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This paper provides a discourse analysis of 12 Swedish sexuality education texts intended for preschool practitioners and published between 1969 and 2021. Using Fairclough's framework, we identify three discourses about children's sexual play in relation to children's sexual agency in the texts: child sexuality as encouraged and entangled with adult sexuality; child sexuality as conditioned by what is perceived as normal or abnormal in children; and child sexuality as repressed. These three discourses mainly appear chronologically, but also overlap and connect with one another. When analysis begins from children's position and a theoretical understanding of children's and adults' agency as interdependent, it becomes possible to see how the child is construed as agentic, and how the adult role changes from encouraging sexual play to regulating and monitoring behaviour so that it does not occur. Over time, discourse on young children's sexual play has changed our understanding of both adults and children. Adults are increasingly construed as less knowledgeable in relation to young children's sexuality, and young children have become understood as more dangerous and in need of having their sexuality constrained and civilised.

Abstract Background Medical treatment for children with Juvenile Idiopathic Arthritis (JIA) has improved radically since the development of biological disease-modifying antirheumatic drugs. However, children suffer from pain and anxiety, and parents often experience loneliness and lack of support. Some parents reported that information provided at the time their child was diagnosed could be difficult to assimilate. Therefore, the aim of this study was to develop a Juvenile Arthritis Support Program (JASP-1) for children recently diagnosed with JIA and their parents. Moreover, the aim was to explore patients´ and parents´ experiences with JASP-1 and its potential impact on patients´ physical health. Methods JASP-1 included seven patient- and family-centered clinical visit from time of diagnose and one year ahead. Data were collected from a study-specific questionnaire answered by children and their parents after participation in JASP-1 and from the pediatric rheumatology register. The study-specific questionnaire explored participants´ experience with the care they received during their first year with JIA. Registry and questionnaire data from the intervention (JASP-1) group was compared to a control group. Results The analysis revealed that children and parents who completed JASP-1 were more satisfied with the care they had received during their first year with JIA than the control group. The results also showed that children who completed JASP-1 were assessed as having better overall health after 12 months, than children in the control group (JASP-1 = mean 4.33, 95% Confidence Interval (CI) 4.17 − 4.46), (Control = mean 3.68, 95% CI 3.29 − 4.06), (p = 0.002). Moreover, children in the JASP-1 group had less disease impact on daily life (JASP-1 = mean 0.15, 95% CI 0.07 − 0.24) (Control = mean 0.40, 95% CI 0.13 − 0.67), (p = 0.017) and less active joints than the control group (JASP-1 = mean 0.62, 95% CI 0.35 − 1.58), (Control = mean 0.87, 95% CI 0.18 − 1.56), (p = 0.054). Conclusion A support program like JASP-1 could be an effective way of not only supporting children newly diagnosed with JIA and their parents psychologically but may also increase children’s overall physical health and improve quality of care within pediatric rheumatology. Trial registration Retrospectively registered in ClinicalTrials.gov, the 13th of February with ID NCT06284616.

Abstract Background In Sweden, approximately 2000 children live with Juvenile Idiopathic Arthritis (JIA). About half of them continue to have an active disease and need to transfer to adult rheumatology care. This study aimed to investigate Swedish adolescents’ and parents´ perceptions of readiness for transition from pediatric to adult rheumatology care. Methods The study was a cross-sectional quantitative study. Patients at the pediatric rheumatology clinic at a university hospital in Sweden and members of The Swedish National Organization for Young Rheumatics aged 14–18 and their parents were invited to participate in the study. Data was collected with the Readiness for Transition Questionnaire (RTQ) focusing on adolescents' transition readiness, adolescents' healthcare behaviors and responsibility, and parental involvement. Data were analyzed with descriptive statistics. Comparative analyses were made using non-parametric tests with significance levels of 0.05 as well as factor analyses and logistic regression. Results There were 106 adolescents (85 girls, 20 boys) and 96 parents answering the RTQ. The analysis revealed that many adolescents and parents experienced that the adolescents were ill-prepared to take over responsibility for several healthcare behaviors, such as booking specialty care appointments, calling to renew prescriptions and communicating with medical staff on phone and to transfer to adult care. Parents and adolescents alike stated that it was especially difficult for the adolescents to take responsibility for healthcare behaviors meaning that the adolescents had to have direct interaction with the healthcare professionals (HCPs) at the paediatric rheumatology clinic, for example to renew prescriptions. It was evident that the adolescents who perceived they were ready to take responsibility for the aspects related to direct interaction with HCPs were more overall ready to be transferred to adult care. Conclusion Adolescents need more support to feel prepared to transfer to adult care. With the results from this study, we can develop, customize, and optimize transitional care programs in Sweden for adolescents.

