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Abstract Objective To explore trends in prognosis and use of glucose-lowering drugs (GLD) in patients with diabetes and coronary artery disease (CAD). Research design and methods All patients with diabetes and CAD undergoing a coronary angiography between 2010 and 2021 according to the Swedish Angiography and Angioplasty Registry were included. Information on GLD (dispended 6 months before or after coronary angiography) was collected from the Swedish Prescribed Drug Registry. Data on major cardiovascular events (MACE; mortality, myocardial infarction, stroke, heart failure) through December 2021 were obtained from national registries. Cox proportional survival analysis was used to assess outcomes where cardioprotective GLD (any of Sodium Glucose Lowering Transport 2 receptor inhibitors [SGLT2i] and Glucagon Like Peptide Receptor Agonists [GLP-1 RA]) served as a reference. Results Among all patients (n = 38,671), 31% had stable CAD, and 69% suffered an acute myocardial infarction. Mean age was 69 years, 67% were male, and 81% were on GLD. The use of cardioprotective GLD increased rapidly in recent years (2016–2021; 7–47%) and was more common in younger patients (66 vs. 68 years) and men (72.9% vs. 67.1%) than other GLD. Furthermore, compared with other GLD, the use of cardioprotective GLD was more common in patients with a less frequent history of heart failure (5.0% vs. 6.8%), myocardial infarction (7.7% vs. 10.5%) and chronic kidney disease (3.7% vs. 5.2%). The adjusted hazard ratio (HR) (95% CI) for MACE was greater in patients on other GLD than in those on cardioprotective GLD (1.10; 1.03–1.17, p = 0.004). Trend analyses for the years 2010–2019 revealed improved one-year MACE in patients with diabetes and CAD (year 2019 vs. 2010; 0.90; 0.81-1.00, p = 0.045), while 1-year mortality was unchanged. Conclusions The prescription pattern of diabetes medication is changing quickly in patients with diabetes and CAD; however, there are worrying signals of inefficient use prioritizing cardioprotective GLD to younger and healthier individuals at lower cardiovascular risk. Despite this, there are improving trends in 1-year morbidity.

Background: Percutaneous coronary intervention (PCI) of saphenous vein grafts (SVG) is associated with poor outcomes and is often regarded as inferior to native vessel PCI. We investigated clinical outcomes of SVG-PCI using contemporary drug-eluting stents (DES), in a complete, nationwide population. Methods: The complete Swedish Coronary Angiography and Angioplasty Registry (SCAAR) was used to identify all patients in Sweden who underwent SVG-PCI with a contemporary DES between 2013 and 2020. Baseline characteristics, procedures, and outcomes were described. Results: A total of 2198 SVG-PCI procedures with 3106 contemporary DES were included. Patients had a high incidence of comorbidities such as diabetes (40%), prior myocardial infarction (MI) (69%), and acute coronary syndrome (74%) at presentation. SVG-PCI procedures commonly involved multiple DES (41%). Native vessel PCI, in addition to SVG-PCI, was performed in only 13% of procedures. At 1 year, adverse clinical outcomes were frequent as exemplified by any death (9.2%), MI (9.1%), or revascularization (21.1%), whereas stent and lesion-related outcomes on a patient level were less common: stent thrombosis (1.2%), in-stent restenosis (4.3%) and target lesion revascularization (4.3%). Similarly, at 3 years, clinical outcomes were frequent: death (19.8%), MI (21.1%), revascularization (32.8%); and stent-related outcomes were less common: stent thrombosis (2.9%), restenosis (10.8), and target lesion revascularization (13.6%). Conclusions: In this nationwide cohort of patients who underwent SVG-PCI with contemporary DES, patients were characterized by a high-risk profile and high rates of adverse clinical events. However, the incidence of stent and lesion-related events was low.

The state of preservation of documents from the historically significant Azzolino collection at the Swedish National Archives has been investigated and analyses carried out of the iron gall inks. The collection shows varied levels of iron gall ink corrosion. An initial visual condition survey was followed by characterisation of the writing ink with XRF spectrometry on a selection of documents. The aim was to investigate whether ink composition could be related to author or geography, and in turn to level of ink corrosion, which could then serve as a basis for decisions on treatment options. Results indicate a relative purity of the inks in this collection in terms of high iron content and low levels of other elements, entailing that elemental analysis is not a good tool to predict potential deterioration of ink in single documents from this historical context. XRF-mapping showed a possibility for discerning authors by ink composition, contributing meaningful information to questions of attribution and historical context for these documents. A tendency for the ink of Queen Christina to contain more copper than inks from the other authors, and the indication that some inks contain calcium, may be of note for further study.

The state of preservation of documents from the historically significant Azzolino collection at the Swedish National Archives has been investigated and analyses carried out of the iron gall inks. The collection shows varied levels of iron gall ink corrosion. An initial visual condition survey was followed by characterisation of the writing ink with XRF spectrometry on a selection of documents. The aim was to investigate whether ink composition could be related to author or geography, and in turn to level of ink corrosion, which could then serve as a basis for decisions on treatment options. Results indicate a relative purity of the inks in this collection in terms of high iron content and low levels of other elements, entailing that elemental analysis is not a good tool to predict potential deterioration of ink in single documents from this historical context. XRF-mapping showed a possibility for discerning authors by ink composition, contributing meaningful information to questions of attribution and historical context for these documents. A tendency for the ink of Queen Christina to contain more copper than inks from the other authors, and the indication that some inks contain calcium, may be of note for further study.

