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Technological and societal developments have increasingly led to higher education programs and courses being offered online as distance education. This can mean an opportunity to study regardless of time and place and thereby combining work, family life, and studies. However, online distance studies also introduce problems at the societal, organisational and individual levels. Due to the rapid transformation of the higher education system towards a larger share of digitalized courses and programs, one can expect that the related problems will also increase. Thus, the present study aimed to investigate experiences and thoughts about challenges and opportunities related to online studies among second-semester master’s students. Data was collected via interviews and analysed using a phenomenographic approach. The analysis revealed increased demands on the student, remote communication and social interaction, and varying conditions for studying from home. The demands on self-leadership, social skills, and digital competence had increased compared to previous campus-based studies at a lower level. These findings pinpoint the importance of taking into consideration student awareness and support regarding self-regulation of study planning, time allocation, and execution of assignments. It also includes teacher awareness of creating a sense of community and avoiding a mere task orientation despite the online context.

The detailed understanding of the conformational pathway of fluticasone, a widely prescribed medicine for allergic rhinitis, asthma, and chronic obstructive pulmonary disease (COPD), from formulation to its protein-bound state, has been limited due to a lack of access to its high-resolution structures. The three-dimensional (3D) structure of fluticasone furoate 1 remains unpublished, and the deposited structure of fluticasone propionate 2 could be further refined due to refinement against new data. We applied microcrystal electron diffraction (MicroED) to determine the 3D structures of 1 and 2 in their solid states. The preferred geometries in solution were predicted by using density functional theory (DFT) calculations. A comparative analysis of the structures of 1 and 2 across three states (in solid state, in solution, and protein-bound conformation) revealed the course of the conformational changes during the entire transition. Potential energy plots were calculated for the most dynamic bonds, uncovering their rotational barriers. This study underscores the combined use of MicroED and DFT calculations to provide a comprehensive understanding of conformational and energy changes during drug administration. The quantitative comparison also highlights the subtle structural differences that may lead to significant changes in the pharmaceutical properties.

Background

Pedagogical meals in preschool are meant to combine learning with nutritious food. Preschools have goals and guidelines for what they should serve, then it is the preschool teacher’s task to support the children in their eating and understanding of how meals work. Iti s important to socialize children through meals and to practice positive eating habits. Preschool teachers have a great influence on children’s eating, in a previous thesis there were differences in the children’s eating when the staff ate at the table with the children compared to when they did not eat at the table with the children.

Purpose

The purpose of the study was to investigate how preschool teachers experienced how their own participation in pedagogical meals affected the children.

Method

The purpose was researched through an interview study with preschool teachers from municipal preschools. Recruitment took place through Facebook with shareable posts in the group Förskolan.se, and between preschool teachers who were asked to recruit other preschool teachers. The interviews followed an interview guide with open-ended questions where participants were encouraged to talk about both positive and negative aspects. Thei nterviews were recorded, transcribed, and analysed using qualitative content analysis.

Results

The results showed that the preschool teachers considered it “correct” when they ate at the table with the children during pedagogical meals, which was confirmed by the children questioning the staff when they did not eat together. Further issues were that they felt the children ate less vegetables, the staff could not demonstrate motor skills with cutlery, and it was more difficult for them to be able to talk about the sensory properties of the food. The conversation and social presence were important. The children were considered to eat better at preschool than at home.

Conclusion

The preschool teachers felt that the conversation and the social togetherness in their participation was important. There are shortcomings where the pedagogical meal is not prioritized enough, where the preschool teacher is placed in a difficult position. Preschool meals would benefit from becoming more of a priority from decision makers.

In his classical contributions, Olavi Kalela proposed that, due to the low primary productivity of the tundra, Norwegian lemmings are locked in a strong interaction with their winter forage plants. Proposedly, Norwegian lemmings respond to the threat of critical resource depletion by conducting long-range migrations at their population peaks. A tacit premise of this conjecture is that predation pressure on the Fennoscandian tundra is too weak to prevent runaway increases of lemming populations, creating violent boom–crash dynamics. Our results on the dynamics of Norwegian lemmings on the Finnmarksvidda tundra during 1977–2017 are in line with the predictions of Kalela's hypothesis. In contrast to the Siberian and North American tundra, densities of avian predators in our study area have been low even during lemming years, and efficient ones have been lacking from lemming habitats. Lemmings have thus increased unhinged in peak summers and crashed to densities below the trappability threshold during post-peak winters. Each lemming crash has been accompanied by massive habitat destruction. Indications of predator activity have been concentrated to productive shrublands, where lemmings have never reached high densities. Young lemmings have responded to high densities by becoming extremely mobile: they have been trapped in large numbers on islands, including a small island in the middle of Iešjávri, a 10 × 8 km tundra lake. Many lemmings have been seen swimming across the lake, and many drowned lemmings have been observed. The dynamics and behavior of Norwegian lemmings recorded by us differ radically from those of other Lemmus spp., indicating that cycles generated by lemming–vegetation interactions have two alternative states – one with and the other without intense summer predation. We propose that the cycles of Norwegian lemmings shifted to the latter state during their unique evolutionary history, when they survived the Last Glacial Maximum in a tiny refugium archipelago.

Purpose: To investigate the eligibility for faricimab in a real-world diabetic macular oedema (DMO) population to the YOSEMITE and RHINE trials, and to compare the eligible DMO populations to the trial populations.

Design, settings and participants: This retrospective cross-sectional analysis used data from the Swedish Macula Registry (SMR) between 1 January 2019 and 31 August 2023. Eligibility criteria mirrored the main criteria of the YOSEMITE and RHINE trials: (1) DMO diagnosis, (2) treatment-naïve, (3) 18 years or older, (4) central retinal thickness (CRT) 325 µm or higher and (5) best-corrected visual acuity (BCVA) ranging from 25 to 73 letters. Individuals with registered proliferative diabetic retinopathy (DR) at the start of treatment were excluded. A secondary selection of eligible individuals was conducted using the same criteria, except for BCVA, which ranged from 25 to 77 letters according to national guidelines (treatment practice).

Main outcome measures: Characteristics at the initial visit of the two eligible SMR populations were compared with baseline data from the clinical trials, respectively.

Results: In total, 3777 individuals with DMO were selected from SMR. Of these, 2357 (62.4%) individuals were treatment-naïve, all were 18 years or older, 1928 (51.0%) exhibited CRT≥325 µm, 1175 (31.1%) had 25-73 letters based on phase III studies, while 1528 (40.5%) had 25-77 letters according to treatment practice. After excluding individuals with registered proliferative DR 1171 (31.0%) individuals in the SMR met all criteria based on phase III studies, while 1522 (40.3%) individuals fulfilled the criteria according to treatment practice. The SMR and treatment practice populations were older (YOSEMITE 67.5±11.6 vs 62.8±10.0 years, p<0.001 and RHINE 67.5±11.6 vs 61.6±10.1 years, p<0.001) than those in the phase III studies and had lower CRT (YOSEMITE 446±96 vs 486±131 µm, p<0.001 and RHINE 446±96 vs 471±127 µm, p=0.001).

Conclusion: Approximately 30% of DMO patients in the SMR met the main trial criteria from YOSEMITE and RHINE, while around 40% met the criteria based on treatment practice. The SMR and treatment practice cohorts were older and had less severe DMO than the trial cohorts. Further research into the safety profile of faricimab in clinical settings is necessary, along with the consideration of additional eligibility criteria when implementing faricimab in ophthalmology practice.

The Wadden Sea is the world’s largest intertidal area and a UNESCO World Heritage Site. Macrozoobenthic invertebrates perform key ecological functions within intertidal areas by regulating nutrient cycles, decomposing organic matter, and providing food for fish, birds and humans. To understand ecological processes and human impacts on biodiversity, the Synoptic Intertidal BEnthic Survey (SIBES) has sampled intertidal macrozoobenthos since 2008. On average 4,109 stations across 1,200 km² of Dutch Wadden Sea mudflats are sampled from June to October to quantify the benthic invertebrate community and sediment composition, including species abundance and biomass, and grain size and mud content. The dataset published now contains 51,851 sampled stations with 3,034,760 individuals of 177 species. This paper details data collection, validation and processing methods. SIBES is ongoing and data will be updated yearly. In sharing these data, we hope to enhance collaborations and understanding of the impact of various pressures on macrozoobenthic invertebrates, sediment composition, food webs, the ecosystem, and biodiversity in the Wadden Sea and other intertidal habitats.

