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Abstract Global ischemia has been shown to induce cardiac regenerative response in animal models. One of the suggested mechanisms behind cardiac regeneration is dedifferentiation of cardiomyocytes. How human adult cardiomyocytes respond to global ischemia is not fully known. In this study, biopsies from the left ventricle (LV) and the atrioventricular junction (AVj), a potential stem cell niche, were collected from multi-organ donors with cardiac arrest (N = 15) or without cardiac arrest (N = 6). Using immunohistochemistry, we investigated the expression of biomarkers associated with stem cells during cardiomyogenesis; MDR1, SSEA4, NKX2.5, and WT1, proliferation markers PCNA and Ki67, and hypoxia responsive factor HIF1α. The myocyte nuclei marker PCM1 and cardiac Troponin T were also included. We found expression of cardiac stem cell markers in a subpopulation of LV cardiomyocytes in the cardiac arrest group. The same cells showed a low expression of Troponin T indicating remodeling of cardiomyocytes. No such expression was found in cardiomyocytes from the control group. Stem cell biomarker expression in AVj was more pronounced in the cardiac arrest group. Furthermore, co-expression of PCNA and Ki67 with PCM1 was only found in the cardiac arrest group in the AVj. Our results indicate that a subpopulation of human cardiomyocytes in the LV undergo partial dedifferentiation upon global ischemia and may be involved in the cardiac regenerative response together with immature cardiomyocytes in the AVj.

This study reports on a case study about multimodal work in a primary physics classroom focusing on forces. Previous research reports that students benefit from multimodal work in science classrooms. Yet, few systematic studies have been performed to reveal how students represent their experiences and ideas of science phenomena over time within and across different semiotic modes (e.g., through action, speech, writing, and image, including multimodal ensembles). The design of the lessons was built around a number of experimental activities, starting with a puzzling phenomenon and where students for each experiment predicted, observed, described, and tried to come up with explanations. Based on social-semiotics, we combined analysis at an overall level (long timescale and large grain size) and a detailed level (short timescale and small grain size) to shed light on how the science content was represented within and between modes over the teaching and learning period, and what content was expressed in these representations. Our findings reveal how students moved from focusing on attributes such as a "heavy" regarding artifacts used in the experiments, towards the central physics processes, such as one object exerting force on another object. Furthermore, we were able to detect that such "signs of learning" were shown in students' small-group discussions and multimodal texts following a carefully orchestrated multimodal exposition by the teacher. Hence, such a careful multimodal orchestration appeared to be critical for the students' meaning-making about the science content.

Worksheets are common in science classrooms with an aim to support pupils' meaning-making, e.g., for guiding them in performing hands-on activities and documenting their experiences of such activities. Yet, there have been few systematic studies of pupils' disciplinary representations in worksheets. Drawing on systemic functional linguistics, we have analyzed fifth grade pupils' (age 10-11) multimodal texts in worksheets (n = 25) when they were working with shadow formation as part of their regular classroom activities. In the worksheets they were asked to first explain in writing why or why not a shadow was formed and then explain shadow formation through a drawing. At an overall level, we found that a majority of the pupils managed to express in writing why a shadow is formed, though it appeared to be more challenging for them to explain why a shadow is not formed. In their drawings, quite a few pupils managed to include several key aspects of shadow formation, at least when combining image with writing. For all tasks, the explanatory parts of the pupils' responses were often implicit. Based on our results, we suggest that pupils may benefit from teaching practices that integrate a parallel focus on form and content as a way to raise their awareness of, for instance, the affordances of different resources and how explanations can be structured. Such practices may support pupils to be able to consider and choose appropriate resources in their disciplinary texts.

Large vehicles such as buses and heavy goods vehicles (HGVs) pose a serious threat to cyclists and can cause serious injuries. Therefore, it is important to understand current safety issues related to these vehicles, to identify and to develop safety interventions that could address these issues. The aim of this study is to describe the characteristics of and injuries resulting from crashes between cyclists and buses and HGVs. In this study, the German In-Depth Accident Study (GIDAS) was queried for all cases that involved either a bus or a HGV and where the opponent was a cyclist. In total, 98 crashes with the involvement of both a bus and a cyclist, and 295 cases where both a HGV and a cyclist were involved, were identified for our analysis. The crashes with cyclists typically occur within city limits, during daylight conditions, on dry surfaces and with clear weather. The cyclists involved in these crashes are mainly male and cyclists under 18-years old account for 28% of crashes with buses, and 16% for crashes with HGVs. The most common crash scenarios are crossing scenarios and turning-off-a-road crashes. In bus crashes, the collision speeds are mainly below 35 km/h and injuries to lower extremities and head are dominating, caused by the road surface and the front of the bus. In HGV crashes, collision speeds are most often below 20 km/h and injuries to the head and thorax are most common, mainly caused by being run over.

