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Abstract Background Toxicity during chemoradiotherapy (CRT) in cervical cancer patients might limit the chances of receiving an optimal treatment and to be cured. Few studies have shown relationships between acute side effects and patient’s age. Here, the association between age and acute side effects such as nausea/vomiting, diarrhea and weight loss during CRT was analysed in cervical cancer patients. Methods This study included 93 patients with primary cervical cancer stage IBI to IVA who received CRT from 2013 to 2019. The frequency of symptoms/toxicity grade was analysed by using the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Results Patients ≥ 52 years had a significantly higher frequency of nausea/vomiting and increased grade ≥ 3 toxicity during CRT compared to younger patients (p

Interprofessional education (IPE) is a growing focus for educators in health professional academic programs. Recommendations to successfully implement IPE are emerging in the literature, but there remains a dearth of evidence informing the bigger challenges of sustainability and scalability. Transformation to interprofessional education for collaborative person-centred practice (IECPCP) is complex and requires "harmonization of motivations" within and between academia, governments, healthcare delivery sectors, and consumers. The main lesson learned at the University of Manitoba was the value of using a formal implementation framework to guide its work. This framework identifies key factors that must be addressed at the micro, meso, and macro levels and emphasizes that interventions occurring only at any single level will likely not lead to sustainable change. This paper describes lessons learned when using the framework and offers recommendations to support other institutions in their efforts to enable the roll out and integration of IECPCP.

Internationally, a growing number of interprofessional education (IPE) offices are being established within academic institutions. However, few are applying educational improvement methodologies to evaluate and improve the interprofessional (IP) learning opportunities offered. The University of Manitoba IPE Initiative was established in 2008 to facilitate the development of IP learning opportunities for pre-licensure learners. The research question for this secondary analysis was: what, if any, changes in the number and attributes of IP learning opportunities occurred in the academic year 2008-2009 compared to 2011-2012? The Points for Interprofessional Scoring (PIPES) tool was used to quantify the attributes of each IP learning opportunity. Most notably in 2012, eight (73%) of 11 IP learning opportunities achieved the highest PIPES score (> 55), compared to only four (36%) in 2009. The concept of the PIPES score is introduced as an educational improvement strategy and a potential predictor of achieving the desired educational outcome: collaborative competence.

The study objective in this article was to present the state-of-the-art on teachers’ professional development to enhance educational quality for students with autism spectrum disorders (ASD) in primary and secondary education. A systematic review was conducted, following the PRISMA guidelines. Quantitative, qualitative, and mixed-methods studies were eligible for inclusion. Fifteen studies were identified and summarized. To identify the eligibility criteria, we applied the SPIDER framework. Quality appraisal was applied using the MMAT. A thematic summary and narrative synthesis of the included studies was conducted to establish a comprehensive understanding of what makes a difference in preparation for teachers of autistic students. Two key factors were found regarding the design of professional development for teachers to enhance their skills to teach autistic students. Firstly, teachers’ developed autism-specific knowledge, and secondly, the need for practice-based training with a focus on the challenges teachers meet at their own schools. Multiple ways of addressing teachers’ need for professional development regarding autistic students may further contribute to inclusive values and actions.

Studies have demonstrated that being bullied in childhood may have long-term associations with lower psychological well-being in adulthood. However, although bullying incidents frequently target the victim's body and appearance, research has overlooked studying victims' long-term body image development and risk of engaging in disordered eating later in life. This 14-year longitudinal research project examined childhood bullying in relation to body image development and disordered eating in emerging adulthood. Growth curve analyses of participants' body image at ages 10-21 years (N = 960) revealed that more victimized children experienced more body dissatisfaction at baseline and maintained their negative body image throughout adolescence and into adulthood. Mediation analyses showed that childhood bullying (age 10 years) predicted more negative body image in adolescence (age 18 years), which in turn predicted more disordered eating in adulthood (age 24 years). The indirect effect was stronger for girls than for boys. The findings suggest that bullied children are likely to face both more body image problems and disordered eating as they evolve through adolescence and into adulthood, indicating the need for early and effective interventions. Incorporating components known to promote a more positive body image could be a valuable feature of future interventions. Thus, as children and adolescents are taught to cope with bullying situations, they could also be helped to deal with the appearance culture that permeates many of these situations.

