Search

Management tools do more than manage and organise - they classify and contribute to the construction of education-as-concept. This article shows how tendering-based procurement, used by Swedish municipalities to outsource adult education to non-public providers, works to commensurate 'education' into measurable tender evaluation criteria. Drawing on the sociology of conventions approach and 47 procurement examples, I show that tendering evaluation criteria define what constitutes 'desirable' education through various degrees of commensuration. Further, I show how mechanisms intended to evaluate and compare bids also construct the value of education different - for example, promoting cost-efficiency as valuable; constructing education as an on-demand service; or by assuming a supply-and-demand approach and viewing value as fluid. Based on the exemplified commensurations and valuations, I discuss the consequences of education privatization via tendering-based procurement. Since competition is inherently built into the tool, it becomes valuable. Further, procurement recasts education stakeholders into market roles and reshapes their relationships. In short, the article underscores the importance of understanding how education privatization is organized and what role management tools play in shaping education, calling for critical education research to delve into their dynamics and impact.

This study used video feedback in a collaborative development study to help improve teachers' perceptions of the learning needs of students with autism spectrum disorders (ASD) and intellectual disabilities (ID) and enhance their active participation in the classroom. Crucially, teachers need the necessary skills to discern students' subtle communications, as students with ASD and co-occurring ID may have reduced or non-existent verbal language and may express their needs mainly through behaviours. The first author video recorded ten classroom lessons and collaborated with three teachers to discuss the recordings in six meetings over the course of one semester. The data used for the analysis was taken from the first (February) and last (June) collaborative meetings of the semester. The results show how collaborative video feedback can influence teachers' judgements about students' learning and further their professional development; the subtle signals that students use to communicate become more visible when the video recordings are viewed multiple times. The collaborative discussions facilitated the teachers' understanding of students' behaviours and actions. In addition, the teachers' focus shifted from identifying general aspects of their students' behaviours to their skills and knowledge.

Background: Physical education (PE) teachers in practically all countries are expected to help their students develop movement capability. To achieve this objective, teachers need certain knowledge and competencies. The question of how PE teachers should develop their capacities to achieve this task has received only limited research attention. Aim: The broad objective of this paper is to contribute to the literature on how PE teachers can develop knowledge and competencies in the area of movement capability related to students' learning. The specific aim is to identify aspects of the design of instruction in physical education that enhance teachers' actor-oriented transfer of movement pedagogy knowledge, during a collaborative professional development intervention. Method: The study is an analysis of three conducted learning studies in PE at upper secondary schools in Sweden. The studies involved seven PE teachers from two different schools. Our empirical material consists of (a) notes from team meetings (n = 14), (b) lesson plans (n = 9), (c) video-recorded and transcribed lessons (n = 9), and (d) results of students' learning outcomes (n = 9). Findings: PE teachers' analysis of their own teaching sequences in teams supported their actor-oriented transfer of movement pedagogy knowledge, which developed their abilities to further elaborate their instruction in new teaching situations. Moreover, teachers gained insights into how to further develop the quality of instructional design as expansions of earlier experiences. Lastly, a relationship between PE teachers' actor-oriented transfer and students' increased learning of movements was found. Conclusion: Our conclusion is that collaborative professional development for PE teachers, which supports actor-oriented transfer, should be offered to enhance teachers' movement pedagogy knowledge.

National policy states that Swedish adult education should be flexible and individualized, based on students' needs. However, adult education in Sweden is a municipal responsibility with a high level of decentralization. Drawing on national policies, this study focuses on how the concepts of flexibility and individualization are enacted locally and what consequences this has for teaching and learning. Starting from a teacher perspective and based on qualitative interviews with 50 teachers, the article analyses how policy requirements for offering flexible and individualized adult education are being enacted, and what the consequences of this are for teaching and learning. The findings show how flexibility and individualization are put into practice through measures such as a fast study pace, continuous admission of students, and pressure on municipalities to maintain a broad course offer, often by turning to distance education. This enactment makes it easier for adult learners to fit education into their lives, but it also has consequences for the quality of teaching and learning. It is causing fragmentation, a learning environment where interactions mainly occur on an individual basis, an instrumental view of education, and teachers experiencing high workloads and low autonomy in making pedagogical decisions.