Abstract We evaluated the performance of 11 SARS-CoV-2 antibody tests using a reference set of heat-inactivated samples from 278 unexposed persons and 258 COVID-19 patients, some of whom contributed serial samples. The reference set included samples with a variation in SARS-CoV-2 IgG antibody titers, as determined by an in-house immunofluorescence assay (IFA). The five evaluated rapid diagnostic tests had a specificity of 99.0% and a sensitivity that ranged from 56.3 to 81.6% and decreased with low IFA IgG titers. The specificity was > 99% for five out of six platform-based tests, and when assessed using samples collected ≥ 22 days after symptom onset, two assays had a sensitivity of > 96%. These two assays also detected samples with low IFA titers more frequently than the other assays. In conclusion, the evaluated antibody tests showed a heterogeneity in their performances and only a few tests performed well with samples having low IFA IgG titers, an important aspect for diagnostics and epidemiological investigations.

Background Dysglycemia at acute myocardial infarction (AMI) is common and is associated with mortality. Information on other outcomes is less well explored in patients without diabetes in a long‐term perspective. We aimed to explore the relationship between admission glucose level and long‐term outcomes in patients with AMI without diabetes in a nationwide setting. Methods and Results Patients without diabetes (n=45 468) with AMI registered in SWEDEHEART (Swedish Web–System for Enhancement and Development of Evidence‐Based Care in Heart Disease Evaluated According to Recommended Therapies) and admission glucose ≤11 mmol/L (≤198 mg/dL) were followed for outcomes (AMI, heart failure, stroke, renal failure, and death) between 2012 and 2017 (mean follow‐up time 3.3±1.7 years). The association between categorized glucose levels and outcomes was assessed in adjusted Cox proportional hazards regression analyses (glucose levels 4.0–6.0 mmol/L [72–109 mg/dL] as reference). Further nonfatal complications and their associated mortality were explored (patients without events served as a reference). A glucose level of 7.8–11.0 mmol/L (140–198 mg/dL) was associated with hospitalization for heart failure (hazard ratio [HR] 1.40 [95% CI, 1.30–1.51], P

A five-month-old, 3.8 kg intact male Maine coon cat presented for dyspnea characterized by increased respiratory effort in addition to open-mouth breathing. Thoracic radiographs showed pectus excavatum, enlarged cardiac silhouette, and generalized interstitial patterns. Echocardiography revealed normal left atrial (LA) and left ventricular dimensions. A large tubular structure, suspected to be a distended pulmonary vein (PV), was identified as draining into the LA. Severe eccentric and concentric right ventricular hypertrophy and paradoxical septal motion were noted. Based on Doppler echocardiography, both pulmonary venous and pulmonary artery pressure was severely elevated. Clinical, radiographic, and echocardiographic abnormalities were hypothesized to result from pulmonary vein stenosis (PVS), causing severely elevated pulmonary venous pressures and resulting in clinical signs of left-sided congestive heart failure (L-CHF) and severe post-capillary pulmonary hypertension (Pc-PH). The prognosis for good quality of life was assessed as poor, and the owner elected euthanasia. Necropsy confirmed the presence of PVS with severe dilation of the PVs draining all but the left cranial lung lobe. All lung lobes except the left cranial lobe had increased tissue density and a mottled cut surface. This case report shows that, in rare cases, both L-CHF and Pc-PH may be present without LA enlargement. To the authors’ knowledge, this is the first report on PVS in veterinary medicine.

Abstract Background To assess the relationship between radiation doses to the coronary arteries (CAs) and location of a coronary stenosis that required intervention after three-dimensional conformal radiotherapy (3DCRT) for breast cancer (BC). Methods The study population consisted of 182 women treated for BC in Sweden between 1992 and 2012. All women received 3DCRT and subsequently underwent coronary angiography due to a suspected coronary event. CA segments were delineated in the patient’s original planning-CT and radiation doses were recalculated based on the dose distribution of the original radiotherapy (RT) plan. The location of the CA stenosis that required intervention was identified from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR). Logistic regression analysis was used to assess the relationship between CA radiation doses and risk of a later coronary intervention at this specific location. Results The odds ratio (OR) varied by radiation dose to the mid left anterior descending artery (LAD) (p = 0.005). Women receiving mean doses of 1–5 Gray (Gy) to the mid LAD had an adjusted OR of 0.90 (95% CI 0.47–1.74) for a later coronary intervention compared to women receiving mean doses of 0–1 Gy to the mid LAD. In women receiving mean doses of 5–20 Gy to the mid LAD, an adjusted OR of 1.24 (95% CI 0.52–2.95) was observed, which increased to an OR of 5.23 (95% CI 2.01–13.6) for mean doses over 20 Gy, when compared to women receiving mean doses of 0–1 Gy to the mid LAD. Conclusions In women receiving conventional 3DCRT for BC between 1992 and 2012, radiation doses to the LAD remained high and were associated with an increased requirement of coronary intervention in mid LAD. The results support that the LAD radiation dose should be considered in RT treatment planning and that the dose should be kept as low as possible. Minimising the dose to LAD is expected to diminish the risk of later radiation-induced stenosis.

Pathogens associated with haemorrhagic fever commonly have zoonotic origins. The first documented imported case of likely viral severe haemorrhagic fever in Sweden occurred in 1990. Despite extensive study, no aetiological agent was identified. Following retrospective investigation with total RNA-sequencing of samples collected between 7 and 36 days from onset of symptoms we identified dengue virus 3 (DENV-3) and a human pegivirus (HPgV). We conclude that the patient likely suffered from haemorrhagic symptoms due to an atypical severe and undiagnosed dengue infection.

Inland waterways and their connections to marine transport systems constitute a substantial resource for the establishment of green infrastructures, flood prevention, and environmental conservation. However, these developments have numerous inherent environmental hazards such as water and air pollution, a loss of habitats, increased coastal erosion, the transfer of invasive species between connected watercourses and lakes, and the transport of pollutants through watercourses to coastal areas. Climate change may aggravate these environmental problems through changing temperatures, reduced precipitation, enhancing the adverse impact of excess nutrient discharge, and the entry of invasive species. In this study, we analyse the main European inland waterway corridors and their branches to assess the ecological viability of a pan-European inland waterway network. The environmental viability of such network depends on the right assessment of ecosystem services and protection of biodiversity. A model structure for landscape conservation, green infrastructure development, water replenishment, and ecosystem reconstruction is proposed, considering a sustainable combination of multimodal inland waterway and rail transport.