Mudbrick constructions are extremely common in ancient western Asia, including the 1st millennium structures of the southern Caucasus and Armenian highlands. However, in the Caucasus the geoarchaeological study of these materials to provide insight into building practices and social structure is a topic little researched, especially when focusing on the longue durée. Artashat/Artaxata (Ararat region, Armenia) was the capital of the Armenian Kingdom of the Artaxiads, founded in the eighties of the 2nd century BC, but even before this the site was occupied in the Chalcolithic period, (ca. 5200-3500 BC), Early Iron Age (ca. 1200-900 BC) and in the Urartian period (ca. 800-600 BC) as well. All the previous occupation phases showed communities that made extensive use of earthen constructions as determined during past and recent archaeological excavations. This multidisciplinary study seeks to examine mudbrick architecture as a proxy for environmental and social interactions during the 1st millennium BC combining geoarchaeology, archaeobotany and building archaeology. We analyzed changes and continuities in architectural form and practices, alongside reconstruction of technological and social processes, to identify issues of raw material procurement, attestation of re-use, and consistency of building practices. The results of the geoarchaeological analysis of the earthen building materials used in different parts of the ancient city point to a re-use of materials over time.

Aerococcus sanguinicola is a bacterium that can cause urinary tract infections and on rare occasions infective endocarditis (IE). The prognosis of IE caused by aerococci is generally favourable despite that the patients are typically old and have multiple comorbidities. Here we report a case of A. sanguinicola native valve aortic IE in a 68-year-old man with an underlying urinary tract condition. The infection led to severe aortic valve insufficiency and rapid death before the patient could be subjected to surgery. This demonstrates that IE caused by A. sanguinicola can be severe and cause valve destruction. In addition to the case report, we provide a review of the current literature on A. sanguinicola IE.

In these transformative times of interrupted lives, humanity has had to take a step back and subject its frantic, rushed existence to a profound analytical glance. The COVID pandemic has caused millions to suffer and the elderly are more vulnerable than ever; moreover, many families are left to mourn alone, not always able to gather around their departed loved ones at the time of grief. This has led many to believe that humanity has lost control of its environment and its destiny. Yet, if recent predictions by sociologists come true, the current, seemingly never-ending pandemic might have some positive results. The anguish it causes may be, in fact, teaching us to appreciate the value of the natural world that we are depleting, to understand “the other”, and to recognise the planet-saving significance of the phrase “less is more”. And while the world’s populations slowly realise that their social environment has changed permanently, the pandemic’s beneficial upshot might be that people will be mindful of things beyond their immediate concerns and will begin to see the “bigger picture”. In view of the speculative disarray inherent to our present condition, this paper proposes existentialism as a system of thought with the intrinsic power to guide individual and social awareness; it thus analyses our present in an interpretive and pragmatic light while it draws on the existentialist theories of Søren Kierkegaard and Simone de Beauvoir. Both philosophers are querying and inquisitive and both timelessly relevant, sensible and direct about what they see is at the core of human existence.

Abstract Aims Left ventricular (LV) dysfunction can be triggered by non‐cardiac disease, such as sepsis, hypoxia, major haemorrhage, or severe stress (Takotsubo syndrome), but its clinical importance is not established. In this study, we evaluate the incidence and impact on mortality of LV dysfunction associated with critical illness. Methods and results In this single‐centre, observational study, consecutive patients underwent an echocardiographic examination within 24 h of intensive care unit (ICU) admission. LV systolic dysfunction was defined as an ejection fraction (EF)

In Sweden as in many other countries, there has been increasing recognition of the importance of health, social participation, and active leisure time for people with disabilities. Against this background, a three-year music education was started for a group of young adults with disabilities in order to enhance their wellbeing, learning, and emotional and social development. The aim of the study was to evaluate the results of a 3-year education program with set goals for young adults with disabilities using a qualitative method. The study was conducted from autumn 2014 to 2018. Four semi-structured interviews were conducted with the participants, the first at the beginning of the education, after the first year, second, and third year respectively. The interviews were tape recorded and transcribed verbatim. The teachers and care staff made process notes about the development of each participant. The transcribed interviews and process notes were analyzed using Thematic Content Analysis. The education achieved its purpose and goals as evidenced by participants, teachers, and staff. It showed that music education training may revitalize people with disabilities. Furthermore, it demonstrated that persons with disabilities can learn, develop, and even change on a personal level, if they are given the right conditions.

