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The forced-choice response format is often considered superior to the standard Likert-type format for controlling social desirability in personality inventories. We performed simulations and found that the trait information based on the two formats converges when the number of items is high and forced-choice items are mixed with regard to positively and negatively keyed items. Given that forced-choice items extract the same personality information as Likert-type items do, including socially desirable responding, other means are needed to counteract social desirability. We propose using evaluatively neutralized items in personality measurement, as they can counteract social desirability regardless of response format.

Abstract Background Haemorrhage is a leading cause of preventable mortality in high-income countries and emergency management presents unique challenges in the prehospital setting. The study aimed to determine incidence and characteristics of fatalities from prehospital haemorrhage in Sweden. Methods A nationwide retrospective cohort study 2012–2021 was conducted using data from the Swedish National Board of Health and Welfare. Prehospital fatality from haemorrhage was defined as a cause of death related to haemorrhage (Appendix 1) without a hospital admission on the same day. Primary outcome was age-standardized mortality rate per 100,000 inhabitants. Results A total of 9801 prehospital fatalities from haemorrhage were identified. Annual age-standardized mortality rate decreased from 10.97 to 8.18 per 100,000 population (coefficient = − 0.28, r2 = 0.85, p =

Abstract Background Despite efforts to promote guideline use, guideline adoption is often suboptimal due to failure to identify and address relevant barriers. Barriers vary not only between guidelines but also between settings, intended users, and targeted patients. Multi-professional guidelines are often used in child and adolescent mental health services (CAMHS), making the implementation process more difficult. Despite this, there is a lack of knowledge about which barriers to consider or if barriers vary by profession. The aim of this study was to address these gaps by examining barriers to adopting a multi-professional depression guideline in the context of a nationwide implementation study. Methods 440 CAMHS clinicians across Sweden (52%) completed the Barriers and Facilitators Assessment Instrument (BFAI) ahead of an implementation endeavour. BFAI is a widely used and validated measure of guideline implementation on four scales: Innovation, Provider, Context, and Patient. Barriers were calculated at scale and at item levels. ANOVA and chi-square tests were used to analyse differences by profession and effect sizes were calculated. Results Overall, clinicians were optimistic about guideline uptake, particularly about guideline characteristics and their own adoption ability. Barriers were related to the patient and the context domains, as well as to individual clinician knowledge and training. Perceptions differed across professions; psychiatrists were most, and counsellors were least positive about guideline embeddedness. Conclusion This large-scale quantitative study suggests that CAMHS clinicians have an overall favourable attitude towards guideline adoption but highlights the need for adaptations to certain patient groups. Strategies to improve guideline use should primarily address these patient issues while securing proper support to the implementation. Implementation efforts, particularly those targeting staff knowledge, training, and involvement, may benefit from being tailored to different professional needs. These findings may inform implementation projects in CAMHS and future research.

Purpose: The purpose of this paper is to explore existing and desired methodologies for systematic quality work to promote quality in preschools from the principal's perspective. Design/methodology/approach: A collaborative approach was used in this research project, and principals were asked to complete portfolio assignments. Their answers to those portfolio assignments were analysed by the research team and subsequently compared to total quality management values. Findings: Existing and desired methodologies for systematic quality work are presented and sorted into 13 and 17 groups, respectively. The principals desire four times more methodologies than they are presently using to promote systematic quality work, and the results show that they must extend their methodologies to support TQM values. Research limitations/implications: This research is based on answers collected from 18 principals in one municipality in Sweden. Practical implications: The use of the cornerstone model provides a framework to illustrate the application of TQM in preschools. Originality/value: Principals struggle to find time for systemic quality work. The presented results can be used to work systematically with quality in preschools and other organizations.

Avant-garde aesthetic movements react on and appropriate new technological media in a process of breaking down the boundaries between different media and different “arts," in an attempt to generate meaning from the sheer materiality of the artwork. Avant-garde artworks will therefore by necessity be marked by media in different ways, at the same time as these art forms are processual, performative and transgressive. One of the prime Swedish examples of this avant-garde strategy is Ake Hodell’s many realizations of his manuscript Lågsniff. The manuscript, written in 1963, was in the form of a text-sound-composition, which means that Lågsniff, already in this form, took many configurations with a plurality of genres and media modalities involved. Later the manuscript was realized as a series of performances, a TV-film, a book, and in 2002 as a DVD. For such a collection of art works, I would like to suggest the term “intermedial cluster.” The point of departure for my discussion is the DVD, a remediation of the TV- film from 1966, and I will focus on two of the juxtaposed discourses in the cluster that this DVD represents: the package tour and warfare, and on two thematic foci in the film: media and memory, and man as automaton.

