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Educational transitions can influence loneliness and increase mental health issues for young people transitioning between educational stages. The aim was to explore the link between educational transitions and emerging adults' loneliness and mental health and how they perceive they can alleviate and/or improve these issues. Semi-structured qualitative interviews with a total of 12 emerging adults, 10 females and two males aged 18–29 (mean age, 22.91) were conducted. Data were analysed using qualitative content analysis. Emerging adults' loneliness and mental health across educational transitions could be influenced by changes to their sense of security, for example concurrent transitions, increased academic demands, changed social network, insufficient attachment, lack of community, or changed physical environment. Transitions can be associated with positive expectations and self-development but also worry, emotional turmoil, loneliness, and mental health issues. A better transition experience can be enabled by increasing resources and activities and promoting a secure environment. [ABSTRACT FROM AUTHOR]

This article compares two science advisory organizations: the Intergovernmental Panel for Climate Change (IPCC) and the International Council for the Exploration of the Seas (ICES), with a special focus on how their respective policy systems absorb the knowledge delivered for use in decision processes. The science-policy processes of these two organizations differ in important respects; ICES delivers highly specified knowledge to a specified uptake mechanism, while the IPCC produces unspecified knowledge for an unspecified uptake mechanism. Since both environmental governance areas are criticized for lack of needed action, a comparison is of interest asking how this might relate to the organization of science advice. As theoretical resources for this explorative comparison we utilize two approaches from the field of science and technology studies: the co-production approach, which focuses on the entanglements of scientific and political processes, and the systems-theory-oriented multiple-worlds model, which assumes a clear difference in institutional logics between the scientific and the political field. Since the IPCC has been critically analysed by several studies utilizing resources from the two approaches, we contribute with new insights by bringing in ICES, which is a much less studied organization exposing a different science-policy structure. One important finding is that the two theoretical approaches focus on different aspects, exposing 'links' and 'integration', both of which we argue are important for analysing and assessing science advisory organizations. Moreover, these aspects can be advantageously integrated into a single theoretical framework. [ABSTRACT FROM AUTHOR]

Background: As family members affect patient outcomes following open‐heart surgery, the objective was to provide updated knowledge on family involvement in to guide future interventions facilitating family involvement. Aim: The aim was to explore and describe the experiences and actions of important situations of family involvement asexpressed by patients who underwent elective open‐heart surgery in Sweden. Methodological Design and Justification: The critical incident technique (CIT) was used, which is a qualitative research method suitable for clinical problems when a phenomenon is known but the experiences and consequences of it are not. Ethical Issues and Approval: Considerations for patient integrity were made during the recruitment phase by ensuring that voluntary informed consent was obtained in two steps. Research Methods: Individual interviews were conducted with 35 patients who underwent open‐heart surgery in Sweden in 2023. Important situations were analysed according to the CIT method. Results: Two main areas emerged: Patients described important situations of family involvement as experiences of mutual dependency while also being independent individuals. These experiences led to balancing healing and risk‐taking activities as a family. The positive consequences of family involvement described by patients included improved recovery through practical help at home and emotional support. Conclusions: As complements to preserving the existing positive aspects of family involvement, social support screening, the establishment of individualised visitation policies and the provision of professional and peer support earlier can improve patient recovery following open‐heart surgery. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Conclusion Clinical Implications Challenges in mutual awareness in interprofessional collaboration (IPC) along with relational and cultural barriers among professionals disrupt flow and delay decision‐making in trauma care. Thus, this study explores team behaviours within IPC in trauma teams during trauma alerts from the perspective of radiographers.A qualitative approach was used with a critical incident technique (CIT) design applying interviews with radiographers within three hospitals in Sweden from May 2022 to May 2023. CIT analysis was conducted with an abductive approach, applying an IPC core competency framework.The results present collaborative requirements in trauma care from radiographers' perspective narrating a distribution of team behaviours within trauma team collaboration and fundamental skills in IPC. Behaviours within interprofessional values and ethics were the most reported incidents related to valuing radiographers' contributions to IPC in acute trauma care.Exploring behaviour through critical incidents associated with core competencies of IPC highlights the importance of interprofessional values as a foundation for successful IPC in the trauma team. The results show deficiencies in inclusive behaviour, influenced by the hierarchical environment of IPC. Power imbalances in this setting are traced to differences in perceived value and shared understanding among team members, possibly rooted in professional identity and culture. A dedicated leader is argued, as the recognition of radiographers' scope of practice in trauma imaging, emphasising the significance of shared decision‐making.The findings highlight organisational and relational coordination challenges for optimising competencies in IPC. IPC's success requires reinforcing values and ethics by empowering members' contributions and shared decision‐making. This involves clarifying and recognising responsibilities, particularly for radiographers, ensuring their role in trauma imaging is respected and integrated into decision‐making. [ABSTRACT FROM AUTHOR]

Herbivores drive shifts in plant species composition by interacting with vegetation through defoliation, trampling and nutrient addition: urine and faeces. As herbivore effects on vegetation accumulate over time, they might spillover to other trophic levels, but how and when this happens is poorly understood. Since it is methodologically demanding to measure biodiversity across spatial gradients, an alternative approach is to assess it through biodiversity indices of vascular plants. We employed the Index of biodiversity relevance developed for Swedish flora which provides an estimated number of organisms associated with a plant species, allowing the quantification of trophic community size. Values from this index were coupled with vegetation data from a network of 96 fenced and paired grazed plots across Fennoscandia. We analysed the role herbivory has on plant richness and diversity, and on the number of organisms that interact with the vegetation according to the index values. We also explored how herbivores influence the competitive effects of tall shrubs on other plants since the dominance of a vegetation type links directly to biodiversity. Plant diversity had no clear response to grazing. Overall vegetation and the vegetation subgroups herbs and non‐fruit shrubs had higher biodiversity index values in fenced plots, indicating a higher number of plant–host interactions. Herb cover was negatively related to shrubs in both treatments but with a faster decline in the absence of herbivores. This study highlights the importance of maintaining herbivore populations in the Arctic to conserve the vegetation structure and biodiversity of the tundra. This method of coupling biodiversity indexes with vegetation data provides complementary information to the plant diversity, especially when methodological or time constraints prevent complete field inventories. [ABSTRACT FROM AUTHOR]

Memory develops across the course of the first years of life and is influenced by daily experiences, such as exposure to media like books and television. Memory as tapped by Deferred imitation (DI) requires that toddlers form a representation of the target actions that they can later use to reproduce the actions and in addition to measuring memory for real live events, it can also be used to measure memory for events viewed through media. Toddlers are frequently exposed to multiple forms of digital media in addition to more traditional forms of picture book reading. In a within‐subjects design, memory was assessed with a DI task in 2‐year‐olds (n = 89) using the Frankfurt Imitation Test. Deferred imitation was assessed after live and video demonstrations. Parents completed a survey about children's media use. Picture book reading for less than 30 min a day predicted lower memory scores for actions demonstrated live. Watching video content for more than 1 h a day predicted lower memory scores for actions demonstrated on video. Results are interpreted in terms of individual differences in experiences of traditional and digital media and the development of symbolic understanding. [ABSTRACT FROM AUTHOR]

