connectivity; here, we test whether these concepts apply in naturally disconnected paraglacial stream networks with lakes and coarse glacial sediment. We determined downstream hydraulic geometry relationships (DHG) for channel width; riparian vegetation was inventoried across process domains (rapids, flats, lakes) over 10 km in two northern Swedish catchments—one above and one below the former highest coastline (FHC). Below the FHC, finer sediment from marine/deltaic deposition may allow more stream self-adjustment. DHG relationships were weak overall, with large local width variation, but slightly stronger in the FHC-below catchment, where a lake-effect was found, with wider channels downstream of lakes. Riparian vegetation species density did not substantially increase downstream as in connected stream networks, and vegetation similarity between reaches was weakly related to distance, suggesting disrupted dispersal. These findings indicate that formerly glaciated catchments are highly fragmented, with local factors dominating geomorphic and ecological patterns.

Aim: To explore factors associated with one-year mortality risk after hip fracture among very old adults (85 +) in Northern Sweden.

Methods: This cohort study includes data derived from Umeå 85 + /Gerontological Regional Database (GERDA), encompassing a representative sample of those aged 85, 90 and ≥ 95 years in Northern Sweden. Data were assessed during home visits and interviews conducted between 2000 and 2017. Associations of baseline characteristics with hip fracture during a follow-up period of 5 years and one-year mortality were analyzed using Cox proportional hazards regression.

Results: Of 1,277 participants, 184 (14.4%) sustained a hip fracture during follow-up, of whom 47.8% died within 1 year of the fracture. Among those with hip fracture, 65% were women. Increased 1-year mortality risk was associated with the presence of depressive disorders (hazard ratio, HR 2.55, 95% confidence interval 95%CI, 1.32–4.93), history of stroke (HR 2.34, 95%CI 1.17–4.66) and subtrochanteric fractures (HR 4.40, 95%CI 1.73–11.21). Conversely, obesity (HR 0.26, 95%CI 0.10–0.67) was associated with reduced mortality risk.

Conclusion: Nearly half of all very old adults sustaining a hip fracture die within 1 year. Depressive disorders, history of stroke and subtrochanteric fractures were identified as significant predictors of increased mortality, whereas obesity appeared to mitigate mortality risk. These findings underscore the need for targeted interventions to manage these risk factors in hip fracture patients very old adults.

Purpose: Parastomal hernia (PSH) is a common and often burdensome stoma complication. Surgical repair carries high morbidity and mortality. Hence, prevention of PSH formation would be ideal, which requires better understanding of risk factors. We aimed to examine the role of abdominal rectus muscle (ARM) thickness and its postoperative atrophy in PSH pathogenesis. We hypothesised that a thin ARM upon stoma creation is a risk factor for PSH development, and that patients developing PSH show a higher degree of postoperative ARM atrophy compared to patients without PSH.

Methods: Radiological bilateral ARM measurements on 205 patients, before and after rectal cancer surgery with Hartmann’s procedure or abdominoperineal resection, among Swedish patients recruited retrospectively from the Swedish Colorectal Cancer Registry. Hypotheses were tested using t-test and multivariable logistic regression.

Results: Patients developing PSH had a greater degree of ARM atrophy than hernia-free patients (-3.2 mm [-36.4%] vs. -1.6 mm [-18.2%]; p = 0.002). Postoperative ARM atrophy (OR 1.17; 95% CI 1.05–1.31, p = 0.006), body mass index (OR 1.15; 95% CI 1.06–1.24, p < 0.001) and laparoscopic approach (OR 2.60; 95% CI 1.27–5.31, p = 0.009) were independent risk factors for PSH in the multivariable model. Preoperative anteroposterior thickness of the ARM was not found to be a risk factor.

Conclusion: Patients developing PSH had a more pronounced atrophy of the ipsilateral ARM than patients without PSH. A thinner ARM preoperatively did not increase the risk for PSH. Further research should focus on what causes postoperative ARM atrophy.

Network methods capture the interplay between structure and dynamics of complex systems across scales by modeling indirect interactions as random walks. However, path data from real-world systems frequently exhibit memory effects that this first-order Markov model fails to capture. Although higher-order Markov models can capture these effects, they grow rapidly in size and require large amounts of data, making them prone to overfitting some parts and underfitting others in systems with uneven coverage. To address this challenge, we construct concise networks from path data by interpolating between first-order and second-order Markov models. We prioritize simplicity and interpretability by creating state nodes that capture prominent second-order effects and by proposing a transparent measure that balances model size and quality. Our concise networks reveal large-scale memory patterns in both synthetic and real-world systems while remaining far simpler than full second-order models.

Background: Mass casualty incidents (MCIs), though infrequent compared with routine emergencies, are increasing globally. They pose exceptional challenges for emergency medical responders (EMRs), who must make rapid decisions under conditions of uncertainty and resource scarcity. To meet these demands, EMRs require proficiency in both technical procedures and non-technical capacities. Conventional training formats are valuable but cannot fully accommodate this breadth of skills. Mixed-reality (MR) training has been proposed as a complementary approach. However, evidence as to whether MR constitutes an effective pedagogical method for developing the skills required for MCI preparedness remains limited and fragmented.

Aim: The overall aim of this thesis was to investigate EMRs’ perspectives on how MR-based training is perceived to enhance or hinder the learning of skills essential for effective MCI response.

Methods: Study I used semi-structured interviews with EMRs (n = 27) from four EU countries, analysed using qualitative content analysis. Study II developed and validated CASPER, an instrument designed to assess perceived learning outcomes in MCI response, drawing on data from bachelor’s students of disaster medicine (n = 75). Study III applied CASPER in a cross-sectional survey of EMRs (n = 266) from six countries following MR-based MCI training, analysed using exploratory and non-parametric methods. Study IV explored learning affordances and constraints of MR-based MCI training through multi-source group discussions with EMRs (n = 25), analysed using qualitative content analysis.

Results: Study I identified limited realism and a lack of structured debriefing as constraints on learning in conventional training. In continuation, Study II demonstrated strong reliability and factorial validity for CASPER. Building on these findings, Study III showed that EMRs reported the highest perceived learning outcomes for scene assessment and situational awareness, and the lowest for stress management and risk assessment, with novices rating these higher than experienced responders. Finally, Study IV indicated that while MR-based MCI training promoted learning through greater immersion, it also hindered it due to technical issues and limited real-world relevance.

Conclusion: This thesis demonstrates that MR-based MCI training supports the learning of non-technical skills through enhanced immersion and situational awareness. At the same time, its pedagogical value is currently limited by technical and design-related constraints that affect the learning of technical procedures. Effective training depends not only on the degree of realism but on the alignment of MR design with clinical practice. The development and validation of CASPER provide a reliable instrument for assessing perceived learning outcomes across both technical and non-technical domains, thereby strengthening the evaluation of simulation-based education for mass casualty response.

Background: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are a class of drugs that has been used in the treatment of type 2 diabetes mellitus (T2DM) since 2012. Later trials showed that SGLT2i-treatment was also beneficial for patients with heart failure (HF) with reduced ejection fraction (HFrEF), mildly reduced ejection fraction (HFmrEF) and preserved ejection fraction (HFpEF) regardless of diabetes status. SGLT2is are now considered a cornerstone treatment for HF regardless of left ventricle ejection fraction (LVEF), and usage is increasing year-on-year, including in patient groups that were excluded from the clinical trials that the indication and recommendations are based on, such as patients suffering from HF caused by transthyretin amyloid cardiomyopathy (ATTR-CM).

Aims: This thesis aimed to evaluate the basis for the universal adoption of SGLT2is in HF treatment over four papers which explore different facets of this subject.

I. Evaluate external validity of pivotal SGLT2i trials in patients with HFrEF by assessing eligibility in a real-world, all-comer HF cohort

II. Assess the prevalence of diabetes mellitus (DM) and prediabetes in a real-world, all-comer HF cohort

III. Conduct a pilot trial evaluating tolerability and effect of SGLT2i in patients with ATTR-CM

IV. Plan a multicentre randomized controlled trial (RCT) to further establish the role of SGLT2i-treatment in patients with ATTR-CM

Methods: In papers I and II, a cohort of 2433 patients made up from patients with at least one registered diagnosis of HF from the Heart Centre or Department of Internal Medicine at the University Hospital of Umeå between the dates 2010-01-01 and 2019-12-31 was used (the HF cohort).

In paper I, data regarding 681 patients in the HF cohort with a documented left ventricle ejection fraction (LVEF) of ≤40% (HFrEF) were reviewed with regards to the eligibility criteria of the DAPA-HF and EMPEROR-reduced trials, and the characteristics of this HF cohort were compared with the comparator trials.

In paper II, patients were divided into groups based on glycaemic profiles and HF phenotype. Prevalence of glycaemic status was compared between HF phenotypes, HF treatment compared between glycaemic groups, and T2DM treatment compared between HF phenotypes.