The ForMAX beamline at the MAX IV Laboratory provides multiscale and multimodal structural characterization of hierarchical materials in the nanometre to millimetre range by combining small- and wide-angle X-ray scattering with full-field microtomography. The modular design of the beamline is optimized for easy switching between different experimental modalities. The beamline has a special focus on the development of novel fibrous materials from forest resources, but it is also well suited for studies within, for example, food science and biomedical research.

Objective: Tricuspid annuloplasty is associated with increased risk of atrioventricular block and subsequent implantation of a permanent pacemaker. However, the exact incidence of permanent pacemaker, associated risk factors, and outcomes in this frame remain debated. The aim of the study was to report permanent pacemaker incidence, risk factors, and outcomes after tricuspid annuloplasty from nationwide databases. Methods: By using data from multiple Swedish mandatory national registries, all patients (n = 1502) who underwent tricuspid annuloplasty in Sweden from 2006 to 2020 were identified. Patients who needed permanent pacemaker within 30 days from surgery were compared with those who did not. The cumulative incidence of permanent pacemaker implantation was estimated. A multivariable logistic regression model was fit to identify risk factors of 30-day permanent pacemaker implantation. The association between permanent pacemaker implantation and long-term survival was evaluated with multivariable Cox regression. Results: The 30-day permanent pacemaker rate was 14.2% (214/1502). Patients with permanent pacemakers were older (69.8 ± 10.3 years vs 67.5 ± 12.4 years, P = .012). Independent risk factors of permanent pacemaker implantation were concomitant mitral valve surgery (odds ratio, 2.07; 95% CI, 1.34-3.27), ablation surgery (odds ratio, 1.59; 95% CI, 1.12-2.23), and surgery performed in a low-volume center (odds ratio, 1.85; 95% CI, 1.17-2.83). Permanent pacemaker implantation was not associated with increased long-term mortality risk (adjusted hazard ratio, 0.74; 95% CI, 0.53-1.03). Conclusions: This nationwide study demonstrated a high risk of permanent pacemaker implantation within 30 days of tricuspid annuloplasty. However, patients who needed a permanent pacemaker did not have worse long-term survival, and the cumulative incidence of heart failure and major adverse cardiovascular events was similar to patients who did not receive a permanent pacemaker.

A diet with low content of fermentable oligo-, di-, and monosaccharides and polyols (FODMAP) is established treatment for irritable bowel syndrome (IBS), with well-documented efficiency. A starch- and sucrose-reduced diet (SSRD) has shown similar promising effects. The primary aim of this randomized, non-inferiority study was to test SSRD against low FODMAP and compare the responder rates (RR = ∆Total IBS-SSS ≥ −50) to a 4-week dietary intervention of either diet. Secondary aims were to estimate responders of ≥100 score and 50% reduction; effects on extraintestinal symptoms; saturation; sugar craving; anthropometric parameters; and blood pressure. 155 IBS patients were randomized to SSRD (n = 77) or low FODMAP (n = 78) for 4 weeks, with a follow-up 5 months later without food restrictions. The questionnaires Rome IV, IBS-severity scoring system (IBS-SSS), and visual analog scale for IBS (VAS-IBS) were completed at baseline and after 2 and 4 weeks and 6 months. Weight, height, waist circumference, and blood pressures were measured. Comparisons were made within the groups and between changes in the two groups. There were no differences between groups at baseline. The responder rate of SSRD was non-inferior compared with low FODMAPs at week 2 (79.2% vs. 73.1%; p = 0.661;95% confidence interval (CI) = −20–7.2) and week 4 (79.2% vs. 78.2%; p = 1.000;95%CI = −14–12). Responder rate was still high when defined stricter. All gastrointestinal and extraintestinal symptoms were equally improved (p < 0.001 in most variables). SSRD rendered greater reductions in weight (p = 0.006), body mass index (BMI) (p = 0.005), and sugar craving (p = 0.05), whereas waist circumference and blood pressure were equally decreased. Weight and BMI were regained at follow-up. In the SSRD group, responders at 6 months still had lowered weight (−0.7 (−2.5–0.1) vs. 0.2 (−0.7–2.2) kg; p = 0.005) and BMI (−0.25 (−0.85–0.03) vs. 0.07 (−0.35–0.77) kg/m2; p = 0.009) compared with baseline in contrast to non-responders. Those who had tested both diets preferred SSRD (p = 0.032). In conclusion, a 4-week SSRD intervention was non-inferior to low FODMAP regarding responder rates of gastrointestinal IBS symptoms. Furthermore, strong reductions of extraintestinal symptoms were found in both groups, whereas reductions in weight, BMI, and sugar craving were most pronounced following SSRD.