Abstract On September 26th, 2022, the detonations at the gas pipelines Nord Stream 1 and 2 resulted in some of the largest non-natural releases of methane known. The distribution of methane in the surrounding seawater and the possible effects were not apparent. To trace the pathways of methane we recorded CH4 concentrations and the isotopic signal (δ13C-CH4) in seawater, and air. A week post-explosion, we detected methane concentrations up to 4 orders of magnitude above the natural Baltic Sea background. The released fossil methane created a distinct plume with δ13C-CH4 ratios differing from natural background values. The strong water stratification preserved the distribution pattern initiated by the explosion, shown by the laterally strong concentration gradient within the plume. Our analysis encompasses three stages of the explosion's impact; the initial sea-air methane release, measurements taken during our research expedition one week later, and a third stage triggered by the shift from summer to winter conditions as an outlook on how winter mixing and microbial activity will influence the plume.

Abstract Synthetic aperture radar (SAR) has emerged as a key instrument in oceanography due to its high spatial resolution and sensitivity to ocean surface dynamics. The main limitation of a single spaceborne SAR is the long repeat cycle (e.g., 12 days for Sentinel‐1), which hinders its capability to monitor the temporal evolution of oceanic processes. The principal objective of this study is to demonstrate the potential of spaceborne SAR to monitor the temporal variation of ocean surface circulation. This is assessed using the Baltic Sea flow through the Danish strait Fehmarn Belt as a case study. In order to overcome the temporal sampling limitation, data from three satellites are combined, namely Sentinel‐1A, Sentinel‐1B and TanDEM‐X. The average revisit time achieved by combining the three satellites is 1.2 days. Two months of opportunistic SAR data (June and July 2020) covering the Fehmarn Belt are used. The radial surface current derived from SAR is compared to ocean model and in situ data. It is shown that the dominant processes that govern the circulation in the Fehmarn Belt exhibit time scales larger than 2 days. Subsequently, it is demonstrated that SAR effectively captures the synoptic‐scale features (time scales larger than 2 days) of the Baltic Sea circulation, thereby enabling monitoring the temporal variations of flow dynamics. Comparison of the SAR‐derived radial surface current against in situ measurements yields comparable bias (≤0.08 m/s) and correlation coefficient (R ≈ 0.75) but lower standard deviations and rms errors (0.15 m/s) than those exhibited by the ocean model (0.31 m/s).

Purpose Restless Legs Syndrome (RLS) is a widespread condition that affects sleep leading to daytime sleepiness, depression, and reduced quality of life. This study aims to determine and describe how patients with RLS experience their everyday life, with a focus on facilitators and barriers related to Maslow’s hierarchical theory of human needs. Method Semi-structured interviews were analysed with qualitative content analysis resulting in facilitators and barriers affecting the fulfilment of the five human needs. Results Addressing RLS symptoms through medications and a quiet sleep environment fulfils psychological needs. Control over RLS symptoms, engagement in activities, trust in treatments, and social support meet safety and security needs. Social inclusion, close relationships, and meaningful interactions fulfil a sense of belongingness and love needs despite RLS. Competence in managing RLS, effective self-care strategies, confident communication, and trust-building support esteem needs. Finally, comprehensive understanding through person-centred interventions and coping fulfils the self-actualization needs in managing RLS. Conclusion Holistic and person-centred interventions, including facilitators for the fulfilment of physiological, psychological, and social needs could help healthcare professionals to provide holistic care.

