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This study investigated whether the improved performance observed with maximal self-paced single-leg (SL), compared with double-leg (DL) cycling, is associated with enhanced femoral blood flow and/or altered tissue oxygenation. The hyperaemic response to exercise was assessed in younger and older athletes. Power output was measured in 12 older (65 ± 4 y) and 12 younger (35 ± 5 y) endurance-trained individuals performing 2 x 3 min maximal self-paced exercise using SL and DL cycling. Blood flow (BF) in the femoral artery was assessed using Doppler ultrasound and muscle oxygenation was measured using near-infrared spectroscopy on the vastus lateralis. SL cycling elicited a greater power output (295 ± 83 vs 265 ± 70 W, P < 0.001) and peak femoral BF (1749.1 ± 533.3 vs 1329.7 ± 391.7 ml/min, P < 0.001) compared with DL cycling. Older individuals had a lower peak BF in response to exercise (1355.4 ± 385.8 vs 1765.2 ± 559.6 ml/min, P = 0.019) compared with younger individuals. Peak BF in response to exercise was correlated with power output during SL (r = 0.655, P = 0.002) and DL (r = 0.666, P = 0.001) cycling. The greater exercise performance during SL compared with DL cycling may be partly explained by a greater hyperaemic response when reducing active muscle mass. Despite regular endurance training, older athletes had a lower femoral BF in response to maximal self-paced exercise compared with younger athletes.

Ripley, NJ, Comfort, P, and McMahon, JJ. Relationships between modifiable risk factors of hamstring strain injury. J Strength Cond Res 38(3): 510-516, 2024 - The aims of this study were to determine whether any relationship exists between eccentric hamstring strength and isokinetic strength imbalances and bicep femoris long head (BFLH) architecture. Eighteen physically active men (age 24.7 ± 4.3 years, height 181.9 ± 7.2 cm, mass 84.9 ± 12.9 kg) had resting BFLHmuscle architecture assessed using ultrasound, with images taken at the midmuscle belly. Measures of isokinetic strength of the knee extensors and flexors involved subjects performing 3 maximal effort repetitions of concentric knee extension and eccentric knee flexion at 60°·s-1. Good-excellent relative reliability (intraclass correlation coefficient ≥ 0.86) and low variability (coefficient of variation < 10%) were observed for all variables. Relative BFLHfascicle length (FL) demonstrated significant moderate-to-nearly-perfect associations with isokinetic measures identified as hamstring strain injury risk factors (p < 0.05, r = 0.38-0.92), whereas absolute BFLHFL was not significantly or meaningfully associated with isokinetic measures (p = 0.07-0.961, r = 0.01-0.30). Relative BFLHFL should be considered when assessing resting BFLHmuscle architecture because it is potentially a more appropriate measure of injury risk because of its greater association with strength measures. However, absolute BFLHFL may have a greater usefulness during growth, maturation, and individual proportions.

The discourse surrounding equity, diversity and inclusion is gaining significant traction across various domains, and the world of sports medicine is no exception. Recognising the profound impact of societal structures, cultural norms, systemic and unconscious biases is imperative for all of us. We need to be comfortable with discomfort and address these issues head-on to move the field forward. . . .

Background: Australia has one of the highest rates of asbestos-associated diseases. Mesothelioma remains an area of unmet need with a 5-year overall survival of 10%. First-line immunotherapy with ipilimumab and nivolumab is now a standard of care for unresectable pleural mesothelioma following the CheckMate 743 trial, with supportive data from the later line single-arm MAPS2 trial. RIOMeso evaluates survival and toxicity of this regimen in real-world practice. Methods: Demographic and clinicopathologic data of Australian patients treated with ipilimumab and nivolumab in first- and subsequent-line settings for pleural mesothelioma were collected retrospectively. Survival was reported using the Kaplan-Meier method and compared between subgroups with the log-rank test. Toxicity was investigator assessed using Common Terminology Criteria for Adverse Events version 5.0. Results: A total of 119 patients were identified from 11 centers. The median age was 72 years, 83% were male, 92% had Eastern Cooperative Oncology Group less than or equal to 1, 50% were past or current smokers, and 78% had known asbestos exposure. In addition, 50% were epithelioid, 19% sarcomatoid, 14% biphasic, and 17% unavailable. Ipilimumab and nivolumab were used first line in 75% of patients. Median overall survival (mOS) was 14.5 months (95% confidence interval [CI]: 13.0–not reached [NR]) for the entire cohort. For patients treated first line, mOS was 14.5 months (95% CI: 12.5–NR) and in second- or later-line patients was 15.4 months (95% CI: 11.2–NR). There was no statistically significant difference in mOS for epithelioid patients compared with nonepithelioid (19.1 mo [95% CI: 15.4–NR] versus 13.0 mo [95% CI: 9.7–NR], respectively, p = 0.064). Furthermore, 24% of the patients had a Common Terminology Criteria for Adverse Events grade greater than or equal to 3 adverse events, including three treatment-related deaths. Colitis was the most frequent adverse event. Conclusions: Combination immunothe

Worldwide stroke is the second leading cause of death and the third leading cause of death and disability combined. The estimated global economic burden by stroke is over US$891 billion per year. Within three decades (1990–2019), the incidence increased by 70%, deaths by 43%, prevalence by 102%, and DALYs by 143%. Of over 100 million people affected by stroke, about 76% are ischemic stroke (IS) patients recorded worldwide. Contextually, ischemic stroke moves into particular focus of multi-professional groups including researchers, healthcare industry, economists, and policy-makers. Risk factors of ischemic stroke demonstrate sufficient space for cost-effective prevention interventions in primary (suboptimal health) and secondary (clinically manifested collateral disorders contributing to stroke risks) care. These risks are interrelated. For example, sedentary lifestyle and toxic environment both cause mitochondrial stress, systemic low-grade inflammation and accelerated ageing; inflammageing is a low-grade inflammation associated with accelerated ageing and poor stroke outcomes. Stress overload, decreased mitochondrial bioenergetics and hypomagnesaemia are associated with systemic vasospasm and ischemic lesions in heart and brain of all age groups including teenagers. Imbalanced dietary patterns poor in folate but rich in red and processed meat, refined grains, and sugary beverages are associated with hyperhomocysteinaemia, systemic inflammation, small vessel disease, and increased IS risks. Ongoing 3PM research towards vulnerable groups in the population promoted by the European Association for Predictive, Preventive and Personalised Medicine (EPMA) demonstrates promising results for the holistic patient-friendly non-invasive approach utilising tear fluid-based health risk assessment, mitochondria as a vital biosensor and AI-based multi-professional data interpretation as reported here by the EPMA expert group. Collected data demonstrate that IS-relevant risks and

This study aimed to investigate how overall competitive winningness in combat sports depended on patterns of victory and loss, as well as training habits. Competitors (N = 280) from several combat sports participated in the study. The online survey included questions on self-reported patterns of victory (and loss), training habits, general demographics (e.g., age), and sport-specific information (e.g., stage of career and competitive style). Overall, it was found across four models that reflected diversity of winningness in combat sports that the most important predictors of competitive winningness were loss by points (negative), loss by submission (negative), loss (negative) or victory (positive) by throw or technical fall, and loss (negative) or victory (positive) by knockout. The findings applied to amateur and regional/state athletes, and rarely to karate or tae kwon do. Findings around demographics or training habits were largely unremarkable, outside of a relationship between higher training loads and less career winning in wrestlers. Results show that while winning via a finishing sequence (e.g., knockout or submission) is preferable to the judge's decision or points, the matter of victory is less important than the methods by which an athlete loses. In grappling-only sports, we observed a trend that more losses via finishing sequence were worse for careers than losing by points. In fact, having most of one's losses coming via judge's decision or points was beneficial in wrestling and judo, perhaps due to athletes taking less risks and having better defence. These findings may aid practitioners developing effective tactics and training programs.

Identifying rare patterns for medical diagnosis is a challenging task due to heterogeneity and the volume of data. Data summarization can create a concise version of the original data that can be used for effective diagnosis. In this paper, we propose an ensemble summarization method that combines clustering and sampling to create a summary of the original data to ensure the inclusion of rare patterns. To the best of our knowledge, there has been no such technique available to augment the performance of anomaly detection techniques and simultaneously increase the efficiency of medical diagnosis. The performance of popular anomaly detection algorithms increases significantly in terms of accuracy and computational complexity when the summaries are used. Therefore, the medical diagnosis becomes more effective, and our experimental results reflect that the combination of the proposed summarization scheme and all underlying algorithms used in this paper outperforms the most popular anomaly detection techniques.