ABSTRACT Bacterial populations can survive exposure to antibiotics through transient phenotypic and gene expression changes. These changes can be attributed to a small subpopulation of bacteria, giving rise to antibiotic persistence. Although this phenomenon has been known for decades, much remains to be learned about the mechanisms that drive persister formation. The RNA-binding protein ProQ has recently emerged as a global regulator of gene expression. Here, we show that ProQ impacts persister formation in Salmonella. In vitro, ProQ contributes to growth arrest in a subset of cells that are able to survive treatment at high concentrations of different antibiotics. The underlying mechanism for ProQ-dependent persister formation involves the activation of metabolically costly processes, including the flagellar pathway and the type III protein secretion system encoded on Salmonella pathogenicity island 2. Importantly, we show that the ProQ-dependent phenotype is relevant during macrophage infection and allows Salmonella to survive the combined action of host immune defenses and antibiotics. Together, our data highlight the importance of ProQ in Salmonella persistence and pathogenesis. IMPORTANCE Bacteria can avoid eradication by antibiotics through a phenomenon known as persistence. Persister cells arise through phenotypic heterogeneity and constitute a small fraction of dormant cells within a population of actively growing bacteria, which is susceptible to antibiotic killing. In this study, we show that ProQ, an RNA-binding protein and global regulator of gene expression, promotes persisters in the human pathogen Salmonella enterica serovar Typhimurium. Bacteria lacking the proQ gene outcompete wild-type bacteria under laboratory conditions, are less prone to enter growth dormancy, and form fewer persister cells. The basis for these phenotypes lies in ProQ’s ability to activate energy-consuming cellular processes, including flagellar motility and protein secretion. Importantly, we show that ProQ contributes to the persister phenotype during Salmonella infection of macrophages, indicating an important role of this global regulator in Salmonella pathogenesis.

Kviteseid Old Church in Telemark, Norway, is a medieval stone church with murals of a seemingly informal character. These depictions consist of ships, figures, individual letters, and longer inscriptions, apparently randomly placed on the interior chancel walls. By studying the painting techniques, the stratigraphic structure and the motifs of the paintings, the authors explore the intentions behind these motifs. They argue that, although of simple manufacture and unprogrammatic, they were an important part of the late-medieval and post-Reformational church experience. Several of the images and inscriptions may have had a memorial intention. This study provides a new understanding of a type of murals found in several medieval churches in Norway and abroad that has often been (mis)interpreted as graffiti.

Abstract Background Time management skills are essential for living in modern society. People with mental or neurodevelopmental disorders typically have cognitive limitations, including affected time management, which might lead to poor occupational balance, low self-efficacy, and poor parental sense of competence. “Let’s Get Organized” (LGO) is a recently developed manual-based group intervention to train time management skills. The aim of this trial is to evaluate the efficiency of the Swedish version of LGO (LGO-S) compared to treatment as usual (individual occupational therapy) to improve time management for adults with impaired time management skills due to mental or neurodevelopmental disorders. Furthermore, to evaluate if the intervention is a cost-effective way to improve the quality of life and time management skills of these individuals, we will conduct a health economic evaluation. Methods The trial will have a multi-centre, open, parallel randomised controlled design. A total of 104 adults with cognitive limitations due to mental or neurodevelopmental disorders will be recruited from open psychiatric or habilitation care units. Outcomes will be measured before and after a 10-week intervention, with a follow-up 3 months after completing the intervention. The primary outcome will be self-assessed time management skills. Secondary outcomes will be e.g. self-assessed skills in organisation and planning, regulation of emotions, satisfaction with daily occupations, occupational balance, self-efficacy, and quality-adjusted life years. Discussion A recent feasibility study has shown promising results for LGO-S, and a randomised trial will provide robust evidence for the possible efficacy of LGO-S in comparison to treatment as usual. Trial registration ClinicalTrials.gov NCT03654248 . Registered on 20 August 2018.

