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Fish early life stages are well known for their sensitivity to crude oil exposure. However, the effect of crude oil exposure on adults and their gametes during their spawning period is not well studied. Polar cod, a key arctic fish, may be at risk for crude oil exposure during this potentially sensitive life stage. Additionally, this species experiences lower food availability during their spawning season, with unknown combined consequences. In the present study, wild-caught polar cod were exposed to decreasing levels of a water-soluble fraction (WSF) of crude oil or control conditions and fed either at a low or high feed ration to assess the combined effect of both stressors. Samples were taken during late gonadal development, during active spawning (spawning window), and in the post-spawning period. Histology analysis of gonads from fish sampled during the spawning window showed that oil-exposed polar cod were more likely to have spawned compared to controls. Oil-exposed females had 947 differentially regulated hepatic genes, and their eggs had a higher polycyclic aromatic hydrocarbon body burden compared to controls. Feed ration did not consistently affect polar cod's response to oil exposure for the endpoints measured, however, did alone result in decreases in some sperm motility parameters. These results suggest that polar cod's spawning period is a sensitive life event to crude oil exposure, while feed limitation may play a minor role for this supposedly capital breeder. The effects of adult exposure to crude oil on gamete quality and the next generation warrant further investigation. [ABSTRACT FROM AUTHOR]

Objectives. Atrial fibrillation is a common arrhythmia in patients with ischemic heart disease. This study aimed to determine the cumulative incidence of new-onset atrial fibrillation after percutaneous coronary intervention or coronary artery bypass grafting surgery during 30 days of follow-up. Design. This was a prospective multi-center cohort study on atrial fibrillation incidence following percutaneous coronary intervention or coronary artery bypass grafting for stable angina or non-ST-elevation acute coronary syndrome. Heart rhythm was monitored for 30 days postoperatively by in-hospital telemetry and handheld thumb ECG recordings after discharge were performed. The primary endpoint was the cumulative incidence of atrial fibrillation 30 days after the index procedure. Results. In-hospital atrial fibrillation occurred in 60/123 (49%) coronary artery bypass graft and 0/123 percutaneous coronary intervention patients (p <.001). The cumulative incidence of atrial fibrillation after 30 days was 56% (69/123) of patients undergoing coronary artery bypass grafting and 2% (3/123) of patients undergoing percutaneous coronary intervention (p <.001). CABG was a strong predictor for atrial fibrillation compared to PCI (OR 80.2, 95% CI 18.1–354.9, p <.001). Thromboembolic stroke occurred in-hospital in one coronary artery bypass graft patient unrelated to atrial fibrillation, and at 30 days in two additional patients, one in each group. There was no mortality. Conclusion. New-onset atrial fibrillation during 30 days of follow-up was rare after percutaneous coronary intervention but common after coronary artery bypass grafting. A prolonged uninterrupted heart rhythm monitoring strategy identified additional patients in both groups with new-onset atrial fibrillation after discharge. [ABSTRACT FROM AUTHOR]

Background. Surgery for acute type A aortic dissection confers a risk for significant bleeding. We analyzed the impact of massive bleeding on complications after surgery for acute type A aortic dissection. Methods. Patients undergoing surgery for acute type A aortic dissection from the retrospective multicenter Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD) database 2005–2014 were eligible. Massive bleeding was defined according to the Universal Definition of Perioperative Bleeding. The primary outcome measure was early mortality and secondary outcome measures were perioperative stroke, mechanical ventilation more than 48 h, new-onset dialysis, and intensive care unit stay. Propensity score matching was performed to adjust for differences in covariates. Results. Nine hundred ninety-seven patients were included, of whom 403 (40.4%) had massive bleeding. In the propensity score-matched cohort (344 pairs), patients with massive bleeding had higher 30-day mortality (17.2 versus 7.6%, p <.001), mechanical ventilation more than 48 h (52.8 versus 22.6%, p <.001), perioperative stroke (24.3 versus 14.8%, p =.002), new-onset dialysis (22.5 versus 4.9%, p <.001), and longer intensive care unit stay (6 versus 3 days, p <.001), compared with patients without massive bleeding. Risk factors for massive bleeding were previous cardiac surgery, preoperative clopidogrel or ticagrelor therapy, DeBakey type I dissection, and localized or generalized malperfusion. Conclusions. Massive bleeding in surgery for acute type A aortic dissection is associated with a markedly increased risk for severe complications as well as early death. Further improvement of surgical technique and pharmacological optimization of coagulation is paramount to possibly improve outcomes in acute type A aortic dissection repair. [ABSTRACT FROM AUTHOR]

Developments in Virtual Reality (VR) technology have led to an increased use in research, practice, and for entertainment purposes. There is also a perceived applicability and suitability of the technology for educational purposes. For VR to be properly implemented in schools and special education, there is a need for understanding what teachers, special education teachers, and student teachers view as important implementation factors. We interviewed a total of 13 Norwegian teachers in which eight were interviewed individually and five were interviewed as a group. We thematically analysed the data, which resulted in five themes of implementation factors: training and knowledge, networks, resources, positive attitudes, and technological features. This study provides the educational-technology community with important insights from stakeholders for a successful implementation of VR in education. The themes elucidate the success factors, possible pitfalls, or challenges in implementing VR, and the perceived workload for the school personnel. Our findings are in line with existing research on the implementation of desktop computer technology, and we extended the scope to include VR technology in educational settings. [ABSTRACT FROM AUTHOR]

Innovations and advancements in technology create new opportunities to run and maintain manufacturing plants, which we refer to as digitalised manufacturing. This development is recognised as a socio-technical system (STS) change, where a change in the production system's goals, technology, processes, people, or environment may lead to ripple effects between those sub-systems. Despite this, technology development and technology use cases account for most of the research within digitalised manufacturing, while little attention has been devoted to leadership practices considering digitalised manufacturing from a socio-technical perspective. This paper focuses on the maintenance organisation, whose mission in a company is to keep production systems functional. We aim to describe leadership in industrial maintenance from an STS perspective. This is a unique interview study where twenty maintenance managers from Swedish manufacturing industry offer their perspective on the changing leadership within maintenance, providing a unique insight into the challenges facing leaders of maintenance in digitalised manufacturing. We frame the empirical findings using an STS framework and propose an overall consideration model for leadership that supports the development of a functional maintenance organisation in the face of pervasive digitalisation. [ABSTRACT FROM AUTHOR]