Background: Normal brain aging is associated with dopamine decline, which has been linked to age-related cognitive decline. Factors underlying individual differences in dopamine integrity at older ages remain, however, unclear. Here we aimed at investigating: (i) whether inflammation is associated with levels and 5-year changes of in vivo dopamine D2-receptor (DRD2) availability, (ii) if DRD2-inflammation associations differ between men and women, and (iii) whether inflammation and cerebral small-vessel disease (white-matter lesions) serve as two independent predictors of DRD2 availability.

Methods: Analyses were performed in a sample of healthy adults > 60 years assessed at two measurement occasions separated by 5 years. At both occasions, DRD2 availability was estimated by ¹¹C-raclopride PET, and white-matter lesions by MRI. Inflammation was assessed by two C-reactive protein-associated DNA methylation scores at study baseline.

Results: Individuals with higher DNA methylation scores at baseline showed reduced striatal DRD2 availability. An interaction was found between DNA methylation scores and sex in relation to striatal DRD2 availability, such that associations were found in men but not in women. DNA methylation scores at study entrance were not significantly associated with 5-year striatal DRD2 decline rates. No significant association was found between DNA methylation scores and white-matter lesions, but higher scores as well as higher lesion burden were independently associated with reduced striatal DRD2 availability in men.

Conclusions: These findings suggest negative associations between one proxy of inflammation and DRD2 availability in older adults, selectively for men who had higher DNA methylation scores. Future studies should investigate other inflammatory markers in relation to dopamine integrity.

In this paper, we empirically investigate how environmental protection expenditures affect sector-level employment within manufacturing industries, using detailed firm-level data for Sweden for the years 2002–2021. We use a structural model that allows for a decomposition of the total employment effect of environmental protection expenditures within a sector into a cost effect, a factor shift effect, and a demand effect. We add to previous literature by using instrumental variables in our empirical framework, to account for endogenous environmental spending stemming from, e.g., corporate social responsibility and self-regulation. Our results reveal that increased environmental protection expenditures generally have no statistically significant effect on employment among the sectors studied, with the paper and pulp sector being the exception, showing non-negligible negative effects on employment.

To meet the aim of synthesising research on nurses' experiences of promoting personal recovery within psychiatric inpatient care, meta ethnography according to Noblit and Hare has been chosen as the method, which is a qualitative review of scientific literature that results in a synthesis. The focus is on interpretation and is expressed to be able to reduce a story, but at the same time keep what is unique using metaphors. Nine articles formed the basis of the synthesis. The analysis resulted in two levels of synthesis. The first level involved the translation of metaphors into one another, which proceeded in two directions, described as two principal headings. The second level produced five overarching metaphors. The first principal heading is that ‘erected walls in psychiatric inpatient care impedes personal recovery.’ It encompasses the overarching metaphors ‘cultivating in exhausted soil’ and ‘nurses are gatekeeping watchdogs’. The second principal heading is ‘torn-down walls in psychiatric inpatient care enable personal recovery’. It encompasses the overarching metaphors ‘disarming and de-escalating’, ‘facing suffering together reveals treasures’ and ‘elevating the competent partner promotes recovery’. Conclusively, if the nurse is to be able to promote personal recovery in psychiatric inpatient care, bridges of cooperation and consensus need to be built to other professions in care. Otherwise, the obstacles to promoting personal recovery will be far too hard to overcome.

Gängkriminalitet i Sverige är ett aktuellt problem. Gängkriminalitet visar sig i tidigare forskning som ett avgörande och växande problem för samhället. Fenomenet ter sig i uttryck i framför allt utsatta områden som präglas av gängens inflytande, med våld riktat mot poliser, ambulanspersonal, egenföretagare, civilpersoner och andra gäng. Studiens syfte är att göra en litteraturöversikt över publikationer som studerar gängkriminalitet med fokus på att identifiera publikationer som belyser orsaker till gängkriminalitet i Sverige. Med forskningsfrågan: Vad visar forskning för evidens till orsaker till gängkriminalitet i Sverige? Narrativ review tillsammans med datainsamling inspirerat av arbetsprocess för scoping review visade att 25 artiklar berörde gängkriminalitet och att sex av dessa handlade om eller belyste orsaker till gängkriminalitet. De inkluderade sex artiklarna analyserades med en tematisk analys. Tematiseringen visade teman som yttre och inre faktorer till orsaker till gängkriminalitet. Bland yttre faktorer identifierades underkategorier såsom, miljö, sanktioner, inlärning och grupptryck. Bland inre faktorer identifierades tillhörighet, motivation och psykologiska orsaker. Dessa teman och underkategorier kan hjälpa till att förstå varför gäng bildas, kriminalitet inom gäng fortgår och varför individer går med i gäng. Studiens huvudfynd demonstrerar att miljö och tillhörighet var två primära underkategorier till att begripliggöra orsaker till gängkriminalitet och att endast sex artiklar berörde orsaker till gängkriminalitet i Sverige.

Histones are conserved nuclear proteins that function as part of the nucleosome in the regulation of chromatin structure and gene expression. Interestingly, extracellular histones populate biofluids from healthy individuals, and when elevated, may contribute to various acute and chronic diseases. It is generally assumed that most extracellular histones exist as nucleosomes, as components of extracellular chromatin. We analysed cell culture models under normal and stressed conditions to identify pathways of histone secretion. We report that core and linker histones localize to extracellular vesicles (EVs) and are secreted via the multivesicular body/exosome pathway. Upregulation of EV histone secretion occurs in response to cellular stress, with enhanced vesicle secretion and a shift towards a population of smaller EVs. Most histones were membrane associated with the outer surface of EVs. Degradation of EV-DNA did not impact significantly on EV-histone association. Individual histones  and histone octamers bound strongly to liposomes and EVs, but nucleosomes did not, showing histones do not require DNA for EV binding. Histones colocalized to tetraspanin positive EVs but using genetic or pharmacological intervention, we found that all known pathways of exosome biogenesis acted positively on histone secretion. Inhibition of autophagy and lysosomal degradation had a strong positive effect on EV histone release. Unexpectedly, EV-associated histones lacked the extensive post-translational modification of their nuclear counterparts, suggesting loss of PTMs may be involved in their trafficking or secretion. Our data does not support a significant role for EV-histones existing as nucleosomes. We show for the first time that histones are secreted from cells as membrane proteins via EVs/exosomes. This fundamental discovery provides support for further investigation of the biological activity of exosome associated histones and their role in disease.

BACKGROUND: Ankylosing spinal disorders (ASD) increase the risk of unstable cervical spine fractures, posing a significant mortality risk. Surgery is recommended for patients with neurological deficits, but the effectiveness of non-surgical treatment in those without deficits remains unclear. This study aimed to compare survival rates between surgical and non-surgical treatments of ASD-related cervical fractures in a matched cohort.

METHODS: The study analyzed data from the Swedish Fracture Registry (SFR) on adult patients treated for ASD-related cervical spine fractures between January 2015 and December 2021. Preoperative variables included age, sex, trauma type, neurological function, fracture morphology, and treatment method. Propensity score matching was conducted to compare outcomes between treatment groups, ensuring balanced comparison groups regarding age, sex, type of trauma, time from injury to admission, fracture type, level of injury, and neurological function.

