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We have synthesized and characterized a collagen-hyaluronic acid hybrid network. The aim was to create a hydrogel mimicking the extracellular matrix of adipose tissue, primarily for use in in vitro studies of protein drug transport in the subcutaneous interstitial space. The network was created by covalently crosslinking methacryloyl-functionalized collagen type I and thiol-functionalized hyaluronic acid by means of thiol-Michael and thiol-ene photo-click reaction. The degree of modification corresponded to 74 % of the lysine and arginine groups on collagen, and 16 to 29 % of the carboxylate groups on hyaluronic acid, as determined with H-1 NMR. Circular dichroism measurements showed that the triple helix of modified collagen remained intact. Oscillatory shear rheology tests showed that the hydrated networks displayed viscoelastic properties characteristic of hydrogels. The storage modulus, measured at 1 Hz frequency in the linear viscoelastic range (<5%), varied in a controllable way between 1.5 and 4 kPa depending on the collagen concentration and collagen-to-hyaluronic acid ratio. The hydrogels had a lower collagen content (0.6--1.2 wt%) but similar hyaluronic acid content and shear modulus at low strain rates as the extracellular matrix in adipose tissue and were penetrable by albumin and lysozyme. The results show that the hydrogels are promising as model systems for investigations of drug transport.

We have synthesized and characterized a collagen-hyaluronic acid hybrid network. The aim was to create a hydrogel mimicking the extracellular matrix of adipose tissue, primarily for use in in vitro studies of protein drug transport in the subcutaneous interstitial space. The network was created by covalently crosslinking methacryloyl-functionalized collagen type I and thiol-functionalized hyaluronic acid by means of thiol-Michael and thiol-ene photo-click reaction. The degree of modification corresponded to 74 % of the lysine and arginine groups on collagen, and 16 to 29 % of the carboxylate groups on hyaluronic acid, as determined with H-1 NMR. Circular dichroism measurements showed that the triple helix of modified collagen remained intact. Oscillatory shear rheology tests showed that the hydrated networks displayed viscoelastic properties characteristic of hydrogels. The storage modulus, measured at 1 Hz frequency in the linear viscoelastic range (<5%), varied in a controllable way between 1.5 and 4 kPa depending on the collagen concentration and collagen-to-hyaluronic acid ratio. The hydrogels had a lower collagen content (0.6--1.2 wt%) but similar hyaluronic acid content and shear modulus at low strain rates as the extracellular matrix in adipose tissue and were penetrable by albumin and lysozyme. The results show that the hydrogels are promising as model systems for investigations of drug transport.

We have synthesized and characterized a collagen-hyaluronic acid hybrid network. The aim was to create a hydrogel mimicking the extracellular matrix of adipose tissue, primarily for use in in vitro studies of protein drug transport in the subcutaneous interstitial space. The network was created by covalently crosslinking methacryloyl-functionalized collagen type I and thiol-functionalized hyaluronic acid by means of thiol-Michael and thiol-ene photo-click reaction. The degree of modification corresponded to 74 % of the lysine and arginine groups on collagen, and 16 to 29 % of the carboxylate groups on hyaluronic acid, as determined with H-1 NMR. Circular dichroism measurements showed that the triple helix of modified collagen remained intact. Oscillatory shear rheology tests showed that the hydrated networks displayed viscoelastic properties characteristic of hydrogels. The storage modulus, measured at 1 Hz frequency in the linear viscoelastic range (<5%), varied in a controllable way between 1.5 and 4 kPa depending on the collagen concentration and collagen-to-hyaluronic acid ratio. The hydrogels had a lower collagen content (0.6--1.2 wt%) but similar hyaluronic acid content and shear modulus at low strain rates as the extracellular matrix in adipose tissue and were penetrable by albumin and lysozyme. The results show that the hydrogels are promising as model systems for investigations of drug transport.

We have synthesized and characterized a collagen-hyaluronic acid hybrid network. The aim was to create a hydrogel mimicking the extracellular matrix of adipose tissue, primarily for use in in vitro studies of protein drug transport in the subcutaneous interstitial space. The network was created by covalently crosslinking methacryloyl-functionalized collagen type I and thiol-functionalized hyaluronic acid by means of thiol-Michael and thiol-ene photo-click reaction. The degree of modification corresponded to 74 % of the lysine and arginine groups on collagen, and 16 to 29 % of the carboxylate groups on hyaluronic acid, as determined with H-1 NMR. Circular dichroism measurements showed that the triple helix of modified collagen remained intact. Oscillatory shear rheology tests showed that the hydrated networks displayed viscoelastic properties characteristic of hydrogels. The storage modulus, measured at 1 Hz frequency in the linear viscoelastic range (<5%), varied in a controllable way between 1.5 and 4 kPa depending on the collagen concentration and collagen-to-hyaluronic acid ratio. The hydrogels had a lower collagen content (0.6--1.2 wt%) but similar hyaluronic acid content and shear modulus at low strain rates as the extracellular matrix in adipose tissue and were penetrable by albumin and lysozyme. The results show that the hydrogels are promising as model systems for investigations of drug transport.

Climate change mitigation by increased paper recycling can alleviate the two-sided pressure on the Swedish forest sector: supplying growing demands for wood-based products and increasing the forest carbon sink. This study assesses two scenarios for making use of a reduced demand for primary pulp resulting from an increased paper recycling rate in Sweden, from the present 72% to 78%. A Conservation scenario uses the saved primary pulp to reduce pulplog harvests so as to increase the forest carbon sink concomitant with constant overall wood product supply. In contrast, a Substitution scenario uses the saved primary pulp to produce man-made cellulosic fibers (MMCF) from dissolving pulp replacing cotton fiber, implying increased overall wood product supply. Our results suggest that utilizing efficiency gains in paper recycling to reduce pulplog harvests is better from a climate change mitigation perspective than producing additional MMCF to substitute cotton fiber. This conclusion holds even when assuming the use of by-products from dissolving pulp making and an indirect increase in MMCF availability. Hence, unless joint improvements across the value chain materialize, the best climate change mitigation option from increased paper recycling in Sweden would seemingly be to reduce fellings rather than producing additional MMCF.

Background: Stroke is a common and severe disease that requires prompt care. Symptom expressions as one-sidedweakness and speech difficulties are common and included in public stroke campaigns. For some patients stroke canpresent with subtle and less common symptoms, difficult to interpret. The symptom severity assessed by the NationalInstitutes of Health Stroke Scale has decreased, and symptoms at onset may have changed. Therefore, we aimed toinvestigate how patients describe their symptoms at the onset of a first-time stroke. Methods:The study used a qualitative descriptive design and conventional content analysis. Data were collectedthrough recorded interviews with 27 patients aged 18 years and older hospitalised with a first-time stroke betweenOctober 2018 and April 2020. Data were analysed on a manifest level. Results: Symptoms at stroke onset were presented in two themes: Altered Reality and Discomfort and Changed BodyFunctions and described in five categories. Various types of symptoms were found. All symptoms were perceivedas sudden, persistent, and never experienced before and this appear as a “red thread” in the result. Regardless ofsymptom expressions, no specific symptom was described as more severe than another. Conclusions: Stroke symptoms were described with a variety of expressions. Many described complex symptomsnot typical of stroke, which can make it difficult to recognise the symptoms as a stroke and delay medical care. Publicstroke campaigns should emphasize the importance of seeking medical care at the slightest suspicion of stroke andcould be designed to help achieve this., CC-BY 4.0Grants for this study were supported by the Swedish Heart and Lung Foundation (Grant 2018 − 0589), the Agneta Prytz-Folke and Gösta Folke Foundation, the Swedish Stroke Association, the Swedish National Board of Health and Medical Care, region Västra Götaland and the Swedish state according to agreement between the Swedish Government and the County Councils Concerning Economic Support of Research and Education of Doctors (Grant ALFGBG-942665).