Echocardiography is recommended as a first-line diagnostic tool in patients with premature ventricular contractions (PVCs). However, standard echocardiography is not always able to identify early signs of myocardial dysfunction and cardiac magnetic resonance (CMR) may offer additional information. Since CMR has lower accessibility and higher cost compared to echocardiography, we wanted to evaluate how additional echocardiographic parameters, not included in routine examinations, perform compared to CMR in detecting signs of cardiomyopathy in PVC patients with normal findings at a standard echocardiogram. We compared CMR findings and results from an extended echocardiographic examination in thirty-nine patients who had a high PVC burden. The additional echocardiographic parameters were global longitudinal strain, mechanical dispersion, ventricular–arterial coupling, integrated backscatter and left atrial activation time. Eleven patients had pathological findings at CMR. The additional echocardiographic parameters did not significantly differ between patients with or without CMR findings. However, several patients with normal CMR findings showed signs of ventricular dysfunction when evaluated with the additional echocardiographic parameters, which suggests that these could possibly offer supplementary information in the assessment of PVC patients. [ABSTRACT FROM AUTHOR]

Secondary tropical forests are at the forefront of deforestation pressures. They store large amounts of carbon, which, if compensated for to avoid net emissions associated with conversion to non-forest uses, may help advance tropical forest conservation. We measured above- and below-ground carbon stocks down to 1 m soil depth across a secondary forest and in oil palm plantations in Malaysia. We calculated net carbon losses when converting secondary forests to oil palm plantations and estimated payments to avoid net emissions arising from land conversion to a 22-year oil palm rotation, based on land opportunity costs per hectare. We explored how estimates would vary between forests by also extracting carbon stock data for primary forest from the literature. When tree and soil carbon was accounted for, payments of US$18–51 tCO2–1 for secondary forests and US$14–40 tCO2–1 for primary forest would equal opportunity costs associated with oil palm plantations per hectare. If detailed assessments of soil carbon were not accounted for, payments to offset opportunity costs would need to be considerably higher for secondary forests (US$28–80 tCO2–1). These results show that assessment of carbon stocks down to 1 m soil depth in tropical forests can substantially influence the estimated value of avoided-emission payments. [ABSTRACT FROM AUTHOR]

Secondary tropical forests are at the forefront of deforestation pressures. They store large amounts of carbon, which, if compensated for to avoid net emissions associated with conversion to non-forest uses, may help advance tropical forest conservation. We measured above- and below-ground carbon stocks down to 1 m soil depth across a secondary forest and in oil palm plantations in Malaysia. We calculated net carbon losses when converting secondary forests to oil palm plantations and estimated payments to avoid net emissions arising from land conversion to a 22-year oil palm rotation, based on land opportunity costs per hectare. We explored how estimates would vary between forests by also extracting carbon stock data for primary forest from the literature. When tree and soil carbon was accounted for, payments of US$18–51 tCO2–1 for secondary forests and US$14–40 tCO2–1 for primary forest would equal opportunity costs associated with oil palm plantations per hectare. If detailed assessments of soil carbon were not accounted for, payments to offset opportunity costs would need to be considerably higher for secondary forests (US$28–80 tCO2–1). These results show that assessment of carbon stocks down to 1 m soil depth in tropical forests can substantially influence the estimated value of avoided-emission payments. [ABSTRACT FROM AUTHOR]

Co-teaching has been brought forth as an inclusive teaching approach in research and in the Finnish core curriculum. The realisation of co-teaching at the school level puts great demands on teachers, but also on school leaders (SLs) who are expected to lead educational change. The aim of the study was to examine how SLs in Finnish schools were co-teaching has been realised experience their own and co-teachers' roles in leading the realisation of co-teaching as an inclusive approach. Data were collected through semi-structured interviews with nine SLs in Finland. Inductive thematic analysis was used and revealed two overarching themes: SLs as facilitators of co-teaching and teachers as driving forces of co-teaching. The need for a more active and goal-oriented SL role focused on involving the whole school community in developing co-teaching rather than delegating the responsibility to single teachers is discussed through the lens of distributed leadership and earlier research. [ABSTRACT FROM AUTHOR]

This study examined how Finnish primary school students perceive teachers' roles and responsibilities, their own learning and participation, and the social climate during co-taught lessons. Data were collected through a web-based questionnaire among primary school students (N = 242) from grades four to six from Finnish schools where Swedish is the medium of instruction and co-teaching has been initiated. Students with and without special educational needs participated in the study. Students without special educational needs were more positive to co-teaching the more co-taught lessons they received per week, while students with special educational needs were most positive when they received four to five lessons weekly. Students also perceived that mostly the general education teacher is responsible for lesson planning and instruction but that both teachers contribute to the students' learning. In earlier research, the students' perceptions have seldom been in focus and there is an obvious need for more research on students' perspectives to develop and realise co-teaching as a teaching approach that promotes learning and participation for all students in a general classroom. [ABSTRACT FROM AUTHOR]

Introduction: Vulvar cancer is a rare gynecological cancer affecting mostly older women. The aim of this population‐based study was to investigate the incidence and net survival of vulvar cancer in Swedish women from 1960 to 2019. Material and methods: Data were retrieved from the mandatory Swedish Cancer Registry consisting of all women diagnosed with vulvar cancer between 1960 and 2019. Only women with a morphologically verified diagnosis of vulvar cancer were included. The individuals were then further matched with the Swedish Death Registry up until May 31, 2020. Results: In total, 8499 women were included with the following morphologies: squamous cell carcinoma 7250 (85.8%), malignant melanoma 539 (6.4%), adenocarcinoma 401 (4.8%) and other: 259 (3.1%). More than 50% of vulvar cancer cases occurred in women aged between 65 and 84 years of age. The 5‐year age‐standardized net survival increased from 53.0% (95% confidence interval [CI] 48.9–57.5) in 1960 to 72.1% (95% CI 68.8–75.5) in 2019. The proportion of adenocarcinoma among all cases increased from 2.0% to 8.7% between the 1960s and 2010s and an increase in age‐standardized 5‐year net survival was found for adenocarcinoma. Conclusions: The age‐standardized incidence of vulvar cancer cases in Sweden was stable between 1960 and 2019. During the study period, an increase in adenocarcinoma and a decrease in malignant melanoma cases was found. Five‐year net survival increased by 20 percent units during the study period. For squamous cell carcinoma, an increased age‐specific 5‐year net survival was observed for all age groups, apart for women aged ≥85. [ABSTRACT FROM AUTHOR]

Aim: This study addresses the scarcity of longitudinal research on the influence of screen media on children. It aims to explore the longitudinal relationship between children's vocabulary development and their exposure to screen media. Methods: The study, initiated in 2017, included 72 children (37 boys) in Östergötland, Sweden, at three key developmental stages: preverbal (9.7 months), early verbal (25.5 months) and preliterate (5.4 years). Parents completed online surveys at each time point, reporting their child's screen time. At 10 months and 2 years, age‐appropriate vocabulary assessments were conducted online. At age 5, children's vocabulary was laboratory assessed. Results: Correlational analysis revealed a negative relationship between language scores and screen media use across all time points. Furthermore, a cross‐lagged panel model demonstrated that screen media use showed significant continuity over time, with screen use at age 2 predicting language development at ages 2 and 5. Conclusion: This longitudinal study, spanned from 9 months to 5 years of age, established a predictive negative association between children's exposure to screen media and their vocabulary development. These findings underscore the need to consider the impact of screen media on early childhood development and may inform guidelines for screen media use in young children. [ABSTRACT FROM AUTHOR]

Mass-loss is a key parameter throughout the evolution of massive stars. In this work we probe the radial clumping stratification of OB stars in the intermediate and outer wind regions (r ≳ 2 R *; r , radial distance to photosphere), derive upper limits for mass-loss rates, Ṁ max, and compare them to current theoretical mass-loss recipes implemented in evolutionary models. A key conclusion of our analysis regards the derived upper-limit mass-loss rates of B supergiants, independently of clumping, which calls for an urgent revision of the role recombination of iron-like elements plays in determining the mass-loss rates of objects that cross the bi-stability region, and a careful analysis of corresponding effects for stellar evolution models. [ABSTRACT FROM AUTHOR]