We aimed to explore the experiences of teachers, autistic students and students' parents, before and after professional development intervention for teachers in primary school. The main participants were five autistic students aged 7-11 years in three primary schools (intervention schools), their parents and teachers. Five school contexts were studied, with three interventions and two comparisons. Data collected included questionnaires, student evaluations and recorded follow-up conversations. The results showed statistically significant changes among teachers pre- to postintervention at all three intervention schools; no differences were found at control schools. However, analyses of the case studies showed that parents and students did not experience changes at the same levels as teachers. Identified barriers to change included a lack of physical space, time to focus on each child, and resources. Professional development is effective in changing teachers' understanding and attitudes, but not enough to change classroom practice in the views of students and parents.

In order to provide clinical utility for research of how art therapists perceive clients' inner change, the authors created a structured observational framework. This note-taking and assessment consist of five themes and sub-themes: Therapeutic Alliance, Creating, Affect-Awareness, Self-Awareness, and Ego-Strength. The framework was designed to be clinically-friendly, adaptable to various settings, and assist communication with both patients and relevant healthcare professionals.

Abstract Despite their ubiquity, Mesolithic lithic tools given as funerary offerings have rarely been studied in detail. Whereas personal ornaments (e.g. beads, pendants) are commonly interpreted as markers of social identity and status, archaeologists have struggled to understand the stone tools, commonly regarded as “utilitarian” items. As a result, this class of grave goods has not received the same level of attention, leaving a significant gap in our understanding of Mesolithic mortuary behaviours. Our research challenges long-lasting perceptions of lithic tools as strictly utilitarian objects and draws on studies of one of the most substantial stone axe funerary collections from one of the largest Stone Age cemeteries in Europe–Zvejnieki, Latvia. Evidence suggests the selection of unused axes as grave offerings, while unusual wear traces on an axe found in a female grave (no 57) raises questions about its use in the burial rites. Using a multi-proxy approach, we compare life histories of axes placed in burials to those recovered from contemporary, nearby settlement contexts. Finally, a strong correlation between axes and women and children at Zvejnieki challenges gendered stereotypes of stone tools, historically regarded as possessions of the adult male members of Stone Age societies.

Abstract Introduction Idiopathic pulmonary fibrosis (IPF) is a progressive disease presenting with symptoms like dyspnoea, dry cough, and fatigue, which affect physical function and quality of life. No earlier qualitative studies have investigated physical activity in IPF. This study aims to explore experiences of living with IPF in relation to physical activity. Materials and methods Qualitative interviews were conducted with 14 participants living with IPF. The participants were 77 years old (range: 56–86) and diagnosed with IPF between 2 and 9 years ago. The analysis was performed by qualitative content analysis according to Graneheim and Lundman. Results The results indicated that life and one’s ability to be physically active is affected by IPF. Despite this, it seems possible to navigate past obstacles, which was illustrated by an overall theme: “My life is constrained, but I am hanging on”. Two major categories cover topics of IPF being a life changing diagnosis with changes in self-image and changed future plans regarding physical activity, as well as life. Physical activity was perceived to be challenging, yet in many ways used as a strategy, developed to manage life. Conclusions IPF affects physical activity as well as life, from onset onwards. By developing strategies for facilitating physical activity as well as identifying barriers, it seems possible to maintain an active life despite the disease. The healthcare system needs to create support systems that meet different needs during different phases of the disease. Trial registration “FoU in Sweden” Research and Development in Sweden (id: 227081).