Common ionisable amphiphilic drug molecules form micelles in aqueous solution. Loaded onto oppositely charged polyelectrolyte microgels they associate with the network chains to form dense complex phases. The self-assembling properties control the loading and release properties in drug delivery applications of microgel systems but little is known about the nature of the aggregates and the phase structure. In this paper, we investigated the size and organization of the self-assemblies formed by the hydrochloride salts of amitriptyline (AMT), chlorpromazine (CPZ), and doxepin (DXP) in sodium polyacrylate microgels. Small-angle X-ray scattering (SAXS) was used to determine the microstructure of drug loaded microgels in aqueous environment at ionic strengths relevant for drug loading (0.01 M) and release (0.15 M). The composition of drug loaded microgels was determined by means of a purpose built microscopy cell and UV spectroscopy measurements. Upon drug loading the microgels formed complex phases of low water content. SAXS experiments showed that the drugs formed oblate shaped or spherical micelles displaying local ordering but without long-range ordering even at very high micelle volume fractions. The local ordering resembled the packing of randomly packed hard oblates and spheres. The aggregation number of AMT varied between 10 and 49 depending on the composition. Incorporation of the uncharged base form of the drug caused a transformation of oblate shaped (aspect ratio ∼ 0.4) to spherical micelles, accompanied by an abrupt increase of the aggregation number. Variation of the ionic strength had minor effects on the aggregation number. CPZ formed oblate shape micelles (aspect ratios 0.3–0.4) with aggregation number between 9 and 30. DXP formed oblate shape micelles (aspect ratios 0.3–0.4) with aggregation numbers 10 − 11 at all studied compositions. The results provide a structural basis for, and justification of, previously assumed microstructures underlying mechani

Common ionisable amphiphilic drug molecules form micelles in aqueous solution. Loaded onto oppositely charged polyelectrolyte microgels they associate with the network chains to form dense complex phases. The self-assembling properties control the loading and release properties in drug delivery applications of microgel systems but little is known about the nature of the aggregates and the phase structure. In this paper, we investigated the size and organization of the self-assemblies formed by the hydrochloride salts of amitriptyline (AMT), chlorpromazine (CPZ), and doxepin (DXP) in sodium polyacrylate microgels. Small-angle X-ray scattering (SAXS) was used to determine the microstructure of drug loaded microgels in aqueous environment at ionic strengths relevant for drug loading (0.01 M) and release (0.15 M). The composition of drug loaded microgels was determined by means of a purpose built microscopy cell and UV spectroscopy measurements. Upon drug loading the microgels formed complex phases of low water content. SAXS experiments showed that the drugs formed oblate shaped or spherical micelles displaying local ordering but without long-range ordering even at very high micelle volume fractions. The local ordering resembled the packing of randomly packed hard oblates and spheres. The aggregation number of AMT varied between 10 and 49 depending on the composition. Incorporation of the uncharged base form of the drug caused a transformation of oblate shaped (aspect ratio ∼ 0.4) to spherical micelles, accompanied by an abrupt increase of the aggregation number. Variation of the ionic strength had minor effects on the aggregation number. CPZ formed oblate shape micelles (aspect ratios 0.3–0.4) with aggregation number between 9 and 30. DXP formed oblate shape micelles (aspect ratios 0.3–0.4) with aggregation numbers 10 − 11 at all studied compositions. The results provide a structural basis for, and justification of, previously assumed microstructures underlying mechani

Climate change mitigation by increased paper recycling can alleviate the two-sided pressure on the Swedish forest sector: supplying growing demands for wood-based products and increasing the forest carbon sink. This study assesses two scenarios for making use of a reduced demand for primary pulp resulting from an increased paper recycling rate in Sweden, from the present 72% to 78%. A Conservation scenario uses the saved primary pulp to reduce pulplog harvests so as to increase the forest carbon sink concomitant with constant overall wood product supply. In contrast, a Substitution scenario uses the saved primary pulp to produce man-made cellulosic fibers (MMCF) from dissolving pulp replacing cotton fiber, implying increased overall wood product supply. Our results suggest that utilizing efficiency gains in paper recycling to reduce pulplog harvests is better from a climate change mitigation perspective than producing additional MMCF to substitute cotton fiber. This conclusion holds even when assuming the use of by-products from dissolving pulp making and an indirect increase in MMCF availability. Hence, unless joint improvements across the value chain materialize, the best climate change mitigation option from increased paper recycling in Sweden would seemingly be to reduce fellings rather than producing additional MMCF.

Background: Stroke is a common and severe disease that requires prompt care. Symptom expressions as one-sidedweakness and speech difficulties are common and included in public stroke campaigns. For some patients stroke canpresent with subtle and less common symptoms, difficult to interpret. The symptom severity assessed by the NationalInstitutes of Health Stroke Scale has decreased, and symptoms at onset may have changed. Therefore, we aimed toinvestigate how patients describe their symptoms at the onset of a first-time stroke. Methods:The study used a qualitative descriptive design and conventional content analysis. Data were collectedthrough recorded interviews with 27 patients aged 18 years and older hospitalised with a first-time stroke betweenOctober 2018 and April 2020. Data were analysed on a manifest level. Results: Symptoms at stroke onset were presented in two themes: Altered Reality and Discomfort and Changed BodyFunctions and described in five categories. Various types of symptoms were found. All symptoms were perceivedas sudden, persistent, and never experienced before and this appear as a “red thread” in the result. Regardless ofsymptom expressions, no specific symptom was described as more severe than another. Conclusions: Stroke symptoms were described with a variety of expressions. Many described complex symptomsnot typical of stroke, which can make it difficult to recognise the symptoms as a stroke and delay medical care. Publicstroke campaigns should emphasize the importance of seeking medical care at the slightest suspicion of stroke andcould be designed to help achieve this., CC-BY 4.0Grants for this study were supported by the Swedish Heart and Lung Foundation (Grant 2018 − 0589), the Agneta Prytz-Folke and Gösta Folke Foundation, the Swedish Stroke Association, the Swedish National Board of Health and Medical Care, region Västra Götaland and the Swedish state according to agreement between the Swedish Government and the County Councils Concerning Economic Support of Research and Education of Doctors (Grant ALFGBG-942665).

Common ionisable amphiphilic drug molecules form micelles in aqueous solution. Loaded onto oppositely charged polyelectrolyte microgels they associate with the network chains to form dense complex phases. The self-assembling properties control the loading and release properties in drug delivery applications of microgel systems but little is known about the nature of the aggregates and the phase structure. In this paper, we investigated the size and organization of the self-assemblies formed by the hydrochloride salts of amitriptyline (AMT), chlorpromazine (CPZ), and doxepin (DXP) in sodium polyacrylate microgels. Small-angle X-ray scattering (SAXS) was used to determine the microstructure of drug loaded microgels in aqueous environment at ionic strengths relevant for drug loading (0.01 M) and release (0.15 M). The composition of drug loaded microgels was determined by means of a purpose built microscopy cell and UV spectroscopy measurements. Upon drug loading the microgels formed complex phases of low water content. SAXS experiments showed that the drugs formed oblate shaped or spherical micelles displaying local ordering but without long-range ordering even at very high micelle volume fractions. The local ordering resembled the packing of randomly packed hard oblates and spheres. The aggregation number of AMT varied between 10 and 49 depending on the composition. Incorporation of the uncharged base form of the drug caused a transformation of oblate shaped (aspect ratio ∼ 0.4) to spherical micelles, accompanied by an abrupt increase of the aggregation number. Variation of the ionic strength had minor effects on the aggregation number. CPZ formed oblate shape micelles (aspect ratios 0.3–0.4) with aggregation number between 9 and 30. DXP formed oblate shape micelles (aspect ratios 0.3–0.4) with aggregation numbers 10 − 11 at all studied compositions. The results provide a structural basis for, and justification of, previously assumed microstructures underlying mechani

Subcutaneous (SC) injection is a common route of administration for drug compounds with poor oral bioavailability. However, bioavailability is often variable and incomplete, and there is as yet no standard accepted medium for simulation of the human SC environment. In this work we evaluate a FRAP based method for quantitative determination of local self-diffusion coefficients within extracellular matrix (ECM) mimetic hydrogels, potentially useful as in vitro models for drug transport in the ECM after SC injection. Gels were made consisting of either agarose, cross-linked collagen (COL) and hyaluronic acid (HA) or cross-linked HA. The diffusivities of uncharged FITC-dextran (FD4), the highly charged poly-lysine (PLK20) and poly-glutamic acid (PLE20) as well as the GLP-1 analogue exenatide were determined within the gels using FRAP. The diffusion coefficients in uncharged agarose gels were in the range of free diffusion in PBS. The diffusivity of cationic PLK20 in gels containing anionic HA was substantially decreased due to strong electrostatic interactions. Peptide aggregation could be observed as immobile fractions in experiments with exenatide. We conclude that the FRAP method provides useful information of peptides’ interactions and transport properties in hydrogel networks, giving insight into the mechanisms affecting absorption of drug compounds after subcutaneous injection.