Sexual self-concept and sexual self-schema are multidimensional constructs critical to developing a more holistic theoretical understanding of the sexual self. With an increased amount of research exploring these constructs over the past few decades, a systematic review was warranted to highlight next steps for future research in this area. Therefore, utilizing a staged systematic review, we aimed to explore how these parallel concepts are measured and among which populations they are used. The evaluation of 236 unique manuscripts published 1990–2020 revealed the use of 38 established or constructed measures of sexual self-concept, and 16 established or constructed measures of sexual self-schema. Three distinct measures were used in more than one-fifth of the studies reviewed, although the use of full-form measures vs. subscales differed across studies. Although there was diversity in the samples used in the studies reviewed, these studies were conducted most commonly with samples consisting of individuals who were primarily, if not solely, cisgender, women, heterosexual, White, non-college attending, U.S. residents, and/or had no unique characteristics identified (e.g., cancer patient/survivor, pregnant). The largest proportion of studies reviewed examined sexual self-concept during emerging adulthood, followed by early adulthood and middle adulthood. Suggested directions for future research in this area include (a) reexamining and testing how current measures are capturing these constructs and among whom; (b) expanding samples to include and/or target specifically gender, sexual, and racial/ethnic minoritized groups as well as individuals with unique characteristics that would affect sexual well-being; and (c) utilizing samples in childhood, adolescence, and late adulthood. [ABSTRACT FROM AUTHOR]

This essay explores the aesthetics of naval war literature within the broader context of war studies and literary theory. While modern war scholarship has largely focused on land and aerial warfare, naval warfare has often been neglected. Drawing on classical aesthetic traditions from Plato to Baumgarten, alongside more contemporary thinkers like Rancière and Kittler, the essay outlines a theoretical framework for naval war literature by combining aesthetic theory, perceptual orders, and media-technological conditions. The essay identifies the unique features that differentiate naval warfare from its land and aerial counterparts and suggests that we consider naval war literature as a distinct subgenre. [ABSTRACT FROM AUTHOR]

Introduction: Eosinophilic esophagitis (EoE) is a chronic inflammatory condition that affects the esophagus. Previous studies have indicated a substantial increase of EoE over the last decades. The aim of the current study was to describe the incidence and prevalence of EoE over time and by geographical regions in Sweden, utilizing nationwide population-based registries. Material and methods: The number of hospital admissions (in-patient and out-patient) for patients were identified using ICD-10-SE code K20.9A from the National Patient Registry between 1st January 2011 and 31st December 2021. Crude incidence and prevalence numbers were presented per 100,000 person years and persons, respectively. Results: In 2011, no hospital visits of EoE were recorded. A total of 3,243 incident patients (2,379 (73.4%) men and 864 (26.6%) women) had a record of EoE between 2012 and 2021. The incidence increased over calendar year in where the incidence was from 1.59 per 100,000 person years in 2012 to 5.34 per 100,000 person years in 2021. The prevalence was 1.29 per 100,000 person years and 31.02 per 100,000 person years in 2012 and 2021, respectively. Major differences in the prevalence between geographical regions in Sweden were observed, e.g. in 2021, the prevalence was 12.24 in Västernorrland compared to 43.26 in Västra Götaland per 100,000 person years, which is similar to the prevalence in the Stockholm region. Conclusion: The incidence and prevalence of eosinophilic esophagitis has significantly increased over calendar year but differs between geographical regions in Sweden. These differences should be further investigated. [ABSTRACT FROM AUTHOR]

Research has demonstrated that preschool teachers are particularly prone to develop burnout symptoms, such as emotional exhaustion. However, which workplace conditions are particularly related to burnout symptoms in preschool teachers remains widely unknown. Hence, this study aims to disentangle personal characteristics (e.g. educational degree, working experience) and structural as well as social conditions of preschool teachers' work environment (e.g. teacher–child ratio, team climate) in relation to emotional exhaustion. We draw on data collected from a nation-wide sample of 1,394 preschool teachers nested in 204 preschools. Multilevel analysis demonstrated that center differences explained only 5.8% of the overall variance in levels of emotional exhaustion. Emotional exhaustion was strongly associated with social experiences at the workplace, but much less with structural or personal job conditions. Hence, practical interventions should also focus on social aspects, such as team cohesion and dealing with challenges in parent-teacher collaborations. [ABSTRACT FROM AUTHOR]

Established firms are increasingly forming alliances with green start-ups, i.e. newly-started ventures dedicated to eco-innovation. This study explores the rationales for the initiation and continuation of such alliances. We investigate how established firms leverage these alliances to facilitate eco-innovation adoption alongside their pursuit of legitimacy. Findings from a case study on seven alliances focused on food waste reduction initiatives in Italy and Sweden indicate that legitimacy-seeking rationales are predominant during alliance formation. As alliances evolve, they transition into a phase where firms identify opportunities for eco-innovation, while ambitions of capability-building and new revenue creation shape the development of the alliances. This study contributes to eco-innovation and environmental alliance literature by showcasing how the pursuit of legitimacy facilitates established firms' adoption and implementation of eco-innovation through alliances with green start-ups. [ABSTRACT FROM AUTHOR]

People often visit natural settings for recreation and psychological restoration. This study aims to improve understanding of how exposure to and experiences of mammalian wildlife in local natural settings can permit and promote recreation and restoration. Randomly sampled residents in three regions of Sweden (N = 303) with varying presence of fear-relevant species (wolf, wild boar) and fear-irrelevant species (roe deer, squirrel) completed a questionnaire. Squirrel and roe deer were rated significantly higher than wolf and wild boar for anticipated positive feelings and restoration outcomes, and significantly lower for negative feelings and avoidance of natural settings. The possibility of exposure explained little of the variation in the restoration variables, whereas the experiences anticipated with an animal encounter contributed substantially to explanation. Vulnerability seems to counteract the restorative benefit of fascination. Wildlife conservation efforts and public health initiatives may find practical utility in distinguishing between potential exposure and anticipated experience when designing interventions. [ABSTRACT FROM AUTHOR]

