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AIMS - Starting from the notion of the Finnish “non-medical approach” in the handling of alcohol and drug problems, this article analyses expressions of the medicalisation of drug problems and drug users in Finnish social work and specialised substance abuse treatment. The article focuses on the first drug wave, in the 1960s, and the second, at the end of the 1990s. DESIGN - The data consists of all texts on illegal drugs found in the years 1968-1972 and 1997-2001 in two leading journals of social work, one from the social care and social service field, the other issued by the key provider of specialist substance abuse treatment. The texts were systematically analysed (author(s), problem descriptions, suggested solutions, and words used for the problem and the drug user). RESULTS - In both periods, we found in the journals a social perspective on drugs and drug problems. There is more emphasis on prevention and more optimism on the possibilities of prevention in the first than in the second period. During the first period the call for medicine or medical solutions are few and the medical voices rare. Medical expertise gets more space in both journals in the second period. The predominant understanding of the problem changes from drugs as part of a new youth culture, possibly an epidemic in the first period, to a dependence/ addiction in the second. The description of the user shifts from a young person to a (marginalised) dependent or addict. The proposed solutions in the 1960s are (youth focused) social policy and social change, while the 1990s solutions highlight refined treatment and more specific interventions. The society seems difficult to change, and so do the established institutions. CONCLUSIONS - The medicalisation of the Finnish perspective on drugs in the 1990s is expressed through a narrowing of perspective on illegal drugs as social problems. While present, the social perspective is impotent.

Abstract Although digital breast tomosynthesis has higher sensitivity than digital mammography and at least as high specificity, digital mammography remains the most common method for conducting mammographic screening. At the same time, mammography systems are now delivered “DBT-ready” and can be used for either digital mammography or digital breast tomosynthesis. In this paper, we ask whether it is ethically permissible to use such equipment for digital mammography, given its lower sensitivity. We argue it is not, and that clinics are ethically required to use their DBT-ready equipment to screen with digital breast tomosynthesis whenever this is practically possible. Our argument relies on a comparison between digital breast tomosynthesis and a hypothesized improvement in the image quality of digital mammography. Critical relevance statement Women may lose out on the benefits of screening with digital breast tomosynthesis when DBT-ready equipment is used to screen with digital mammography; we argue that this practice is ethically problematic. Key Points Digital breast tomosynthesis finds more cases of breast cancer than digital mammography. Mammography equipment can often be used to screen with both digital breast tomosynthesis and digital mammography. When they can, clinics are ethically required to use existing equipment to screen with digital breast tomosynthesis instead of digital mammography.

PurposeThis case study examined long-term cognitive deficits after botulism. Only a very limited number of studies on post-acute cognitive impairment after botulism exist, and data are incomplete.MethodA semi-structured interview on long-term cognitive consequences of botulism was conducted for six family members, who contracted the infection after ingestion of lumpfish-roe 2.5 years ago. Two of the family members underwent neuropsychological assessment of attention, memory, and executive functioning as well.FindingResults of the semi-structured interviews showed individual subjective cognitive deficits across processing speed, attention, concentration, short-and long-term memory, and executive functioning. Test results showed mild cognitive impairment in attention and mild–moderate deficits in executive functioning.ConclusionThese results support previous findings that patients of various infectious diseases may suffer unspecific long-term neurocognitive deficits. Assessment and initiation of relevant post-acute treatment and rehabilitation might be central to prognosis, functional ability, and psychological well-being.

Abstract Background Partial nitritation-anammox (PNA) is a biological nitrogen removal process commonly used in wastewater treatment plants for the treatment of warm and nitrogen-rich sludge liquor from anaerobic digestion, often referred to as sidestream wastewater. In these systems, biofilms are frequently used to retain biomass with aerobic ammonia-oxidizing bacteria (AOB) and anammox bacteria, which together convert ammonium to nitrogen gas. Little is known about how these biofilm communities develop, and whether knowledge about the assembly of biofilms in natural communities can be applied to PNA biofilms. Results We followed the start-up of a full-scale PNA moving bed biofilm reactor for 175 days using shotgun metagenomics. Environmental filtering likely restricted initial biofilm colonization, resulting in low phylogenetic diversity, with the initial microbial community comprised mainly of Proteobacteria. Facilitative priority effects allowed further biofilm colonization, with the growth of initial aerobic colonizers promoting the arrival and growth of anaerobic taxa like methanogens and anammox bacteria. Among the early colonizers were known ‘oligotrophic’ ammonia oxidizers including comammox Nitrospira and Nitrosomonas cluster 6a AOB. Increasing the nitrogen load in the bioreactor allowed colonization by ‘copiotrophic’ Nitrosomonas cluster 7 AOB and resulted in the exclusion of the initial ammonia- and nitrite oxidizers. Conclusions We show that complex dynamic processes occur in PNA microbial communities before a stable bioreactor process is achieved. The results of this study not only contribute to our knowledge about biofilm assembly and PNA bioreactor start-up but could also help guide strategies for the successful implementation of PNA bioreactors. Video Abstract