Abstract Objective The COVID‐19 pandemic poses an immense need for accurate, sensitive and high‐throughput clinical tests, and serological assays are needed for both overarching epidemiological studies and evaluating vaccines. Here, we present the development and validation of a high‐throughput multiplex bead‐based serological assay. Methods More than 100 representations of SARS‐CoV‐2 proteins were included for initial evaluation, including antigens produced in bacterial and mammalian hosts as well as synthetic peptides. The five best‐performing antigens, three representing the spike glycoprotein and two representing the nucleocapsid protein, were further evaluated for detection of IgG antibodies in samples from 331 COVID‐19 patients and convalescents, and in 2090 negative controls sampled before 2020. Results Three antigens were finally selected, represented by a soluble trimeric form and the S1‐domain of the spike glycoprotein as well as by the C‐terminal domain of the nucleocapsid. The sensitivity for these three antigens individually was found to be 99.7%, 99.1% and 99.7%, and the specificity was found to be 98.1%, 98.7% and 95.7%. The best assay performance was although achieved when utilising two antigens in combination, enabling a sensitivity of up to 99.7% combined with a specificity of 100%. Requiring any two of the three antigens resulted in a sensitivity of 99.7% and a specificity of 99.4%. Conclusion These observations demonstrate that a serological test based on a combination of several SARS‐CoV‐2 antigens enables a highly specific and sensitive multiplex serological COVID‐19 assay.

BackgroundProteins and lipids of milk fat globule membrane (MFGM) and probiotics are immunomodulatory. We hypothesized that Lactobacillus paracasei ssp. paracasei strain F19 (F19) would augment vaccine antibody and T helper 1 type immune responses whereas MFGM would produce an immune response closer to that of breastfed (BF) infants.ObjectiveTo compare the effects of supplementing formula with F19 or bovine MFGM on serum cytokine and vaccine responses of formula-fed (FF) and BF infants.DesignFF infants were randomized to formula with F19 (n = 195) or MFGM (n = 192), or standard formula (SF) (n = 194) from age 21±7 days until 4 months. A BF group served as reference (n = 208). We analyzed seven cytokines (n = 398) in serum at age 4 months using magnetic bead-based multiplex technology. Using ELISA, we analyzed anti-diphtheria IgG (n = 258) and anti-poliovirus IgG (n = 309) concentrations in serum before and after the second and third immunization, respectively.ResultsCompared with SF, the F19 group had greater IL-2 and lower IFN-γ concentrations (pConclusionsContrary to previous studies F19 increased IL-2 and lowered IFN-γ production, suggesting that the response to probiotics differs across populations. The cytokine profile of the MFGM group approached that of BF infants, and may be associated with the previous finding that infectious outcomes for the MFGM group in this cohort were closer to those of BF infants, as opposed to the SF group. These immunomodulatory effects support future clinical evaluation of infant formula with F19 or MFGM.

Utifrån tvärvetenskapliga perspektiv och metoder, hämtade från etnologin och kulturgeografin, och med en empirisk utgångspunkt i tre kulturmiljöer som förvaltas av Statens fastighetsverk (SFV) i Sverige, analyserar artikeln historiebruk i form av kulturarvsproduktion och föreslår ett applicerbart normkritiskt samt i förlängningen normkreativt angreppssätt för att möjliggöra alternativa, varierade och mer inkluderande historieskildringar kring kulturmiljöer. Genom att utveckla och integrera dessa synsätt och verktyg vill artikeln argumentera för att man får tillgång till nya berättelser om platsen; berättelser som går utöver den traditionella, „normala“ historien om staten, enskilda byggnaders materiella utformning och den sociokulturella och ekonomiska eliten. En långsiktig effekt blir att det möjliggör ökad mångfald och inkludering både i fråga om förmedling och representation av platser som komplexa rumsliga och sociokulturella helheter.

When young people travel, they are often very dependent on public transport or parents. This study uses interviews with 16–19 years old teenagers in Stockholm to investigate their everyday experiences of public transit. The paper explores the experiences of buses and subways, here conceptualized as mobile places, to understand how they shape teenagers’ daily life. Understanding teenagers’ experiences of public transportation is part of understanding their everyday life, struggles, and possibilities to be mobile and participate in society. It is also a step towards ensuring that they find public transportation inclusive, safe, and worth traveling with today and in the future. Conceptually, the analysis focuses on how these mobile places are experienced as providing weights or reliefs to the everyday and if, how and when they may be places of interaction or retreat, addressing two needs in teenagers’ personal being and development. The study shows how various experiences of traveling with buses and subways shape how the teenagers feel, and how they make strategic choices in relation to this. A quite manifold, varying, and complex picture of public transportation arises, with stories of wellbeing, comfort, discomfort, and exclusion, and with sharp differences between girls and boys, and between buses and subways. These nuances are essential in planning and evaluation of transport systems in regard to how, when, where, or for whom public transport can be a part of social sustainability, as public policies often assume.