In paper III, 10 patients with ATTR-CM were recruited into a pilot trial set up as a n-of-1 series with 3 periods: a baseline period, an intervention period with dapagliflozin 10 mg o.d. and a withdrawal period. Patients were assessed repeatedly for vital parameters, n-terminal pro-brain natriuretic peptide levels (NT-proBNP), 6-minute walking tests (6MWT) and Kansas City Cardiomyopathy Questionnaires (KCCQ).

In IV, design and rationale for a future multicentre RCT is presented, with sample size calculations.

Results: Paper I: Eligibility rates for the HF cohort for DAPA-HF and EMPEROR-reduced was 52% and 39%, respectively. The most common reasons for ineligibility were low levels of NT-proBNP and reduced renal function. Patients in the HF cohort were on average 13 years older and generally more comorbid than comparator trial participants but with a lower prevalence of DM.

Paper II: Of the 2326 patients in the HF cohort with a documented LVEF, 681 had HFrEF, 561 HFmrEF and 1084 HFpEF. The proportion of patients in different glycaemic groups was not significantly different between HF phenotypes, with 26-27% having known DM, 3-6% having probable DM, 18-20% having prediabetes and 22-25% being normoglycemic. Compared to normoglycemic patients, patients with glycaemic disorders were more likely to be treated with beta blockers and loop diuretics. The treatment of DM was not different between HF phenotypesv

Paper III: 54 patients were reviewed for eligibility, of which 10 were enrolled and 7 completed the trial. There was a trend towards better outcome parameters during the intervention phase. Compared to baseline, NT-proBNP was 142 (95% CI -324 to +41) ng/l lower during intervention and 6MWT distance 24.3 (95% CI -2.8 to +51.5) meters longer, while KCCQ was stable over the baseline and intervention phase but declined by 2.9 (95% CI -7.3 to +1.5) points during the withdrawal phase). Systolic blood pressure was lower during the intervention phase, -8.8 (95% CI -13.2 to 4.4) mmHg.

IV: Design for a multicentre RCT to assess the effect of dapagliflozin is considered and a placebo-controlled, double-blinded 2x2 crossover trial with KCCQ total symptom score as primary outcome variable is suggested, which would require 80 participants.

Conclusions: There are significant differences between trial populations and the target population for SGLT2i treatment, which challenged the external validity of the trial results in a real-world setting.

The prevalence of T2DM and prediabetes among HF patients is not different between HF phenotypes. The prevalence in Northern Sweden is comparable to what have been found in other settings.

Treatment with SGLT2i dapagliflozin in patients with ATTR-CM may be associated with beneficial effects on NT-proBNP, walking distance and symptom burden, but could also cause a potentially clinically significant drop in systolic blood pressure. These effects need to be studied in a larger, adequately powered trial, where a multicentre crossover trial with 80 participants could be an effective method to do so.

Athletes undergoing psychotherapy, such as cognitive behavioural therapy (CBT), is an understudied group. Therefore, the aim of this study was to examine the feasibility of combining a single-case design (SCD) with ecological momentary assessment (EMA) throughout a CBT intervention with athletes. We conducted an SCD with multiple-baselines with three athletes seeking treatment at a university sports psychology clinic. EMA was employed with six daily questionnaires measuring positive and negative affect, and momentary context and activity for 105 days. A feasibility questionnaire and semi-structured interviews were conducted post-intervention to investigate the overall experience of participation and specific features of the design. Feasibility was determined by descriptively investigating the assessment frequency, questionnaire length, compliance, potential response patterns, and perceived burden of the sampling protocol. The three participants completed an average of 455 questionnaires with response rates of 48%, 73%, and 77%, respectively. Compliance varied more over weeks than within week or day. The main reason for compliance was the quickness of completing the questionnaire. The number of daily questionnaires was perceived as more burdensome than the number of items in each questionnaire and the length of the study. The current study is the first to demonstrate the feasibility of combining SCD and EMA during CBT with athletes in a real-world clinical setting. This study contributes to evidence-based care for athletes' mental health by demonstrating a design that enables the analysis of individual processes throughout a CBT intervention. This approach can be adopted to further investigate the effectiveness and mechanisms of psychotherapeutic interventions.

Background: Regular exercise training provides significant health benefits among cancer survivors and is associated with lower breast cancer mortality and reduced risk of recurrence. Both exercise-induced factors secreted into circulation (exerkines) and bioactive molecules contained in skeletal muscle secretome have been proposed to affect the tumor microenvironment and mediate some of the anti-carcinogenic effects of exercise. This study utilized exercise-conditioned human serum obtained from breast cancer patients during chemotherapy and skeletal myotubes’ secretome after mechanical loading to investigate their effects on breast cancer cells in vitro.

Methods: Breast cancer patients participated in a 12-week exercise training program during their chemotherapy, and blood serum was collected immediately before and after an exercise session in the 2nd and 12th weeks of training. Skeletal myoblasts were differentiated into myotubes and subjected to mechanical stretching to collect their secretome (stretch medium (SM)). Hormone-sensitive Michigan Cancer Foundation-7 (MCF-7) and triple-negative M.D. Anderson-Metastatic Breast-231 (MDA-MB-231) breast cancer cells were treated with either human serum or with the skeletal myotubes’ secretome to examine their metabolic activity, migration, cytotoxicity levels and apoptosis regulation.

Results: The exercise-conditioned serum obtained from breast cancer patients who were subjected to the 12-week training during chemotherapy resulted in reduced metabolic activity (p < 0.001) and increased lactate dehydrogenase activity (cytotoxicity) (p < 0.001) in both MCF-7 and MDA-MB-231 breast cancer cells when compared with the control condition. Moreover, incubation of breast cancer cells with the post-exercise serum induced apoptosis in MCF-7 and MDA-MB-231 cells, as indicated by increase in DNA damage and the percentage of necrotic cells (p < 0.05) when compared to pre-exercise condition. Similarly, a significant decrease (p < 0.001) was observed in the metabolic activity of MCF-7 cells treated with the SM, along with increased cytotoxicity (p < 0.05), compared to the cells cultured with the regular growth media. Comparable though not as profound effects were observed in MDA-MB-231 cells when treated with the SM secretome. Furthermore, the expression of apoptosis-inducing Caspase-7 (p < 0.001) and Caspase-8 (p < 0.01) proteins was increased, whereas cell survival-regulating factors interleukin-8 (IL-8) (p < 0.001), superoxide dismutase-2 (p < 0.05), Fas cell surface death receptor (p < 0.05), and vascular endothelial growth factor (p < 0.01) were downregulated in the SM-treated MCF-7 cells. In addition, the migrating behavior of MCF-7 cells was diminished, and higher levels of DNA damage were observed in cells treated with either SM or non-stretch media.

Conclusion: Both exercise-conditioned serum of breast cancer patients and skeletal myotubes secretome after mechanical loading can reduce the metabolic activity, promote cell toxicity and DNA damage, modulate the protein expression of crucial cell survival-regulating factors, and lead to apoptosis in breast cancer cells. These findings suggest that even after cancer diagnosis, exercise may exert beneficial effects additive to chemotherapy against breast cancer prognosis.

Athletes undergoing psychotherapy, such as cognitive behavioural therapy (CBT), is an understudied group. Therefore, the aim of this study was to examine the feasibility of combining a single-case design (SCD) with ecological momentary assessment (EMA) throughout a CBT intervention with athletes. We conducted an SCD with multiple-baselines with three athletes seeking treatment at a university sports psychology clinic. EMA was employed with six daily questionnaires measuring positive and negative affect, and momentary context and activity for 105 days. A feasibility questionnaire and semi-structured interviews were conducted post-intervention to investigate the overall experience of participation and specific features of the design. Feasibility was determined by descriptively investigating the assessment frequency, questionnaire length, compliance, potential response patterns, and perceived burden of the sampling protocol. The three participants completed an average of 455 questionnaires with response rates of 48%, 73%, and 77%, respectively. Compliance varied more over weeks than within week or day. The main reason for compliance was the quickness of completing the questionnaire. The number of daily questionnaires was perceived as more burdensome than the number of items in each questionnaire and the length of the study. The current study is the first to demonstrate the feasibility of combining SCD and EMA during CBT with athletes in a real-world clinical setting. This study contributes to evidence-based care for athletes' mental health by demonstrating a design that enables the analysis of individual processes throughout a CBT intervention. This approach can be adopted to further investigate the effectiveness and mechanisms of psychotherapeutic interventions.

