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Purpose: Expressing a desire for surgery already before participating in first-line osteoarthritis (OA) interventions (patient education and exercise therapy) has in previous research shown to contribute to poorer outcomes from the interventions, yet we lack knowledge about patients’ views of health care and self-management of osteoarthritis (OA). This study aimed to explore and describe patients’ perspective of health care and self-management of OA among those expressing a desire for surgery before participating in first-line OA intervention. Methods: Sixteen patients with hip or knee OA who had expressed a desire to undergo surgery before they participated in a standardized first-line OA intervention program in primary health care in Sweden were included in the study. We used individual semi-structured interviews to collect data, which were then analysed using inductive qualitative content analysis to identify, describe, and categorize patterns detected within the data. Results: The analysis resulted in one main theme “A multifaceted picture of needs, expectations and individual choices”, which illustrates how the informants expressed a broad range of topics in their perspectives on health care and self-management of OA. Five categories, with its subcategories were identified: (1) lacking control and needing support, consisting of the perspectives; limiting activities due to pain, having difficulties in identifying patterns and finding strategies, feeling frustration and stress, seeing OA as an inevitable deterioration and needing help and being insecure (2) standing alone in an unsupportive environment, comprised of the two subcategories; being left alone and not being taken seriously (3) being passive, which included the subcategories; unstructured self-management, getting used to and adapting to the situation, limited retrieval of information and knowledge and passive health care consumer. (4) having expectations which was divided into the following subcategori

The integration of CO2 capture with biomass-fired power plants has attracted much attention due to its ability to achieve negative emissions. Waste-fired combined heat and power (CHP) plants with CO2 capture, on the other hand, has received little attention, and their potential remains unclear. This study aims to identify the possible range of the amount of captured CO2 and investigate the impact of CO2 capture on the performance of waste-fired CHP plants. Since heat is the primary product of CHP plants, it is important to maintain heat production unchanged when CO2 capture is integrated. Based on this prerequisite, two operating strategies (OS) were investigated, which correspond to the upper and lower boundaries of CO2 capture: OS1 was to maximize the amount of captured CO2 while keeping the heat supplied to the district heating (DH) network unchanged; and OS2 was to maximize CO2 capture while keeping both supplied heat and generated electricity unchanged. To obtain more accurate results regarding the CO2 capture, a dynamic model developed in Aspen Hysys™ was utilized to simulate monoethanolamine (MEA) based chemical absorption for CO2 capture. By using real dynamic data from a waste-fired CHP plant, dynamic simulation results showed that the highest amount of captured CO2, which was achieved in OS1, was 401 kton/year, corresponding to a CO2 capture ratio of 82%; while the lowest amount of captured CO2, which was achieved in OS2, was 99 kton/year, corresponding to a CO2 capture ratio of 20%. For OS1, the electricity generation was substantially decreased by 61%. When determining the negative emission, the emission resulted from the share of fossil fuel in the waste needs to be excluded. For the studied CHP plant, the fossil share was around 45%. As a result, only OS1 can achieve the negative emission, which was 181 kton/year; while OS2 still led to positive emissions. Compared to the plant without CO2 capture, the carbon intensity of heat was reduced from 0.405 to

Osteoporosis is an age-dependent serious skeletal disease that leads to great suffering for the patient and high social costs, especially as the global population reaches higher age. Decreasing estrogen levels after menopause result in a substantial bone loss and increased fracture risk, whereas estrogen treatment improves bone mass in women. RSPO3, a secreted protein that modulates WNT signaling, increases trabecular bone mass and strength in the vertebrae of mice, and is associated with trabecular density and risk of distal forearm fractures in humans. The aim of the present study was to determine if RSPO3 is involved in the bone-sparing effect of estrogens. We first observed that estradiol (E2) treatment increases RSPO3 expression in bone of ovariectomized (OVX) mice, supporting a possible role of RSPO3 in the bone-sparing effect of estrogens. As RSPO3 is mainly expressed by osteoblasts in the bone, we used a mouse model devoid of osteoblast-derived RSPO3 (Runx2-creRspo3flox/flox mice) to determine if RSPO3 is required for the bone-sparing effect of E2 in OVX mice. We confirmed that osteoblast-specific RSPO3 inactivation results in a substantial reduction in trabecular bone mass and strength in the vertebrae. However, E2 increased vertebral trabecular bone mass and strength similarly in mice devoid of osteoblast-derived RSPO3 and control mice. Unexpectedly, osteoblast-derived RSPO3 was needed for the full estrogenic response on cortical bone thickness. In conclusion, although osteoblast-derived RSPO3 is a crucial regulator of vertebral trabecular bone, it is required for a full estrogenic effect on cortical, but not trabecular, bone in OVX mice. Thus, estradiol and RSPO3 regulate vertebral trabecular bone mass independent of each other.