Common ionisable amphiphilic drug molecules form micelles in aqueous solution. Loaded onto oppositely charged polyelectrolyte microgels they associate with the network chains to form dense complex phases. The self-assembling properties control the loading and release properties in drug delivery applications of microgel systems but little is known about the nature of the aggregates and the phase structure. In this paper, we investigated the size and organization of the self-assemblies formed by the hydrochloride salts of amitriptyline (AMT), chlorpromazine (CPZ), and doxepin (DXP) in sodium polyacrylate microgels. Small-angle X-ray scattering (SAXS) was used to determine the microstructure of drug loaded microgels in aqueous environment at ionic strengths relevant for drug loading (0.01 M) and release (0.15 M). The composition of drug loaded microgels was determined by means of a purpose built microscopy cell and UV spectroscopy measurements. Upon drug loading the microgels formed complex phases of low water content. SAXS experiments showed that the drugs formed oblate shaped or spherical micelles displaying local ordering but without long-range ordering even at very high micelle volume fractions. The local ordering resembled the packing of randomly packed hard oblates and spheres. The aggregation number of AMT varied between 10 and 49 depending on the composition. Incorporation of the uncharged base form of the drug caused a transformation of oblate shaped (aspect ratio ∼ 0.4) to spherical micelles, accompanied by an abrupt increase of the aggregation number. Variation of the ionic strength had minor effects on the aggregation number. CPZ formed oblate shape micelles (aspect ratios 0.3–0.4) with aggregation number between 9 and 30. DXP formed oblate shape micelles (aspect ratios 0.3–0.4) with aggregation numbers 10 − 11 at all studied compositions. The results provide a structural basis for, and justification of, previously assumed microstructures underlying mechani

Background: Stroke is a common and severe disease that requires prompt care. Symptom expressions as one-sidedweakness and speech difficulties are common and included in public stroke campaigns. For some patients stroke canpresent with subtle and less common symptoms, difficult to interpret. The symptom severity assessed by the NationalInstitutes of Health Stroke Scale has decreased, and symptoms at onset may have changed. Therefore, we aimed toinvestigate how patients describe their symptoms at the onset of a first-time stroke. Methods:The study used a qualitative descriptive design and conventional content analysis. Data were collectedthrough recorded interviews with 27 patients aged 18 years and older hospitalised with a first-time stroke betweenOctober 2018 and April 2020. Data were analysed on a manifest level. Results: Symptoms at stroke onset were presented in two themes: Altered Reality and Discomfort and Changed BodyFunctions and described in five categories. Various types of symptoms were found. All symptoms were perceivedas sudden, persistent, and never experienced before and this appear as a “red thread” in the result. Regardless ofsymptom expressions, no specific symptom was described as more severe than another. Conclusions: Stroke symptoms were described with a variety of expressions. Many described complex symptomsnot typical of stroke, which can make it difficult to recognise the symptoms as a stroke and delay medical care. Publicstroke campaigns should emphasize the importance of seeking medical care at the slightest suspicion of stroke andcould be designed to help achieve this., CC-BY 4.0Grants for this study were supported by the Swedish Heart and Lung Foundation (Grant 2018 − 0589), the Agneta Prytz-Folke and Gösta Folke Foundation, the Swedish Stroke Association, the Swedish National Board of Health and Medical Care, region Västra Götaland and the Swedish state according to agreement between the Swedish Government and the County Councils Concerning Economic Support of Research and Education of Doctors (Grant ALFGBG-942665).

Background: Stroke is a common and severe disease that requires prompt care. Symptom expressions as one-sidedweakness and speech difficulties are common and included in public stroke campaigns. For some patients stroke canpresent with subtle and less common symptoms, difficult to interpret. The symptom severity assessed by the NationalInstitutes of Health Stroke Scale has decreased, and symptoms at onset may have changed. Therefore, we aimed toinvestigate how patients describe their symptoms at the onset of a first-time stroke. Methods:The study used a qualitative descriptive design and conventional content analysis. Data were collectedthrough recorded interviews with 27 patients aged 18 years and older hospitalised with a first-time stroke betweenOctober 2018 and April 2020. Data were analysed on a manifest level. Results: Symptoms at stroke onset were presented in two themes: Altered Reality and Discomfort and Changed BodyFunctions and described in five categories. Various types of symptoms were found. All symptoms were perceivedas sudden, persistent, and never experienced before and this appear as a “red thread” in the result. Regardless ofsymptom expressions, no specific symptom was described as more severe than another. Conclusions: Stroke symptoms were described with a variety of expressions. Many described complex symptomsnot typical of stroke, which can make it difficult to recognise the symptoms as a stroke and delay medical care. Publicstroke campaigns should emphasize the importance of seeking medical care at the slightest suspicion of stroke andcould be designed to help achieve this., CC-BY 4.0Grants for this study were supported by the Swedish Heart and Lung Foundation (Grant 2018 − 0589), the Agneta Prytz-Folke and Gösta Folke Foundation, the Swedish Stroke Association, the Swedish National Board of Health and Medical Care, region Västra Götaland and the Swedish state according to agreement between the Swedish Government and the County Councils Concerning Economic Support of Research and Education of Doctors (Grant ALFGBG-942665).

We have synthesized and characterized a collagen-hyaluronic acid hybrid network. The aim was to create a hydrogel mimicking the extracellular matrix of adipose tissue, primarily for use in in vitro studies of protein drug transport in the subcutaneous interstitial space. The network was created by covalently crosslinking methacryloyl-functionalized collagen type I and thiol-functionalized hyaluronic acid by means of thiol-Michael and thiol-ene photo-click reaction. The degree of modification corresponded to 74 % of the lysine and arginine groups on collagen, and 16 to 29 % of the carboxylate groups on hyaluronic acid, as determined with H-1 NMR. Circular dichroism measurements showed that the triple helix of modified collagen remained intact. Oscillatory shear rheology tests showed that the hydrated networks displayed viscoelastic properties characteristic of hydrogels. The storage modulus, measured at 1 Hz frequency in the linear viscoelastic range (<5%), varied in a controllable way between 1.5 and 4 kPa depending on the collagen concentration and collagen-to-hyaluronic acid ratio. The hydrogels had a lower collagen content (0.6--1.2 wt%) but similar hyaluronic acid content and shear modulus at low strain rates as the extracellular matrix in adipose tissue and were penetrable by albumin and lysozyme. The results show that the hydrogels are promising as model systems for investigations of drug transport.

Common ionisable amphiphilic drug molecules form micelles in aqueous solution. Loaded onto oppositely charged polyelectrolyte microgels they associate with the network chains to form dense complex phases. The self-assembling properties control the loading and release properties in drug delivery applications of microgel systems but little is known about the nature of the aggregates and the phase structure. In this paper, we investigated the size and organization of the self-assemblies formed by the hydrochloride salts of amitriptyline (AMT), chlorpromazine (CPZ), and doxepin (DXP) in sodium polyacrylate microgels. Small-angle X-ray scattering (SAXS) was used to determine the microstructure of drug loaded microgels in aqueous environment at ionic strengths relevant for drug loading (0.01 M) and release (0.15 M). The composition of drug loaded microgels was determined by means of a purpose built microscopy cell and UV spectroscopy measurements. Upon drug loading the microgels formed complex phases of low water content. SAXS experiments showed that the drugs formed oblate shaped or spherical micelles displaying local ordering but without long-range ordering even at very high micelle volume fractions. The local ordering resembled the packing of randomly packed hard oblates and spheres. The aggregation number of AMT varied between 10 and 49 depending on the composition. Incorporation of the uncharged base form of the drug caused a transformation of oblate shaped (aspect ratio ∼ 0.4) to spherical micelles, accompanied by an abrupt increase of the aggregation number. Variation of the ionic strength had minor effects on the aggregation number. CPZ formed oblate shape micelles (aspect ratios 0.3–0.4) with aggregation number between 9 and 30. DXP formed oblate shape micelles (aspect ratios 0.3–0.4) with aggregation numbers 10 − 11 at all studied compositions. The results provide a structural basis for, and justification of, previously assumed microstructures underlying mechani

Background: Stroke is a common and severe disease that requires prompt care. Symptom expressions as one-sidedweakness and speech difficulties are common and included in public stroke campaigns. For some patients stroke canpresent with subtle and less common symptoms, difficult to interpret. The symptom severity assessed by the NationalInstitutes of Health Stroke Scale has decreased, and symptoms at onset may have changed. Therefore, we aimed toinvestigate how patients describe their symptoms at the onset of a first-time stroke. Methods:The study used a qualitative descriptive design and conventional content analysis. Data were collectedthrough recorded interviews with 27 patients aged 18 years and older hospitalised with a first-time stroke betweenOctober 2018 and April 2020. Data were analysed on a manifest level. Results: Symptoms at stroke onset were presented in two themes: Altered Reality and Discomfort and Changed BodyFunctions and described in five categories. Various types of symptoms were found. All symptoms were perceivedas sudden, persistent, and never experienced before and this appear as a “red thread” in the result. Regardless ofsymptom expressions, no specific symptom was described as more severe than another. Conclusions: Stroke symptoms were described with a variety of expressions. Many described complex symptomsnot typical of stroke, which can make it difficult to recognise the symptoms as a stroke and delay medical care. Publicstroke campaigns should emphasize the importance of seeking medical care at the slightest suspicion of stroke andcould be designed to help achieve this., CC-BY 4.0Grants for this study were supported by the Swedish Heart and Lung Foundation (Grant 2018 − 0589), the Agneta Prytz-Folke and Gösta Folke Foundation, the Swedish Stroke Association, the Swedish National Board of Health and Medical Care, region Västra Götaland and the Swedish state according to agreement between the Swedish Government and the County Councils Concerning Economic Support of Research and Education of Doctors (Grant ALFGBG-942665).