Consumer goods and building materials present in the preschool environment can be important sources of hazardous chemicals, such as plasticizers, bisphenols, organophosphorus and brominated flame retardants, poly- and perfluoroalkyl substances, which may pose a health risk to children. Even though exposure occurs via many different pathways, such as food intake, inhalation, dermal exposure, mouthing of toys etc., dust has been identified as a valuable indicator for indoor exposure. In the present study, we evaluate the efficiency of product substitution actions taken in 20 Swedish preschools from the Stockholm area to reduce the presence of hazardous substances in indoor environments. Dust samples were collected from elevated surfaces in rooms where children have their everyday activities, and the concentrations found were compared to the levels from a previous study conducted in 2015 at the same preschools. It was possible to lower levels of hazardous substances in dust, but their continued presence in the everyday environment of children was confirmed since bisphenol A, restricted phthalates and organophosphate esters were still detectable in all preschools. Also, an increase in the levels of some of the substitutes for the nowadays restricted substances was noted; some of the alternative plasticizers to phthalates, such as DEHA and DEHT, were found with increased concentrations. DINP was the dominant plasticizer in preschool dust with a median concentration of 389 μg/g, while its level was significantly (p = 0.012) higher at 716 μg/g in preschools with polyvinyl chloride (PVC) flooring. PBDEs were now less frequently detected in dust and their levels decreased 20% to 30%. This was one of the few times that PFAS were analyzed in preschool dust, where 6:2 diPAP was found to be most abundant with a median concentration of 1140 ng/g, followed by 6:2 PAP 151 ng/g, 8:2 diPAP 36 ng/g, N-Et-FOSAA 18 ng/g, PFOS 12 ng/g, PFOA 7.7 ng/g and PFNA 1.1 ng/g. In addition, fluorotelomer alcohols were detected in 65–90% of the samples. Children's exposure via dust ingestion was evaluated using intermediate and high daily intake rates of the targeted chemicals and established health limit values. In each case, the hazard quotients (HQs) were

In wine producing countries viticultural and oenological practices and traditions, trades and crafts, the built and written heritage, the history, social structures, economy, a number of intangible values and the viticultural landscape constitute the cultural heritage of a wine region. Thus, the touristic products of oenotourism are complex attractions with a substantial number of educational elements, such as on-site wine appreciation courses, organized wine excursions on well-known wine routes, wine festivals, international sommelier days or agro-tourism in wine estates where tourists may have the opportunity to participate in the harvest and learn more about the wine making process. The main target groups of wine-tourism consist of educated, mostly middle aged people with reasonably good economy and a clear intention to learn more about the culture and history of the country and its viticultural areas in an informal, entertaining way. An increasing number of vintners expand their agribusiness with a complete product structure such as grape seed oil, grappa, fruit juice, cheese, olive oil, food supplements produced from grapes, accommodation facilities from bed and breakfast to hotels and restaurants, creating herewith ideal conditions for tourism, often utilizing the network of completing, additional tourist attractions in the neighborhood. Special attention shall be paid to the organic viticulture and wine production based on the maintenance of ecological cycles in the vineyard, because it can be the basis of eco-wine tourism, and even wine-heritage tourism due to the revival of certain traditional cultivation methods, trades and crafts linked to the historical routes of the wine industry. In this study we analyze the main aspects of wine-heritage and the terroir as source for touristic product development and propose a model for micro-region based sustainable oenotourism and eco-oenotourism with increasing economic viability.

Invasive species are flowers or animals that have moved from one "origin" area to a new region, often with the help of humans. This article focus on the work of reducing lupines in the county of Dalarna. The example is used as a test case to explore what a cultural analytical interpretation can provide to the discussion of invasive species: How did the lupine come to be considered a strange element in the regional and national flora? What are the social, cultural and biological contexts that makes the flower threatening? We identify the work of reducing invasive species to be part of an ecological memory complex. To this, we argue for a critical heritage perspective as a rewarding way of understanding such questions, practices and discourses.

Albania is formerly the most closed country in Europe and has suffered from severe economic and political problems during the last two decades. In the southern part lies Gjirokastra, birthplace of former dictator Enver Hoxha, and home to diverse communities of Albanians and Greeks. Gjirokastra Old Town, proclaimed “Museum City” by the regime in 1961 and later turned into a UNESCO World Heritage City, climbs the steep western side of the Drinos valley. During the communist era the city was heavily industrialized with a metal work factory as well as factories for products such as shoes, refrigerators, and umbrellas. On the eastern side is the archaeological site of the ancient city of Antigonea, thus defining a landscape with long historical processes and a multitude of narratives and interpretations. In recent years this landscape has witnessed increased efforts to secure what are perceived heritage values, focusing on the older structures i.e. the world heritage part of the city and the archaeological site. However, the structures of post-war era of Albania contribute significantly to the full context of the landscape, but since the mid-1990s and the collapse of Albanian post-communist economy the former industrial sites are increasingly deteriorating. Parallel with severe economic problems with massive volumes of unemployed, a criminally based economy on drug trafficking is increasing. This paper will discuss the societally based problems in securing different heritage assets for a positive societal development.

Heritage’ could be the driving force in developing new economies in geographic areas with unstable growth. The establishment of industrial remains as heritage during the 1980s and 90s describes a development of heritage practices that improved possibilities to address such issues, as compared with traditional sub-divided heritage work. Heritage afloat exemplifies how industrial and maritime heritage could be instrumental in rethinking heritage practices. Two examples are presented. The first concerns a recent reconstruction of an early 19th century paddle steamer, where tacit knowledge within both traditional as well as industrially based craft skills became the main issue. The other example builds on a century old steamboat that has been preserved as designated heritage with original appearance, in original route, and with original function. ‘Working order’ and the difference between ‘heritage’ as the material result, and ‘heritage’ as a process resulting in both intangible and material qualities are discussed as a necessary base in strategies to develop new economies by merging heritage and entrepreneurship, specifically in non-urban landscape perspectives.