Aims: To review the contemporary international literature on nurse preceptor competencies and map the components and their descriptors. Review Methods: A mapping review. Data Sources: Articles reporting evidence-based and validated Registered Nurse (RN) preceptor competencies published between 2013 and 2022 were identified. Open access databases such as PubMed and Google Scholar and the library healthcare databases Scopus and CINAHL were searched. The authors collaborated at each review stage that included screening, article selection, tabulation, mapping and preparation of findings. Results: Seven quantitative studies were included. Three were based on existing nurse preceptor competency data sets and four were purposely developed using collaborative research methods. Each study validated findings through a survey of nurse stakeholders. Three key competencies shared across all studies were ‘facilitating teaching’, ‘being a role model’ and ‘evaluating student's performance’. The number of competency categories ranged from three to 10 and the accompanying item descriptors from 9 to 83. Although terminology describing data sets was inconsistent, similarity was seen across competency domains. Conclusion: The contemporary nursing preceptor role is considered an emerging specialist education role. The results offer a set of validated preceptor competency descriptors, applicable to practice, that provide insight into ways employers may recruit, support and retain nurse preceptors. Implications for the Profession: The mapped results provide a concise summary of nurse preceptor competency research internationally that can inform further development of RN preceptors. Impact: This review addresses the lack of consensus around nursing preceptor competencies for clinical supervision of undergraduate nursing students. Seven competency domains were identified describing key preceptor role capabilities. The domains Facilitator’, ‘Role model’ and ‘Evaluator’ featured across the inc

Background: Clinical placements (CPs) in the final year of nursing education largely impact nursing students’ professional development by exposing them to nursing realities. Nursing students also use placement exposure to identify suitable career opportunities for their upcoming professional life. However, there is limited evidence on how final-year CPs may attract pre-registration nursing students into different nursing specialties, including hospital and non-hospital settings. Aim: To explore the influence of CPs in the final year of nursing education on pre-registration student nurses’ career decisions. Method: A narrative inquiry approach was utilised. A purposeful sample of 12 final-year students from two Western Australian public universities participated in the study. Data were collected through semi-structured individual interviews. This article follows the Consolidated Criteria for Reporting Qualitative Research. Findings: The final-year CPs mainly influenced nursing students’ career decisions in three ways: they helped them create new career paths, and some students refined their career plans while others reaffirmed their career choices. Four main themes were generated, including nature of the clinical environment, ward or unit culture, preceptorship, and career progression. Conclusion: The final year of study is crucial for nursing students as they make career plans in preparation for the transition to their professional roles. The students make short- and long-term career plans at this stage, which may influence their commitment to nursing. Implication for practice: The outcome of this study may assist stakeholders in nursing education and health care in developing policies for CPs and students’ career guidance. These policies may encourage pre-registration nurses to develop career interests in the less-preferable nursing specialties such as community nursing and residential aged care.

Background: Inflammatory bowel disease (IBD), which includes Crohn’s disease (CD) and ulcerative colitis (UC), has been associated with several cancer risks in observational studies, but the observed associations have been inconsistent and may face the bias of confounding and reverse causality. The potential causal relationships between IBD and the risk of cancers remain largely unclear. Methods: We performed genome-wide linkage disequilibrium score regression (LDSC), standard two-sample Mendelian randomization (MR), and colocalization analyses using summary genome-wide association study (GWAS) data across East Asian and European populations to evaluate the causal relationships between IBD and cancers. Sensitivity analyses for the MR approach were additionally performed to explore the stability of the results. Results: There were no significant genetic correlations between IBD, CD, or UC and cancers (all P values > 0.05) in East Asian or European populations. According to the main MR analysis, no significant causal relationship was observed between IBD and cancers in the East Asian population. There were significant associations between CD and ovarian cancer (odds ratio [OR] = 0.898, 95% CI = 0.844–0.955) and between UC and nonmelanoma skin cancer (OR = 1.002, 95% CI = 1.000–1.004, P = 0.019) in the European population. The multivariable MR analysis did not find any of the above significant associations. There was no shared causal variant to prove the associations of IBD, CD, or UC with cancers in East Asian or European populations using colocalization analysis. Conclusions: We did not provide robust genetic evidence of causal associations between IBD and cancer risk. Exposure to IBD might not independently contribute to the risk of cancers, and the increased risk of cancers observed in observational studies might be attributed to factors accompanying the diagnosis of IBD.

Backgrounds/Aims: Optimal intravenous fluid management during the perioperative period for patients undergoing pancreaticoduodenectomy (PD) within the framework of enhanced recovery after surgery (ERAS) is unclear. Studies have indicated that excessive total body salt and water can contribute to the development of oedema, leading to increased morbidity and extended hospital stays. This study aimed to assess the effects of an intravenous therapy regimen during postoperative day (POD) 0 to 2 in PD patients within ERAS. Methods: A retrospective interventional cohort study was conducted, and it involved all PD patients before and after implementation of ERAS (2009–2017). In the ERAS group, a targeted maintenance fluid regimen of 20 mL/kg/day with a sodium requirement of 0.5 mmoL/kg/day was administered. Outcome measures included the mmol of sodium and chloride administered, length of stay, and morbidity (postoperative pancreatic fistula, POPF; acute kidney injury, AKI; ileus). Results: The study included 169 patients, with a mean age of 64 ± 11.3 years. Following implementation of the intravenous fluid therapy protocol, there was a significant reduction in chloride and sodium loading. However, in the multivariable analysis, chloride administered (mmoL/kg) did not independently influence the length of stay; or rates of POPF, ileus, or AKI (p > 0.05). Conclusions: The findings suggested that a postoperative intravenous fluid therapy regimen did not significantly impact morbidity. Notably, there was a trend towards reduced length of stay within an increasingly comorbid patient cohort. This targeted fluid regimen appears to be safe for PD patients within the ERAS program. Further prospective research is needed to explore this area.

Background: The dietary source and intake levels of nitrate and nitrite may govern its deleterious versus beneficial effects on human health. Existing evidence on detailed source-specific intake is limited. The objectives of this study were to assess nitrate and nitrite intakes from different dietary sources (plant-based foods, animal-based foods, and water), characterize the background diets of participants with low and high intakes, and investigate how sociodemographic and lifestyle factors associate with intake levels. Methods: In the Danish Diet, Cancer and Health Cohort, sociodemographic and lifestyle information was obtained from participants at enrolment (1993–1997). Source-dependent nitrate and nitrite intakes were calculated using comprehensive food composition databases, with tap water nitrate intakes estimated via the national drinking water quality monitoring database linked with participants’ residential addresses from 1978 to 2016. Underlying dietary patterns were examined using radar plots comparing high to low consumers while sociodemographic predictors of source-dependent nitrate intakes were investigated using linear regression models. Results: In a Danish cohort of 55,754 participants aged 50–65 at enrolment, the median [IQR] intakes of dietary nitrate and nitrite were 58.13 [44.27–74.90] mg/d and 1.79 [1.43–2.21] mg/d, respectively. Plant-based foods accounted for ~76% of nitrate intake, animal-based foods ~10%, and water ~5%. Nitrite intake was sourced roughly equally from plants and animals. Higher plant-sourced nitrate intake was associated with healthier lifestyles, better dietary patterns, more physical activity, higher education, lower age and lower BMI. Females and participants who had never smoked also had significantly higher plant-sourced nitrate intakes. Higher water-sourced nitrate intake was linked to sociodemographic risk factors (smoking, obesity, lower education). Patterns for animal-sourced nitrate were less clear. Conclusion: Pa