Objectives To investigate factors associated with severe COVID-19 in people with idiopathic inflammatory myopathy (IIM).Methods Demographic data, clinical characteristics and COVID-19 outcome severity of adults with IIM were obtained from the COVID-19 Global Rheumatology Alliance physician-reported registry. A 3-point ordinal COVID-19 severity scale was defined: (1) no hospitalisation, (2) hospitalisation (and no death) and (3) death. ORs were estimated using multivariable ordinal logistic regression. Sensitivity analyses were performed using a 4-point ordinal scale: (1) no hospitalisation, (2) hospitalisation with no oxygen (and no death), (3) hospitalisation with oxygen/ventilation (and no death) and 4) death.Results Of 348 patients, 48% were not hospitalised, 39% were hospitalised (and did not die) and 13% died. Older age (OR=1.59/decade, 95% CI 1.31 to 1.91), high disease activity (OR=3.50, 95% CI 1.25 to 9.83; vs remission), ≥2 comorbidities (OR=2.63, 95% CI 1.39 to 4.98; vs none), prednisolone-equivalent dose >7.5 mg/day (OR=2.40, 95% CI 1.09 to 5.28; vs no intake) and exposure to rituximab (OR=2.71, 95% CI 1.28 to 5.72; vs conventional synthetic disease-modifying antirheumatic drugs only) were independently associated with severe COVID-19. In addition to these variables, in the sensitivity analyses, male sex (OR range: 1.65–1.83; vs female) was also significantly associated with severe outcomes, while COVID-19 diagnosis after 1 October 2020 (OR range: 0.51–0.59; vs on/before 15 June 2020) was significantly associated with less severe outcomes, but these associations were not significant in the main model (OR=1.57, 95% CI 0.95 to 2.59; and OR=0.61, 95% CI 0.37 to 1.00; respectively).Conclusions This is the first large registry data on outcomes of COVID-19 in people with IIM. Older age, male sex, higher comorbidity burden, high disease activity, prednisolone-equivalent dose >7.5 mg/day and rituximab exposure were associated with severe COVID-19. These findings will enable risk stratification and inform management decisions for patients with IIM.

Background and Aim Strategies to modify and adjust the educational setting in mainstream education for autistic students are under-researched. Hence, this review aims to identify qualitative research results of adaptation and modification strategies to support inclusive education for autistic students at school and classroom levels. Method In this systematic review, four databases were searched. Following the preferred PRISMA approach, 108 studies met the inclusion criteria, and study characteristics were reported. Synthesis of key findings from included studies was conducted to provide a more comprehensive and holistic understanding. Main Contribution This article provides insights into a complex area via aggregating findings from qualitative research a comprehensive understanding of the phenomena is presented. The results of the qualitative analysis indicate a focus on teachers' attitudes and students' social skills in research. Only 16 studies were at the classroom level, 89 were at the school level, and three studies were not categorized at either classroom or school level. A research gap was identified regarding studies focusing on the perspectives of autistic students, environmental adaptations to meet the students' sensitivity difficulties, and how to enhance the students' inclusion regarding content taught and knowledge development from a didactic perspective. Conclusions and Implications Professional development that includes autism-specific understanding and strategies for adjusting and modifying to accommodate autistic students is essential. This conclusion may direct school leaders when implementing professional development programs. A special didactical perspective is needed to support teachers' understanding of challenges in instruction that autistic students may encounter.

Abstract Background Older persons with polypharmacy are at increased risk of harm from medications. Therefore, it is important that physicians and nurses, together with the persons, evaluate medications to avoid hazardous polypharmacy. It remains unclear how healthcare professionals experience such evaluations. This study aimed to explore physicians’ and nurses’ experiences from evaluations of older persons’ medications, and their related actions to manage concerns related to the evaluations. Method Individual interview data from 29 physicians and nurses were collected and analysed according to the critical incident technique. Results The medication evaluation for older persons was influenced by the working conditions (e.g. healthcare professionals’ clinical knowledge, experiences, and situational conditions) and working in partnership (e.g. cooperating around and with the older person). Actions taken to manage these evaluations were related to working with a plan (e.g. performing day-to-day work and planning for continued treatment) and collaborative problem-solving (e.g. finding a solution, involving the older person, and communicating with colleagues). Conclusion Working conditions and cooperation with colleagues, the older persons and their formal or informal caregivers, emerged as important factors related to the medication evaluation. By adjusting their performance to variations in these conditions, healthcare professionals contributed to the resilience of the healthcare system by its capacity to prevent, notice and mitigate medication problems. Based on these findings, we hypothesize that a joint plan for continued treatment could facilitate such resilience, if it articulates what to observe, when to act, who should act and what actions to take in case of deviations from what is expected.