Metastasis reflects both the inherent properties of tumor cells and the response of the stroma to the presence of the tumor. Vascular barrier properties, either due to endothelial cell (EC) or pericyte function, play an important role in metastasis in addition to the contribution of the immune system. The Shb gene encodes the Src homology-2 domain protein B that operates downstream of tyrosine kinases in both vascular and immune cells. We have investigated E0771.lmb breast carcinoma metastasis in mice with conditional deletion of the Shb gene using the Cdh5-CreERt2 transgene, resulting in inactivation of the Shb-gene in EC and some hematopoietic cell populations. Lung metastasis from orthotopic tumors, tumor vascular and immune cell characteristics, and immune cell gene expression profiles were determined. We found no increase in vascular leakage that could explain the observed increase in metastasis upon the loss of Shb expression. Instead, Shb deficiency in EC promoted the recruitment of monocytic/macrophagic myeloid-derived suppressor cells (mMDSC), an immune cell type that confers a suppressive immune response, thus enhancing lung metastasis. An MDSC-promoting cytokine/chemokine profile was simultaneously observed in tumors grown in mice with EC-specific Shb deficiency, providing an explanation for the expanded mMDSC population. The results demonstrate an intricate interplay between tumor EC and immune cells that pivots between pro-tumoral and anti-tumoral properties, depending on relevant genetic and/or environmental factors operating in the microenvironment.

Aims: Labour market marginalisation (LMM), i.e. severe problems in finding and keeping a job, is common among young adults with attention-deficit/hyperactivity disorder (ADHD). This study aimed to disentangle the extent of LMM as well as the heterogeneity in patterns of LMM among young adults with ADHD and what characterises those belonging to these distinct trajectories of LMM. Methods: This population-based register study investigated all 6287 young adults, aged 22-29 years, who had their first primary or secondary diagnosis of ADHD in Sweden between 2006 and 2011. Group-based trajectory (GBT) models were used to estimate trajectories of LMM, conceptualised as both unemployment and work disability, 3 years before and 5 years after the year of an incident diagnosis of ADHD. Odds ratios (ORs) with 95% confidence intervals (CIs) for the association between individual characteristics and the trajectory groups of LMM were estimated by multinomial logistic regression. Results: Six distinct trajectories of LMM were found: 'increasing high' (21% belonged to this trajectory group) with high levels of LMM throughout the study period, 'rapidly increasing' (19%), 'moderately increasing' (21%), 'constant low' (12%) with low levels of LMM throughout the study period, 'moderately decreasing' (14%) and finally 'fluctuating' (13%), following a reversed u-shaped curve. Individuals with the following characteristics had an increased probability of belonging to trajectory groups of increasing LMM: low educational level (moderately increasing: OR: 1.4; CI: 1.2-1.8, rapidly increasing: OR: 1.7; CI: 1.3-2.1, increasing high: OR: 2.9; CI: 2.3-3.6), single parents (moderately increasing: OR: 1.6; CI: 1.1-2.4, rapidly increasing: OR: 2.0; CI: 1.3-3.0), those born outside the European Union/the Nordic countries (rapidly increasing: OR: 1.7; CI: 1.1-2.5, increasing high: OR: 2.1; CI: 1.4-3.1), persons living in small cities/villages (moderately increasing: OR: 2.4; CI: 1.9-3.0, rapidly incre

With increasing age of the population, countries across the globe are facing a substantial increase in osteoporotic fractures. Genetic association signals for fractures have been reported at the RSPO3 locus, but the causal gene and the underlying mechanism are unknown. Here we show that the fracture reducing allele at the RSPO3 locus associate with increased RSPO3 expression both at the mRNA and protein levels, increased trabecular bone mineral density and reduced risk mainly of distal forearm fractures in humans. We also demonstrate that RSPO3 is expressed in osteoprogenitor cells and osteoblasts and that osteoblast-derived RSPO3 is the principal source of RSPO3 in bone and an important regulator of vertebral trabecular bone mass and bone strength in adult mice. Mechanistic studies revealed that RSPO3 in a cell-autonomous manner increases osteoblast proliferation and differentiation. In conclusion, RSPO3 regulates vertebral trabecular bone mass and bone strength in mice and fracture risk in humans.