In 2008, the Republic of Ireland entered a severe financial crisis partly as a part of the global economic crisis. Since then, it has seen large raises in income taxes and cuts in state spending on health, welfare, education and on heritage, which has suffered relatively large cuts. This implies a need for rethinking choices and prioritisations to cope with the changing circumstances. Across Europe, the effects of the crisis on heritage, or the whole cultural sector, have yet mostly been highlighted in general or supposed terms rather than empirically analysed. But what actually happens to how heritage is conceptualised in times of crisis? Inspired by Critical Discourse Analysis, this paper explores representation of and argumentation for heritage in Irish state heritage policies pre and post the recession 2008. Much concerns regarding heritage management are discursively shaped. Policies, stating the authorised viewpoint, are thus key in the construction of heritage and its values in society. Recently, research has highlighted a shift towards more instrumentality in cultural policy due to wider societal changes. A crisis could influence such development. The analysis departs from an often-stated notion of heritage as a part of the Irish national recovery, but what does that imply? Focus is therefore put on how different representations of heritage and its values are present, argued for and compete in a situation with increasing competition regarding relevance and support. The paper shows how heritage matters are refocused, streamlined and packaged as productive, good-for-all, unproblematic and decomplexified in order to be perceived and valued as part of the national recovery. This includes privileging certain instrumental values, foremost economic, by means of specificity, space and quantification, while heritage's contribution to social life, education or health, although often mentioned, are downplayed by being expressed in much more vague terms.

Cancer stem cells (CSC) are responsible for cancer chemoresistance and metastasis formation. Here we report that Δ133p53β, a TP53 splice variant, enhanced cancer cell stemness in MCF-7 breast cancer cells, while its depletion reduced it. Δ133p53β stimulated the expression of the key pluripotency factors SOX2, OCT3/4, and NANOG. Similarly, in highly metastatic breast cancer cells, aggressiveness was coupled with enhanced CSC potential and Δ133p53β expression. Like in MCF-7 cells, SOX2, OCT3/4, and NANOG expression were positively regulated by Δ133p53β in these cells. Finally, treatment of MCF-7 cells with etoposide, a cytotoxic anti-cancer drug, increased CSC formation and SOX2, OCT3/4, and NANOG expression via Δ133p53, thus potentially increasing the risk of cancer recurrence. Our findings show that Δ133p53β supports CSC potential. Moreover, they indicate that the TP53 gene, which is considered a major tumor suppressor gene, also acts as an oncogene via the Δ133p53β isoform.

BackgroundLong‐term disease progression after myocardial infarction (MI) is inadequately understood. We evaluated the pattern and angiographic properties (culprit lesion [CL]/non‐CL [NCL]) of recurrent MI (re‐MI) in a large real‐world patient population. Methods and ResultsOur observational study used prospectively collected data in 108 615 patients with first‐occurrence MI enrolled in the SWEDEHEART (Swedish Web System for Enhancement and Development of Evidence‐Based Care in Heart Disease Evaluated According to Recommended Therapies) between July 1, 2006 and November 29, 2014. During follow‐up (median, 3.2 years), recurrent hospitalization for MI occurred in 11 117 patients (10.2%). Of the patients who underwent coronary angiography for the index MI, a CL was identified in 44 332 patients. Of those patients, 3464 experienced an re‐MI; the infarct originated from the NCL in 1243 patients and from the CL in 655 patients. In total, 1566 re‐MIs were indeterminate events and could not be classified as NCL or CL re‐MIs. The risk of re‐MI within 8 years related to the NCL was 0.06 (95% confidence interval [CI], 0.05–0.06), compared with 0.03 (95% CI, 0.02–0.03) for the CL. There were no large differences in baseline characteristics of patients with subsequent NCL versus CL re‐MIs. Independent predictors of NCL versus CL re‐ MI were multivessel disease (odds ratio, 2.29; 95% CI, 1.87–2.82), male sex (odds ratio, 1.36; 95% CI, 1.09–1.71), and a prolonged time between the index and re‐MI (odds ratio, 1.16; 95% CI, 1.10–1.22). ConclusionsIn a large cohort of patients with first‐occurrence MI undergoing percutaneous coronary intervention, the risk of re‐MI originating from a previously untreated lesion was twice higher than the risk of lesions originating from a previously stented lesion. Clinical Trial RegistrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT03099395.

Introduction: Avian influenza viruses circulate in bird populations, and it is important to maintain and uphold our knowledge of the viral strains that are currently of interest in this context. Here, we describe the use of hemagglutinin-pseudotype retroviruses based on highly pathogenic influenza viruses for the screening of avian sera for influenza A antibodies. Our aim was also to determine whether the pseudovirus neutralization tests that we assessed were sensitive and simple to use compared to the traditional methods, including hemagglutination inhibition assays and microneutralization tests. Material and methods: H5 and H7 pseudovirus neutralization tests were evaluated by using serum from infected rabbits. Subsequently, the assays were further investigated using a panel of serum samples from avian species. The panel contained samples that were seropositive for five different hemagglutinin subtypes as well as influenza A seronegative samples. Results and discussion: The results suggest that the pseudovirus neutralization test is an alternative to hemagglutination inhibition assays, as we observed comparable titers to those of both standard microneutralizations assays as well as hemagglutinin inhibition assays. When evaluated by a panel of avian sera, the method also showed its capability to recognize antibodies directed toward low-pathogenic H5 and H7. Hence, we conclude that it is possible to use pseudoviruses based on highly pathogenic avian influenza viruses to screen avian sera for antibodies directed against influenza A subtypes H5 and H7.

Along with urbanisation and modernisation, the use of second homes has increased in the Western world. This can be seen as part of the increasing mobility of people in society, but also as part of a search for stillness and escape from modern urban society. Recently, scholars in geography and other disciplines have argued that mobility and fixity are two sides of the same coin. This paper aims to explore the complex, manifold and often paradoxical relationship between mobility and immobility in practices of dwelling and seeking stillness in a highly mobile society. It elaborates on how mobility and stillness, in both space and time, are intertwined and mutually influence each other by analysing second home usage of old cottages that formally were dwelling houses of poor tenant smallholdings in Sweden. How do mobility and stillness exist and interact at these cottages and what parts do the cottages themselves have in this? This is studied through interviews with cottage users on their daily life practices and encounters with history and materiality at the cottages. These cottages are easily thought of as places of immobility where time has stood still. However, the paper shows that these cottages are places that continuously emerge through entanglements of mobility and stillness and of present and past times. The practices and experiences of mobility and stillness at the cottage are much integrated in and directed by the cottages’ specific geography, history and materiality, and the activities and thinking of their users because of these characteristics. The users go to the cottage to be at a place where they, with the help of the preserved materiality and history of the cottages, can feel rooted and still. At the same time the cottages offer imaginary time travels and experiences of other times and lifestyles.