Background: Rapid antigen detection tests (RADT) for Group A streptococci (GAS) and point-of-care tests for C-reactive protein (CRP) are commonly used in patients with pharyngotonsillitis in Sweden and Denmark although CRP testing is not supported by guidelines. We aimed to describe (1) the proportion of patients tested with RADT and/or CRP, (2) the relation between test results and antibiotic prescribing, and (3) the association between CRP level and microbial aetiology. Methods: We used a post-hoc-analysis of data collected in primary health care in a prospective aetiological study of 220 patients 15–45 years old diagnosed with pharyngotonsillitis. The outcomes of RADTs and CRP tests were related to antibiotic prescribing and microbial aetiology. Results: A RADT was used in 94% of the patients. A CRP test was used in 50% of the patients but more commonly in those with a negative RADT (59%) than in those with a positive RADT (38%) (p = 0.005). Most (74%) CRP tests were used in patients with a negative RADT. Antibiotic prescribing differed greatly between patients with a positive RADT (96%) and patients with a negative RADT (17%) (p < 0.001). In patients with a negative RADT, there was a positive association between CRP value and antibiotic prescribing (OR 1.05; 95% CI 1.02–1.07; p < 0.001). Patients with CRP values ≤ 30 mg/l were seldomly prescribed antibiotics. Patients with GAS in culture had the highest median CRP (46 mg/l), which was higher than in patients without GAS (8 mg/l; p < 0.001). However, the positive predictive value for GAS never exceeded 0.60 (95% CI 0.31–0.83) at the investigated CRP levels. Conclusions: The widespread use of tests is a major deviation from national guidelines. Most CRP tests were used in patients with a negative RADT, suggesting a belief in the added value of a CRP test, and the CRP result seemed to influence antibiotic prescribing. However, as an aetiological test, CRP is not useful for predicting GAS. [ABSTRACT FROM AUTHOR]

The comorbidity between problem gambling and substance use/abuse is high in many populations previously studied. However, the occurrence of problem gambling among individuals with substance abuse has not been thoroughly studied, which is especially true for individuals in inpatient or compulsory care. The present early-stage study explored the presence of gambling and problem gambling among inpatients in compulsory care in Sweden who has been court-ordered to treatment for their substance abuse (alcohol and/or drugs). The study furthermore investigates the use of preventive measures and treatment seeking. The most effective strategy to recruit participants (no incentive, incentive and incentive and face-to-face recruitment) was also explored. Twenty-one participants were recruited and seven of them had at-risk or problem gambling and none of them had accessed treatment. The best way of recruiting was to offer a gift certificate and inform about the study face-to-face. The implications are that individuals in compulsory care for substance abuse need to be screened for problem gambling, that recruitment for studies in this population is best carried out by offering incentives and educational efforts and that it might be beneficial for the clients in compulsory care to be offered gambling treatment. [ABSTRACT FROM AUTHOR]

Intermediation and transformative capacity building are identified as important issues in sustainability transformations. Yet the connection of these two concepts has not been systematically analysed. This empirical, qualitative case study on active transport in Finland investigates intermediation in building local transformative capacity. The study shows that intermediaries are a heterogeneous group of actors that support transformative capacity building by facilitating the flows of knowledge, linking actors, forming ties across different scales, and supporting visioning and strategic planning. Intermediation manifests in five of the seven elements of local transformative capacity building. Our study, thus, contrasts with previous understanding wherein intermediation is considered only as a criterion for multiform governance. As intermediation is central in building transformative capacity, it should be better acknowledged, particularly by authorities and policymakers to secure legitimacy, operational capabilities, and funding for intermediaries. [ABSTRACT FROM AUTHOR]

Background: Cervical cancer is preventable through screening and vaccination against high-risk human papillomavirus (hr-HPV). For a screening program to be successful it is vital that the clinical management and follow-up regime of patients with abnormal screening results is well developed and that the attendance rate for follow-up is high. The aim of the study was to analyze how effective conization with recommended follow-up was in preventing subsequent cervical cancer, and to evaluate how clinical follow-up recommendations are obeyed in the region of Skåne, Sweden. Methods: All women (n = 8835) who had undergone conization in the region of Skåne, Sweden, between the years of 2015 and 2021 were identified. Individuals with confirmed cervical cancer in the conization material were referred for additional treatment (n = 114), leaving 8721 included in the follow-up. Adherence to follow-up and cytological, histopathological and HPV status at follow-up were collected at eight, 12 and 24 months post-conization. The total follow-up time was from January 1, 2015, to January 30, 2023. Results: Within 12 months post-conization, 90% of the patients conducted a cytological cervical sample. The rates of a negative test of cure (HPV negative and normal cytology) were 69.7%, 76.3% and 84.4% at eight, 12 and 24 months post-conization respectively. The clearance of HPV was 79.6%, 80.8% and 87.8% at eight, 12 and 24 months post-conization respectively. Out of 5613 patients with a negative test of cure within one year after conization, no cervical cancer was found during follow-up and 11 (0.2%) women developed high-grade intraepithelial lesions/adenocarcinoma in situ (HSIL/AIS) with an average time from conization to new diagnosis of 42 months. The mean follow-up time was 32.1 months. Conclusions: The clearance rate of hr-HPV post cervical conization due to dysplasia appears to be high within eight months. With a negative test of cure post cervical conization, the risk of cervical cancer within the following three years seems to be extremely low and the risk of developing HSIL/AIS was lower than the incidence of HSIL/AIS in the general screening population. [ABSTRACT FROM AUTHOR]

Myocardial infarction (MI) with obstructive coronary artery disease (MI-CAD) and MI in the absence of obstructive coronary artery disease (MINOCA) affect different populations and may have separate pathophysiological mechanisms, with greater inflammatory activity in MINOCA compared to MI-CAD. Helicobacter pylori (Hp) can cause systemic inflammation and has been associated with cardiovascular disease (CVD). We aimed to investigate whether Hp infection is associated with concentrations of protein biomarkers of inflammation and CVD. In a case-control study, patients with MINOCA (n = 99) in Sweden were included, complemented by matched subjects with MI-CAD (n = 99) and controls (n = 100). Protein biomarkers were measured with a proximity extension assay in plasma samples collected 3 months after MI. The seroprevalence of Hp and cytotoxin-associated gene A (CagA) was determined using ELISA. The associations between protein levels and Hp status were studied with linear regression. The prevalence of Hp was 20.2%, 19.2%, and 16.0% for MINOCA, MI-CAD, and controls, respectively (p = 0.73). Seven proteins were associated with Hp in an adjusted model: tissue plasminogen activator (tPA), interleukin-6 (IL-6), myeloperoxidase (MPO), TNF-related activation-induced cytokine (TRANCE), pappalysin-1 (PAPPA), soluble urokinase plasminogen activator receptor (suPAR), and P-selectin glycoprotein ligand 1 (PSGL-1). Hp infection was present in one in five patients with MI, irrespective of the presence of obstructive CAD. Inflammatory proteins were elevated in Hp-positive subjects, thus not ruling out that Hp may promote an inflammatory response and potentially contribute to the development of CVD. [ABSTRACT FROM AUTHOR]