RESULTS: In total, 357 adult patients with ASD-related cervical spine fractures were analyzed. Among them, 186 were treated surgically and 171 non-surgically. Treatment failure and conversion so surgical treatment was seen in 3.4% of the non-surgically treated patients. Most patients were male (80%), with a median age of 75 years. Fractures were mainly caused by low-energy trauma (69%). Most patients (92%) were ambulatory (Frankel grade D or E). In the unmatched analysis, surgically treated patients had significantly lower 1-year mortality rates (13% vs. 22%; p < 0.001), but after matching, there were no longer any difference between the two groups (16% vs. 22%; p = 0.44). These findings were also validated on Kaplan-Meier analysis. Multivariable logistic regression analysis identified high age as the only predictor for 30-day mortality (OR 1.14 [95% CI 1.09-1.22], p < 0.001).

CONCLUSION: Following propensity score matching, surgical and conservative management result in similar mortality outcomes for neurologically intact patients with ASD fractures. Age, rather than treatment approach, emerged as a stronger predictor of overall mortality. Nonetheless, treatment decisions should also consider other clinical outcomes beyond mortality, emphasizing the need for an individualized approach until more robust evidence is available.

Background: The Vertigo Symptom Scale–short form (VSS–SF) is commonly used to measure dizziness and vertigo over the past month. This study aimed to (1) adapt the VSS–SF for the Swedish population and assess its psychometric properties, and (2) develop a modified version for measuring symptoms in the acute phase of acute vestibular syndrome (AVS).

Methods: The VSS–SF was translated into Swedish and adapted cross-culturally. Its psychometric properties were evaluated in 86 AVS patients, both in the acute stage (1–7 days from symptom onset) with a modified acute version, and after six weeks of vestibular rehabilitation using the standard VSS–SF. Factor structure, convergent and discriminant validity, and internal consistency were analyzed. Test-retest reliability was assessed at six weeks. Participants were also evaluated with the Dizziness Handicap Inventory (DHI) and balance tests. Controls included 54 healthy participants.

Results: Exploratory factor analysis revealed a two-factor structure for both versions, corresponding to vertigo-balance (VSS–V) and autonomic-anxiety (VSS–A) subscales. Both versions demonstrated strong factor structures with adequate loadings. Internal consistency was high for the standard version (Cronbach’s alpha 0.76 to 0.87) and for the total and VSS–V subscale of the acute version (0.82 and 0.85, respectively), but poor for the acute VSS–A subscale (0.50). Convergent validity was supported by Spearman’s rank correlations. The discriminative ability was excellent for the acute VSS–SF and VSS–V (AUC 0.98 and 0.99), and acceptable for VSS–A (AUC 0.77). After six weeks, discriminative ability decreased but remained above 0.5. Test-retest reliability at six weeks was excellent for all scales (ICC 0.94, 0.93, and 0.93 for VSS–SF, VSS–V, and VSS–A).

Conclusions: The VSS–SF was successfully adapted for the Swedish population, including an acute version for early dizziness assessment. Both versions confirmed a robust two-factor structure, with the acute version showing excellent early discriminative ability, particularly for the vertigo-balance dimension. However, the autonomic-anxiety subscale showed weaker psychometric properties, suggesting limited suitability for AVS patients. The adapted scales show promise for clinical use in diagnosing and evaluating dizziness and vertigo in the Swedish population.

Trial registration: Clinicaltrials.gov Identifier NCT05056324, September 24, 2021. https://clinicaltrials.gov/ct2/show/NCT05056324.

Aims: The aim of this study was to describe the prevalence, associations, and reasons for the use of complementary and alternative medicine (CAM) in Sweden, as well as to further explore possible self-perceived outcomes including adverse effects as well as the sources of information used.

Methods: Data were collected by a cross-sectional survey, administered by computer assisted telephone interviews, in June 2020 (n = 500), during the first three months of the COVID-19 pandemic. The survey was a modified version of the International Questionnaire to measure use of Complementary and Alternative Medicine (I-CAM-Q) instrument.

Results: 63.6% of respondents reported use of CAM. The most common reasons for use were to improve general well-being and/or to treat long-term illness or its symptoms. Very few used CAM to prevent or treat COVID-19. The most used CAMs were natural remedies and dietary supplements (50%), followed by self-help practices (33.2%) and consultation of CAM providers (13%). Women, those of older age (40+), and living in larger cities were more likely to use CAMs compared to the entire sample. Household income or level of education did not predict CAM use. Few adverse effects were reported. The main sources for information were media and the Internet followed by family and friends.

Conclusions: This study contributes with updated knowledge about Swedish citizens’ use of CAM. The results are important to inform health care policy about patterns of CAM use among Swedish citizens.

Introduction: Computational sciences have significantly contributed to characterizing airway disease phenotypes, complementing medical expertise. However, comparing studies that derive phenotypes is challenging due to varying decisions made during phenotyping. We conducted a systematic review to describe studies that utilized unsupervised computational approaches for phenotyping obstructive airway diseases in children and adults.

Methods: We searched for relevant papers published between 2010 and 2020 in PubMed, EMBASE, Scopus, Web of Science, and Google Scholar. Additional sources included conference proceedings, reference lists, and expert recommendations. Two reviewers independently screened studies for eligibility, extracted data, and assessed study quality. Disagreements were resolved by a third reviewer. An in-house quality appraisal tool was used. Evidence was synthesized, focusing on populations, variables, and computational approaches used for deriving phenotypes.

Results: Of 120 studies included in the review, 60 focused on asthma, 19 on severe asthma, 28 on COPD, 4 on asthma-COPD overlap (ACO), and 9 on rhinitis. Among asthma studies, 31 focused on adults and 9 on children, with phenotypes related to atopy, age at onset, and disease severity. Severe asthma phenotypes were characterized by symptomatology, atopy, and age at onset. COPD phenotypes involved lung function, emphysematous changes, smoking, comorbidities, and daily life impairment. ACO and rhinitis phenotypes were mostly defined by symptoms, lung function, and sensitization, respectively. Most studies used hierarchical clustering, with some employing latent class modeling, mixture models, and factor analysis. The comprehensiveness of variable reporting was the best quality indicator, while reproducibility measures were often lacking.

Conclusion: Variations in phenotyping methods, study settings, participant profiles, and variables contribute to significant differences in characterizing asthma, severe asthma, COPD, ACO, and rhinitis phenotypes across studies. Lack of reproducibility measures limits the evaluation of computational phenotyping in airway diseases, underscoring the need for consistent approaches to defining outcomes and selecting variables to ensure reliable phenotyping.

The facultative pathogen Listeria monocytogenes uses a master regulator, PrfA, to tightly control the fitness-costly expression of its virulence factors. We found that PrfA activity is repressed via competitive occupancy of the binding site for the PrfA-activating cofactor, glutathione, by exogenous nutritional oligopeptides. The inhibitory peptides show different sequence and physicochemical properties, but how such a wide variety of oligopeptides can bind PrfA was unclear. Using crystal structure analysis of PrfA complexed with inhibitory tri- and tetrapeptides, we show here that the binding promiscuity is due to the ability of PrfA β5 in the glutathione-binding inter-domain tunnel to establish parallel or antiparallel β sheet-like interactions with the peptide backbone. Spacious tunnel pockets provide additional flexibility for unspecific peptide accommodation while providing selectivity for hydrophobic residues. Hydrophobic contributions from two adjacent peptide residues appear to be critical for efficient PrfA inhibitory binding. In contrast to glutathione, peptide binding prevents the conformational change required for the correct positioning of the DNA-binding helix-turn-helix motifs of PrfA, effectively inhibiting virulence gene expression.

Background: Exercise-induced metabolic changes, especially lipidomic changes are generally associated with improvements in cardiovascular health. Despite numerous previous studies, the differences in lipidomic profile response to different types of exercise training remain unclear. This study aimed to investigate how two different exercise intensities affect aerobic capacity and serum lipidomic profiles in healthy adolescents.

Methods: Twenty-four healthy untrained male adolescents (13.08 ± 0.88 years old) were recruited and randomly assigned to moderate-intensity continuous training (MICT) group or sprint interval training (SIT) group to complete a specific training on a cycle ergometer for 6 weeks. Peak oxygen uptake (VO2peak) and body composition were measured, and blood samples were collected for serum lipoproteins and lipidomic analysis. Anthropometric, VO2peak, and serum biochemical data were analyzed using two-way repeated analysis of variance, while targeted lipidomic analysis was performed by principal component analysis and paired-sample t-test.

