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Introduction: The aim of this study was to describe parents' and nurses’ experiences when children undergo limb lengthening procedures. Anisomelia (difference in limb length) great enough to need treatment is relatively rare in children. In Sweden the mean number of limb lengthening operations per year is 22 (National Board of Social Affairs and Health, 2025).

Nurses at these orthopaedic clinics are responsible to provide information to the child and caregivers about what to expect pre- and postoperatively. Treatment is lengthy and often painful. The actual lengthening process starts at the hospital and then proceeds at home for several months. The parents of most children treated for anisomelia are responsible for the day-to-day handling of the limb lengthening instrument, and this could put a large strain on them.

Background: Unhealthy lifestyle behaviours, including unhealthy alcohol consumption, physical inactivity, smoking, and nonadherence to dietary recommendations, are major contributors to non-communicable diseases and mortality. While adopting healthy behaviours can reduce these risks in middle-aged adults, research is limited. Therefore, the aim of this study was to assess the distribution of unhealthy lifestyle behaviours in middle-aged adults and their associations with socioeconomic factors, social support, and history of disease.

Method: This was a cross-sectional study of the Swedish CArdioPulmonary bioImage Study (SCAPIS) cohort (2013–2018) at six Swedish university hospitals. Multilevel regression models were estimated using Bayesian inference with priors shrinking covariate estimates towards the null.

Results: In total, 59 909 participants, aged 50–64 years old were invited to SCAPIS, of which 30 154 (50.3%) decided to participate. The mean age of participants was 58 (SD = 4) years old, and 51% were women (n = 15 508). Men had higher unhealthy alcohol consumption and were less adherent to dietary recommendations compared to women. Older participants were more physically inactive compared to younger participants.

Low education and financial difficulties were associated with smoking, physical inactivity, and poor diet adherence. Financial difficulties were also associated with unhealthy alcohol consumption. Having more people to turn to in difficulties was associated with lower alcohol consumption. Lack of appreciation and comfort support was associated with smoking and poor diet adherence. Diabetes was associated with lower alcohol consumption. Diabetes and lung diseases were associated with smoking and inactivity.

Conclusions: Middle-aged adults with lower socioeconomic status, less quality social support, and a history of disease were more likely to engage in unhealthy behaviours. This study helps to identify groups of middle-aged adults who may require additional attention when it comes to prioritizing the development of preventive measures.

Soil bacterial and fungal communities play fundamental roles in biogeochemical cycles and ecosystem stability. Urbanization alters soil properties and microbial habitats, driving shifts in community composition, yet the divergent responses of bacteria and fungi and their ecological consequences remain inadequately understood. To elucidate these differential responses, we investigated soil bacterial and fungal communities along an urbanization gradient, ranging from undisturbed reference forests to urban parks, across three distinct climatic regions. To capture different disturbance intensities, urban parks were classified by tree age into old parks (>60-year-old trees) and young parks (10–20-year-old trees). Climate had a strong influence on soil microbiota, yet urbanization still significantly altered both bacterial and fungal communities in all regions. Urban disturbances homogenized soil microbial communities: average similarity among bacterial communities increased from ∼79 % in forests to ∼85 % in young urban parks, indicating substantial homogenization, whereas fungal communities showed little homogenization. Urbanization also homogenized microbial functional traits, with a greater reduction in trait dissimilarity for bacteria than for fungi. Bacterial communities exhibited high adjustability to urban conditions, dominated by generalist taxa (∼90 %), whereas fungal communities consisted mostly of specialists (∼83 %). Despite these asynchronous responses—bacteria adjusting and homogenizing more than fungi—overlapping functional traits between bacteria and fungi help maintain functional resilience in urban ecosystems.

Background: Clinical education in Emergency services (EMS) is unique due to its dynamic environment, brief patient encounters, and unpredictable cases. EMS provides valuable learning opportunities for nursing students, fostering person-centered care approaches and a variation of clinical training and learning. Formative feedback is crucial to develop knowledge and skills. Multisource feedback (MSF) offers a comprehensive assessment by incorporating feedback from various individuals, promoting self-reflection and targeted learning. MSF has not, to our knowledge, been systematically evaluated in the context of EMS, and therefore, the aim of the study was to describe nursing students’ experiences with MSF during their clinical education in the EMS, using a digital instrument as a facilitating tool.

Methods: A qualitative design with an inductive approach was used. Data were collected in 2021, using focus group interviews (n = 4) with 31 final-semester nursing students in Stockholm, Sweden, who had conducted clinical education in the EMS and received MSF through a digital instrument. Data were analyzed using reflexive thematic analysis, guided by Braun and Clarke’s methodology.

Results: Three themes revealed: feedback from sources familiar with the student’s learning objectives, feedback from sources unfamiliar with the learning objectives, and general perceptions of MSF in the EMS. Students valued self-reflection and feedback from peers and supervisors for personal and professional growth. Patient feedback was challenging due to their limited contextual understanding and emotional states, while feedback from other healthcare professionals was appreciated but hindered by the healthcare professionals’ workload and timing constraints. Overall, students appreciated MSF’s diverse perspectives, enriching their learning, performance, and development.

Conclusion: This study underscores the value of MSF in nursing students’ clinical education within the EMS. Feedback from peers, supervisors, and self-reflection enhances self-awareness, professional growth, and mutual support. Despite challenges like stress and logistical barriers, structured support and a digital instrument improved accessibility and alignment with learning objectives for the students. Incorporating patient and healthcare professionals’ feedback enriches education by promoting patient-centred care and collaboration. MSF supported reflective practice, and team dynamics and highlights the need for refined feedback processes to optimize learning and professional development for nursing students during clinical education.

Background: Recent trends indicate that the frequency of major incidents (MIs) is increasing. Healthcare systems are vital actors in societies’ responses to MIs. Well-prepared healthcare systems may mitigate the effects of MIs. Disaster preparedness is based on region-specific risk and vulnerability analyses (RVAs). Hospital incident command groups (HICGs) are commonly formed per hospital’s contingency plan MI to aid in disaster response. Acquiring situational awareness and decision-making in the face of uncertainty are known challenges for HICGs during MIs. However, the remoteness of rural hospitals presents unique challenges.

Aim: The aim of this study was to explore HICG leaders’ perceptions of disaster preparedness in rural hospitals.

Methods: A qualitative study with semi-structured, focus group, and individual interviews was used. The data were analyzed through inductive content analysis.

Results: The analysis generated the main category, HICGs’ confidence in handling major incidents and four categories. These were Uncertainty and level of recognition (containing two subcategories); Awareness of challenges and risks (containing two subcategories); Factors that facilitate preparedness, response, and leadership (containing three subcategories); and Prerequisites for decision-making (containing three subcategories and four subcategories).

Conclusions: HICG leaders generally perceived their hospital’s disaster preparedness as adequate. However, preparedness was found to be influenced by several factors. The findings revealed a complex interplay of factors influencing preparedness and response, particularly highlighting challenges related to geographical isolation and resource constraints. Effective preparedness requires a comprehensive understanding of local contexts, hospital capabilities, and risks, which directly impacts training, decision-making, and resource allocation. Addressing the identified vulnerabilities necessitates targeted interventions focused on situational awareness, decision-making, collaboration, and training.

Clinical trial number: Not applicable.

Recent environmental changes due to land-use and climate change threaten biodiversity and the ecosystem services it provides. Understanding the true scope of these changes is complicated by the lack of historical baselines for many of the interactions underpinning ecosystem services, such as pollination, or disservices, such as disease spreading. To assess changes in such services, it is vital to find ways of comparing past and current interactions between species. Here, we focus on interactions between honey bees – one of the world’s most important agricultural pollinators, the plants they visit, and the microbes they encounter in the environment. DNA in honey offers insights into the contemporary interactions of honey bees. Old honey samples could serve to describe honey bees’ interactions in previous decades, providing a baseline against which to assess changes in interactions over time. By identifying the taxonomic origin of plant, bacterial and fungal DNA in fifty-year-old honey samples, we show that plant DNA can reveal which plants honey bees visited in the past. Likewise, microbe DNA records the microbes, including pollinator and plant pathogens, honey bees encountered and possibly spread. However, some differences in the DNA recovered between old and new honey suggest that differences in DNA degradation of different microbes could bias naive comparisons between samples. Like other types of ancient samples, old honey may be most useful for identifying interactions that historically occurred and should not be taken as proof that an interaction did not occur. Keeping these limits of the data in mind, time series of honey may offer unique information about how honey bees’ associations with flowers and microbes have changed during decades of environmental change.