This study aims to identify candidate genes involved in the biosynthesis of salicinoid phenolic glycosides (SPGs), a group of specialised metabolites characteristic of the Salicaceae family. While the integration of multi-omics data represents a powerful approach to link genes encoding enzymes and their regulatory factors to metabolite biosynthesis, suitable multi-omics data resources are scarce. We present a comprehensive dataset comprising untargeted liquid chromatography–mass spectrometry (LC–MS) and mRNA-sequencing data from various organs of European aspen (Populus tremula L.) and from genotypes that produce contrasting sets of SPGs. We present a reproducible pipeline for the analysis of the LC–MS data, including predicted annotation of potential novel SPGs. We demonstrate the utility of the resource by identifying candidate genes involved in the biosynthesis of SPGs with a cinnamoyl moiety. By integrating gene and metabolite differential analyses with a gene co-expression network, we identified two HXXXD-type acyltransferase genes and one UDP-glucosyltransferase gene as candidates for future downstream characterisation. The combined gene expression and metabolomics resource is integrated into PlantGenIE.org to facilitate easy access and data mining. All raw data are available in public databases, and all data and results files are available at an associated Figshare repository.

Extensive primary boreal forests within Europe are primarily located in Fennoscandia and northwestern Russia. These forests host numerous endemic and red-listed species but are rapidly being exploited and transformed to production forests that lack the habitat characteristics that are required for sustained biodiversity. Over the past 30 years, certain highly valuable areas within Swedish forests have been designated and registered as “woodland key habitats” (WKH) to be safeguarded from clear-cutting. However, despite their high conservation values, WKH lack proper legislative protection. Recently, many WKH were deregistered and thereby lost their potential protection against clear-cutting, jeopardizing biodiversity values in these forests. Moreover, the former way of classifying WKH has been criticized for being too lenient, making conventional forestry difficult. To assess the leniency of WKH registration and effect of WKH deregistration, we conducted a field inventory of WKH following a new inventory method proposed by the Swedish Forest Agency, featuring more stringent criteria for classification of WKH in north-western Sweden. The inventory was conducted in 9 still registered and 9 recently deregistered WKH to assess their conservation values. Our inventory results show that all 18 areas reach the criteria for WKH with the new method, despite higher, more stringent thresholds for conservation values. Hence, formerly registered WKH were not deregistered due to lower values. Moreover, analysis of recent harvest actions within deregistered WKH in Sweden showed that almost 1,200 hectares (~ 2%) of these areas were clear-cut or reported for clear-cutting 1–7 years post deregistration. As such, our results indicate that WKH contain high values, even using more stringent classification criteria, but also that deregistration of WKH does not consider these values and increases the risk of losing them to forest management. Given past and current declines in forest biodiversity, this is concerning, as conservation of areas containing high conservation values are needed, in order to preserve biodiversity in boreal forests.

This thesis investigates anisotropic cosmological models within the Bianchi classification, with a particular focus on Bianchi type III spacetimes. Using the formalism of general relativity, one explore the mathematical structure and physical implications of these models. One begin by establishing the theoretical foundations of general relativity and relativistic cosmology, one then present a detailed study of homogeneous but anisotropic models of Bianchi types I and III. Our results underscore the importance of Bianchi cosmologies as generalizations of the standard isotropic models. The study offers insight into how geometric symmetries govern cosmological dynamics and how anisotropy may decay over cosmic time.

Broadband optical frequency combs (OFCs) in combination with Fourier transform spectrometers (FTSs) offer state-of-the-art precision in studying molecular ro-vibrational transitions. However, the frequency accuracy of such systems is limited by accurate calibration of optical path difference (OPD), which can be measured using a monochromatic reference laser as a ruler. Conventional path-parallel OPD calibration methods suffer from inaccuracies in optical path matching and requires a time-consuming iterative wavelength calibration process.

This thesis presents the implementation and evaluation of an alternative OPD calibration method using a copropagating near-infrared continuous-wave (NIR–CW) laser that is frequency-locked to a comb mode. This approach eliminates the need for wavelength calibration of the reference laser while improving path matching with the OFC.

The NIR–CW laser with a wavelength inside the molecular important NIR region falls within the bandwidth of the OFC, providing means to frequency-lock the reference laser to a nearby comb mode. This provides a basis where the wavelength can be found from known parameters and thus eliminates the wavelength calibration time. The method is experimentally validated through cavity-enhanced Doppler-broadened methane absorption spectra and compared to a conventional calibration method. We also include a discussion about system design considerations like beam combination and separation techniques, noise assessments and distortion analysis.

Results showed that the NIR–CW calibration method accurately determined the reference wavelength up to some integer multiples of the OFC repetition rate. However, noise evaluation against the conventional calibration method found challenges in reaching comparable noise levels due to signal leakage between the OFC and reference detectors.

Background: The ethical climate in healthcare is part of the work environment and a basis for professional nursing practice. The ethical climate is crucial as it is closely associated with staff job satisfaction, the quality-of-care provision, and nurses’ intention to stay in their current occupation and position. Even though several instruments assessing ethical climate in healthcare have been developed over the years, their psychometric properties have not been systematically reviewed.

Objectives: This study was conducted to identify and critically appraise the psychometric properties of instruments used to measure the ethical climate among healthcare professionals in care settings prior to the COVID-19 pandemic.

Methods: A systematic review was performed, covering papers published between 1994 and 2019, excluding grey literature sources. The literature search was performed in October 2019 in Cinahl, PsychINFO, PubMed, and SocIndex. Empirical studies were included describing the psychometric properties of instruments measuring the ethical climate among healthcare professionals in healthcare settings. Data on psychometric properties were extracted and a quality assessment was performed following the quality criteria for measurement properties proposed by Terwee et al. criteria 2007.

Result: Our search yielded 15,150 publications. After title and abstract screening, 611 studies were retained for full-text analysis, of which eight studies describing five instruments were included (five instrument development studies and three translation studies). Four studies concerned the Hospital Environment Climate Scale (HECS). All instruments had been assessed for content validity and internal consistency. Information concerning criterion validity, construct validity, and reproducibility was lacking or intermediate. No information concerning floor/ceiling effect or interpretability was reported in most cases. One study reported having performed a test-retest analysis. None of the included studies fulfilled all the Terwee et al. criteria.

Conclusion: Five instruments were identified as having undergone psychometric testing; however, none fulfilled all the criteria outlined by Terwee et al. Also, only one of the instruments had been subjected to the well-established test-retest analysis. This highlights a need for further well-structured validation studies of instruments assessing the ethical climate among healthcare professionals in care settings.

Standardized admission tests such as the Swedish Scholastic Aptitude Test (SweSAT) aim to ensure fairness in higher education selection by assessing verbal and quantitative skills. Previous research on the SweSAT indicates declining scores in the Swedish Reading subtest and improved scores in the English reading subtest. Gender differences are present, with males outperforming females on most SweSAT subtests–males often perform better on the multiple-choice format used in SweSAT, especially in English as a foreign language, while females typically perform better in school. Informal English exposure through Extramural English (EE) activities, such as digital gaming and reading, is associated with higher English proficiency, with males engaging more in gaming. However, EE impact on first-language proficiency alongside gender-related differences in test performance remains unclear. This study investigates how EE activities and item format contribute to gender-related performance differences in the SweSAT verbal subtests. A total of 5,230 SweSAT test-takers completed a questionnaire on their engagement in EE activities, focusing on reading and gaming. The SweSAT verbal items were examined using Mantel-Haenszel (MH) Differential Item Functioning (DIF) analyses to identify gender- and EE-related item biases. Results showed that gamers were more likely to be favored on English reading comprehension items, whereas non-gamers were favored on Swedish subtests. English items displayed DIF favoring frequent readers, whereas low-frequency readers were favored on some Swedish items. Male-favored DIF appeared mainly on English items, and females were favored on Swedish items. No consistent DIF patterns were linked to item format or word class across verbal items.

User-focused monitoring (UFM) is a method for service evaluation led by service users, aimed at enhancing quality and service user involvement. Our study examines the experienced outcomes following the completion of five UFM projects within Swedish mental health service programs. Specifically, we focus on the barriers and facilitators to integrating user-led evaluations into service program development. Through interviews with user monitors, managers, staff, and service users involved in these evaluation projects, we conducted a directed content analysis focused on preconditions, processes, and outcomes. Our findings indicate that UFM projects contribute to specific development measures and improved relationships within service programs but also to broader cultural change. However, a lack of trust among service users in actual change poses a significant obstacle to their involvement. Additionally, the absence of feedback regarding the implementation of change measures by service programs to service user groups risks reinforcing this lack of trust. To enhance the integration of evaluation results into quality development, early engagement with staff groups and clear implementation plans are recommended.

Many individuals usebackground noise to aid concentration on tasks, yet its effect on workingmemory, especially for those with ADHD, is not well understood. This studyexamined how background white noise influences short-term serial recall inadults with self-reported ADHD (n = 66) and those without (n = 66), controllingfor anxiety and depression. Participants performed a visual-verbal serialshort-term memory task under two conditions: continuous white noise interruptedby quiet intervals (omission deviant) and continuous quiet interrupted by whitenoise (addition deviant). Results showed that addition deviants disruptedperformance more in non-ADHD adults, while omission deviants had a greater disruptiveeffect on adults with self-reported ADHD. These findings suggest thatinterruptions in background sound may differently affect individuals with ADHDsymptoms. Exploratory analyses showed the absence of a primacy effect in adultswith self-reported ADHD. Future research might explore optimal auditoryenvironments tailored to attention differences in those with and without ADHD.