Abstract Objective/Background The Consensus Sleep Diary (CSD) is widely used to assess subjective sleep. Psychometric evaluations and focus-groups support its validity and clinical usefulness, but further research into its validity is needed. The aim of the study was to evaluate a Swedish translation of the CSD regarding test content and response processes in patients with insomnia. Patients/Methods In connection with translating the CSD into Swedish, we used cognitive interviewing to evaluate test content and the response process, that is, how people make decisions when responding to survey items. Cognitive interviews were conducted with 13 primary health care patients with insomnia disorder (mean age, 49 years; SD 15.5). Iterative, reparative analysis was used to investigate test content. Descriptive deductive analysis was used to investigate interview transcripts for the themes of the cognitive model: comprehension, retrieval, decision process, and judgement. Together, the themes explain the response process when responding to a patient-reported outcome measure. Results The overall comprehension of the CSD could be affected by poor adherence to the instructions (comprehension). Patients had difficulty with recall if they did not complete the diary immediately in the morning and just before bedtime (retrieval). They could have problems deciding how to respond to certain items because they imbued sleep-related concepts with extra meaning (decision process), and had trouble finding response alternatives nuanced enough to describe their experience of sleep and tiredness (judgement). Conclusions This study contributes knowledge on how the instrument is perceived and used by care-seeking patients with insomnia. In this context, the CSD exhibits known flaws such as memory lapses if the diary is not filled in directly in the morning. To increase the accuracy of patients’ responses, therapists should support patients in reading the instructions.

Abstract Background Bronchopulmonary Dysplasia (BPD) in infants born prematurely is a risk factor for chronic airway obstruction later in life. The distribution of T cell subtypes in the large airways is largely unknown. Objective To characterize cellular and T cell profiles in the large airways of young adults with a history of BPD. Methods Forty-three young adults born prematurely (preterm (n = 20), BPD (n = 23)) and 45 full-term-born (asthma (n = 23), healthy (n = 22)) underwent lung function measurements, and bronchoscopy with large airway bronchial wash (BW). T-cells subsets in BW were analyzed by immunocytochemistry. Results The proportions of both lymphocytes and CD8 + T cells in BW were significantly higher in BPD (median, 6.6%, and 78.0%) when compared with asthma (3.4% and 67.8%, p = 0.002 and p = 0.040) and healthy (3.8% and 40%, p

Abstract Background Roughly 10% of fractures in adults are ankle fractures. These injuries are found in both sexes and present with different fracture characteristics. The treatment varies with the patients’ biology and fracture type, and the goals are to restore stability, prevent pain and maintain ankle function. Clinicians generally use outcomes like assessment of radiography, pain level, or function. The use of patient-reported outcome measures is increasing, and the Manchester–Oxford Foot Questionnaire (MOXFQ) has been shown to have good measurement properties when validated in patients with foot and ankle disorders. However, the instrument has not been validated for ankle fracture patients. This study aims to assess the content validity of the items in MOXFQ in surgically treated ankle fracture patients. Methods A qualitative deductive design was used to investigate patients’ response process of the MOXFQ. Individual interviews were conducted using cognitive interviewing based on the theoretical framework of the 4-step model by Tourangeau. Adult patients that were surgically treated for an ankle fracture between four weeks and 18 months were purposively sampled, and interviews followed a semi-structured interview guide. The predetermined categories were comprehension, retrieval, judgement, and response. Results Seventeen respondents (65% females) were interviewed. Respondents’ age ranged from 27 to 76 years. Some of the respondents in the early recovery phase were limited by post-operative restrictions and did not find the items in the walking/standing domain relevant. Respondents that were allowed weight-bearing as tolerated (WBAT) were able to recall relevant information for most items. Respondents with time since surgery more than 12 months had less pain and remembered fewer relevant episodes in the recall period. Items in the social interaction domain contained ambiguous questions and were generally considered less important by respondents. The summary index score lacked important concepts in measuring overall quality of life. Conclusions Pain was a central concept in the post-operative recovery of ankle fracture patients. The MOXFQ-subscales for pain and walking/standing had acceptable content validity in patients that were allowed WBAT. The social interaction-subscale and the summary index score had insufficient content validity for this patient population.

Purpose: This article aims to outline an approach to education for sustainability based on play and science activities. Design/Approach/Methods: While deviated from traditional academic articles, this article has combined knowledge drawn from various action research projects and personal observations from a number of preschool settings. Findings: The article results in the development of an educational method: a scientific playworld to support emergent science and sustainability. Originality/Value: The constructed educational approach is value-oriented and challenges children to strike a balance between pessimism and optimism in addressing major societal themes.

