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Background: It can be challenging for people with intellectual disabilities to convey their thoughts and opinions because of cognitive, speech and language impairments. Consequently, facilitating their ability to communicate using augmentative and alternative communication methods is essential. The picture-based framework Talking Mats has been applied in many studies and has been shown to be successful in facilitating communication and soliciting views from individuals with intellectual disabilities and communication difficulties. The aim of this study was to describe the views of students with intellectual disabilities and communication difficulties on speech and reading activities and to examine whether valence scores (from negative to positive) on these views were associated with performance on tests of their corresponding abilities. Methods: This is a cross-sectional quantitative survey study. A group of 111 students with intellectual disabilities and communication difficulties aged 7-21 were interviewed about their speech and reading activities using the visual framework Talking Mats. Their answers were scored on a three-grade like-dislike continuum and were correlated with their results on adapted tests of the corresponding abilities. Findings: The students expressed their views on speech and reading activities. The scored views on speech were positively associated with speech production, and the scored views on reading activities were positively related to reading ability. This suggests that their opinions as expressed through Talking Mats were consistent and reliable. Conclusions: Most students with intellectual disabilities and communicative difficulties can reliably express their own opinions of their abilities when they are provided with a clear visual structure and pictorial support, such as Talking Mats. In this study, this was seen for students with a mild intellectual disability from age seven and onwards and for students with a more severe intellectual disability from 12 years of age and onwards.

Parent training programs aimed at improving language outcomes for children with complex communication needs have predominantly been evaluated on child-centered outcomes and less often on the impact on social life or parental well-being. This study examined parent perceptions of social life before and after ComAlong, a group intervention providing parents with knowledge and training in responsive communication, environmental-milieu teaching strategies and augmentative and alternative communication (AAC). Parents (N = 467) completed questionnaires during the first and last sessions of ComAlong groups held in Sweden 2012 to 2018. Main outcome measure was change in the Social Life Scale from the Family Impact Questionnaire. Associations between this measure and demographic factors of parents and children were analyzed, along with reported change in parents' use of AAC. Pre-post comparisons revealed small significant positive changes in perceived impact of social life following intervention. The magnitude of the positive change was larger among parents of children with non-syndromic diagnoses and parents of children with autism spectrum disorder or attention deficit hyper activity disorder (ADHD). Differences in social life impact was not associated with parents' gender, language proficiency, age, or educational background. In conclusion, communication-focused parent training programs can have a positive impact on social family life and may thereby influence children's participation.

Most students with intellectual and communicative disability who rely on augmentative and alternative communication (AAC) attend non-inclusive school settings. Little is known about turn-taking and the use of various communication modes in groups of students and staff in this context. Previous studies on single students with intellectual disability in various school settings have found that staff tend to dominate interactions and augmented communication modes are used more during structured than unstructured activities. The present study explored turn-taking contributions and communication modes in whole groups of students and staff in non-inclusive school settings in Sweden. Video observations of 33 students and 30 school staff were conducted in seven classrooms during one structured activity (circle time) and one unstructured activity (leisure time). Turn-taking contributions and communication modes were examined when comparing students and staff and when comparing the two activities. Findings revealed that staff dominated the interactions and augmented communication modes were used less during leisure time than circle time. Notably, aided augmented communication modes, particularly speech-output technologies, were used sparsely. Findings of this study highlight the importance of supporting staff members in applying partner strategies and incorporating augmented input, especially aided augmented input, across various group activities at school.

Several studies have shown that Swedish students' reading comprehension and ability to understand fiction are decreasing year by year. Numerous alarming reports point to the unsustainable situation concerning young people's reading engagement, but the ideas of how it can be remedied are few. This study aims to investigate and evaluate a didactic design that includes avatars as game elements in order to promote students' reading of fiction. What opportunities and challenges might such a design present? In the study, an action research method and game theory were used, where teachers and researchers collaboratively explored and evaluated the outcome. The results showed that this design offered many opportunities and generated reading engagement. The students co-design their learning by creating an avatar and then entering the fictional world of a short story. Creating an avatar that interacts with the fictional text requires both participation, reading comprehension and meta analytic skills. However, the design also presented challenges, that some students did not link their avatars clearly to the text and instead did their own stories. The design could thus be further developed to provide more room for avatars to interact more with the chosen literary environment.

Neuroinflammation has been implicated in the pathophysiology of schizophrenia and obsessive-compulsive disorder (OCD) and deviations in brain structure and connectivity are seen in these disorders. Here, we explore the effects of a potent immunomodulatory treatment on neuroimaging. In a pilot study of rituximab treatment in schizophrenia and OCD, a subgroup (n = 13) underwent structural and functional magnetic resonance imaging before and 5 months after treatment, to study longitudinal changes in resting-state functional connectivity (rsFC) and voxel-based morphometry (VBM).A hypothesis-free exploratory whole-brain analysis was performed twice to assess changes in rsFC, using anterior cingulate cortex, anterior insula, posterior insula and nucleus accumbens as seed regions. There were significant interactions (diagnosis x time) in connectivity between right posterior insula and two clusters encompassing basal ganglia and anterior frontal pole, and between left anterior insula and a cluster in basal ganglia, where connectivity decreased in OCD and increased in schizophrenia. The increase of connectivity after rituximab, between left anterior insula and parts of cerebellum and lingual gyrus and between left posterior insula and parts of cerebellum, correlated with improved global psychosocial functioning according to the Personal and Social Performance Scale, especially in schizophrenia. VBM analysis identified two clusters with increased grey matter volumes (GMV) after rituximab, one in right insula overlapping one of the seed regions with significant rsFC changes. This pilot study implies that rituximab may influence both brain structure and connectivity and that GMV changes and rsFC changes are regionally associated.