Background The prevalence of type 2 diabetes is increasing rapidly, particularly among younger age groups. Estimates suggest that people with diabetes die, on average, 6 years earlier than people without diabetes. We aimed to provide reliable estimates of the associations between age at diagnosis of diabetes and all-cause mortality, cause-specific mortality, and reductions in life expectancy. Methods For this observational study, we conducted a combined analysis of individual-participant data from 19 high income countries using two large-scale data sources: the Emerging Risk Factors Collaboration (96 cohorts, median baseline years 1961-2007, median latest follow-up years 1980-2013) and the UK Biobank (median baseline year 2006, median latest follow-up year 2020). We calculated age-adjusted and sex-adjusted hazard ratios (HRs) for all-cause mortality according to age at diagnosis of diabetes using data from 1 515 718 participants, in whom deaths were recorded during 23 center dot 1 million person-years of follow-up. We estimated cumulative survival by applying age-specific HRs to age-specific death rates from 2015 for the USA and the EU. Findings For participants with diabetes, we observed a linear dose-response association between earlier age at diagnosis and higher risk of all-cause mortality compared with participants without diabetes. HRs were 2 center dot 69 (95% CI 2 center dot 43-2 center dot 97) when diagnosed at 30-39 years, 2 center dot 26 (2 center dot 08-2 center dot 45) at 40-49 years, 1 center dot 84 (1 center dot 72-1 center dot 97) at 50-59 years, 1 center dot 57 (1 center dot 47-1 center dot 67) at 60-69 years, and 1 center dot 39 (1 center dot 29-1 center dot 51) at 70 years and older. HRs per decade of earlier diagnosis were similar for men and women. Using death rates from the USA, a 50-year-old individual with diabetes died on average 14 years earlier when diagnosed aged 30 years, 10 years earlier when diagnosed aged 40 years, or 6 years earlier

OBJECTIVE: To study cumulative incidence and predictors of myocardial infarction (MI) in two random general population samples consisting of middle-aged Swedish men born 30 years apart. METHOD: Results from the "Study of Men Born In 1913" and the "Study of Men Born In 1943", two longitudinal cohort studies performed in the same geographic area and using the same methodology were compared. Both cohorts were followed prospectively from 50 to 70 years of age. MI was defined as first myocardial infarction, fatal or non-fatal. RESULTS: Men born in 1943 had a 34% lower cumulative risk of first MI [HR 0.66 (0.50-0.88), p = 0.0051] during follow-up as compared to men born in 1913. Interaction analysis showed that hypertension had a significantly higher impact on risk of MI in cohort 1943 than in cohort 1913 [HR 2.33 (95% CI 1.41-3.83)] and [HR 1.10 (0.74-1.62)], p = 0.0009 respectively. The population attributable risk for hypertension was 2.5-fold higher in the cohort of men born in 1943 as compared to men born in 1913, and diabetes mellitus and sedentary lifestyle attributed more to MI risk in cohort 1943 than in cohort 1913. On the contrary, smoking and total cholesterol have less attributable risk to MI in cohort 1943 than in cohort 1913. CONCLUSION: Despite declining incident MI and improved cardiovascular prevention in general, hypertension remains an increasingly important attributable risk factor to MI together with diabetes mellitus and sedentary lifestyle over time.

This paper describes and evaluates student teachers’ virtual simulation training on teaching a controversial issue. In the fourth year of their program to become social science teachers at lower and upper secondary schools, 43 student teachers in Sweden conducted simulation teaching on conspiracy theories as an example of a controversial issue. Conspiracy theories appeal to young people and they often encounter these theories online, but they can be met with increased knowledge about how conspiracy theories work, and how they can be identified and countered. Thus, students at primary and secondary school need to develop their critical source skills. The Swedish Schools Inspectorate (2022) found that these issues were not properly taught because they were not connected to schools’ values-based work or to the development of students’ democratic competence. To analyze the simulation teaching, data was collected through observations, video-recorded simulation teaching, interviews with student teachers, and reflective documents. The results show that simulation teaching offers student teachers the opportunity to integrate content knowledge, pedagogical content knowledge, and subject knowledge, by being trained to become flexible and responsive to avatars’ individual differences as well as their different attitudes and understanding of the subject.

Stroke patients not eligible for acute intervention often have low priority and may spend long time at the emergency department (ED) waiting for admission. The aim of this retrospective case-control register study was to evaluate outcomes for such "low priority" stroke patients who were transported via Fast Track directly to the stroke unit, according to pre-specified criteria by emergency medical service (EMS). The outcomes of Fast Track patients, transported directly to stroke unit (cases) were compared with the outcomes of patients who fulfilled these critera for Fast Track, but instead were transported to the ED (controls). In all, 557 cases and 509 controls were identified. The latter spent a mean time of 237 min in the ED before admission. The 90-day mortality rate was 12.9% for cases and 14.7% for controls (n.s.). None of the secondary outcome events differed significantly between the groups: 28-day mortality rate; death rate during hospitalisation; proportion of pneumonias, falls or pressure ulcers; or health-related outcomes according to the EQ-5D-5L questionnaire. These findings indicates that the Fast Track to the stroke unit by an EMS is safe for selected stroke patients and could avoid non-valuable time in the ED.

Background The prevalence of type 2 diabetes is increasing rapidly, particularly among younger age groups. Estimates suggest that people with diabetes die, on average, 6 years earlier than people without diabetes. We aimed to provide reliable estimates of the associations between age at diagnosis of diabetes and all-cause mortality, cause-specific mortality, and reductions in life expectancy. Methods For this observational study, we conducted a combined analysis of individual-participant data from 19 high income countries using two large-scale data sources: the Emerging Risk Factors Collaboration (96 cohorts, median baseline years 1961-2007, median latest follow-up years 1980-2013) and the UK Biobank (median baseline year 2006, median latest follow-up year 2020). We calculated age-adjusted and sex-adjusted hazard ratios (HRs) for all-cause mortality according to age at diagnosis of diabetes using data from 1 515 718 participants, in whom deaths were recorded during 23 center dot 1 million person-years of follow-up. We estimated cumulative survival by applying age-specific HRs to age-specific death rates from 2015 for the USA and the EU. Findings For participants with diabetes, we observed a linear dose-response association between earlier age at diagnosis and higher risk of all-cause mortality compared with participants without diabetes. HRs were 2 center dot 69 (95% CI 2 center dot 43-2 center dot 97) when diagnosed at 30-39 years, 2 center dot 26 (2 center dot 08-2 center dot 45) at 40-49 years, 1 center dot 84 (1 center dot 72-1 center dot 97) at 50-59 years, 1 center dot 57 (1 center dot 47-1 center dot 67) at 60-69 years, and 1 center dot 39 (1 center dot 29-1 center dot 51) at 70 years and older. HRs per decade of earlier diagnosis were similar for men and women. Using death rates from the USA, a 50-year-old individual with diabetes died on average 14 years earlier when diagnosed aged 30 years, 10 years earlier when diagnosed aged 40 years, or 6 years earlier

Drug-eluting beads made of responsive polyelectrolyte networks are used in the treatment of liver cancer. Aggregates of loaded drugs in complex with the networks dissolve upon release, causing swelling of the network. According to a recent mechanism the release and swelling rates are controlled by the mass transport of drug through a depletion layer created in the microgel. We hypothesise that the mechanism, in which the stability of the drug aggregates and the swelling properties of the network play crucial roles, offers means to control the release profile also for other drugs. To test this, we investigated the loading and release properties of amitriptyline, chlorpromazine and doxepin in polyacrylate, hyaluronate and DCbeadTM microgels in a microfluidic setup. Loaded drugs could be released to a medium with physiological ionic strength and pH. The binding strength increased with decreasing critical micelle concentration of the drugs and increasing linear charge density of network chains. Microgels displayed drug-rich core/swollen shell coexistence, and swelled during release at a rate in agreement with the depletion layer mechanism, indicating its generality. The results demonstrate the potential of microgels as vehicles for amphiphilic drugs and the usefulness of the microfluidics method for in vitro studies of such systems.