Linguistic uncertainty is a prime source of uncertainty pervading ecology and conservation. Coralline algae are a widespread and diverse group of calcifying red macroalgae that underpin coastal ecosystem function and service provision. Recent increasing interest in coralline algae in the scientific literature has revealed a diverse but confusing terminology at organism to habitat scales. Coralline algal research and conservation are international and multidisciplinary, so there are geographic and disciplinary imbalances in research and conservation efforts. To reach consensus and reduce uncertainty, we propose a unified terminology. We review trends in cultural and scientific use of coralline algal terms and propose a system based on six morphologies: (1) attached, (2) free-living geniculate, (3) encrusting and free-living nongeniculate coralline algae, the latter either being (4) nucleated or (5) non-nucleated thalli or (6) fragments. We take inspiration from other coastal systems that have achieved consensus through umbrella terms, such as ‘coral’ and ‘kelp’, to accelerate global progress in coralline algal research and conservation. We characterise 14 coralline algae–dominated habitat global types, falling within seven functional groups, four biomes and four realms: (1) freshwater coralline streams; (2) coralline tide pools; (3) intertidal coralline rims and (4) turf; (5) coralline sea caves; (6) coral–algal reefs; (7) algal ridges; (8) coralligenous reefs; subtidal (9) carbonate crusts, (10) coralline barrens and (11) turf; and (12) articulith, (13) maerl and (14) rhodolith beds, which fall into the coralline algal bed functional group. We hope this unified terminology promotes data comparison, enables cross-boundary and cross-sector sharing of best practices, develops capacity for meta-analyses and improves conservation strategies.

Political efforts in the Nordic countries aim to promote gender equality. However, an assumption is that patriarchal structures remain embedded in EMS organizations, often leading to a ‘glass ceiling’ effect for women. The Emergency Medical Services (EMS), generally positioned at the intersection of safety authorities and healthcare, operates within environments often shaped by masculine values and norms. Concurrently, the service also connects strongly to compassion, caring and nursing, which have been historically female-dominant professions and working environments. In recent decades, more females have entered the EMS. Despite the growing number of female paramedics, challenges persist, particularly in relation to gender inequality and workplace culture. Females in EMS field continue to face gender stereotypes, which may contribute to inequality. Gender stereotypes, combined with research describing sexual harassment and bias, underscore the need for further discussions and research on the impact of gender on paramedic work environments and career pathways for women working in the service.

RecoSal-hankkeen tavoitteena on tukea yhteistoiminnallista hallintaa, jolla pohjoisimmassa Fennoskandiassa sijaitsevan Tenojoen (norjaksi Tana, saameksi Deatnu) vesistön monimuotoisia lohikantoja saadaan elvytettyä. Hankkeessa tutkitaan, miten geneettisesti monimuotoisten lohikantojen tilan arviointia ja hoidon tietopohjaa voidaan laajentaa yhdistämällä tieteellistä ja paikallista tietoa. Tätä varten luodaan yhteistyöhön pohjautuva Tenon lohifoorumi, joka toimii monikulttuurisessa, perinteistä ja alkuperäiskansojen tietämystä sekä heidän oikeuksiaan arvostavassa ympäristössä. RecoSal-hanke tarjoaa poikkitieteellistä asiantuntemusta tehokkaiden ja sosiaalisesti kestävien hallinnointi- ja hoitokäytäntöjen kehittämiseksi ja toteuttamiseksi. Tavoitteena on ekologinen suojelu ja köyhtyneen biodiversiteetin palauttaminen.

Transcriptomics is an important OMICs method that is often unavailable in biobank research. Frozen blood samples are routinely collected and stored in medical biobanks, but transcriptional studies have been limited due to technical difficulties of extracting high-quality RNA from blood frozen in standard tubes (without RNA preservatives). We aimed to determine whether biobanked buffy coat samples stored at -80°C for up to 23 years could be successfully used for mRNA sequencing. We used a CryoXtract CXT 350 to remove frozen sample cores, which were immersed in RNA preservative during thawing prior to RNA extraction. RNA sequencing was then performed on extractions from pooled samples as well as from 23 buffy coat samples from prospective colorectal cancer cases and 23 matched controls included in the population-based, prospective Northern Sweden Health and Disease Study (NSHDS). For all samples, two library preparation methods were used (Illumina TruSeq Stranded mRNA poly-A selection and Illumina Stranded Total RNA with Ribo-Zero Globin). RNA yields of over 1 µg were obtained from the majority of NSHDS samples (mean = 2.57 µg), and over 92% of samples had RIN values of ≥ 6, indicating suitability for downstream analyses. In conclusion, we developed a method for successfully extracting and sequencing high-quality mRNA from frozen buffy coat samples stored long term in tubes with no RNA preservative.

The aim of the study was to examine the experiences of primary school teachers regarding their work environment in relation to threats and violence. Data was collected through 10 semi-structured interviews with five primary school teachers and five primary school principals. The results were presented along with an analysis and a discussion based on previous research within the field of teachers’ work environment and violence in schools. Findings indicated that several teachers have been exposed to threats and violence at their workplace. It appears that teachers have been subjected to threats and violence from both students and guardians. The principals also noted that threats from guardians have been a common occurrence. Essentially, most respondents stated that threats and violence have increased over time. The most commonly mentioned explanation for this change was the digitalization and the expansion of social media. Children with neuropsychiatric diagnoses are in some cases difficult to establish meaningful connections with, which can hinder the ability to decrease problematic behaviors. Teachers expressed a feeling of inadequacy towards the students who do not receive the time they need, due to conflicts and disputes among other students, consuming a significant amount of time. A significant challenge in regards to teachers’ work environment is the shortage of sufficient financial resources needed in order to fulfill the educational needs. Overall, the study found that one of the most effective measures to prevent threats and violence in schools is to form student-centred relationships. Meaningful relationships can help teachers and principals become better equipped to handle challenging situations and address underlying problems before they escalate.

Biopharmaceuticals are medical compounds derived from biological sources and are often manufactured by living cells, primarily Chinese hamster ovary (CHO) cells. CHO cells display variation among cell clones, leading to growth and productivity differences that influence the product's quantity and quality. The biological and environmental factors behind these differences are not fully understood. To identify metabolites with a consistent relationship to productivity or cell death over time, we analyzed the extracellular metabolome of 11 CHO clones with different growth and productivity characteristics over 14 days. However, in bioreactor processes, metabolic profiles and process variables are both strongly time-dependent, confounding the metabolite-process variable relationship. To address this, we customized an existing hierarchical approach for handling time dependency to highlight metabolites with a consistent correlation to a process variable over a selected timeframe. We benchmarked this new method against conventional orthogonal partial least squares (OPLS) models. Our hierarchical method highlighted several metabolites consistently related to productivity or cell death that the conventional method missed. These metabolites were biologically relevant; most were known already, but some that had not been reported in CHO literature before, such as 3-methoxytyrosine and succinyladenosine, had ties to cell death in studies with other cell types. The metabolites showed an inverse relationship with the response variables: those positively correlated with productivity were typically negatively correlated with the death rate, or vice versa. For both productivity and cell death, the citrate cycle and adjacent pathways (pyruvate, glyoxylate, pantothenate) were among the most important. In summary, we have proposed a new method to analyze time-dependent omics data in bioprocess production. This approach allowed us to identify metabolites tied to cell death and productivity that were not detected with traditional models.

Background: Large bowel obstruction is a possible complication in patients undergoing neoadjuvant treatment for rectal cancer; however, it may be prevented by placing a pretreatment defunctioning stoma. The aim of this retrospective study was to investigate complication rates in patients with rectal cancer undergoing long-course neoadjuvant therapy, comparing those with and without a prophylactic stoma.

Methods: All patients with rectal cancer undergoing neoadjuvant therapy between 2007 and 2022 in Region Västerbotten, Sweden, were identified using the Swedish Colorectal Cancer Registry. Patients not planned for curative long-course neoadjuvant therapy and those requiring a stoma due to urgent bowel-related issues before treatment were excluded. The primary outcome was the incidence of complications between diagnosis and resection surgery or end of follow-up. The secondary outcomes were 30-day complications following resection, time to treatment (neoadjuvant therapy and surgery), and overall survival. Multivariable regression analysis was used, with adjustment for age, sex, American Society of Anesthesiologists fitness grade, and clinical tumour stage.