Red blood cells (RBCs) mediate cardioprotection via nitric oxide–like bioactivity, but the signaling and the identity of any mediator released by the RBCs remains unknown. We investigated whether RBCs exposed to hypoxia release a cardioprotective mediator and explored the nature of this mediator. Perfusion of isolated hearts subjected to ischemiareperfusion with extracellular supernatant from mouse RBCs exposed to hypoxia resulted in improved postischemic cardiac function and reduced infarct size. Hypoxia increased extracellular export of cyclic guanosine monophosphate (cGMP) from mouse RBCs, and exogenous cGMP mimicked the cardioprotection induced by the supernatant. The protection induced by hypoxic RBCs was dependent on RBC-soluble guanylate cyclase and cGMP transport and was sensitive to phosphodiesterase 5 and activated cardiomyocyte protein kinase G. Oral administration of nitrate to mice to increase nitric oxide bioactivity further enhanced the cardioprotective effect of hypoxic RBCs. In a placebo-controlled clinical trial, a clear cardioprotective, soluble guanylate cyclase–dependent effect was induced by RBCs collected from patients randomized to 5 weeks nitrate-rich diet. It is concluded that RBCs generate and export cGMP as a response to hypoxia, mediating cardioprotection via a paracrine effect. This effect can be further augmented by a simple dietary intervention, suggesting preventive and therapeutic opportunities in ischemic heart disease. [ABSTRACT FROM AUTHOR]

This study investigates how the different political opportunity structures (POS) are related to NGO mobilization in two Chinese cities, Guangzhou and Hangzhou. Based on 48 interviews from 2016–2019, the study finds that variance in NGO mobilization is related to differences such as rules for NGO registration, more or less open-minded local leaders, and a relatively more independent media. NGO governance in Hangzhou is characterized as coopted participation. A few NGOs are allowed some influence in policy making, but in order to be allowed to mobilize, NGOs must accept a certain degree of cooptation. NGO governance in Guangzhou is characterized as constrained autonomy as the government plays a less active role in mobilizing NGOs, and more initiative for policy influence comes from the NGOs themselves. [ABSTRACT FROM AUTHOR]

Vocabulary experts recommend first language (L1) translation equivalents for establishing form–meaning mappings for new second language (L2) words, especially for lower proficiency learners. Empirical evidence to date speaks in favor of L1 translation equivalents over L2 meaning definitions, but most studies have investigated bi‐ rather than multilingual learners. In our study, we investigated instructed English vocabulary learning through an intervention study in six language‐diverse secondary school English classrooms in Sweden (N = 74) involving three conditions for presentation of word meanings: (a) definitions in the L2 (English), (b) translation equivalents in the shared school and majority language (Swedish), and (c) translation equivalents in the shared school and majority language plus other prior languages among the learners (Swedish and other). Based on overall weighted mean effect sizes and mixed‐effects modeling, the results showed that conditions that involved L1 translation equivalents yielded higher scores than did target language definitions in immediate posttests with a small effect size but no differences in delayed posttests. A one‐page Accessible Summary of this article in non‐technical language is freely available in the Supporting Information online and at https://oasis‐database.org [ABSTRACT FROM AUTHOR]

Background: Deafblindness is a rare condition, and its prevalence has been reported to be approximately 1 in 27 000 new‐borns worldwide. For individuals with deafblindness, lifelong interventions and support are needed to be able to develop communication, be active and preserve a good quality of life. Because little is known about what kind of support and interventions can be offered to children with deafblindness, the aim was to summarize and disseminate research findings regarding this topic. Methods: Integrative review principles were employed. Systematic searches in eight databases and additional manual searches were conducted. The inclusion criteria were as follows: original studies published between 2000 and 2021 examining either interventions for children between 0 and 18 years of age with deafblindness or interventions aimed at children with deafblindness but offered to their relatives or professionals working with them. Studies on support for family members were also sought. Study characteristics were described, and key findings were synthesized into categories based on their similarities. Results: Of the 6268 identified original studies, 32 were included. The key outcomes from the included studies were synthesized into three categories, with two categories illustrating the goal/intention of the intervention (social interaction and communication, motivation and participation) and one focusing on or identifying the action taken to benefit the child (adaptation of the educational environment). Social interaction and communication was the dominant category, covering 24 of the 32 included studies. Conclusions: This review concludes that there are a limited number of evaluated interventions for children with deafblindness. In many cases, the interventions were adapted to the individual child's needs, and most of them were found within the area of social interaction and communication. More research is needed to strengthen the level of evidence for interventions for children with deafblindness. [ABSTRACT FROM AUTHOR]

Despite sleep disturbance and somatic symptoms being common health complaints, the relationship between these disturbances and single somatic symptoms is not well documented. The objectives of this study were to (i) identify somatic symptoms that are particularly associated with sleep disturbance, here referred to as somatic symptoms related to sleep disturbance (SS-SD), (ii) determine increased risk of sleep disturbance for each SS-SD and for a certain number of SS-SD, with and without controlling for anxiety and depression, and (iii) determine sensitivity and specificity for identifying sleep disturbance based on number of SS-SD in a general Swedish sample. Population-based, cross-sectional data based on validated questionnaire instruments were used from participants who constituted a sleep disturbance (n = 864) or a reference (n = 2340) group. Among 15 common somatic symptoms, stomach pain, back pain nausea/gas/indigestion, dizziness, and constipation/loose bowels/diarrhea were identified as SS-SD, with odds ratios of increased risk of sleep disturbance that ranged from 1.93 to 2.44 (1.36–1.79 and 1.54–1.91 when controlled for anxiety and depression, respectively). The risk of sleep disturbance increased by 1.44 times for each SS-SD (1.25 and 1.30 when controlled for anxiety and depression, respectively). A cutoff of two/three or more SS-SD had a sensitivity of 72.5/54.2% and a specificity of 50.0/69.7% for identifying sleep disturbances. When patients present with these somatic symptoms with or without a pathophysiological explanation, primary care clinicians may consider screening for sleep disturbance. [ABSTRACT FROM AUTHOR]

Helicobacter pylori (H. pylori) has been associated with cardiovascular diseases. The pro-inflammatory H. pylori virulence factor cytotoxin-associated gene A (CagA) has been detected in serum exosomes of H. pylori-infected subjects and may exert systemic effects throughout the cardiovascular system. The role of H. pylori and CagA in vascular calcification was hitherto unknown. The aim of this study was to determine the vascular effects of CagA through human coronary artery smooth muscle cell (CASMC) osteogenic and pro-inflammatory effector gene expression as well as interleukin 1β secretion and cellular calcification. CagA upregulated bone morphogenic protein 2 (BMP-2) associated with an osteogenic CASMC phenotype switch and induced increased cellular calcification. Furthermore, a pro-inflammatory response was observed. These results support that H. pylori may contribute to vascular calcification through CagA rendering CASMCs osteogenic and inducing calcification. [ABSTRACT FROM AUTHOR]

The Adjusted Rand Index (ARI) is arguably one of the most popular measures for cluster comparison. The adjustment of the ARI is based on a hypergeometric distribution assumption which is not satisfactory from a modeling point of view because (i) it is not appropriate when the two clusterings are dependent, (ii) it forces the size of the clusters, and (iii) it ignores the randomness of the sampling. In this work, we present a new "modified" version of the Rand Index. First, as in Russell et al. (J Malar Inst India 3(1), 1940), we consider only the pairs consistent by similarity and ignore the pairs consistent by difference to define the MRI. Second, we base the adjusted version, called MARI, on a multinomial distribution instead of a hypergeometric distribution. The multinomial model is advantageous because it does not force the size of the clusters, correctly models randomness and is easily extended to the dependent case. We show that ARI is biased under the multinomial model and that the difference between ARI and MARI can be significant for small n but essentially vanishes for large n, where n is the number of individuals. Finally, we provide an efficient algorithm to compute all these quantities ((A)RI and M(A)RI) based on a sparse representation of the contingency table in our aricode package. The space and time complexity is linear with respect to the number of samples and, more importantly, does not depend on the number of clusters as we do not explicitly compute the contingency table. [ABSTRACT FROM AUTHOR]