We developed a serious game with avatars driven by empirically-based algorithms of suspect behavior to train participants in using the Evidence Framing Matrix (EFM), a component of the SUE technique. Ninety-six participants were allocated into four groups (i.e. Control, Training, Feedback, and Training & Feedback) for two interviews. EFM-trained participants used the EFM more than untrained participants in the first interview. Receiving feedback improved EFM use in the second interview. Theoretical training plus feedback made participants use within-statement (in)consistencies more to evaluate avatar statements. The results suggested the potential for using algorithm-driven suspect avatars in investigative interview training. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the effects of plyometric (PT) or strength (ST) training on change of direction (COD) performance at two differing angles among highly trained youth footballers. Seventy-one national-level youth football players (14.6 ± 1.8 years) were randomly allocated to either an 8-week, twice weekly, plyometric (PT) or strength training (ST) group. Pre- and post-intervention testing consisted of measures of COD performance at 45 and 180º, as well as maximal strength assessed via Trap Bar Deadlift 5RM (TBD5RM) and reactive strength index (RSI) from a 40 cm drop jump, respectively. Changes from pre- to post-testing were assessed via mixed ANOVAs (p ≤ .05) and effect sizes. Both training groups improved TBD5RM (PT = 7.8%, p < .001, ES = 0.32. ST = 6.9%, p < .001, ES = 0.28) and RSI (PT = 15.9%, p < .001, ES = 0.59. ST = 15.6%, p < .001, ES = 0.64) measures. Significant improvement in 45° COD performance was found for both training groups (PT = 4.0%, p < .001, ES = –0.68. ST = 3.6%, p < .001, ES = –0.61), whilst neither group improved at 180° (PT = 0.8%, p = .192, ES = –0.17. ST = 0.8%, p = .282, ES = –0.23). No significant differences in changes were found between training groups. Both PT and ST were effective at enhancing maximal and explosive strength as well as COD performance measured at shallow angles. Neither method enhanced the sharp angle COD performance. [ABSTRACT FROM AUTHOR]

We study the condenser capacity capp⁡(E, Ω) on unbounded open sets Ω in a proper connected metric space X equipped with a locally doubling measure supporting a local p-Poincaré inequality, where 1 < p < ∞. Using a new definition of capacitary potentials, we show that capp is countably subadditive and that it is a Choquet capacity. We next obtain formulas for the capacity of superlevel sets for the capacitary potential. These are then used to show that p-harmonic Green functions exist in an unbounded domain Ω if and only if either X is p-hyperbolic or the Sobolev capacity C p (X ∖ Ω) > 0. As an application, we deduce new results for Perron solutions and boundary regularity for the Dirichlet boundary value problem for p-harmonic functions in unbounded open sets. [ABSTRACT FROM AUTHOR]

Using rich longitudinal data from the UK's Millennium Cohort Study (MCS), the authors compare the performance of private and state school pupils in age 16 national examinations (GCSEs) in England, where private schools are particularly well resourced by international standards. Performance among pupils attending private secondary schools is superior. However, this raw difference ignores the highly socially selective nature of the English private school system. Adjusting for socioeconomic background, the overall performance difference between the sectors disappears. The picture is also quite different when considering English, Maths, Science and Arts subjects separately. Implications are reviewed for debate surrounding the role of private schools and the emphasis of lower secondary state education on core subjects at the expense of Arts subjects. [ABSTRACT FROM AUTHOR]

Objectives: This study describes aortic growth, survival and events in patients with aortic arch pathology. Methods: Patients with an index diameter ≥4.5 cm or other pathology of the native aortic arch, were followed with longitudinal computed tomography and clinical data collected retrospectively. Aortic growth was estimated using a linear mixed model. Survival and event rates were estimated using Kaplan-Meier methods. Cox analysis assessed clinical and radiological predictors with outcomes (death, local or remote aortic events (acute aortic syndromes or intervention)). Results. 186 patients underwent 683 CT scans during 638 of patient years. The estimated annual growth was 0.28 (mm/year). 47 (25%) patients had an event and a 66% five-year event-free survival. 29 patients died, of whom 11 suffered an aortic death. 19 events were local and 25 events were remote, mostly primary events were interventions. In Cox analysis, increasing descending aortic diameter was an independent predictor of all cause of death (hazard ratio [HR], 2.16), aortic death (HR 4.81), and local event (HR 1.71). Conclusions. In patients with aortic arch pathology, growth, and aortic events should be expected. Increasing descending aortic diameter could presage an added risk, but other variables appear needed to identify patients at risk, select them for intervention or surveillance. [ABSTRACT FROM AUTHOR]

Objectives. This study describes growth, local and remote aortic events, and survival in patients with proximal (root, ascending) aortic diameters just below threshold for operation. Methods. Patients with proximal aortic diameter of 4.5 to 5.4 cm at baseline, were followed with serial computed tomography studies and data collected retrospectively. Aortic growth rate was estimated using mixed effects modelling. Clinical and radiological features associated with outcomes (all-cause death, aortic death, local or remote aortic events (dissection, rupture, intramural hematoma, or intervention)) were assessed with Cox analysis. Survival and freedom from events were estimated using Kaplan-Meier methods. Results. 80 patients underwent 274 CT scans during 265 patient-years. Median proximal aortic growth was 0.2 cm in 3 years. 32 events occurred in 28 patients (35%). Eleven events were local, all elective proximal aortic surgery. Nine events were remote: 5 type B aortic dissections, 3 descending aneurysms undergoing elective repair, and one infrarenal aortic rupture. Twelve patients died, half of type B aortic dissection. Relative survival compared to a matched normal population was 82% (95% confidence limits 55–98%) at 10 years. In Cox analysis, increased descending aortic diameter was an independent predictor of all-cause death (hazard ratio [HR], 1.39) and aortic death (HR 1.96). Conclusions. Descending, but not proximal, aortic growth was predictive of lethal events. The decreased relative survival, the substantial number of remote aortic events and aortic deaths strongly suggest continuous serial CT surveillance of the entire aorta. Other indicators than proximal aortic diameter appear needed to improve management of this patient group. [ABSTRACT FROM AUTHOR]

Purpose: Individuals with Low Back Pain (LBP) often face significant disabilities, including walking limitations. We use the Two-Minute Walk Test (2MWT) to assess walking performance, comparing overground and treadmill versions for correlation and interchangeability. Material and methods: A randomised cross-over study of 40 participants with LBP randomly completed the 2MWT in a hallway and on a treadmill. The correlation was analysed by the Spearman Rho correlation coefficient (r), the agreement by the Bland-Altman method, differences between the testing orders by a paired sample t-test, and the association by a univariate regression. Results: A high correlation was found between the methods (r = 0.76, p < 0.01). The difference between the methods was 45.4 metres (95% CI 33.4: 57.4, p < 0.01) or 29%, with an insignificant 6.8 metres (95% CI −17.4: 31.0, p = 0.57) between the testing orders. Notably, the distance walked in the hallway served as a strong predictor, explaining a substantial portion of the variation observed in the distance covered on the treadmill (R2 = 0.61, p < 0.01). Conclusion: Performance of the 2MWT overground and on a treadmill correlate highly in people with LBP. However, because participants walked 29% further in the hallway, treadmill walking is likely not an interchangeable alternative to testing when the aim is to evaluate performance. [ABSTRACT FROM AUTHOR]