Abstract Knowledge of functional dispersal barriers in the marine environment can be used to inform a wide variety of management actions, such as marine spatial planning, restoration efforts, fisheries regulations, and invasive species management. Locations and causes of dispersal barriers can be studied through various methods, including movement tracking, biophysical modeling, demographic models, and genetics. Combining methods illustrating potential dispersal, such as biophysical modeling, with realized dispersal through, e.g., genetic connectivity estimates, provides particularly useful information for teasing apart potential causes of observed barriers. In this study, we focus on blue mussels (Mytilus edulis) in the Skagerrak—a marginal sea connected to the North Sea in Northern Europe—and combine biophysical models of larval dispersal with genomic data to infer locations and causes of dispersal barriers in the area. Results from both methods agree; patterns of ocean currents are a major structuring factor in the area. We find a complex pattern of source‐sink dynamics with several dispersal barriers and show that some areas can be isolated despite an overall high dispersal capability. Finally, we translate our finding into management advice that can be used to sustainably manage this ecologically and economically important species in the future.

Abstract Objectives Through inflammation and hyposalivation, obstructive sleep apnea (OSA) is suggested to affect periodontal status over time. Our aim was to compare the clinical and radiographic periodontal status of hypertensive patients with or without long‐term presence of OSA, treated or untreated with continuous positive airway pressure treatment (CPAP). Materials and Methods In 2007–2009, a screening for OSA was conducted among 394 hypertensive primary care patients. Polygraphy was used to create three groups: no OSA, non‐CPAP, or adherent CPAP based on the apnea hypopnea index (AHI). After 10 years, a cross‐sectional sleep and periodontal examination including a clinical and radiographic examination, a questionnaire, and a matrix metalloproteinase‐8 (MMP‐8) chair‐side test was conducted. Based on levels of alveolar bone, bleeding on probing (BoP), and probing pocket depth (PPD), patients were categorized into four periodontal stages: periodontal health/gingivitis and three periodontal disease stages. Periodontal status and periodontal stages were compared between the OSA (n = 49), non‐CPAP (n = 38), or adherent CPAP (n = 34) groups. Results The 121 patients (53% women) had a median age of 71 years. No differences were seen between the OSA groups regarding median number of teeth (p = .061), teeth/implants, (p = .107), plaque index (p = .245), BoP (p = .848), PPD ≥ 4 mm (p = .561), PPD ≥ 6 mm (p = .630), presence of MMP‐8 (p = .693) except for bone loss (p = .011). Among patients with stage periodontal health/gingivitis a significant difference was seen, as 70% of those were categorized as no OSA, 20% as non‐CPAP, and 10% as adherent CPAP (p = .029). Differences were not seen in periodontal disease stages. Conclusions Hypertensive patients with obstructive sleep apnea (OSA) did not have an adverse clinical periodontal status compared to patients without OSA. However, when combining radiographic and clinical status into periodontal stages, patients without OSA more frequently exhibited periodontal health or gingivitis compared to patients without OSA, regardless of CPAP treatment.

The Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS) is effective in assessing positive aspects of mental health. Despite its advantages, little is known about group differences in the interpretation of SWEMWBS items across age groups, especially during the adolescence period. Hence, this study examined the psychometric properties of the SWEMWBS through Confirmatory Factor Analysis (CFA), Rasch analysis and network analysis of Swedish adolescents during the COVID-19 pandemic. A total of 5548 participants from the south of Sweden (i.e., Jönköping County) took part in this cross-sectional study through an online platform between September 2020 and October 2020. The CFA, Rasch (including differential item functioning, DIF) analysis and network analysis were used to examine the psychometric properties and measurement invariance of the SWEMWBS. The SWEMWBS had a unidimensional structure with robust psychometric properties. The CFA demonstrated measurement invariance across gender, school year and country of birth, which was also confirmed by Rasch DIF. Furthermore, considerable associations between the items of the SWEMWBS, general health and COVID-19 impact items were observed in network analysis. The SWEMWBS showed robust psychometric properties capable of assessing positive aspects of mental health and well-being among adolescents.