The increase in Earth observations from space in recent years supports improved quantification of carbon storage by terrestrial vegetation and fosters studies that relate satellite measurements to biomass retrieval algorithms. However, satellite observations are only indirectly related to the carbon stored by vegetation. While ground surveys provide biomass stock measurements to act as reference for training the models, they are sparsely distributed. Here, we addressed this problem by designing an algorithm that harnesses the interplay of satellite observations, modeling frameworks and field measurements, and generated global estimates of above-ground biomass (AGB) density that meet the requirements of the scientific community in terms of accuracy, spatial and temporal resolution. The design was adapted to the amount, type and spatial distribution of satellite data available around the year 2020. The retrieval algorithm estimated AGB annually by merging estimates derived from C- and L-band Synthetic Aperture Radar (SAR) backscatter observations with a Water Cloud type of model and does not rely on AGB reference data at the same spatial scale as the SAR data. This model is integrated with functions relating to forest structural variables that were trained on spaceborne LiDAR observations and sub-national AGB statistics. The yearly estimates of AGB were successively harmonized using a cost function that minimizes spurious fluctuations arising from the moderate-to-weak sensitivity of the SAR backscatter to AGB. The spatial distribution of the AGB estimates was correctly reproduced when the retrieval model was correctly set. Over-predictions occasionally occurred in the low AGB range (300 Mg ha−1). These errors were a consequence of sometimes too strong generalizations made within the modeling framework to allow reliable retrieval worldwide at the expense of accuracy. The precision of the estimates was mostly between 30% and 80% relative to the estimated value. While the framework is well founded, it could be improved by incorporating additional satellite observations that capture structural properties of vegetation (e.g., from SAR interferometry, low-frequency SAR, or high-resolution observations), a dense network of regularly monitored high-quality forest biomass reference sites, and spatially more detailed characterization of all model parameters estimates to better reflect regional differences.

It has been argued that digital platform firms leverage their position at spatial bottlenecks in such a fashion so as to allow operations in local labour markets while at the same time insulating themselves from the regulatory provisions that govern those local markets. This is not necessarily a stable condition, but as long as platform firms exert power, they may shift the social relationships that platforms embody in their favour: domination trumps mutuality and autonomy. However, this does not have to be so. Depending on the context, opportunities for breaking out of this mould exist. Specifically, we focus on the institutional context provided by coordinated market economies to argue that, depending on pre-existing forms of cooperation, platforms can be designed and applied in a manner that enables the building and maintenance of trust through an emphasis on mutuality and autonomy rather than inevitably drifting towards the pole of domination. Using the example of the hospitality industry and focusing on training and certification in geographically fragmented labour markets, we set out to explore the possible role of the institutional setting in shaping platform use as recruitment needs are to be resolved.

Motivated by earlier research highlighting Swedish teachers' beliefs that the setting of homework compromises deep-seated principles of educational equity, this paper presents an exploratory study of Swedish parents' perspectives on homework in their year-one children's learning. Twenty-five parents, drawn from three demographically different schools in the Stockholm region, participated in semi-structured interviews. The interviews, broadly focused on how parents support their children's learning and including questions about homework in general and mathematics homework in particular, were transcribed and data subjected to a constant comparison analytical process. This yielded four broad themes, highlighting considerable variation in how parents perceive the relationship between homework and educational equity. First, all parents spoke appreciatively of their children receiving reading homework and, in so doing, indicated a collective construal that reading homework is neither homework nor a threat to equity. Second, four parents, despite their enthusiasm for reading homework, opposed the setting of any homework due to its potential compromise of family life. Third, seven parents indicated that they would appreciate mathematics homework where it were not a threat to equity. Finally, fourteen parents, despite acknowledging homework's potential compromise to equity, were unequivocally in favour of mathematics homework being set to their children.

The ability to accurately map tropical wetland dynamics can significantly contribute to a number of areas, including food and water security, protection and enhancement of ecosystems, flood hazard management, and our understanding of natural greenhouse gas emissions. Yet currently, there is not a tractable solution for mapping tropical forested wetlands at high spatial and temporal resolutions at a regional scale. This means that we lack accurate and up-to-date information about some of the world’s most significant wetlands, including the Amazon Basin. RadWet-L is an automated machine-learning classification technique for the mapping of both inundated forests and open water using ALOS ScanSAR data. We applied and validated RadWet-L for the Amazon Basin. The proposed method is computationally light and transferable across the range of landscape types in the Amazon Basin allowing, for the first time, regional inundation maps to be produced every 42 days at 50 m resolution over the period 2019–2023. Time series estimates of inundation extent from RadWet-L were significantly correlated with NASA-GFZ GRACE-FO water thickness (Pearson’s r = 0.96, p < 0.01), USDA G-REALM lake hight (Pearson’s r between 0.63 and 0.91, p < 0.01), and in situ river stage measurements (Pearson’s r between 0.78 and 0.94, p < 0.01). Additionally, we conducted an evaluation of 11,162 points against the input ScanSAR data revealing spatial and temporal consistency in the approach (F1 score = 0.97). Serial classifications of ALOS-2 PALSAR-2 ScanSAR data by RadWet-L can provide unique insights into the spatio-temporal inundation dynamics within the Amazon Basin. Understanding these dynamics can inform policy in the sustainable use of these wetlands, as well as the impacts of inundation dynamics on biodiversity and greenhouse gas budgets.