Results: VO2peak significantly improved from 39.05 ± 8.17 to 47.52 ± 8.51 [F (1, 44) = 14.75, p < 0.05] for MICT and from 40.13 ± 6.37 to 48.42 ± 7.01 [F (1, 44) = 14.75, p < 0.05] for SIT. A total of 28 lipids in MICT and 5 lipids in SIT showed significant changes out of 276 identified lipids (FC > 1.5 or <1/1.5, FDR <0.05). In MICT, 21 lipids, including sphingolipid (SP) and phospholipid (PL), decreased, while 7 lipids increased. In SIT, all 5 lipids, which were free fatty acid (FFA), decreased.

Conclusion: Although both MICT and SIT induced similar and significant improvements in VO2peak, serum lipid adaptations to the training differed. The primary changes in serum lipidomic intermediates for both types of training were reductions; however, SIT affected FFA, while MICT predominantly influenced SPs and PLs.

Objectives: The study aimed to describe and compare the clinical physiotherapy management of patients hospitalised due to chest trauma in South Africa (SA) and Sweden.

Design: A prospective observational multicentre international study.

Setting: Two university-Affiliated public sector hospitals in SA and four university-Affiliated public sector hospitals in Sweden.

Participants: In total, 364 adults, hospitalised due to chest trauma were consecutively recruited of which 179 were from SA and 185 were from Sweden.

Outcome measures: Physiotherapy practice was recorded in parallel with standard care. In addition, pulmonary complications and length of hospital stay were collected.

Results: Despite differences in the type of trauma between the national cohorts (83% penetrating traumas in SA and 95% blunt traumas in Sweden), most patients received physiotherapy treatment during the first 3 days in hospital. Physiotherapy interventions such as mobilisation (day 1: sit on edge of bed; days 1-3: walking) and exercises to maintain range of motion (days 1-3: shoulder; day 3: trunk) were initiated earlier in SA (p<0.05). Treatment with the active cycle of breathing technique was more used in SA while deep breathing exercises were more common in Sweden and positive expiratory pressure was common in both countries. Length of stay was in mean 5.4 (95% CI 4.8, 6.0) days in SA and 6.6 (5.8, 7.4) days in Sweden (p=0.024).

Conclusions: Despite differences in trauma panoramas and the national cohorts there seem to be similarities in clinical physiotherapy practices between the two countries.

Background: The associations between physical activity and various social determinants with quality of life (QoL) among teenagers with cerebral palsy (CP) are inconclusive.

Objective: To explore associations between perceived QoL among teenagers with CP in Sweden and participation in physical leisure activity and physical education in school, as well as sex, gross motor function, pain and bother, caregivers’ birth country and socioeconomic status.

Methods: A cross-sectional study with teenagers who have CP, aged 15–18 years. The survey, including the assessment form Cerebral Palsy Quality of Life-teenager (CP QoL-teen), was sent to all youths in the national patient registry held by the Swedish National Board of Health and Welfare (n = 900). Survey data was complemented with data from other national health registries containing information on demographics, physical leisure activity, physical education, and gross motor function. Multivariable linear- and quantile regression analyses were performed.

Results: The survey was answered by 149 participants. Physical leisure activity was positively associated with the QoL-domain Communication and physical health. Gross motor function was associated with domains referring to physical function and participation; more severe motor difficulties indicated lower QoL. Pain was negatively associated with all QoL domains. Low caregiver educational levels were associated with higher social well-being domain.

Conclusion: Minimizing pain and facilitating physical activity may enhance QoL for teenagers who have CP. To improve participation for teenagers with severe disabilities, with non-Nordic caregivers, and caregivers without postgraduate education, targeted measures to facilitate participation are needed.

Purpose: To evaluate current MRI-based criteria for malignancy in mesorectal nodal structures in rectal cancer.

Method: Mesorectal nodal structures identified on baseline MRI as lymph nodes were anatomically compared to their corresponding structures histopathologically, reported as lymph nodes, tumour deposits or extramural venous invasion. All anatomically matched nodal structures from patients with primary surgery and all malignant nodal structures from patients with neoadjuvant treatment were included. Mixed-effects logistic regression models were used to evaluate the morphological criteria irregular margin, round shape, heterogeneous signal and nodal size, as well as the combined 2016 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus criteria, with histopathological nodal status as the gold standard.

Results: In total, 458 matched nodal structures were included from 46 patients (mean age, 67.7 years ± 1.5 [SD], 27 men), of which 19 received neoadjuvant treatment. The strongest associations in the univariable model were found for short-axis diameter ≥ 5 mm (OR 21.43; 95% CI: 4.13–111.29, p < 0.001) and heterogeneous signal (OR 9.02; 95% CI: 1.33–61.08, p = 0.024). Only size remained significant in multivariable analysis (OR 12.32; 95% CI: 2.03–74.57, p = 0.006). When applying the ESGAR consensus criteria to create a binary classification of nodal status, the OR of malignant outcome for nodes with positive ESGAR was 8.23 (95% CI: 2.15–31.50, p = 0.002), with corresponding sensitivity and specificity of 54% and 85%, respectively.

Conclusion: The results confirm the role of morphological and size criteria in predicting lymph node metastases. However, the current criteria might not be accurate enough for nodal staging.

Background: Left-sided pancreatic cancer is associated with worse overall survival (OS) compared with right-sided pancreatic cancer. Although neoadjuvant therapy is currently seen as not effective in patients with resectable pancreatic cancer (RPC), current randomized trials included mostly patients with right-sided RPC. The purpose of this study was to assess the association between neoadjuvant therapy and OS in patients with left-sided RPC compared with upfront surgery.

Patients and methods: This was an international multicenter retrospective study including consecutive patients after left-sided pancreatic resection for pathology-proven RPC, either after neoadjuvant therapy or upfront surgery in 76 centers from 18 countries on 4 continents (2013-2019). The primary endpoint was OS from diagnosis. Time-dependent Cox regression analysis was carried out to investigate the association of neoadjuvant therapy with OS, adjusting for confounders at the time of diagnosis. Adjusted OS probabilities were calculated.

Results: Overall, 2282 patients after left-sided pancreatic resection for RPC were included of whom 290 patients (13%) received neoadjuvant therapy. The most common neoadjuvant regimens were (m)FOLFIRINOX (38%) and gemcitabine-nab-paclitaxel (22%). After upfront surgery, 72% of patients received adjuvant chemotherapy, mostly a single-agent regimen (74%). Neoadjuvant therapy was associated with prolonged OS compared with upfront surgery (adjusted hazard ratio 0.69, 95% confidence interval 0.58-0.83) with an adjusted median OS of 53 versus 37 months (P = 0.0003) and adjusted 5-year OS rates of 47% versus 35% (P = 0.0001) compared with upfront surgery. Interaction analysis demonstrated a stronger effect of neoadjuvant therapy in patients with a larger tumor (Pinteraction = 0.003) and higher serum carbohydrate antigen 19-9 (CA19-9; Pinteraction = 0.005). In contrast, the effect of neoadjuvant therapy was not enhanced for splenic artery (Pinteraction = 0.43), splenic vein (Pinteraction = 0.30), retroperitoneal (Pinteraction = 0.84), and multivisceral (Pinteraction = 0.96) involvement.

Conclusions: Neoadjuvant therapy in patients with left-sided RPC was associated with improved OS compared with upfront surgery. The impact of neoadjuvant therapy increased with larger tumor size and higher serum CA19-9 at diagnosis. Randomized controlled trials on neoadjuvant therapy specifically in patients with left-sided RPC are needed.