Purpose: Cancer survivors experience barriers to primary healthcare (PHC) services. The aim was to explore reactions to and opinions about perceived challenges associated with PHC access and quality among cancer survivors in Sweden, including how they have acted to adapt to challenges. Methods: Five semi-structured focus group interviews were conducted with cancer survivors (n = 20) from Skåne, Sweden, diagnosed with breast, prostate, lung, or colorectal cancer or malignant melanoma. Focus groups were mixed in regard to diagnosis. Data were analysed using a descriptive template analysis approach. Results: In light of perceived challenges associated with access to adequate PHC, participants experienced that they had been forced to work hard to achieve functioning PHC contacts. The demands for self-sufficiency were associated with negative feelings such as loneliness and worry. Participants believed that cancer survivors who lack the ability to express themselves, or sufficient drive, risk missing out on necessary care due to the necessity of being an active patient. Conclusions: The findings highlight negative patient experiences. They have implications for the organization of care for cancer survivors as they indicate a need for more efficient post-treatment coordination between cancer specialist care and PHC providers, as well as increased support for patients leaving primary cancer treatment. [ABSTRACT FROM AUTHOR]

Our body temperature is normally kept within a narrow range of 1°C. For example, if our body temperature rises, such as in a hot environment or due to strenuous exercise, our thermoregulatory system will trigger a powerful heat defense response with vasodilation, sweating, and lowered metabolism. During fever, which often involves body temperatures of up to 41°C, this heat defense mechanism is apparently inhibited; otherwise, the rising body temperature would be immediately combated, and fever would not be allowed to develop. New evidence suggests how and where this inhibition takes place. In two consecutive studies from Cheng et al. and Xu et al., it has been shown that prostaglandin E2, which generates fever by acting on thermosensory neurons in the preoptic hypothalamus, also acts on neurons in the brainstem parabrachial nucleus, which receive temperature information from temperature-activated spinal cord neurons and relay this information to the thermoregulatory center in the hypothalamus to either induce cold or heat defenses. By acting on the same type of prostaglandin E2 receptor that is critical for fever generation in the preoptic hypothalamus, the EP3 receptor, prostaglandin E2 inhibits the signaling of the heat-responsive parabrachial neurons, while stimulating the cold-responsive neurons. These novel findings thus show that prostaglandin E2, by binding to the same receptor subtype in the parabrachial nucleus as in the preoptic hypothalamus, adjusts the sensitivity of the thermosensory system in a coordinated manner to allow the development of febrile body temperatures. [ABSTRACT FROM AUTHOR]

There is a renewed interest in third sector organizations with hope for contributions to systems of new public governance and welfare services. This study is based on a survey to the local authorities in Sweden and aims to analyze how collaboration between public and third sector organizations occurs at the local level. A special focus for the study is idea-driven public partnerships (IOPs). The results indicate that collaboration mainly occurs outside of the core fields of welfare and also that the national level agreements set standards to be used in especially the larger local authorities who are more in need of formalized policies to handle the local relations. The institutionalized collaborative relations are diverse and mainly meant to promote a thriving third sector for its democratic values, but there are also certain welfare fields with less local remit such as sports, leisure time activities, and homelessness where NPOs are not crowded out by the public sector. Collaboration with IOPs are more common in larger local authorities and places with a larger proportion of immigrants. [ABSTRACT FROM AUTHOR]

Diagnostic mediastinoscopy is a procedure with well-known serious complications: Hemorrhage, mediastinitis, pneumothorax and recurrent nerve damage. Esophageal perforation is a less known potentially life-threatening complication. Here the case of a young man with an iatrogenic esophageal perforation following a diagnostic mediastinoscopy is presented with a literary review of previously published cases. [ABSTRACT FROM AUTHOR]

Rising energy prices and fuel scarcity are exposing the volatility of our energy system and creating additional pressures to speed up the transition towards renewable energy using distributed production and integrated local grids. This raises the need for local governments to become more actively involved in energy governance by managing the transition of their energy systems and involving local stakeholders. However, the exact role of local authorities in steering this transition remains uncertain as they lack financial and administrative capacities and rely extensively on experimental innovation projects and external stakeholders. This paper therefore asks what functions local authorities exercise to govern the energy transition and under what conditions they can facilitate participation in and scaling of energy innovations. Drawing on the literature on experimental governance, the paper analyses four qualitative case studies of energy innovation projects run by local governments in Sweden, Belgium, the Netherlands, and the UK. It finds that local authorities can actively support innovation projects through funding and knowledge, convene between stakeholder groups, scale innovations through planning and promotional work, and use trial insights to advocate for policy change. However, their ability to exercise these functions is dependent on local stakeholder constellations and domestic policy conditions. [ABSTRACT FROM AUTHOR]

Objective: To improve health conditions among hypogonadal men ≥70 years of age using testosterone undecanoate (TU) injections, progressive strength training, and oral supplements of vitamin D, calcium, and protein. Methods: This study is a 1-year follow-up of a double-blind RCT lasting 20 weeks, including 148 older men ≥70 years old with low testosterone levels and mobility problems. During 52 weeks, 4 groups received either testosterone therapy (TU) or progressive resistance training (Training), both (Combo), or no intervention (Controls). Physiotherapists supported the training groups until week 20, while these participants continued trained on their own during weeks 21 to 52. The main outcome measure was the 30-s chair stand test. Results: The following numbers of participants completed the trial: 20 (Combo), 20 (Controls), 24 (TU), and 14 (Training). When examining 30-s chair stand test performance within each group at baseline, and at weeks 4, 20 and 52, only the Combo group improved (p = 0.001, Friedman Test). Compared to controls, only the Combo group experienced reduced fatigue and tiredness (p < 0.05). Conclusions: Fifty-two weeks of testosterone supplementation combined with progressive resistance training may enhance physical performance, alleviate fatigue, and had no notable detrimental impacts among males aged ≥70 suffering from mobility issues and testosterone insufficiency. Trial registration - Clinical Trials NCT02873559. [ABSTRACT FROM AUTHOR]