Background and aims Teachers serve as critical communication partners for students with intellectual disability (ID) who face communication difficulties. However, teachers may lack sufficient training in using communication partner strategies and augmentative and alternative communication (AAC) in the classroom. This study aimed to explore teacher application of a communication partner intervention (AKKtiv ComPal) in schools for students with ID. Methods Video observations were conducted at four schools during a teacher-led group activity at pre- and postintervention, with follow-up 7 months later, focusing on communication partner strategies and AAC use applied as a universal approach in the classroom. Differences and similarities in intervention application and contextual factors that may influence teacher application were investigated using a multiple case study approach, in which the four teachers and their contexts served as the four examined cases. Results All cases increased the access to communication boards in the classroom and used more augmented input and responsive strategies following intervention. Follow-up measures revealed variability in augmented input and sustained or more use of responsive strategies. Despite increased strategy use, access to communication boards remained inconsistent, and augmented input was used with variability across observation minutes. Influencing factors to teacher application seemed to be classroom setups (such as having a table), previous AAC skills, student characteristics, and postintervention efforts such as repeating the intervention or participating in follow-up sessions. Conclusions This study demonstrates that classroom teachers for students with ID can use augmented input and responsive strategies as a universal design approach in the classroom following the AKKtiv ComPal intervention. However, teachers may utilize the strategies somewhat differently, partly influenced by their contextual factors. Implications The findings suggest that while teachers for students with ID can successfully use communication partner strategies in the classroom, their use of augmented input should be nurtured over time to ensure sustained use and possibly improve consistency. Additionally, adapting to the physical environment of the classroom is crucial to optimize the application of these strategies.

Psychiatric disorders are categorized on the basis of presence and absence of diagnostic criteria using classification systems such as the international classification of diseases (ICD) and the diagnostic and statistical manual for mental disorders (DSM). The research domain criteria (RDoC) initiative provides an alternative dimensional framework for conceptualizing mental disorders. In the present paper, we studied neural and behavioral effects of central stimulant (CS) medication in adults with attention deficit hyperactivity disorder (ADHD) and healthy controls using categorical and dimensional stratifications. AX-Continuous Performance Task (AX-CPT) was utilized for the later purpose, and participants were classified as “reactive” or “proactive” based on their baseline proactive behavioral index (PBI). Out of the 65 individuals who participated (33 healthy controls and 32 patients with ADHD), 53 were included in the final analysis that consisted of 31 healthy controls and 22 ADHD patients. For the dimensional stratification, a median split of PBI scores divided participants into “reactive” and “proactive” groups irrespective of whether they had ADHD or not. Participants performed AX-CPT in conjunction with functional magnetic resonance imaging (fMRI) before and after CS medication. We found no significant within or between group CS effect when participants were categorically assigned as healthy controls and ADHD patients. For the dimensional stratification, however, CS selectively increased activation in frontoparietal cognitive areas and induced a shift towards proactive control mode in the reactive group, without significantly affecting the proactive group. In conclusion, the neural and behavioral effects of CS were more clear-cut when participants were stratified into dimensional groups rather than diagnostic categories.

There is limited research targeting communication interventions for children with severe/profound intellectual and multiple disabilities. This study addressed outcomes from a communication course for parents of children with severe/profound intellectual and multiple disabilities and follows up on a previous publication by Rensfeldt Flink et al. (2020). Potential observable changes in the children's and parents' communicative behavior were studied as well as the parents' experiences of the intervention process and the effect of the course on parent--child communication. A mixed-methods design with a case-study framework was used. Two mother--child dyads participated. Data were collected before, during, and after the course. Video-recorded repeated play interactions by the dyads were coded and analyzed for the mothers' responsivity and use of augmentative and alternative communication and the children's interactive engagement. Longitudinal interview data from the mothers were analyzed thematically. No clear signs of behavioral change were observed in the coded video data. However, thematic analyses showed that the mothers experienced changes to communicative behaviors. Moreover, the course affected both mothers' reasoning about communication with their child and their child's communicative needs. The mothers' narratives contributed insights into how reflective processes might guide action in parent-mediated communication interventions. The implications for research and clinical practice are discussed.

Abstract Background The role of inflammation in the aetiology of schizophrenia has gained wide attention and research on the association shows an exponential growth in the last 15 years. Autoimmune diseases and severe infections are risk factors for the later development of schizophrenia, elevated inflammatory markers in childhood or adolescence are associated with a greater risk of schizophrenia in adulthood, individuals with schizophrenia have increased levels of pro-inflammatory cytokines compared to healthy controls, and autoimmune diseases are overrepresented in schizophrenia. However, treatments with anti-inflammatory agents are so far of doubtful clinical relevance. The primary objective of this study is to test whether the monoclonal antibody rituximab, directed against the B-cell antigen CD20 ameliorates psychotic symptoms in adults with schizophrenia or schizoaffective disorder and to examine potential mechanisms. A secondary objective is to examine characteristics of inflammation-associated psychosis and to identify pre-treatment biochemical characteristics of rituximab responders. A third objective is to interview a subset of patients and informants on their experiences of the trial to obtain insights that rating scales may not capture. Methods A proof-of-concept study employing a randomised, parallel-group, double-blind, placebo-controlled design testing the effect of B-cell depletion in patients with psychosis. 120 participants with a diagnosis of schizophrenia spectrum disorders (SSD) (ICD-10 codes F20, F25) will receive either one intravenous infusion of rituximab (1000 mg) or saline. Psychiatric measures and blood samples will be collected at baseline, week 12, and week 24 post-infusion. Brief assessments will also be made in weeks 2 and 7. Neuroimaging and lumbar puncture, both optional, will be performed at baseline and endpoints. Approximately 40 of the patients and their informants will be interviewed for qualitative analyses on the perceived changes in well-being and emotional qualities, in addition to their views on the research. Discussion This is the first RCT investigating add-on treatment with rituximab in unselected SSD patients. If the treatment is helpful, it may transform the treatment of patients with psychotic disorders. It may also heighten the awareness of immune-psychiatric disorders and reduce stigma. Trial registration NCT05622201, EudraCT-nr 2022–000220-37 version 2.1. registered 14th of October 2022.