To propagate their genetic material, flowering plants rely on the production of large amounts of pollen grains that are capable of germinating on a compatible stigma. Pollen germination and pollen tube growth are thought to be extremely energy-demanding processes. This raises the question of whether mitochondria from pollen grains are specifically tuned to support this developmental process. To address this question, we isolated mitochondria from both mature pollen and floral buds using the isolation of mitochondria tagged in specific cell-type (IMTACT) strategy and examined their respective proteomes. Strikingly, mitochondria from mature pollen grains have lost many proteins required for genome maintenance, gene expression, and translation. Conversely, a significant accumulation of proteins associated with the tricarboxylic acid (TCA) cycle, the electron transport chain (ETC), and Ca2+ homeostasis was observed. This supports the current model in which pollen requires large quantities of ATP for tube growth but also identifies an unexpected depletion of the gene expression machinery, aligned with the fact that the mitochondrial genome is actively degraded during pollen maturation. Altogether, our results uncover that mitochondria from mature pollen grains are strategically prepared for action by increasing their respiratory capacity and dismantling their gene expression machinery, which raises new questions about the assembly of respiratory complexes in pollen mitochondria, as they rely on the integration of proteins coded by the nuclear and mitochondrial genomes. In addition, the approach described here opens a new range of possibilities for studying mitochondria during pollen development and in pollen-specific mitochondrial events.

This study investigates the effects of various chemical and physical treatments on the structural and surface properties of activated carbon and hydrochar. Both materials were subjected to treatments with hydrochloric acid, sodium hydroxide, and ethylenediaminetetraacetic acid solutions, as well as microwave irradiation and hydrothermal processing. The resulting changes were analyzed using scanning electron microscopy, energy-dispersive X-ray spectroscopy, nitrogen adsorption-desorption isotherms, and X-ray photoelectron spectroscopy. Results indicate that activated carbon exhibits remarkable chemical resistance, maintaining its intrinsic porous framework across all treatments. However, subtle modifications in surface chemistry were observed, with acid and base treatments slightly increasing the surface area, while ethylenediaminetetraacetic acid treatment decreased it. Hydrochar exhibited more significant changes, notably a drastic reduction in surface area and porosity following sodium hydroxide treatment, indicating low alkaline resistance. Microwave and hydrothermal treatments showed potential as regeneration methods for both materials, slightly increasing the specific surface area while preserving the physical structure. X-ray photoelectron spectroscopy revealed increases in oxygen-containing functional groups for activated carbon after treatments, while hydrochar showed more variable changes, notably in carbonyl functionalities. This comprehensive study provides crucial insights for optimizing the regeneration and modification processes of carbon-based adsorbents, potentially enhancing their performance and sustainability in water treatment applications.

In the present article, the author discusses two Old Norse texts that may indicate that the Sami cult of sieidis had spread to the neighbouring Old Norse culture in the period before the Christianization of Norway. One of these texts is found in the Older Eiðsifaþing law, the law of the inland part of Eastern Norway. According to this law, it was prohibited to believe in (the power of) the finnar (Sami), and among their powerful objects, rót (the root of a tree) is mentioned. This root is in all likelihood a Sami sieidi that was sought out by Norwegians for help, probably for medical reasons. The other text is a notice in the Icelandic Landnámabók in which it is mentioned that a settler from Northern Norway worshipped some stones in the outfields on the border of his settlement, called Gunnsteinar. There are closer parallels to this outfields cult in Sami culture than in Old Norse culture.

The question of personal religion among the ancient Scandinavians has centered around the concept of having a deity as one’s fulltrúi ‘trustworthy friend,’ ástvinr ‘close friend,’ or vinr ‘friend.’ Most scholars of the twentieth century regarded the concept as a true expression of pre-Christian Germanic belief. By contrast, modern scholarship strongly tends to see it as a construct of medieval authors who took the saints’ cult as a model to describe the personal piety of their ninth and tenth century compatriots. On the basis of a passage in the Old Norse translation of Clemens saga, corroborated with archaeological evidence and some skaldic verse, e.g. Sonatorrek, the present study argues that the religious concept of fulltrúi and its parallel terms developed in pre-Christian times.

Compensation is a common strategy to alleviate financial losses caused by wildlife, but its effects on farmers' tolerance towards damage to crops caused by wildlife are poorly understood. To address this knowledge gap, we conducted semi-structured interviews in three areas in and around biosphere reserves in Sweden and Germany to examine farmers' appraisals of wildlife-related crop damage and their evaluation of financial compensation in relation to crop damage prevention measures. We found that tolerated yield loss was higher and more variable with compensation compared to a scenario without compensation. Yet, also under a scenario of full financial compensation, farmers tolerated a median of less than 10% yield loss. Using an environmental stress model, our analysis revealed that farmers' perception of crop damage risk was influenced by their experience with wildlife and crop damage, their coping appraisals (e.g. accessibility of prevention measures and compensation), and individual motivations. Our results indicate that while compensation can be effective, its success to increase tolerance to crop damage varies most likely based on farmers' values and how they perceive administrative challenges. Effective management of wildlife-related crop damage near and within protected areas should thus combine compensation schemes with tailored communication and crop damage prevention strategies involving governmental authorities, farmers, and other stakeholders.

AIM: This study explores HICGs' experience of disaster response during a terrorist-induced major incident major incident.

DESIGN: A qualitative descriptive design with individual semi-structured interviews was used.

METHODS: This was a qualitative study based on seven individual interviews. Participants were members of hospital incident command groups during a terror attack. The interviews were transcribed verbatim and analyzed using deductive content analysis. The SRQR checklist was used to report the findings.

RESULTS: The data created from the interviews identified barriers and facilitators for hospital response as well as aligned with previously established categories: Expectations, prior experience, and uncertainty affect hospital incident command group response during a Major Incident and three categories, (I) Gaining situational awareness (containing two subcategories), (II) Transitioning to management (containing three subcategories) and (III) Experiences of hospital incident command group response (containing two subcategories). In addition, the results suggest that an exaggerated response may have led to unanticipated adverse events.

CLINICAL TRIAL NUMBER: Not applicable.

All nations have their own view of the world in which they live, of nature, of society, and of the human self. The Hokkaido Ainu’s world view, for example, is deeply connected with their way of life, backed by man–nature relationships, and what this relationship symbolizes is always part of their rituals. The Ainu are known as one of the peoples, like the Sami, the Khanty, and the Nivkh, who perform a bear festival, although they deify the bear and refer to it using the term kamui [‘deity’ or ‘spirit’]. Moreover, the Ainu and the Nivkh perform the bear ceremony for a bear cub reared by them, although the meaning of the ceremonies differ between them. This paper aims to reveal the Ainu conception of the bear and bear ceremony, which enables them to hunt the deified bear, in terms of the Ainu bear ceremonial, their conception of kamui, and human-kamui relationships. The study reveals that the Ainu logic for hunting the bear, or kamui, is encapsulated in an idea about the necessity of maintaining the complementary and reciprocal relationship between humans and the kamui and, as such, the bear ceremony is a symbolic representation of this relationship.

Background: Despite several studies suggesting a potential oligogenic risk model in amyotrophic lateral sclerosis (ALS), case-control statistical evidence implicating oligogenicity with disease risk or clinical outcomes is limited. Considering its direct clinical and therapeutic implications, we aim to perform a large-scale robust investigation of oligogenicity in ALS risk and in the disease clinical course. Methods: We leveraged Project MinE genome sequencing datasets (6711 cases and 2391 controls) to identify associations between oligogenicity in known ALS genes and disease risk, as well as clinical outcomes. Results: In both the discovery and replication cohorts, we observed that the risk imparted from carrying multiple ALS rare variants was significantly greater than the risk associated with carrying only a single rare variant, both in the presence and absence of variants in the most well-established ALS genes. However, in contrast to risk, the relationships between oligogenicity and ALS clinical outcomes, such as age of onset and survival, did not follow the same pattern. Conclusions: Our findings represent the first large-scale, case-control assessment of oligogenicity in ALS and show that oligogenic events involving known ALS risk genes are relevant for disease risk in ∼6% of ALS but not necessarily for disease onset and survival. This must be considered in genetic counselling and testing by ensuring to use comprehensive gene panels even when a pathogenic variant has already been identified. Moreover, in the age of stratified medication and gene therapy, it supports the need for a complete genetic profile for the correct choice of therapy in all ALS patients.