Results: Of 482 identified patients, 105 were analysed after exclusion. Among these, 22.9% (24 of 105) received a pretreatment stoma, whereas 77.1% (81 of 105) received upfront neoadjuvant therapy. The complication incidence before resection in the group with a defunctioning stoma and in the group without a defunctioning stoma was 75.0% (18 of 24) and 29.6% (24 of 81) respectively. A considerable number of complications were directly caused by the stoma surgery. Patients in the stoma group had an adjusted OR of 6.71 (95% c.i. 2.17 to 20.76) for any complication. However, for 30-day complications following resection, an adjusted non-significant OR of 2.05 (95% c.i. 0.62 to 6.81) was documented for the stoma group, in comparison with the control group. Neoadjuvant treatment was also delayed for the stoma group (adjusted mean time difference: 21 (95% c.i. 14 to 27) days), whereas the difference was not significant for the time to resection surgery. The median survival after diagnosis was 4.7 years in the stoma group and 12.2 years in the control group (P = 0.015); however, adjustment in the multivariable analysis rendered the estimate non-significant (HR 1.71 (95% c.i. 0.93 to 3.14)).

Conclusion: Patients with rectal cancer who receive a stoma before long-course neoadjuvant therapy, in the absence of urgent symptoms, experience more complications than those without a stoma and a delay with regard to the start of neoadjuvant treatment.

The thermal conductivity κ of solid CO2 was studied in the temperature T range of 100–220 K and at pressures up to 200 MPa using the transient hot-wire method. The results are consistent with those expected for a polycrystal composed of small molecules, with κ increasing significantly as the temperature decreases and as pressure and density increase. The variation in κ with temperature is primarily attributed to changes in phonon–phonon scattering and density. The thermal conductivity behaviour is described using a two-basis model, where heat is transported by both phonons and diffuse modes. The density ρ dependence of the thermal conductivity, represented by the Bridgman parameter g = (d ln κ/d ln ρ)T, was found to be g = 6.7 at 190 K, increasing to 9.4 at 110 K as the temperature decreases. This increase is attributed to an enhanced phonon contribution to the total κ.

The human epididymis protein 4 (HE4) remains the best available endometrial cancer (EC) biomarker; however, its discrimination between cases and cancer-free individuals is limited and might be improved when combined with other protein markers. We evaluated the discrimination capacity of 92 proteins as potential early detection biomarkers for EC in nested case–control studies in the European Prospective Investigation into Cancer and Nutrition (EPIC) (63 cases, 123 controls) and Janus (75 cases, 146 controls) cohorts, evaluating blood samples taken ≤2 years prior to diagnosis. Proteins were measured with the Olink Target 96 Oncology II panel assays. Areas under the receiver operating characteristic curves (AUCs) were calculated using logistic regression. The discrimination between cases and controls of top-performing proteins was modest (EPIC: HE4, CA125, CAIX, and S100A4; Janus: HE4, CA125, FURIN, CXCL13, and IL6; AUC range: 0.65 [S100A4], 0.76 [HE4, EPIC] within 0 to <12 months of blood collection) and decreased as the time between blood draw and cancer diagnosis increased (12–24 months AUC range: 0.49 [S100A4], 0.69 [CA125, Janus]). The combination of these other markers with HE4 did not improve discrimination. HE4 and other candidate proteins had limited discrimination between EC cases and controls and hence do not appear to be useful for early detection of this disease in women at average population risk.

In boreal landscapes, forest management has the potential to become a major driver of surface water quality due to the large proportion of actively-used land areas and the intensity of forestry operations. In Fennoscandia, forest management is comprised of different operations during a single rotation, where final harvest by clear cutting and subsequent ditch cleaning to restore drainage capacity are among the most influential on water quality. Here, we analyzed the single and combined effect of these forest management operations on the concentrations and exports of dissolved organic carbon (DOC), dissolved organic nitrogen (DON), dissolved inorganic nitrogen (DIN) and dissolved inorganic phosphate (PO4) in boreal Sweden. We measured groundwater table level, stream discharge, and water chemistry data continuously following experimental clear cutting and ditch cleaning applied to a historically drained forest using a before-after-control-impact (BACI) design. We used linear mixed models to test whether DOC, DON, DIN and PO4 concentrations were affected after each individual forest management operation, and further analyzed the response of the cumulative operations. We found that after clear cutting, concentrations of organic and inorganic nutrients increased significantly. However, for catchments with ditch cleaning after clear cutting, concentrations of organic nutrients in surface water decreased to pre-disturbance levels; inorganic nutrient concentrations also decreased but less strongly than organic counterparts. Despite this effect, catchments with ditch cleaning after clear cutting still showed an increase in overall organic and inorganic nutrient exports when compared to the reference catchments and the pre-treatment period. Nevertheless, catchments without ditch cleaning showed an even higher increase in both concentration and exports of most solutes. Overall, our results suggest changes in C, N and P exports due to forest management, along with the large spatial extent of this activity, could promote biogeochemical shifts and trigger water quality deterioration in boreal streams.

Understanding how species respond to climate change can facilitate species conservation and crop breeding. Current prediction frameworks about population vulnerability focused on predicting range shifts or local adaptation but ignored genetic load, which is also crucial for adaptation. By analyzing 1115 globally distributed Arabidopsis thaliana natural accessions, we find that effective population size (Ne) is the major contributor of genetic load variation, both along genome and among populations, and can explain 74-94% genetic load variation in natural populations. Intriguingly, Ne affects genetic load by changing both effectiveness of purifying selection and GC biased gene conversion strength. In particular, by incorporating genetic load, genetic offset and species distribution models (SDM), we predict that, the populations at species’ range edge are generally at higher risk. The populations at the eastern range perform poorer in all aspects, southern range have higher genetic offset and lower SDM suitability, while northern range have higher genetic load. Among the diverse natural populations, the Yangtze River basin population is the most vulnerable population under future climate change. Overall, here we deciphered the driving forces of genetic load in A. thaliana, and incorporated SDM, local adaptation and genetic load to predict the fate of populations under future climate change.

Objectives: Socioeconomic status (SES) is in many cases related to air pollution exposure, but less is known about its effects on susceptibility to air pollution. The main aim of this study was to analyse the impact of SES on health effects associated with exposure to fine particles (PM_2.5).

Methods: Firstly, a systematic literature review of studies analysing the impacts of SES on health effects related to air pollution exposure was carried out. Secondly, a meta-analysis was performed by analysing studies on long-term mortality associated with exposure to PM_2.5 divided into different SES groups.

Results: The meta-analysis showed that the relative risk (RR) for all-cause mortality associated with PM_2.5 did not depend on individual education or income. It also revealed that adjustment for individual lifestyle factors (such as smoking, alcohol intake, physical activity, eating behaviours, and body mass index), in addition to adjustment for SES, did not significantly change the RR.

Conclusion: The association between all-cause mortality and PM_2.5 did not depend on education or individual income. Due to the high heterogeneity observed, further studies are required to draw firm conclusions.

Climate change has led to shifts in phenology, food availability and increasing temperatures, affecting ecosystems and organisms. According to Bergmann’s rule, endotherms, such as birds, are expected to develop a smaller body size in a warmer climate. At the same time, insect populations seem to decline, causing food shortage that may primarily affect insectivorous birds and leading to a reduction in body size. Increasing temperatures could also prolong growing seasons leading to increased food availability later in the season and change the timing of migration. By using bird ringing data collected over 15 years (2010-2024) of six passerine species from the Ume River Delta Field Station the study examined if: (i) weight and wing length in fall migrating birds have decreased, (ii) changes in weight and wing length are general or if insectivores and seed eaters differ, and (iii) the timing of fall migration has changed over the past 15 years. The results showed a significant effect for diet on change in body size and migration over time. In general, the weight increased, wings became shorter, and the migration was delayed. The changes appear to be mainly driven by longer growing seasons and extended availability to food and are most likely an indirect consequence of a warmer climate. There was also a great variation in change within both diets and species, indicating that the causes are multiple and complex and have not yet been fully explained or understood.