Background: Obesity is a classified risk factor for several of the world’s leading causes of death. In this study, we combined information contained in body mass index (BMI), total percentage body fat (TPBF) and relative fat mass (RFM) to estimate obesity prevalence and examine the risk factors associated with obesity. Methods: The study recruited 1027 undergraduate students aged between 16 and 25 years using a cross-sectional study design and two-stage stratified random sampling between January and April 2019 from the Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. Demographic, lifestyle, and family history of chronic disease data, were collected using a structured questionnaire. Bioelectrical impedance, along with height, weight, age, and gender, were used to estimate BMI and TPBF. The RFM was calculated using a published equation. The TPBF and RFM ranges were evaluated based on standard BMI thresholds and an informative combined obesity prevalence estimated in a Bayesian framework. Multiple logistic regression analysis was used to evaluate potential risk factors of overweight/obesity. Results: Concordance between BMI, TPBF and RFM for obesity classification was 84% among female and 82.9% among male students. The Bayesian analysis revealed a combined prevalence means of obesity of 9.4% (95%CI: 6.9-12.2%) among female students and 6.7% (95%CI:4.3-9.5%) among male students. The odds of obesity were increased between 1.8 and 2.5 for females depending on the classification index. A significant increasing trend of obesity was observed with university-level. A family history of obesity was associated with a high estimate of general, central, and high TPBF. Conclusion: Using multiple adiposity indicators conjointly in a Bayesian framework offers a greater power to examine obesity prevalence. We have applied this and reported high obesity prevalence, especially among female students. University level and family history of obesity were key determinants f

This is a protocol for a Cochrane Review. The objectives are as follows. This paper aims to describe a protocol for a systematic review that will synthesise the qualitative evidence regarding factors influencing the implementation of non-pharmacological interventions (NPIs) for behavioural and psychological symptoms of dementia (BPSD) management in residential aged care homes (RACHs). The planned systematic review aims to answer the research question: ‘What are the factors influencing the implementation of NPIs in the management of BPSD at RACHs?’. Additionally, the planned systematic review also aims to generate recommendations to guide stakeholders (e.g., clinicians and aged care staff) and policymakers in the implementation of NPIs for managing BPSD at RACHs.

Background: One of the pathological hallmarks distinguishing Alzheimer's disease from other dementias is the accumulation of amyloid beta (A ). Higher physical activity is associated with decreased dementia risk, and one potential path could be through A levels modulation. We aimed to explore the relationship between physical activity and A in middle-aged and older adults. Methods: A systematic search of PubMed, Web of Science, PsycINFO, Cochrane Central Register of Controlled Trials, and SPORTDiscus was performed from inception to April 28, 2022. Studies were eligible if they included physical activity and A data in adults aged 45 years or older. Multi-level meta-analyses of intervention and observational studies were performed to examine the role of physical activity in modulating A levels. Results: In total, 37 articles were included (8 randomized controlled trials, 3 non-randomized controlled trials, 4 prospective longitudinal studies, and 22 cross-sectional studies). The overall effect size of physical activity interventions on changes in blood A was medium (pooled standardized mean difference = –0.69, 95% confidence interval (95%CI): –1.41 to 0.03; I2 = 74.6%). However, these results were not statistically significant, and there were not enough studies to explore the effects of physical activity on cerebrospinal fluid (CSF) and brain A . Data from observational studies were examined based on measurements of A in the brain using positron emission tomography scans, CSF, and blood. Higher physical activity was positively associated with A only in the CSF (Estimate r = 0.12; 95%CI: 0.05–0.18; I2 = 38.00%). Conclusion: Physical activity might moderately reduce blood A in middle-aged and older adults. However, results were only near statistical significance and might be interpreted with caution given the methodological limitations observed in some of the included studies. In observational studies, higher levels of physical activity were positively associated with A

Problem: Like other low- and middle-income countries, Ghana has high maternal mortality stemming from pre-eclampsia. Ghanaian midwives are frontline service providers of emergency care in obstetric complications and have the greatest potential to maximise pre-eclampsia outcomes. Little is known about the potential barriers and challenges to midwives' capacity to provide quality care in pre-eclampsia in Ghana. Therefore, we aimed to explore and gain insights into midwives’ experiences of pre-eclampsia care including their knowledge, skills, and psychological aspects such as midwives' resilience. Background: There is a rising global incidence of pre-eclampsia. Quality midwifery care in inter-professional collaborative practice is crucial to reducing pre-eclampsia-related morbidity and mortality. Methods: A qualitative descriptive exploratory study. In-depth semi-structured interviews (n = 35) were performed in 2021 and analysed by thematic analysis. Findings: There were three main themes. 1) Competence and Confidence in care; midwives provided timely and appropriate care based on sound knowledge and skills; they explained how pre-eclampsia care was organised within a multidisciplinary context and described collaborative working amongst midwives for mutual learning and support. 2) Emotional concerns and empathy; midwives’ described fulfillment in achieving positive pre-eclampsia outcomes. In contrast, maternal loss was distressing and traumatic. 3) Call for improved care resources for pre-eclampsia; midwives recommended expansion of continuing professional development opportunities, appropriate infrastructure, resources, tailored public education, and a review of pre-service education to support their participation in pre-eclampsia care. Conclusion: To improve the quality of care in pre-eclampsia, midwives should be capacitated, systems should promptly address barriers, and prioritise midwives’ emotional well-being.

Aims: This study had three objectives: 1) to determine final-year nursing students' career preferences and long-term career plans; 2) to investigate factors influencing nursing students' specialty choices following their final-year clinical placement(s); and 3) to understand how final-year clinical placements can be used to develop the career interests of nursing students to different nursing specialties. Background: Clinical placement provides an insightful experience that may influence students to feel inclined to work in certain specialties. Therefore, each clinical placement should promote students' learning and enhance positive experiences that could develop their career interests and encourage them to seek employment in the specialty on graduation. Design: A cross-sectional online survey. Methods: The survey was structured using the Career Decision Self-Efficacy Scale – Short Form. The questionnaire was distributed to final-year nursing students (N = 222) at two public universities in Western Australia. This study specifically reports on the Goal selection and Planning domains of the Career Decision Self-Efficacy Scale – Short Form, which were explored through additional questions prompting participants to explain their career preferences and reasons for their nursing specialty choices. Results: Most participants, fifty-three percent, had low confidence in making career decisions. The Goal Selection and Planning questions measured the students' confidence in choosing a suitable practice destination and preparing for their professional careers. Overall, participants prefer employment in hospital settings both in the short- and long-term aspects of their nursing career. The factors influencing the students' career decisions were classified into three main categories: the clinical environment, educational factors and individual factors. Conclusions: The nursing curriculum may encourage nursing students to work in some specialties over others. This study provides

Background: The relationship between nurse staffing, skill-mix and quality of care has been well-established in medical and surgical settings, however, there is relatively limited evidence of this relationship in emergency departments. Those that have been published identified that lower nurse staffing levels in emergency departments are generally associated with worse outcomes with the conclusion that the evidence in emergency settings was, at best, weak. Methods: We searched thirteen electronic databases for potentially eligible papers published in English up to December 2023. Studies were included if they reported on patient outcomes associated with nurse staffing within emergency departments. Observational, cross-sectional, prospective, retrospective, interrupted time-series designs, difference-in-difference, randomised control trials or quasi-experimental studies and controlled before and after studies study designs were considered for inclusion. Team members independently screened titles and abstracts. Data was synthesised using a narrative approach. Results: We identified 16 papers for inclusion; the majority of the studies (n = 10/16) were observational. The evidence reviewed identified that poorer staffing levels within emergency departments are associated with increased patient wait times, a higher proportion of patients who leave without being seen and an increased length of stay. Lower levels of nurse staffing are also associated with an increase in time to medications and therapeutic interventions, and increased risk of cardiac arrest within the emergency department. Conclusion: Overall, there remains limited high-quality empirical evidence addressing the association between emergency department nurse staffing and patient outcomes. However, it is evident that lower levels of nurse staffing are associated with adverse events that can result in delays to the provision of care and serious outcomes for patients. There is a need for longitudinal studies coup