Background The prevalence of type 2 diabetes is increasing rapidly, particularly among younger age groups. Estimates suggest that people with diabetes die, on average, 6 years earlier than people without diabetes. We aimed to provide reliable estimates of the associations between age at diagnosis of diabetes and all-cause mortality, cause-specific mortality, and reductions in life expectancy. Methods For this observational study, we conducted a combined analysis of individual-participant data from 19 high income countries using two large-scale data sources: the Emerging Risk Factors Collaboration (96 cohorts, median baseline years 1961-2007, median latest follow-up years 1980-2013) and the UK Biobank (median baseline year 2006, median latest follow-up year 2020). We calculated age-adjusted and sex-adjusted hazard ratios (HRs) for all-cause mortality according to age at diagnosis of diabetes using data from 1 515 718 participants, in whom deaths were recorded during 23 center dot 1 million person-years of follow-up. We estimated cumulative survival by applying age-specific HRs to age-specific death rates from 2015 for the USA and the EU. Findings For participants with diabetes, we observed a linear dose-response association between earlier age at diagnosis and higher risk of all-cause mortality compared with participants without diabetes. HRs were 2 center dot 69 (95% CI 2 center dot 43-2 center dot 97) when diagnosed at 30-39 years, 2 center dot 26 (2 center dot 08-2 center dot 45) at 40-49 years, 1 center dot 84 (1 center dot 72-1 center dot 97) at 50-59 years, 1 center dot 57 (1 center dot 47-1 center dot 67) at 60-69 years, and 1 center dot 39 (1 center dot 29-1 center dot 51) at 70 years and older. HRs per decade of earlier diagnosis were similar for men and women. Using death rates from the USA, a 50-year-old individual with diabetes died on average 14 years earlier when diagnosed aged 30 years, 10 years earlier when diagnosed aged 40 years, or 6 years earlier

Stroke patients not eligible for acute intervention often have low priority and may spend long time at the emergency department (ED) waiting for admission. The aim of this retrospective case-control register study was to evaluate outcomes for such "low priority" stroke patients who were transported via Fast Track directly to the stroke unit, according to pre-specified criteria by emergency medical service (EMS). The outcomes of Fast Track patients, transported directly to stroke unit (cases) were compared with the outcomes of patients who fulfilled these critera for Fast Track, but instead were transported to the ED (controls). In all, 557 cases and 509 controls were identified. The latter spent a mean time of 237 min in the ED before admission. The 90-day mortality rate was 12.9% for cases and 14.7% for controls (n.s.). None of the secondary outcome events differed significantly between the groups: 28-day mortality rate; death rate during hospitalisation; proportion of pneumonias, falls or pressure ulcers; or health-related outcomes according to the EQ-5D-5L questionnaire. These findings indicates that the Fast Track to the stroke unit by an EMS is safe for selected stroke patients and could avoid non-valuable time in the ED.

Background The prevalence of type 2 diabetes is increasing rapidly, particularly among younger age groups. Estimates suggest that people with diabetes die, on average, 6 years earlier than people without diabetes. We aimed to provide reliable estimates of the associations between age at diagnosis of diabetes and all-cause mortality, cause-specific mortality, and reductions in life expectancy. Methods For this observational study, we conducted a combined analysis of individual-participant data from 19 high income countries using two large-scale data sources: the Emerging Risk Factors Collaboration (96 cohorts, median baseline years 1961-2007, median latest follow-up years 1980-2013) and the UK Biobank (median baseline year 2006, median latest follow-up year 2020). We calculated age-adjusted and sex-adjusted hazard ratios (HRs) for all-cause mortality according to age at diagnosis of diabetes using data from 1 515 718 participants, in whom deaths were recorded during 23 center dot 1 million person-years of follow-up. We estimated cumulative survival by applying age-specific HRs to age-specific death rates from 2015 for the USA and the EU. Findings For participants with diabetes, we observed a linear dose-response association between earlier age at diagnosis and higher risk of all-cause mortality compared with participants without diabetes. HRs were 2 center dot 69 (95% CI 2 center dot 43-2 center dot 97) when diagnosed at 30-39 years, 2 center dot 26 (2 center dot 08-2 center dot 45) at 40-49 years, 1 center dot 84 (1 center dot 72-1 center dot 97) at 50-59 years, 1 center dot 57 (1 center dot 47-1 center dot 67) at 60-69 years, and 1 center dot 39 (1 center dot 29-1 center dot 51) at 70 years and older. HRs per decade of earlier diagnosis were similar for men and women. Using death rates from the USA, a 50-year-old individual with diabetes died on average 14 years earlier when diagnosed aged 30 years, 10 years earlier when diagnosed aged 40 years, or 6 years earlier

This paper describes and evaluates student teachers’ virtual simulation training on teaching a controversial issue. In the fourth year of their program to become social science teachers at lower and upper secondary schools, 43 student teachers in Sweden conducted simulation teaching on conspiracy theories as an example of a controversial issue. Conspiracy theories appeal to young people and they often encounter these theories online, but they can be met with increased knowledge about how conspiracy theories work, and how they can be identified and countered. Thus, students at primary and secondary school need to develop their critical source skills. The Swedish Schools Inspectorate (2022) found that these issues were not properly taught because they were not connected to schools’ values-based work or to the development of students’ democratic competence. To analyze the simulation teaching, data was collected through observations, video-recorded simulation teaching, interviews with student teachers, and reflective documents. The results show that simulation teaching offers student teachers the opportunity to integrate content knowledge, pedagogical content knowledge, and subject knowledge, by being trained to become flexible and responsive to avatars’ individual differences as well as their different attitudes and understanding of the subject.

Drug-eluting beads made of responsive polyelectrolyte networks are used in the treatment of liver cancer. Aggregates of loaded drugs in complex with the networks dissolve upon release, causing swelling of the network. According to a recent mechanism the release and swelling rates are controlled by the mass transport of drug through a depletion layer created in the microgel. We hypothesise that the mechanism, in which the stability of the drug aggregates and the swelling properties of the network play crucial roles, offers means to control the release profile also for other drugs. To test this, we investigated the loading and release properties of amitriptyline, chlorpromazine and doxepin in polyacrylate, hyaluronate and DCbeadTM microgels in a microfluidic setup. Loaded drugs could be released to a medium with physiological ionic strength and pH. The binding strength increased with decreasing critical micelle concentration of the drugs and increasing linear charge density of network chains. Microgels displayed drug-rich core/swollen shell coexistence, and swelled during release at a rate in agreement with the depletion layer mechanism, indicating its generality. The results demonstrate the potential of microgels as vehicles for amphiphilic drugs and the usefulness of the microfluidics method for in vitro studies of such systems.

This paper describes and evaluates student teachers’ virtual simulation training on teaching a controversial issue. In the fourth year of their program to become social science teachers at lower and upper secondary schools, 43 student teachers in Sweden conducted simulation teaching on conspiracy theories as an example of a controversial issue. Conspiracy theories appeal to young people and they often encounter these theories online, but they can be met with increased knowledge about how conspiracy theories work, and how they can be identified and countered. Thus, students at primary and secondary school need to develop their critical source skills. The Swedish Schools Inspectorate (2022) found that these issues were not properly taught because they were not connected to schools’ values-based work or to the development of students’ democratic competence. To analyze the simulation teaching, data was collected through observations, video-recorded simulation teaching, interviews with student teachers, and reflective documents. The results show that simulation teaching offers student teachers the opportunity to integrate content knowledge, pedagogical content knowledge, and subject knowledge, by being trained to become flexible and responsive to avatars’ individual differences as well as their different attitudes and understanding of the subject.