Fatigue is common in patients with chronic pain. Still, there is a lack of studies examining objectively measurable cognitive aspects of fatigue: cognitive fatigability (CF). We aimed to investigate the presence of CF in patients with chronic pain and its relation to self-rated fatigue, attention, pain characteristics, sleep disturbance, depression, and anxiety.

Abstract Background Population-based cancer quality registries are of great importance for the improvement of cancer care. However, little is known about the quality of recurrence data in cancer quality registries. The aim of this study was to evaluate data quality in the regional Breast Cancer Quality Registry of Central Sweden, with emphasis on the validity of recorded information on recurrence. Methods Validation by re-abstraction was performed on a random sample of 800 women with primary invasive breast cancer stage I-III diagnosed between 1993 and 2010, of which 400 had at least one registered recurrence and 400 had no registered recurrence. Registry data were compared with data from medical records. Exact agreement, correlation and kappa values, sensitivity and specificity were calculated. Results Seven hundred forty-seven women (93%) were available for analysis. Exact agreement was high for diagnostics, tumor characteristics, surgery, and adjuvant oncological treatment (90% or more for most variables). The registry’s sensitivity was low for regional recurrence (47%), but higher for local and distant recurrence (80% and 75%), whereas specificity was overall high (≥ 95%). Combining all recurrence categories irrespective of localization improved sensitivity to 90% with a specificity of 91%. In 87% of women, the date of first recurrence according to medical records fell within ± 90 days of the date recorded in the registry. Conclusions While the quality of data in the regional Breast Cancer Quality Registry was generally high, data accuracy on recurrences was lower. The overall precision of identifying any recurrence, irrespective of localization, was high. However, the accuracy of classification of recurrences (local, regional or distant) was lower, with evidence of underreporting for each of the recurrence categories. Given the importance of recurrence-related outcomes in the assessment of quality of care, efforts should be made to improve the reporting of recurrences.

Purpose: Due to limited data on treatment-related risk factors associated with esophageal stricture in childhood cancer survivors, this study aimed to assess such factors in long-term survivors. Methods: A case-cohort study was conducted involving 36 cases of five-year childhood cancer survivors with esophageal stricture and a sub-cohort of 540 survivors diagnosed with cancer in 1970–2007 as identified within the Nordic ‘Adult Life after Childhood Cancer in Scandinavia’ program. Individualized treatment details were retrieved from medical records. Radiation doses to each body region and average dose to the esophagus were reconstructed for patients that received radiotherapy. We used a modified Cox proportional hazard model to evaluate associations between esophageal stricture and risk factors by calculating incidence rate ratio (IRR), with 95 % confidence intervals (CIs). Results: An increased rate of esophageal stricture was found in survivors who received total body irradiation (IRR=13.7, 95 %CI 4.6–41.1), chest- and neck-directed radiotherapy (IRR=23.5, 95 %CI 8.5−64.7) and doses of ≥12 Gy to the esophagus (IRR=26.8, 95 % CI=9.0–80.3) compared to non-irradiated survivors. Treatment with chemotherapy was also associated with esophageal stricture (IRR=8.4, 95 % CI=2.9–24.4). Notably, leukemia survivors faced an elevated rate (IRR=3.8, 95 % CI 1.8–8.1) compared with survivors of CNS and other solid tumors. Conclusions: Our findings indicate an increased risk of esophageal stricture among childhood cancer survivors, with both neck- and chest-directed radiotherapy and chemotherapy as important risk factors.

AbstractThis study aimed to contribute to knowledge about research on educational superintendents as decision-maker through a systematic review of research on this topic undertaken between 2000 and 2022. A literature search followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach. Of the 313 articles identified, 36 met the inclusion and quality criteria of the mixed-methods appraisal tool (MMAT) 2018. Six main areas emerged in research on superintendents’ decision-making tasks: policy implementation (n = 9), contextual issues (n = 7), general decision-making processes (n = 7), decision-making competence (n = 5), gender (n = 4), and values/ethics (n = 4). Results showed that most articles (28) were about research in the US. The review identified a lack of research about superintendents’ tasks as decision-makers, such as 1. knowledge about the significant differences between superintendents’ roles as decision-makers in urban and rural areas, 2. professional development programs for superintendents’ as decision-makers, and 3. studies about gender issues as the majority of teachers were women, while the majority of superintendents as decision-makers are men.