Umeå universitet avstyrker förslaget till ny lag om insatser inom socialtjänsten till vårdnadshavare, barn och unga när samtycke saknas (LIV). De huvudsakliga skälen är att den omfattande promemorian inte övervägt människors grundläggande fri- och rättigheter och barns rätt enligt barnkonventionen i tillräcklig grad för införande av en ytterligare tvångslag avseende barn och familjer, att regleringen både i sig och i förhållande till angränsande regelverk (liksom parallellt pågående lagstiftningsärenden) innebär ett svårnavigerat och svåröverblickbart regelsystem.

Därtill kan lagförslagets mer spekulativa fördelar inte anses överväga de nackdelar och risker för barn och unga som, mera underbyggt och grundat på kunskap och forskning, visats i utredningen.

Sammantaget anser Juridiska institutionen att det finns ett behov av ett kunskapsbaserat och sammanhängande regelverk, till skydd och stöd för barn och unga som på olika sätt riskerar att fara illa. Juridiska institutionen instämmer därför helt i det av utredningen uttalade behovet att det fortsatta lagstiftningsarbetet måste samordnas, så att slutresultatet åstadkommer en samverkande lagstiftning.

Background: Premenstrual dysphoric disorder (PMDD) is an understudied, debilitating, and hormone-related mental disorder. Recent evidence suggests alterations in white matter structure during the symptomatic luteal phase in PMDD. In this study, white matter volumes (WMVs) in the brains of women with PMDD versus control women were compared across the menstrual cycle, to determine whether these differences reflect state- or trait-like characteristics.

Methods: Anatomical magnetic resonance imaging was performed during the midfollicular phase and the late luteal phase of the menstrual cycle in 28 women with PMDD and 27 control women. WMVs were assessed using voxel-based morphometry, employing both region-of-interest (ROI) and exploratory whole-brain approaches.

Results: No group-by-phase interaction effects on WMVs were found. Across menstrual cycle phases, women with PMDD exhibited greater WMVs than control women within ROIs (in the bilateral uncinate fasciculus, right inferior fronto-occipital fasciculus, and left crus and fimbria of the fornix) and across the whole brain (in inferior occipital areas and near the angular gyrus), indicating trait- rather than state-like structural markers of PMDD.

Conclusions: These findings suggest that women with PMDD exhibit larger WMVs than healthy control women, during both the symptomatic and asymptomatic phases of the menstrual cycle, in white matter tracts involved in emotion processing and regulation, memory, and connecting limbic and prefrontal regions of relevance to mood disorders.

Background: There is an ongoing need to develop diverse career paths that support the vital contributions of staff scientists, research engineers, scientific officers, and other knowledge professionals in scientific discovery. Research infrastructures and core facilities have a particular need to support sustainable and diverse careers, as they either employ – if being a legal entity – or daily manage research professionals in a broad variety of roles to enable resources, services, and innovation.

Methods: In 2019, a survey of the facility staff at SciLifeLab, a large national research infrastructure in Sweden, led to a recommendation for universities to develop career paths for their staff scientists. Five years later, we have conducted a survey and workshop to determine current views of infrastructure staff on career path diversity in Sweden.

Results: Our results indicate there is a strong need for clarity and communication about planning and implementation of career path structures at Swedish universities, as well as opportunities to foster excellence in infrastructure staff. While the workshop participants ranked Sweden as a stable and attractive place to work and reported continuous development of their technical and service skills, the lack of recognition of this expertise presents a barrier to a sustainable career.

Conclusions: We conclude that there is a need to continue advocating for increased clarity and diversity in career paths for staff scientists in Sweden, and raise the views presented by infrastructure staff on the challenges and opportunities unique to their roles.

The rise of remote work has reshaped organizational dynamics, necessitating a deeper understanding of its implications for leadership, employee motivation, and performance. This longitudinal study examined direct and indirect effects (via leadership behaviors) of remote work intensity on employee motivation and performance. Using three waves of survey data from 512 Norwegian employees, results indicate that higher remote work intensity positively predicted perceived need-supportive leadership and negatively predicted perceived controlling and laissez-faire leadership. Need-supportive leadership positively predicted intrinsic motivation, which in turn predicted adaptability and proactivity, whereas controlling leadership positively predicted extrinsic regulation and amotivation. Amotivation negatively predicted proficiency but was a positive predictor of proactivity. Laissez-faire leadership also positively predicted proactivity, suggesting that reduced managerial oversight may encourage initiative in certain remote work contexts. These results offer valuable insights for organizations navigating the future of work, highlighting the need for leadership strategies that enhance intrinsic motivation and adaptability in remote work settings.

Background: Population reference data based on self-reported EQ-5D constitute a valuable resource in a broad range of settings. Within the UK, EQ-5D has been included in national population surveys for over 30 years, notably as part of the Health Survey for England, however, the extent to which such data varies over time remains largely unknown.

Methods: Between 1996 and 2014, the Health Survey for England included the original 3-level version of EQ-5D (EQ-5D-3L) and provides data from more than 100,000 respondents; these data form the basis of the present study. Age-stratified rates of reporting any problem in EQ-5D dimensions were computed for men and women; these were standardised using 1996 as the index year. Logit regression was used to examine the influence of year respondent socio-demographic characteristics, and current health status on rates of reporting any problems in EQ-5D-3L. The data of self-rated health status recorded on a 0-100 scale (EQ VAS) was also analyzed.

Results: More than 30% report a problem with Pain/Discomfort with around 20% reporting a problem with Anxiety/Depression, Mobility having a similar problem rate, about 18%. Some 5% of respondents report a problem with Self Care. After an initial fall from 1996, self-reported health remains relatively stable across 10 years, however between 2008 and 2012 rates of reporting any problem increased, particularly in the Anxiety/Depression dimension and amongst older women. Logit regression analysis demonstrates that most of the covariates had statistically significant coefficients, such as age, gender, education, economic activity, income, and long-standing illness/condition.

Conclusions: The study demonstrates the stability of EQ-5D responses over time in HSE data from 1996 to 2014. However, there is evidence of periodic deterioration in health status notably in the years immediately after 2007. Further investigation of this effect could have implications for the interpretation and use of population data based on EQ-5D. The study demonstrates the importance in national surveys of the general population of regular collection of health status data using a standardised measure of health-related quality of life.

Background: Current evidence indicates that Post COVID-19 Condition (PCC) is multifaceted with distinct phenotypes. While previous studies have identified symptom clusters—commonly featuring fatigue, respiratory symptoms, and cognitive impairment—findings have been inconsistent, and no clear consensus exists. Moreover, how these symptom clusters evolve over time, particularly beyond the first year post-infection, remains poorly understood.

Methods: This multicentre prospective cohort study included 470 hospitalised and non-hospitalised adult individuals from the CoVUm study across four sites in Sweden between 2020 and 2021. Follow-ups were conducted up to 3 years after infection to assess persistent symptoms, health-related quality of life (HRQoL), and work capacity. Symptom clusters at 6 months were identified via hierarchical cluster analysis, and participants were tracked using a k-nearest neighbour algorithm.

Results: The most common symptoms at 6 months were fatigue (33 %), dyspnoea (32 %), mental fatigue (30 %), and concentration difficulties (28 %), with a median EQ-5D-5L index of 0.98 (IQR 0.93–1). Four distinct symptom clusters were identified: (i) “Few Symptoms” (n = 265, 57 %), (ii) “Respiratory Symptoms” (n = 66, 14 %), (iii) “Neurocognitive Symptoms” (n = 75, 16 %), and (iv) “Multisystem Symptoms” (n = 52, 11 %). Participants in the latter three clusters were older, had more comorbidities, and were more often hospitalised during primary COVID-19 infection. These clusters also had significantly lower HRQoL compared to the “Few Symptoms” cluster. Over time, more than half of participants transitioned to a cluster with fewer or no symptoms, with significant perceived HRQoL improvement in the “Multisystem Symptoms” cluster.

Conclusion: While many patients with PCC improved over time, a subset had persistent symptoms at 3 years, especially if primary infection required hospitalisation. The identification of symptom clusters and their trajectories over time contributes to a better understanding of PCC heterogeneity, ultimately bringing the field closer to consensus on the classification and long-term impact of PCC.