Co-teaching is highlighted as an opportunity to develop inclusive practices. This study aimed to investigate how teacher candidates experienced co-teaching during supervised teacher training periods. Data were collected through pair interviews and questionnaires (N = 22). The analysis was conducted through thematic analysis. Results show that the participants experienced both possibilities and challenges. Generally, they experienced planning and communication as time-consuming but as an opportunity to share ideas and knowledge. They experienced shared responsibilities and equal roles, but in some cases, inequalities appeared. Furthermore, they saw co-teaching as a way to meet diverse needs in the class, but some of the participants had some concerns regarding meeting the individual needs of pupils with individual educational plans (IEPs). Despite challenges, the results show that co-teaching is a valuable element of teacher training. Implications for teacher education are discussed. [ABSTRACT FROM AUTHOR]

Elevational gradients are useful for predicting how plant communities respond to global warming, because communities at lower elevations experience warmer temperatures. Fine root traits and root trait variation could play an important role in determining plant community responses to warming in cold‐climate ecosystems where a large proportion of plant biomass is allocated belowground. Here, we investigated the effects of elevation‐associated temperature change on twelve chemical and morphological fine root traits of plant species and plant communities in a Swedish subarctic tundra. We also assessed the relative contributions of plant species turnover and intraspecific variation to the total amount of community‐level root trait variation explained by elevation. Several root traits, both at the species and whole community levels, had significant linear or quadratic relationships with elevation, but the direction and strength of these relationships varied among traits and plant species. Further, we found no support for a unidirectional change from more acquisitive root trait values at the lower elevations towards trait values associated with greater nutrient conservation at the higher elevations, either at the species or community level. On the other hand, root trait coefficients of variation at the community level increased with elevation for several root traits. Further, for a large proportion of the community‐level traits we found that intraspecific variation was relatively more important than species turnover, meaning that trait plasticity is important for driving community‐level trait responses to environmental factors in this tundra system. Our findings indicate that with progressing global warming, intraspecific trait variation may drive plant community composition but this may not necessarily lead to shifts in root resource–acquisition strategy for all species. [ABSTRACT FROM AUTHOR]

Objective: Nationwide register data provide unique opportunities for real-world assessment of complications from different surgical methods. This study aimed to assess incidence of, and predictors for, post-operative complications and to evaluate 90-day mortality following different surgical procedures and thermal ablation for renal cell carcinoma (RCC). Material and methods: All patients undergoing surgical treatment and thermal ablation for RCC in Sweden during 2015-2019 were identified from the National Swedish Kidney Cancer Register. Frequencies and types of post-operative complications were analysed. Logistic regression models were used to identify predictors for 90-day major (Clavien-Dindo grades III-V) complications, including death. Results: The overall complication rate was 24% (1295/5505), of which 495 (8.7%) were major complications. Most complications occurred following open surgery, of which bleeding and infection were the most common. Twice as many complications were observed in patients undergoing open surgery compared to minimally invasive surgery (20% vs. 10%, P < 0.001). Statistically significant predictors for major complications irrespective of surgical category and technique were American society of anesthiologists (ASA) score, tumour diameter and serum creatinine. Separating radical and partial nephrectomy, surgical technique remained a significant risk factor for major complications. Most complications occurred within the first 20 days. The overall 90-day readmission rate was 6.2%, and 30- and 90-day mortality rates were 0.47% and 1.5%, respectively. Conclusions: In conclusion, bleeding and infection were the most common major complications after RCC surgery. Twice as many patients undergoing open surgery suffer a major post-operative complication as compared to patients subjected to minimally invasive surgery. General predictors for major complications were ASA score, tumour size, kidney function and surgical technique. [ABSTRACT FROM AUTHOR]

The neurovascular and neurometabolic couplings (NVC and NMC) connect cerebral activity, blood flow, and metabolism. This interconnection is used in for instance functional imaging, which analyses the blood-oxygen-dependent (BOLD) signal. The mechanisms underlying the NVC are complex, which warrants a model-based analysis of data. We have previously developed a mechanistically detailed model for the NVC, and others have proposed detailed models for cerebral metabolism. However, existing metabolic models are still not fully utilizing available magnetic resonance spectroscopy (MRS) data and are not connected to detailed models for NVC. Therefore, we herein present a new model that integrates mechanistic modelling of both MRS and BOLD data. The metabolic model covers central metabolism, using a minimal set of interactions, and can describe time-series data for glucose, lactate, aspartate, and glutamate, measured after visual stimuli. Statistical tests confirm that the model can describe both estimation data and predict independent validation data, not used for model training. The interconnected NVC model can simultaneously describe BOLD data and can be used to predict expected metabolic responses in experiments where metabolism has not been measured. This model is a step towards a useful and mechanistically detailed model for cerebral blood flow and metabolism, with potential applications in both basic research and clinical applications. Author summary: The neurovascular and neurometabolic couplings are highly central for several clinical imaging techniques since these frequently use blood oxygenation (the BOLD signal) as a proxy for neuronal activity. This relationship is described by the highly complex neurovascular and neurometabolic couplings, which describe the balancing between increased metabolic demand and blood flow, and which involve several cell types and regulatory systems, which all change dynamically over time. While there are previous works that describe the neurovascular coupling in detail, neither we nor others have developed connections to corresponding mechanistic models for the third aspect, the metabolic aspect. Furthermore, magnetic resonance spectroscopy (MRS) data for such modelling readily is available. In this paper we present a minimal mechanistic model that can describe the metabolic response to visual stimuli. The model is trained to describe experimental data for the relative change in metabolic concentrations of several metabolites in the visual cortex during stimulation. The model is also validated against independent validation data, that was not used for model training. Finally, we also connect this metabolic model to a detailed mechanistic model of the neurovascular coupling. Showing that the model can describe both the metabolic response and a neurovascular response simultaneously. [ABSTRACT FROM AUTHOR]

The family life of people living with one family member with deafblindness has been sparsely described. The aim of the study was to explore how children experience their everyday family life when having a parent with deafblindness. An explorative study in which data have been collected by qualitative interviews of children. Qualitative content analysis has been used for analysing the data. Overall theme; Living an ordinary life—yet not, is based on four categories with subcategories. A family like any other describes: Having the same family life as their friends, Acting like other children and It is what it is. Different everyday life describes: Acknowledging differences, Adjusting to the parent's needs and Financial strain. Being there for the parent describes: Helping the parent and Protecting the parent from harm. Being emotionally affected describes: Feelings of frustration, Feelings of compassion and Need for support. Children as relatives of parents with deafblindness have been given a voice. The children live an ordinary life, but at the same time a different ordinary life. Professionals need to take the child and their needs into account when support is given. [ABSTRACT FROM AUTHOR]

Co-occurring psychiatric comorbidity is high among problem gamblers, and anxiety disorders has repeatedly been linked to problem gambling. Less conclusive, however, is the association between problem gambling and specific anxiety disorders. The aim of this study is to examine the association between problem gambling and specific anxiety disorders in subgroups of gender, age and socio-economic status (SES) in the general Swedish population. A case-control design was employed - nested in the Swedish longitudinal gambling study cohort. All anxiety disorders studied - Panic Disorder, Social Phobia, Generalized Anxiety Disorder (GAD) and Post-Traumatic Stress Disorder (PTSD), were significantly associated with problem gambling, however the pattern differed across subgroups. Social Phobia was the anxiety disorder most commonly associated with problem gambling across subgroups. The strongest associations between problem gambling and various anxiety disorders were found in participants under the age of 25, among females, and in the group with middle SES. In those groups three of the four anxiety disorders studied were significantly associated with problem gambling, with different patterns. Quite remarkably, participants under the age of 25 had three times higher risk of having had GAD compared to their controls. Efforts to prevent an escalation of either gambling or anxiety could target the presented vulnerable groups specifically. [ABSTRACT FROM AUTHOR]