Bakgrund: Diabetes typ 1 är en kronisk sjukdom som inte bara påverkar den drabbade, utan hela familjen. När barn och ungdomar drabbas tvingas föräldrar anta det yttersta ansvaret gällande diabeteshantering för att undvika kort- och långsiktiga konsekvenser hos den drabbade.  Syfte: Syftet med litteraturstudien var att beskriva erfarenheter av att vara förälder till ungdomar drabbade av diabetes typ 1.  Metod: En litteraturstudie baserad på nio kvalitativa artiklar. Databassökningar genomfördes i PubMed, Cinahl och PsycInfo. Fribergs femstegsmodell användes för att analysera artiklarna.  Resultat: Analysen resulterade i fem teman och fem subteman. De fem olika teman var: påfrestningar i vardagslivet, föräldrars erfarenheter av ungdomarnas skolgång och sociala liv, föräldrars behov av stöd, föräldrars kunskapsbehov och erfarenheter av vården samt föräldrars oro i samband med ökad självständighet hos ungdomarna. Konklusion: Föräldrars oro och behov av stöd ökar i samband med att deras barn eller ungdom drabbas av diabetes typ 1. Sjuksköterskan kan bidra med emotionellt stöd och information kring sjukdomen för att främja familjens välmående.  

This qualitative study protocol outlines a co-creation project between researchers and the Swedish police to improve cross-functional collaboration in online child sexual abuse (CSA) investigations. Online CSA cases are complex and require extensive collaboration between prosecutors, IT forensic expertise, and investigators with expertise in child sexual offenses. Despite the recognized need for cross-functional teamwork, research evaluating methods for such collaboration in crime investigations, especially in online CSA, is scarce. This project, funded by the Swedish research agency FORTE (2023-00085), addresses this gap by employing the ‘double diamond’ co-creation framework (discovery, define, develop, deliver) to co-create, implement, and evaluate a team-based intervention within three online CSA units in northern Sweden. Data collection will involve semi-structured interviews (n ≈ 35), participant observations of workshops, workshop appraisals, document analysis, and analysis of organizational metrics. The project aims to: (1) identify challenges and potentials for cross-functional teamwork in online CSA investigations; (2) co-design a team-based intervention to address identified needs; and (3) evaluate the intervention’s impact on efficiency and organizational outcomes. By working collaboratively with police practitioners throughout the research process, this project aims to generate practical and sustainable solutions to enhance the effectiveness of online CSA investigations.

Denna studie har studerat sjuksköterskor inom Generation Z och deras syn på ledarskap, arbetsmiljö och motivation. Idag står branschen vård och omsorg inför en ökande personalbrist, vilket har gjort det nödvändigt att förstå vad som påverkar sjuksköterskors trivsel och engagemang. Syftet med studien var att undersöka hur sjuksköterskor inom Generation Z upplever sina arbetsvillkor och vilket ledarskap som påverkar deras motivation att stanna kvar inom branschen. En kvalitativ metod har använts, där nio sjuksköterskor intervjuades genom semistrukturerade intervjuer. Materialet har analyserats genom en tematisk analys för att identifiera återkommande mönster i respondenternas upplevelser och erfarenheter. Resultaten har visat att individer inom Generation Z värderade ett närvarande och kommunikativt ledarskap som skapar en trygghet och delaktighet. Respondenterna har beskrivit att arbetsmiljön påverkas negativt av hög arbetsbelastning, stress och resursbrist vilket i flera fall har resulterat i tankar om att lämna yrket. Samtidigt har ett stöd från kollegor och chefer framställts som viktiga faktorer för trivsel och arbetsglädje. Ledarskapet har visat spela en avgörande roll där bristande närvaro och otydliga riktlinjer minskar motivationen, medan ett engagerat och lyhört ledarskap stärker arbetsviljan. Denna studie har bidragit med insikter om hur ledarskapet och arbetsvillkoren kan anpassas för att bättre möta behoven hos individer inom Generation Z, vilket är avgörande för att minska personalomsättningen och därmed säkerställa en hållbar personalförsörjning inom vården.

Formal verification is essential for ensuring that systems behave according to their mathematical specifications. However, applying formal verification to human-agent interactions presents unique challenges due to the dynamic nature of human mental states and behaviors. Unlike traditional verification tasks, which focus on ensuring correctness in a well-defined action space, this work addresses reasoning over beliefs, intentions, and emotions that evolve through interaction. Two main contributions are introduced: (1) Belief Graphs for modeling mental state dynamics, and (2) the integration of these with formal dialogue games for verifying strategies and influence. To this end, the developed verification methods are rooted in two main pillars: psychological theories formalized to represent mental state dynamics as logical frameworks, and Non-Monotonic Reasoning (NMR) methods, including techniques such as Formal Argumentation and Answer Set Programming (ASP). By modeling  mental dynamics as states and transitions in a layer atop the action space—referred to as the Belief Graph methodology—we are provided a tool for modeling context and context dynamics that supports counterfactual, forward and backward reasoning about mental states and behaviors. By incorporating Belief Graphs into formal dialogue games we gain mathematical frameworks for analyzing and verifying agent beliefs, intentions and strategies, thereby enabling the verification of human-agent interactions.Whether it concerns potentially harmful human behaviors—such as malicious activities on social media—or intelligent systems that interact with humans, such as chatbots that are increasingly capable of influencing users’ emotions, thoughts, and decisions—there is an urgent need for formal verification methods to ensure safe and reliable human interactions in digital communication.The proposed methods have been evaluated through formal analysis, case studies, and published peer-reviewed research.

We introduce opinion units, a contribution to the field Aspect-Based Sentiment Analysis (ABSA) that extends aspect- sentiment pairs by including substantiating excerpts, derived through hybrid abstractive-extractive summarisation. The goal is to provide fine-grained information without sacrificing succinctness and abstraction. Evaluations on review datasets demonstrate that large language models (LLMs) can accurately extract opinion units through few-shot learning. The main types of errors are providing incomplete contexts for opinions and and mischaracterising objective statements as opinions. The method reduces the need for labelled data and allows the LLM to dynamically define aspect types. As a practical evaluation, we present a case study on similarity search across academic datasets and public review data. The results indicate that searches leveraging opinion units are more successful than those relying on traditional data-segmentation strategies, showing robustness across datasets and embeddings.

BACKGROUND: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.

METHODS: A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.

FINDINGS: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58-5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23-0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.

INTERPRETATION: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised.

FUNDING: National Institute for Health and Care Research.

BACKGROUND: The outcomes of liver surgery worldwide remain unknown. The true population-based outcomes are likely different to those vastly reported that reflect the activity of highly specialized academic centers. The aim of this study was to measure the true worldwide practice of liver surgery and associated outcomes by recruiting from centers across the globe. The geographic distribution of liver surgery activity and complexity was also evaluated to further understand variations in outcomes.

METHODS: LiverGroup.org was an international, prospective, multicenter, cross-sectional study following the Global Surgery Collaborative Snapshot Research approach with a 3-month prospective, consecutive patient enrollment within January-December 2019. Each patient was followed up for 90 days postoperatively. All patients undergoing liver surgery at their respective centers were eligible for study inclusion. Basic demographics, patient and operation characteristics were collected. Morbidity was recorded according to the Clavien-Dindo Classification of Surgical Complications. Country-based and hospital-based data were collected, including the Human Development Index (HDI). (NCT03768141).

RESULTS: A total of 2159 patients were included from six continents. Surgery was performed for cancer in 1785 (83%) patients. Of all patients, 912 (42%) experienced a postoperative complication of any severity, while the major complication rate was 16% (341/2159). The overall 90-day mortality rate after liver surgery was 3.8% (82/2,159). The overall failure to rescue rate was 11% (82/ 722) ranging from 5 to 35% among the higher and lower HDI groups, respectively.

CONCLUSIONS: This is the first to our knowledge global surgery study specifically designed and conducted for specialized liver surgery. The authors identified failure to rescue as a significant potentially modifiable factor for mortality after liver surgery, mostly related to lower Human Development Index countries. Members of the LiverGroup.org network could now work together to develop quality improvement collaboratives.

AIM: Adhesive small bowel obstruction (ASBO) is a common surgical emergency condition. Research in the field is plentiful; however, inconsistency in outcome reporting makes comparisons challenging. The aim of this study was to define a core outcome set (COS) for studies of ASBO.

METHODS: The long list of outcomes was identified through systematic review, and focus groups across different geographical regions. A modified Delphi consensus exercise of three rounds was undertaken with stakeholder groups (patients and clinicians). Items were rated on a 9-point Likert scale. Items exceeding 70% rating at 7-9 were passed to the consensus meeting. New item proposals were invited in round 1. Individualised feedback on prior voting compared to other participants was provided. An international consensus meeting was convened to ratify the final COS.

RESULTS: In round 1, 56 items were rated by 118 respondents. A total of 18 items reached consensus, and respondents proposed an additional 10 items. Round 2 was completed by 90 respondents, and nine items achieved consensus. In round 3, 80 surveys were completed; one item achieved consensus, and five borderline items were identified. The final COS included 26 outcomes, mapped to the following domains: Interventions, need for stoma, septic complications, return of gut function, patient reported outcomes, and recurrence of obstruction, as well as mortality, failure to rescue, and time to resolution.