Despite major advances in artificial intelligence (AI) research for healthcare, the deployment and adoption of AI technologies remain limited in clinical practice. This paper describes the FUTURE-AI framework, which provides guidance for the development and deployment of trustworthy AI tools in healthcare. The FUTURE-AI Consortium was founded in 2021 and comprises 117 interdisciplinary experts from 50 countries representing all continents, including AI scientists, clinical researchers, biomedical ethicists, and social scientists. Over a two year period, the FUTURE-AI guideline was established through consensus based on six guiding principles-fairness, universality, traceability, usability, robustness, and explainability. To operationalise trustworthy AI in healthcare, a set of 30 best practices were defined, addressing technical, clinical, socioethical, and legal dimensions. The recommendations cover the entire lifecycle of healthcare AI, from design, development, and validation to regulation, deployment, and monitoring.

Objective: The aim of this study was to evaluate the utilization and impact of emergency computed tomography (CT) on the management of renal colic, focusing on treatment decisions, time to treatment and the subsequent need for additional emergency department (ED) visits.

Materials and methods: Retrospective analysis of patient visits to the ED in Helsingborg with a diagnosis of urolithiasis (ICD codes N20-23) between July 1, 2019 and June 30, 2020.

Results: Out of 64,263 visits, 1.4% (880) visits were related to urolithiasis, involving 612 patients. Emergency CT (within 24 h) was performed in 43% of the cases, with an additional 9% undergoing CT at a subsequent emergency visit. Radiological confirmation of kidney or ureteral stone was found in 324 patients, of which 63% (204) required no treatment. Comparison between patients who underwent emergency CT and those who did not, revealed a significantly shorter time to treatment and closure in the emergency CT group. The median time to treatment was 28 days for those with an emergency CT and 59 days for those without (P < 0.001), acute surgery excluded. The median time to closure was 31 days for emergency CT compared to 37 days without emergency CT (P < 0.010), acute surgery excluded.

Conclusion: In this study, the use of emergency CT shortened the time to treatment and rendered the patient stone free earlier compared to deferred diagnostics, with a note of caution that emergency CT may have led to increased surgical treatments for stones that might otherwise have passed spontaneously.

ClinicalTrials.gov Identifier: NCT06535711.

Probabilistic metric spaces are natural extensions of metric spaces, where the function that computes the distance outputs a distribution on the real numbers rather than a single value. Such a function is called a distribution function. F-spaces are constructions for probabilistic metric spaces, where the distribution functions are built for functions that map from a measurable space to a metric space. In this paper, we propose an extension of F-spaces, called Generalized F-space. This construction replaces the metric space with a probabilistic metric space and uses fuzzy measures to evaluate sets of elements whose distances are probability distributions. We present several results that establish connections between the properties of the constructed space and specific fuzzy measures under particular triangular norms. Furthermore, we demonstrate how the space can be applied in machine learning to compute distances between different classifier models. Experimental results based on Sugeno λ-measures are consistent with our theoretical findings.

The plasma package Analyzer of Space Plasma and Energetic Atoms (ASPERA-3) onboard Mars Express has observed ions and electrons accelerated by the Mars Advanced Radar for Subsurface and Ionosphere Sounding (MARSIS) radar when it operates in its active ionospheric sounding mode. To better study the processes involved, new operational modes for MARSIS have been developed. In the first, a fixed frequency mode, the transmitter does not sweep over a range of frequencies, as normal, but instead transmits pulses at a fixed frequency. This frequency has been chosen to be close to the fundamental frequency of the local ionosphere around the spacecraft, which in all cases is < 350 kHz. Also, an alternating mode has been introduced, where observations in the fixed frequency mode are interleaved with observations that sweep over frequencies in order to investigate how ions are accelerated. Here we describe the new operational modes and present the results of several tests performed in the years 2020, 2021, and 2023.

In the autumn of 1944, five hundred Skolt Sami were forced to leave their home region in the Pechenga (Petsamo) area together with other inhabitants. After the war, their fate was discussed by Finnish officials and in the media. The question was whether they should be returned to the Soviet Union or relocated to Finland. This article describes the five-year-long process to relocate the Skolt Sami to the Inari region. Following a recommendation by Håkan Rydving to focus studies on Sami agency, in addition to non-Sami actors whose role is usually emphasised, the aim of this article is to identify key actors who made crucial choices in the relocation process. In addition to the Finnish “Skolt friend” Karl Nickul, the Skolt Sami meetings and Jaakko Sverloff, the trustee of the Skolts, appear to have had important roles in key decisions, for example regarding the expansion of the Skolt area from Nellim to Sevettijärvi, the role of the winter village and the choice of settlements along the waterways.

Background: There is limited experience in combining interdisciplinary rehabilitation for persons with dementia and caregiver support.

Aim: To explore how informal caregivers perceive participation in a person-centred, multidimensional, interdisciplinary rehabilitation programme targeting community-dwelling older adults with dementia and their informal caregivers, and how the programme has influenced their everyday life.

Material and Methods: Fourteen informal caregivers, aged 45–84 years, participated in a qualitative interview following a randomised controlled pilot study. Transcribed interviews were analysed using qualitative content analysis.

Results: The analysis resulted in seven categories and three themes: feelingchallenged and boostedto face an uncertain future, perceiving supportive activities as sources ofbothjoy and frustration in everyday life and finding relief in recognising their relative’s former self.

Conclusions and Significance: Combining interdisciplinary rehabilitation for adults with dementia with education and support for caregivers was perceived as viable and valuable for the informal caregivers. They felt strengthened by the rehabilitation and better prepared for their uncertain future. However, participation also challenged everyday routines, but the benefits appeared to outweigh the strain.

This study focuses on the use of polypores in northern Fennoscandia, especially the now rare Haploporus odorus, which was once used by Sami and Swedish peasantry in the north. However, other taxa that were culturally salient are also discussed. Polypores have been used for health-related, technical and other purposes. The use of some of the taxa, such as Fomes fomentarius and Fomitopsis betulina, has been widely known over Eurasia and beyond, while Haploporus odorus has been utilized only by the North American Plains tribes and in northern Scandinavia. From cultural historical information, ethnographical data and observations reported in travelogues, the ethnomycological significance of five bracket fungi species in northern Fennoscandia has been identified.

Background: Although shared decision-making (SDM) has been widely recommended in clinical guidelines, it is not implemented in practice. In early 2024, managers of a centre (home for care or residence, HVB) in Sweden decided to implement SDM. Researchers arranged an intensive course that included training in SDM, which was offered to all users, staff members and managers at the centre.

Aim: To explore the experiences of users, staff members and managers when SDM was introduced at a centre for women suffering from mental illness.

Method and Results: After introducing SDM, persons who had experience as users of mental health services conducted individual interviews with users, staff members and managers. The data were transcribed automatically during the video interviews. The data were analysed using thematic analysis, and the results represent three different aspects. Users: Previous experience is important, Attitudes to participation and What is needed for continuation. Staff: Ability to increase participation and SDM as an integrated way of working. Managers: Changes in the care atmosphere and Management during the introduction.

Relevance: Research concerning people staying at HVBs is scarce, as is research on SDM concerning adults with severe mental illness. It is important to highlight the needs of this group, as participation today and in the future is an important and often overlooked aspect for these users.

Background: The COVID-19 pandemic has impacted the provision and utilisation of health care services with varying magnitude across settings due to spatial temporal variation in the burden of COVID-19 cases and the roll-out of local COVID-19 response policies. This study assesses changes in the provision and utilisation of health care services for three major chronic health conditions (HIV/AIDS, hypertension, and diabetes) over the pre-COVID-19 and COVID-19 pandemic periods in a rural South African sub-district of Agincourt.

Methods: Segmented interrupted time series regression models are applied to assess changes in the number of medication collection visits and new diagnoses for HIV/AIDS, hypertension, and diabetes from 1 January 2018 to 30 September 2021 covering the pre- COVID-19 period and the first three waves of the COVID-19 pandemic.