Although red supergiants (RSGs) are observed to be undergoing vigorous mass loss, explaining the mechanism launching their winds has been a long-standing problem. Given the importance of mass loss to stellar evolution in this phase, this is a key uncertainty. In this contribution we present a recently published model (Kee et al. 2021) showing that turbulent pressure alone can extend the stellar atmosphere of an RSG to the degree that a wind is launched. This provides a fully analytic mass-loss prescription for RSGs. Moreover, utilising observationally inferred turbulent velocities for these objects, we find that this wind can carry an appropriate amount of mass to overall match observations. Intriguingly, when coupled to stellar evolution models the predicted mass-loss rates show that stars with initial masses above M ini∼17 M ⊙ may naturally evolve back to the blue and as such not end their lives as RSGs; this is also in overall good agreement with observations, here of Type II-P/L supernova progenitors. Moreover, since the proposed wind launching mechanism is not necessarily sensitive to metallicity, this could have important implications for stellar evolution predictions in low-metallicity environments. [ABSTRACT FROM AUTHOR]

To examine the association between surgical waiting times (SWTs) and all-cause mortality (ACM) in non-metastatic patients with RCC, in relation to tumour stage. This nation-wide population-based cohort study included 9,918 M0 RCC patients registered in the National Swedish Kidney Cancer Register, between 2009 and 2021, followed-up for ACM until 9 December 2021, and having measured SWTs. The associations between primarily SWTs from date of radiological diagnosis to date of surgery (WRS) and secondarily SWTs from date of radiological diagnosis to date of treatment decision (WRT) and date of treatment decision to date of surgery (WTS), in relation to ACM, were analysed using Cox regression analysis, adjusted for clinical and demographic characteristics, stratified and unstratified according to T-stage. During a mean follow-up time of 5 years (49,873 person-years), 23% (n = 2291) of the patients died. The adjusted hazard ratio (AHR) for WRS (months) for all patients was 1.03 (95% confidence interval [CI] = 1.02–1.04; p < 0.001). When subdividing WRS on T-stage, the AHRs were 1.03 (95% CI = 1.01–1.04; p < 0.001) and 1.05 (95% CI = 1.02–1.08; p = 0.003) for stages T1 and T3, respectively, while non-significant for T2 (p = 0.079) and T4 (p = 0.807). Similar results were obtained for WRT and WTS. Prolonged SWTs significantly increased the risk of early overall death among patients with RCC. The increased risk of early death from any cause show the importance of shortening SWTs in clinical work of patients with this malignant disease. [ABSTRACT FROM AUTHOR]

Today, we globally observe a sharp increase in learners' engagement in extramural (out-of-class) English (EE; Sundqvist 2009). This undoubtedly affords new opportunities for, but also challenges to, English language teaching (ELT) and learning. To our knowledge, this study is the first to explore this topic from a cross-national perspective. Upper secondary English teachers (N  =   534) from Austria, France ('dubbing countries'), Finland, and Sweden ('subtitling countries') answered a web-based survey on their students' EE practices and the estimated impact on teaching and learning. Results showed that overall EE use appears lower in the dubbing countries, especially France (p < 0.001). The teachers' estimated effect of EE on different areas of learning overall was also the weakest in France (p ≤.01). Further, teachers in subtitling countries agreed more strongly with statements about adapting instruction to what is (not) learned extramurally (p < 0.001). As EE use is growing, individual learner needs within a class, such as emerging gaps in learner motivation and/or language knowledge and skills, will increasingly have to be catered to in ELT. [ABSTRACT FROM AUTHOR]

In recent decades the preschool has leaned more towards a learning-oriented pedagogy, where the subject of technology has been given a more prominent place. Still, studies on how individual preschool staff members perceive and teach technology is scarce. This study shows how seven preschool staff in Sweden describe their work with the subject of technology and how technology education is characterized in these descriptions. The data was produced by means of semi-structured interviews and a questionnaire and analyzed with narrative analysis. The results show very diverse practices of technology education, implying the learning possibilities for children in different preschools are not equal. Some of the staff describe a clear and conscious teaching of technology, while others describe teaching what can be viewed as a limited and/or shallow technology education, where technology is sometimes used as means for learning other subjects or contents rather than being the learning objective. Six ways to characterize technology education was found, namely: technology education (1) concerns technological objects and systems in children's environment, (2) concerns learning to handle technological objects, (3) is doing experiments, (4) involves developing abilities, (5) is naturally included in children's play and (6) departs from digital technology. [ABSTRACT FROM AUTHOR]

Simple Summary: Merkel cell carcinoma (MCC) is a rare and aggressive skin cancer. Developing targeted therapies for MCC requires increased understanding of the mechanisms driving tumor progression. In this study, we aimed to identify genes, signaling pathways, and processes that play crucial roles in determining disease-specific survival in MCC. We analyzed the gene expression of 102 MCC tumors and identified genes that were upregulated among survivors and in patients who died from MCC. We cross-referenced these genes with online databases to identify the pathways and processes in which they function. Genes upregulated among survivors were mostly immune response related and genes upregulated among patients who died from MCC function in various pathways that promote cancer progression. These results could guide future studies investigating whether these genes and pathways could be used as prognostic markers, as markers to guide therapy selection, or as targets of precision therapy in MCC. Background: Merkel cell carcinoma (MCC) is a rare but highly aggressive neuroendocrine carcinoma of the skin with a poor prognosis. Improving the prognosis of MCC by means of targeted therapies requires further understanding of the mechanisms that drive tumor progression. In this study, we aimed to identify the genes, processes, and pathways that play the most crucial roles in determining MCC outcomes. Methods: We investigated transcriptomes generated by RNA sequencing of formalin-fixed paraffin-embedded tissue samples of 102 MCC patients and identified the genes that were upregulated among survivors and in patients who died from MCC. We subsequently cross-referenced these genes with online databases to investigate the functions and pathways they represent. We further investigated differential gene expression based on viral status in patients who died from MCC. Results: We found several novel genes associated with MCC-specific survival. Genes upregulated in patients who died from MCC were most notably associated with angiogenesis and the PI3K-Akt and MAPK pathways; their expression predominantly had no association with viral status in patients who died from MCC. Genes upregulated among survivors were largely associated with antigen presentation and immune response. Conclusion: This outcome-based discrepancy in gene expression suggests that these pathways and processes likely play crucial roles in determining MCC outcomes. [ABSTRACT FROM AUTHOR]

Helicobacter pylori (H. pylori) and its cytotoxin-associated gene A (CagA) have been associated with myocardial infarction (MI), but existing data are conflicting possibly due to limitations in study designs and lack of data on important confounders. The aim of this study was to determine whether H. pylori or CagA seropositivity is associated with incident MI, including MI phenotypes, and to describe temporal trends. We used the Northern Sweden Health and Disease study, a prospective biobank with data from residents enrolled in a population-based cohort from health examinations between 1986 and 2006. A total of 826 first time MI cases with available blood samples from their index health examination were identified up to 2006. Each case was 1:2 matched with controls by age, sex, sample date and geographical area. Blood samples were analysed using ELISA to determine seroprevalence of H. pylori and CagA, which were then used to study the association with incident MI. The median age at baseline was 50 years, and 71% of participants were male. Seroprevalence of H. pylori and CagA was 46.5% and 32.1% in cases, respectively, compared to 43.7% and 30.6% in controls. Overall, H. pylori prevalence decreased over the study period. After multivariable adjustments, no significant association was observed between H. pylori seropositivity and incident MI (odds ratio: 1.15, 95% CI 0.94–1.42) nor between CagA-positive H. pylori and incident MI. In a Swedish population-based cohort, no significant association was observed between H. pylori or CagA seropositivity and incidence of MI. [Display omitted] • Prospective data was used to study incident MI cases, MI subtypes, and temporal trends. • Detailed adjustments were made, including socioeconomic status from national registries. • Over time, the Helicobacter pylori seroprevalence decreased. • Baseline Helicobacter pylori seropositivity was not associated with future incident MI. • Seropositivity of CagA did not affect the association with incident MI. [ABSTRACT FROM AUTHOR]