CONCLUSION: This COS should be used in future studies in the treatment of adhesive SBO. Further studies to define a core measurement set are needed to identify the optimum tools to measure each outcome.

BACKGROUND: Pulmonary complications are the most common cause of death after surgery. This study aimed to derive and externally validate a novel prognostic model that can be used before elective surgery to estimate the risk of postoperative pulmonary complications and to support resource allocation and prioritisation during pandemic recovery.

METHODS: Data from an international, prospective cohort study were used to develop a novel prognostic risk model for pulmonary complications after elective surgery in adult patients (aged ≥18 years) across all operation and disease types. The primary outcome measure was postoperative pulmonary complications at 30 days after surgery, which was a composite of pneumonia, acute respiratory distress syndrome, and unexpected mechanical ventilation. Model development with candidate predictor variables was done in the GlobalSurg-CovidSurg Week dataset (global; October, 2020). Two structured machine learning techniques were explored (XGBoost and the least absolute shrinkage and selection operator [LASSO]), and the model with the best performance (GSU-Pulmonary Score) underwent internal validation using bootstrap resampling. The discrimination and calibration of the score were externally validated in two further prospective cohorts: CovidSurg-Cancer (worldwide; February to August, 2020, during the COVID-19 pandemic) and RECON (UK and Australasia; January to October, 2019, before the COVID-19 pandemic). The model was deployed as an online web application. The GlobalSurg-CovidSurg Week and CovidSurg-Cancer studies were registered with ClinicalTrials.gov, NCT04509986 and NCT04384926.

FINDINGS: Prognostic models were developed from 13 candidate predictor variables in data from 86 231 patients (1158 hospitals in 114 countries). External validation included 30 492 patients from CovidSurg-Cancer (726 hospitals in 75 countries) and 6789 from RECON (150 hospitals in three countries). The overall rates of pulmonary complications were 2·0% in derivation data, and 3·9% (CovidSurg-Cancer) and 4·7% (RECON) in the validation datasets. Penalised regression using LASSO had similar discrimination to XGBoost (area under the receiver operating curve [AUROC] 0·786, 95% CI 0·774-0·798 vs 0·785, 0·772-0·797), was more explainable, and required fewer covariables. The final GSU-Pulmonary Score included ten predictor variables and showed good discrimination and calibration upon internal validation (AUROC 0·773, 95% CI 0·751-0·795; Brier score 0·020, calibration in the large [CITL] 0·034, slope 0·954). The model performance was acceptable on external validation in CovidSurg-Cancer (AUROC 0·746, 95% CI 0·733-0·760; Brier score 0·036, CITL 0·109, slope 1·056), but with some miscalibration in RECON data (AUROC 0·716, 95% CI 0·689-0·744; Brier score 0·045, CITL 1·040, slope 1·009).

INTERPRETATION: This novel prognostic risk score uses simple predictor variables available at the time of a decision for elective surgery that can accurately stratify patients' risk of postoperative pulmonary complications, including during SARS-CoV-2 outbreaks. It could inform surgical consent, resource allocation, and hospital-level prioritisation as elective surgery is upscaled to address global backlogs.

FUNDING: National Institute for Health Research.

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery.

METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin.

RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes.

CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease.

SARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri-operative or prior SARS-CoV-2 were at further increased risk of venous thromboembolism. We conducted a planned sub-study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS-CoV-2 diagnosis was defined as peri-operative (7 days before to 30 days after surgery); recent (1-6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre-operative anti-coagulation for baseline comorbidities was not available. Postoperative venous thromboembolism rate was 0.5% (666/123,591) in patients without SARS-CoV-2; 2.2% (50/2317) in patients with peri-operative SARS-CoV-2; 1.6% (15/953) in patients with recent SARS-CoV-2; and 1.0% (11/1148) in patients with previous SARS-CoV-2. After adjustment for confounding factors, patients with peri-operative (adjusted odds ratio 1.5 (95%CI 1.1-2.0)) and recent SARS-CoV-2 (1.9 (95%CI 1.2-3.3)) remained at higher risk of venous thromboembolism, with a borderline finding in previous SARS-CoV-2 (1.7 (95%CI 0.9-3.0)). Overall, venous thromboembolism was independently associated with 30-day mortality (5.4 (95%CI 4.3-6.7)). In patients with SARS-CoV-2, mortality without venous thromboembolism was 7.4% (319/4342) and with venous thromboembolism was 40.8% (31/76). Patients undergoing surgery with peri-operative or recent SARS-CoV-2 appear to be at increased risk of postoperative venous thromboembolism compared with patients with no history of SARS-CoV-2 infection. Optimal venous thromboembolism prophylaxis and treatment are unknown in this cohort of patients, and these data should be interpreted accordingly.

BACKGROUND: The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as indispensable parts of holistic health-care systems. However, COVID-19 exposed the fragility of planned surgical services around the world, which have also been neglected in pandemic recovery planning. This study aimed to develop and validate a novel index to support local elective surgical system strengthening and address growing backlogs.

METHODS: First, we performed an international consultation through a four-stage consensus process to develop a multidomain index for hospital-level assessment (surgical preparedness index; SPI). Second, we measured surgical preparedness across a global network of hospitals in high-income countries (HICs), middle-income countries (MICs), and low-income countries (LICs) to explore the distribution of the SPI at national, subnational, and hospital levels. Finally, using COVID-19 as an example of an external system shock, we compared hospitals' SPI to their planned surgical volume ratio (SVR; ie, operations for which the decision for surgery was made before hospital admission), calculated as the ratio of the observed surgical volume over a 1-month assessment period between June 6 and Aug 5, 2021, against the expected surgical volume based on hospital administrative data from the same period in 2019 (ie, a pre-pandemic baseline). A linear mixed-effects regression model was used to determine the effect of increasing SPI score.

FINDINGS: In the first phase, from a longlist of 103 candidate indicators, 23 were prioritised as core indicators of elective surgical system preparedness by 69 clinicians (23 [33%] women; 46 [67%] men; 41 from HICs, 22 from MICs, and six from LICs) from 32 countries. The multidomain SPI included 11 indicators on facilities and consumables, two on staffing, two on prioritisation, and eight on systems. Hospitals were scored from 23 (least prepared) to 115 points (most prepared). In the second phase, surgical preparedness was measured in 1632 hospitals by 4714 clinicians from 119 countries. 745 (45·6%) of 1632 hospitals were in MICs or LICs. The mean SPI score was 84·5 (95% CI 84·1-84·9), which varied between HIC (88·5 [89·0-88·0]), MIC (81·8 [82·5-81·1]), and LIC (66·8 [64·9-68·7]) settings. In the third phase, 1217 (74·6%) hospitals did not maintain their expected SVR during the COVID-19 pandemic, of which 625 (51·4%) were from HIC, 538 (44·2%) from MIC, and 54 (4·4%) from LIC settings. In the mixed-effects model, a 10-point increase in SPI corresponded to a 3·6% (95% CI 3·0-4·1; p<0·0001) increase in SVR. This was consistent in HIC (4·8% [4·1-5·5]; p<0·0001), MIC (2·8 [2·0-3·7]; p<0·0001), and LIC (3·8 [1·3-6·7%]; p<0·0001) settings.

INTERPRETATION: The SPI contains 23 indicators that are globally applicable, relevant across different system stressors, vary at a subnational level, and are collectable by front-line teams. In the case study of COVID-19, a higher SPI was associated with an increased planned surgical volume ratio independent of country income status, COVID-19 burden, and hospital type. Hospitals should perform annual self-assessment of their surgical preparedness to identify areas that can be improved, create resilience in local surgical systems, and upscale capacity to address elective surgery backlogs.

FUNDING: National Institute for Health Research (NIHR) Global Health Research Unit on Global Surgery, NIHR Academy, Association of Coloproctology of Great Britain and Ireland, Bowel Research UK, British Association of Surgical Oncology, British Gynaecological Cancer Society, and Medtronic.

In the era of migrations, cities constantly experience an oscillation between cultures, space, and power. A change in social and cultural patterns between the precedented societies and newcomers has become highly controversial in the political climate.1 On the one hand, the pivotal concept of integration as a homogenizing practice seems no longer to function, as the host/guest dichotomy has failed to realize the racial structures of power and the inequalities in society. On the other hand, the rise of right-wing populism is increasingly framing migration as a threat to dominant cultures, leading to policies that racialize human rights values such as freedom of movement. Here, the question is no longer about who is accepting who, but about where control has stabilized certain regimes of visibility. When different regimes of control tend to exclude some identities while including others through ‘structures of sensibilities’, possible modes of perception become limited through a codified society.