Results: The number of medication collection visits for HIV/AIDS, hypertension, and diabetes dropped following the imposition of level 5 lockdown. Despite some improvements over the course of the pandemic, by the end of the third wave in September 2021, visits remained below the pre-COVID-19 era. The number of clinic visits for new diagnoses of HIV/AIDS and hypertension also fell after the introduction of level 5 lockdown. Although the number of new visits for HIV/AIDS bounced back to the pre-COVID-19 trends by the end of the third wave, the number of visits for new hypertension diagnoses remained significantly lower than expected. Referrals for collection of medications from the Central Chronic Medicines Dispensing and Distribution (CCMDD) programme, as an alternative to collection from clinics, increased exponentially over the course of the pandemic.

Conclusions: Although the increased adoption of the CCMDD programme can in part account for decreased medication collection visits which persisted well after lockdown measures were lifted, marked reductions in the number of newly diagnosed cases of hypertension warrant concern. A deeper assessment of the appropriateness of referrals to the CCMDD programme as well as the longer-term effects on morbidity and mortality of missed treatment and/or delayed diagnosis is needed for a more granular understanding of the true ramifications of the COVID-19 pandemic and associated lockdown policies in the Agincourt subdistrict and other rural African settings.

Objectives: Previous research has suggested antiviral properties for lithium, including potential effectiveness against COVID-19 in vitro. This study aimed to investigate the impact of lithium and other psychotropic drugs on the risks of mortality, hospitalization, and ICU admission due to COVID-19 among individuals with bipolar disorder. The primary objective was to assess whether lithium was beneficial in COVID-19-infection in a real-world population.

Methods: Retrospective register study using data from multiple Swedish patient registers, including 39,063 individuals in Sweden with bipolar disorder and prescribed mood stabilizers. Outcomes included COVID-19-associated death, hospitalization, and ICU admission between 11 March 2020 and 10 March 2021. Multivariate logistic regression adjusted for age, sex, and somatic comorbidities was conducted.

Results: Lithium were prescribed to 44.2 % of patients, either as mono- or combination therapy; other mood stabilizers were prescribed to 55.8 %. There were no significant associations between lithium and COVID-19-associated death, hospitalization, or ICU admission. Atypical antipsychotics were associated with increased odds ratios for COVID-19-associated death (OR 1.58 [95 % CI 1.01–2.47]), hospitalization (OR 1.80 [95 % CI 1.49–2.18]), and ICU admission (OR 2.25 [95 % CI 1.33–3.80]). Benzodiazepines were associated with a significant increase in COVID-19-associated death (OR 1.54 [95 % CI 1.01–2.35]) and hospitalization OR 1.26 [95 % CI 1.03–1.53]). In an ad hoc analysis, lithium monotherapy was, however, associated with reduced hospitalizations and ICU admissions.

Conclusions: Our findings weaken the hypothesis that lithium reduces the risk of severe events associated with COVID-19 infection in bipolar disorder.

Research on pancreatic cancer has transformed with the advent of organoid technology, providing a better platform that closely mimics cancer biology in vivo. This review highlights the critical advancements facilitated by pancreatic organoid models in understanding disease progression, evaluating therapeutic responses, and identifying biomarkers. These three-dimensional cultures enable the proper recapitulation of the cellular architecture and genetic makeup of the original tumors, providing insights into the complex molecular and cellular dynamics at various stages of pancreatic ductal adenocarcinoma (PDAC). We explore the applications of pancreatic organoids in dissecting the tumor microenvironment (TME); elucidating cancer progression, metastasis, and drug resistance mechanisms; and personalizing therapeutic strategies. By overcoming the limitations of traditional 2D cultures and animal models, the use of pancreatic organoids has significantly accelerated translational research, which is promising for improving diagnostic and therapeutic approaches in clinical settings, ultimately aiming to improve the outcomes of patients with pancreatic cancer.

There is a disparity between the number of graduates and the demand for professionals in science, technology, engineering, and mathematics (STEM)-related fields globally. This gap underscores the importance of understanding and addressing the factors that drive student interest in the STEM career. Consequently, the education sector around the world is increasingly focused on identifying and improving these influencing factors to better align educational outcomes with the needs of the STEM industry. Thus, this study examined the cognitive (mathematics knowledge, science knowledge, and academic achievement), motivational (self-efficacy and outcome expectation), and socioeconomic status (parents’ education and family income) factors involved in predicting student interest in pursuing STEM careers. The data were conducted from tests, questionnaires, and documents from grade 10 and 11 students (n = 738) in Indonesia. In addition, two theoretical models (i.e., Models 1 and 2) were developed and were tested using structural equation modeling. The results showed that both models met the required standards for good fit, but Model 2 fit the data better overall, while Model 1 was only slightly below the ideal range for one measure (RMSEA). We found that motivational and cognitive factors were crucial predictors in shaping student interest in general STEM and STEM discipline–specific fields. A strong indirect effect was found in the relationship between self-efficacy and career interest through the outcome expectation factor, and the indirect effect of mathematics and science knowledge on interest in STEM careers through academic achievement is an important concern. Similar and different factors are discussed in terms of student interest in general STEM-related fields and STEM discipline–specific careers.

Transmission of Zika virus (ZIKV) has been reported in 92 countries and the geographical spread of invasive virus-borne vectors has increased in recent years. Arboviruses naturally survive between vertebrate hosts and arthropod vectors. Transmission success requires the mosquito to feed on viraemic hosts. There is little specific understanding of factors that may promote ZIKV transmission-success. Here we show that mosquito host-seeking behaviour is impacted by viral infection of the vertebrae host and may be essential for the effective transmission of arboviruses like ZIKV. Human skin fibroblasts produce a variety of metabolites, and we show that ZIKV immediately alters gene/protein expression patterns in infected-dermal fibroblasts, altering their metabolism to increase the release of mosquito-attractive volatile organic compounds (VOCs), which improves its transmission success. We demonstrate that at the invasion stage, ZIKV differentially altered the emission of VOCs by significantly increasing or decreasing their amounts, while at the transmission stage of the virus, all VOCs are significantly increased. The findings are complemented by an extensive meta-proteome analysis. Overall, we demonstrate a multifaceted role of virus-host interaction and shed light on how arboviruses may influence the behaviour of their vectors as an evolved means of improving transmission-success.

Single-cell RNA-seq methods can be used to delineate cell types and states at unprecedented resolution but do little to explain why certain genes are expressed. Single-cell ATAC-seq and multiome (ATAC + RNA) have emerged to give a complementary view of the cell state. It is however unclear what additional information can be extracted from ATAC-seq data besides transcription factor binding sites. Here, we show that ATAC-seq telomere-like reads counter-inituively cannot be used to infer telomere length, as they mostly originate from the subtelomere, but can be used as a biomarker for chromatin condensation. Using long-read sequencing, we further show that modern hyperactive Tn5 does not duplicate 9 bp of its target sequence, contrary to common belief. We provide a new tool, Telomemore, which can quantify nonaligning subtelomeric reads. By analyzing several public datasets and generating new multiome fibroblast and B-cell atlases, we show how this new readout can aid single-cell data interpretation. We show how drivers of condensation processes can be inferred, and how it complements common RNA-seq-based cell cycle inference, which fails for monocytes. Telomemore-based analysis of the condensation state is thus a valuable complement to the single-cell analysis toolbox.

Efficient electrocatalysts are vital for advancing sustainable fuel cell technology, and the use of affordable alternatives that enhance the reaction kinetics is key to progress. Although, tungsten diselenide (WSe2) is promising for electrocatalysis, it is not fully explored, especially in oxygen evolution and in applications such as polymer electrolyte membrane water electrolyzer. In this work, we use a simple approach to dope WSe2 with cobalt or nickel atoms. Both Co- and Ni-WSe2 exhibit excellent oxygen evolution reaction activity, with overpotentials of 370 and 400 mV at 10 mA/cm2, only 90 and 120 mV higher than those of RuO2, respectively. For hydrogen evolution reaction, the materials register low potentials at −10 mA/cm2, with −0.20 V and −0.22 V vs RHE for Ni- and Co-WSe2, respectively. The effective introduction of heteroatoms causes the retention of coordination vacancies, furnishing active catalytic sites that enhanced electrocatalytic performance, resembling this of noble metals in both activity and charge transfer. Moreover, both doped materials show excellent performance and stability as cathode electrocatalysts in the polymer electrolyte membrane water electrolyzer, with great promise for real-world applications. This study promotes sustainable fuel-cell technology through the development of cost-effective, doped WSe2 electrocatalysts that improve water splitting and hydrogen production efficiency.