Abstract Background The aim of this study was to establish a consensus among experts in prehospital work regarding the management of difficult airways in prehospital care in Sweden. The results were subsequently used to develop an algorithm for handling difficult airway in prehospital care, as there was none available in Sweden prior to this study. Methods This two-round Delphi study was conducted by forming an expert panel comprising anesthesiologists and anesthesia nurses working in prehospital setting in Sweden. The expert panel responded digital forms with questions and statements related to airway management. The study continued until consensus was reached, defined as more than 70% agreement. The study took place from December 4, 2021, to May 15, 2022. Results In the first round, 74 participants took part, while the second round involved 37 participants. Consensus was reached in 16 out of 17 statements. 92% of the participants agreed that an airway algorithm adapted for prehospital use is necessary. Conclusions The capacity to adapt the approach to airway management based on specific pre-hospital circumstances is crucial. It holds significance to establish a uniform framework that is applicable across various airway management scenarios. Consequently, the airway management algorithm that has been devised should be regarded as a recommendation, allowing for flexibility rather than being interpreted as a rigid course of action. This represents the inaugural nationwide algorithm for airway management designed exclusively for pre-hospital operations in Sweden. The algorithm is the result of a consensus reached by experts in pre-hospital care.

Abstract Background Reports of freezing of gait (FoG) in idiopathic normal pressure hydrocephalus (iNPH) are few and results are variable. This study’s objective was to evaluate the frequency of FoG in a large cohort of iNPH patients, identify FoG-associated factors, and assess FoG’s responsiveness to shunt surgery. Methods Videotaped standardized gait protocols with iNPH patients pre- and post-shunt surgery (n = 139; median age 75 (71–79) years; 48 women) were evaluated for FoG episodes by two observers (Cohens kappa = 0.9, p

Abstract Background In the rapid development in prehospital medicine the awareness of the many challenges in prehospital care is important as it highlights which areas need improvement and where special attention during education and training should be focused. The purpose of this study is to identify challenges that physicians face when working in the prehospital environment. The research question is thus; what challenges do physicians face when working in prehospital care? Method This is a qualitative study with an inductive approach and is based on individual interviews. The interviews were analyzed using the Classic Grounded Theory (GT) method as an approach. The interviews were conducted as semi-structured interviews via the digital platform Zoom during winter / early spring 2022. Results Challenges for prehospital physicians can be understood as a process that involves a balancing act between different factors linked to the extreme environment in which they operate. This environment creates unique challenges not usually encountered in routine hospital practice, which results in trade-offs that they would not otherwise be faced with. Their individual situation needs to be balanced against organizational conditions, which means, among other things, that their medical decisions must be made based on limited information as a result of the constraints that exist in the prehospital environment. They must, both as individuals and as part of a team, manoeuvre in time and space for decision-making and practical tasks. This theory of balancing different entities is based on four themes; thus the theory is the relation between the four themes: leadership, environment, emotion management and organization. Conclusions With the help of previous studies and what we have found, it is reasonable to review what training is needed before starting to work prehospital as a physician. This should include components of the themes we have described: organization, environment, leadership and emotional management.

Summary: The MUC2 mucin protects the colonic epithelium by a two-layered mucus with an inner attached bacteria-free layer and an outer layer harboring commensal bacteria. CysD domains are 100 amino-acid-long sequences containing 10 cysteines that separate highly O-glycosylated proline, threonine, serine (PTS) regions in mucins. The structure of the second CysD, CysD2, of MUC2 is now solved by nuclear magnetic resonance. CysD2 shows a stable stalk region predicted to be partly covered by adjacent O-glycans attached to neighboring PTS sequences, whereas the CysD2 tip with three flexible loops is suggested to be well exposed. It shows transient dimer interactions at acidic pH, weakened at physiological pH. This transient interaction can be stabilized in vitro and in vivo by transglutaminase 3-catalyzed isopeptide bonds, preferring a specific glutamine residue on one flexible loop. This covalent dimer is modeled suggesting that CysD domains act as connecting hubs for covalent stabilization of mucins to form a protective mucus.