Obesity has been associated with increased prevalence of asthma in cross-sectional studies. We aim to examine the relation of obesity and weight change to 8-year asthma incidence in a randomly selected population-based adult cohort. West Sweden asthma study survey was performed in 2008 (18,087 participated) and follow-up in 2016 (12,449 participated). Participants responded to a questionnaire on these two occasions. Obesity was defined as body mass index (BMI) ≥ 30 (kg/m2), and overweight as 25 ≤ BMI < 30 (kg/m2). Asthma was defined with affirmative answer to the question "Have you been diagnosed with asthma by a physician?". Asthma incidence was reported per 1000 person-year over the 8-year follow-up period. Among participants without asthma (N = 10,769) in 2008, asthma incidence was 1.8 per 1000 person-year. Asthma incidence was higher in 40-60 years old, normal, or overweight participants who gained ≥ 4 BMI (kg/m2), or in those who were obese with a stable BMI. Asthma incidence sharply increased in those who gained ≥ 4 BMI (kg/m2), especially in women. Additionally, the risk of asthma was significantly higher in a dose-dependent manner among those who gained ≥ 0.5 BMI (kg/m2) compared to those with stable, normal weight. The risk of asthma was higher in those who were obese at baseline regardless of their weight change than individuals with stable, normal weight. Our findings highlight the necessity for health care to integrate weight management strategies as a key component of asthma prevention and care, particularly for women in middle age who are overweight or obese.

Recent psychological research highlights the substantial benefits of self-transcendent emotions encompassing both physiological and psychological improvement for the individual. In contrast to stress and fear, which tend to make us self-centered, and tunnel visioned, self-transcendent emotions expand perspective, enhancing psychological well-being, by shifting attention away from the self and toward a broader awareness of the surroundings. Studies suggest that these emotions foster a state of presence known as the “dissolution of the default self” which also has shown to promote greater social engagement and increased meaning in life. The wide spectrum of benefits associated with these positive emotions has led to a steady growing interest around if and how they could be cultivated intentionally.

This thesis posits that feelings such as compassion, gratitude, and awe systematically can be nurtured and improved through techniques aimed at enhancing awareness and calm. To test this hypothesis, the study employed a mixed-methods approach, consisting of a prominent quantitative component in which a group of yoga practitioners were evaluated over a period of nine months. They participated in a practical regime that included circulatory movements, breath control and different forms of awareness exercises. In addition, a qualitative element was included based on five semi-structured interviews to further address the research questions. This second part of the study particularly focused on the emotion of awe and the relationship between self-transcendent emotions and felt spirituality.

The results from both the qualitative and quantitative components indicated signs that self-transcendent emotions can be developed through practices that nurture awareness and nervous system regulation. In the qualitative data this development was reflected in increased experiences of self-dissolution and interconnectedness. At the same time the interviews revealed a more ambiguous result regarding the link between self-transcendent emotions, the concrete methods of practice, and spirituality. This raises new questions around how spirituality can be defined, and which factors contribute to whether an experience is interpreted as spiritual or not.

Background: With nearly one-third of patients with advanced non-small cell lung cancer (NSCLC) and PD-L1 Tumor Proportion Score≥50% surviving beyond 5 years following first-line pembrolizumab, long-term outcomes challenge traditional paradigms of cancer prognostication. The emergence of non-cancer-related factors and time-dependent trends underscores the need for advanced analytical frameworks to unravel their complex interplay.

Methods: We analyzed the Pembro-real 5Y registry, a global real-world dataset of 1050 patients treated across 61 institutions in 14 countries with a long-term follow-up and a large panel of baseline variables. Two complementary approaches were employed: ridge regression, chosen for its ability to address multicollinearity while retaining interpretability, and not another imputation method (NAIM), a transformer-based artificial intelligence model designed to handle missing data without imputation. Endpoints included risk of death at 6, 12, 24, 60 months and 5-year survival.

Results: The ridge regression model achieved a c-statistic of 0.66 (95% CI: 0.59 to 0.72) for the risk of death and an area under the curve (AUC) of 0.72 (95% CI: 0.65 to 0.78) for 5-year survival, identifying Eastern Cooperative Oncology Group Performance Status (ECOG-PS)≥2, increasing age, and metastatic burden as primary risk factors. However, wide CIs for some predictors highlighted statistical instability. NAIM demonstrated robust handling of missing data, with a c-index of 62.98±2.11 for risk of death and an AUC of 60.52±3.71 for 5-year survival. The comprehensive SHapley Additive exPlanations analysis revealed dynamic, time-dependent patterns, with early mortality dominated by acute factors (eg, ECOG-PS, steroids) and long-term outcomes increasingly influenced by systemic health markers (eg, absence of hypertension, increasing body mass index). Unexpected insights included the protective role of dyslipidemia (but not statins) and the nuanced impact of smoking status, reflecting evolving disease dynamics and host-tumor interplay.

Conclusions: Our integrative framework illuminates the complexity of long-term outcomes in patients with NSCLC treated with pembrolizumab, uncovering dynamic, non-linear prognostication trends. This analysis provides insights into patient trajectories, emphasizing the need for holistic, long-term management strategies.

Recent droughts have accentuated problems with attacks of the European spruce bark beetle (SBB) (Ips typographus) on Norway spruce (Picea abies), one of the most important tree species in European forestry. SBB attacks are typically accompanied by infestation with Ophiostomatoid fungi causing blue stain. The chemical composition of sapwood and bark from spruce trees infested by SBB, or by both SBB and blue-stain fungi (BSF), was investigated and compared to corresponding fractions from non-infested reference (REF) trees. While sapwood from infested trees showed higher carbohydrate:lignin (C:L) ratios (SBB, 2.21; BSF, 2.47) than sapwood from non-infested trees (REF, 2.17), BSF bark showed lower C:L ratio (0.81) than REF bark (1.23). For BSF sapwood and bark, and SBB bark, the fractions of extractives were half or less than half of that of the corresponding REF materials. Group analysis using GC-FID showed significantly (p ≤ 0.01) lower levels of resin acids, fatty acids, steryl esters, and triglycerides in BSF materials than in REF materials, a phenomenon that was, however, not observed for sterols. Analysis of subgroups and individual fatty acids, resin acids, and sterols identified using GC-MS revealed complex patterns, in which many, but not all, substances exhibited lower values in BSF and SBB materials than in REF materials. Overall, the results point towards the possibility to utilize a larger portion of wood logs from trees infested by beetles and fungi for value-added applications, such as pulping, rather than as fuel wood.

Military chaplains (MCs) in Sweden embody a hybrid professional identity at the intersection of ecclesiastical and military institutions. Ordained Lutheran priests serve within the Swedish Armed Forces, where they may carry arms for self-defense—challenging conventional boundaries between religious and military roles. This study investigates the identity work undertaken by Swedish MCs as they navigate this complex terrain. Based on qualitative data from a 2025 study involving 50 Swedish MCs, this article adopts a narrative approach to understanding identity work in hybrid professional roles. An anonymous qualitative questionnaire enabled participants to reflect openly on their experiences of negotiating the contrasting demands of military and clerical life. The findings reveal that Swedish MCs engage in continuous identity work to maintain clerical integrity while adapting to military culture. Entering the Armed Forces necessitates the deliberate acquisition and internalization of military culture, including its values, hierarchies, practices, and norms, while simultaneously preserving the integrity of the priestly identity, perspective, and commitment. Military culture, shaped by discipline, loyalty, and the potential use of lethal force, both challenges and transforms aspects of MCs’ identities. Carrying weapons intensifies underlying conflicts and constitutes a particularly charged locus of ethical and identity-related tension, which may also generate cognitive dissonance. Furthermore, MCs often inhabit a liminal position, fully belonging neither to the military community nor to the ecclesiastical sphere, which necessitates ongoing negotiation of professional boundaries and personal values. This study contributes to the sociology of hybrid professions and institutional complexity by illustrating how implicit work contracts and organizational cultures shape identity work in boundary-spanning roles. It highlights the need for structured support and reflective practice to sustain professional integrity in such demanding contexts. Future research should adopt longitudinal designs to explore how MCs’ identity work evolves over time, especially in light of shifting geopolitical contexts and increasing demands on their hybrid role.

This thesis investigates the effects of recent U.S. tariffs on Scandinavian economies, with focus on exports of steel, aluminum, machinery, and agricultural products. The study provides clear evidence of substantial negative impacts on trade flows from Scandinavia to the United States in industries that are targeted by tariffs, using a gravity model of international commerce and extensive data from 2015 to 2024. Trade diversion indicated some small benefits, but there were insufficient to offset larger cost. The results demonstrate the effects of small, trade-dependent countries to external protectionist measures, showing the necessity of strong international trade agreements and aggressive domestic policies for economic resilience.

Boreal forests provide important habitat for biodiversity, store vast amounts of carbon, and support a range of ecosystem services, including forestry and reindeer herding. Across northern Fennoscandia, reindeer (Rangifer tarandus) grazing overlaps extensively with forestry, creating both ecological and cultural tensions. Yet, the impacts of reindeer on the structure, function, and carbon dynamics of boreal pine forests remain poorly understood.

My thesis investigates how reindeer influence forest structure and dynamics in boreal pine (Pinus sylvestris) forests. Using detailed field measurements from long-term reindeer exclosures in lichen-rich pine forests across broad climatic and productivity gradients, I quantified reindeer impacts on soils, vegetation, saplings, and mature trees, linking these to variation in microclimate, nutrient availability, and forest composition.

