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Synthetic cannabinoids are a group of compounds that act on the CB1 receptor and are used illicitly as substitutes for cannabis. Given the rapid and extensive metabolism of synthetic cannabinoids, urinary biomarkers are essential if proof of drug intake is to be obtained in forensic laboratories. To identify good biomarker candidates, the metabolism of synthetic cannabinoids must be studied and reference standards need to be acquired. Studies on the metabolism of synthetic cannabinoids containing a terminally fluorinated pentyl side chain have shown that hydroxylation can occur at the four position of the side chain. This makes the 4-hydroxy-5-fluoropentyl side-chain metabolite a good urinary biomarker for proving intake of the corresponding parent drug, as this compound cannot be formed from its nonfluorinated analogue. Here, a concise synthetic route to the 4-hydroxy-5-fluoropentyl side-chain metabolites of the synthetic cannabinoids STS-135, MAM-2201, AM-2201, and XLR-11 is reported.

This paper argues that the ‘open space’ idea remains the key source of strength for the World Social Forum as a tool for transformative, liberatory politics. We suggest that this space can ...

On all continents the enormity of the violence and danger of the times gives rise to multiple new practices of struggle and to conceptual innovations, which seek to serve justice, solidarity, and d...

Aims and objectives To describe breast cancer (BC) survivors' experiences of participating in a 2-day educational programme (Breast Cancer School, BCS) and their critical reflection on information received during and after adjuvant treatment. The following research questions guided the study. How do BC survivors experience their participation in an educational programme? How do BC survivors experience the information trajectory during and after adjuvant treatment? Background BC is the most prevalent cancer among women in Norway. BC survivors have a substantial need for information about the disease, treatment and recovery. During the past few years, BC treatment in Norway has changed from inpatient- to outpatient-based treatment. Oncology nurses and oncologists are obliged to provide patients and their families with information, which has necessitated reorganisation of the procedures for providing information. New arenas such as the Breast Cancer School (BCS) offer the opportunity to learn from experts and fellow patients. Design Qualitative, descriptive design. Methods Focus groups with 20 BC survivors after having participated in the BCS were used to enable critical reflection. The COREQ checklist was followed to ensure rigour in the study. Results Two themes emerged from qualitative analysis: Balancing between the need for and the fear of information and Moving from a safe structure to lonely recovery. We identified differences between BC survivors in diversity, uniqueness and need for information. Continuity and expert knowledge provided by a primary oncology nurse and oncologists were highlighted as important. Conclusion The study reveals the need for information tailored to each BC survivor's unique needs. The BC survivors expressed both the need for and the fear of information. BCS takes both a systematic and individual approach to provide expert information, dialog and the opportunity to meet with fellow patients. The transition from the structure of the treatment to lonely recovery after the most intensive treatment was perceived as unsafe and challenging. BC patients' experiences must be continuously valued and used to improve educational programmes, care and treatment. Oncology nurses play an important part in the information chain and continuity. Relevance to clinical practice This study highlights the importance of including BC survivors in the design and evaluation of educational programmes. The provision of information and supportive care with continuity between oncology nurses and oncologists through the trajectory of treatment and care is crucial.

The congenital myopathies form a large clinically and genetically heterogeneous group of disorders. Currently mutations in at least 27 different genes have been reported to cause a congenital myopathy, but the number is expected to increase due to the accelerated use of next-generation sequencing methods. There is substantial overlap between the causative genes and the clinical and histopathologic features of the congenital myopathies. The mode of inheritance can be autosomal recessive, autosomal dominant or X-linked. Both dominant and recessive mutations in the same gene can cause a similar disease phenotype, and the same clinical phenotype can also be caused by mutations in different genes. Clear genotype-phenotype correlations are few and far between.

Reducing browsing damages from cervids (Cervidae) on economically valuable tree species is a challenging task in many countries. Apart from cervid abundance, landscape characteristics, such as forest composition, land use, forage availability and climatic conditions, may affect the degree of browsing through both direct and indirect effects. A better understanding of basic mechanisms in this complex system is needed to design efficient and convincing management strategies. Focusing on Sweden as a case, which has been widely studied using regression analyses only, we applied path analysis to test the validity of a model on the indirect and direct links between landscape characteristics, cervid populations, and browsing damages on Scots pine (Pinus sylvestris). Our results validated the tested model in which moose (Alces alces) density and pine availability directly influence browsing damages. Increasing amounts of pine forests, preferred deciduous trees, and young forest had positive direct effects on moose densities and thereby indirectly contributed to increased browsing damages. The density of smaller deer species showed no direct effect on browsing damages on pine. Path analysis corroborated our attempt to disentangle direct and indirect potential causal drivers of browsing damages and shows that the choice of statistical method may alter the understanding of mechanistic driving forces.

Background Sepsis is a life-threatening condition, causing almost one fifth of all deaths worldwide. The aim of the current study was to identify variables predictive of 7- and 30-day mortality among variables reflective of the presentation of septic patients arriving to the emergency department (ED) using machine learning. Methods Retrospective cross-sectional design, including all patients arriving to the ED at Södersjukhuset in Sweden during 2013 and discharged with an International Classification of Diseases (ICD)-10 code corresponding to sepsis. All predictions were made using a Balanced Random Forest Classifier and 91 variables reflecting ED presentation. An exhaustive search was used to remove unnecessary variables in the final model. A 10-fold cross validation was performed and the accuracy was described using the mean value of the following: AUC, sensitivity, specificity, PPV, NPV, positive LR and negative LR. Results The study population included 445 septic patients, randomised to a training (n = 356, 80%) and a validation set (n = 89, 20%). The six most important variables for predicting 7-day mortality were: “fever”, “abnormal verbal response”, “low saturation”, “arrival by emergency medical services (EMS)”, “abnormal behaviour or level of consciousness” and “chills”. The model including these variables had an AUC of 0.83 (95% CI: 0.80–0.86). The final model predicting 30-day mortality used similar six variables, however, including “breathing difficulties” instead of “abnormal behaviour or level of consciousness”. This model achieved an AUC = 0.80 (CI 95%, 0.78–0.82). Conclusions The results suggest that six specific variables were predictive of 7- and 30-day mortality with good accuracy which suggests that these symptoms, observations and mode of arrival may be important components to include along with vital signs in a future prediction tool of mortality among septic patients presenting to the ED. In addition, the Random Forests appears to be a suitable machine learning method on which to build future studies.