Abstract Background Dalbavancin is a lipoglycopeptide antibiotic approved for treatment of skin and soft tissue infections, administered as a single or two-dose treatment. The extended half-life, good penetration into bone and synovial fluid, and bactericidal activity against gram-positive bacteria, including those in biofilm, make dalbavancin an appealing choice for treatment of bone and joint infections in outpatient settings. However, we present a rare case of ototoxicity associated with off-label extended dalbavancin treatment of a prosthetic joint infection. Case presentation A 55-year-old man with a prosthetic joint infection of the shoulder underwent off-label extended dalbavancin treatment, receiving a cumulative dose of 2500 mg. The patient experienced a gradual onset of hearing loss following the first dose, leading to a diagnosis of bilateral sensorineural hearing loss that persisted 1 year after dalbavancin was discontinued. Conclusions This case report highlights the importance of exercising caution when administering dalbavancin beyond approved dosing guidelines, and emphasizes the need for vigilance regarding the potential for ototoxicity.

Abstract γδ T cells play a pivotal role in protection against various types of infections and tumours, from early childhood on and throughout life. They consist of several subsets characterised by adaptive and innate-like functions, with Vγ9Vδ2 being the largest subset in human peripheral blood. Although these cells show signs of cytotoxicity, their modus operandi remains poorly understood. Here we explore, using live single-cell imaging, the cytotoxic functions of γδ T cells upon interactions with tumour target cells with high temporal and spatial resolution. While γδ T cell killing is dominated by degranulation, the availability of lytic molecules appears tightly regulated in time and space. In particular, the limited co-occurrence of granzyme B and perforin restrains serial killing of tumour cells by γδ T cells. Thus, our data provide new insights into the cytotoxic arsenal and functions of γδ T cells, which may guide the development of more efficient γδ T cell based adoptive immunotherapies.

Abstract Background Emotion regulation difficulties underlie several psychiatric conditions, and treatments that focus on improving emotion regulation can have an effect on a broad range of symptoms. However, participants’ in-depth experiences of participating in emotion regulation treatments have not been much studied. In this qualitative study, we investigated participants’ experiences of a joint emotion regulation group skills training in a child and adolescent psychiatric outpatient setting. Methods Twenty-one participants (10 adolescents and 11 parents) were interviewed about their experiences after they had participated in a seven-session transdiagnostic emotion regulation skills training for adolescents and parents. The aim of the skills training was to decrease emotion regulation difficulties, increase emotional awareness, reduce psychiatric symptoms, and enhance quality of life. The skills training consisted of psychoeducation about emotions and skills for regulating emotions. The interviews were transcribed and analysed using reflexive thematic analysis. Results The analysis resulted in three overarching themes: Parent – Child processes, Individual processes, and Group processes. The result showed that participants considered an improved parent-child relationship to be the main outcome. Increased knowledge, emotion regulation skills and behavioural change were conceptualised as both mechanisms of change and outcomes. The group format, and the fact that parents and adolescents participated together, were seen as facilitators. Furthermore, the participants experienced targeting emotions in skills training as meaningful and helpful. Conclusion The results highlight the potential benefits of providing emotion regulation skills training for adolescents and parents together in a group format to improve the parent-child relationship and enable the opportunity to learn skills.

Deficits in several cognitive domains are prevalent in men with Klinefelter Syndrome (KS). Verbal deficits are among the most characteristic cognitive impairments of KS, yet other cognitive domains also exhibit deficits. Executive functions, especially working memory capacity and inhibitory control, are frequently affected as well. A common limitation of previous studies addressing potential deficits in inhibitory control is their potential conflation with language-related capabilities, as for example is the case with the Stroop task. Importantly, none of the prior studies utilized the best-accepted approach to study inhibition, namely the Stop Signal Task (SST). This study therefore tested for deficits in inhibitory control in individuals with KS and controls (HC) using a version of the SST with non-semantic auditory stimuli. In addition to the classic behavioral performance measures (e.g., the go reaction time, stopping accuracy, or stop signal reaction time), we also derived parameters of inhibition and attention from electromyography (EMG), electroencephalography (EEG), and Bayesian modeling. Men with KS exhibited prolonged stopping latencies (i.e., stop signal reaction times) and reduced stopping accuracies. Yet, whereas these model-based indices were indicative of attenuated inhibitory control, neither event-related brain potentials nor an EMG-measure of the stopping latency confirmed such deficits. Behavioral and EEG indices, however, provided evidence for deficits in motor response preparation and generation, as well as the early processing of auditory stimuli. In sum, the overall pattern of results does not support the existence of inhibitory deficits in KS per se, but rather suggests that behavioral indices of impaired inhibition may result from early low-level deficits in the auditory and motor domains, as well as a differential weighting in the processing of different aspects of the task.