Reindeer reduced lichen cover and biomass by more than 50%, which in very dry, lichen-dominated forests led to warmer and drier summer soils and an earlier spring thaw. These microclimatic shifts, together with reduced litter input, were associated with 22% lower soil organic carbon stocks, although the remaining carbon was chemically more stable. Reindeer had only minor direct effects on forest regeneration, which was primarily shaped by changes in field- and ground-layer vegetation. Effects on tree growth and stand biomass depended strongly on forest structure: winter grazing in older forests increased stand biomass, whereas grazing in younger forests mainly caused declines.

Overall, these findings demonstrate that reindeer effects on carbon storage and tree dynamics are highly site-specific. Sustainable forest and herding management will therefore benefit from close collaboration between herders and forest owners to identify grazing strategies that align forest carbon goals with viable herding practices, directing grazing toward areas where outcomes are most beneficial for both ecosystems and livelihoods.

The COVID-19 pandemic caused a global health crisis that affected every aspect of society worldwide. However, the detrimental health effects of the pandemic were not equally distributed across groups and places. Likewise, adherence to preventive measures varied across groups and communities. Having supportive social networks and living in areas with social cohesion—social capital—is believed to protect against adverse consequences of social crises. This mixed method study aims to investigate the bidirectional relationship between social capital and the COVID-19 pandemic, and to analyze the significance of individual and neighborhood social capital for physical and mental health, attitudes toward- and adherence to preventive measures. The specific objectives are to; (1) Investigate the development of neighborhood social capital during the COVID-19 pandemic and to assess whether perceptions on how the pandemic affected life situation and attitudes toward preventive measures differ across neighborhoods with different social capital profiles and population characteristics. (2) Analyze the effects of individual social capital on physical and mental health, as well as attitudes toward and adherence to preventive measures for diverse population sub-groups, living in neighborhoods with different social capital profiles. (3) Analyze how the pandemic and its associated preventive measures impacted people’s access to and utilization of social capital. Sub-study 1 will utilize data from repeated cross-sectional social capital surveys conducted before and after the COVID-19 pandemic, in 2020 and 2024. Data from a cohort who responded to both the post- and the pre-COVID social capital surveys will be linked to population register data on socioeconomic and sociodemographic factors and health registers to be used for the quantitative sub-study 2. A strategic sample of individuals who participated in both the 2020 and the 2024 social capital surveys will be invited to participate in interviews for a subsequent qualitative sub-study 3. This study is carried out in Umeå Municipality, Northern Sweden, where extensive research on social capital, health and social sustainability has been conducted since 2006. The proposed study contributes novel knowledge on how a social crisis affects unequal living conditions between groups and places. This knowledge can provide a basis for what actions are needed to reduce adverse health consequences of social crises.

Background: Post-COVID condition (PCC) affects ~10% of SARS-CoV-2–infected individuals and manifests as persistent symptoms such as fatigue, exercise intolerance and muscle weakness. This study aimed to assess the skeletal muscle of these patients and compare them with healthy controls.

Methods: Biopsies were obtained from the vastus lateralis muscle of 28 nonhospitalised PCC patients without concomitant diseases (75% women, mean age 46.4 ± 10.4 years) and 28 age- and sex-matched healthy controls (79% women, mean age 46.6 ± 8.7 years). The analysis included morphological and pathological alterations, fibre type composition, fibre cross-sectional area, capillarisation, number of myonuclei, presence of developmental myosin, CD68+ cells, macroautophagy markers, mitochondrial respiration, lipidomics and RNA sequencing.

Results: PCC patients, compared to controls, had a higher percentage of angulated fibres (median [IQR] 0.43 [0.00–3.20] vs. 0.00 [0.00–0.00]; p < 0.001), small, rounded fibres (0.21 [0.00–1.20] vs. 0.00 [0.00–0.00]; p < 0.001) and fibres expressing fetal myosin (0.26 [0.00–1.15] vs. 0.00 [0.00–0.17]; p = 0.015). Semiquantitative analysis showed nuclear clumps (18/27, 66.6%), hypertrophic fibres (9/27, 33.3%) and fibrosis (22/27, 81.4%) in PCC patients. Fibre cross-sectional area was significantly lower in PCC patients (4031 ± 1365 vs. 4982 ± 1463 μm2; p = 0.018), largely driven by differences in type 2 fibre size (3533 ± 1249 vs. 4275 ± 1646 μm2; p = 0.068) than type 1 fibre size (4553 ± 1422 vs. 4932 ± 1380 μm2; p = 0.325). There was a significantly lower number of myonuclei per fibre in PCC (3.4 ± 1.1 vs. 4.1 ± 1.0; p = 0.012), but no difference in the presence of CD68+ per fibre (0.28 ± 0.15 vs. 0.22 ± 1.0; p = 0.115). No group differences were observed in macroautophagy markers LC3B (0.0032 ± 0.0007 vs. 0.0030 ± 0.0006; p = 0.232) or p62 (0.0072 ± 0.0023 vs. 0.0079 ± 0.0016; p = 0.814). Capillary-to-fibre ratio in PCC patients was lower for both type 1 (2.2 ± 0.7 vs. 2.6 ± 0.9; p = 0.044) and type 2 fibres (1.8 ± 0.6, vs. 2.2 ± 0.8; p = 0.022). Mitochondrial respiration was 11–28% lower in PCC patients, although not statistically significant. Lipidomics showed a lower number of phospholipids, and RNA sequencing revealed downregulation of eight metabolic pathways, primarily related to oxidative phosphorylation in PCC patients compared to controls (FDR < 0.05).

Conclusions: Nonhospitalised patients with PCC show signs of morphological and pathological muscle changes suggestive of degeneration and regeneration. The smaller overall fibre size, lower number of phospholipids, reduced mitochondrial oxidative capacity and lower capillarisation in these patients may be a consequence of reduced physical activity levels. The presence of clusters of atrophied angular and round-shaped fibres, signs of inflammation and fibrosis and increased expression of fetal myosin may reflect myopathic and neurogenic post-viral effects. Trial Registration: ClinicalTrials.gov Identifier: NCT05445830.

This study explores how lower secondary school students describe their motivation for pullout-lessons in music during school hours, interrupting regular classroom schedule, and how this affectstheir motivation in regular classroom subjects. The theoretical framework is based on Expectancy-Value Theory.A qualitative approach was applied using semi-structured group interviews with students fromschools in Västerbotten, Sweden. Data was analyzed through deductive thematic analysis focusingon four themes: intrinsic value, utility value, attainment value, and cost.Findings indicate that students’ motivation for pullout instruction is primarily driven by strongintrinsic value (enjoyment and satisfaction) and clear utility value (increased energy andconcentration). Attainment value, linked to identity, appeared to a lesser extent. Costs such as stressand missed class time were perceived as minor and manageable. Students reported that pulloutlessons contributed to increased motivation for regular schoolwork.The study concludes that individual music pullout-lessons during school hours, interrupting regularclassroom schedule, can enhance students’ well-being and strengthen overall school motivation,provided it is organized in a flexible manner with clear communication.

Objectives: Breast-fed (BF) have lower risk of infections during infancy compared to those formula-fed (FF). A higher content of alpha-lactalbumin (α-lac) in breast milk, which may promote a more favorable gut microbiota, could be one reason. In this study, we evaluated whether increased concentration of α-lac in low-protein infant formula affects the immune response and the incidence of infections during infancy.

Methods: In a double-blinded randomized controlled trial, healthy-term infants (n = 245) received low-protein infant formulas with α-lac-enriched whey (α-lac-EW; 1.75 g protein/100 kcal, 27% α-lac) or casein glycomacropeptide-reduced whey (CGMP-RW; 1.76 g protein/100 kcal, 14% α-lac), or standard formula (SF; 2.2 g protein/100 kcal, 10% α-lac) from 2 to 6 months. BF constituted a reference group. Cytokines and high-sensitivity C-reactive protein (hsCRP) were measured during intervention and infection-related morbidity, and treatment was evaluated until 12 months.

Results: Serum interleukin-6 (IL-6) was lower in BF than in all FF groups during intervention (p < 0.001). No other differences in cytokines (tumor necrosis factor alpha [TNF-α], transforming growth factor beta 1 [TGF-β1], TGF-β2, IL-1, IL-10, IL-12, interferon gamma [INF-γ]) or hsCRP were found among the study groups. Infection-related morbidity did not differ among study groups, except slight differences in the use of antibiotics during (α-lac-EW vs. CGMP-RW [p = 0.008]) and after intervention (α-lac-EW vs. BF [p = 0.016]).

Conclusions: Increased α-lac concentration in low-protein infant formula to levels similar to breast milk did not affect the cytokine profile and had minor effect on infection-related morbidity. The higher IL-6 concentrations in FF than in BF needs further investigation.

Background: The Autism- Tics, ADHD and other Comorbidities inventory (A-TAC) has been validated in epidemiological data. However, validation against clinical diagnostic assessments in a population-based sample has been lacking, limiting the implications for clinical practice, clinical research and public health decisions.