Abstract Background Atrial pacing and right ventricular (RV) pacing are both associated with adverse outcomes among patients with first‐degree atrioventricular block (1°AVB). His‐bundle pacing (HBP) provides physiological activation of the ventricle and may be able to improve both atrioventricular (AV) and inter‐ventricular synchrony in 1°AVB patients. This study evaluates the acute echocardiographic and hemodynamic effects of atrial, atrial‐His‐bundle sequential (AH), and atrial‐ventricular (AV) sequential pacing in 1°AVB patients. Methods Patients with 1°AVB undergoing atrial fibrillation ablation were included. Following left atrial (LA) catheterization, patients underwent atrial, AH‐ and AV‐sequential pacing. LA/left ventricular (LV) pressure and echocardiographic measurements during the pacing protocols were compared. Results Thirteen patients with 1°AVB (mean PR 221 ± 26 ms) were included. The PR interval was prolonged with atrial pacing compared to baseline (275 ± 73 ms, p = .005). LV ejection fraction (LVEF) was highest during atrial pacing (62 ± 11%), intermediate with AH‐sequential pacing (59 ± 7%), and lowest with AV‐sequential pacing (57 ± 12%) though these differences were not statistically significant. No significant differences were found in LA or LV mean pressures or LV dP/dT. LA and LV volumes, isovolumetric times, electromechanical delays, and global longitudinal strains were similar across pacing protocols. Conclusion Despite pronounced PR prolongation, the acute effects of atrial pacing were not significantly different than AH‐ or AV‐sequential pacing. Normalizing atrioventricular and/or inter‐ventricular dyssynchrony did not result in acute improvements in cardiac output or loading conditions.

Intraindividual variability (IIV) across neuropsychological measures within a single testing session is a promising marker predictive of cognitive decline and development of Alzheimer’s disease (AD). We have previously shown that greater IIV is cross-sectionally associated with reduced cerebral blood flow (CBF), but not with cortical thickness or brain volume, in older adults without dementia who were amyloid beta (Aβ) positive. However, there is little known about the association between change in IIV and CBF over time. Therefore, we examined 12-month longitudinal change in IIV and interactions of IIV and AD biomarker status on changes in regional CBF. Fifty-three non-demented Alzheimer’s Disease Neuroimaging Initiative (ADNI) participants underwent lumbar puncture to obtain cerebrospinal fluid (CSF) at baseline and neuropsychological testing and magnetic resonance imaging (MRI) exams at baseline and 12-month follow-up evaluation. IIV was calculated as the intraindividual standard deviation across 6 demographically-corrected neuropsychological measures. Pulsed arterial spin labeling (ASL) MRI was acquired to quantify CBF and FreeSurfer-derived a priori CBF regions of interest (ROIs) were examined. AD biomarker positivity was determined using a published CSF p-tau/Aβ ratio cut-score. Change scores were calculated for IIV, CBF, and mean neuropsychological performance from baseline to 12 months. Hierarchical linear regression models showed that after adjusting for age and gender, there was a significant interaction between IIV change and biomarker-positivity (p-tau/Aβ+) for change in entorhinal and hippocampal CBF but not for the other ROIs. Specifically, increases in IIV were associated with reductions in entorhinal and hippocampal CBF among individuals who were biomarker-positive (n = 21). In contrast, there were no significant associations between change in IIV and CBF among those who were biomarker-negative (n = 32). Findings remained similar when analyses were performed adjusting for change in mean level of neuropsychological performance. Changes in IIV may be sensitive to changes in regional hypoperfusion in AD-vulnerable regions among AD biomarker-positive individuals, above and beyond demographics and mean neuropsychological performance. These findings provide further evidence supporting IIV as a potential marker of cerebrovascular brain changes in individuals at risk for dementia.

[Background] Why clients discontinue their psychotherapies has attracted more attention recently as it is a major problem for many healthcare services. Studies suggest that dropout rates may be affected by the mode of therapy, low-quality therapeutic alliance, low SES, and by conditions such personality disorders or substance abuse. The aims of the study were to investigate what happens in therapies which end in a dropout, and to estimate how common dropout is as reported by practicing clinicians. [Method] An online questionnaire was developed and completed by 116 therapists working in clinical settings. They were recruited via social media (Facebook and different online psychotherapy groups) in Sweden and worked with Cognitive Behavioural Therapy (CBT), Psychodynamic Therapy (PDT), Interpersonal Psychotherapy (IPT) and Integrative Psychotherapy (IP). [Results] Psychotherapists rated the frequency of premature dropout in psychotherapy to be on average 8.89% (MD = 5, SD = 8.34, Range = 0-50%). The most common reasons for a dropout, as stated by the therapists, were that clients were not satisfied with the type of intervention offered, or that clients did not benefit from the treatment as they had expected. The most common feeling following a dropout was self-doubt. [Conclusion] In conclusion, premature dropout is common in clinical practice and has negative emotional consequences for therapists. Premature dropout may lead to feelings of self-doubt and powerlessness among therapists. The therapeutic alliance was mostly rated as good in dropout therapies. Further research is needed to validate the findings with data on the prevalence and subjective reasons behind a dropout from point of view of clients.