Abstract Objectives Anterior active rhinomanometry (AAR) is widely used in Swedish routine clinical practice to decide if septoplasty is necessary. The scientific basis for the method needs to be strengthened. Therefore, the aims were to evaluate nasal airway resistance (NAR), paradoxical reactions to pharmacological decongestion, and test–retest characteristics of the Rhino‐Comp® AAR in healthy subjects. Methods A prospective longitudinal design was used. AAR was performed before and after decongestion at baseline and after ≥6 months on 60 healthy volunteers. The relationships between NAR, height, weight, BMI, sex, and allergic rhinitis were evaluated by regression analyses. Descriptive statistics were used to evaluate paradoxical reactions. Test–retest and repeatability characteristics were evaluated with intra‐class coefficients (ICC), Cronbach's α, and standard error of measurement Results No statistically significant differences were found between genders or nasal cavity sides. NAR was statistically significantly related to height. Short‐ and long‐term test–retest characteristics were good with ICC and Cronbach's α > .75. The minimal significant difference in NAR Log10V2 values between the two measurements was 0.11 and 0.09 (long‐ and short‐term). Paradoxical reactions to pharmacological decongestion were rare, mostly weak, and not evidently reproducible. Conclusion In this study, we report reference data for healthy subjects, test–retest capabilities, and the minimal relevant difference between two measurements for the Rhino‐Comp® AAR, information that is vital and necessary for the appropriate use of AAR in clinical practice. An effective method for pharmacological decongestion is described and recommended for future studies and clinical practice. Paradoxical reactions to pharmacological decongestants exist but maybe without clinical significance. Level of Evidence NA.

Quicklime, rich in CaO(s), is generated by calcining limestone at high temperatures. Parallel-flow regenerative lime kilns are the most energy-effective industrial method available today. To prevent major disruptions in such kilns, a high raw material quality is necessary. Under some conditions, impurity-enriched material may adhere to limestone pebbles and enter the kiln. In this study, limestone and corresponding quicklime were analyzed to evaluate the extent and composition of surface impurities and assess the effect on quicklime product quality, here defined as free CaO. This was performed by sampling and analyzing limestone, quarry clay, laboratory-produced quicklime, and industrially produced quicklime with XRF, SEM/EDX, and XRD; interpretations were supported by thermodynamic equilibrium calculations. In the laboratory-produced quicklime, the surface impurities reacted with calcium forming Larnite, Gehlenite, Åkermanite and Merwinite, reducing the quicklime quality. The results showed that the limestone surface layer comprised 1.2 wt.-% of the total mass but possessed 4 wt.-% of the total impurities. The effect on industrially produced quicklime quality was lower; this indicated that the limestone surface impurities were removed while the material moved through the kiln. Multicomponent chemical equilibrium calculations showed that the quarry clay was expected to be fully melted at 1170 °C, possibly leading to operational problems.

Classifications of higher education institutions into categories that are more or less clearly differentiated through prestige and status are legion in the world of higher education. The notion of parallel categories with comparable statuses, such as those of different types of universities, is however much less well understood. This paper investigates how universities navigate between such alternative categories. We examine boundary work and institutional change involving Swedish higher education institutions with significant activity in engineering sciences in order to analyse how actors relate to ideas regarding the category 'technical university' as an ideal potentially distinct from that of the broad, comprehensive university. Analysis of two cases in the second half of the twentieth century shows that for engineering faculty, a focused technical university was an attractive alternative to the institutional model of the broad university. In contrast, analysis of two twenty-first-century cases suggests that aspirations to be recognised as a technical university were largely driven by adaption to external stakeholders' interests. We discuss these findings in light of the emergence of the global hegemonic category 'research university'. We also suggest that the organisational identity of a HEI may be tied to ideas about an organisational category through imprinting and path dependency. Moreover, we propose that changes over time in how categories are perceived may serve as an impetus to organisational change.

Abstract Ambulance personnel in emergency medical services are exposed to physical demands and stress during work, and an increased prevalence of ill health has been observed in this group. The aim was to compare hair cortisol concentration (HCC) among Swedish ambulance personnel with HCC in a population-based reference sample, to analyse differences between women and men, and differences due to work-related factors. Samples of hair 1 cm closest to the skin (5–10 mg) were collected and analysed for cortisol by radioimmunoassay. Moreover, the participants responded to a questionnaire regarding their work environment. The HCC among the ambulance personnel did not differ from the HCC in the population-based reference sample (median 19.2 vs. 22.2 pg/mg, p = 0.319), nor were there statistically significant differences between women and men. Furthermore, no associations were found between HCC and physical and psychosocial work demands, work stress, or rest and recovery from work. However, occupational balance was positively correlated with HCC (rp = 0.240; p = 0.044). The association remained statistically significant after adjustment for sex, age, hair bleaching, and corticosteroid treatment in a linear regression model. This study adds knowledge regarding HCC among ambulance personnel, and thus contributes to the overall picture of work environment and health for this group.