Background: Colorectal cancer (CRC) is a highly heterogeneous cancer. This heterogeneity has an impact on the efficacy of immunotherapy. Long noncoding RNAs (lncRNAs) have been found to play regulatory functions in cancer immunity. However, the global landscape of immune-derived lncRNA signatures has not yet been explored in colorectal cancer. Methods: In this study, we applied DESeq2 to identify differentially expressed lncRNAs in colon cancer. Next, we performed an integrative analysis to globally identify immune-driven lncRNA markers in CRC, including immune-associated pathways, tumor immunogenomic features, tumor-infiltrating immune cells, immune checkpoints, microsatellite instability (MSI) and tumor mutation burden (TMB). Results: We also identified dysregulated lncRNAs, such as LINC01354 and LINC02257, and their clinical relevance in CRC. Our findings revealed that the differentially expressed lncRNAs were closely associated with immune pathways. In addition, we found that RP11-354P11.3 and RP11-545G3.1 had the highest association with the immunogenomic signature. As a result, these signatures could serve as markers to assess immunogenomic activity in CRC. Among the immune cells, resting mast cells and M0 macrophages had the highest association with lncRNAs in CRC. The AC006129.2 gene was significantly associated with several immune checkpoints, for example, programmed cell death protein 1 (PD-1) and B and T lymphocyte attenuator (BTLA). Therefore, the AC006129.2 gene could be targeted to regulate the condition of immune cells or immune checkpoints to enhance the efficacy of immunotherapy in CRC patients. Finally, we identified 15 immune-related lncRNA-generated open reading frames (ORFs) corresponding to 15 cancer immune epitopes. Conclusion: In conclusion, we provided a genome-wide immune-driven lncRNA signature for CRC that might provide new insights into clinical applications and immunotherapy.

The advancement of RNAseq and isoform-specific expression platforms has led to the understanding that isoform changes can alter molecular signaling to promote tumorigenesis. An active area in cancer research is uncovering the roles of ubiquitination on spliceosome assembly contributing to transcript diversity and expression of alternative isoforms. However, the effects of isoform changes on functionality of ubiquitination machineries (E1, E2, E3, E4, and deubiquitinating (DUB) enzymes) influencing onco- and tumor suppressor protein stabilities is currently understudied. Characterizing these changes could be instrumental in improving cancer outcomes via the identification of novel biomarkers and targetable signaling pathways. In this review, we focus on highlighting reported examples of direct, protein-coded isoform variation of ubiquitination enzymes influencing cancer development and progression in gastrointestinal (GI) malignancies. We have used a semi-automated system for identifying relevant literature and applied established systems for isoform categorization and functional classification to help structure literature findings. The results are a comprehensive snapshot of known isoform changes that are significant to GI cancers, and a framework for readers to use to address isoform variation in their own research. One of the key findings is the potential influence that isoforms of the ubiquitination machinery have on oncoprotein stability.

Presented at the 2024 Association of periOperative Registered Nurses (AORN) Global Surgical Conference & Expo.

STUDY DESIGN: Systematic review update. OBJECTIVES: Interventions that aim to optimize spinal cord perfusion are thought to play an important role in minimizing secondary ischemic damage and improving outcomes in patients with acute traumatic spinal cord injuries (SCIs). However, exactly how to optimize spinal cord perfusion and enhance neurologic recovery remains controversial. We performed an update of a recent systematic review (Evaniew et al, J. Neurotrauma 2020) to evaluate the effects of Mean Arterial Pressure (MAP) support or Spinal Cord Perfusion Pressure (SCPP) support on neurological recovery and rates of adverse events among patients with acute traumatic SCI. METHODS: We searched PubMed/MEDLINE, EMBASE and ClinicalTrials.gov for new published reports. Two reviewers independently screened articles, extracted data, and evaluated risk of bias. We implemented the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach to rate confidence in the quality of the evidence. RESULTS: From 569 potentially relevant new citations since 2019, we identified 9 new studies for inclusion, which were combined with 19 studies from a prior review to give a total of 28 studies. According to low or very low quality evidence, the effect of MAP support on neurological recovery is uncertain, and increased SCPP may be associated with improved neurological recovery. Both approaches may involve risks for specific adverse events, but the importance of these adverse events to patients remains unclear. Very low quality evidence failed to yield reliable guidance about particular monitoring techniques, perfusion ranges, pharmacological agents, or durations of treatment. CONCLUSIONS: This update provides an evidence base to support the development of a new clinical practice guideline for the hemodynamic management of patients with acute traumatic SCI. While avoidance of hypotension and maintenance of spinal cord perfusion are important principles in the management

OBJECTIVE: To synthesize evidence for the effectiveness of self-management interventions for chronic health conditions that have symptom overlap with traumatic brain injury (TBI) in order to extract recommendations for self-management intervention in persons with TBI. DESIGN: An umbrella review of existing systematic reviews and/or meta-analyses of randomized controlled trials or nonrandomized studies targeting self-management of chronic conditions and specific outcomes relevant to persons with TBI. METHOD: A comprehensive literature search of 5 databases was conducted using PRISMA guidelines. Two independent reviewers conducted screening and data extraction using the Covidence web-based review platform. Quality assessment was conducted using criteria adapted from the Assessing the Methodological Quality of Systematic Reviews-2 (AMSTAR-2). RESULTS: A total of 26 reviews met the inclusion criteria, covering a range of chronic conditions and a range of outcomes. Seven reviews were of moderate or high quality and focused on self-management in persons with stroke, chronic pain, and psychiatric disorders with psychotic features. Self-management interventions were found to have positive effects on quality of life, self-efficacy, hope, reduction of disability, pain, relapse and rehospitalization rates, psychiatric symptoms, and occupational and social functioning. CONCLUSIONS: Findings are encouraging with regard to the effectiveness of self-management interventions in patients with symptoms similar to those of TBI. However, reviews did not address adaptation of self-management interventions for those with cognitive deficits or for populations with greater vulnerabilities, such as low education and older adults. Adaptations for TBI and its intersection with these special groups may be needed.

STUDY DESIGN: Systematic review and meta-analysis. OBJECTIVE: Surgical decompression is a cornerstone in the management of patients with traumatic spinal cord injury (SCI); however, the influence of the timing of surgery on neurological recovery after acute SCI remains controversial. This systematic review aims to summarize current evidence on the effectiveness, safety, and cost-effectiveness of early (≤24 hours) or late (>24 hours) surgery in patients with acute traumatic SCI for all levels of the spine. Furthermore, this systematic review aims to evaluate the evidence with respect to the impact of ultra-early surgery (earlier than 24 hours from injury) on these outcomes. METHODS: A systematic search of the literature was performed using the MEDLINE database (PubMed), Cochrane database, and EMBASE. Two reviewers independently screened the citations from the search to determine whether an article satisfied predefined inclusion and exclusion criteria. For all key questions, we focused on primary studies with the least potential for bias and those that controlled for baseline neurological status and specified time from injury to surgery. Risk of bias of each article was assessed using standardized tools based on study design. Finally, the overall strength of evidence for the primary outcomes was assessed using the GRADE approach. Data were synthesized both qualitatively and quantitively using meta-analyses. RESULTS: Twenty-one studies met inclusion and exclusion criteria and formed the evidence base for this review update. Seventeen studies compared outcomes between patients treated with early (≤24 hours from injury) compared to late (>24 hours) surgical decompression. An additional 4 studies evaluated even earlier time frames: CONCLUSIONS: This review provides an evidence base to support the update on clinical practice guidelines related to the timing of surgical decompression in acute SCI. Overall, the strength of evidence was moderate that early surgery (≤24 hours

Multiple myeloma (MM) is characterized by the neoplastic proliferation of plasma cells, leading to the production of monoclonal immunoglobulins. High-dose chemotherapy with autologous stem cell transplant has been used in the treatment of patients with MM (1). Melphalan (L-phenylalanine nitrogen mustard) is one of the most effective chemotherapeutic drugs in the treatment of MM (2). The side effects of melphalan include anemia, nausea, vomiting, allergic reactions, oral ulcers, nephrotoxicity, and arrhythmia at high doses (3). The effect of this drug on cardiac mechanics and heart damage is not well established, as previous studies have only focused on the electrocardiographic and metabolic effects of this drug.

Epilepsy is associated with increased mortality. Cardiovascular disease confers a significant portion of this increased risk. Recently there is increased interest in the burden of cardiovascular mortality in people with epilepsy. This review discusses the most common cardiovascular risk factors and their association with epilepsy including obesity, diabetes mellitus, and hyperlipidemia. Hyperlipidemia related to the use of enzyme inducing anti-seizure medications is also discussed as a topic that is of particular importance to prescribers that have patients with comorbid cardiovascular risk and epilepsy. Heart rate variability (HRV) and its association with SUDEP is discussed as well as a contributor to vascular risk. Finally, the authors discuss a potential role for neurologists who treat epilepsy to engage closer with their patient's cardiovascular risk factors using available tools such as a the ASCVD score calculator to determine the overall risk of mortality, as well as acting upon this information to guide treatment approaches integrating the information provided in this review.