Narrative interviews with young victims of crime can provide information regarding their unique situations and how the victimization has affected their lives. However, the method can be intrusive, and not all young people are able to safeguard their personal integrity. This research note offers reflections on the use of narrative interviews with young victims of crime, and on interview situations that raised ethical quandaries about whether to discontinue the interviews to reduce the risk of harm. The note starts with a brief description of research on sensitive topics, the study, and the narrative method. After that, I reflect upon some interview situations that have left me wondering what I could have done differently, resulting in suggestions on what could be changed.

COVID-19 has changed the way research can be conducted. The present literature review, based on 29 studies (2008-2020), investigates and compiles existing research to identify possibilities and limitations of using digital interviews within social work, sociology and adjacent disciplines. The results show that digital interviews can enhance long-distance participation, and that they may be cost-effective. However, technical difficulties can arise that adversely affect the quality of the interviews. Concerning sensitive topics (e.g., victimization, health issues, sexuality), more rich data can be reached with digital options than with in-person options, but it can be difficult to read visual cues, as the camera only captures the participants' upper body. Based on these results, it is important to strike a balance between the positive and negative aspects associated with digital interviews, and to understand that digital interviews are something different than in-person interviews, with their own logic and rules.

We analyse and self-reflect on an action research project conducted in a financial organisation twelve years ago. The research question was: What are the challenges of initiating an action research project in a financial organisation with top-down control that uses the Balanced Scorecard? The data came from action learning seminars with line managers, observations, interviews, and meetings in a Norwegian bank (Bank) with approximately 800 employees. The data were analysed using thematic analysis. This study's findings indicate that performance management and top-down senior management control may unintentionally hinder the possibilities for proceeding with action research projects. The researchers lacked open communication with senior management about the purpose of the project, and the managers who participated in the action learning found it difficult to explain to colleagues and senior management what they learned from the processes. Action research did not fit with the Bank's strategic use of performance management. The project may have increased the stress on the line managers as we identified problems without providing the opportunity to make real changes in their organisation. As a result, we determined that action researchers should be cautious in initiating action research without concrete support, active participation and 'common ground' dialogues with senior management.

The overall aim was to examine participants' perceptions of a communication course as held for parents of children with profound intellectual and multiple disabilities. The course curriculum included responsive strategies and augmentative and alternative communication. The research questions addressed the favourability, changes in parents' or children's communication and appreciated or unappreciated course features. Twenty-two written course evaluations were analysed. The mean scores for ratings were compared with ratings in a previous study, including those of parents of children with generally milder disabilities. Comments and answers to open-ended questions were analysed using thematic analysis. Participants were slightly more satisfied with the course as compared with parents who had children with milder disabilities. The thematic analysis suggested increased parental responsiveness after the course. Perceptions of augmentative and alternative communication varied. It was unclear whether the course altered the children's communication or not. The supportive social milieu offered by the course was highly appreciated. Although generalisation beyond this course and setting is to be determined, the results suggest that parents of children with profound intellectual and multiple disabilities can appreciate a communication course and find it useful. An individual approach within the group setting and practical learning opportunities seem important.

Introduction: Impaired quality of life (QoL) and premature death in patients with primary non-affective psychotic disorders is related to lifestyle-induced comorbidities. Current municipal health-promoting treatment and care do not embrace the challenges of living with psychotic disorders. Aim: This cross-sectional study aimed to identify the proportion of outpatients diagnosed with primary psychotic disorders who need health-promoting treatment and care, and who receive municipal health-promoting interventions. Methods: Of 206 eligible invited outpatients from three psychiatric services clinics in Southern Denmark, 165 participated. Demographic and health characteristics, and use of alcohol, cannabis, drugs, and cigarettes were identified via a screening tool. Blood test information, body measurements, and medication status were extracted from the outpatients’ medical records. The need for health promotion was assessed based on body mass index (BMI), and use of alcohol, cannabis, drugs, and cigarettes. Results: Seventy-three percent of outpatients needed health promotion, of whom 61 % were not offered municipal health-promoting treatment and care. Thirty-six percent had one or more somatic comorbidities, including diabetes mellitus (15 %) and cardiovascular disease (10 %); 41 % smoked a mean (SD) of 19 (10) cigarettes daily. Mean (SD) BMI was 34 (8) kg/m2 for women and 29 (7) kg/m2 for men. Conclusion: The majority of outpatients with non-affective psychotic disorders need health-promoting interventions, but only about 40 % of these patients receive such municipal health-promoting treatment and care. Future studies should clarify the impact of these interventions on the health status, QoL, and life expectancy of these patients.

Educational researchers have challenged Bandura’s prediction that self-efficacy beliefs tend to be established early in learning and that once set, self-efficacy beliefs persist unless a critical event causes them to be reevaluated. However, the results have been mixed in previous research, including being positive, negative, and unchanged. In response, we evaluated how 75 teachers (i.e., special educators) rate their teaching self-efficacy beliefs in motivating student reading and adapting reading instruction at two time points. All teachers taught students with an intellectual disability, communication difficulties, and poor reading skills. The teachers participated in a workshop to learn teaching reading strategies with apps under various conditions (comprehension strategies, phonemic strategies, or both comprehension and phonemic strategies). We analyzed teacher self-efficacy beliefs at two time points with a 12-week span (pre-and postintervention). First, we developed measures of teacher self-efficacy through confirmatory factor analyses. Next, we analyzed the data with multiple imputation and mixed linear regression with difference-in-differences (DiD). The results indicated no statistically significant treatment effect on teachers’ rating of their teaching self-efficacy beliefs. We conclude that our results agree with Bandura’s original prediction and thus, his social cognitive theory.