Obesity has previously been thought to protect bone since high body weight and body mass index are associated with high bone mass. However, some more recent studies suggest that increased adiposity negatively impacts bone mass. Here, we aimed to test whether acute loss of adipose tissue, via adipocyte apoptosis, alters bone mass in age-related obese mice. Adipocyte apoptosis was induced in obese male FAT-ATTAC mice through AP20187 dimerizer-mediated activation of caspase 8 selectively in adipocytes. In a short-term experiment, dimerizer was administered to 5.5 month-old mice that were terminated 2 weeks later. At termination, the total fat mass weighed 58% less in dimerizer-treated mice compared with vehicle-treated controls, but bone mass did not differ. To allow for the detection of long-term effects, we used 9-month-old mice that were terminated six weeks after dimerizer administration. In this experiment, the total fat mass weighed less (− 68%) in the dimerizer-treated mice than in the controls, yet neither bone mass nor biomechanical properties differed between groups. Our findings show that adipose tissue loss, despite the reduced mechanical loading, does not affect bone in age-related obese mice. Future studies are needed to test whether adipose tissue loss is beneficial during more severe obesity.

Even though all capture technologies developed for capturing CO2 from the utilization of fossil fuels can be applied to capture CO2 from the utilization of biomass, due to the obvious different properties, the performance can also be quite different. This work investigates the differences when using chemical absorption to capture CO2 from the combustion of recycled woods and coal, in order to provide suggestions on the integration of CO2 capture in the utilization of bioenergy and promote the application of bioenergy with CO2 capture and storage (BECCS). Two solvents, Monoethanolamine (MEA) and hot potassium carbonate (HPC), have been included. The results show that the flue gas (FG) from the combustion of recycled wood (RW) has a higher CO2 content, but lower O2, SOx and NOx content compared to the coal fired FG. In comparison to the coal fired FG, capturing CO2 from the RW fired FG requires less energy for both solvents, due to its higher CO2 content. The estimated oxidative and acid gas degradations are higher for FFCCS compared to BECCS, due to the higher O2, SOx and NOx contents in coal fired FG compared to those in the RW fired FG. For HPC process, FG compression work account for the largest part of the total energy consumption. Even though, the reboiler duty of the HPC process is lower than that of the MEA process, the total energy penalty is higher.

BACKGROUND: The Promoting Action on Research Implementation in Health Services (PARIHS) framework was developed two decades ago and conceptualizes successful implementation (SI) as a function (f) of the evidence (E) nature and type, context (C) quality, and the facilitation (F), [SI = f (E,C,F)]. Despite a growing number of citations of theoretical frameworks including PARIHS, details of how theoretical frameworks are used remains largely unknown. This review aimed to enhance the understanding of the breadth and depth of the use of the PARIHS framework. METHODS: This citation analysis commenced from four core articles representing the key stages of the framework's development. The citation search was performed in Web of Science and Scopus. After exclusion, we undertook an initial assessment aimed to identify articles using PARIHS and not only referencing any of the core articles. To assess this, all articles were read in full. Further data extraction included capturing information about where (country/countries and setting/s) PARIHS had been used, as well as categorizing how the framework was applied. Also, strengths and weaknesses, as well as efforts to validate the framework, were explored in detail. RESULTS: The citation search yielded 1613 articles. After applying exclusion criteria, 1475 articles were read in full, and the initial assessment yielded a total of 367 articles reported to have used the PARIHS framework. These articles were included for data extraction. The framework had been used in a variety of settings and in both high-, middle-, and low-income countries. With regard to types of use, 32% used PARIHS in planning and delivering an intervention, 50% in data analysis, 55% in the evaluation of study findings, and/or 37% in any other way. Further analysis showed that its actual application was frequently partial and generally not well elaborated. CONCLUSIONS: In line with previous citation analysis of the use of theoretical frameworks in implementation

Background: Improving use of anticoagulants in atrial fibrillation (AF) patients in primary care has proved challenging. Anticoagulants are often prescribed by primary care physicians in the long term. Suboptimal anticoagulant use may be partly due to physicians' non-prescribing. One potential way of targeting physician prescribing behavior is “audit & feedback”. The documented use of audit and feedback in research aimed at increasing use of anticoagulants in primary care is limited. The objective was to test if an audit & feedback intervention aimed at directors in primary care centers could increase the use of anticoagulants in patients with AF. Methods: Database generated quality reports with primary care center specific data on recommended medication use in their patients with previous stroke or atrial fibrillation were sent to intervention centers. Results: 94 centers received the intervention, 102 centers were controls. 31,477 patients in total were included. Use of anticoagulants in all primary care centers increased from 76% before to 82% after the intervention. Patients in intervention centers were more likely than patients in control centers to use anticoagulants after the intervention, adjusted odds ratio increasing slightly from 1.04 (95%, CI, 0.98–1.10) before to 1.08 (95% CI, 1.02–1.15) after the intervention. Conclusions: An audit & feedback intervention with quality reports in primary care had only a small effect on anticoagulant use in patients with AF. A combined and more complex intervention may have a greater effect in improving anticoagulation use., Funding Agencies:Stockholm Drug and Therapeutics CommitteeBLIWAStrokeRiksförbundetCapio Research Foundation