Objectives The objectives of this study are to study the risk of developing cardiac arrhythmia and its subtypes over time in patients with systemic sclerosis (SSc), to assess potential risk factors for arrhythmia in SSc and to explore whether arrhythmia is associated with mortality.Methods We used nationwide Swedish registers to identify patients with incident SSc 2004–2019 and matched general population comparators (1:10). The primary outcome was incident arrhythmia. Follow-up started at the date of SSc diagnosis and ended at the primary outcome, death, emigration or 31 December 2019. We estimated the incidence of arrhythmia overall and stratified by subtype and explored the relative risk in relation to time since diagnosis using flexible parametric models. We used Cox regression to study risk factors for arrhythmia and the association of arrhythmia with mortality.Results We identified 1565 patients and 16 009 comparators. The overall incidence of arrhythmia was 255 (95% CI 221 to 295) and 119 (95% CI 112 to 127) per 10 000 person years in patients with SSc and comparators, respectively, corresponding to an IRR of 2.1 (95% CI 1.8 to 2.5). The greatest hazard difference between patients with SSc compared with the comparators was seen in the first year of follow-up (HR for arrhythmia 3.0; 95% CI 2.3 to 3.8). Atrial fibrillation and flutter were the most common arrhythmia subtypes. Male sex, index age and pulmonary arterial hypertension were significant risk factors for arrhythmia in SSc. Incident arrhythmia was significantly associated with mortality (HR 2.2; 95% CI 1.6 to 3.0).Conclusion SSc is associated with higher incidence of cardiac arrhythmia compared with general population. Arrhythmia seems to be an early manifestation of SSc and is associated with higher mortality.

Abstract Background Experiencing gender‐based violence (GBV) is common among refugees. Intersecting systems of oppression can increase the risk of GBV and of suffering detrimental consequences, while concurrently creating barriers to meaningful support. Despite this, refugees with lived experience of GBV are rarely involved in the development, planning and adaptation of services and policies. Methods This article reports on a formative research process that aimed to involve public contributors (refugee victim‐survivors of GBV) and relevant stakeholders in co‐designing a service model aimed at improving psychosocial support in Sweden. Led by a partnership of public contributors and academic researchers, the research process consisted of iterative cycles of co‐design workshops, complemented by scoping of existing literature. Results The co‐design process resulted in a characterisation of the psychosocial service system needs, as perceived by the survivor co‐researchers and stakeholders, and a two‐level empowerment and support service model. The model included (i) a community‐based intervention to promote help‐seeking and (ii) psychosocial group support delivered in specialist clinics. Outcomes of the project included perceived benefits for those involved, service‐led direct changes and acquisition of funding for continued research on the co‐designed model. Conclusion Improving psychosocial support for refugees in Sweden affected by GBV requires safe spaces to connect with peers and familiarise with available services, laws and rights in the society. Further, strengthened collaborations across sectors are necessary to meet the variety of needs. Co‐design workshops were an effective way to initiate changes in the service delivery model for psychosocial support for refugees in Sweden affected by GBV. Patient or Public Contributions This is a participatory reflection on a participatory process. The survivor co‐researchers contributed to designing and carrying out the PPI process and have co‐authored this manuscript.