This qualitative study focuses on preschool practitioners' teaching about death. The theoretical framework draws on ideas about dialogic teaching and the concepts that are of importance for understanding what biological death entails. The study was conducted within a qualitative, participant centered paradigm. The data consist of video recordings of four visits to cemeteries conducted by 6 practitioners and 26 children (three-five years old) from two preschools. The findings show that relying on a child centered pedagogy, when the practitioners do not plan the content of the activity but rely exclusively on the children's curiosity, does not function well as a pedagogical strategy in relation to an existential question that the practitioners themselves find sensitive. The article contributes to developing the didactics of death that enables preschool practitioners to develop the ability to reflect critically on questions and topics related to different understandings of death(s) in early childhood education.

This study is part of a larger project with the general aim of developing the ability of preschool teachers to reflect critically on questions, topics and theories related to different understandings of death(s). The article is based on three focus-group interviews with a focus on how preschool teachers reflect on what, how, why and when they teach about death and death-related issues. The results show that preschool teachers consider that it is important in early childhood education to teach about death because death is a fundamental aspect of life in daily reality, and they consider it to be their task to comfort a child in grief, as well as care for the well-being of the group. However, much of the time, they avoid teaching about biological death relative to concrete goals that the children are to achieve in understanding what death implies. Instead, they use child-responsive, improvisational teaching that is intended to calm and comfort the children. The content of the teaching arises at the intersection of expert knowledge in talking about death as an irreversible outcome of natural processes and the preschool teachers' own beliefs and ideas about death, dying and an afterlife. As a consequence, the biological conceptions of death coexist with the teachers' own beliefs in an afterlife, reflecting a dualistic thinking within which culturally constructed beliefs coexist with biological views.

Abstract Current environmental changes may increase temporal variability of life history traits of species thus affecting their long‐term population growth rate and extinction risk. If there is a general relationship between environmental variances (EVs) and mean annual survival rates of species, that relationship could be used as a guideline for analyses of population growth and extinction risk for populations, where data on EVs are missing. For this purpose, we present a comprehensive compilation of 252 EV estimates from 89 species belonging to five vertebrate taxa (birds, mammals, reptiles, amphibians and fish) covering mean annual survival rates from 0.01 to 0.98. Since variances of survival rates are constrained by their means, particularly for low and high mean survival rates, we assessed whether any observed relationship persisted after applying two types of commonly used variance stabilizing transformations: relativized EVs (observed/mathematical maximum) and logit‐scaled EVs. With raw EVs at the arithmetic scale, mean–variance relationships of annual survival rates were hump‐shaped with small EVs at low and high mean survival rates and higher (and widely variable) EVs at intermediate mean survival rates. When mean annual survival rates were related to relativized EVs the hump‐shaped pattern was less distinct than for raw EVs. When transforming EVs to logit scale the relationship between mean annual survival rates and EVs largely disappeared. The within‐species juvenile‐adult slopes were mainly positive at low (0.5) mean survival rates for raw and relativized variances while these patterns disappeared when EVs were logit transformed. Uncertainties in how to interpret the results of relativized and logit‐scaled EVs, and the observed high variation in EV's for similar mean annual survival rates illustrates that extrapolations of observed EVs and tests of life history drivers of survival–EV relationships need to also acknowledge the large variation in these parameters.