Den nye norske femårige grunnskolelærerutdanningen har som mål at studentene skal utvikle sin FoU-kompetanse. I artikkelen undersøker vi hvordan aksjonslæring i FoU-oppgaven kan bidra til lærerstudenters kompetanse i utviklingsarbeid. Vi har induktivt og deretter deduktivt analysert 51 kvalitative semistrukturerte intervjuer med lærerstudenter som har gjennomført aksjonslæring som en del av FoU-oppgaven på det tredje året av en femårig integrert masterutdanning. Vi har komplementert datamaterialet ved å analysere fire av studentenes FoU-oppgaver. Det teoretiske begrepsapparatet for den deduktive analysen er Dales (1989) kompetanseområde K3, som dreier seg om læreres kompetanse i utviklingsarbeid. Til K3 knytter Dale tre kjennetegn: konstruksjon av hverdagsteori, forskningsavstand til egen praksis og kritisk drøfting i førsteperson. Studien viser at aksjonslæring i FoU-oppgaven bidro til å gi lærerstudentene kompetanse, som de anvendte til å reflektere over og forbedre sin egen praksis, i tråd med Dales tre kjennetegn på K3-området. Studien viser imidlertid også at utdanningsinstitusjonen sendte studenter ut i praksis uten å ha forberedt praksislærerne på aksjonslæring og etablering av et lærende partnerskap.

Introduction Immunological mechanisms may contribute to the causation of mental illness. Autoimmunity is most convincingly shown for anti-NMDA-R encephalitis and Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS); disorders that overlap clinically with schizophrenia and OCD. Altered inflammatory cytokine production, glial activation and auto-antibodies have also been associated with schizophrenia and OCD. In these disorders, however, the treatment results with anti-inflammatory or immunomodulating drugs have hitherto been limited and inconsistent. Yet other targets within the immune system may still be effective and new options are warranted for treatment-resistant patients. Rituximab targets B-lymphocytes and is often used in autoimmune disorders such as rheumatoid arthritis, multiple sclerosis and anti-NMDA-R encephalitis. Objectives We aimed to investigate whether rituximab is clinically effective, safe and tolerable as add-on therapy in markedly ill, treatment-resistant adult psychiatric patients with schizophrenia or OCD. We also wanted to identify putative mediating mechanisms in treatment responders, such as cytokine changes and functional connectivity (FC). Methods In an open pilot study, adults (18-39 years) with treatment-resistant schizophrenia and/or OCD were included. They received an intravenous infusion of rituximab 1000 mg, once at baseline, in addition to their regular psychiatric medication and were followed for 1 year. The main outcome measures were the Positive and Negative Syndrome Scale (PANSS) or Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the Clinical Global Impression-Improvement scale (CGI-I) and the Personal and Social Performance scale (PSP). Treatment response was defined as ≥ 40 % decrease in PANSS or ≥ 35 % decrease in Y-BOCS, and much improved according to CGI-I. Resting-state fMRI was applied at baseline and after 5 months. Plasma cytokines were measured at 0, 3 and 5 months. Cognitive tests and the recently developed PsychoNeuroinflammatory Related Signs and Symptoms Inventory (PNISSI) were used to identify and measure symptoms related to neuro-inflammation and cognitive function. Results Nineteen patients were treated with rituximab. 3-5 months after treatment, 6/9 patients with schizophrenia and 1/10 with OCD responded. One schizophrenia patient continues with rituximab every 6 months and has reportedly done well for almost 3 years. No severe side effects were reported apart from recurrent abdominal pain in a schizophrenia patient and one case of post-COVID-19 syndrome. Significant changes of FC were detected in responders only and correlated with PSP changes. Conclusions Aberrant B-cell activities may contribute to treatment-resistant schizophrenia and be amenable to treatment with rituximab. However, the results of this pilot study need confirmation in placebo-controlled trials. Disclosure of Interest None Declared

Connected and automated vehicles (CAVs) will be a key component of future cooperative intelligent transportation systems (C-ITS). Since the adoption of C-ITS is not foreseen to happen instantly, not all of its elements are going to be connected at the early deployment stages. We consider a scenario where vehicles approaching a traffic light are connected to each other, but the traffic light itself is not cooperative. Information about indented trajectories such as decisions on how and when to accelerate, decelerate and stop, is communicated among the vehicles involved. We provide an optimization-based procedure for efficient and safe passing of traffic lights (or other temporary road blockage) using vehicle-to-vehicle communication (V2V). We locally optimize objectives that promote efficiency such as less deceleration and larger minimum velocity, while maintaining safety in terms of no collisions. The procedure is computationally efficient as it mainly involves a gradient decent algorithm for one single parameter.

Intelligent intersections have the potential to serve as an integral part of tomorrow’s traffic infrastructure. Wireless communication is key to enabling such technology. We consider a scenario where two flows of vehicles traverse an intelligent intersection. We investigate safety in emergency braking scenarios, where one of the vehicles in a flow suddenly decides to emergency brake and emergency braking messages are broadcast to affected vehicles. We provide a framework for computing lower bounds on probabilities for safe braking – collisions between vehicles are to be avoided. If we require that a crash or collision, for example, occurs at most once in a million scenarios, our approach allows for computation of lower bounds on the time-varying (or distance-varying) packet loss probabilities to ensure this. One of the benefits of the proposed framework is that the computational time is reduced; eliminating, for example, the need for time-consuming Monte Carlo simulations.