One of the management strategies which guides people and organizations to focus their efforts towards achievement of individual and organizational objectives is goal orientation. While it has been documented by previous researchers that learning goal as well as performance goal orientations are significant in influencing employee behaviour, how the same influence job commitment among university lecturers is still a matter of conjecture. This knowledge would be significant especially in the context of public universities in Kenya where missing lecture sessions are rampant on one hand, while more employers prefer graduates from Technical, Industrial and Vocational Enterprise Training (TIVET) institutions than university graduates, on the other hand. This study explored the influence of goal orientation culture on job commitment among lecturers at the University of Nairobi and South Eastern University. The hypothesis that: Organizational goal orientation culture does not have significant relationship with job commitment among lecturers at the Nairobi University and South Eastern Kenya University was tested. Self-determination theory (SDT) of motivation originated by Ryan and Deci was used to guide the study. Descriptive survey design was used on a target population of 56191 lecturers, Deans and students from which 377 was derived as a sample size via Krejcie and Morgan’s (1970) Table. Closed and open-ended questionnaire was used for data collection, and regressions (at 0.05 level of significance) as well as thematic analyses used respectively to analyse quantitative and qualitative data. Findings revealed that 86.1% of changes in job commitment among the lecturers is attributed to goal-oriented culture (R2 =0.861), with goals related to timelines for examination result submission and number of units taught strictly adhered to. It is concluded that matching of the university and lecturers’ goals related to teaching timelines among others significantly enhance lecturers’

One of the management strategies which guides people and organizations to focus their efforts towards achievement of individual and organizational objectives is goal orientation. While it has been documented by previous researchers that learning goal as well as performance goal orientations are significant in influencing employee behaviour, how the same influence job commitment among university lecturers is still a matter of conjecture. This knowledge would be significant especially in the context of public universities in Kenya where missing lecture sessions are rampant on one hand, while more employers prefer graduates from Technical, Industrial and Vocational Enterprise Training (TIVET) institutions than university graduates, on the other hand. This study explored the influence of goal orientation culture on job commitment among lecturers at the University of Nairobi and South Eastern University. The hypothesis that: Organizational goal orientation culture does not have significant relationship with job commitment among lecturers at the Nairobi University and South Eastern Kenya University was tested. Self-determination theory (SDT) of motivation originated by Ryan and Deci was used to guide the study. Descriptive survey design was used on a target population of 56191 lecturers, Deans and students from which 377 was derived as a sample size via Krejcie and Morgan’s (1970) Table. Closed and open-ended questionnaire was used for data collection, and regressions (at 0.05 level of significance) as well as thematic analyses used respectively to analyse quantitative and qualitative data. Findings revealed that 86.1% of changes in job commitment among the lecturers is attributed to goal-oriented culture (R2 =0.861), with goals related to timelines for examination result submission and number of units taught strictly adhered to. It is concluded that matching of the university and lecturers’ goals related to teaching timelines among others significantly enhance lecturers’

One of the management strategies which guides people and organizations to focus their efforts towards achievement of individual and organizational objectives is goal orientation. While it has been documented by previous researchers that learning goal as well as performance goal orientations are significant in influencing employee behaviour, how the same influence job commitment among university lecturers is still a matter of conjecture. This knowledge would be significant especially in the context of public universities in Kenya where missing lecture sessions are rampant on one hand, while more employers prefer graduates from Technical, Industrial and Vocational Enterprise Training (TIVET) institutions than university graduates, on the other hand. This study explored the influence of goal orientation culture on job commitment among lecturers at the University of Nairobi and South Eastern University. The hypothesis that: Organizational goal orientation culture does not have significant relationship with job commitment among lecturers at the Nairobi University and South Eastern Kenya University was tested. Self-determination theory (SDT) of motivation originated by Ryan and Deci was used to guide the study. Descriptive survey design was used on a target population of 56191 lecturers, Deans and students from which 377 was derived as a sample size via Krejcie and Morgan’s (1970) Table. Closed and open-ended questionnaire was used for data collection, and regressions (at 0.05 level of significance) as well as thematic analyses used respectively to analyse quantitative and qualitative data. Findings revealed that 86.1% of changes in job commitment among the lecturers is attributed to goal-oriented culture (R2 =0.861), with goals related to timelines for examination result submission and number of units taught strictly adhered to. It is concluded that matching of the university and lecturers’ goals related to teaching timelines among others significantly enhance lecturers’

In this study, we examined knowledge and understandingof sport-related injuries among youth athletics (track andfield) athletes and assessed their needs in managing anyhealth problems. Qualitative data were collected via 12focus groups with youth athletes (16–19 years) studying atSwedish sports high schools with an athletics specialism. Allfocus group discussions were audiorecorded and transcribedbefore being analysed using a thematic analysis approach.Four researchers independently reviewed the transcripts,generated codes and developed themes. Three overarchingthemes related to the athletes’ knowledge and understandingof sport-related injury were developed: (1) awareness ofinjuries, (2) perception of injuries, and (3) factors contributingto injuries. The youth athletes were typically uncertain abouthow to acknowledge a sport-related injury. They expressed thatknowledge about injuries was obtained in part by reflecting onthe lived experiences of their peers. It was also demonstratedthat there appears to be a ‘culture of acceptance’ regardinginjury occurrence. In contrast, causes of injuries were viewedas dependent on multiple factors (eg, lack of context-specificknowledge about training practices). Regarding athletes’needs in managing injuries, an additional three themes weredeveloped: (1) creating functioning elite sports environments,(2) application of knowledge and (3) fostering athletes. Anapparent lack of structure and organisation related to theschool environment was identified as an important issueto review to create opportunities for sustainable athleticdevelopment. The study identified areas that can be improvedin Swedish sports high schools with an athletic specialism andcould be applied in other youth sports contexts. The resultsof this study guide school stakeholders, alongside the sportgoverning bodies who have the mandate to influence activitiesin youth sports contexts, whereby special attention should bedirected towards improving the social environmen

What happened after? A study of the careers of priests within the Church of Sweden who have been assigned a rebuke or probationary period. The purpose of this study is to examine whether a rebuke or probationary time affects the careers of priests within the Church of Sweden. It is the diocesan chapter that decides on such measures. The reason may be a breach of consecration vows or that the priest has damaged the esteem of ordained ministry to a great extent. The purpose is primarily to protect the congregations from unsuitable priests. The career of a study group of 35 priests who received a rebuke or probationary period was compared with a control group of 42 priests, who were reported to the diocesan chapter but where the case did not lead to any action. Data were collected for every three years 2004–2019. The priests have been followed through a register­­ study for up to 10 years or until retirement. The careers of priests in the study group are negatively affected. For five years they have an average lower position. The year after the decision, about 25% are without employment in the church. After five years, the careers of these priests are on a par with the careers of the control group. The results indicate that priests in the study group have a worse career than the priests in the control group. This is particularly obvious in the first five years after the decision. The purpose of the disciplinary decisions is partly fulfilled by the fact that these priests for a period do not work within the church. This study is one of the few, which examines the careers of professionals who have received some form of reprimand. It thus constitutes a new contribution to the research on professionals.

What happened after? A study of the careers of priests within the Church of Sweden who have been assigned a rebuke or probationary period. The purpose of this study is to examine whether a rebuke or probationary time affects the careers of priests within the Church of Sweden. It is the diocesan chapter that decides on such measures. The reason may be a breach of consecration vows or that the priest has damaged the esteem of ordained ministry to a great extent. The purpose is primarily to protect the congregations from unsuitable priests. The career of a study group of 35 priests who received a rebuke or probationary period was compared with a control group of 42 priests, who were reported to the diocesan chapter but where the case did not lead to any action. Data were collected for every three years 2004–2019. The priests have been followed through a register­­ study for up to 10 years or until retirement. The careers of priests in the study group are negatively affected. For five years they have an average lower position. The year after the decision, about 25% are without employment in the church. After five years, the careers of these priests are on a par with the careers of the control group. The results indicate that priests in the study group have a worse career than the priests in the control group. This is particularly obvious in the first five years after the decision. The purpose of the disciplinary decisions is partly fulfilled by the fact that these priests for a period do not work within the church. This study is one of the few, which examines the careers of professionals who have received some form of reprimand. It thus constitutes a new contribution to the research on professionals.

Objectives To examine whether universal prevention via a digital health platform can reduce the injury incidence in athletics athletes aged 12-15 years and if club size had an influence on the effect of the intervention. Methods This was a cluster randomised trial where young athletics athletes were randomised through their club following stratification by club size into intervention (11 clubs; 56 athletes) and control (10 clubs; 79 athletes) groups. The primary endpoint was time from baseline to the first self-reported injury. Intervention group parents and coaches were given access to a website with health information adapted to adolescent athletes and were encouraged to log in and explore its content during 16 weeks. The control group continued training as normal. Training exposure and injury data were self-reported by youths/parents every second week, that is, eight times. The primary endpoint data were analysed using the log-rank test. Cox proportional hazards regression was used to analyse the second study aim with intervention status and club size included in the explanatory models. Results The proportion of completed training reports was 85% (n=382) in the intervention group and 86% (n=545) in the control group. The injury incidence was significantly lower (HR=0.62; chi(2)=3.865; p=0.049) in the intervention group. The median time to first injury was 16 weeks in the intervention group and 8 weeks in the control group. An interaction effect between the intervention and stratification factor was observed with a difference in injury risk between athletes in the large clubs in the intervention group versus their peers in the control group (HR 0.491 (95% CI 0.242 to 0.998); p=0.049). Conclusions A protective effect against injury through universal access to health information adapted for adolescent athletes was observed in youth athletics athletes. The efficacy of the intervention was stronger in large clubs., Funding Agencies|Swedish Research Council for Sport Science (CIF); [FO2017-0010]

What happened after? A study of the careers of priests within the Church of Sweden who have been assigned a rebuke or probationary period. The purpose of this study is to examine whether a rebuke or probationary time affects the careers of priests within the Church of Sweden. It is the diocesan chapter that decides on such measures. The reason may be a breach of consecration vows or that the priest has damaged the esteem of ordained ministry to a great extent. The purpose is primarily to protect the congregations from unsuitable priests. The career of a study group of 35 priests who received a rebuke or probationary period was compared with a control group of 42 priests, who were reported to the diocesan chapter but where the case did not lead to any action. Data were collected for every three years 2004–2019. The priests have been followed through a register­­ study for up to 10 years or until retirement. The careers of priests in the study group are negatively affected. For five years they have an average lower position. The year after the decision, about 25% are without employment in the church. After five years, the careers of these priests are on a par with the careers of the control group. The results indicate that priests in the study group have a worse career than the priests in the control group. This is particularly obvious in the first five years after the decision. The purpose of the disciplinary decisions is partly fulfilled by the fact that these priests for a period do not work within the church. This study is one of the few, which examines the careers of professionals who have received some form of reprimand. It thus constitutes a new contribution to the research on professionals.