Given the transformative nature of the digital realm, new domains for interaction with societies have allowed new visibilities to emerge. If demonstration through streets was one day the most provocative act of gaining visibility, nowadays appearance on social media and open-source apps come with a much stronger influence on societies which indeed, is a profound shift in power structures mediated by the digital realm. In this context, the role of architecture as an agent that is controlled by and at the same time controls the different regimes of visibility in urban space, is a question of the tools and the mediums that architects work with.

Defining my role as a design activist, I attempt to challenge the conventional tools of architecture through different visual and digital disruptive interventions in the digital sphere to investigate the domains of influence of an architect in socio-political space. Through different visual techniques, I investigate the concept of defamiliarization to invent a new aesthetic regime that challenges territorialization by redistributing fragments of reality and ultimately, questioning the presence of diversity in the artefacts of today’s urban imaginaries.

Background: In the fast-expanding field of life-prolonging-treatment of metastatic, castration-resistant prostate cancer, treatment decision-making is very complex - both for patients and healthcare professionals since there is no “one size that fits all” in choosing treatment in this phase. Little research has been conducted about men’s experiences of treatment decision-making in this advanced, incurable, phase. Hence, this study aimed to describe men’s experiences of decision-making in life-prolonging treatments of metastatic castration-resistant prostate cancer.

Methods: Seventeen men were recruited from four oncology clinics in Sweden and interviewed at baseline. Qualitative interviews (n = 31) were conducted over two years, the timepoints for subsequent interviews (10 men were interviewed twice or more) adhered to when each man switched or terminated life-prolonging treatment. Data was analysed with qualitative content analysis.

Results: Initially, the men were adamant about proceeding with treatment. As their illness continued to progress, they gradually turned their focus more towards their well-being. They wished for continuity regarding treating physicians and constantly being assigned new physicians compromised the quality of care and complicated decision-making. In their decision-making, the men adapted their own approach to the approach taken by their physician, even if it was not an approach they had originally preferred. They wished for their role preferences to be respected. Most men had made treatment decisions collaboratively with their physician, but some described having taken on a more, or less, driving role in decision-making than they really wished for. Navigating healthcare was perceived as difficult and for some it thus felt necessary to pursue and coordinate their own care by e.g. using personal connections or contacting clinics ahead of referral. A part of treatment decision-making was forming a basis for a decision, in which the need for personalized information (quality, quantity and timing) came forth as important.

Conclusions: When diagnosed with metastatic castration-resistant prostate cancer, men’s preferences for their decision-making role, and perspectives on the treatment outcome need to be continuously addressed throughout their disease course. Improved continuity of care and a more personalised care approach should meet these patients’ wishes and needs in this phase.

Trial registration: Clinical trial number: Not applicable.

This study investigates the cash-holding motivations of issuers with excess cash. It aims to explain why these issuers choose to accumulate even more cash through stock issuances rather than utilize their existing surplus. I assess three competing cash-holding motivation hypotheses: whether issuers raise cash: (i) to fund the needs of future growth opportunities; (ii) for precautionary reasons; or (iii) to misuse it to maximize managerial benefits. I identify 480 issuers with pro-forma excess cash surpassing the seasoned equity offering size by considering a dataset of 3,438 issuers from 1996 to 2018. Results reveal that these issuers have stronger funding needs, and precautionary and agency-driven spending motivations, with precautionary reasons being the most dominant motivation. The results suggest that the benefits of cash-holding could motivate stock issuances.

Objective: Platelet activation is thought to participate in polymyalgia rheumatica (PMR) pathogenesis. Upon platelet activation, mitochondria are expelled into the extracellular space. However, whether extracellular mitochondria are present in patients with PMR and whether they can induce platelet activation is not known.

Methods: To investigate this, we measured markers of platelet activation (thrombospondin-1 [TSP-1]), mitochondrial-derived N-formyl methionine peptide (fMET), and autoantibodies directed toward specific mitochondrial antigen mitofusin-1 (MFN1) by enzyme-linked immunosorbent assay in plasma of healthy controls (HCs, n = 30) and patients with PMR without giant cell arteritis (GCA) (n = 45) and patients with PMR with GCA (n = 9) before and after treatment with glucocorticoid therapy. Ultrapure mitochondria were opsonized with plasma from patients with PMR without GCA (n = 45) or HCs (n = 10) and were subsequently incubated with HC platelets. Platelet activation was assessed by P-selectin levels using flow cytometry.

Results: Plasma levels of anti-MFN1 IgG were elevated in patients with PMR with and without GCA before glucocorticoid therapy when compared with HCs (P < 0.01 for both groups). Levels of anti-MFN1 IgG significantly reduced after treatment with glucocorticoids in both groups (P < 0.01). Levels of fMET were also significantly higher in patients with PMR with and without GCA before glucocorticoid therapy in comparison with HCs (P < 0.001 and P < 0.01, respectively). However, the levels of fMET only dropped significantly after therapy in patients with PMR without GCA (P < 0.001). Plasma levels of TSP-1 were elevated in patients with PMR with and without GCA before glucocorticoid therapy when compared to HC (P < 0.001 for both groups). After glucocorticoid therapy, plasma levels of TSP-1 decreased significantly only in patients with PMR without GCA (P = 0.023). Mitochondria opsonized with plasma from patients with PMR without GCA induced higher platelet activation regardless of treatment status as compared with plasma from HCs (P < 0.0001 and P < 0.01 for pretreatment and posttreatment).

Conclusion: Our results indicate increased platelet activation and the presence of mitochondrial antigens and antibodies in the circulation of patients with PMR. Blocking mitochondrial-mediated platelet activation may reduce inflammation in patients with PMR, with potential therapeutic implications.

An exhausted antiviral immune response is observed in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and post-SARS-CoV-2 syndrome, also termed long COVID. In this study, potential mechanisms behind this exhaustion were investigated. First, the viral load of Epstein–Barr virus (EBV), human adenovirus (HAdV), human cytomegalovirus (HCMV), human herpesvirus 6 (HHV6), and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was determined in sputum samples (n = 29) derived from ME/CFS patients (n = 13), healthy controls (n = 10), elderly healthy controls (n = 4), and immunosuppressed controls (n = 2). Secondly, autoantibodies (autoAbs) to type I interferon (IFN-I) in sputum were analyzed to possibly explain impaired viral immunity. We found that ME/CFS patients released EBV at a significantly higher level compared to controls (p = 0.0256). HHV6 was present in ~50% of all participants at the same level. HAdV was detected in two cases with immunosuppression and severe ME/CFS, respectively. HCMV and SARS-CoV-2 were found only in immunosuppressed controls. Notably, anti-IFN-I autoAbs in ME/CFS and controls did not differ, except in a severe ME/CFS case showing an increased level. We conclude that ME/CFS patients, compared to controls, have a significantly higher load of EBV. IFN-I autoAbs cannot explain IFN-I dysfunction, with the possible exception of severe cases, also reported in severe SARS-CoV-2. We forward that additional mechanisms, such as the viral evasion of IFN-I effect via the degradation of IFN-receptors, may be present in ME/CFS, which demands further studies.

Deep learning has been used extensively for medical image analysis applications, assuming the training and test data adhere to the same probability distributions. However, a common challenge arises when dealing with medical images generated by different systems or even the same system with varying parameter settings. Such images often contain diverse textures and noise patterns, violating the assumption. Consequently, models trained on data from one machine or setting usually struggle to perform effectively on data from another. To address this issue in ultrasound images, we proposed a Generative Adversarial Network (GAN) based model in this paper. We formulated image harmonization and denoising tasks as an image-to-image translation task, wherein we adapt the texture pattern and reduced noise in Carotid ultrasound images while keeping the image content (the anatomy) unchanged. The performance was evaluated using feature distribution and pixel-space similarity metrics. In addition, blood-to-tissue contrast and influence on computed risk markers (Grey scale median, GSM) were evaluated. The results showed that domain adaptation was achieved in both tasks (histogram correlation 0.920 (0.043) and 0.844 (0.062)), as compared to no adaptation (0.890 (0.077) and 0.707 (0.098)), and that the anatomy of the images was retained (structure similarity index measure e.g. the arterial wall 0.71 (0.09) and 0.80 (0.08)). In addition, the image noise level (contrast) did not change in the image harmonization task (-34.1 (3.8) vs -35.2 (4.1) dB) but was improved in the noise reduction task (-23.5 (3.2) vs -46.7 (18.1) dB). To validate the performance of the proposed model, we compare its results with CycleGAN, the current state-of-the-art model. Our model outperformed CycleGAN in both tasks. Finally, the risk marker GSM was significantly changed in the noise reduction but not in the image harmonization task. We conclude that domain translation models are powerful tools for improving ultrasound image while retaining the underlying anatomy, but downstream calculations of risk markers may be affected.