Methods: Study participants were recruited from the longitudinal Child and Adolescent Twin Study in Sweden (CATSS) inviting parents to all twins in Sweden. We investigated the psychometric properties of the A-TAC in 263 children, where one or both twins screened positive for neuropsychiatric problems, as well as control pairs, where both twins were screen negative. Study participants underwent thorough clinical examination within one year of the A-TAC interview. The psychometric properties of the A-TAC were then investigated. We also mapped the extent of comorbidity of neurodevelopmental disorders.

Results: Using the A-TAC as screening for neurodevelopmental disorders we could discriminate two groups of children with clearly different occurrences of clinical diagnoses. The predictive screening properties of the A-TAC were good for most of the neurodevelopmental disorders (AUC ranging from 0.806 to 0.958), with exception for developmental coordination disorder (AUC = 0.616). More than 40% of children fulfilling diagnostic criteria for a neurodevelopmental disorder, also fulfilled diagnostic criteria for at least one other neurodevelopmental disorder.

Conclusion: This study confirms the utility of the A-TAC interview as a screening tool for neuropsychiatric disorders in a non-clinical sample. It also supports the necessity to maintain a broad diagnostic approach in clinical child psychiatric investigations for meaningful understanding of the child’s problems. Although, A-TAC can be informative on neurodevelopmental problems in both clinical and population-based samples, it cannot replace a clinical neurodevelopmental investigation or be used to delimit individual access to specialized care.

This paper explores Thomas Aquinas’s presentation of the cosmological and teleological arguments for God’s existence in Summa Theologica, as well as David Hume’s critique of those arguments in Dialogues Concerning Natural Religion. This paper shows that Hume’s objections, though fruitful at times in order to question theistic assumptions, containin adequacies, and that Aquinas’s argumentation appears as more valid. This paper concludes that Aquinas’ rationalism appears as the more plausible foundation for examining the question of God’s existence.

Background: The SWEDish registry of CONgenital heart disease is a Swedish national quality register for collecting data on pediatric and adult (GUCH) patients with congenital heart diseases that aims to improve medical practice and research. The aim of this study was to validate data in the register using data in medical records.

Methods: This cross-sectional observational study compared specific variables from SWEDCON with data retrieved from medical records for 182 pediatric and 186 adult patients who were randomly selected from four different hospitals.

Results: The absolute concordance for date of visit, diagnosis, information on surgery and catheter intervention was 71–98% between SWEDCON and medical journals. The specificity for cardiac examinations and specific medical therapy was 71–100%. The concordance for information for transition from pediatric care to GUCH or finishing regular check-ups was 92%.

Conclusion: The overall concordance between data in SWEDCON-pediatric as well as SWEDCON-GUCH with data in medical records was good, and data from SWEDCON is reliable to use for medical improvements and for research purposes.

Background: Aeration plays a critical role in the bioconversion of pretreated lignocellulose by enhancing lytic-polysaccharide-monooxygenase(LPMO)-supported enzymatic saccharification. However, its broader impact, particularly on fermentation inhibitors, remains insufficiently understood. The hypothesis that aeration not only promotes LPMO activity, which has been shown clearly in previous studies, but also affects fermentation inhibitors was investigated in experiments with softwood pretreatment liquids. The effects of aeration were explored through chemical analysis of fermentation inhibitors and through subsequent fermentations with the xylose-utilizing Saccharomyces cerevisiae yeast CelluX^™4 to test the fermentability. Controls in which N₂ rather than air was supplied to the pretreatment liquids were used to distinguish between evaporation effects and effects caused by oxidation due to O₂ in air. In separate experiments, two redox-dependent detoxification methods, treatments with sulfite and laccase, were further investigated.

Results: While aeration had no negative effects on the subsequent fermentation of a sugar control, it compromised the fermentability of the pretreatment liquids. Compared to the N₂ control, subsequent fermentation of aerated samples showed reduced consumption of fermentable sugar (glucose, mannose, xylose) at 0.61 compared to 0.76 g L⁻¹ h⁻¹, and lower ethanol productivity (0.23 vs. 0.30 g L⁻¹ h⁻¹). Apart from more commonly studied pretreatment by-products (such as aliphatic carboxylic acids, furan aldehydes, and phenolics), methanol (~ 1 g L⁻¹) was detected in both pretreatment liquids. The methanol concentration decreased during gas addition, which was attributed to evaporation. Compared to the initial pretreatment liquid, aerated reaction mixtures exhibited slightly elevated levels of formaldehyde, but lower levels of furfural and vanillin. Sulfite detoxification was successful under both aeration and N₂ conditions. Treatment with laccase was found to have variable effects on the fermentability depending on the conditions applied.

Conclusions: The results underscore the dual role of aeration in softwood bioconversion, positive for promoting LPMO activity but potentially negative with respect to subsequent fermentability, and highlight the need to carefully tailor aeration strategies for the design of efficient biochemical processing of lignocellulosic feedstocks. Treatment with reducing agents, such as sulfite, emerges as a possibility to alleviate negative side-effects on the fermentability when aeration is used to promote LPMO activity.

Objective: To explore health professionals’ perspectives on the barriers and enablers of healthcare access for older adults in Cambodia.

Design: A qualitative study based on semi-structured interviews conducted in Khmer, recorded, transcribed, translated into English and analysed using an abductive thematic analysis approach.

Setting: Phnom Penh, Cambodia.

Participants: A purposive sample of 11 health professionals serving in diverse roles and sectors participated in the study.

Results: Three key barriers emerged: (1) institutional barriers, (2) patient-specific access barriers and (3) communication barriers. However, four key enablers were also identified: (1) supportive healthcare environment, (2) reaching out to improve access to health services, (3) peer and community engagement and (4) government direct support to access healthcare. Despite previous policy efforts, gaps in the implementation of healthcare services for older adults persist across all health facilities. Health professionals identified that improving healthcare access for older adults in Cambodia requires a multifaceted strategy involving proactive outreach, health promotion, financial assistance and stronger community and family support.

Conclusion: Effective policy implementation requires collaboration among stakeholders and the active involvement of older adults in programme design to enhance dignity and well-being in Cambodia’s ageing population.

We determine forest lease value and optimal harvesting strategies under model parameter uncertainty within stochastic bio-economic models that account for catastrophe risk. Catastrophic events are modeled as a Poisson point process, with a two-factor stochastic convenience yield model capturing the lumber spot price dynamics. Using lumber futures and US wildfire data, we estimate model parameters through Kalman filtering and maximum likelihood estimation and specify the model parameter uncertainty set as the 95% confidence region. We numerically determine the forest lease value under catastrophe risk and parameter uncertainty using reflected backward stochastic differential equations (RBSDEs) and establish conservative and optimistic bounds for lease values and optimal stopping boundaries for harvesting. Numerical experiments further explore how parameter uncertainty, catastrophe intensity, and carbon sequestration impact the lease valuation and harvesting decision. In particular, we explore the costs arising from this form of uncertainty in the form of a reduction of the lease value. These are implicit costs which can be attributed to climate risk, and are likely to become more significant as forestry resources play a larger role in the energy transition. We conclude that in the presence of parameter uncertainty, it is better to lean toward a conservative strategy reflecting, to some extent, the worst case than being overly optimistic. Moreover, our results suggest that convenience yield plays a substantial role in determining optimal harvesting strategies within the two-factor model adopted in this study.

This project evaluates the performance of a conceptual louver design mountedat the cooling shaft exhaust of a CV90 combat vehicle. The cooling shaft is arectangular box placed at the back of the CV90. Its purpose is to create an airflowusing a fan to create a constant flow of air to exchange heat. The analysis includedsimulating airflow through the cooling system and comparing the pressure dropacross the conceptual louver with that of the standard louver. The primary goalof this project was to determine whether the new louver design could improveairflow efficiency and reduce friction losses. Key design changes included buildinga cooling shaft with an inlet on the roof similar to its real design. The louver weredesigned in order to take advantage of the radial velocity generated by the axial fanand positioning the louver further upstream to reduce the distance between the fanand the louver. Simulation results indicated a steady increase in pressure drop forthe concept louver, which are partially attributed to a reduction in free flow area, causing restrictions in the airflow and increased friction. Consequently, the newconcept design proved less efficient than the standard design, largely due to its lowfree area and its requirement for structural integrity and protective capabilities.

This thesis investigates how I, as an architect, can develop a safe housing option that can empower women and reinforce their agency in Umeå. This format aims to offer a safe environment for women to thrive and grow, breaking free from the domestic labor related to gender, gaining economic empowerment through shared resources, and supporting each other.

One of the methods that will be used is interviews with both professionals and individuals related to the investigated topic, as well as a physical anonymous survey set in Umeå, to gain a deeper understanding of what women are willing to share with others in a long-term setting. By first-handedly including women’s preferences and input for spatial conditions, it will navigate the design to a strong and well-thought-out project. The gathered knowledge will be translated into diagrammatic, visual, and spatial context, resulting in a radical housing format designated for women.