Although prior research has independently linked vocabulary development with toddlers' media usage, parental mental state talk (MST), and parent–child conversational turn‐taking (CTT), these variables have not been investigated within the same study. In this study, we focus on associations between these variables and 2‐year‐old's (N = 87) vocabulary. Child vocabulary and digital media use were measured through online questionnaires. We took a multimethod approach to measure parents' child‐directed talk. First, we used a home sound environment recording (Language ENvironment Analysis technology) to estimate parents' talk (CTT). Second, parents narrated a picture book, the Frog story, to assess the parent's MST. There was a negative association between how much children watched video content and their vocabulary. However, parents reported that they frequently co‐viewed and engaged with the child and media. The negative association first displayed between the amount of video content viewed and the child's developing vocabulary was fully mediated by the parents' qualitative and quantitative talk as measured by MST and CCT, respectively. We propose that the parent relative level of MST and CTT also occurs when parents engage with the child during media use. [ABSTRACT FROM AUTHOR]

Whole genome sequencing (WGS) of methicillin-resistant Staphylococcus aureus (MRSA) provides high-resolution typing, facilitating surveillance and outbreak investigations. The aim of this study was to evaluate the genomic variation rate in MRSA, by comparing commonly used core genome multilocus sequencing (cgMLST) against single nucleotide polymorphism (SNP) analyses. WGS was performed on 95 MRSA isolates, collected from 20 carriers during years 2003–2019. To assess variation and methodological-related differences, two different cgMLST schemes were obtained using Ridom SeqSphere+ and the cloud-based 1928 platform. In addition, two SNP methods, 1928 platform and Northern Arizona SNP Pipeline (NASP) were used. The cgMLST using Ridom SeqSphere+ and 1928 showed a median of 5.0 and 2.0 allele variants/year, respectively. In the SNP analysis, performed with two reference genomes COL and Newman, 1928 showed a median of 13 and 24 SNPs (including presumed recombination) and 3.8 respectively 4.0 SNPs (without recombination) per individual/year. Accordantly, NASP showed a median of 5.5 and 5.8 SNPs per individual/year. In conclusion, an estimated genomic variation rate of 2.0–5.8 genetic events per year (without recombination), is suggested as a general guideline to be used at clinical laboratories for surveillance and outbreak investigations independently of analysis approach used. [ABSTRACT FROM AUTHOR]

The association between problem gambling and suicidal behaviours is well established in treatment seeking populations, but less explored among sub-clinical problem gamblers in the general population. The aim of this study was to examine the association between problem gambling (including moderate risk gambling) and suicidal ideations/suicide attempts, in the general Swedish population. Another aim was to compare problem gamblers with and without suicide ideation/attempts. A case-control study nested in the Swelogs cohort was used. Both ideations and attempts were about twice as frequent among the cases compared to the controls. After controlling for socio-economic status and life-time mental health problems, suicidal ideation, but not attempts, remained significantly higher among the cases compared to the controls. The largest difference between attempters and non-attempters were on payment defaults and illicit drug abuse, whereas depression yielded the largest difference between ideators and non-ideators. Problem gambling severity (PGSI 8+) resulted in the smallest difference, compared to the other variables, between attempters and non-attempters. Even though no conclusion regarding the casual relationship can be drawn in this type of study, it seems like sub-clinical levels of problem gambling might have an impact on suicidal ideations whereas for suicide attempts to occur, other factors need to be present. In addition to mental health issues, financial difficulties may be such factors. [ABSTRACT FROM AUTHOR]

Our aim was therefore to investigate if treatment with peanut OIT (pOIT) in combination with omalizumab improves self-reported HRQoL among adolescents with severe peanut allergy. To measure HRQoL, the food allergy questionnaire Food Allergy Quality of Life Questionnaire-Teenager Form (FAQLQ-TF) was used. Peanut allergy is one of the major food allergies, and has an impact on the health-related quality of life (HRQoL).[1] As for today there is no curative treatment, however guidelines recommend oral immunotherapy (OIT) as a therapeutic option to increase the threshold for reactions in children with persistent peanut allergy.[[2]] In line with the guidelines, measurements of treatment effect should include patient-reported outcomes such as HRQoL. [Extracted from the article]

Accurate measurements of metabolic fluxes in living cells are central to metabolism research and metabolic engineering. The gold standard method is model-based metabolic flux analysis (MFA), where fluxes are estimated indirectly from mass isotopomer data with the use of a mathematical model of the metabolic network. A critical step in MFA is model selection: choosing what compartments, metabolites, and reactions to include in the metabolic network model. Model selection is often done informally during the modelling process, based on the same data that is used for model fitting (estimation data). This can lead to either overly complex models (overfitting) or too simple ones (underfitting), in both cases resulting in poor flux estimates. Here, we propose a method for model selection based on independent validation data. We demonstrate in simulation studies that this method consistently chooses the correct model in a way that is independent on errors in measurement uncertainty. This independence is beneficial, since estimating the true magnitude of these errors can be difficult. In contrast, commonly used model selection methods based on the χ2-test choose different model structures depending on the believed measurement uncertainty; this can lead to errors in flux estimates, especially when the magnitude of the error is substantially off. We present a new approach for quantification of prediction uncertainty of mass isotopomer distributions in other labelling experiments, to check for problems with too much or too little novelty in the validation data. Finally, in an isotope tracing study on human mammary epithelial cells, the validation-based model selection method identified pyruvate carboxylase as a key model component. Our results argue that validation-based model selection should be an integral part of MFA model development. Author summary: Measuring metabolic reaction fluxes in living cells is difficult, yet important. The gold standard is to label extracellular metabolites with 13C, to use mass spectrometry to find out where the 13C-atoms ends up, and finally use mathematical modelling to calculate how quickly each reaction must have flowed, for the 13C-atoms to end up like that. This measurement thus relies on usage of the right mathematical model, which must be selected among various candidate models. In this manuscript, we present a new way to do this model selection step, utilizing validation data. Using an adopted approach to calculate the uncertainty of model predictions, we identify new validation experiments, which are neither too similar, nor too dissimilar, compared to the previous training data. The model candidate that is best at predicting this new validation data is the one chosen. Tests on simulated data where the true model is known, shows that the validation-based method is robust when the magnitude of the error in the measurement uncertainty is unknown, something that conventional methods are not. This improvement is important since true uncertainties can be difficult to estimate for these data. Finally, we demonstrate how the new method can be used on real data, to identify fluxes and important reactions. [ABSTRACT FROM AUTHOR]