OBJECTIVE: The current study aimed to identify the association between COVID-19 vaccination and prolonged post-COVID symptoms (long-COVID) in adults who reported suffering from this condition. METHODS: This was a retrospective follow-up study of adults with long-COVID syndrome. The data were collected during a phone call to the participants in January-February 2022. We inquired about their current health status and also their vaccination status if they agreed to participate. RESULTS: In total, 1236 people were studied; 543 individuals reported suffering from long long- COVID (43.9%). Chi square test showed that 15 out of 51 people (29.4%) with no vaccination and 528 out of 1185 participants (44.6%) who received at least one dose of any vaccine had long long- COVID symptoms (p = 0.032). CONCLUSIONS: In people who have already contracted COVID-19 and now suffer from long-COVID, receiving a COVID vaccination has a significant association with prolonged symptoms of long-COVID for more than one year after the initial infection. However, vaccines reduce the risk of severe COVID-19 (including reinfections) and its catastrophic consequences (e.g., death). Therefore, it is strongly recommended that all people, even those with a history of COVID-19, receive vaccines to protect themselves against this fatal viral infection.

OBJECTIVES: To describe a patient with mild GAD-positive stiff-leg syndrome (SLS) who developed severely disabling stiff-person syndrome (SPS) 1 week after mild COVID-19 and discuss the impact of viral implications. METHODS: Video-documented serial clinical observations at baseline, after acute COVID-19, and after IVIG treatments. RESULTS: A 39-year-old man with left-SLS was stable during a 2-year follow-up with low-dose antispasmodics, working fully and functioning normally, even able to run. One week after mild COVID-19, he started to experience generalized SPS symptomatology that steadily worsened the following 2-3 weeks, becoming unable to walk, requiring a walker, with significant thoracolumbar and bilateral leg stiffness and spasms. GAD ab were very high. After 3 monthly IVIg infusions he showed improvements, but his gait remains significantly stiff. All clinical changes, from baseline to post-Covid, and then post- IVIg have been video-documented. DISCUSSION: This is the first, clearly documented, severe GAD-positive SPS after COVID-19. Although viral or postviral causation can be incidental, the temporal connection with acute COVID-19, the severe disease worsening after symptom-onset, and the subsequent steady improvement after IVIg, suggest viral-triggered autoimmunity. Because COVID-19 reportedly can trigger or worsen GAD-associated diabetes type 1 through proinflammatory mediators, and SPS has been reportedly triggered by West Nile Virus, possibly through molecular mimicry, this case of acutely converting GAD-SLS to GAD-SPS suggest the need to explore viral etiologies in patients with GAD-SPS experiencing acute, long-lasting episodic exacerbations of stiffness and spasms.

BACKGROUND: Comparative evaluations of preventive migraine treatments can help inform clinical decision making for managing migraine in clinical practice. METHODS: An anchored matching-adjusted indirect comparison analysis was conducted using pooled participant-level data from two phase 3 atogepant trials (ADVANCE and PROGRESS) and one phase 2/3 rimegepant trial (BHV3000-305) to evaluate the relative efficacy and safety/tolerability of atogepant and rimegepant as preventive migraine treatments. Participants receiving atogepant 60 mg once daily, rimegepant orally disintegrating tablet 75 mg once every other day, and placebo were included. Only participants meeting the BHV3000-305 inclusion/exclusion criteria were analyzed: ≥6 monthly migraine days and ≤18 monthly headache days at baseline. The primary efficacy assessment of interest was change in monthly migraine days across weeks 1-12. RESULTS: There were 252 participants in the atogepant group and 348 in the rimegepant group. Across weeks 1–12, atogepant 60 mg demonstrated a significantly greater reduction in mean monthly migraine days compared with rimegepant 75 mg (mean difference [95% CI]: −1.65 [−2.49, −0.81]; p < 0.001). Both atogepant and rimegepant demonstrated similar safety/tolerability profiles. CONCLUSION: In this matching-adjusted indirect comparison analysis, oral atogepant 60 mg once daily demonstrated a significantly greater reduction in monthly migraine days compared with rimegepant 75 mg orally disintegrating tablet once every other day.

BACKGROUND: Cerebral cavernous malformations are complex vascular anomalies in the central nervous system associated with a risk of intracranial hemorrhage. Traditional guidelines have been cautious about the use of antithrombotic therapy in this patient group, citing concerns about potential bleeding risk. However, recent research posits that antithrombotic therapy may actually be beneficial. This study aims to clarify the association between antithrombotic therapy, including antiplatelet and anticoagulant medications, and the risk of intracranial hemorrhage in patients with cerebral cavernous malformations. METHODS AND RESULTS: A comprehensive literature search was conducted in PubMed, Web of Science, and Scopus databases, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Nine single-center, nonrandomized cohort studies involving 2709 patients were included. Outcomes were analyzed using random-effects model, and a network meta-analysis was conducted for further insight. Of the 2709 patients studied, 388 were on antithrombotic therapy. Patients on antithrombotic therapy had a lower risk of presenting with intracranial hemorrhage (odds ratio [OR], 0.56 [95% CI, 0.45-0.7]; CONCLUSIONS: Our study explores the potential benefits of antithrombotic therapy in cerebral cavernous malformations. Although the analysis suggests a possible role for antithrombotic agents, it is critical to note that the evidence remains preliminary. Fundamental biases in study design, such as ascertainment and assignment bias, limit the weight of our conclusions. Therefore, our findings should be considered hypothesis-generating and not definitive for clinical practice change.

BACKGROUND: Positive correlations between low- and high-frequency spectra from stereotactic electroencephalogram (SEEG) recordings have been implicated in pathological brain activity interictally and have been used for ictal detection in both focal and network models. OBJECTIVE: We evaluated SEEG signals in patients who ultimately underwent temporal lobectomy to evaluate their utility in seizure localization and prediction of seizure freedom post-resection. METHODS: We retrospectively analyzed cross-frequency correlations between beta and high gamma (HG) interictal SEEG signals from 22 patients. We compared signals based on temporal versus extra-temporal locations, seizure-free (SF) versus non-seizure-free (NSF) outcomes, and mesial (M) versus mesial temporal-plus (M+) onset. RESULTS: Positive cross-correlations were increased in temporal areas. NSF patients showed a higher proportion of positive electrodes in temporal areas. SF patients had a greater proportion of significant channels in mesial versus lateral temporal areas. HG/Beta correlations in mesial versus lateral temporal areas predicted seizure freedom better than ictal SEEG seizure onset localization to M or M+ locations. CONCLUSIONS: We present preliminary data that local HG/Beta correlations may predict epilepsy focus and surgical outcome and may have utility as adjunct methods to conventional SEEG analysis. Further studies are needed to determine strategies for prospective studies and clinical use.

Background: Interactive dashboards are a powerful tool for dynamic visualization and monitoring of patient performance and serve as a useful to for optimal decision-making. The National Spinal Column and Cord Injury Registry of Iran (NSCIR-IR) was designed to efficiently display and broadcast important patient care data. This has been achieved through an electronic dashboard display (graph and visual displays), rather than traditional static paper reports (text). Objectives: The objective of this study was to design and develop an electronic visual dashboard as a display system to monitor the quality of care in the NSCIR-IR collaborating centers. Methods: The indicators chosen were 20 pre-hospital and in-hospital quality of care (QoC) assessment tool indicators. A structured query was created from the NSCIR-IR system database to create the dashboard database. The Microsoft Power BI software was used. After data cleaning, filtering of erroneous records, and modeling, visual displays were designed and evaluated. Results: The dashboard reported on quality of care (QoC) for 2,745 patients registered in NSCIR-IR. 17% of registered cases had at least one data error in the quality of care indicators. These errors were automatically filtered by the system. The two most prominent weaknesses in (QoC indicators were delay in patient transfer by EMS (Mean and SD were 9.54 ± 13.8 h) and timing of surgical spinal cord decompression (114.5 ± 45.3 h). Conclusions: Electronic dashboards provide efficient and concise data summaries “at a glance”. However, their value and accuracy are dependent on the entered data quality. Identifying data source errors and correcting them continuously led to improved quality of data.