Abstract Background The benefits of helicopter emergency medical services (HEMS) transport of adults following major trauma have been examined with mixed results, with some studies reporting a survival benefit compared to regular emergency medical services (EMS). The benefit of HEMS in the context of the Swedish trauma system remains unclear. Aim To investigate differences in survival and prehospital time intervals for trauma patients in Sweden transported by HEMS compared to road ambulance EMS. Methods A total of 74,032 trauma patients treated during 2012–2022 were identified through the Swedish Trauma Registry (SweTrau). The primary outcome was 30-day mortality and Glasgow Outcome Score at discharge from hospital (to home or rehab); secondary outcomes were the proportion of severely injured patients who triggered a trauma team activation (TTA) on arrival to hospital and the proportion of severely injured patients with GCS ≤ 8 who were subject to prehospital endotracheal intubation. Results 4529 out of 74,032 patients were transported by HEMS during the study period. HEMS patients had significantly lower mortality compared to patients transported by EMS at 1.9% vs 4.3% (ISS 9–15), 5.4% vs 9.4% (ISS 16–24) and 31% vs 42% (ISS ≥ 25) (p

This article seeks to contribute to an early childhood specific conceptualisation of physics education. The article is a collaboration between a researcher in science education and two preschool teachers and revolves around the teachers' work with 2-4 year old children. Grounded in a posthumanist understanding of the world, we focus on physics learning that emerge in children's intra-actions with material. In our analysis, we first use 'physics verbs' to identify everyday intra-actions where physical phenomena act as 'playmates'. For instance, the verbs climbing and clinging point at intra-actions where gravity and counterforce act as playmates. Next, we seek to identify signs of children's physics learning within these intra-actions. Our findings suggest that emergent physics learning can be inferred from changing levels of trust in child-matter intra-actions. For example, children may move from distrustfully clinging onto a railing, towards trustingly pushing and pulling the railing to climb higher. The article provides pioneering conceptual support for researchers and teachers who seek to identify non-verbal signs of physics learning in the everyday life of early childhood settings.

The contexts in which young people participate in sport are diverse. In Scandinavia, as in many other countries, child and youth sport is mainly organised in non-profit, membership-based and voluntary driven sports clubs. In Sweden, this model is now challenged by commercial businesses providing child and youth sport services. The overall aim of this article is to provide empirically based knowledge about these ongoing and largely unexplored commercialisation processes. The focus of the article is to illuminate how commercial businesses produce immaterial values through the promotion of sport services. In this article, we have explored the cultural and social values produced and promoted by commercial businesses in youth sport. Drawing on the website communications of eight commercial businesses from four different commercial strands, we use the concept of immaterial labour to consider the values produced when child and youth sport is turned into a desirable product on the market. The values generated from the texts on the selected websites are the immaterial values of: (1) competence; (2) individually adjusted training; and (3) happiness. These values are enunciated differently by the businesses in the different strands. We situate the findings in relation to western social and cultural values and discuss the potential consequences of these value productions for contemporary ideas about youth sport and the way it should be organised.

In the educational literature on peer effects, attention has been brought to the fact that the mechanisms creating peer effects are still to a large extent hidden in obscurity. The hypothesis in the study reported in this article was that the Frame Factor Theory (FFT) can be used to reveal such mechanisms. Using data from the Swedish TIMSS 2015 (N = 3761 students in 179 classes), a multilevel structural equation model (M-SEM) was specified in accordance with the FFT. As predicted, the SEM-model verified a strong relationship between class composition and a latent variable of limitations on instruction, a variable which in turn had a great impact on individual students' results in TIMSS 2015. The study hereby seems to reveal a fundamental mechanism of peer effects and provides evidence for the FFT.

While the well-being of the Swedish peacekeepers deployed to Bosnia in the 1990s has received a great deal of attention over the years, very little is known about how these military veterans have fared on the labour market after returning home. In this paper, I provide novel evidence on the relationship between military deployment to Bosnia and adverse outcomes on the labour market. The analysis is based on longitudinal administrative data for a sample of 2,275 young Swedish veterans who served as peacekeepers in Bosnia at some point during the years 1993–1999. I follow these veterans for up to 20 years after deployment. Using propensity score matching based on a rich set of covariates, I estimate the effects of deployment on three broad measures of labour market marginalisation: long-term unemployment, work disability, and social welfare assistance. I find no indication of long-term labour market marginalisation for the veterans. Even though the veterans experienced an increase in the risk of unemployment in the years immediately following their return from service, in the long run their attachment to the labour market is not affected negatively.