The Covid19 pandemic has pushed a large number of people to change their mode of transport from (mainly) public transport to cycling, and thus given us an opportunity to study the adoption process of cycling. The paper reports on an interview study with 12 participants who started, or significantly increased, cycling during the pandemic, and utilises the Innovation-Decision Process to analyse the participants' cycling adoption and draw implications. The results show that adopting cycling as a primary mode of transport is a journey of constant reinvention of practices based on positive and negative discoveries, and that equipment (incl. a variety of clothes, bicycles, and bells) is key to overcome the negative discoveries. The main implication for urban policy and planning is that many measures can be taken to increase adoption of everyday cycling in addition to building more protected bicycle lanes. Examples include 1) develop new equipment more suited for everyday cycling, 2) create meeting points to transfer knowledge on equipment as well as good routes, 3) prioritize cycling at workplaces and other destinations with lockers, indoor storage, etcetera. To influence people to begin everyday cycling, it is also important to address the measures towards 'people who cycle' rather than 'cyclists' as many people do not wish to identify themselves as the latter.

We report the first mosaic mutation, a deletion of exons 11-107, identified in the nebulin gene in a Finnish patient presenting with a predominantly distal congenital myopathy and asymmetric muscle weakness. The female patient is ambulant and currently 26 years old. Muscle biopsies showed myopathic features with type 1 fibre predominance, strikingly hypotrophic type 2 fibres and central nuclei, but no nemaline bodies. The deletion was detected in a copy number variation analysis based on next-generation sequencing data. The parents of the patient did not carry the deletion. Mosaicism was detected using a custom, targeted comparative genomic hybridisation array. Expression of the truncated allele, less than half the size of full-length nebulin, was confirmed by Western blotting. The clinical and histological picture resembled that of a family with a slightly smaller deletion, and that in patients with recessively inherited distal forms of nebulin-caused myopathy. Asymmetry, however, was a novel feature. (c) 2021 Elsevier B.V. All rights reserved.

Trichothiodystrophy is a group of multisystem neuroectodermal disorders with dysplastic hair as the cardinal symptom. We describe three patients from two Finnish families in whom whole-exome sequencing revealed a novel homozygous variant, c.26del, p.(Pro9Glnfs*144) in the MPLKIP-gene, confirming the diagnosis of non-photosensitive trichothiodystrophy type 4 (TTD4). The variant was confirmed by Sanger sequencing and inherited from unaffected carrier parents. This report adds to the literature by expanding the genetic and phenotypic spectra of MPLKIP-related trichothiodystrophy. We describe dysmorphic features in the patients and provide a comparison of clinical characteristics in patients with TTD4 reported to date.

The global pig production has undergone major changes over the past 30 years with larger farms, more intensified production as well as improved hygiene and biosecurity practices. To investigate whether these changes, along with expanded pig welfare, have had an impact on parasite occurrence, a cross-sectional study was conducted in Sweden on farms where the pigs are always loose-housed, floors are solid and bedding material is provided. A total of 1615 faecal samples were collected on 42 conventional indoor farms from a) post-weaning piglets (n = 337); b) growers (n = 345); c) fatteners (n = 308); d) dry sows (n = 277) and e) pre-partum sows (n = 348). Samples were analysed using centrifugal flotation with a saturated glucose-salt solution and a modified McMaster technique, with a lower detection limit of 50 eggs or oocysts per gram. Samples positive for strongyle-type eggs were cultured to third stage larvae for genus identification. Farms also responded to a questionnaire regarding biosecurity, hygienic measures, and other management routines. Risk factors for parasite occurrence were assessed using mixed-effects logistical regression to account for farm-level clustering of samples. Interestingly, the prevalence of Ascaris suum was reduced compared to a similar investigation in the 1980s. In the present study A. suum was detected only in 43 % of the herds, with the highest prevalence in pre-partum sows (37 %) followed by fatteners (25 %). Small sized farms were associated with higher odds of being positive, compared to large sized farms (OR = 159.1, P = 0.010). Oesophagostomum spp. were detected in 64 % of the herds and again mainly in pre-partum sows (63 %). Trichuris suis was detected in 10 % of the herds but only in

While modern civilization takes pride in its commitment to reason, its discourse of technology remains confused and paradoxical. Technology has what the chapter calls a noisy presence in everyday life, art, advertisements, corporate propaganda and popular culture, characterized by the interplay between boyish enthusiasm and dark presentiment. Oddly, the noisy acknowledgment of the historical force of technology tends to transmute into embarrassed silence in critical debate and political life. Therefore, technology stands out as a scandalous affront to the paramount ideal of modernity, self-determination. The chapter’s diagnostic suggestion is that the paradoxical status in the discourse of technology is produced and upheld in the interplay between four incompatible notions of technology, namely that technology is progressive, unstoppable, neutral, and natural. It closes with some remarks on the moral dynamic that allows the preservation of much noise and little reason in the modern discourse of technology.