Cooperative driving is a promising paradigm to improve traffic efficiency and safety. In congested traffic scenarios, such cooperation allows for safe maneuvering and driving with small inter-vehicle spatial gaps. The vehicles involved coordinate their movements in real-time and continuously update each other about their maneuver execution status by means of Vehicle-to-Everything (V2X) communication. However, unreliable V2X communication increases the Age of Information (AoI) of vehicles’ status updates, posing a challenge in situations where emergency braking is required during cooperative maneuvering. To address the interplay between unreliable V2X communication and the resulting impact on traffic safety, we introduce a so-called safety time function, specifically designed for cooperative driving use-cases. The safety time function provides the time available for a vehicle to react to an unexpected event of another vehicle – such as emergency braking to avoid a collision. We provide a computationally efficient algorithm for the computation of safety time functions, which allows for efficient and safe cooperative maneuver planning – even in dense traffic scenarios with many vehicles involved. We show the applicability of our proposed safety time function based on the assessed communication quality for IEEE 802.11p-based V2X communication to meet safety constraints in dense vehicular traffic.

Response inhibition is among the core constructs of cognitive control. It is notoriously difficult to quantify from overt behavior, since the outcome of successful inhibition is the lack of a behavioral response. Currently, the most common measure of action stopping, and by proxy response inhibition, is the model-based stop signal reaction time (SSRT) derived from the stop signal task. Recently, partial response electromyography (prEMG) has been introduced as a complementary physiological measure to capture individual stopping latencies. PrEMG refers to muscle activity initiated by the go signal that plummets after the stop signal before its accumulation to a full response. Whereas neither the SSRT nor the prEMG is an unambiguous marker for neural processes underlying response inhibition, our analysis indicates that the prEMG peak latency is better suited to investigate brain mechanisms of action stopping. This study is a methodological resource with a comprehensive overview of the psychometric properties of the prEMG in a stop signal task, and further provides practical tips for data collection and analysis.

BackgroundEvidence from preclinical studies suggests that probiotics affect brain function via the microbiome-gut-brain axis, but evidence in humans remains limited.ObjectiveThe present proof-of-concept study investigated if a probiotic product containing a mixture of Bifidobacterium longum R0175, Lactobacillus helveticus R0052 and Lactiplantibacillus plantarum R1012 (in total 3 × 109 CFU/day) affected functional brain responses in healthy subjects during an emotional attention task.DesignIn this double-blinded, randomized, placebo-controlled crossover study (Clinicaltrials.gov, NCT03615651), 22 healthy subjects (24.2 ± 3.4 years, 6 males/16 females) were exposed to a probiotic intervention and a placebo for 4 weeks each, separated by a 4-week washout period. Subjects underwent functional magnetic resonance imaging while performing an emotional attention task after each intervention period. Differential brain activity and functional connectivity were assessed.ResultsAltered brain responses were observed in brain regions implicated in emotional, cognitive and face processing. Increased activation in the orbitofrontal cortex, a region that receives extensive sensory input and in turn projects to regions implicated in emotional processing, was found after probiotic intervention compared to placebo using a cluster-based analysis of functionally defined areas. Significantly reduced task-related functional connectivity was observed after the probiotic intervention compared to placebo. Fecal microbiota composition was not majorly affected by probiotic intervention.ConclusionThe probiotic intervention resulted in subtly altered brain activity and functional connectivity in healthy subjects performing an emotional task without major effects on the fecal microbiota composition. This indicates that the probiotic effects occurred via microbe-host interactions on other levels. Further analysis of signaling molecules could give possible insights into the modes of action of the probiotic intervention on the gut-brain axis in general and brain function specifically. The presented findings further support the growing consensus that probiotic supplementation influences brain function and emotional regulation, even in healthy subjects. Future studies including patients with altered emotional processing, such as anxiety or depression symptoms are of great interest.Clinical Trial Registration[http://clinicaltrials.gov/], identifier [NCT03615651].

Interaction between humans and robots will benefit if people have at least a rough mental model of what a robot knows about the world and what it plans to do. But how do we design human-robot interactions to facilitate this? Previous research has shown that one can change people’s mental models of robots by manipulating the robots’ physical appearance. However, this has mostly not been done in a user-centred way, i.e. without a focus on what users need and want. Starting from theories of how humans form and adapt mental models of others, we investigated how the participatory design method, PICTIVE, can be used to generate design ideas about how a humanoid robot could communicate. Five participants went through three phases based on eight scenarios from the state-of-the-art tasks in the RoboCup@Home social robotics competition. The results indicate that participatory design can be a suitable method to generate design concepts for robots’ communication in human-robot interaction.

BackgroundChildren with long-term illnesses frequently experience symptoms that could negatively affect their daily lives. These symptoms are often underreported in health care. Despite a large number of mobile health (mHealth) tools, few are based on a theoretical framework or supported by scientific knowledge. Incorporating universal design when developing a product can promote accessibility and facilitate person-centered communication. ObjectiveThe aim of this study is to identify the symptom-reporting needs of children with cancer and congenital heart defects that could be satisfied by using a mobile app. Another aim is to evaluate how the child might interact with the app by considering universal design principles and to identify parents’ views and health care professionals’ expectations and requirements for an mHealth tool. MethodsUser-centered design is an iterative process that focuses on an understanding of the users. The adapted user-centered design process includes 2 phases with 4 stages. Phase 1 involved interviews with 7 children with long-term illnesses, 8 parents, and 19 health care professionals to determine their needs and wishes for support; a workshop with 19 researchers to deepen our understanding of the needs; and a workshop with developers to establish a preliminary tool to further investigate needs and behaviors. Phase 2 involved interviews with 10 children with long-term illnesses, 9 parents, and 21 health care professionals to evaluate the mock-up (prototype) of the mHealth tool. Data were synthesized using the interpretive description technique. ResultsA total of 4 aspects of needs emerged from the synthesis of the data, as follows: different perspectives on provided and perceived support; the need for an easy-to-use, non–clinic-based tool to self-report symptoms and to facilitate communication; the need for safety by being in control and reaching the child’s voice; and a way of mapping the illness journey to facilitate recall and improve diagnostics. The children with long-term illnesses expressed a need to not only communicate about pain but also communicate about anxiety, fatigue, fear, and nausea. ConclusionsThe findings of this study indicated that the PicPecc (Pictorial Support in Person-Centered Care for Children) app is a potential solution for providing communicative support to children with long-term illnesses dealing with multiple symptoms and conditions. The interview data also highlighted symptoms that are at risk of being overlooked if they are not included in the mobile app. Further studies are needed to include usability testing and evaluation in hospitals and home care settings.