To support manufacturing firms in realising the value of Artificial Intelligence (AI), we embarked on a six-year process of research and practice to enhance the popular and widely used CRISP-DM methodology. We extend CRISP-DM into a continuous, active, and iterative life-cycle of AI solutions by adding the phase of 'Operation and Maintenance' as well as embedding a task-based framework for linking tasks to skills. Our key findings relate to the difficult trade-offs and hidden costs of operating and maintaining AI solutions and managing AI drift, as well as ensuring the presence of domain, data science, and data engineering competence throughout the CRISP-DM phases. Further, we show how data engineering is an essential but often neglected part of the AI workflow, provide novel insights into the trajectory of involvement of the three competences, and illustrate how the enhanced CRISP-DM methodology can be used as a management tool in AI projects. [ABSTRACT FROM AUTHOR]

The effect of late-follicular phase progesterone elevation (LFPE) during ovarian stimulation on reproductive outcomes in ART treatment remains controversial, but recent studies indicate lower pregnancy rates with rising progesterone levels. This study aims to investigate the prevalence of late-follicular phase progesterone elevation (LFPE) and possible impact on ongoing pregnancy rate after fresh or frozen blastocyst transfer in a sub-study setting of a randomised controlled trial. A total of 288 women were included (n=137 and n=151 in the fresh transfer and freeze-all group, respectively). Among these 11(3.8%) had a progesterone level ≥1.5 ng/ml, and 20(6.9%) had a progesterone level ≥1.2 ng/ml on trigger day. Spline regression analysis showed no significant effect of late follicular phase progesterone levels on ongoing pregnancy. In the multivariate regression analysis (n = 312) only age, but not progesterone level on trigger day was significantly associated with ongoing pregnancy. In conclusion, in a clinical setting with moderate gonadotrophin stimulation and well-defined trigger and fresh transfer cancellation criteria, the prevalence of women with LFPE ≥1.5 ng/ml was low and did not indicate the clinical value of routine measurement of progesterone in the late follicular phase. [ABSTRACT FROM AUTHOR]

Introduction: This study investigated the health effects of two different architectural glass types: A two-layered low-iron high transmittance glass and a three-layered low energy glass with lower transmittance. The study investigated how these glass types affected daylight conditions in 72 residential apartments, as well as health and satisfaction of the residents. Methods: The study installed high transmittance glass (light transmittance LT:0.82) in 36 apartments and low transmittance (LT:0.74) in 36 identical apartments. The study then analyzed the light transmittance of each glass type in the laboratory and analyzed the indoor environmental quality (IEQ) in eight representative apartments before and after renovation. Self-reported questionnaires were handed out and collected before and after renovation. Results: The results showed that the glass types differed significantly in measured daylight transmittance. The two-layered high transmittance glass transmitted 15% more visual light (380-750 nm) and 20% more light in the spectral range (460-480 nm), stimulating ipRGCs and circadian rhythm, when compared to three-layered low energy glass. In addition, significant differences were observed in the UV-B spectrum (280-315 nm). While two-layered high transmittance glass transmitted UV-B, three-layered low transmittance glass did not. During the 12-month study period, residents in apartments with three-layered low energy glass reported more difficulties sleeping (p=0.05), higher satisfaction with daylight (p=0.03) and higher satisfaction with ventilation (p=0.04). Residents in apartments with three-layered low energy glass experienced fewer days with too cold indoor temperatures (p=0.02), compared to residents with two-layered low-iron glass. The results of energy consumption for heating showed that two-layered low-iron glass reduced the energy consumption by 11.0%, while three-layered low energy glass reduced the energy consumption by 9.4%, compared to the year prior to renovation. Conclusion: The results contribute to a discussion about potential energy savings on one hand and potential non-energy benefits, such as daylight quality, overall health, and total economy/life cycle assessment of the built environment on the other hand. The results suggest further research performed in randomized large-scale studies. [ABSTRACT FROM AUTHOR]

Purpose: The suicidal process contains both observable and non-observable phases, and patients have described the process as characterized by loneliness and darkness. Ambulance clinicians encounter patients in all phases of the suicidal process but little is known on what meaning this encounter has to the patients. The aim of this study was to elucidate meanings of encountering ambulance clinicians while being in a suicidal process. Methods: Data were collected through fifteen individual interviews with eight participants who had lived experiences of encountering ambulance clinicians. Inductive design using phenomenological hermeneutical approach was used. Findings: Patients are impacted by the clinicians, both in how they find their value in the situation, but also in expected trajectory. Three themes; 'Being impacted by representatives of society', 'Being unsure of one´s own value' and 'Regaining hope in moments of togetherness' generated the main theme ´Navigating oneself through the eyes of the other´. Conclusion: The way ambulance clinicians communicate impacts how patients navigate themselves in the ambivalence about living or dying, and the encounter either consolidate a feeling of being a burden, or instil hope of an endurable life. Through conversation, clinicians could support the patients in taking the first steps in the journey of recovery. [ABSTRACT FROM AUTHOR]

Purpose: Restless Legs Syndrome (RLS) is a widespread condition that affects sleep leading to daytime sleepiness, depression, and reduced quality of life. This study aims to determine and describe how patients with RLS experience their everyday life, with a focus on facilitators and barriers related to Maslow's hierarchical theory of human needs. Method: Semi-structured interviews were analysed with qualitative content analysis resulting in facilitators and barriers affecting the fulfilment of the five human needs. Results: Addressing RLS symptoms through medications and a quiet sleep environment fulfils psychological needs. Control over RLS symptoms, engagement in activities, trust in treatments, and social support meet safety and security needs. Social inclusion, close relationships, and meaningful interactions fulfil a sense of belongingness and love needs despite RLS. Competence in managing RLS, effective self-care strategies, confident communication, and trust-building support esteem needs. Finally, comprehensive understanding through person-centred interventions and coping fulfils the self-actualization needs in managing RLS. Conclusion: Holistic and person-centred interventions, including facilitators for the fulfilment of physiological, psychological, and social needs could help healthcare professionals to provide holistic care. [ABSTRACT FROM AUTHOR]

Technology-rich integrated assessment models (IAMs) provide high resolution of the energy-related climate impacts, when exploring prospective climate change mitigation strategies. However, energy system models (ESMs), the core of integrated assessment models, usually ignore industrial linkages other than those related to energy. Furthermore, these models focus on climate change and neglect other environmental pressures. In this manuscript we present an approach for coupling ESMs with multiregional input–output models (MRIOs) based on the Make and Use framework. The main advantage of using the Make and Use framework can be seen in improving both models simultaneously. An exemplary case study is carried out for the energy system model of MESSAGEix and the multi-regional input–output database of EXIOBASE. We further elaborate on the methodology to illustrate the usefulness but also challenges of this approach. Finally, we identify further steps to be carried out toward systematic prospective analyzes. [ABSTRACT FROM AUTHOR]