This article investigates how participants in simulations of extreme events handle inadequacy, contributing to the discussion on workplace learning in high-pressure and unpredictable scenarios. The study is based on ethnographic fieldwork conducted across five simulations in three organizations (military, police, and county administrative board), involving 288 h of observations, ethnographic interviews, and 18 semi-structured interviews. The analysis focused on identifying episodes where participants encountered inadequacy, exploring how they recognized, attributed, and addressed it. Our findings reveal that inadequacy disrupts routine practices but also fosters opportunities for learning and innovation. Key conditions for effectively handling inadequacy include the voicing of inadequacy, which requires psychologically safe environments, and proactive responses such as improvisation or acceptance under urgency. Additionally, simulations, while controlled and artificial, effectively expose inadequacies, revealing gaps in preparedness that can inform future crisis responses. This article contributes to professional learning by highlighting inadequacy as a critical factor in both individual and collective learning, offering insights into how simulations can be designed to enhance preparedness for unpredictable, high-stakes events.

Addressing the challenge of bone tissue regeneration requires creating an optimal microenvironment that promotes both osteogenesis and angiogenesis. Electroconductive scaffolds have emerged as promising solutions for bone regeneration; however, existing conductive polymers often lack biofunctionality and biocompatibility. In this study, we synthesized poly(3,4-ethylenedioxythiophene) nanoparticles (PEDOT NPs) using chemical oxidation polymerization and incorporated them into gelatin/hyaluronic acid/hydroxyapatite (Gel:HA:HAp) scaffolds to develop Gel:HA:HAp:PEDOT-NP scaffolds. Morphological analysis by scanning electron microscopy (SEM) showed a honeycomb-like structure with pores of 228–250 μm in diameter. The addition of the synthesized PEDOT NPs increased the conductive capabilities of the scaffolds to 1 × 10−6 ± 1.3 × 10−7 S/cm. Biological assessment of PEDOT NP scaffolds using human foetal osteoblastic 1.19 cells (hFOB), and human bone marrow-derived mesenchymal stem cells (hBMSCs) revealed enhanced cell proliferation and viability compared to control scaffold without NPs, along with increased osteogenic differentiation, evidenced by higher levels of alkaline phosphatase activity, osteopontin (OPN), alkaline phosphatase (ALP), and osteocalcin (OCN) expression, as observed through immunofluorescence, and enhanced expression of osteogenic-related genes. The conductive scaffold shows interesting mineralization capacity, as shown by Alizarin red and Osteoimage staining. Furthermore, PEDOT-NP scaffolds promoted angiogenesis, as indicated by improved tube formation abilities of human umbilical vein endothelial cells (HUVECs), especially at the higher concentrations of NPs. Overall, our findings demonstrate that the integration of PEDOT NPs scaffold enhances their conductive properties and promotes cell proliferation, osteogenic differentiation, and angiogenesis. Gel:HA:HAp:PEDOT-NP scaffolds exhibit promising potential as efficient biomaterials for bone tissue regeneration, offering a potential engineered platform for clinical applications.

Deep learning has revolutionized biomedical research by providing sophisticated methods to handle complex, high-dimensional data. Multimodal deep learning (MDL) further enhances this capability by integrating diverse data types such as imaging, textual data, and genetic information, leading to more robust and accurate predictive models. In MDL, differently from early and late fusion methods, intermediate fusion stands out for its ability to effectively combine modality-specific features during the learning process. This systematic review comprehensively analyzes and formalizes current intermediate fusion methods in biomedical applications, highlighting their effectiveness in improving predictive performance and capturing complex inter-modal relationships. We investigate the techniques employed, the challenges faced, and potential future directions for advancing intermediate fusion methods. Additionally, we introduce a novel structured notation that standardizes intermediate fusion architectures, enhancing understanding and facilitating implementation across various domains. Our findings provide actionable insights and practical guidelines intended to support researchers, healthcare professionals, and the broader deep learning community in developing more sophisticated and insightful multimodal models. Through this review, we aim to provide a foundational framework for future research and practical applications in the dynamic field of MDL.

Introduction: Prostate cancer (PC) diagnosis relies on histopathological examination of prostate biopsies, which is restricted by insufficient sampling of all tumors present. Including samples from non-PC but tumor instructed normal tissues (TINT) may increase the diagnostic power by displaying the adaptive responses in benign tissues near tumors.

Methods: Here, we applied high-resolution magic angle spinning nuclear magnetic resonance (HR MAS NMR) to identify metabolomic biomarkers of possible diagnostic value in benign prostate tissues near low/high-grade tumors.

Results: Benign samples near high-grade tumors (B ISUP 3 + 4) exhibited altered metabolic profiles compared to those close to low-grade tumors (B ISUP 1 + 2). The levels of six metabolites differentiated between the two groups; myo-inositol, lysine, serine and combined signal of lysine/leucine/arginine were increased in benign samples near high-grade tumors (B ISUP 3 + 4) compared to near low-grade tumors (B ISUP 1 + 2), while levels of ethanolamine and lactate were decreased. Additionally, we revealed metabolic differences in non-cancer tissues as a function of their distance to the nearest tumor. Eight metabolites (glutathione, glutamate, combined signal of glutamate/glutamine - glx, glycerol, inosine, ethanolamine, serine and arginine) differentiated between benign tissue located close to the tumor (d ≤ 5 mm) compared to those far away (d ≥ 1 cm).

Conclusion: Our HR MAS NMR-based approach identified metabolic signatures in prostate biopsies that reflect the response of benign tissues to the presence of nearby located tumors in the same prostate and confirmed the power of the TINT concept for improved PC diagnostics and understanding of tumor-tissue interactions.

This study explored the adsorption capacity of hydrochars derived from a strain of microalgae biomass native to northern Sweden for contaminants of emerging concern (CECs) such as caffeine, chloramphenicol, trimethoprim, carbamazepine, bisphenol A, diclofenac, and triclosan. The findings indicate that the surface functionality of the microalgae-derived hydrochars – a blend of alkane/alkene and aromatic structures, coupled with different oxygen-containing functional groups (hydroxyl, carboxyl, and lactone) – significantly influenced the adsorption of the contaminants. The alkane/alkene and aromatic structures increased with increasing hydrothermal treatment temperature, while the oxygen- and nitrogen-containing groups diminished. Bisphenol A and triclosan, which were the compounds with the highest distribution coefficients, displayed improved adsorption on the hydrochars. The study measured peak adsorption values for the hydrochars processed at 180 °C, which achieved adsorption levels of 25.8 mg g− 1 for bisphenol A and 58.8 mg g− 1 for triclosan. The hydrochars produced using lower carbonisation temperatures (180 and 220 °C) exhibited enhanced adsorption of positively charged molecules such as trimethoprim, which was attributed to the increased presence of negatively charged oxygen-containing functional groups. Contrastingly, negatively charged molecules such as diclofenac and chloramphenicol demonstrated either low adsorption (2.5 mg g− 1 for chloramphenicol on hydrochar prepared at 180 °C) or no adsorption (diclofenac) due to repulsion by the negatively charged functional groups on the surface of the hydrochars.

BACKGROUND: 5-Fluorouracil (5-FU) is a cornerstone in treatment of colorectal cancer (CRC) and is usually combined with leucovorin (LV) to enhance the antitumour effect by increase thymidylate synthase (TS) inhibition, the key target enzyme for 5-FU. Arfolitixorin (Arfo) is an active form of the reduced folate, [6 R]-5,10-methylenetetrahydrofolate ([6 R]-MeTHF and in contrast to LV, does not need to be metabolized. The Modelle-001 was designed to explore whether a single intravenous bolus injection of Arfo as compared to LV, together with 5-FU increases the inhibition of TS, levels of folate concentrations and polyglutamylation in CRC liver metastases (CRLM) and liver parenchyma.