Hypoxemia and hypoglycemia are known risks for mortality in children in low-income settings. Routine screening with pulse oximetry and blood glucose assessments for outpatients could assist in early identification of high-risk children. We assessed the prevalence of hypoglycemia and hypoxemia, and the overlap with Integrated Management of Childhood Illness (IMCI) general danger signs, among children seeking outpatient care in Malawi. A cross-sectional study was conducted at 14 government primary care facilities, four rural hospitals and one district referral hospital in Mchinji district, Malawi from August 2019-April 2020. All children aged 0-12 years seeking care with an acute illness were assessed on one day per month in each facility. Study research assistants measured oxygen saturation using Lifebox LB-01 pulse oximeter and blood glucose was assessed with AccuCheck Aviva glucometers. World Health Organization definitions were used for severe hypoglycemia (

Objective:. To evaluate the immediate effects of positive expiratory pressure therapy on oxygen saturation and ventilation after abdominal surgery. Background:. Positive expiratory pressure therapy to treat postoperative hypoxia is widespread, despite a lack of evidence of effect. Methods:. This randomized, sham-controlled, crossover trial investigated adults 1–2 days after abdominal surgery at Umeå University Hospital, Sweden. The intervention was positive expiratory pressure of 10–15 cm H2O. The control was a sham device. The investigations were ended with deep-breathing maneuvers. Outcomes were the gradient of changes in peripheral oxygen saturation and transcutaneous carbon-dioxide partial pressure (PtcCO2). Results:. Eighty patients were included and randomized and 76 patients were analyzed. Oxygen saturation increased from a baseline mean of 92% to 95%, P < 0.001, during positive expiratory pressure breathing, while PtcCO2 decreased from a mean of 36 to 33 mm Hg, P < 0.001. This was followed by apnea, oxygen desaturations to a mean of 89%, P < 0.001, and increased PtcCO2 before returning to baseline values. The changes in oxygen saturation and PtcCO2 did not differ from sham breathing or deep-breathing maneuvers. Conclusions:. Positive expiratory pressure breathing after abdominal surgery improves oxygen saturation during the maneuver because of hyperventilation, but it is followed by apnea, hypoventilation, and oxygen desaturation. The effect is not different from the expiration to a sham device or hyperventilation. It is time to stop positive expiratory pressure therapy after abdominal surgery, as there is no evidence of effect in previous trials, apart from the adverse effects reported here.

Transition problems from secondary to tertiary level in mathematics have been a recurrent issue in Sweden. This paper summarises the development during the last decades. Results from two recent research studies that illuminate the transition problem are presented. The first one, based on empirical data from a major Swedish technical university, characterises the widening gap, in content and in approach, between secondary school and first year university courses. The second study deals with students' encounters with mathematical proof and is based on a large investigation at another main Swedish university. We discuss the influence on the current transition problems of school reforms and of the great expansion of higher education in Sweden during the last 10 - 15 years in view of the results from the research studies. (Contains 2 footnotes and 2 figures.)

From previous research it is well known that victimization can have various short- and long-term consequences resulting in a need for support to cope with the victimization. Research also shows, however, that not all victims of crime seek or receive support. One cause of this might be the conditions and constraints that affect professionals' matching of support services with individual victims' needs. The purpose of the present conceptual paper is to discuss how professionals can co-produce support services with the individual victim and if needed engage suitable external organizations for the purpose of adapting support services to the individual victim's needs, while also considering the complex field of constraints that professionals need to navigate during this process. The paper makes two main contributions. First, it conceptualizes the complex field of constraints as consisting of five sets of conditions (mandatory, local, professional, support-user, and inter-organizational conditions), which professionals must navigate during the co-production of victim support services. Second, the paper suggests a seven-step process of how professionals can navigate this complex field during co-production of victim support services' activities with the individual victim, and potentially those of external organizations as well. [ABSTRACT FROM AUTHOR]

Background: Staphylococcus aureus (S. aureus) can behave both as a harmless commensal and as a pathogen. Its significance in the pathogenesis of chronic rhinosinusitis (CRS) is not yet fully understood. This study aimed to determine serum antibody responses to specific staphylococcal antigens in patients with CRS and healthy controls, and to investigate the correlation between specific antibody response and severity of symptoms. Methodology: Serum samples from 39 patients with CRS and 56 healthy controls were analysed using a protein microarray to investigate the antibody response to S. aureus specific antigens, with a focus on immunoglobulin G (IgG) directed toward staphylococcal components accessible to the immune system. Holm-Bonferroni corrections were applied in all analyses. Information about growth of S. aureus in nares and maxillary sinus was taken from a previous study based on the same individuals. Clinical symptoms were assessed using a scoring system. Results: IgG antibody levels toward staphylococcal TSST-1 and LukF-PV were significantly higher in the CRS patient group compared to healthy controls, and levels of anti-TSST-1 antibodies were significantly higher in the CRS patient group with S. aureus in maxillary sinus than in controls. There were no correlations between the severity of symptoms and levels of serum anti-staphylococcal IgG antibody levels for LukF-PV and TSST-1. Conclusions: TSST-1 and LukF-PV could be interesting markers for future studies of the pathogenesis of CRS.