LTX-315 is an oncolytic peptide that elicits both local and systemic immune responses upon intratumoral injection. In the present pilot trial, we treated patients with metastatic soft tissue sarcoma with the combination of LTX-315 and adoptive T-cell therapy using in vitro expanded tumor-infiltrating lymphocytes. Six heavily pretreated patients were included in the trial and treated with LTX-315 of which four patients proceeded to adoptive T-cell therapy. Overall, the treatment was considered safe with only expected and manageable toxicity. The best overall clinical response was stable disease for 208 days, and in this patient, we detected tumor-reactive T cells in the blood that lasted until disease progression. In three patients T-cell reactivity against in silico predicted neoantigens was demonstrated. Additionally, de novo T-cell clones were generated and expanded in the blood following LTX-315 injections. In conclusion, this pilot study provides proof that it is feasible to combine LTX-315 and adoptive T-cell therapy, and that this treatment can induce systemic immune responses that resulted in stabilization of the disease in sarcoma patients with otherwise progressive disease. Further optimization of the treatment protocol is warranted to increase clinical activity. ClinicalTrials.gov Identifier: NCT03725605 [ABSTRACT FROM AUTHOR]

Cold climate and unique genetic and environmental factors may influence the prevalence of skin diseases in Greenland. However, there is a lack of epidemiological studies on skin diseases in the adult Greenlandic population. To address this unmet need a cross-sectional study, run by dermatologists from Denmark, the UK, and Switzerland estimated the prevalence and clinical manifestations of skin diseases among adults in East Greenland in May 2022. All adults ≥18 years in the town of Tasiilaq were invited, and 295 individuals aged 18–78 years participated (22.5% of the overall adult population in Tasiilaq). Two-hundred and three participants (69%) had visible signs of current skin disease, and among these, 242 cases of dermatoses were identified. The most common skin diseases were hand eczema (22.4%), lichen simplex (9.5%), discoid eczema (7.1%), psoriasis, atopic dermatitis and acne vulgaris (5.8% each). Scabies was the most frequent infectious skin disease (4.4%). No cases of skin cancer were identified. Atopic dermatitis and psoriasis presented with disease that was of limited extent and different from the classical presentations. Skin diseases showed a high prevalence among adults in East Greenland, and some of them were severe. This indicates a noteworthy public health problem that warrants better access to dermatologist support. [ABSTRACT FROM AUTHOR]

In the United States, it is permissible to place an undercover police officer in the jail cell with a suspect. This tactical move is rare and launched only for serious crimes, and it takes place before any charges have been filed. This tactic goes under the name of Perkins operations, from the case ruling that if an individual speaks freely to someone whom they believe is a fellow inmate it is allowed to take advantage of their misplaced trust (Illinois v. Perkins, 1990). In this study, we examine 22 Perkins operations, 60 hours of secretly taped interactions in the cells, and we describe and categorize the different approaches and tactics that the undercover officers used. Based on the descriptive analysis, we conceptualize two pathways to information elicitation (direct and relational) and explore the undercover officers' use of risky interview tactics. The findings suggest that undercover officers use four broader approaches to establish relationships and gather information, and we were able to identify only a few instances of risky tactics in this sample. The relevance of the findings for human intelligence gathering and counterintelligence are discussed. [ABSTRACT FROM AUTHOR]

Objectives: Compare mental health, stress, and well-being in the Swedish population as measured before and during the COVID-19 pandemic. Methods: Repeated cross-sectional design using data measured before (Jan-2019; n = 2791) and during (Oct/Nov-2020; n = 2926) COVID-19 pandemic in Swedish population-representative cohorts. Following constructs were measured: anxiety (Beck Anxiety Inventory), depression (Beck Depression Inventory-II), stress (Perceived Stress Scale-10 items), health-related quality of life (HRQOL[Functional Assessment of Cancer Therapy–General Population]) and self-rated health (SRH) was assessed with a single-item question. Results: When adjusting for age, sex, education, and income there were significantly higher levels of anxiety (M̂ = 9.15 vs. 8.48, p < 0.01) and depression (M̂ = 3.64 vs. 3.30, p = 0.03), lower levels of stress (M̂ = 14.06 vs. 14.91, p < 0.001), but worsened HRQOL (M̂ = 76.40 vs. 77.92, p < 0.01) and SRH (M̂ = 6.91 vs. 7.20, p < 0.001), observed in 2020 compared to 2019. For the negative effects seen in anxiety, depression, HRQOL, and SRH, higher income and education had a protective effect. The decrease in stress was also correlated with higher income. Conclusions: The COVID-19 pandemic led to a small but significant worsening in mental health and well-being in the general Swedish population, where higher socioeconomic status seemed to have a protective effect. [ABSTRACT FROM AUTHOR]

AbstractMonoclonal gammopathy has been reported to interfere with several laboratory measurement results. We investigated potential interference in monoclonal gammopathy on immunoglobulin A (IgA), immunoglobulin G (IgG), and immunoglobulin M (IgM) concentrations using three different routine chemistry instruments: Alinity (Abbott Laboratories), Cobas 8000 (Roche Diagnostics) and Optilite (Binding Site) at the Department of Clinical Biochemistry, Aalborg University Hospital, Denmark. Blood samples collected from 216 patients with known monoclonal gammopathy were analyzed on Alinity, Cobas and Optilite. Diagnoses were ascertained from clinical records. Scatter plots with Passing-Bablok regression were used to investigate associations between concentrations of IgA, IgG and IgM measured with each of the different instruments. Furthermore, comparison of IgG analyses on Alinity, Optilite and Cobas according to monoclonal IgM concentration was explored with Bland-Altman plots. A total of 81 patients were identified with IgM type monoclonal gammopathy and 8 of these patients (10%) had analytical interference as reflected by more than 25% decrease in the level of IgG measured on Alinity as compared to Optilite and Cobas. All blood samples with interference on IgG measurement using Alinity were from patients with lymphoplasmacytic lymphoma/Waldenströms macroglobulinemia and all of them had monoclonal IgM concentrations above 10 g/L. This study identified a source of interference from IgM monoclonal gammopathy on IgG measurement performed using Alinity. The interferences caused falsely low results of IgG which is important to recognize to ensure proper patient management. [ABSTRACT FROM AUTHOR]