Objectives To examine whether universal prevention via a digital health platform can reduce the injury incidence in athletics athletes aged 12-15 years and if club size had an influence on the effect of the intervention. Methods This was a cluster randomised trial where young athletics athletes were randomised through their club following stratification by club size into intervention (11 clubs; 56 athletes) and control (10 clubs; 79 athletes) groups. The primary endpoint was time from baseline to the first self-reported injury. Intervention group parents and coaches were given access to a website with health information adapted to adolescent athletes and were encouraged to log in and explore its content during 16 weeks. The control group continued training as normal. Training exposure and injury data were self-reported by youths/parents every second week, that is, eight times. The primary endpoint data were analysed using the log-rank test. Cox proportional hazards regression was used to analyse the second study aim with intervention status and club size included in the explanatory models. Results The proportion of completed training reports was 85% (n=382) in the intervention group and 86% (n=545) in the control group. The injury incidence was significantly lower (HR=0.62; chi(2)=3.865; p=0.049) in the intervention group. The median time to first injury was 16 weeks in the intervention group and 8 weeks in the control group. An interaction effect between the intervention and stratification factor was observed with a difference in injury risk between athletes in the large clubs in the intervention group versus their peers in the control group (HR 0.491 (95% CI 0.242 to 0.998); p=0.049). Conclusions A protective effect against injury through universal access to health information adapted for adolescent athletes was observed in youth athletics athletes. The efficacy of the intervention was stronger in large clubs., Funding Agencies|Swedish Research Council for Sport Science (CIF); [FO2017-0010]

What happened after? A study of the careers of priests within the Church of Sweden who have been assigned a rebuke or probationary period. The purpose of this study is to examine whether a rebuke or probationary time affects the careers of priests within the Church of Sweden. It is the diocesan chapter that decides on such measures. The reason may be a breach of consecration vows or that the priest has damaged the esteem of ordained ministry to a great extent. The purpose is primarily to protect the congregations from unsuitable priests. The career of a study group of 35 priests who received a rebuke or probationary period was compared with a control group of 42 priests, who were reported to the diocesan chapter but where the case did not lead to any action. Data were collected for every three years 2004–2019. The priests have been followed through a register­­ study for up to 10 years or until retirement. The careers of priests in the study group are negatively affected. For five years they have an average lower position. The year after the decision, about 25% are without employment in the church. After five years, the careers of these priests are on a par with the careers of the control group. The results indicate that priests in the study group have a worse career than the priests in the control group. This is particularly obvious in the first five years after the decision. The purpose of the disciplinary decisions is partly fulfilled by the fact that these priests for a period do not work within the church. This study is one of the few, which examines the careers of professionals who have received some form of reprimand. It thus constitutes a new contribution to the research on professionals.

Objectives To examine whether universal prevention via a digital health platform can reduce the injury incidence in athletics athletes aged 12-15 years and if club size had an influence on the effect of the intervention. Methods This was a cluster randomised trial where young athletics athletes were randomised through their club following stratification by club size into intervention (11 clubs; 56 athletes) and control (10 clubs; 79 athletes) groups. The primary endpoint was time from baseline to the first self-reported injury. Intervention group parents and coaches were given access to a website with health information adapted to adolescent athletes and were encouraged to log in and explore its content during 16 weeks. The control group continued training as normal. Training exposure and injury data were self-reported by youths/parents every second week, that is, eight times. The primary endpoint data were analysed using the log-rank test. Cox proportional hazards regression was used to analyse the second study aim with intervention status and club size included in the explanatory models. Results The proportion of completed training reports was 85% (n=382) in the intervention group and 86% (n=545) in the control group. The injury incidence was significantly lower (HR=0.62; chi(2)=3.865; p=0.049) in the intervention group. The median time to first injury was 16 weeks in the intervention group and 8 weeks in the control group. An interaction effect between the intervention and stratification factor was observed with a difference in injury risk between athletes in the large clubs in the intervention group versus their peers in the control group (HR 0.491 (95% CI 0.242 to 0.998); p=0.049). Conclusions A protective effect against injury through universal access to health information adapted for adolescent athletes was observed in youth athletics athletes. The efficacy of the intervention was stronger in large clubs., Funding Agencies|Swedish Research Council for Sport Science (CIF); [FO2017-0010]

Drug-eluting beads made of responsive polyelectrolyte networks are used in the treatment of liver cancer. Aggregates of loaded drugs in complex with the networks dissolve upon release, causing swelling of the network. According to a recent mechanism the release and swelling rates are controlled by the mass transport of drug through a depletion layer created in the microgel. We hypothesise that the mechanism, in which the stability of the drug aggregates and the swelling properties of the network play crucial roles, offers means to control the release profile also for other drugs. To test this, we investigated the loading and release properties of amitriptyline, chlorpromazine and doxepin in polyacrylate, hyaluronate and DCbeadTM microgels in a microfluidic setup. Loaded drugs could be released to a medium with physiological ionic strength and pH. The binding strength increased with decreasing critical micelle concentration of the drugs and increasing linear charge density of network chains. Microgels displayed drug-rich core/swollen shell coexistence, and swelled during release at a rate in agreement with the depletion layer mechanism, indicating its generality. The results demonstrate the potential of microgels as vehicles for amphiphilic drugs and the usefulness of the microfluidics method for in vitro studies of such systems.

Objective Although injury burden prompts elite athletics (track and field) athletes to engage in injury management, little is known about their health literacy. We investigated musculoskeletal (MS) health literacy in world-leading athletics athletes and associations with prechampionship injury acknowledgement by reduction of training load in different socioeconomic environments. Methods Adult and youth athletics athletes (n=1785) Methods Adult and youth athletics athletes (n=1785) preparing for World Championships were invited to complete the Literacy in Musculoskeletal Problems instrument and report acknowledgement of injury by reduction in training load during prechampionship tapering. Their socioeconomic standing was estimated through the Human Development Index of their home country. Demographic differences were examined using X-2 tests and determinants of injury acknowledgement assessed using logistic regression. Results Complete data were obtained from 780 athletes (43.7%) with 26% demonstrating sufficient MS health literacy, higher in adult (41%) than youth (13%) athletes (p<0.001). Adult athletes at the uppermost socioeconomic level showed higher MS health literacy than athletes at lower socioeconomic levels (p<0.001). At the uppermost socioeconomic level, adult athletes with sufficient MS health literacy had increased likelihood of acknowledging an injury by reduction in training load compared with peers demonstrating insufficient MS health literacy (OR=2.45; 95% CI 1.33-4.53). Athletes at middle socioeconomic levels with sufficient MS health literacy had decreased likelihood for acknowledging an injury during tapering (OR=0.29; 95% CI 0.11-0.78). Conclusions The prevalence of sufficient MS health literacy in world-leading athletics athletes is low. Associations between MS health literacy and injury acknowledgement in these athletes vary with the resourcefulness of the socioeconomic environment, implying that health literacy and resources for