Abstract Introduction The relationship between neurochemical changes and outcome after shunt surgery in idiopathic normal pressure hydrocephalus (iNPH), a treatable dementia and gait disorder, is unclear. We used baseline ventricular CSF to explore associations to outcome, after shunting, of biomarkers selected to reflect a range of pathophysiological processes. Methods In 119 consecutive patients with iNPH, the iNPH scale was used before and after shunt surgery to quantify outcome. Ventricular CSF was collected perioperatively and analyzed for biomarkers of astrogliosis, axonal, amyloid and tau pathology, and synaptic dysfunction: glial fibrillary acidic protein (GFAP), chitinase-3-like protein 1 (YKL40/CHI3L1), monocyte chemoattractant protein-1 (MCP-1) neurofilament light (NfL), amyloid beta 38 (Aβ38), Aβ40, Aβ42, amyloid beta 42/40 ratio (Aβ42/40), soluble amyloid precursor protein alfa (sAPPα), sAPPβ, total tau (T-tau), phosphorylated tau (P-tau), growth-associated protein 43 (GAP43), and neurogranin. Results The neurogranin concentration was higher in improved (68%) compared to unimproved patients (median 365 ng/L (IQR 186–544) vs 330 (205–456); p = 0.046). A linear regression model controlled for age, sex and vascular risk factors including neurogranin, T-tau, and GFAP, resulted in adjusted R2 = 0.06, p = 0.047. The Aβ42/40 ratio was bimodally distributed across all samples, as well as in the subgroups of improved and unimproved patients but did not contribute to outcome prediction. The preoperative MMSE score was lower within the low Aβ ratio group (median 25, IQR 23–28) compared to the high subgroup (26, 24–29) (p = 0.028). The T-Tau x Aβ40/42 ratio and P-tau x Aβ40/42 ratio did not contribute to shunt response prediction. The prevalence of vascular risk factors did not affect shunt response. Discussion A higher preoperative ventricular CSF level of neurogranin, which is a postsynaptic marker, may signal a favorable postoperative outcome. Concentrations of a panel of ventricular CSF biomarkers explained only 6% of the variability in outcome. Evidence of amyloid or tau pathology did not affect the outcome.

Abstract Background Neurofilament light chain protein (NFL), a marker of neuronal axonal degeneration, is increased in cerebrospinal fluid (CSF) of patients with idiopathic normal pressure hydrocephalus (iNPH). Assays for analysis of NFL in plasma are now widely available but plasma NFL has not been reported in iNPH patients. Our aim was to examine plasma NFL in iNPH patients and to evaluate the correlation between plasma and CSF levels, and whether NFL levels are associated with clinical symptoms and outcome after shunt surgery. Methods Fifty iNPH patients with median age 73 who had their symptoms assessed with the iNPH scale and plasma and CSF NFL sampled pre- and median 9 months post-operatively. CSF plasma was compared with 50 healthy controls (HC) matched for age and gender. Concentrations of NFL were determined in plasma using an in-house Simoa method and in CSF using a commercially available ELISA method. Results Plasma NFL was elevated in patients with iNPH compared to HC (iNPH: 45 (30–64) pg/mL; HC: 33 (26–50) (median; Q1–Q3), p = 0.029). Plasma and CSF NFL concentrations correlated in iNPH patients both pre- and postoperatively (r = 0.67 and 0.72, p

Background: There is scarce knowledge about the association between socioeconomic status and mortality in patients undergoing surgical aortic valve replacement. This study explores the associations between income, education and marital status, and long-term mortality risk. Methods: In this national registry-based observational cohort study we included all 14,537 patients aged >18 years who underwent isolated surgical aortic valve replacement for aortic stenosis in Sweden 1997–2020. Socioeconomic status and comorbidities were collected from three mandatory national registries. Cox regression models adjusted for patient characteristics and comorbidities were used to estimate the mortality risk. Results: Mortality risk was higher for patients in the lowest versus the highest income quintile (adjusted hazard ratio [aHR] 1.36, 95 % confidence interval [CI]: 1.11–1.65), for patients with 12 years (aHR 1.20, 95 % CI:1.08–1.33), and for patients who were not married/cohabiting versus those who were (aHR 1.24, 95 % CI:1.04–1.48). Patients with the most unfavorable socioeconomic status (lowest income, shortest education, never married/cohabiting) had an adjusted median survival of 2.9 years less than patients with the most favorable socioeconomic status (14.6 years, 95 % CI: 13.2–17.4 years vs. 11.7 years, 95 % CI: 9.8–14.4). Conclusions: Low socioeconomic status in patients undergoing surgical aortic valve replacement is associated with shorter survival and an increased long-term adjusted mortality risk. These results emphasize the importance of identifying surgical aortic valve replacement patients with unfavorable socioeconomic situation and ensure sufficient post-discharge surveillance.