An increasing number of studies support the existence of a liquid–liquid critical point (LLCP) in water, implying that under ambient conditions, water is a supercritical mixture of low-density (LDL) and high-density liquid (HDL) structures. Here, we analyse X-ray scattering data in terms of this model. Small-angle X-ray scattering data shows that anomalies are seen at temperatures as high as 360 K. By assuming the local structure in LDL-domains resembles that of the corresponding amorphous solid, we estimate the population of LDL-domains at different temperatures from pair-correlation functions (PCFs). By subtracting the LDL contribution, we isolate the PCF of the HDL component. The temperature-dependent HDL-PCFs show a feature around 4 Å in the supercooled regime, interpreted as interstitials resulting from collapse of the second coordination shell. We define the first coordination shell as neighbours up to 3.3 Å, based on an isosbestic point in the running coordination number. Our analysis shows that the HDL-domains have on average two strongly and two weakly H-bonded neighbours. The LDL population in TIP4P/2005-water is less temperature dependent than in real water, and the HDL component contains more structures with three strongly H-bonded neighbours, leading to a slight overestimation of the first peak of the PCF. [ABSTRACT FROM AUTHOR]

This article examines the therapist experience of their role in providing Stepped Care Cognitive-Behavioral-Therapy for Children after Trauma (SC-CBT-CT), a semi-homebased, parent-led trauma-treatment for children (7–12). Previous research has documented that parent-led, therapist-assisted psychological interventions are an acceptable and effective type of service delivery. Yet, the therapist perspective on their role when providing parent-led treatments has received limited research attention. Attention is therefore directed to the therapist experience of engaging parents, establishing relationships, and working with children's trauma narratives from a distance—through the engagement of parents. The data material consists of semi-structured interviews with SC-CBT-CT therapists. To identify patterns of experience, thought, and viewpoints in the overall data, a stepwise thematic analysis approach was applied. Two core themes emerged: 1) Perceptions of therapeutic control and therapeutic presence when engaging parents to lead their own children through an exposure-based program; 2) Establishment and maintenance of therapeutic alliances with and between parents and children. Although parents are inherently well-positioned to engage with their own children about trauma, the article highlights that treatment adherence, progression, and perseverance is contingent upon systematic therapist guidance, monitoring, and availability for support and problem-solving. [ABSTRACT FROM AUTHOR]

Background: Hospital-acquired pneumonia (HAP) is the most common hospital-acquired infection (HAI). HAP is associated with a high burden of morbidity and mortality, but the diagnosis is difficult to establish and the incidence uncertain. Methods: Patients aged ≥ 18 years hospitalised with radiologically verified non-ventilator hospital acquired pneumonia (NV-HAP) during 2018 were retrospectively identified at Drammen Hospital, a Norwegian general hospital. Infectious Diseases Society of America and the American Thoracic Society's definition of HAP was used. Results: In total 119 cases of NV-HAP were identified among 27,701 admissions. The incidence was 4.3 per 1000 admissions and 1.2 per 1000 patient-days. The median age was 74 years, 63% were male and median Charlson comorbidity index was 5. Coronary heart disease (42%) was the most common comorbidity. Median length of stay was 17.2 days. A blood culture was obtained in 53.8% of patients, while samples from lower airways were seldom obtained (10.9%). In-hospital mortality was 21%, accumulated 30-day mortality was 27.7% and accumulated 1-year mortality was 39.5%. Thirty-day readmission rate among survivors was 39.4%. Conclusion: NV-HAP was present in approximately 1 in 250 hospitalisations, most had multiple comorbidities, and 1 in 5 died in hospital. Although thorough microbiological sampling is recommended when NV-HAP is suspected, our data indicate that airway sampling is infrequent in clinical practice. Our findings underscore the need to develop microbiological diagnostic strategies to achieve targeted antimicrobial treatment that may improve patient outcomes and reduce broad-spectrum antibiotic usage. [ABSTRACT FROM AUTHOR]

Effective carbon taxation is essential for achieving the green transition. However, there is typically stiff opposition to carbon taxation due to adverse equity and other impacts. Hence, it is essential to get a better understanding of which factors, including the use of tax revenue, can increase acceptability. To date, stated preference methods, rarely used to analyse this issue, have focused only on households. We conduct two national choice experiment surveys of Norwegian households and companies. The experiments include carbon taxes on transport fuel and associated emission reductions and different revenue recycling options as attributes. We find that both groups are more accepting of higher tax levels if the revenues finance climate change mitigation efforts. There is some heterogeneity among the groups with regard to using revenues to reduce different dimensions of inequality. Simulating policy scenarios, we find acceptance for the highest carbon tax among both groups when the revenues are used both to finance climate change mitigation efforts and to reduce rural-urban inequalities. This policy option points to an acceptable carbon tax close to an estimated level necessary for reaching the most ambitious climate target set by the Norwegian government. In Norway, further research should explore whether an effective carbon tax level could be achieved with modest efficiency loss, while also alleviating inequality. Key policy insights: Policymakers need a better understanding of the factors, including the use of associated tax revenues, that increase carbon tax acceptability in order to ensure that the tax is high enough to effectively reduce emissions. Simultaneously considering levels of carbon tax acceptance among households and companies could increase the chance of implementing higher, more effective carbon tax levels by identifying mutual interests and points of divergence. Our results show that companies and households concur to a certain extent on the most socially acceptable policy option; earmarking carbon tax revenues to finance climate change mitigation efforts and to reduce rural-urban inequalities. [ABSTRACT FROM AUTHOR]

Childhood cancers are life-threatening diseases that affect the whole family. During the treatment moral situations might arise. Research on how parents perceive moral challenges in childhood cancer care is sparse. The aim was to explore parents' main concern, and how they deal with their main concern, when facing moral challenges in childhood cancer care. Data collection included focus group interviews with parents. The data analysis was carried out according to a classical theory and revealed the core category "Sheltering in chaos". The strategies to handle the main concern included "To bring the child through a life-saving trajectory" by "Balancing control" and "Deliberating of suffering. The consequences included feelings of being "Torn between roles". "Familiarity" emerged as a facilitating factor to handle moral challenges. The results indicate that parents are torn between different roles, and that the care experience is improved through familiarity with the healthcare professionals. The following findings may inspire new ways of offering moral support to families in childhood cancer care. [ABSTRACT FROM AUTHOR]