In this study, we examined knowledge and understanding of sport-related injuries among youth athletics (track and field) athletes and assessed their needs in managing any health problems. Qualitative data were collected via 12 focus groups with youth athletes (16-19 years) studying at Swedish sports high schools with an athletics specialism. All focus group discussions were audiorecorded and transcribed before being analysed using a thematic analysis approach. Four researchers independently reviewed the transcripts, generated codes and developed themes. Three overarching themes related to the athletes' knowledge and understanding of sport-related injury were developed: (1) awareness of injuries, (2) perception of injuries, and (3) factors contributing to injuries. The youth athletes were typically uncertain about how to acknowledge a sport-related injury. They expressed that knowledge about injuries was obtained in part by reflecting on the lived experiences of their peers. It was also demonstrated that there appears to be a 'culture of acceptance' regarding injury occurrence. In contrast, causes of injuries were viewed as dependent on multiple factors (eg, lack of context-specific knowledge about training practices). Regarding athletes' needs in managing injuries, an additional three themes were developed: (1) creating functioning elite sports environments, (2) application of knowledge and (3) fostering athletes. An apparent lack of structure and organisation related to the school environment was identified as an important issue to review to create opportunities for sustainable athletic development. The study identified areas that can be improved in Swedish sports high schools with an athletic specialism and could be applied in other youth sports contexts. The results of this study guide school stakeholders, alongside the sport governing bodies who have the mandate to influence activities in youth sports contexts, whereby special attention should be directed toward

In this study, we examined knowledge and understandingof sport-related injuries among youth athletics (track andfield) athletes and assessed their needs in managing anyhealth problems. Qualitative data were collected via 12focus groups with youth athletes (16–19 years) studying atSwedish sports high schools with an athletics specialism. Allfocus group discussions were audiorecorded and transcribedbefore being analysed using a thematic analysis approach.Four researchers independently reviewed the transcripts,generated codes and developed themes. Three overarchingthemes related to the athletes’ knowledge and understandingof sport-related injury were developed: (1) awareness ofinjuries, (2) perception of injuries, and (3) factors contributingto injuries. The youth athletes were typically uncertain abouthow to acknowledge a sport-related injury. They expressed thatknowledge about injuries was obtained in part by reflecting onthe lived experiences of their peers. It was also demonstratedthat there appears to be a ‘culture of acceptance’ regardinginjury occurrence. In contrast, causes of injuries were viewedas dependent on multiple factors (eg, lack of context-specificknowledge about training practices). Regarding athletes’needs in managing injuries, an additional three themes weredeveloped: (1) creating functioning elite sports environments,(2) application of knowledge and (3) fostering athletes. Anapparent lack of structure and organisation related to theschool environment was identified as an important issueto review to create opportunities for sustainable athleticdevelopment. The study identified areas that can be improvedin Swedish sports high schools with an athletic specialism andcould be applied in other youth sports contexts. The resultsof this study guide school stakeholders, alongside the sportgoverning bodies who have the mandate to influence activitiesin youth sports contexts, whereby special attention should bedirected towards improving the social environmen

Background: The optimal duration of anticoagulation in patients with active cancer and venous thromboembolism (VTE) is unknown. Current clinical guidelines advocate anticoagulant therapy for 3–6 months and to continue anticoagulant therapy for as long as the cancer is active. However, an adequate systematic review on the rate of recurrent VTE after discontinuation of anticoagulant therapy has not been performed. Methods: For this systemic review and meta-analysis, we searched Embase.com, Medline (Ovid), Web of Science, Cochrane Library, and Google Scholar, from database inception to February 16, 2023, for studies on anticoagulant therapy in patients with cancer and the recurrence of venous thromboembolism after discontinuation of this therapy. We included randomised controlled trials and cohort studies published in English that reported on patients who met the following: cancer and a first VTE, completed at least 3 months of anticoagulant therapy, were followed after discontinuation of anticoagulant therapy, and with symptomatic recurrent VTE as an outcome during follow-up. Study-level data were requested from study authors. The primary outcome was the rate of recurrent VTE after discontinuation of anticoagulant therapy. A Bayesian random-effects meta-analysis was used to estimate the rate of recurrent VTE per 100 person-years for the pooled studies at different time intervals after discontinuation of anticoagulation therapy. We also calculated the cumulative VTE recurrence rate at different time intervals. Forest plots were mapped and the results were summarized by the median and 95% credible interval (CIs). This study was registered with PROSPERO, CRD42021249060. Findings: Of 3856 studies identified in our search, 33 studies were identified for inclusion. After requesting study-level data, 14 studies involving 1922 patients with cancer-associated thrombosis were included. The pooled rate of recurrent VTE p

Objective Although injury burden prompts elite athletics (track and field) athletes to engage in injury management, little is known about their health literacy. We investigated musculoskeletal (MS) health literacy in world-leading athletics athletes and associations with prechampionship injury acknowledgement by reduction of training load in different socioeconomic environments. Methods Adult and youth athletics athletes (n=1785) Methods Adult and youth athletics athletes (n=1785) preparing for World Championships were invited to complete the Literacy in Musculoskeletal Problems instrument and report acknowledgement of injury by reduction in training load during prechampionship tapering. Their socioeconomic standing was estimated through the Human Development Index of their home country. Demographic differences were examined using X-2 tests and determinants of injury acknowledgement assessed using logistic regression. Results Complete data were obtained from 780 athletes (43.7%) with 26% demonstrating sufficient MS health literacy, higher in adult (41%) than youth (13%) athletes (p<0.001). Adult athletes at the uppermost socioeconomic level showed higher MS health literacy than athletes at lower socioeconomic levels (p<0.001). At the uppermost socioeconomic level, adult athletes with sufficient MS health literacy had increased likelihood of acknowledging an injury by reduction in training load compared with peers demonstrating insufficient MS health literacy (OR=2.45; 95% CI 1.33-4.53). Athletes at middle socioeconomic levels with sufficient MS health literacy had decreased likelihood for acknowledging an injury during tapering (OR=0.29; 95% CI 0.11-0.78). Conclusions The prevalence of sufficient MS health literacy in world-leading athletics athletes is low. Associations between MS health literacy and injury acknowledgement in these athletes vary with the resourcefulness of the socioeconomic environment, implying that health literacy and resources for

Objective Although injury burden prompts elite athletics (track and field) athletes to engage in injury management, little is known about their health literacy. We investigated musculoskeletal (MS) health literacy in world-leading athletics athletes and associations with prechampionship injury acknowledgement by reduction of training load in different socioeconomic environments. Methods Adult and youth athletics athletes (n=1785) Methods Adult and youth athletics athletes (n=1785) preparing for World Championships were invited to complete the Literacy in Musculoskeletal Problems instrument and report acknowledgement of injury by reduction in training load during prechampionship tapering. Their socioeconomic standing was estimated through the Human Development Index of their home country. Demographic differences were examined using X-2 tests and determinants of injury acknowledgement assessed using logistic regression. Results Complete data were obtained from 780 athletes (43.7%) with 26% demonstrating sufficient MS health literacy, higher in adult (41%) than youth (13%) athletes (p<0.001). Adult athletes at the uppermost socioeconomic level showed higher MS health literacy than athletes at lower socioeconomic levels (p<0.001). At the uppermost socioeconomic level, adult athletes with sufficient MS health literacy had increased likelihood of acknowledging an injury by reduction in training load compared with peers demonstrating insufficient MS health literacy (OR=2.45; 95% CI 1.33-4.53). Athletes at middle socioeconomic levels with sufficient MS health literacy had decreased likelihood for acknowledging an injury during tapering (OR=0.29; 95% CI 0.11-0.78). Conclusions The prevalence of sufficient MS health literacy in world-leading athletics athletes is low. Associations between MS health literacy and injury acknowledgement in these athletes vary with the resourcefulness of the socioeconomic environment, implying that health literacy and resources for

In this study, we examined knowledge and understanding of sport-related injuries among youth athletics (track and field) athletes and assessed their needs in managing any health problems. Qualitative data were collected via 12 focus groups with youth athletes (16-19 years) studying at Swedish sports high schools with an athletics specialism. All focus group discussions were audiorecorded and transcribed before being analysed using a thematic analysis approach. Four researchers independently reviewed the transcripts, generated codes and developed themes. Three overarching themes related to the athletes' knowledge and understanding of sport-related injury were developed: (1) awareness of injuries, (2) perception of injuries, and (3) factors contributing to injuries. The youth athletes were typically uncertain about how to acknowledge a sport-related injury. They expressed that knowledge about injuries was obtained in part by reflecting on the lived experiences of their peers. It was also demonstrated that there appears to be a 'culture of acceptance' regarding injury occurrence. In contrast, causes of injuries were viewed as dependent on multiple factors (eg, lack of context-specific knowledge about training practices). Regarding athletes' needs in managing injuries, an additional three themes were developed: (1) creating functioning elite sports environments, (2) application of knowledge and (3) fostering athletes. An apparent lack of structure and organisation related to the school environment was identified as an important issue to review to create opportunities for sustainable athletic development. The study identified areas that can be improved in Swedish sports high schools with an athletic specialism and could be applied in other youth sports contexts. The results of this study guide school stakeholders, alongside the sport governing bodies who have the mandate to influence activities in youth sports contexts, whereby special attention should be directed toward