Standard-of-care first-line therapy for patients with newly diagnosed glioblastoma (ndGBM) is maximal safe surgical resection, then concurrent radiotherapy and temozolomide, followed by maintenance temozolomide. IGV-001, the first product of the Goldspire™ platform, is a first-in-class autologous immunotherapeutic product that combines personalized whole tumor-derived cells with an antisense oligonucleotide (IMV-001) in implantable biodiffusion chambers, with the intent to induce a tumor-specific immune response in patients with ndGBM. Here, we describe the design and rationale of a randomized, double-blind, phase IIb trial evaluating IGV-001 compared with placebo, both followed by standard-of-care treatment in patients with ndGBM. The primary end point is progression-free survival, and key secondary end points include overall survival and safety.

Type 2 diabetes (T2D) is a major health threat of our era and has become a health priority worldwide. Emerging evidence suggests that T2D is a main post-COVID-19 metabolic sequela, further exacerbating its epidemic. Inflammation and metabolic disorders are two hallmarks of T2D, and both have been shown to heighten the risk of incident diabetes. However, there are significant heterogeneities in the risks of incident diabetes with exposure to each of them. Notably, accumulated evidence suggests a closely intertwined biological process between them. It is unknown whether elevated inflammation could interact with metabolic disorders acting on diabetogenesis and explain the diabetic risk heterogeneity in metabolic disorders. Furthermore, different levels of inflammation have distinct sources. Low-grade systemic inflammation commonly results from metabolic disorders, whereas highgrade inflammation is indicative of an acute phase response, mainly initiated from acute infectious processes and acute stress. Currently, mainstream knowledge excludes highgrade inflammation for addressing the risk of cardiometabolic diseases and has seldom linked it to the pathophysiology of diabetes. Nonetheless, the alarmingly high incidence of T2D postacute SARS-CoV-2 infections has awakened a need to link infectious diseases to the development of T2D. This thesis aims to provide data-based epidemiological insights into the combined effect of different sources and levels of inflammation with a wide range of metabolic disorders on the development of diabetes and specifically considers the potential interactive effects between them. This thesis is composed of nine chapters: an overview of the thesis (Chapter 1); a comprehensive literature review (Chapter 2); six results chapters (Chapters 3–8); and a final chapter with a general discussion of the main findings and future directions (Chapter 9). The first chapter of the thesis includes an introduction and overview of the entire thesis. This is t

Small-molecule modulators of diverse voltage-gated K+ (Kv) channels may help treat a wide range of neurological disorders. However, developing effective modulators requires understanding of their mechanism of action. We apply an orthogonal approach to elucidate the mechanism of action of an imidazolidinedione derivative (AUT5), a highly selective positive allosteric modulator of Kv3.1 and Kv3.2 channels. AUT5 modulation involves positive cooperativity and preferential stabilization of the open state. The cryo-EM structure of the Kv3.1/AUT5 complex at a resolution of 2.5 Å reveals four equivalent AUT5 binding sites at the extracellular inter-subunit interface between the voltage-sensing and pore domains of the channel’s tetrameric assembly. Furthermore, we show that the unique extracellular turret regions of Kv3.1 and Kv3.2 essentially govern the selective positive modulation by AUT5. High-resolution apo and bound structures of Kv3.1 demonstrate how AUT5 binding promotes turret rearrangements and interactions with the voltage-sensing domain to favor the open conformation.

Bloodstream infections (BSIs) are among the top causes of death in Europe and as such, a serious health concern. Blood cultures are the most common method to diagnose this condition, bringing certain disadvantages. Mainly, it is time- consuming as it can take several days to get the test results back. Furthermore, the blood cultures carry a high risk of contamination. For this reason, a successful deployment of machine learning in the field could reduce arbitrary antibiotic usage and expedite correct treatment. This was the motivation for our thesis, where XGBoost, TabNet and a Multilayer Perceptron are used to predict blood culture outcomes. The main question is which model performs the best on the provided dataset? This dataset contains vital measurements and laboratory results in tabular format. Furthermore, due to the required preprocessing of the raw data and handling of its missing values, which imputation method is most suitable? To answer these questions, we conduct a study where the models and multiple imputation methods are evaluated and compared. We find that XGBoost is the superior model, while imputing with median values and including missing indicators obtains the best results. This combination of methods obtained an Area under Receiver operating characteristic of 0.763 and an Area under Precision-Recall curve of 0.361. With this model and a threshold of 5%, the amount of blood cultures could be reduced by 29%, with the drawback that 1% of true positives are missed.

Background: Occupational therapists in municipality health care are often seen as prescribers of assistive devices first and foremost, at the expense of other health-promoting interventions. They are sometimes given the role of a provider of assistive devices or fire extinguisher but would like to work more preventively in the long-term. Aim: To get a better understanding of occupational therapists’ view of their process in prescribing assistive devices. - How do they describe their process? How do they wish to work in the future? Method: Semi-structured focus group with an inductive approach where eleven municipally employed occupational therapists participated in two focus groups. Result: Four themes with associated categories emerged. Assessment is fundamental to the work process. Prescription should be based on an assessment of the client's occupational deprivation, with focus on independence. Expectations of others affect the way of working. Constant need to promote occupational therapy to others. Focus on the client's needs. The client should control the process based on autonomy. Organization takes time from client contact. Need for increased collaboration between occupational therapists and other professions. Conclusion: Occupational therapists need to work continuously with clarify their work and remove the label as assistive device- prescriber., Bakgrund: Arbetsterapeuter i kommunal verksamhet ses ofta som förskrivare av hjälpmedel i första hand, på bekostnad av andra hälsofrämjande åtgärder. De får ibland rollen som hjälpmedesleverantör eller brandsläckare men skulle vilja arbeta mer förebyggande och långsiktigt. Syfte: En ökad förståelse för hur arbetsterapeuter ser på sitt arbetssätt gällande förskrivningar av hjälpmedel - Hur beskriver arbetsterapeuterna sin arbetsprocess? Hur skulle de vilja arbeta med förskrivningar i framtiden? Metod: Halvstrukturerad fokusgrupp med induktiv ansats där elva kommunalt anställda arbetsterapeuter deltog i två fokusgrupper. Resultat: Fyra teman med tillhörande kategorier togs fram: Bedömningen är grundläggande för arbetsprocessen. Förskrivning bör utgå ifrån bedömning av klientens aktivitetsbegränsningar, vilket sker med självständighet som målbild. Andras förväntningar påverkar arbetssättet. Arbetsterapeuterna såg ett ständigt behov av att sälja in sig inför klienter och andra professioner. Fokusera på klientens behov. Klienten bör styra processen utifrån självbestämmanderätten. Organisation tar tid från klientkontakten. Ett behov av utökat samarbete mellan arbetsterapeuter och övriga professioner. Slutsats: Arbetsterapeuterna behöver i fortsättningen arbeta för att förtydliga sitt arbetssätt och komma ifrån stämpeln som hjälpmedelsförskrivare.