Abstract Cumulative exposure to psychosocial adversity at an early age has been shown to be a risk factor for attention-deficit hyperactivity disorder (ADHD) and autism that often co-occur. However, it is not clear if this association reflects a causal effect or familial confounding. We aimed to assess whether cumulative psychosocial adversity in the family increases the risk for ADHD and autism in offspring while accounting for unmeasured familial confounding. We used a population-based cohort of 1,877,901 individuals born in Sweden between 1990 and 2009. Participants were followed from the age of 3 until 2013, with a median follow up time of 13.8 years. We created a cumulative index based on 7 psychosocial adversity factors. We used Cox regression to estimate the hazard ratios (HRs) relating neurodevelopmental conditions to cumulative psychosocial adversity. To address familial confounding, the analyses were repeated in groups of relatives of different kinship: siblings and half-siblings and cousins. A dose-response relationship was observed between cumulative exposure to psychosocial adversity and ADHD at a general population level (covariate adjusted HRs (aHRs) with 95% confidence intervals ranged from 1.55 [one adversity; 1.53–1.58] to 2.65 [ ≥ 4 adversities; 1.98–3.54]). No clear dose-response relation was seen for autism (aHRs ranged from 1.04 [.59–1.84] to 1.37 [1.30–1.45]). HRs of ADHD and autism decreased with increasing level of kinship in the analysis of relatives. Cumulative exposure to psychosocial adversity was associated with both ADHD and autism in the general population, these associations were partly explained by unmeasured familial confounding between relatives. This highlights the need for using family-based designs in studies of psychosocial adversity and ADHD and autism.

Abstract Monochloramine is used to regulate microbial regrowth in drinking water distribution systems (DWDS) but produces carcinogenic disinfection byproducts and constitutes a source of energy for nitrifying bacteria. This study followed biofilm-dispersed microbial communities of a full-scale DWDS distributing ultrafiltered water over three years, before and after removal of monochloramine. Communities were described using flow cytometry and amplicon sequencing, including full-length 16S rRNA gene sequencing. Removal of monochloramine increased total cell counts by up to 440%. Increased abundance of heterotrophic bacteria was followed by emergence of the predatory bacteria Bdellovibrio, and a community potentially metabolizing small organic compounds replaced the nitrifying core community. No increased abundance of Mycobacterium or Legionella was observed. Co-occurrence analysis identified a network of Nitrosomonas, Nitrospira, Sphingomonas and Hyphomicrobium, suggesting that monochloramine supported this biofilm community. While some species expanded into the changed niche, no immediate biological risk to consumers was indicated within the DWDS.

Plants’ response to single environmental changes can be highly distinct from the response to multiple changes. The effects of a single environmental factor on wheat growth have been well documented. However, the interactive influences of multiple factors on different wheat genotypes need further investigation. Here, treatments of three important growth factors, namely water regime, temperature, and CO2 concentration ([CO2]), were applied to compare the response of two wheat genotypes with different heat sensitivities. The temperature response curves showed that both genotypes showed more variations at elevated [CO2] (e[CO2]) than ambient [CO2] (a[CO2]) when the plants were treated under different water regimes and temperatures. This corresponded to the results of water use efficiency at the leaf level. At e[CO2], heat-tolerant ‘Gladius’ showed a higher net photosynthetic rate (Pn), while heat-susceptible ‘Paragon’ had a lower Pn at reduced water, as compared with full water availability. The temperature optimum for photosynthesis in wheat was increased when the growth temperature was high, while the leaf carbon/nitrogen was increased via a reduced water regime. Generally, water regime, temperature and [CO2] have significant interactive effects on both wheat genotypes. Two wheat genotypes showed different physiological responses to different combinations of environmental factors. Our investigation concerning the interactions of multi-environmental factors on wheat will benefit the future wheat climate-response study.