The dramatic event that the great migration in the summer of 2015 entailed changed the migration policies of various countries. Substantial amendments were hastily made in a policy field in which already tense state-local relations struggled to manage coordination, responsibilities, and funding. Sweden, recognized as a final host country of the massive flows of refugees and asylum-seekers, was no exception. In Sweden, autonomy in terms of local refugee reception was circumvented in 2016. Municipalities' remaining discretion is above all concentrated to one of the most crucial spheres of refugee reception: the outline of local housing policies. We argue that housing may be perceived as a tool of resilience that local governments may use to maintain far-reaching influence over the settlement of migrants with a refugee background by selecting restrictive or generous policy options. In this paper, we conduct a theoretically grounded analysis of local housing policy for refugees among Swedish municipalities. To capture the intrinsic dynamic, we propose a generic typology applying the dimension of either a liberal or a restrictive housing policy and relate it to theoretical notions of refugee policy as characterized by either a rights-based or a more restrictive approach. Our findings show that local governments in Sweden pursue a wide array of policy stances that appear to be correlated with factors originating from prior experiences of refugee reception, conditions in the labor and housing markets, and political circumstances. Based on this, we argue that local housing policy has offered municipalities a tool to exert a form of intentional, or unintentional, migration control despite national efforts to impose a more just system of refugee reception.

Swedish early childhood education (ECE) offers a curriculum-based preschool for children aged one to five, and a preschool class for children aged six years. Activities in these programs have traditionally been based on play and having fun, avoiding structured activities with formal learning objectives. Due to indications that Swedish ECE has failed to use its resources to stimulate children's learning, the revised ECE curriculum now contains discernible learning objectives. This study analyses the process by which preschool teachers shifted their emphasis when participating in an learning study based on three projects conducted in Swedish ECE practice. In total, 14 preschool teachers, 95 children (2-6-year-olds), and five researchers participated. The objects of learning were: (1) 3D geometrical forms (2-3-year-olds), (2) organic decomposition (4-5-year-olds), and (3) the concept "twice as" (6-year-olds). The empirical material comprises 278 pre-, post-, and delayed post-tests, twelve planning meetings, and nine teaching activities. The results indicate that, during the projects, the initial focus on mere play expanded to include a focus on the object of learning. Three modes of change were discerned in how (1) the activities were framed, (2) the learning was perceived, and (3) the learning activities were conducted.

Technology volition is the will to develop knowledge of, and use, the physical world to design products, processes and systems. The aim of this study was to contribute new knowledge of children's technology volition when they identify, build and improve technical constructions, and how teachers support this learning. Analysis focused on moments when children's volition was expressed in a construction activity. In total, eleven preschool teachers and 49 children, aged 4-5 years, from three preschools, participated. Data consists of video-recordings from four activities, two each in preschool A and B, showing children's expressed technological volition, as well as field notes about the teachers' preparations. Results show how differences among children's expressed volition is connected to their imagination of how materials can be combined to construct 'houses' and 'vehicles' from everyday objects. Building a house resulted in a focus on how to make the building solid and water resistant, and inspired children to learn about materials for different purposes in houses such as the floor, walls and an angled roof. Building a vehicle encouraged children to talk about speed, movements and fuel. Results show how children indicate and express their discernment of how materials are combined to create constructions, and how they discover ways in which materials change during the building process. For some of the children it was difficult to see the potential of a material other than its original use, while others used their imagination to find opportunities to use materials to make new objects.