Abstract Aim To describe demographic, physical and psychological characteristics associated with insomnia in patients with cardiovascular disease (CVD) participating in nurse‐led Internet‐based cognitive behavioural therapy for insomnia (I‐CBTI), and their motives and expectations regarding participation in I‐CBTI. Design A mixed method design was applied, including primary care patients with angina pectoris, myocardial infarction, heart failure, atrial fibrillation and atrial flutter or arrhythmia in southern Sweden. Methods Data on demographics, insomnia severity and physical and psychological characteristics were collected through self‐rated validated questionnaires (n = 126). Motives and expectations were collected through interviews (n = 19) and analysed using the ‘personas’ model. Results Physical symptoms and psychological characteristics were associated with insomnia. Three personas were identified: the pragmatist (a curious and optimistic persona), the philosopher (a problem‐solving persona) and the philanthropist (an altruistic persona). Expectations were positive among the three personas, but comorbid conditions reduced the perceived ability to make necessary behavioural changes.

Abstract Background Oral diseases have been associated with cardiovascular diseases, and persons with continuous positive airway pressure [CPAP]-treated obstructive sleep apnoea [OSA] have an increased risk for negative consequences for both oral and general health. CPAP treatment is often life-long and adherence to treatment is essential. Xerostomia is a common side-effect which can lead to treatment abandonment. Oral health is a changeable part of our general health and well-being and exploring the views of oral health determinants from persons with experience of CPAP-treatment is important to prevent adverse oral health outcomes. The purpose of this study was to explore what persons with experience of CPAP-treated OSA view as determinants for their oral health. Methods Eighteen persons with long-term experience of CPAP-treated OSA were purposively selected. Data were collected by semi-structured individual interviews. A code book based on the World Dental Federation’s [FDI] theoretical framework for oral health was developed and used to analyse the data using directed content analysis. The domains in the framework’s component driving determinants were used as pre-determined categories. Using the description of driving determinants as a guide, meaning units were extracted from the interview transcripts through an inductive approach. Then, by employing a deductive approach the code book was used to categorise the meaning units into the pre-determined categories. Findings The views on oral health determinants described by the informants were compatible with the five domains in the component driving determinants in the FDI’s theoretical framework. Ageing, heredity, and salivation (biological and genetic factors), influences from family and the wider society (social environment), location and re-localisation (physical environment), oral hygiene habits, motivation, willingness to change, professional support (health behaviours), and availability, control, finances, and trust (access to care) were viewed as important oral health determinants by the informants. Conclusion The study points to a variety of individual oral health-related experiences that oral healthcare professionals could consider when designing interventions to reduce xerostomia and prevent adverse oral health outcomes for persons undergoing long-term CPAP-treatment.

A three-stage solid state synthesis assisted by thermodynamic modelling was developed to prepare highly pure (>99 %) beta tricalcium phosphate (β-TCP) powder. The optimal synthesis temperature was experimentally determined to be 1000 °C in good agreement with the theoretical calculations. The synthesis design described here has substantially improved the product quality and eliminated the presence of secondary phosphate phases compared to one- and two-stage methods investigated in this work. A comprehensive characterization of the material’s structural, vibrational, and morphological characteristics was conducted. Rietveld refinement of the X-ray diffraction data confirmed the high purity of the samples. The crystal structure of the prepared β-TCP was determined and the refined unit cell parameters agreed well with the reference values. From infrared and Raman spectral analyses, the characteristics of β-TCP were observed and discussed in details. Furthermore, the morphology and elemental composition of the products were examined and found to be homogenous and impurity free. The reproducibility of the material was scrutinized and showed no significant data variations. Using our three-stage synthesis method, it is possible to produce β-TCP powder of high purity with consistent repeatability.

Ship-related energy pollution has received increasing attention but almost exclusively regarding radiated underwater noise, while the effect of ship-induced turbulence is lacking in the literature. Here we present novel results regarding turbulent wake development, the interaction between ship-induced turbulence and stratification, and discuss the impact of turbulent ship wakes in the surface ocean, in areas with intense ship traffic. The turbulent wake development was studied in situ, using Acoustic Doppler Current Profilers (ADCP) and conductivity, temperature, depth (CTD) observations of stratification, and through computational fluid dynamics (CFD) modelling. Our results show that the turbulent wake interacts with natural hydrography by entraining water from below the pycnocline, and that stratification influences the turbulent wake development by dampening the vertical extent, resulting in the wake water spreading out along the pycnocline rather than at the surface. The depth and intensity of the turbulent wake represent an unnatural occurrence of turbulence in the surface ocean. The ship-induced turbulence can impact local hydrography, nutrient dynamics and increase plankton mortality due to physical disturbance, especially in areas with intense traffic. Therefore, sampling and modelling of e.g., contaminants in shipping lanes need to consider hydrographic conditions, as stratification may alter the depth and spread of the wake, which in turn governs dilution. Finally, the frequent ship traffic in estuarine and coastal areas, calls for consideration of ship-induced turbulence when studying hydrographic processes.