Lilli Zickerman (1858–1949) was an entrepreneur who took part in organising the Swedish handicraft associations in the late 19th century. She was also a pioneer in the archives and active in the feminine sphere of textile handicraft. From 1914–1931 she conducted a huge inventory called Swedish Folk Textile Art that consists of more than 24,000 photographs and descriptions of vernacular textiles and manuscripts for a planned series of books and films. By mapping textile handicrafts, she aimed to preserve traditional textile craft techniques to inspire their continued production. Her intention was to create an archive for the inspiration and education of future textile artists. The inventory has had effects that are still apparent today; this paper illuminates the ways in which Zickerman’s ideas about textile handicrafts have contributed to the continuation of Swedish cultural heritage and how it has become an authorised heritage discourse that continues to guide the scholars and practitioners involved in the history of textiles and their production. Here, we will present the first article within an ongoing project on Swedish Folk Textile Art and how it was conducted. We will contextualise the ideas and knowledge that it contains by focusing on Zickerman’s intention to preserve the past to serve the future. From a critical craft perspective, we will discuss geographical mapping as a method for investigating the invent­tory; the inclusion and exclusion of geographical areas, textile techniques, materials and people; the ideas and the knowledge that are expressed in the inventory; and the networks that it created. By doing so, we aim to highlight the connections between people, between people and materials, and between history and the current day.

With global climate change, the frequency and intensity of waterlogging events are increasing due to frequent and heavy precipitation. Little is known however about the response of plants to repeated waterlogging stress events. The aim is to clarify physiological regulation mechanisms of tomato plants under repeated waterlogging stress, and whether Trichoderma harzianum can alleviate waterlogging injury. We identified two genotypes of tomato, ‘MIX-002’ and ‘LA4440’, as waterlogging tolerant and sensitive genotypes, respectively, based on plant biomass accumulation. The two tomato genotypes were subjected to a waterlogging priming treatment for 2 days (excess water for 1 cm above substrate surface) followed by a recovery stage for 2 days, and then a second waterlogging stress for 5 days (excess water for 1 cm above substrate surface) followed by a second recovery stage for 3 days. Leaf physiological, plant growth parameters, and the expression of five key genes were investigated. We found that the two genotypes responded differently to waterlogging priming and stress in terms of photosynthesis, reactive oxygen species (ROS), and osmotic regulatory mechanisms. Waterlogging stress significantly increased H2O2 content of ‘MIX-002’, while that of ‘LA4440’ had no significant change. Under waterlogging stress, photosynthesis of the two genotypes treated with waterlogging priming returned to the control level. However, Trichoderma harzianum treatment during the second recovery stage did not show positive mitigative effects. The plants of ‘LA4440’ with priming showed lower peroxidase (POD) activity and proline content but higher H2O2 content than that without priming under waterlogging stress. Under waterlogging stress with priming as compared to without priming, SODCC2 was downregulated in two tomatoes, and AGR2 and X92888 were upregulated in ‘MIX-002’ but downregulated in ‘LA4440’. Overall, the two tomato genotypes exhibited distinct photosynthetic, ROS and osmotic regulatory mechanisms responding to the waterlogging stress. Waterlogging priming can induce stress memory by adjusting stomatal conductance, sustaining ROS homeostasis, regulating osmotic regulatory substances and key gene expressions mediated by H2O2, and thus alleviate the damage on tomato photosynthesis when waterlogging reoccurred.

Abstract Background Premature ventricular contractions (PVCs) are a common form of arrhythmia associated with an unfavorable prognosis in patients with structural heart disease. It is unclear whether PVCs site of origin and QRS‐width has a prognostic significance in patients without structural heart disease. The aim of this study was to assess the prognostic importance of PVCs morphology and duration in this patient group. Methods We included 511 consecutive patients without a history of previous heart disease. They were examined with echocardiography and exercise test with normal findings. We categorized the PVCs from a 12 lead ECG according to morphology and width of the QRS‐complex and analyzed the outcome in terms of a composite endpoint of total mortality and cardiovascular morbidity. Results During a median follow‐up time of 5.3 years, 19 patients (3.5%) died and 61 (11.3%) met the composite outcome. Patients with PVCs originating from the outflow tracts had a significantly lower risk for the composite outcome compared to patients with non‐OT‐PVCs. Similarly, patients with PVC originating from the right ventricle had a better outcome than patients with left ventricular PCVs. No difference in outcome depending on QRS‐width during PVCs was noticed. Conclusion In our cohort of consecutively included PVC patients without structural heart disease PVCs from the outflow tracts were associated with a better prognostic outcome than non‐OT PVCs; the same was true for right ventricular PVCs when compared to left ventricular ones. The classification of the origin of the PVCs was based on 12‐lead ECG morphology. QRS‐width during PVC did not seem to have prognostic significance.