The aim of this study is to explore pre-service teachers' procedural and conceptual understanding of pupils' understanding of mean value, before and after an intervention. Participants are 66 pre-service teachers, and two teacher educators. The data consists of five video-recorded lessons and pre-service teachers' pre- and post-test discussions. Based on variation theory, the analysis aimed to identify pre-service teachers' expressed knowledge of procedural and conceptual understanding, focusing four categories of expressions: procedural (P), procedural didactics (PD), conceptual (C), and conceptual didactics (CD). The pre-service teachers' expressed understanding of pupils' knowledge developed differently in the five teacher student groups. A shift from procedural to conceptual focus occurred in two groups. The number of procedural related words expressed in the first group decreased from 104 (pre-test: 65 P and 39 PD) to 16 (post-test: 9 P and 7 PD), at the same time as the conceptual related words increased (pre 4 C and 0 CD and post 11 C and 16 CD). In the second group, 87 procedure-related words (36 P and 51 PD) identified during pre-test decreased after the intervention (3 P and 9 PD). Instead, concept-related words increased from 16 (12 C and 4 CD) to 29 (10 C and 19 CD). The changes occurred among participants who had got, except of theoretical instruction, challenging hands-on tasks about the Mathematical content in focus. The findings from this study contribute to understand how design of instruction for pre-service teacher contributes to enhance teacher students' didactic perspective on pupils' learning.

White matter hyperintensities (WMH), a marker of small vessel cerebrovascular disease, increase risk of developing mild cognitive impairment (MCI) and Alzheimer's disease (AD). Less is known about the extent and pattern of WMH in pre-MCI stages, such as among those with objectively-defined subtle cognitive decline (Obj-SCD). Five hundred and fifty-nine Alzheimer's Disease Neuroimaging Initiative participants (170 cognitively unimpaired [CU]; 83 Obj-SCD; 306 MCI) free of clinical dementia or stroke completed neuropsychological testing and MRI exams. ANCOVA models compared cognitive groups on regional WMH adjusting for age, sex, and apolipoprotein E (APOE) ɛ4 frequency. Compared with the CU group, those with Obj-SCD had greater temporal, occipital, and frontal WMH whereas those with MCI had higher WMH volume across all regions (p's < 0.01). No differences in WMH volume were observed between the Obj-SCD and MCI groups (p's > 0.05). Findings add to growing evidence of associations between Obj-SCD and imaging biomarkers, providing support for utility of these criteria to capture subtle cognitive changes that are biologically based.

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

Abstract Postural Orthostatic Tachycardia Syndrome (POTS) reflects an autonomic dysfunction, which can occur as a complication to COVID-19. Our aim was to examine gastrointestinal symptoms and gut microbiota composition in patients with POTS and post-acute COVID-19 syndrome (PACS), compared with controls. POTS patients (n = 27), PACS patients (n = 32) and controls (n = 39) delivered fecal samples and completed a 4-day food diary, irritable bowel syndrome-severity scoring system (IBS-SSS), and visual analog scale for IBS (VAS-IBS). A total of 98 DNA aliquots were sequenced to an average depth of 28.3 million (M) read pairs (Illumina 2 × 150 PE) per sample. Diversity and taxonomic levels of the microbiome, as well as functional abundances were calculated for POTS and PACS groups, then compared with controls. There were several differences in taxonomic composition between POTS and controls, whereas only the abundance of Ascomycota and Firmicutes differed between PACS and controls. The clinical variables total IBS-SSS, fatigue, and bloating and flatulence significantly correlated with multiple individual taxa abundances, alpha diversity, and functional abundances. We conclude that POTS, and to a less extent PACS, are associated with differences in gut microbiota composition in diversity and at several taxonomic levels. Clinical symptoms are correlated with both alpha diversity and taxonomic and functional abundances.