Syfte: Den åldrande populationen ökar globalt och behovet av fortsatt forskning kring röstbehandling för den åldrande rösten ökar. Syftet med uppsatsen är att utforska hur behandling med Complete Vocal Technique (CVT) fungerar som behandlingsmetod mot åldersrelaterad glottisk atrofi. Metod: En pre-experimental single-subject design användes, där varje studiedeltagare agerade som sin egen kontroll. Fyra cis-män deltog i studien (68–79 år), diagnostiserade med åldersrelaterad glottisk atrofi. Studien omfattade 6 veckor, en 3 veckors behandlingsfri period följt av en 3 veckors behandlingsperiod. Akustiska mätningar och självskattning utfördes vid tre tillfällen. Efter avslutad behandling gjordes en perceptuell bedömning av röstkvalitén genom en konsensusbedömning, där intrabedömarreliabiliteten beräknades. Resultat: Ökad maximal intensitet (4/4), ökad maximalt röstomfång (4/4), minskad totalpoäng på Voice Handicap Index-Throat (4/4), ökat Harmonics-to-Noise ratio (4/4), ökad resonans (2/4), ökat intensitetsomfång vid tal (1/4), ökat kommunikativt deltagande (1/4), ökning av registerbrott (2/4), och ökad rösttrötthet (1/4). Slutsats: Trots att studien inte kan bevisa eller motbevisa effektiviteten av CVT som behandlingsmetod för åldersrelaterad glottisk atrofi, indikerar resultaten en potential för vidare forskning och användning av CVT som behandlingsmetod för denna patientgrupp. CVT kan erbjuda ett nytt perspektiv på röstbehandling och möjliggör vidareutbildning för röstlogopeder samt samarbete med sångpedagoger., Purpose: The aging population is increasing globally, and the need for continued research on voice therapy for the aging voice is growing. The purpose of the study is to explore how Complete Vocal Technique (CVT) functions as a treatment method for age-related vocal fold atrophy. Method: A pre-experimental single-subject design was used, where each study participant acted as their own control. Four cisgender males aged 68–79, diagnosed with age-related vocal fold atrophy, participated in the study. The study spanned 6 weeks, starting with a 3-week treatment-free period followed by a 3-week treatment period. Acoustic measurements and self-assessments were conducted three times. After completing the treatment, an auditory-perceptual assessment of voice quality was conducted through a consensus assessment, where intra-rater reliability was calculated. Results: Increased maximum voice range (4/4), increased maximum intensity (4/4), a decrease in Voice Handicap Index-Throat (4/4), increased Harmonics-to-Noise Ratio (4/4), increased resonance (2/4), increased speech intensity range (1/4), increased communicative participation (1/4), an increase of vocal breaks (2/4), and increased vocal fatigue (1/4). Conclusion: Although the study cannot prove or disprove the effectiveness of CVT as a treatment method for age-related vocal fold atrophy, the results indicate potential for further research and utilization of CVT in this patient group. CVT may provide a new perspective on voice therapy and enable further education for speech and language therapists and collaboration with vocal coaches.

Syfte: Syftet med studien var att undersöka sambandet mellan autistiska drag, sensorisk sensitivitet och vänskapsrelationer i vuxen normalpopulation. Det undersöktes även om det förekom några könsskillnader i kvalitet i vänskapsrelationer. Metod: Studien bestod av 115 deltagare i åldrarna 18-65 år och data erhölls via frågeformulär. Datan analyserades i SPSS genom en hierarkisk multipel regressionsanalys, korrelationsanalys och oberoende t-test. Deskriptiv statistik togs fram för att tydliggöra könsskillnader. Resultat: Det förekom ett signifikant samband mellan autistiska drag och kvaliteten i vänskapsrelationer. Även ett signifikant samband mellan sensorisk sensitivitet och kvaliteten i vänskapsrelationer förekom. Det oberoende t-testet visade signifikanta könsskillnader och den deskriptiva statistiken visade att män i genomsnitt hade lägre kvalitet i vänskapsrelationer än kvinnor. Slutsatser: Denna studie visar att en högre förekomst av autistiska drag och sensorisk sensitivitet associeras med lägre kvalitet i vänskapsrelationer hos vuxna i normalpopulation. Resultatet indikerar att män har lägre kvalitet i sina vänskapsrelationer i jämförelse med kvinnor. Studien bidrar med djupare förståelse för vilka sociala utmaningar som kan förekomma hos personer med hög förekomst av sensorisk sensitivitet och autistiska drag., Purpose: The purpose of the study was to examine the relationship between autistic traits, sensory processing and the quality of friendships in the general adult population. It was also investigated whether there were any gender differences in quality of friendship. Method: The study consisted of 115 participants aged 18-65 years, and data was obtained through questionnaires. The data was analyzed using SPSS through hierarchical multiple regression analysis, correlation analysis and independent t-test. Descriptive statistics were used to clarify the gender differences. Results: There was a significant correlation between autistic traits and the quality of friendships. There was also a significant correlation between sensory processing and the quality of friendships. The independent t-test revealed significant gender differences and the descriptive statistics showed that men on average had lower quality of friendships. Conclusion: This study demonstrates that a higher prevalence of autistic traits and sensory processing sensitivity are associated with lower quality of friendship among adults in the general population. The results suggest that men have lower quality of friendship compared to women. Future research should focus on further studying gender differences to generalize the findings. The study contributes to a deeper understanding of the social challenges that individuals with high levels of sensory sensitivity and autistic traits may face.

Bakgrund: Föräldrar till barn med funktionsnedsättning spenderar ofta mer tid i omsorgsaktiviteter jämfört med föräldrar till typiskt utvecklade barn och är en grupp som har en ökad risk för obalans i vardagen. Syfte: Syftet med denna litteraturstudie är att kartlägga forskningen kring aspekter av livsbalans hos föräldrar till barn med funktionsnedsättning. Metod: Tolv vetenskapliga artiklar erhölls ur databaserna PubMed, CINAHL och PsychINFO. Artiklarna hade kvalitativ, kvantitativ och mixade metoder. Litteraturöversikten utfördes med en riktad innehållsanalys utifrån behovsdimensionerna i Life Balance Model. Resultat: Resultatet visar aspekter kring livsbalans som adresseras i de fyra behovsdimensionerna i Life Balance Model. Barnens behov kräver mycket tid av föräldrar vilket medför svårigheter att upprätthålla en god livsbalans. Stress, otillgängligt stöd, avsaknad av tid för att utföra egenvalda aktiviteter och begränsade möjligheter att kunna arbeta hade negativ påverkan på livsbalansen. Hälsofrämjande strategier, tillgång till stöd, anpassningar i vardagliga aktiviteter och aktiva val kring sin arbetssituation främjade en balanserad vardag. Slutsats: De utmaningar i vardagen som föräldrar till barn med funktionsnedsättning behöver hantera påverkar deras möjlighet till att upprätthålla en balanserad livsstil. För att stödja föräldrar kan familjecentrerade arbetsterapeutiska insatser främja deras hälsa och livsbalans. Vidare forskning kring förebyggande insatser behövs för att främja livsbalans för målgruppen., Background: Parents of children with disabilities often spend more time in caregiving activities compared to parents of typically developing children and are a group at increased risk of life imbalance. Aim: The purpose of this literature review is to map the research aspects of life balance among parents of children with disabilities. Method: Twelve scientific articles were obtained from the PubMed, CINAHL, and PsychINFO databases, employing both qualitative, quantitative and mixed methods. A directed content analysis based on the need dimensions in the Life Balance Model. Results: The findings show aspects of life balance addressed in the four need dimensions of the Life Balance Model. The needs of the children require a lot of time from parents, which makes it difficult to maintain a good life balance. Stress, lack of support, time for engaging in chosen activities and limited work opportunities had a negative impact on life balance. Health-promoting strategies, access to support, adaptations in daily activities and active choices regarding their work situation promoted a balanced daily life. Conclusion: The challenges in daily life that parents of children with disabilities need to manage affect their ability to maintain a balanced lifestyle. To support parents, family-centered occupational therapy interventions can promote their health and life balance. Further research on preventive interventions is needed to promote life balance for this target group.

Bakgrund: I takt med utvecklingen av avancerade och tidskrävande undersökningar och behandlingar utsätts röntgensjuksköterskan för ökad exponering av joniserande röntgenstrålning. Trots tydliga föreskrifter finns brister i användning av strålskydd. Syfte: Att beskriva röntgensjuksköterskans användning av strålskyddsutrustning vid angiografier och interventioner. Metod: En kvantitativ enkätstudie med induktiv ansats som besvarades online av 23 röntgensjuksköterskor från 12 röntgenavdelningar i södra Sverige. Deskriptiv statistik användes för att analysera data. Resultatet visade varierande följsamhet till lokala rekommendationer för strålskyddsutrustning. Trots att majoriteten anser att riktlinjer för kontroll efterföljs framkommer det brister i tillämpningen. Användningen av strålskyddsutrustning kan ibland vara bristfällig, särskilt i stressiga situationer eller på grund av trånga utrymmen. Slutsats: Det finns behov att förbättra rutiner för optimal säkerhet och minskade risker för strålningsrelaterade skador. Genom att anpassa skyddsutrustningen efter individuella behov säkerställs att personalen är skyddade och att hälsa och säkerhet prioriteras.