CD169+ resident macrophages in lymph nodes of breast cancer patients are for unknown reasons associated with a beneficial prognosis. This contrasts CD169+ macrophages present in primary breast tumors (CD169+ TAMs), that correlate with a worse prognosis. We recently showed that these CD169+ TAMs were associated with tertiary lymphoid structures (TLSs) and Tregs in breast cancer. Here, we show that CD169+ TAMs can be monocyte-derived and express a unique mediator profile characterized by type I IFNs, CXCL10, PGE2 and inhibitory co-receptor expression pattern. The CD169+ monocyte-derived macrophages (CD169+ Mo-M) possessed an immunosuppressive function in vitro inhibiting NK, T and B cell proliferation, but enhanced antibody and IL6 secretion in activated B cells. Our findings indicate that CD169+ Mo-M in the primary breast tumor microenvironment are linked to both immunosuppression and TLS functions, with implications for future targeted Mo-M therapy.

Historically, Sweden has reported several impacts on transformers and transmission lines related to geomagnetically induced currents (GICs) that develop during strong space weather events. GICs are driven by the geoelectric field (E), and their intensity depends on various factors, including the lithology conductivity and the rate of change of the Earth’s magnetic field. The purpose of this study is to perform an extreme value (EV) analysis of the E magnitude at six different latitudes in Sweden and to express the maximum |E| that might be observed in 10, 50, and 100 years. We analyzed 10-s E data in Sweden, obtained from a 1-D model. This model incorporates 10-s geomagnetic measurements from the IMAGE network and the vertical Earth’s ground electrical conductivity in Sweden, extracted from a 3-D conductance map for the Fennoscandian region. Extreme E events tend to occur in clusters around geomagnetic disturbances (substorms and geomagnetic storms). Therefore, we applied two different methods to decluster the data. After declustering, Generalized Pareto (GP) distributions were fitted to the remaining extreme events that exceeded the 99.5th percentile. The EV analysis indicates that the shape parameter of the GP distribution depends on latitude. This implies that at higher geographic latitudes (64.52–68.02°N) the distribution decreases faster toward zero than at lower latitudes (58.26–62.25°N). As a result the expected maximum |E| in 100 years in central Sweden ranges between 4.0 and 8.5 V/km, while at higher latitudes, it ranges between 2.0 and 2.5 V/km, similar to the modeled geoelectric field values during the Halloween event in October 2003. In particular, around 60.50°N the distribution of extreme events exhibits the heaviest tail. When we additionally consider the effect of conductivity, the region of west Sweden around 60.50°N exhibits the largest expected maximum in 100 years with a value around 8.5 V/km. This is three times larger than the maximum modeled |E| at that latitude.

Summary: Space-based remote sensing can make an important contribution toward monitoring greenhouse gas emissions and removals from the agriculture, forestry, and other land use (AFOLU) sector, and to understanding and addressing human-caused climate change through the UNFCCC Paris Agreement. Space agencies have begun to coordinate their efforts to identify needs, collect and harmonize available data and efforts, and plan and maintain a long-term roadmap for observations. International cooperation is crucial in developing and realizing the roadmap, and the Committee on Earth Observation Satellites (CEOS) is a key coordinating driver of this effort. Here, we first identify the data and information that will be useful to support the global stocktake (GST) of the Paris Agreement. Then, the paper explains how existing and planned space-based capabilities and products can be used and combined, particularly in the land use sector, and provides a workflow for their harmonization and contribution to greenhouse gas inventories and assessments at the national and global level.

BackgroundThe Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry.Methods and resultsA total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P

Current mangrove mapping efforts, such as the Global Mangrove Watch (GMW), have focused on providing one-off or annual maps of mangrove forests, while such maps may be most useful for reporting regional, national and sub-national extent of mangrove forests, they may be of more limited use for the day-to-day management of mangroves and for supporting the Global Mangrove Alliance (GMA) goal of halting global mangrove loss. To this end, a prototype change mangrove loss alert system has been developed to identify mangrove losses on a monthly basis. Implemented on the Microsoft Planetary Computer, the Global Mangrove Watch v3.0 mangrove baseline extent map for 2018 was refined and used to define the mangrove extent mask under which potential losses would be identified. The study period was from 2018 to 2022 due to the availability of Sentinel-2 imagery used for the study. The mangrove loss alert system is based on optimised normalised difference vegetation index (NDVI) thresholds used to identify mangrove losses and a temporal scoring system to filter false positives. The mangrove loss alert system was found to have an estimated overall accuracy of 92.1%, with the alert commission and omission estimated to be 10.4% and 20.6%, respectively. Africa was selected for the mangrove loss alert system prototype, where significant losses were identified in the study period, with 90% of the mangrove loss alerts identified in Nigeria, Guinea-Bissau, Madagascar, Mozambique and Guinea. The primary drivers of these losses ranged from economic activities that dominated West Africa and Northern East Africa (mainly agricultural conversion and infrastructure development) to climatic in Southern East Africa (primarily storm frequency and intensity). The production of the monthly mangrove loss alerts for Africa will be continued as part of the wider Global Mangrove Watch project, and the spatial coverage is expected to be expanded to other regions over the coming months and years. The mangrove loss alerts will be published on the Global Mangrove Watch online portal and updated monthly.