Abstract Background Germinal matrix intraventricular hemorrhage (GM-IVH) is associated with deposition of redox active cell-free hemoglobin (Hb), derived from hemorrhagic cerebrospinal fluid (CSF), in the cerebrum and cerebellum. In a recent study, using a preterm rabbit pup model of IVH, intraventricularly administered haptoglobin (Hp), a cell-free Hb scavenger, partially reversed the damaging effects observed following IVH. Together, this suggests that cell-free Hb is central in the pathophysiology of the injury to the immature brain following GM-IVH. An increased understanding of the causal pathways and metabolites involved in eliciting the damaging response following hemorrhage is essential for the continued development and implementation of neuroprotective treatments of GM-IVH in preterm infant. Methods We exposed immature primary rat mixed glial cells to hemorrhagic CSF obtained from preterm human infants with IVH (containing a mixture of Hb-metabolites) or to a range of pure Hb-metabolites, incl. oxidized Hb (mainly metHb with iron in Fe3+), oxyHb (mainly Fe2+), or low equivalents of heme, with or without co-administration with human Hp (a mixture of isotype 2-2/2-1). Following exposure, cellular response, reactive oxygen species (ROS) generation, secretion and expression of pro-inflammatory cytokines and oxidative markers were evaluated. Results Exposure of the glial cells to hemorrhagic CSF as well as oxidized Hb, but not oxyHb, resulted in a significantly increased rate of ROS production that positively correlated with the rate of production of pro-inflammatory and oxidative markers. Congruently, exposure to oxidized Hb caused a disintegration of the polygonal cytoskeletal structure of the glial cells in addition to upregulation of F-actin proteins in microglial cells. Co-administration of Hp partially reversed the damaging response of hemorrhagic CSF and oxidized Hb. Conclusion Exposure of mixed glial cells to oxidized Hb initiates a pro-inflammatory and oxidative response with cytoskeletal disintegration. Early administration of Hp, aiming to minimize the spontaneous autoxidation of cell-free oxyHb and liberation of heme, may provide a therapeutic benefit in preterm infant with GM-IVH.

The aim of this study is to study learning the positional ten base notation by the increase of students' test scores during the learning study process. Five teachers, one researcher and 53 students participated. Three research lessons in three different groups of students were conducted. The improvement in the third lesson (C) correlates with the more developed theoretical based assumptions the design is made, which resulted in a pattern of variation that stronger pointed out the aspect needed to discern to understand the object of learning in a new and more developed way. The differences in the third research lesson (C) was significant** p = 0.005 while the differences in research lessons A and B were not significant.

Abstract Background Interpersonal psychotherapy (IPT) can be effective for both Bulimia Nervosa (BN) and co-occurring depression. While changes in symptoms of Eating disorder (ED) and depression have been found to correlate, it is unclear how they interact during treatment and in which order the symptoms decrease. Methods Thirty-one patients with BN and depressive symptoms received IPT using the manual IPT-BNm in a naturalistic design. The outcome was measured with the Eating Disorder Examination Questionnaire (EDE-Q) and the Montgomery Åsberg Depression Rating Scale (MADRS-S). Symptom improvement at each session was measured with Repeated Evaluation of Eating Disorder Symptoms (REDS) and the Patient Health Questionnaire-9 (PHQ-9). Results Significant improvements with large effect sizes were found on both ED symptoms and depression. The rates of change were linear for both BN and depression. A strong correlation between reduction of depressive symptoms and ED symptoms was found. Depressive symptom reduction at one session predicted improvement of ED symptoms at the next session. Conclusions IPT-BNm had an effect on both BN and co-occurring depressive symptoms. The analyses indicated that reduction in depressive symptoms preceded reduction in bulimic symptoms.

Abstract Background Emotion regulation difficulties appear to play a role in the development and maintenance of several eating disorders. This pilot study aimed at examining whether a short add-on group skills training in emotion regulation for young adults with different eating disorders was feasible in a psychiatric clinical setting. We also investigated if the treatment increased knowledge of emotions, and decreased self-reported difficulties with emotion regulation, alexithymia, symptoms of eating disorder, anxiety and depression, as well as clinical impairment. Methods Six skills training groups were piloted with a total of 29 participants (M = 21.41 years, SD = 1.92). The treatment consisted of five sessions dealing with psychoeducation about emotions and emotion regulation skills training. Paired samples t-test was used to compare differences between before-and-after measures. Results The primary outcomes measures difficulties in emotion regulation (p