PATIENTS AND METHODS: Thirty patients with CRLM received either LV (60 mg/m²) or Arfo (30 mg/m² or 120 mg/m²) in combination with 5-FU preoperatively. Levels of folates and and TS inhibition were measured.

RESULTS: Significantly higher MeTHF levels and higher TS inhibition were measured in the Arfo groups compared to LV60, and there was a difference in folate poly-glutamylation between the groups.

CONCLUSION: The Modelle-001 Trial demonstrated significantly higher levels of MeTHF in metastases following Arfo compared to LV. This resulted in a greater increase TS inhibition in metastases although not statistically significant.

The Arctic is warming faster than anywhere else on Earth, placing tundra ecosystems at the forefront of global climate change. Plant biomass is a fundamental ecosystem attribute that is sensitive to changes in climate, closely tied to ecological function, and crucial for constraining ecosystem carbon dynamics. However, the amount, functional composition, and distribution of plant biomass are only coarsely quantified across the Arctic. Therefore, we developed the first moderate resolution (30 m) maps of live aboveground plant biomass (g m−2) and woody plant dominance (%) for the Arctic tundra biome, including the mountainous Oro Arctic. We modeled biomass for the year 2020 using a new synthesis dataset of field biomass harvest measurements, Landsat satellite seasonal synthetic composites, ancillary geospatial data, and machine learning models. Additionally, we quantified pixel-wise uncertainty in biomass predictions using Monte Carlo simulations and validated the models using a robust, spatially blocked and nested cross-validation procedure. Observed plant and woody plant biomass values ranged from 0 to ∼6000 g m−2 (mean ≈ 350 g m−2), while predicted values ranged from 0 to ∼4000 g m−2 (mean ≈ 275 g m−2), resulting in model validation root-mean-squared-error (RMSE) ≈ 400 g m−2 and R2 ≈ 0.6. Our maps not only capture large-scale patterns of plant biomass and woody plant dominance across the Arctic that are linked to climatic variation (e.g., thawing degree days), but also illustrate how fine-scale patterns are shaped by local surface hydrology, topography, and past disturbance. By providing data on plant biomass across Arctic tundra ecosystems at the highest resolution to date, our maps can significantly advance research and inform decision-making on topics ranging from Arctic vegetation monitoring and wildlife conservation to carbon accounting and land surface modeling.

Temporary anchorage devices (TADs) have evolved as useful anchorage providers for orthodontic tooth movements. To improve the stability of TADs, a number of modifications on their surface have been developed and investigated. This review comprehensively summarizes recent findings of clinically applied surface modifications of TADs and compared the biological improvement of these modifications. We focused on sandblasting, large-grit, acid etching (SLA), anodic oxidation (AO) and ultraviolet photofunctionalization (UVP). In vitro, in vivo and clinical studies of these surface modifications on TADs with clear explanations, low possibility of bias and published in English were included. Studies demonstrated that SLA, AO and UVP enhance cell attachment, proliferation, and differentiation in vitro. The biocompatibility and osteoconductivity of TAD surface are improved in vivo. However, in clinical studies, the changes are generally not so impressive. Furthermore, this review highlights the promising potential in combinations of different modifications. In addition, some other surface modifications, for instance, the biomimetic calcium phosphate coating, deserve to be proposed as future strategies.

Background: Childhood stunting, defined as height-for-age below − 2 standard deviations (SD), disproportionately affects the Northern Province of Rwanda. We investigated risk factors contributing to stunting in this region at individual, household, and societal/community levels to inform future interventions. Methods: We conducted a population-based, cross-sectional study using a quantitative questionnaire in households with children aged 1–36 months in the Northern Province. Anthropometric measurements of children and mothers were taken to estimate nutritional status. Multivariable logistic regressions were performed to identify independent risk factors of stunting, reporting odds ratios, 95% confidence intervals and p-values. Results: Overall, stunting prevalence was 27.1% in children aged 1–36 months. At the individual level, boys exhibited 82% higher risk of stunting compared to girls (aOR: 1.82, 95% CI: 1.19, 2.78). Household-level factors such as maternal height and BMI were inversely associated with the risk of childhood stunting (aOR: 0.94, 95% CI: 0.90, 0.97 and aOR: 0.92, 95% CI: 0.86, 0.99, respectively). Other risk factors included no breastfeeding at the time of interview (aOR: 2.00, 95% CI: 1.23, 3.25), presence of twins or triplets aged 1–36 months (aOR: 2.60, 95% CI: 1.21, 5.57), female-headed (single parent) households (aOR: 2.07, 95% CI: 1.00, 4.26), and absence of handwashing facilities near the toilet (aOR: 3.30, 95% CI: 1.36, 7.98). No societal/community factors were significantly associated with childhood stunting in the Northern Province. Conclusion: Childhood stunting in the Northern Province of Rwanda is associated with several factors that could lend themselves to interventions, e.g., improved handwashing facilities, improved childcare practices and targeting vulnerable groups such as boys, households with twins or single parents. Additionally, a thorough exploration of identified risk factors through qualitative approaches involving all stakeholders in child and maternal nutrition is warranted.

Aquatic ecosystems are subjected to many chemical stressors, including nutrients and emerging contaminants like pharmaceuticals. While pharmaceutical concentrations in streams and rivers are often below the thresholds for acute toxicity, they nonetheless disrupt ecology through changes to organisms' physiology, metabolism, and behavior. However, analyzing samples for the wide range of manufactured pharmaceuticals is often prohibitively expensive for many monitoring efforts. As such, the ability to predict pharmaceutical concentrations over space and time using easier-to-monitor water quality parameters would expand our understanding of the scope and consequences of pharmaceutical contamination in aquatic ecosystems. We applied random forest models to data from the Baltimore Ecosystem Study to investigate how well routinely monitored water quality parameters could be used to predict concentrations of nutrients and pharmaceuticals. We found that concentrations of nutrients were accurately predicted by these models, but models for predicting concentrations of pharmaceuticals had high error rates and low predictive ability. Differences in our ability to predict concentrations of nutrients as opposed to pharmaceuticals could be due to differences in their sources, chemistries, or behavior in the environment. More concerted efforts to monitor pharmaceutical concentrations over time in aquatic ecosystems may help to resolve environmental drivers of their concentration and improve our ability to predict them.

Effektivt språkstöd och lärmiljöer som främjar inkludering är avgörande för att flerspråkiga barn ska känna sig välkomna i svenska förskolor. För att stötta elever med annat modersmål än svenska betonar forskningen vikten av specialpedagogiska insatser som möjliggör att dessa elever får använda och lära sig sitt modersmål parallellt med svenska. Rektorer har ett juridiskt ansvar att skapa sådana inkluderande miljöer som stödjer flerspråkighet och garanterar en utbildning av hög kvalitet. Trots detta har Skolinspektionen bevisat att det finns ett likvärdighetsproblem i skapandet av lärmiljöer som inkluderar flerspråkiga barn. Syftet med denna studie var att beskriva hur rektorer i kommunala förskolor uppfattar specialpedagogikens och specialpedagogens roll i arbetet med att skapa inkluderande lärmiljöer för flerspråkiga barn. Erfarenheter från fem rektorer i kommunala förskolor sammanställdes med hjälp av semistrukturerade intervjuer. Studien visade att rektorer ansåg att specialpedagogik och nära samarbete med specialpedagogen spelade en avgörande roll för att skapa tydliga och inkluderande lärmiljöer för flerspråkiga barn. Studien har även visat att inkluderingsnivåerna för flerspråkiga barn i förskolan varierar beroende på rektorernas personliga värderingar, kommunens insatser och hur rektorerna själva tolkar begreppet inkludering. Vidare forskning med flerspråkiga barns vårdnadshavare eller en jämförande studie i andra skolformer skulle kunna komplettera denna studie.

This project investigated and evaluated the louver covering the outlet cooling shaft of combat vehicle 90 together with two possible redesigns. The goal was to investigate the flow properties of the new design models on the louver and then compare how they performed with the current in-use standard louver. The design concepts included the current in-use standard louver, a modified version whose details cannot be disclosed due to company confidentiality and lastly a design arranging the standard louvre vanes in an octagonal pattern with the center completely sealed off. The model which cannot be disclosed due to confidentiality showed significant increases in pressure drop across the louvre compared to the other designs. The octagonal louvre performed similarly as the standard model which shows that there could be possible gains from placing the vanes in a rotational flow pattern. The octagonal model also indicated that only a fraction of the flow exits the louvre through the center. Indicating that sealing off the center does not cause any significant changes to the overall flow and thus it could be sealed off.