Summary: Background: Several studies indicate increasing hospitalisation rates for specific infectious diseases (IDs). Studies describing the entire ID spectrum are scarcer. Our aim was to describe hospital use with ID diagnoses in Swedish adults from 1998 to 2019. Methods: All four-position codes in ICD-10 were reclassified as ID or non-ID diagnoses. Using data from the National Patient Register, age-standardised hospitalisation rates and average length-of-stay (LOS) was determined for hospitalisations with ID vs non-ID diagnoses in the primary position at discharge. The 22-year study period was divided into five periods that were compared using standardised rate ratios (SRR). Findings: Annual hospitalisations with ID diagnoses increased from 115 thousand in 1998-2002 to 182 thousand in 2015-2019, for a rate increase from 17·4 to 23.0 per 1000 person-years, and a SRR (95%CI) of 1.32 (1.32-1.33). Concurrently, the hospitalisation rate with non-ID diagnoses decreased from 147 to 110, for a SRR of 0.75 (0.75-0.75). Average LOS decreased less for IDs than for non-IDs. Consequently, the proportion of hospital nights for which an ID was considered causing the hospitalisation increased from 11% to 21%. Persons aged 80+ years had the highest ID hospitalisation rate. Interpretation: The increased hospital use with ID diagnoses suggests an increasing incidence of severe IDs as well as a changing case-mix of hospitalised patients. Given the anticipated demographic change, this trend is likely to persist. Healthcare systems will need to address IDs in a comprehensive and standardised way. Funding: Governmental Funding of Research within the Clinical Sciences (ALF)

Introduction Continuous subcutaneous insulin infusion (CSII) treatment is beneficial for obtaining glycaemic control for many persons with type 1 diabetes mellitus (T1DM). Still, some individuals do not obtain improved HbA1C levels despite CSII treatment, and there is a lack of evidence regarding how psychosocial factors may influence glycaemic control. Thus, we aimed to explore the attitudes and experiences of self-management among people with T1DM and suboptimal glycaemic control despite CSII treatment.Research design and methods A qualitative inductive design was applied, and four FGDs were performed with 37 adult men and women of various ages and duration of T1DM. All participants had suboptimal glycaemic control despite CSII treatment. Transcripts were analysed using qualitative manifest and latent content analysis.Results and conclusion The themes Searching for freedom and flexibility and Preferring safety and the well-known illustrated the divergent psychosocial strategies adapted, which both resulted in suboptimal glycaemic control. The technical devices and their effects on glycaemic levels may be challenging to understand and adjust to fit people’s lifestyles. The rapid advances of technology devices in diabetes care can potentially change peoples’ lives, but is the educational support developing as fast? Multifaceted web-based education of high quality, including tailored support with a person-centred focus, is more important than ever before as the need for technical knowledge and understanding may put further disease burdens to patients with T1DM on CSII treatment.

The degree of phosphorylation and phosphoethanolaminylation of lipid A on neisserial lipooligosaccharide (LOS), a major cell-surface antigen, can be correlated with inflammatory potential and the ability to induce immune tolerance in vitro. On the oligosaccharide of the LOS, the presence of phosphoethanolamine and sialic acid substituents can be correlated with in vitro serum resistance. In this study, we analyzed the structure of the LOS from 40 invasive isolates and 25 isolates from carriers of Neisseria meningitidis without disease. Invasive strains were classified as groups 1-3 that caused meningitis, septicemia without meningitis, and septicemia with meningitis, respectively. Intact LOS was analyzed by high resolution matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Prominent peaks for lipid A fragment ions with three phosphates and one phosphoethanolamine were detected in all LOS analyzed. LOS from groups 2 and 3 had less abundant ions for highly phosphorylated lipid A forms and induced less TNF-α in THP-1 monocytic cells compared with LOS from group 1. Lipid A from all invasive strains was hexaacylated, whereas lipid A of 6/25 carrier strains was pentaacylated. There were fewer O-acetyl groups and more phosphoethanolamine and sialic acid substitutions on the oligosaccharide from invasive compared with carrier isolates. Bioinformatic and genomic analysis of LOS biosynthetic genes indicated significant skewing to specific alleles, dependent on the disease outcome. Our results suggest that variable LOS structures have multifaceted effects on homeostatic innate immune responses that have critical impact on the pathophysiology of meningococcal infections.