Background: In January 2020, the United Nations Convention on the Rights of the Child was incorporated into Swedish law. According to Swedish regulations, patients are to be given the opportunity to participate in quality improvement. Sometimes, the patients are children who have the right to be heard on matters concerning them, such as their experience of a hospital visit. Objective: This study aimed to describe how Swedish paediatric departments facilitate children's voices on their healthcare experiences and how their perspectives are taken into account in quality improvement work. Methods: This study has a descriptive cross‐sectional design. Data were collected using a study‐specific survey sent by e‐mail to all the heads of the paediatric departments in Sweden, with both inpatient and outpatient care. The response rate was 74% (28 of 38 departments). Results: The results demonstrated a variation in questionnaires used and to whom they were targeted; less than half of the participating departments reported having had questionnaires aimed at children. The results also indicated a major variation in other working methods used to allow children to voice their experiences in Swedish paediatric departments. The results indicate that the national co‐ordination in facilitating the children's rights to be heard on their experiences in healthcare organisations can be improved. Conclusion: Further research is required to ascertain which method is the most practically effective in paediatric departments, in what way children prefer to be heard regarding their experience of and perspectives on healthcare, and what questions need to be asked. A validated national patient‐reported experience measure developed with and aimed at children could provide them with equal opportunities to voice their experiences in healthcare, regardless of their diagnoses or which paediatric department they visit. [ABSTRACT FROM AUTHOR]

Background: To enable safe and successful recovery for surgery patients, nurses working in post-anaesthesia care units need competence in postoperative care. No consensus defines what this specific competence includes, and it has not been studied from the perspective of nurses working in post-anaesthesia care units. The aim of this study is twofold: 1) To explore and describe nurses' perception of the competence needed to work in post-anaesthesia care units. 2) To explore and describe nurses' perception of what characterizes an expert nurse in post-anaesthesia care units. Methods: This qualitative inductive study uses individual interviews. Sixteen nurses were recruited from two post-anaesthesia care units located in different parts of Sweden. Inclusion criteria were nurses employed in the post-anaesthesia care units for ≥1 years. Semi-structured individual interviews were conducted; data were analysed using thematic analysis. Results: The interview analysis identified six subthemes and three themes. The themes being adaptable in an ever-changing environment and creating safe care represent the overarching meaning of competence required when working as a nurse in a Swedish post-anaesthesia care unit. Nurses must possess various technical and nontechnical skills, which are core competences that are described in the sub-themes. The theme seeing the bigger picture describes the nurse's perception of an expert nurse in the post-anaesthesia care unit. Conclusions: Nurse competence in post-anaesthesia care units entails specific knowledge, acknowledging the patient, and working proactively at a fast pace with the patient and team to provide safe, high-quality care. An expert nurse in post-anaesthesia care units can see the bigger picture, helping share knowledge and develop post-anaesthesia care. The expert competence to see a bigger picture can be used in supervising novices and creating a knowledge base for postgraduate education in order to promote safe, high-quality post-anaesthesia care. [ABSTRACT FROM AUTHOR]

We show that a recent spectral flow approach proposed by Berkolaiko–Cox–Marzuola for analyzing the nodal deficiency of the nodal partition associated to an eigenfunction can be extended to more general partitions. To be more precise, we work with spectral equipartitions that satisfy a pair compatible condition. Nodal partitions and spectral minimal partitions are examples of such partitions. Along the way, we discuss different approaches to the Dirichlet-to-Neumann operators: via Aharonov–Bohm operators, via a double covering argument, and via a slitting of the domain. [ABSTRACT FROM AUTHOR]

This study investigates the movement behavior of particles of dissimilar morphology in the powder bed in Laser Powder Bed Fusion. Gas atomized (GA) and water atomized (WA) low alloy steel powders were employed to study their motion around the laser scan path. Particle velocities, entrainment distances and denudation zones were measured for both powders using high-speed imaging. The entrainment of GA powder particles in front of the laser beam towards the process area was initiated 1.6 mm from the edge of the melt pool, whereas the distance was 0.6–0.8 mm for the WA powder. The differences in observed behavior were related to the variations in particle shape of the two types of powder. The processing of WA powder resulted in a 16% narrower denudation zone (for a low volumetric energy density) compared to GA powder. However, the denudation width difference decreased with increasing volumetric energy density, most likely due to a steeper pressure gradient in the process area which diminishes the impact of powder shape. X-ray computed microtomography was utilized to estimate the drag force acting on the powder particles of various morphologies. The results showed that the radial drag force exerted on GA powder was 64% greater than when using WA powder. Moreover, if the WA powder particles were of elongated shape the drag force decreased by almost an order of magnitude, demonstrating the importance of the particle's morphology in the process dynamics. [Display omitted] • Movement behavior of particles of dissimilar morphology was studied • Water atomized powder particles had reduced mobility in the powder bed • Processing of water atomized powder resulted in a narrower denudation zone • 50 % less particle entrainment was observed in the water atomized powder bed • Drag force varies depending on the particle shape and position in the powder bed [ABSTRACT FROM AUTHOR]

Society has undergone rapid changes over the last decade affecting adolescents and their mental health as well as experiences of loneliness. The aim of this study is to examine loneliness from adolescents' and young adults' perspectives. Data was collected through semi-structured interviews with eleven (n = 11) Finnish adolescents and young adults aged 17–28 and analysed using qualitative content analysis. Two main themes and six subthemes were found. The main themes were: risk factors for loneliness and different ways of alleviating loneliness. Risk factors for involuntary loneliness were: social transitions, isolation, not having anyone to contact, group differences, social expectations, viewing other companionships, ill-being, negative emotions, former destructive experiences or a negative self-image. Preventive measures, effective coping strategies together with tertiary measures are depicted and discussed. Risk factors should be identified in order to be able to effectively and adequately address involuntary loneliness amongst adolescents and young adults. [ABSTRACT FROM AUTHOR]

This study aims to investigate Finnish home economic (HE) teachers’ use of information and communications technology (ICT) and uses triadic reciprocal causation as a means to enhance understanding of it. The study also aims to provide new insight into how HE teachers should be supported in their use of ICT to enhance student learning. Data were collected through semistructured interviews with 12 HE teachers in 2019 and further examined through an abductive approach to content analysis. The findings show that HE teachers used ICT in a variety of ways, although they had trouble expressing their goals for its use. The findings further show that HE teachers’ use of ICT not only depends on their goals, but also on several influences identified at both environmental and personal level in Bandura’s model of triadic reciprocal determinism. Based on these findings, HE teachers need to be given support in settings goals for their ICT use. These goals are important because, in combination with performance feedback, they enable teachers to specify the conditions for successful ICT use. Furthermore, the study shows the need for HE teachers to develop digital skills and to have sufficient ICT infrastructure, on-hand pedagogical and technical support, shared practices, collegial support and follow-up teacher training that focuses on their individual requirements. Based on the results, we found Bandura’s model to be useful for enhancing our understanding of the influences related to HE teachers’ ICT use and their goals for its use. [ABSTRACT FROM AUTHOR]

This study aimed to investigate Finnish primary school teachers' experiences of the three-tiered support system, which was launched in 2010–2011 with the goal of promoting the inclusive approach in Finnish compulsory school. Data were collected through semi-structured interviews with eight teachers in Finland, and the analysis was based on a thematic analytical approach. Results show that the teachers experienced having a central role in providing continuous support to pupils with different learning disabilities within the support system. Generally, they had a positive assessment of the system, which they saw as a natural part of their regular job. Nevertheless, they expressed facing challenges, such as the extended documentation and too little time for supporting all pupils in the class. The support from colleagues (i.e. special education teachers) was seen as very important, although their experience of consultation time was limited. Regarding the teachers' competences in handling the system, it was evident they had developed relevant skills by collaborating with the special education teacher and by being active themselves. Despite the challenges, the results show that Finnish primary teachers experienced the support system as a possible and practicable way of supporting pupils with learning disabilities. [ABSTRACT FROM AUTHOR]