Pharmacokinetics (PK) of antisense oligonucleotides (ASOs) is characterized by rapid distribution from plasma to tissue and slow terminal plasma elimination driven by re-distribution from tissue. Quantitative understanding of tissue PK and RNA knockdown for various ASO chemistries, conjugations, and administration routes is critical for successful drug discovery. Here, we report concentration-time and RNA knockdown profiles for a gapmer ASO with locked nucleic acid ribose chemistry in mouse liver, kidney, heart, and lung after subcutaneous and intratracheal administration. Additionally, the same ASO with liver targeting conjugation (galactosamine-N-acetyl) is evaluated for subcutaneous administration. Data indicate that exposure and knockdown differ between tissues and strongly depend on administration route and conjugation. In a second study, we show that tissue PK is similar between the three different ribose chemistries locked nucleic acid, constrained ethyl and 2′-O-methoxyethyl, both after subcutaneous and intratracheal administration. Further, we show that the half-life in mouse liver may vary with ASO sequence. Finally, we report less than dose-proportional increase in liver concentration in the dose range of 3–30 μmol/kg. Overall, our studies contribute pivotal data to support design and interpretation of ASO in vivo studies, thereby increasing the probability of delivering novel ASO therapies to patients.

Introduction Psychiatric inpatient care (PIC) is often characterised by high pressure and thresholds for admission, brief periods of care and limited time for caring activities. Dissociative identity disorder (DID) is a contested diagnosis, and persons with DID are at risk of not receiving adequate support when cared for in PIC. Because the limited literature addressing the topic includes no overview on how persons with DID are cared for in psychiatric inpatient settings, the aim of this scoping review is to map the area of knowledge on PIC for persons experiencing DID. This scoping review will provide an overview with the possibility to elucidate gaps in the evidence base and needs for future research on PIC for persons experiencing DID.Methods and analysis This scoping review will follow Preferred Reporting Items for Systematic Review and Meta-Analysis for Scoping Reviews and steps 1–5 described in the established method for scoping reviews: identifying research question, identifying relevant studies, study selection, charting the data and collating, summarising and reporting results.Ethics approval Not applicable.Dissemination This scoping review will be submitted for publication in an international, peer-reviewed journal.

The cell is a multi-scale structure with modular organization across at least four orders of magnitude1. Two central approaches for mapping this structure-protein fluorescent imaging and protein biophysical association-each generate extensive datasets, but of distinct qualities and resolutions that are typically treated separately2,3. Here we integrate immunofluorescence images in the Human Protein Atlas4 with affinity purifications in BioPlex5 to create a unified hierarchical map of human cell architecture. Integration is achieved by configuring each approach as a general measure of protein distance, then calibrating the two measures using machine learning. The map, known as the multi-scale integrated cell (MuSIC 1.0), resolves 69 subcellular systems, of which approximately half are to our knowledge undocumented. Accordingly, we perform 134 additional affinity purifications and validate subunit associations for the majority of systems. The map reveals a pre-ribosomal RNA processing assembly and accessory factors, which we show govern rRNA maturation, and functional roles for SRRM1 and FAM120C in chromatin and RPS3A in splicing. By integration across scales, MuSIC increases the resolution of imaging while giving protein interactions a spatial dimension, paving the way to incorporate diverse types of data in proteome-wide cell maps.

Herpes simplex virus 2 (HSV-2) is a sexually transmitted infection affecting 491 million individuals globally. Consequently, there is a great need for both prophylactic and therapeutic vaccines. Unfortunately, several vaccine clinical trials, primarily employing the glycoprotein D of HSV-2 (gD-2), have failed. The immune protection conferred by human anti-HSV-2 antibodies in genital infection and disease remains elusive. It is well-known that gD-2 elicits cross-reactive neutralizing antibodies, i.e., anti-gD-2 antibodies recognize gD in HSV-1 (gD-1). In contrast, anti-glycoprotein G in HSV-2 (mgG-2) antibodies are exclusively type-specific for HSV-2. In this study, truncated versions of gD-2 and mgG-2 were recombinantly produced in mammalian cells and used for the purification of anti-gD-2 and anti-mgG-2 antibodies from the serum of five HSV-2-infected subjects, creating a pool of purified antibodies. These antibody pools were utilized as standards together with purified mgG-2 and gD-2 antigens in ELISA to quantitatively estimate and compare the levels of cross-reactive anti-gD-1 and anti-gD-2 antibodies, as well as anti-mgG-2 antibodies in sera from HSV-1+2-, HSV-2-, and HSV-1-infected subjects. The median concentration of anti-mgG-2 antibodies was five times lower in HSV-1+2-infected subjects as compared with cross-reactive anti-gD-1 and anti-gD-2 antibodies, and three times lower in HSV-2 infected subjects as compared with anti-gD-2 antibodies. The pool of purified anti-gD-2 antibodies presented neutralization activity at low concentrations, while the pool of purified anti-mgG-2 antibodies did not. Instead, these anti-mgG-2 antibodies mediated antibody-dependent cellular cytotoxicity (ADCC) by human granulocytes, monocytes, and NK-cells, but displayed no complement-dependent cytotoxicity. These findings indicate that antibodies to mgG-2 in HSV-2-infected subjects are present at low concentrations but mediate the killing of infected cells via ADCC rather than by neutralizing free viral particles. We, and others, speculate that Fc-receptor mediated antibody functions such as ADCC following HSV-2 vaccination may serve as a better marker of protection correlate instead of neutralizing activity. In an mgG-2 therapeutic vaccine, our findings of low levels of anti-mgG-2 antibodies in HSV-2-infected subjects may suggest an opportunity to enhance the immune responses against mgG-2. In a prophylactic HSV-2 mgG-2 vaccine, a possible interference in cross-reactive immune responses in already infected HSV-1 subjects can be circumvented.