Abstract Cardiovascular disease (CVD) is strongly associated with chronic low-grade inflammation, involving activated Toll-like receptors and their downstream cellular machinery. Moreover, CVD and other related inflammatory conditions are associated with infiltration of bacteria and viruses originating from distant body sites. Thus, in this study we aimed to map the presence of microbes in the myocardium of patients with heart disease that we previously found to display upregulated Toll-like receptor signaling. We performed metagenomics analysis of atrial cardiac tissue from patients undergoing coronary artery bypass grafting (CABG) or aortic valve replacement (AVR) and compared with atrial cardiac tissue from organ donors. A total of 119 species of bacteria and seven species of virus were detected in the cardiac tissue. RNA expression of five bacterial species were increased in the patient group of which L. kefiranofaciens correlated positively with cardiac Toll-like receptor-associated inflammation. Interaction network analysis revealed four main gene set clusters involving cell growth and proliferation, Notch signaling, G protein signaling and cell communication in association with L. kefiranofaciens RNA expression. Taken together, intracardial expression of L. kefiranofaciens RNA correlates with pro-inflammatory markers in the diseased cardiac atrium and may have an effect on specific signaling processes important for cell growth, proliferation and cell communication.

This paper examines the affordances of physical objects (e.g. apparatus, models, manipulatives) as they were used by teachers and students to make meaning in coordination with their speech and gestures. Despite the pervasive use of physical objects as material and tactile resources in hands-on investigations or demonstrations, there have been few attempts to analyze their role and function in meaning-making, in the same way, that researchers have previously done for other modes of representation such as speech, written text, diagram and gesture. Using social semiotics as a theoretical framework, we conceptualise physical objects as a semiotic mode with a particular affordance for making meaning that involves embodied actions and manipulation of tools. Based on a multimodal discourse analysis of numerous classroom situations, we illustrate how physical objects as a mode have four unique affordances for meaning-making in science classrooms. These affordances are: (a) enacting material interaction, (b) providing evidential meaning, (c) orientating three-dimensional spatial meaning and (d) sensitising experiential meaning. The implication of why we should use physical objects to support or value-add science meaning-making is then discussed.

Hydropower generators withstand multiple forces from diverse sources during operation. To ensure their stability and safe performance, numerical tools are developed to characterize their dynamic properties. Traditionally, generators are assumed to be rigid in rotordynamic analyses. However, the measurements in power stations challenge this assumption. This article proposes a novel approach to modeling hydropower generators with floating rotor rims using a three-dimensional (3-D) Finite Element Method, aiming to study their dynamic performance and properties, including natural frequencies, the modes of vibrations, and expansion due to centrifugal and electromagnetic forces, with the goal of improving the reliability of modern designs. Both this approach and employing a two-dimensional (2-D) model using curved beams result in similar in-plane natural frequencies and the expansion of the rotor rim due to centrifugal forces. However, the 3-D model can be used to calculate the out-of-plane natural frequencies and modes, to model the dynamics of complex geometries, and to perform stress evaluation and fatigue analysis.

Abstract Previous studies have demonstrated that environmental and temporal factors may affect the incidence of acute type A aortic dissection (ATAAD). Here, we aimed to investigate the hypothesis that national holidays and weekends influence the incidence of surgery for ATAAD. For the period 1st of January 2005 until 31st of December 2019, we investigated a hypothesised effect of (country-specific) national holidays and weekends on the frequency of 2995 surgical repairs for ATAAD at 10 Nordic cities included in the Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD) collaboration. Compared to other days, the number of ATAAD repairs were 29% (RR 0.71; 95% CI 0.54–0.94) lower on national holidays and 26% (RR 0.74; 95% CI 0.68–0.82) lower on weekends. As day of week patterns of symptom duration were assessed and the primary analyses were adjusted for period of year, our findings suggest that the reduced surgical incidence on national holidays and weekends does not seem to correspond to seasonal effects or surgery being delayed and performed on regular working days.

Abstract Background Oral administration of health-promoting bacteria is increasingly used in clinical practise. These bacteria have anti-inflammatory characteristics and modulate the immune system without major reported side effects. The mechanisms of action are not yet fully defined. Our aim was to study systemic effects of probiotics by measurements of leukocytes as well as local effects on rectal mucosal biopsies after adding a standardized inflammatory stimulus in vitro. Methods Fourteen healthy subjects were randomized to receive 1010 colony forming units/day orally of the probiotic strain Lactiplantibacillus plantarum 299 (Lp299), n = 7, or Bifidobacterium infantis CURE21 (CURE21), n = 7, for six weeks. Rectal biopsies were taken before and after ingestion of either probiotic strain product, for stimulation in vitro with tumour necrosis factor alpha (TNF-α) at 10 and 100 ng/ml respectively up to 8 h. Blood tests were sampled before and after treatment. Lactate dehydrogenase (LDH) confirmed viable tissue. Results Composition of the intestinal microbiota was not changed. Systemic leukocytes decreased after administration of CURE21 (P