The purpose here is to study patterns of project collaboration found in one government supported programme for construction innovation. Preferred types of interaction were identified using data from two questionnaire surveys, one with experienced construction sector respondents and one aimed at construction researchers. All sixteen development projects within the Swedish Bygginnovationen programme were investigated, relying on documents and a survey of project managers. Important types of interaction, according to construction respondents, are informal contacts, joint research projects and staff mobility. For university respondents, informal contacts is also seen as the most important type of interaction, followed by MSc thesis work in firms and industrial PhD candidates. Grant applicants from manufacturing depended more on university laboratories and were less sensitive to firm/university distance. Laboratory use was also more frequent for projects relying on the field of materials engineering. In conclusion, there is a consensus about which types of collaboration are valuable. The broadness of participation in the programme, ranging over many industries, both as to origin of ideas and ultimate applications, reaches beyond narrow interpretations of the construction industry. Policy makers should recognize the innovation importance of university laboratory facilities and field testing, rather than seeing researchers as sources of ideas.

In 2008, the Republic of Ireland entered a severe financial crisis partly as a part of the global economic crisis. Since then, it has seen large raises in income taxes and cuts in state spending on health, welfare, education and on heritage, which has suffered relatively large cuts. This implies a need for rethinking choices and prioritisations to cope with the changing circumstances. Across Europe, the effects of the crisis on heritage, or the whole cultural sector, have yet mostly been highlighted in general or supposed terms rather than empirically analysed. But what actually happens to how heritage is conceptualised in times of crisis? Inspired by Critical Discourse Analysis, this paper explores representation of and argumentation for heritage in Irish state heritage policies pre and post the recession 2008. Much concerns regarding heritage management are discursively shaped. Policies, stating the authorised viewpoint, are thus key in the construction of heritage and its values in society. Recently, research has highlighted a shift towards more instrumentality in cultural policy due to wider societal changes. A crisis could influence such development. The analysis departs from an often-stated notion of heritage as a part of the Irish national recovery, but what does that imply? Focus is therefore put on how different representations of heritage and its values are present, argued for and compete in a situation with increasing competition regarding relevance and support. The paper shows how heritage matters are refocused, streamlined and packaged as productive, good-for-all, unproblematic and decomplexified in order to be perceived and valued as part of the national recovery. This includes privileging certain instrumental values, foremost economic, by means of specificity, space and quantification, while heritage’s contribution to social life, education or health, although often mentioned, are downplayed by being expressed in much more vague terms.

The Legionellaceae family consists of approximately 50 species, of which the most commonly identified species is L. pneumophila, the causative agent of Legionnaires’ disease. Other Legionella ssp. most often cause clinical infections in the immune-compromised patients, in which L. bozemanii has been known to cause both pneumonia and lung abscesses. In the presented case, a soft tissue infection in a patient with ongoing immunosuppression was determined to be due to L. bozemanii. Hence, in immune-deficient patients, L. bozemanii could be considered a possible agent in soft tissue infections when other common pathogens have been ruled out.

Tick-borne encephalitis virus (TBEV) is transferred to humans by ticks. The virus causes tick-borne encephalitis (TBE) with symptoms such as meningitis and meningoencephalitis. About one third of the patients suffer from long-lasting sequelae after clearance of the infection. Studies of the immune response during TBEV-infection are essential to the understanding of host responses to TBEV-infection and for the development of therapeutics. Here, we studied in detail the primary CD8 T cell response to TBEV in patients with acute TBE. Peripheral blood CD8 T cells mounted a considerable response to TBEV-infection as assessed by Ki67 and CD38 co-expression. These activated cells showed a CD45RA-CCR7-CD127- phenotype at day 7 after hospitalization, phenotypically defining them as effector cells. An immunodominant HLA-A2-restricted TBEV epitope was identified and utilized to study the characteristics and temporal dynamics of the antigen-specific response. The functional profile of TBEV-specific CD8 T cells was dominated by variants of mono-functional cells as the effector response matured. Antigen-specific CD8 T cells predominantly displayed a distinct Eomes+Ki67+T-bet+ effector phenotype at the peak of the response, which transitioned to an Eomes-Ki67-T-bet+ phenotype as the infection resolved and memory was established. These transcription factors thus characterize and discriminate stages of the antigen-specific T cell response during acute TBEV-infection. Altogether, CD8 T cells responded strongly to acute TBEV infection and passed through an effector phase, prior to gradual differentiation into memory cells with distinct transcription factor expression-patterns throughout the different phases.