Probiotics can alter brain function via the gut–brain axis. We investigated the effect of a probiotic mixture containing Bifidobacterium longum, Lactobacillus helveticus and Lactiplantibacillus plantarum. In a randomized, placebo-controlled, double-blinded crossover design, 22 healthy subjects (6 m/16 f; 24.2 ± 3.4 years) underwent four-week intervention periods with probiotics and placebo, separated by a four-week washout period. Voxel-based morphometry indicated that the probiotic intervention affected the gray matter volume of a cluster covering the left supramarginal gyrus and superior parietal lobule (p < 0.0001), two regions that were also among those with an altered resting state functional connectivity. Probiotic intervention resulted in significant (FDR < 0.05) functional connectivity changes between regions within the default mode, salience, frontoparietal as well as the language network and several regions located outside these networks. Psychological symptoms trended towards improvement after probiotic intervention, i.e., the total score of the Hospital Anxiety and Depression Scale (p = 0.056) and its depression sub-score (p = 0.093), as well as sleep patterns (p = 0.058). The probiotic intervention evoked distinct changes in brain morphology and resting state brain function alongside slight improvements of psycho(bio)logical markers of the gut–brain axis. The combination of those parameters may provide new insights into the modes of action by which gut microbiota can affect gut–brain communication and hence brain function.

Introduction This study protocol outlines the evaluation of the pictorial support in person-centred care for children (PicPecc). PicPecc is a digital tool used by children aged 5–17 years to self-report symptoms of acute lymphoblastic leukaemia, who undergo high-dose methotrexate treatments. The design of the digital platform follows the principles of universal design using pictorial support to provide accessibility for all children regardless of communication or language challenges and thus facilitating international comparison.Methods and analysis Both effect and process evaluations will be conducted. A crossover design will be used to measure the effect/outcome, and a mixed-methods design will be used to measure the process/implementation. The primary outcome in the effect evaluation will be self-reported distress. Secondary outcomes will be stress levels monitored via neuropeptides, neurosteroids and peripheral steroids indicated in plasma blood samples; frequency of in-app estimation of high levels of distress by the children; children's use of analgesic medicine and person centeredness evaluated via the questionnaire Visual CARE Measure. For the process evaluation, qualitative interviews will be carried out with children with cancer, their legal guardians and case-related healthcare professionals. These interviews will address experiences with PicPecc in terms of feasibility and frequency of use from the child’s perspective and value to the caseworker. Interview transcripts will be analysed using an interpretive description methodology.Ethics and dissemination Ethical approval was obtained from the Swedish Ethical Review Authority (reference 2019-02392; 2020-02601; 2020-06226). Children, legal guardians, healthcare professionals, policymaking and research stakeholders will be involved in all stages of the research process according to Medical Research Council’s guidelines. Research findings will be presented at international cancer and paediatric conferences and published in scientific journals.Trial registration ClinicalTrials.gov; NCT04433650.

Abstract Objective Human hantavirus infections can cause haemorrhagic fever with renal syndrome (HFRS). The pathogenic mechanisms are not fully understood, nor if they affect the humoral immune system. The objective of this study was to investigate humoral immune responses to hantavirus infection and to correlate them to the typical features of HFRS: thrombocytopenia and transient kidney dysfunction. Methods We performed a comprehensive characterisation of longitudinal antiviral B‐cell responses of 26 hantavirus patients and combined this with paired clinical data. In addition, we measured extracellular adenosine triphosphate (ATP) and its breakdown products in circulation and performed in vitro stimulations to address its effect on B cells. Results We found that thrombocytopenia was correlated to an elevated frequency of plasmablasts in circulation. In contrast, kidney dysfunction was indicative of an accumulation of CD27−IgD− B cells and CD27−/low plasmablasts. Finally, we provide evidence that high levels of extracellular ATP and matrix metalloproteinase 8 can contribute to shedding of CD27 during human hantavirus infection. Conclusion Our findings demonstrate that thrombocytopenia and kidney dysfunction associate with distinctly different effects on the humoral immune system. Moreover, hantavirus‐infected individuals have significantly elevated levels of extracellular ATP in circulation.

Background: Patients with transfusion dependent anemia are at risk of complications from iron overload. Quantitative T2* magnetic resonance imaging (MRI) is the best non-invasive method to assess iron deposition in the liver and heart and to guide chelation therapy. Purpose: To investigate the image quality and inter-observer variations in T2* measurements of the myocardium and the liver, and to obtain the lower limit of cardiac and hepatic quantitative T2* values in patients without suspicion of iron overload. Material and methods: Thirty-eight patients referred for cardiac MRI were prospectively included in the study. Three patients were referred with, and 35 without suspicion of iron overload. Quantitative T2* parametric maps were obtained on a 1.5 T MRI system in the cardiac short axis and liver axial view. Two readers independently assessed the image quality and the representative and the lowest T2* value in the myocardium and the liver. Results: The normal range of representative T2* values in the myocardium and liver was 24−45 ms and 14−37 ms, respectively. None of the 35 participants (0 %, 95 % confidence interval 0–11 %) in the normal reference group demonstrated representative T2* values below previously reported lower limits in the myocardium (20 ms) or the liver (8 ms). Focal myocardial areas with T2* values near the lower normal range, 19−20 ms, were seen in two patients. The readers generally reported good image quality. Conclusion: T2* imaging for assessing iron overload can be performed in a non-dedicated center with sufficient image quality.