Abstract Background Extreme weather events are predicted to increase, such as combined heat and drought. The CO2 concentration ([CO2]) is predicted to approximately double by 2100. We aim to explore how tomato physiology, especially photosynthesis, is affected by combined heat and drought under elevated [CO2] (e [CO2]). Results Two genotypes, ‘OuBei’ (‘OB’, Solanum lycopersicum) and ‘LA2093’ (S. pimpinellifolium) were grown at a [CO2] (atmospheric [CO2], 400 ppm) and e [CO2] (800 ppm), respectively. The 27-days-old seedlings were treated at 1) a [CO2], 2) a [CO2] + combined stress, 3) e [CO2] and 4) e [CO2] + combined stress, followed by recovery. The P N (net photosynthetic rate) increased at e [CO2] as compared with a [CO2] and combined stress inhibited the P N. Combined stress decreased the Fv/Fm (maximum quantum efficiency of photosystem II) of ‘OB’ at e [CO2] and that of ‘LA2093’ in regardless of [CO2]. Genotypic difference was observed in the e [CO2] effect on the gas exchange, carbohydrate accumulation, pigment content and dry matter accumulation. Conclusions Short-term combined stress caused reversible damage on tomato while the e [CO2] alleviated the damage on photosynthesis. However, the e [CO2] cannot be always assumed have positive effects on plant growth during stress due to increased water consumption. This study provided insights into the physiological effects of e [CO2] on tomato growth under combined stress and contributed to tomato breeding and management under climate change.

BackgroundAdrenomedullin is a vasoactive hormone with potentially prognostic and therapeutic value, which mainly has been investigated in intensive care unit (ICU) settings. The triaging in the emergency department (ED) of patients to the right level of care is crucial for patient outcome.ObjectivesThe primary aim of this study was to investigate the association of bioactive adrenomedullin (bio-ADM) with mortality among sepsis patients in the ED. Secondary aims were to investigate the association of bio-ADM with multiple organ failure (MOF), ICU admission and ED discharge.MethodsIn this prospective observational cohort study, adult sepsis patients in the ED (2013-2015) had blood samples collected for later batch analysis of bio-ADM. Odds ratios (OR) with 95% confidence interval (CI) for bio-ADM were calculated.ResultsBio-ADM in 594 sepsis patients was analyzed of whom 51 died within 28 days (8.6%), 34 developed severe MOF, 27 were ICU admitted and 67 were discharged from the ED. The median (interquartile range) bio-ADM was 36 (26-56) and 63 (42-132) pg/mL among survivors and non-survivors, respectively, 81 (56-156) pg/mL for patients with severe MOF and 77 (42-133) pg/mL for ICU admitted patients. Each log-2 increment of bio-ADM conferred an OR of 2.30 (95% CI 1.74-3.04) for mortality, the adjusted OR was 2.39 (95% CI 1.69-3.39). The area under the receiver operating characteristic curve of a prognostic mortality model based on demographics and biomarkers increased from 0.80 to 0.86 (p = 0.02) when bio-ADM was added. Increasing bio-ADM was associated with severe MOF, ICU admission and ED discharge with adjusted ORs of 3.30 (95% CI 2.13-5.11), 1.75 (95% CI 1.11-2.77) and 0.46 (95% CI 0.32-0.68), respectively.ConclusionBio-ADM in sepsis patients in the ED is associated with mortality, severe MOF, ICU admission and ED discharge, and may be of clinical importance for triage of sepsis patients in the ED.

Three genotypes of wheat grown at two CO2 concentrations were used in a drought experiment, where water was withheld from the pots at anthesis until stomatal conductance (gs) dropped below 10% of the control and photosynthesis (A) approached zero. The genotypes had different leaf area (Gladius < LM19 < LM62) and while photosynthesis and shoot growth were boosted by elevated CO2, the water use and drying rate were more determined by canopy size than by stomatal density and conductance. The genotypes responded differently regarding number of fertile tillers, seeds per spike and 1000 kernel weight and, surprisingly, the largest genotype (LM62) with high water use showed the lowest relative decrease in grain yield. The maximum photochemical efficiency of photosystem II (Fv/Fm) was only affected on the last day of the drought when the stomata were almost closed although some variation in A was still seen between the genotypes. A close correlation was found between Fv/Fm and % loss of grain yield. It indicates that the precise final physiological stress level measured by Fv/Fm at anthesis/early kernel filling could effectively predict percentage final yield loss, and LM62 was slightly less stressed than the other genotypes, due to only a small discrepancy in finalising the drying period. Therefore, Fv/Fm can be used as a proxy for estimating the yield performance of wheat after severe drought at anthesis.