The recently developed Xpert® Ebola Assay is a novel nucleic acid amplification test for simplified detection of Ebola virus (EBOV) in whole blood and buccal swab samples. The assay targets sequences in two EBOV genes, lowering the risk for new variants to escape detection in the test. The objective of this report is to present analytical characteristics of the Xpert® Ebola Assay on whole blood samples.This study evaluated the assay's analytical sensitivity, analytical specificity, inclusivity and exclusivity performance in whole blood specimens. EBOV RNA, inactivated EBOV, and infectious EBOV were used as targets. The dynamic range of the assay, the inactivation of virus, and specimen stability were also evaluated. The lower limit of detection (LoD) for the assay using inactivated virus was estimated to be 73 copies/mL (95% CI: 51-97 copies/mL). The LoD for infectious virus was estimated to be 1 plaque-forming unit/mL, and for RNA to be 232 copies/mL (95% CI 163-302 copies/mL). The assay correctly identified five different Ebola viruses, Yambuku-Mayinga, Makona-C07, Yambuku-Ecran, Gabon-Ilembe, and Kikwit-956210, and correctly excluded all non-EBOV isolates tested. The conditions used by Xpert® Ebola for inactivation of infectious virus reduced EBOV titer by ≥6 logs.In summary, we found the Xpert® Ebola Assay to have high analytical sensitivity and specificity for the detection of EBOV in whole blood. It offers ease of use, fast turnaround time, and remote monitoring. The test has an efficient viral inactivation protocol, fulfills inclusivity and exclusivity criteria, and has specimen stability characteristics consistent with the need for decentralized testing. The simplicity of the assay should enable testing in a wide variety of laboratory settings, including remote laboratories that are not capable of performing highly complex nucleic acid amplification tests, and during outbreaks where time to detection is critical.

Dengue is a mosquito-borne viral disease that has become more prevalent in the last few decades. Most patients are viremic when they present with symptoms, and early diagnosis of dengue is important in preventing severe clinical complications associated with this disease and also represents a key factor in differential diagnosis. Here, we designed and validated a hydrolysis-probe-based one-step real-time RT-PCR assay that targets the genomes of dengue virus serotypes 1-4.The primers and probe used in our RT-PCR assay were designed to target the 3' untranslated region of all complete genome sequences of dengue virus available in GenBank (n = 3,305). Performance of the assay was evaluated using in vitro transcribed RNA, laboratory-adapted virus strains, external control panels, and clinical specimens. The linear dynamic range was found to be 104-1011 GCE/mL, and the detection limit was between 6.0×102 and 1.1×103 GCE/mL depending on target sequence. The assay did not cross-react with human RNA, nor did it produce false-positive results for other human pathogenic flaviviruses or clinically important etiological agents of febrile illnesses. We used clinical serum samples obtained from returning travelers with dengue-compatible symptomatology (n = 163) to evaluate the diagnostic relevance of our assay, and laboratory diagnosis performed by the RT-PCR assay had 100% positive agreement with diagnosis performed by NS1 antigen detection. In a retrospective evaluation including 60 archived serum samples collected from confirmed dengue cases 1-9 days after disease onset, the RT-PCR assay detected viral RNA up to 9 days after appearance of symptoms.The validation of the RT-PCR assay presented here indicates that this technique can be a reliable diagnostic tool, and hence we suggest that it be introduced as the method of choice during the first 5 days of dengue symptoms.

Surveillance was enhanced and a retrospective interview study performed in 1998-99 to determine incidence, causes, and costs of foodborne illnesses in Uppsala, Sweden. Sixty-eight percent of the detected foodborne illness incidents were single cases, and 32% were outbreaks. Most (85%) of the incidents came to the attention of the municipal authorities through telephone calls from affected persons. Calicivirus, Campylobacter spp., and Staphyloccocus aureus were the most common etiological agents; meat, meat products, and mixed dishes were the most implicated food categories. The incidence of foodborne illness was estimated to be 38 cases per 1,000 inhabitants per year. The estimated average costs per illness were 2,164 Swedish Krona (SEK) ($246) to society and 500 SEK ($57) to the patient. The annual cost of foodborne illnesses in Sweden was estimated to be 1,082 million SEK ($123 million).

INTRODUCTION: Evidence for the current guidelines for the treatment of patients with chronic total occlusions (CTO) in coronary arteries is limited. In this study we identified all CTO patients registered in the Swedish Coronary Angiography and Angioplasty Registry (SCAAR) and studied the prevalence, patient characteristics and treatment decisions for CTO in Sweden. METHODS AND RESULTS: Between January 2005 and January 2012, 276,931 procedures (coronary angiography or percutaneous coronary intervention) were performed in 215,836 patients registered in SCAAR. We identified all patients who had 100% luminal diameter stenosis known or assumed to be ≥ 3 months old. After exclusion of patients with previous coronary artery bypass graft (CABG) surgery or coronary occlusions due to acute coronary syndrome, we identified 16,818 CTO patients. A CTO was present in 10.9% of all coronary angiographies and in 16.0% of patients with coronary artery disease. The majority of CTO patients were treated conservatively and PCI of CTO accounted for only 5.8% of all PCI procedures. CTO patients with diabetes and multivessel disease were more likely to be referred to CABG. CONCLUSION: CTO is a common finding in Swedish patients undergoing coronary angiography but the number of CTO procedures in Sweden is low. Patients with CTO are a high-risk subgroup of patients with coronary artery disease. SCAAR has the largest register of CTO patients and therefore may be valuable for studies of clinical importance of CTO and optimal treatment for CTO patients.

Along with urbanisation and modernisation, the use of second homes has increased in the Western world. This can be seen as part of the increasing mobility of people in society, but also as part of a search for stillness and escape from modern urban society. Recently, scholars in geography and other disciplines have argued that mobility and fixity are two sides of the same coin. This paper aims to explore the complex, manifold and often paradoxical relationship between mobility and immobility in practices of dwelling and seeking stillness in a highly mobile society. It elaborates on how mobility and stillness, in both space and time, are intertwined and mutually influence each other by analysing second home usage of old cottages that formally were dwelling houses of poor tenant smallholdings in Sweden. How do mobility and stillness exist and interact at these cottages and what parts do the cottages themselves have in this? This is studied through interviews with cottage users on their daily life practices and encounters with history and materiality at the cottages. These cottages are easily thought of as places of immobility where time has stood still. However, the paper shows that these cottages are places that continuously emerge through entanglements of mobility and stillness and of present and past times. The practices and experiences of mobility and stillness at the cottage are much integrated in and directed by the cottages’ specific geography, history and materiality, and the activities and thinking of their users because of these characteristics. The users go to the cottage to be at a place where they, with the help of the preserved materiality and history of the cottages, can feel rooted and still. At the same time the cottages offer imaginary time travels and experiences of other times and lifestyles.