Bakgrund: Forskning visar att aktivitet och delaktighet är viktigt för en persons hälsa. Vikten av att utföra aktiviteter i en miljö med rätt förutsättningar är beforskat. Forskningen om ickebinäras hinder och möjligheter att deltaga och utföra aktiviteter är begränsad. Syfte: Undersöka ickebinära personers upplevelse av hinder och faktorer som möjliggör aktivitet och delaktighet i Sverige. Metod: Intervjustudien hade en induktiv ansats för att fokusera på de 8 informanternas upplevelser. Urvalet skedde via bekvämlighets- och snöbollsurval. Inklusionskriterierna var att minst vara 18 år och identifiera sig som ickebinära. Datainsamlingen genomfördes med intervjuer. Intervjuerna transkriberades och analyserades med latent innehållsanalys. Resultat: Huvudkategorierna som framkom var “Att ha ork att konstant bryta mot tvåkönsnormen”, “Känslan av att vara inplacerad i ett fack hindrar”, “Hårt klimat och mikroaggresioner hindrar aktivitet och delaktighet”, “Välkomnande öppenhet i olika sammanhang möjliggör”. Slutsats: Hinder för ickebinära att utföra de aktiviteter som hen vill och behöver göra påverkas både av den sociala - och fysiska miljön. Hinder återfinns både på samhällsnivå i form av lagar och bemötande i offentlig sektor och i kontexten runt informanten. När möjligheter nämns och informanterna känner att de kan vara sig själva är oftast i sällskap av nära vänner som genuint ser hen som ickebinär., Background: Research shows that occupation and participation are important for a person’s health. The importance of being able to do occupations in an environment with the right conditions has been studied.However, research on what enables nonbinary people to participate and do occupations is limited. Aim: To investigate nonbinary people's experiences of what enable and hinder occupation and participation. Method: The interview study had an inductive approach to focus on the experience of eight informants. The informants were recruited through convenience- and snowball sampling. The inclusion criteria were being at least eighteen years old and identifying as nonbinary. Data collection was conducted through interviews. The interviews were transcribed and analyzed using latent content analysis. Result: The main categories were “To always have energy to not comply with the binarynorm”, “The feeling of being placed in a box hinders”, “Harsh climate and microaggressions hinders occupation and participation” and “Welcoming openness in various contexts enables”. Conclusion: Barriers for occupation and participation for nonbinary people are influenced by both the social and physical environment. Barriers are present on both a societal level and the context surrounding the individual. Enablers were that the informants felt they were seen as a nonbinary person.

Abstrakt Inledning: Undersökningar med jodkontrastmedel utförs som rutin vid undersökningar på röntgenavdelning. Kontrastinducerad njurskada är en risk vid undersökningar med jodkontrastmedel. Syfte: Att undersöka effekter av olika preventiva åtgärder för att förhindra kontrastmedelsinducerad njurskada i samband med administrering av jodkontrastmedel vid röntgenundersökningar. Metod: Icke-systematisk litteraturstudie med integrerad analys av kvantitativa studier. Resultat: Ingen skillnad visades mellan användning av natriumklorid och natriumbikarbonat som hydrering. Dubbel hydrering visade sig effektivt på patienter med låg vätskenivå. Hydrering vid DT-undersökningar minskade inte ytterligare risken för kontrastmedelsinducerad njurskada. Effektiviteten av RIPC och rosuvastatin visade blandade resultat. Slutsats: Anpassning av val av preventiv åtgärd kan vara nödvändigt, hydrering används oftast som standard åtgärd för patienter med nedsatt njurfunktion. Ytterligare forskning av RIPC och rosuvastatin är nödvändigt för att påvisa deras effekter.

Bakgrund: Beroende av alkohol och illegala droger medför fysiska, psykiska och sociala konsekvenser som förändrar personens självbild. Trots detta är arbetsterapeuter en underutnyttjad resurs inom beroendevården där de huvudsakligen arbetar med återgång till arbete. Den arbetsterapeutiska modellen MOHO ger förståelse för hur aktivitetsidentitet, vanor och roller kan förändras. Syfte: Kartlägga behov av stöd hos personer med drogberoende för att dra slutsatser om arbetsterapeutiska insatser som kan ge stöd i förändringen mot drogfri identitet. Metod: Litteraturöversikt med induktiv ansats, kombinerad manifest och integrativ innehållsanalys av tolv vetenskapliga originalartiklar med kvalitativ, kvantitativ och mixad metod. Resultatet: Studien visade behov av förändringar för att utveckla drogfri identitet: Uppfattning och medvetenhet om sig själv, personliga färdigheter, sociala färdigheter och tro på sig själv. Slutsatser drogs om vilka arbetsterapeutiska insatser som skulle kunna ge stöd till förändringarna. Slutsats: Det finns ett behov av arbetsterapeutiska insatser med en helhetssyn på personer med drogberoende där fokus kan vara på aktivitetsträning i ADL och sociala färdigheter med syfte att utveckla en drogfri identitet. Resultatet är tillämpbart inom psykiatrin och inom somatiska vården där personens tilltro till sin egen förmåga är bristande., Background: Addiction to alcohol and illicit drugs has physical, psychological and social consequences that alter a person's self-image. Despite this, occupational therapists are an underutilized resource in addiction treatment where they mainly work with return to work. The occupational therapy model MOHO provides an understanding of how activity identity, habits and roles can be changed. Aim: To map the support needs of people with drug dependence in order to draw conclusions about occupational therapy interventions that can support the change towards a drug-free identity. Method: Literature review with inductive approach, combined manifest and integrative content analysis of twelve original scientific articles with qualitative, quantitative and mixed methods. Results: The study showed the need for changes to develop drug-free identity: Self-perception and self-awareness, personal skills, social skills and self-belief. Conclusions were drawn about which occupational therapy interventions could support these changes. Conclusion: There is a need for occupational therapy interventions with a holistic approach to people with drug dependence where the focus can be on activity training in ADL and social skills aimed at developing a drug-free identity. The results are applicable in psychiatry and in somatic care where the person's confidence in their own ability is lacking.

Bakgrund: Psykisk ohälsa påverkar förmågan att delta i aktiviteter i vardagen. Arbetsterapeuter kan genom gruppinterventioner möjliggöra engagemang i meningsfulla aktiviteter i vardagen för personer med psykisk ohälsa. Gruppinterventioner kan bidra med upplevelse av hälsa och välbefinnande utifrån teorier om aktivitetsvärden som beskrivs i den arbetsterapeutiska modellen ’The Value and Meaning in Occupations’ (ValMO). Syfte: Denna litteraturöversikt har som syfte att sammanställa upplevelser av aktivitetsvärde i samband med deltagande i arbetsterapeutiska gruppinterventioner för vuxna personer med psykisk ohälsa. Metod: En allmän litteraturöversikt genomfördes och data analyserades med innehållsanalys med deduktiv ansats. De 12 artiklarna hämtades från databaserna PsychINFO och CINAHL, samt sekundärsökning. Resultat: Resultatet visar flera upplevelser av aktivitetsvärdena konkret,sociosymboliska och självbelönande värde som framkommit i samband med deltagandet i arbetsterapeutiska gruppinterventioner. Slutsats: Arbetsterapeutiska gruppinterventioner medför upplevelser av aktivitetsvärden och att det är meningsfullt för personer med psykisk ohälsa, vilket möjliggör upplevelser av hälsa och välmående., Background: Mental health affects the ability to participate in everyday life. Occupational therapy group interventions can enable people with mental illness to engage in meaningful occupations. Group interventions can give the participants experiences of health and well-being through the occupational values described in the occupational model ‘Value and Meaning in occupations’ (ValMO). Aim: This literature review has the aim to compile experiences of occupational value in relation to participation in occupational group interventions for adults with mental illness. Method: This study is a general literature review. The data was collected from the databases PsychINFO and CINAHL, and through a secondary search. The data has been analyzed with a deductive data analysis. Result: The result shows multiple experiences of the occupational values concrete, socio-symbolic and self-reward from participation in occupational therapy group interventions. Conclusion: Occupational therapy group intervention contributes to experiences of occupational value and that it is meaningful for people with mental illness, which enables experience of health and well-being.