BackgroundMotor complications are a consequence of the chronic dopaminergic treatment of Parkinson's disease (PD) and include levodopa-induced dyskinesia (LIDs) and motor fluctuations (MF). Currently, evidence is on lacking whether patients with GBA-associated PD differ in their risk of developing motor complications compared to the general PD population.ObjectiveTo evaluate the association of GBA carrier status with the development of LIDS and MFs from early PD.MethodsMotor complications were recorded prospectively in 884 patients with PD from four longitudinal cohorts using part IV of the UPDRS or MDS-UPDRS. Subjects were followed for up to 11 years and the associations of GBA mutations with the development of motor complications were assessed using parametric accelerated failure time models.ResultsIn 439 patients from Europe, GBA mutations were detected in 53 (12.1%) patients and a total of 168 cases of LIDs and 258 cases of MF were observed. GBA carrier status was not associated with the time to develop LIDs (HR 0.78, 95%CI 0.47 to 1.26, p = 0.30) or MF (HR 1.19, 95%CI 0.84 to 1.70, p = 0.33). In the American cohorts, GBA mutations were detected in 36 (8.1%) patients and GBA carrier status was also not associated with the progression to LIDs (HR 1.08, 95%CI 0.55 to 2.14, p = 0.82) or MF (HR 1.22, 95%CI 0.74 to 2.04, p = 0.43).ConclusionThis study does not provide evidence that GBA-carrier status is associated with a higher risk of developing motor complications. Publication of studies with null results is vital to develop an accurate summary of the clinical features that impact patients with GBA-associated PD.

Abstract The CRISPR/Cas9 system offers enormous versatility for functional genomics but many applications have proven to be challenging in primary human cells compared to cell lines or mouse cells. Here, to establish a paradigm for multiplexed gene editing in primary human cord blood-derived hematopoietic stem and progenitor cells (HSPCs), we used co-delivery of lentiviral sgRNA vectors expressing either Enhanced Green Fluorescent Protein (EGFP) or Kusabira Orange (KuO), together with Cas9 mRNA, to simultaneously edit two genetic loci. The fluorescent markers allow for tracking of either single- or double-edited cells, and we could achieve robust double knockout of the cell surface molecules CD45 and CD44 with an efficiency of ~ 70%. As a functional proof of concept, we demonstrate that this system can be used to model gene dependencies for cell survival, by simultaneously targeting the cohesin genes STAG1 and STAG2. Moreover, we show combinatorial effects with potential synergy for HSPC expansion by targeting the Aryl Hydrocarbon Receptor (AHR) in conjunction with members of the CoREST complex. Taken together, our traceable multiplexed CRISPR/Cas9 system enables studies of genetic dependencies and cooperation in primary HSPCs, and has important implications for modelling polygenic diseases, as well as investigation of the underlying mechanisms of gene interactions.

We present pre-stack depth-imaging results for a case study of 3D reflection seismic exploration at the Blötberget iron oxide mining site belonging to the Bergslagen mineral district in central Sweden. The goal of the study is to directly image the ore-bearing horizons and to delineate their possible depth extension below depths known from existing boreholes. For this purpose, we applied a tailored pre-processing workflow and two different seismic imaging approaches, Kirchhoff pre-stack depth migration (KPSDM) and Fresnel volume migration (FVM). Both imaging techniques deliver a well-resolved 3D image of the deposit and its host rock, where the FVM image yields a significantly better image quality compared to the KPSDM image. We were able to unravel distinct horizons, which are linked to known mineralization and provide insights on their possible lateral and depth extent. Comparison of the known mineralization with the final FVM reflection volume suggests a good agreement of the position and the shape of the imaged reflectors caused by the mineralization. Furthermore, the images show additional reflectors below the mineralization and reflectors with opposite dips. One of these reflectors is interpreted to be a fault intersecting the mineralization, which can be traced to the surface and linked to a fault trace in the geological map. The depth-imaging results can serve as the basis for further investigations, drilling, and follow-up mine planning at the Blötberget mining site..