BACKGROUND: Percutaneous coronary intervention (PCI) stent inflation pressure correlates to angiographic lumen improvement and stent expansion but the relation to outcome is not clarified. Using comprehensive registry data our aim was to evaluate how stent inflation pressure influences restenosis, stent thrombosis and death following PCI. METHODS: We evaluated all consecutive coronary stent implantations in Sweden during 46 months from 2008 using data from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR). We used logistic regression and Cox proportional hazard modeling to estimate risk of outcomes with different balloon pressures. RESULTS: In total, 93 697 stents were eligible for analysis and divided into five different pressure interval groups: ≤15 atm, 16-17 atm, 18-19 atm, 20-21 atm and ≥22 atm. The risks of stent thrombosis and restenosis were significantly higher in the ≤15 atm, 18-19 atm and ≥22 atm groups (but not in the 16-17 atm group) compared to the 20-21 atm group. There were no differences in mortality. Post-dilatation was associated with a higher restenosis risk ratio (RR) of 1.22 (95% confidence interval (CI) 1.14-1.32, P

Many construction work tasks are physically very strenuous and the incidence of work‐related musculoskeletal disorders (WMSDs) among construction workers is considerably higher than those in most other occupations. The aim of the study presented in this paper was to contribute to understanding a healthy construction site brought about by the best practices implemented by large construction sites to prevent WMSDs. A triangulation method made of interviews, site observations and studies on company's documents was used to identify the best practices in 13 several construction projects. A range of the best practices both in the pre‐construction and construction phases of the projects were identified in six different areas of the balance of the construction workplace system; however, there seems to be a significant need for good practices in the management of a systematic work environment. It is now established that Swedish construction industry has several best practices to protect work‐related musculoskeletal health. However, inadequate worker participation and the neglect of health and safety issues by designers in the planning process as well as the implications of some remuneration methods on the production schedule were perceived as detrimental to the musculoskeletal health of construction workers. Santrauka Daug statybos darbu yra fiziškai labai itempti, o su darbu susijusiu raumenu ir skeleto sistemos pažeidimu dažnis tarp statybininku yra kur kas aukštesnis negu tarp daugelio kitu profesiju. Šio tyrimo tikslas – pletoti supratima apie sveikatos būkle ir jos svarba dirbant statybu aikštelese, igyvendinant didelius statybos objektus, siekiant išvengti su darbu susijusiu raumenu ir skeleto sistemos pažeidimu. Tyrimams buvo taikytas interviu, pagristas trianguliacijos metodu, darbo procesu stebejimo statybos aikštelese metodas, buvo nagrineti statybos kompaniju dokumentai, siekiant identifikuoti 13 skirtingu statybos projektu. Geriausia praktika, prieš pradedant statybas ir jau statant, buvo nustatyta šešiuose skirtinguose statybu regionuose, tačiau tokia praktika yra svarbi darbo aplinkos vadyboje. Pripažinta, kad Švedijos statybos pramoneje taikomi keli būdai, kaip apsaugoti statybininkus nuo raumenu ir skeleto sistemos pažeidimu. Vis delto mažas darbininku domejimasis šia problema, sveikatos bei saugos problemu nepaisymas planavimo procese, kai kuriu atsilyginimo būdu itraukimas i gamybos veiksniu saraša buvo vertinti kaip faktoriai, žalingai veikiantys statybininku raumenu ir skeleto sistema. First Published Online: 10 Feb 2011 Reikšminiai žodžiai: statybos vadyba, sužalojimai, profesine sveikata, darbo salygos, su darbu susijes raumenu ir skeleto sistemos sutrikimas, nepatogi darbo poza

Abstract Background The proliferating cell nuclear antigen (PCNA) is a key protein in the eukaryotic DNA replication and cell proliferation. Following the cloning and characterisation of the human PCNA gene, the question of the existence of pseudogenes in the human genome was raised. Findings In this short communication we summarise the existing information about the PCNA pseudogenes and critically assess their status. Conclusions We propose the existence of at least four valid PCNA pseudogenes, PCNAP1, PCNAP2, LOC392454 and LOC390102. We would like to recommend assignment of a name for LOC392454 as "proliferating cell nuclear antigen pseudogene 3" (alias PCNAP3) and a name for LOC390102 as "proliferating cell nuclear antigen pseudogene 4" (alias PCNAP4). We prompt for more critical evaluation of the existence of a PCNA pseudogene, designated as PCNAP.

Abstract Background Affecting both livestock and humans, Rift Valley Fever is considered as one of the most important viral zoonoses in Africa. However, no licensed vaccines or effective treatments are yet available for human use. Naked DNA vaccines are an interesting approach since the virus is highly infectious and existing attenuated Rift Valley Fever virus vaccine strains display adverse effects in animal trials. In this study, gene-gun immunisations with cDNA encoding structural proteins of the Rift Valley Fever virus were evaluated in mice. The induced immune responses were analysed for the ability to protect mice against virus challenge. Results Immunisation with cDNA encoding the nucleocapsid protein induced strong humoral and lymphocyte proliferative immune responses, and virus neutralising antibodies were acquired after vaccination with cDNA encoding the glycoproteins. Even though complete protection was not achieved by genetic immunisation, four out of eight, and five out of eight mice vaccinated with cDNA encoding the nucleocapsid protein or the glycoproteins, respectively, displayed no clinical signs of infection after challenge. In contrast, all fourteen control animals displayed clinical manifestations of Rift Valley Fever after challenge. Conclusion The appearance of Rift Valley Fever associated clinical signs were significantly decreased among the DNA vaccinated mice and further adjustment of this strategy may result in full protection against Rift Valley Fever.