Abstract Background Social cognitive theories on behaviour change are increasingly being used to understand and predict healthcare professionals’ intentions and clinical behaviours. Although these theories offer important insights into how new behaviours are initiated, they provide an incomplete account of how changes in clinical practice occur by failing to consider the role of cue-contingent habits. This article contributes to better understanding of the role of habits in clinical practice and how improved effectiveness of behavioural strategies in implementation research might be achieved. Discussion Habit is behaviour that has been repeated until it has become more or less automatic, enacted without purposeful thinking, largely without any sense of awareness. The process of forming habits occurs through a gradual shift in cognitive control from intentional to automatic processes. As behaviour is repeated in the same context, the control of behaviour gradually shifts from being internally guided (e.g., beliefs, attitudes, and intention) to being triggered by situational or contextual cues. Much clinical practice occurs in stable healthcare contexts and can be assumed to be habitual. Empirical findings in various fields suggest that behaviours that are repeated in constant contexts are difficult to change. Hence, interventions that focus on changing the context that maintains those habits have a greater probability of success. Some sort of contextual disturbance provides a window of opportunity in which a behaviour is more likely to be deliberately considered. Forming desired habits requires behaviour to be carried out repeatedly in the presence of the same contextual cues. Summary Social cognitive theories provide insight into how humans analytically process information and carefully plan actions, but their utility is more limited when it comes to explaining repeated behaviours that do not require such an ongoing contemplative decisional process. However, despite a growing interest in applying behavioural theory in interventions to change clinical practice, the potential importance of habit has not been explored in implementation research.

Abstract Objectives The Nasal Obstruction Symptom Evaluation (NOSE) scale is a symptom‐specific quality‐of‐life questionnaire for patients suffering from nasal obstruction. The instrument is designed specifically for patients with septal deviation and for the evaluation of the outcome of septoplasty. The aim of this study was to validate a Swedish version of the NOSE instrument for use in clinical practice and research. Methods A Swedish version of the NOSE was tested in a case group consisting of 125 subjects with nasal obstruction (of which 31 underwent septoplasty) and a control group consisting of 65 healthy subjects. Base line data for the case and control groups were used to evaluate face validity, known groups validity, construct validity, internal consistency and factor structure analysis. Fifty participants in both the case groups and control groups were assessed both at baseline and after 2 weeks to evaluate test–retest reliability. The participants who underwent septoplasty were assessed at baseline and after 3–6 months to evaluate responsiveness. Results The S‐NOSE was found to be reliable, valid, and responsive. Both Cronbach's α and McDonald Omega coefficients were >0.7, and the intra class coefficient was 0.942. The S‐NOSE scores were significantly correlated with nasal patency VAS in both the case group and the control group (p

Background: Insomnia symptoms seem to be common in cardiac arrest survivors but their associations with important outcomes such as self-reported health and life satisfaction have not previously been reported during the early post-event period. Therefore, the aim of the study was to investigate whether symptoms of insomnia are associated with self-reported health and life satisfaction in cardiac arrest survivors six months after the event. Methods: This multicentre cross-sectional survey included cardiac arrest survivors ≥18 years. Participants were recruited six months after the event from five hospitals in southern Sweden, and completed a questionnaire including the Minimal Insomnia Symptom Scale, EQ-5D-5L, Health Index, Hospital Anxiety and Depression Scale, and Satisfaction With Life Scale. Data were analysed using the Mann-Whitney U test, linear regression, and ordinal logistic regression. The regression analyses were adjusted for demographic and medical factors. Results: In total, 212 survivors, 76.4% males, with a mean age of 66.6 years (SD = 11.9) were included, and of those, 20% reported clinical insomnia. Insomnia was significantly associated with all aspects of self-reported health (p