Because repeated incidents of police violence against unarmed Black people are increasingly visible, as a result of technological advances, there is growing need to understand their potentially traumatic mental health effects for other Black people. This narrative review provides an overview of critical race theory, the stress, appraisal, and coping theory, trauma theory, racial trauma theory, and emotional contagion theory to develop an integrated conceptual framework for understanding and explaining psychosocial processes by which exposure to police violence against unarmed Black people affect the mental health of other Black people at individual and community-levels. Black and Blue, a new conceptual framework, adds to the social science literature on police violence in historically marginalized communities. The conceptualization of this framework suggests implications for practice, policy, and research about police violence and trauma exposure in Black communities. Future research is needed to expand and subsequently test the validity and rigor of the Black and Blue framework. [ABSTRACT FROM AUTHOR]

This pilot-scale study investigates the possibility of using nanofiltration after ultrafiltration to improve lignin recovery from kraft black liquor in a pulp mill. The nanofiltration step can increase overall lignin recovery and provide a clean permeate that could be used in the smelt dissolving tank to produce green liquor. Nanofiltration of kraft black liquor ultrafiltration permeate was performed under two operating conditions: (A) 50 °C at 25 bar, and (B) 70 °C at 15 bar, which led to a lignin retention of 82% and 75%, respectively. Experimental data from condition A were used in a techno-economic analysis where four scenarios were evaluated: (1) a reference scenario, without lignin separation; (2) a scenario in which the ultrafiltration permeate was returned to the evaporators; (3) a scenario including ultrafiltration and nanofiltration, where the nanofiltration permeate was sent to the smelt dissolving tank; and (4) a scenario including ultrafiltration and nanofiltration, where the nanofiltration retentate was sent to the evaporators and the nanofiltration permeate to the smelt dissolving tank. The reduced energy consumption of the evaporators in scenario 4 resulted in an increase in sold electrical power of 19.4 GWh/y, giving a pay-back time on the investment in the nanofiltration plant of 2.2 years. [ABSTRACT FROM AUTHOR]

With increasing numbers of prisoners, research on Swedish prison officers' perceptions of management and support at work is warranted. Previous studies have mainly used a variable-centered approach, identifying several individual and organizational factors that influence prison staff's evaluation of their job. The present study adopted a person-centered approach, exploring the heterogeneity in a Swedish national sample of prison officers. Based on an extensive survey of the quality of prison job, 10 key predictors for overall prison regime evaluation were identified. Following latent class analysis, three distinct subgroups were discerned from the entire sample. Remarkably, a sizable subgroup with a relatively negative evaluation of the prison regime was observed. While most background covariates did not associate with the subgroup membership, prison officers who experienced violent or threatening incidents tended to report a negative evaluation of the prison regime. Intra-organizational social support, communication and loyalty are highlighted as key components of overall regime evaluation. Our findings suggest that enhancing collegial, management, and supervision support and communicative skills may increase prison officers' job satisfaction. Beyond the organizational level of prisons, we also discussed the challenges that the Swedish prison system faces, along with the portrayal by social media of a violence-dominated environment. [ABSTRACT FROM AUTHOR]

Background: Play can help paediatric patients cope with hospitalisation. Education on the use of play for healthcare professionals (HCPs) is lacking, with playful interactions often occurring unsystematically without formal training. This scoping review systematically describe the frameworks, design, and evaluation methods of educational programmes for HCPs on the use of play in paediatric clinical practice. Methods: We conducted the scoping review by searching nine databases for white literature and websites for grey literature. Two reviewers independently screened titles/abstracts and reviewed full texts. Kirkpatrick's evaluation model was applied to report the evaluation methods of educational programmes. Results: After identifying 16534 white and 955 grey items we included twenty articles but no grey literature. The educational programmes vaguely defined play for procedural and normalising purposes and mostly targeted mono-professional groups, mainly nurses. The evaluation methods identified in the articles were reported in accordance with Kirkpatrick levels 1: reaction (n = 13); 2a: attitude (n = 7); 2b: knowledge (n = 3); 3: behaviour (n = 6); 4a: organisational practice (n = 1) and 4b: patient outcomes (n = 4). Conclusion: The few educational programmes available on the use of play for HCPs are not uniformly described. Future educational programmes would benefit from integrating the needs of HCPs, patients and parents, and using a theoretical framework and systematic evaluation. [ABSTRACT FROM AUTHOR]

Background: Spinal pain in children and adolescents is common and limits their daily In the Region of Southern Denmark, the Spine Center of Southern Denmark provides care for patients with spinal pain who have not improved through primary care. Limited information exists about children and adolescents seen in medical hospital settings. Method: A retrospective review of clinical encounters with patients under the age of 18 from January 2018 to December 2021. Data were collected on demographic factors, clinical characteristics, functional impairments, and diagnostic codes (International Classification of Disease (ICD-10)). Results: Patients ranged from age 9 to 17, and 60% were female. Most were in primary school, and physically active. The primary complaint was persistent ongoing lumbar pain without nerve root affection and of non-traumatic origin. Mostly used ICD-10 codes were categorized as non-specific spinal pain. However, one-fourth had specific diagnoses, includingdisk herniation, spondylolysis and -listhese, specific spinal-related and non-spinal complaints. Advanced imaging was common, both before referral or at the initial assessment. Approximately 20% were referred to other hospital departments, mostly pediatric departments. Functional impairment varied widely. Conclusion: Children and adolescents with spinal pain seen at an outpatient spine center predominantly received non-specific pain diagnoses. However, approximately 20% did have a specific cause for their pain. Patients demonstrated high variability in how much their pain affected them; a large proportion had received imaging either before the initial assessment or with a referral from the spine center. [ABSTRACT FROM AUTHOR]

The question of what is the right amount of managerial autonomy has been widely debated. The new public management movement argues that increased autonomy will be used by managers to improve organizational performance. Skeptics argue that managers in the public sector are likely to shy away from using increased autonomy. To bring the literature forward we theorize the link between reforms awarding managers increased autonomy and subsequent organizational performance outcomes. We identify four steps in this causal chain, which are easily conflated. We demonstrate empirically the potential of focusing on the intermediary mechanisms of increasing managerial autonomy. A large-scale municipal amalgamation reform in Denmark provides a unique opportunity to study the immediate impacts of changes in managerial autonomy in public schools. The results indicate that granting public managers more freedom has intermediary effects on factors such as hiring patterns and organizational demographics. [ABSTRACT FROM AUTHOR]