This thesis investigates the relationship between an aging workforce, youth unemployment, and union density in 19 European countries over the period 2012–2023. Using a high-dimensional fixed-effects panel regression model, the study examines whether an increased share of older workers correlates with higher youth unemployment and the extent to which union density influences this relationship. Contrary to the initial hypothesis, the findings reveal a negative correlation between the proportion of older workers and youth unemployment. This suggests that part- and full-time retirements among older workers may create job openings for younger individuals. However, the positive correlation between union density and youth unemployment supports the insider-outsider theory, indicating that strong union protections for incumbent workers may limit entry opportunities for younger job seekers.

The findings also reveal that higher educational attainment among young people does not always correspond to lower youth unemployment, possibly due to labor market mismatches and overqualification. These results emphasize the importance of targeted policy interventions, such as phased retirement schemes, vocational training programs, and anti-discrimination measures, to foster more inclusive and dynamic labor markets. While the study provides valuable insights, it acknowledges the limitations of the selected time frame and potential reverse causality, suggesting that future research should extend the temporal scope and explore cross-national differences in labor market structures for a more comprehensive understanding of youth unemployment dynamics.

Pattern-Triggered Immunity (PTI) in plants is activated upon recognition by Pattern Recognition Receptors (PRRs) of Damage- and Microbe-Associated Molecular Patterns (DAMPs and MAMPs) from plants or microorganisms, respectively. An increasing number of identified DAMPs/MAMPs are carbohydrates from plant cell walls and microbial extracellular layers, which are perceived by plant PRRs, such as LysM and Leucine Rich Repeat-Malectin (LRR-MAL) receptor kinases (RKs). LysM-RKs (e.g. CERK1, LYK4 and LYK5) are needed for recognition of fungal MAMP chitohexaose (β-1,4-D-(GlcNAc)6, CHI6), whereas IGP1/CORK1, IGP3 and IGP4 LRR-MAL RKs are required for perception of β-glucans, like cellotriose (β-1,4-D-(Glc)3, CEL3) and mixed-linked glucans. We have explored the diversity of carbohydrates perceived by Arabidopsis thaliana seedlings by determining PTI responses upon treatment with different oligosaccharides and polysaccharides. These analyses revealed that plant oligosaccharides from xylans [β-1,4-D-(xylose)4 (XYL4)], glucuronoxylans and α-1,4-glucans, and polysaccharides from plants and seaweeds activate PTI. Cross-elicitation experiments of XYL4 with other glycans showed that the mechanism of recognition of XYL4 and the DAMP 33-α-L-arabinofuranosyl-xylotetraose (XA3XX) shares some features with that of CEL3 but differs from that of CHI6. Notably, XYL4 and XA3XX perception is impaired in igp1/cork1, igp3 and igp4 mutants, and almost not affected in cerk1 lyk4 lyk5 triple mutant. XYL4 perception is conserved in different plant species since XYL4 pre-treatment triggers enhanced disease resistance in tomato to Pseudomonas syringae pv tomato DC3000 and PTI responses in wheat. These results expand the number of glycans triggering plant immunity and support IGP1/CORK1, IGP3 and IGP4 relevance in Arabidopsis thaliana glycans perception and PTI activation.

Significance Statement: The characterization of plant immune mechanisms involved in the perception of carbohydrate-based structures recognized as DAMPs/MAMPs is needed to further understand plant disease resistance modulation. We show here that IGP1/CORK1, IGP3 and IGP4 LRR-MAL RKs are required for the perception of carbohydrate-based DAMPs β-1,4-D-(xylose)4 (XYL4) and 33-α-L-arabinofuranosyl-xylotetraose (XA3XX), further expanding the function of these LRR-MAL RKs in plant glycan perception and immune activation.

Mutation rate varies within and between genomes. Within genomes, tracts of nucleotides, including short sequence repeats and palindromes, can cause localised elevation of muta tion rate. Additional mechanisms remain poorly understood. Here we report an instance of extreme mutational bias in Pseudomonas fluorescens SBW25 associated with a single base-pair change in nlpD. These mutants frequently evolve in static microcosms, and have a cell-chaining (CC) phenotype. Analysis of 153 replicate populations revealed 137 independent instances of a C565T loss-of-function mutation at codon 189 (CAG to TAG (Q189*)). Fitness measures of alternative nlpD mutants did not explain the deterministic evolution of C565T mutants. Recognising that transcription can be mutagenic, and that codon 189 overlaps with a predicted promoter (rpoSp) for the adjacent stationary phase sigma factor, rpoS, transcription across this promoter region was measured. This confirmed rpoSp is induced in stationary phase and that C565T mutation caused significant elevation of transcription. The latter provided opportunity to determine the C565T mutation rate using a reporter-gene fused to rpoSp. Fluctuation assays estimate the C565T mutation rate to be ~5,000-fold higher than expected. In Pseudomonas, transcription of rpoS requires the positive activator PsrA, which we show also holds for SBW25. Fluctuation assays performed in a ∆psrA background showed a ~60-fold reduction in mutation rate confirming that the elevated rate of mutation at C565T mutation rate is dependent on induction of transcription. This hotspot suggests a generalisable phenomenon where the induction of transcription causes elevated mutation rates within defining regions of promoters.

In this article, we analyse infant mortality in Sundsvall 1860–1892. The focus is on the pattern and development of causes of death with separate analyses of neonatal and post-neonatal mortality. Furthermore, we discuss the development of infant mortality in relation to possible determinants in the historical context in Sundsvall. The results show substantial differences between neonatal and post-neonatal mortality when it comes to causes of death as well as their seasonal pattern. For deaths in the first 28 days, a large proportion of the deaths were diagnosed as unknown disease or given vague and symptom-descriptive diagnoses. For post-neonatal mortality on the other hand, the dominant cause of death categories were water-and food-borne infections and air-borne infections. Water-and food-borne diseases had a very strong seasonal pattern with the peak in late summer — July and August. There is no indication that sanitary improvements in the 1880's led to fewer cases of diarrhoea. Mortality from air-borne diseases on the other hand was lowest during summer, instead peaking in the winter months.

Key features: 

• The Northern Sweden Health and Disease Study (NSHDS) was initiated in the mid-1980s. The NSHDS is a population-based prospective longitudinal cohort comprising >140 000 participants in the two northernmost regions in Sweden, Norrbotten and Västerbotten, with >240 000 blood samples and 1.5 million person-years of follow-up.
• The NSHDS includes three sub-cohorts: the Västerbotten Intervention Programme (VIP), the expanded Northern Sweden Monitoring of Trends and Determinants of Cardiovascular Disease (MONICA) Study, and the Mammography Screening Project (MSP). The VIP is both a community-based cardiometabolic intervention programme encouraging healthy lifestyle (targeting individuals 40, 50, and 60 years of age), and a corresponding research cohort. The MONICA is an observational study focusing on cardiovascular disease and its associated risk factors, recruiting individuals aged 25–74 years. The MSP recruited women attending mammography during 1995–2006. The NSHDS median participation age is 50 years (53% women).
• Most participants contribute data on health, lifestyle, anthropometric measures, blood pressure, blood lipids, and glucose tolerance, along with research blood samples that are fractionated, frozen within an hour of collection, and stored at –80°C. Linkage to registries, clinical cohorts, and biological tissue archives facilitates studies of well-characterized participants (often combined with intervention studies).
• Collaborations are encouraged. Additional information can be found at: info.brs@umu.se; https://www.umu.se/en/biobank