The resolution of the format is a collective house intended for women, not related to protective housing standards, but rather providing a possibility for the residents to live both independently and collaboratively with others. The design outcome is fluid, leaving room for women to inhabit the space according to their own conditions.

There is a local community of citizens, “Kollektivhus i Umeå”, actively fighting for developers to invest in a collective house, which indicates that the interest is a high enough to introduce new housing standards.

While co-housing options are an uprising theme today, the time, effort and financial extraction required of the individuals working towards a collective reality, usually demands more than what most have the resources for. This is usually the main challenge for the actual implementation, resulting in hopelessness in the people dreaming of being a collective.

Moving into the future, where we are currently adjusting and are expected to live in a more sustainable way, both environmentally and socially – there are signs that suggest that there will be more financial aids and support from the authorities to realize a new collective housing standard.

This thesis explores the interconnections between carbon modernity, suburbia, and apocalypse. It proposes ‘unbuilding’ as both a method and an ethic to reimagine the built environment for a post-carbon future.

Architecture and urban planning have a long history of functioning as manifestors of growth, extraction, and control, resulting in the embedding and enabling of carbon-intensive systems into the built environment. Suburbia emerges as a prime example of this logic, with its spatial and cultural forms shaped by sprawl, car-dependence, privatisation, and consumption. The lifestyles enabled and idealised by suburbia appear stable yet remain fragile in the context of apocalypse. This thesis observes suburbia as both a cause of apocalypse and a phenomenon directly affected by it.

Apocalypse is reframed not as the end of the world but as the ending of worlds. Observing the climate crisis through the scenario of apocalypse shifts the narrative from preserving existing systems to dismantling them. The goal is to disrupt normalised patterns of consumption, mobility, and living through a redirection of systems and lifestyles towards resilient, low-carbon, and collective forms of living. In the context of apocalypse, unbuilding is an anticipatory approach of strategically adapting imaginaries that lock the built society into carbon forms and logics. 

By examining the case study of Berghem, an example of a suburban neighbourhood in Umeå, through the method of unbuilding, the thesis develops into a manual of unbuilding, in which seven interdependent strategies are outlined: Retreating, Desealing, Remediating, Rewilding, Densifying, Commoning and Diversifying. The strategies seek to equip citizens with bottom-up tools to dismantle carbon forms and strive for more collective, low-carbon and ecosystem-centred ways of living.

The thesis argues that mainstream green transitions - such as electrification, circularity, or sustainable growth - are inadequate to address the scale of planetary breakdown. Relying on this idea of decarbonising and greening inherently unsustainable systems fails to address the underlying systemic contradictions of carbon forms and logics, including a reliance on continuous growth and resource extraction. 

True transformation requires not just the greening of suburbia, but its strategic unbuilding. As a spatial and political act of degrowth, unbuilding dismantles the normalised systems and structures that are present within the built environment, in the hope that systemic change prompts inhabitants to reconnect with nature and with each other in the face of planetary instability.

This thesis critically examines the green energy transitions through the lens of energy infrastructures as spatial, social, and political forces. By using Swedish wind energy as a case study across three scales: Sweden (national), Västerbotten County (regional), and Blaiken wind park (local), the research shows how the transition materialises in landscapes, infrastructures, and governance structures. While renewable energy promises to break with fossil fuels, this study shows how wind power often reproduces the entrenched logics of the “carbon form”: energy-intensive, growth and production dominated (Iturbe, 2019; Daggett, 2019). In Sweden, the north-south dynamic reveals uneven geographies of energy, where rural and Sámi territories absorb ecological and social costs while urban and industrial centres reap the benefits. The mapping also illustrates global entanglements, as the material flows sustaining wind power depend on extraction and production in other regions, particularly in the Global South.

The findings suggest that the green transition, as currently implemented, remains bound to growth-oriented paradigms that sideline social justice and ecological limits. In response, the thesis explores speculative alternatives such as energy sufficiency and decentralisation. By extending the principle of “form follows energy,” it argues for a paradigm shift in design, one that attends to relational energies of humans, ecosystems, and landscapes, opening space for more just and situated energy futures.

TGFβ functions as a tumor suppressor or promoter, depending on the context, making TGFβ a useful predictive biomarker. Genes related to TGFβ signaling and Aurora kinase were tested for their ability to predict the progression risk of primary prostate tumors. Using data from The Cancer Genome Atlas (TCGA), we trained an elastic-net regularized Cox regression model including a minimal set of gene expression, copy number (CN), and clinical data. A multi-step feature selection and regularization scheme was applied to minimize the number of features while maintaining predictive power. An independent hold-out cohort was used to validate the model. Expanding from prostate cancer, predictive models were similarly trained on all other eligible cancer types in TCGA. AURKA, AURKB, and KIF23 were predictive biomarkers of prostate cancer progression, and upregulation of these genes was associated with promotion of cell-cycle progression. Extending the analysis to other TCGA cancer types revealed a trend of increased predictive performance on validation data when clinical features were complemented with molecular features, with notable variation between cancer types and clinical endpoints. Our findings suggest that TGFβ signaling genes, prostate cancer related genes and Aurora kinases are strong candidates for patient-specific clinical predictions and could help guide personalized therapeutic decisions.

We introduce near triple arrays as binary row-column designs with at most two consecutive values for the replication numbers of symbols, for the intersection sizes of pairs of rows, pairs of columns and pairs of a row and a column. Near triple arrays form a common generalization of such well-studied classes of designs as triple arrays, (near) Youden rectangles and Latin squares. We enumerate near triple arrays for a range of small parameter sets and show that they exist in the vast majority of the cases considered. As a byproduct, we obtain the first complete enumerations of 6×10 triple arrays on 15 symbols, 7×8 triple arrays on 14 symbols and 5×16 triple arrays on 20 symbols. Next, we give several constructions for families of near triple arrays, and e.g. show that near triple arrays with 3 rows and at least 6 columns exist for any number of symbols. Finally, we investigate a duality between row and column intersection sizes of a row-column design, and covering numbers for pairs of symbols by rows and columns. These duality results are used to obtain necessary conditions for the existence of near triple arrays. This duality also provides a new unified approach to earlier results on triple arrays and balanced grids.

Since the discovery of AlQ3 (Q = 8-quinolinolato) quinolinato complexes, they have been extensively scrutinized as emitter materials for organic lighting. Herein, we report on the first representatives of a series of tetrabutylphosphonium tetrakis(8-quinolinolato)lanthanidate complexes [P4444][Ln(Q)4]·2X (Ln = Dy-Lu and Y; X = H2O for Ln = Dy-Tm, Lu and Y and (CH3)2CO for Ln = Yb), which are synthesised by a simple metathesis reaction of the respective potassium tetrakis(8-quinolinolato)lanthanidate salts with tetrabutylphosphonium bromide in acetone at room temperature. Single-crystal X-ray diffraction reveals that Ln(iii) is coordinated by four bidentate 8-quinolinato ligands in the form of a distorted square antiprism. The distinct [Ln(Q)4]− anions interact with the [P4444]+ cations through secondary bonding interactions, such as CH-π and van der Waals interactions, in addition to electrostatic coulombic interactions. Although these compounds contain crystal water/solvent molecules (and their synthesis does not require an inert atmosphere), they do not enter the metal coordination sphere but form pairwise intramolecular hydrogen bonds with the two 8-quinolinato ligands of the complex lanthanide anions. Combined differential scanning calorimetry-thermogravimetric analysis indicates that crystal water is lost at around 100 °C and [P4444][Ln(Q)4] is formed, which is stable up to 300 °C, where further degradation occurs. All compounds feature strong emission in the green region, originating from the π* → π transitions within the 8-quinolinato ligand, with lifetimes in the nanosecond range. The luminescence colour changes from blue-green to yellow-green depending on Ln3+, which opens up additional directions in the colour tuning of emitters for organic lighting applications.

Seeking healing and transformation, numerous people in the west turn to psychedelic retreats, and psychedelic therapy has been revived. This study aimed to shed light on the often-overlooked qualitative perspective on the transformative potential of psychedelic experiences: psychodynamic, archetypal, and in particular, mystical ones. Lifeworld interviews were therefore conducted with six international participants, and analyzed with an integrated hermeneutic and psychodynamic approach. Based on the experiential accounts, the analysis found that psychedelic experiences can be understood to facilitate a transformation of the self through processes of deconstruction and reconstruction. These processes involved not only the “undoing” of the self through ego dissolution, but also the emergence and integration of unconscious contents. Thereby, the revelatory experience of seeing the self in a new light through the primary process was illuminated, alongside the psyche’s striving for unity and harmony via the synthetic ego functions. These mechanisms also proved to be crucial in understanding the heightened efficacy of mystical experiences. By exploring the meanings individuals ascribe to their psychedelic experiences, this study provides insights that may enrich the understanding of intrapsychic processes that can contribute to lasting psychological transformation.