Abstract Background Co-occurrence of cold and drought stress can alter the response of plants at morphological, physiological and molecular levels, which finally affect crop production, more than individual stress. Understanding the responses of crop to combined stress is necessary to improve tolerance and maintain crop production especially in the field where combined stress frequently occurs. We aimed to clarify the underlying leaf physiological and molecular mechanisms of tomato by imposing combining cold and drought on one popular tomato cultivar ‘Jinlingmeiyu’ as an example. Results The physiological and genetic responses were identified in tomatoes after 42 h exposure to control, cold, drought and combined treatments. As compared with control, water loss rate at the three stresses including cold, drought and combined stress significantly decreased until 40 min after taking samples from the plants. The content of H2O2, zeatin riboside (ZR) and melatonin in all stress treatments were significantly higher than the control. Drought stress alone and combined stress induced the accumulation of abscisic acid (ABA) and auxin (IAA) as compared with control. The individual cold and combined stress significantly decreased the maximum quantum efficiency of PSII (Fv/Fm), quantum yield of PSII (Fq ′/Fm ′) and electron transport rate (ETR). In total, 7141, 1850 and 7841 genes were involved in the stress response to cold, drought and their combination. Functional analysis of the stress-inducible genes provided more insights concerning the complex regulatory mechanisms that were involved in combined stress. The expression level of 12 genes were validated by quantitative real-time PCR (qRT-PCR). Conclusions We found that the expression of stress-specific genes changed with physiological variation, indicating the close crosstalk between physiological and genetic response especially under combined stress. This study provides new knowledge on the complex regulatory mechanism genes in tomato (‘Jinlingmeiyu’) leaf to abiotic stresses.

Abstract Background There is a lack of validated tools to assess potential disease progression and hospitalisation decisions in patients presenting to the emergency department (ED) with a suspected infection. This study aimed to identify suitable blood biomarkers (MR-proADM, PCT, lactate and CRP) or clinical scores (SIRS, SOFA, qSOFA, NEWS and CRB-65) to fulfil this unmet clinical need. Methods An observational derivation patient cohort validated by an independent secondary analysis across nine EDs. Logistic and Cox regression, area under the receiver operating characteristic (AUROC) and Kaplan-Meier curves were used to assess performance. Disease progression was identified using a composite endpoint of 28-day mortality, ICU admission and hospitalisation > 10 days. Results One thousand one hundred seventy-five derivation and 896 validation patients were analysed with respective 28-day mortality rates of 7.1% and 5.0%, and hospitalisation rates of 77.9% and 76.2%. MR-proADM showed greatest accuracy in predicting 28-day mortality and hospitalisation requirement across both cohorts. Patient subgroups with high MR-proADM concentrations (≥ 1.54 nmol/L) and low biomarker (PCT

Mangroves are a globally important ecosystem that provides a wide range of ecosystem system services, such as carbon capture and storage, coastal protection and fisheries enhancement. Mangroves have significantly reduced in global extent over the last 50 years, primarily as a result of deforestation caused by the expansion of agriculture and aquaculture in coastal environments. However, a limited number of studies have attempted to estimate changes in global mangrove extent, particularly into the 1990s, despite much of the loss in mangrove extent occurring pre-2000. This study has used L-band Synthetic Aperture Radar (SAR) global mosaic datasets from the Japan Aerospace Exploration Agency (JAXA) for 11 epochs from 1996 to 2020 to develop a long-term time-series of global mangrove extent and change. The study used a map-to-image approach to change detection where the baseline map (GMW v2.5) was updated using thresholding and a contextual mangrove change mask. This approach was applied between all image-date pairs producing 10 maps for each epoch, which were summarised to produce the global mangrove time-series. The resulting mangrove extent maps had an estimated accuracy of 87.4% (95th conf. int.: 86.2–88.6%), although the accuracies of the individual gain and loss change classes were lower at 58.1% (52.4–63.9%) and 60.6% (56.1–64.8%), respectively. Sources of error included misregistration in the SAR mosaic datasets, which could only be partially corrected for, but also confusion in fragmented areas of mangroves, such as around aquaculture ponds. Overall, 152,604 km2 (133,996–176,910) of mangroves were identified for 1996, with this decreasing by −5245 km2 (−13,587–1444) resulting in a total extent of 147,359 km2 (127,925–168,895) in 2020, and representing an estimated loss of 3.4% over the 24-year time period. The Global Mangrove Watch Version 3.0 represents the most comprehensive record of global mangrove change achieved to date and is expected to support a wide range of activities, including the ongoing monitoring of the global coastal environment, defining and assessments of progress toward conservation targets, protected area planning and risk assessments of mangrove ecosystems worldwide.

Purpose: Atrial fibrillation (AF) is associated with an increased risk for cardiovascular morbidity and mortality, not entirely explained by thromboembolism. The underlying mechanisms for this association are largely unknown. Similarly, high blood pressure (BP) increases the risk for cardiovascular events. Despite this the interplay between AF and BP is insufficiently studied. The purpose of this study was to examine and quantify the beat-to-beat blood pressure variability in patients with AF in comparison to a control group of patients with sinus rhythm. Materials and methods: We studied 33 patients - 21 in atrial fibrillation and 12 in sinus rhythm - undergoing routine coronary angiography. Invasive blood pressure was recorded at three locations: radial artery, brachial artery and ascending aorta. Blood pressure variability, defined as average beat-to-beat blood pressure difference, was calculated for systolic and diastolic blood pressure at each site. Results: We observed a significant difference (p