Abstract Background It is well known that a severe cell injury after exposure to ionizing radiation is the induction of DNA double-strand breaks (DSBs). After exposure, an early response to DSBs is the phosphorylation of the histone H2AX molecule regions adjacent to the DSBs, referred to as γ-H2AX foci. The γ-H2AX assay after external exposure is a good tool for investigating the link between the absorbed dose and biological effect. However, less is known about DNA DSBs and γ-H2AX foci within the tissue microarchitecture after internal irradiation from radiopharmaceuticals. Therefore, in this study, we aimed to develop and validate a quantitative ex vivo model using γ-H2AX immunofluorescence staining and confocal laser scanning microscopy (CLSM) to investigate its applicability in nuclear medicine dosimetry research. Liver and testis were selected as the organs to study after intravenous administration of 111InCl3. Results In this study, we developed and validated a method that combines ex vivo γ-H2AX foci labeling of tissue sections with in vivo systemically irradiated mouse testis and liver tissues. The method includes CLSM imaging for intracellular cell-specific γ-H2AX foci detection and quantification and absorbed dose calculations. After exposure to ionizing radiation from 111InCl3, both hepatocytes and non-hepatocytes within the liver showed an absorbed dose-dependent elevation of γ-H2AX foci, whereas no such correlation was seen for the testis tissue. Conclusion It is possible to detect and quantify the radiation-induced γ-H2AX foci within the tissues of organs at risk after internal irradiation. We conclude that our method developed is an appropriate tool to study dose–response relationships in animal organs and human tissue biopsies after internal exposure to radiation.

Objective: To evaluate the effect of multi-grip myoelectric prosthetic hands on performance of daily activities, pain-related disability and prosthesis use, in comparison with single-grip myoelectric prosthetic hands. Design: Single-case AB design. Patients: Nine adults with upper-limb loss participated in the study. All had previous experience of single-grip myoelectric prostheses and were prescribed a prosthesis with multi-grip functions. Methods: To assess the changes in daily activities, pain-related disability and prosthesis use between single-grip and multi-grip myoelectric prosthetic hands, the Canadian Occupational Performance Measure, Pain Disability Index, and prosthesis wearing time were measured at multiple time-points. Visual assessment of graphs and multi-level linear regression were used to assess changes in the outcome measures. Results: At 6 months’ follow-up self-perceived performance and satisfaction scores had increased, prosthesis wearing time had increased, and pain-related disability had reduced in participants with musculoskeletal pain at baseline. On average, 8 of the 11 available grip types were used. Most useful were the power grip, tripod pinch and lateral pinch. Conclusion: The multi-grip myoelectric prosthetic hand has favourable effects on performance of, and satisfaction with, individually chosen activities, prostheses use and pain-related disability. A durable single-grip myoelectric prosthetic hand may still be needed for heavier physical activities. With structured training, a standard 2-site electrode control system can be used to operate a multi-grip myoelectric prosthetic hand. Lay Abstract Individuals with upper limb loss are often offered prosthetic hands during the rehabilitation process, to restore body balance and compensate for lack of grip ability. Prosthetic hands with multiple grip functions have been developed to facilitate fine motor skills and enable an ergonomic movement pattern. However, the impact of these hands on the users’ daily life has been sparsely studied, and the results have been inconsistent. This study evaluates the effect of multi-grip hands on the performance of daily activities, pain-related disability and prosthesis use, compared to single-grip hands. Based on our results, a multi-grip hand was more useful than a single-grip model for performance of specific, individually chosen activities. Further, prosthesis use increased and pain-related disability was reduced by the use of a multi-grip hand. Multi-grip prosthetic hands seem to fill a gap in prosthetic rehabilitation and facilitate activity performance, and are something clinicians can recommend to their patients.

Background. To perform daily activities, time management and organizational skills are essential and therefore also important intervention focus in occupational therapy. To guide and evaluate intervention, valid and reliable instruments that measure time management and organization skills are necessary. The aim of this study was to evaluate the psychometric properties of the Assessment of Time Management Skills (ATMS). Methods. Eligible participants were volunteer adults from the general population who were aged between 18 and 65 years, had a good understanding of English, and were not currently involved in any training or education to improve time management. The ATMS was filled out as a computer-administered survey. Rasch measurement analysis was used to evaluate the validity and aspects of reliability of the ATMS. Results. In total, 241 adults (112 male and 129 female, mean age=40) participated. The analysis of principal components of residuals (PCA) and the item goodness-of-fit indicated that the 30-item scale does not measure only one single trait. Three subscales, time management (11 items), organization and planning (11 items), and regulation of emotion (5 items), were detected. One item each on the 11-item subscale showed misfit, but they were kept due to high relevance. All three subscales showed excellent results on analyses of PCA, local independence, and reliability. Conclusions and Relevance. ATMS can provide valid measures of time management, organization and planning skills, and regulation of emotion in a general population and presumably also in a population with cognitive impairment. The measure is useful for occupational therapists in assessing patients’ strengths and barriers in time management skills. It can also be useful in identifying the necessity of training time management skills, to guide OT intervention programs and to evaluate interventions. What This Article Adds. Knowledge about the psychometric properties and usefulness of the ATMS in English-speaking countries.