Abstract Background Nonsuicidal self-injury (NSSI) is associated with stigma, and negative attitudes among healthcare professionals toward NSSI have been reported. A person-centered approach that focuses on how individuals with lived experience of NSSI perceive the treatment and care they receive is invaluable in reducing barriers to help-seeking and improving treatment and mental healthcare services. The aim of the current qualitative study was to explore the perceptions of young adults when they look back upon their experiences of psychiatric treatment for NSSI during adolescence. Methods Twenty-six individuals with lived experience of NSSI who were in contact with child and adolescent psychiatry during adolescence were interviewed. The interviews were analyzed using thematic analysis. Results Three main themes were developed: Changed perceptions in retrospect, The importance of a collaborative conceptualization and Lasting impression of the relationship. Participants’ perception of themselves as well as the treatment changed over time. The importance of a joint understanding of NSSI and an agreed-upon treatment focus was emphasized. The relationship to the mental health professionals, and experiences of how NSSI was communicated, were salient several years later. Conclusions Healthcare professionals need to communicate about NSSI in a respectful manner and include the perspective of the adolescent with lived experience of NSSI in a joint conceptualization of NSSI and treatment focus.

The aim of this study was to collect and analyze research on inclusive education from the perspective of parents of students with intellectual disability (ID). The review examined characteristics and trends related to geographical origin of research, design, data collection, publication source and year, source of data, age of individuals with ID, and research focus. The initial database search produced a total of 2,540 non-duplicated articles published between 1994 and 2019. In total, 63 articles were included from the initial search and a subsequent ancestry search. The results show a significant increase in publication on the topic in the final one-tenth of the review time parameter, suggesting a continued upward trend. The majority of articles were qualitative in design, used interviews and surveys to collect data, and focus on the perspectives and beliefs of parents on inclusive education. Gaps in the existing set of research included a lack of family perspectives beyond that of mothers (e.g. father, grandparent) and a limited focus beyond perspectives and beliefs, to that of parent experiences of inclusive education.

This study examined whether teachers' professional development of their relational competence with students with attention deficit hyperactivity disorder (ADHD) and/or autism spectrum disorder (ASD) modifies teachers' and students' perceptions of their teacher-student relationships (TSR). Participants comprised teachers (n = 33) and students (n = 232) from two elementary schools: one intervention school (InS) and one control school (CoS). InS teachers reported significant TSR improvements, regardless of student group or gender (p = 0.03). Among InS students, significant results were driven by female neurodiverse (ND) students and neurotypical (NT) male students (p = 0.03). Nevertheless, positive effects were solely observed among ND female students, while NT male students, conversely, reported decreased TSR during follow-up tests. No significant effects were found at the CoS irrespective of teacher or student ratings. The findings suggest that enhancing teachers' understanding of relational competence concerning ND students will not only improve their own perceptions of their TSR but also those of ND female students. Nonetheless, directing teachers' focus towards one student group (ND students) risks diminishing teachers' attention towards other student groups, potentially explaining the poorer follow-up results among NT boys. The finding warrants further investigation, as it indicates a challenge for teachers to establish sufficient relational engagement with all students.

Abstract Background To avoid causing a thromboembolic event in patients undergoing catheter ablation for atrial fibrillation (AF), patients are treated with oral anticoagulants (OAC) prior to the procedure. Despite being on anticoagulants, some patients develop a left atrial appendage thrombus (LAAT). To exclude the presence of LAAT, transesophageal ultrasound (TEE) is performed in all patients prior to the procedure. We hypothesized continuous treatment with anticoagulants would result in a low prevalence of LAAT, in patients with low CHA2DS2‐VASc score. Method Medical records of consecutive patients planned to undergo AF ablation at Lund University Hospital during the years 2018–2020 were reviewed retrospectively. Examination protocols from transesophageal and transthoracic echocardiography were examined for LAAT and spontaneous echo contrast (SEC). Patients with LAAT and SEC were compared to patients without using Mann–Whitney U‐test and Pearson Chi‐squared analysis to test for correlation. Results Of 553 patients, three patients (0.54%) had LAAT, and 18 (3.25%) had spontaneous contrast (SEC). Patients with LAAT or SEC had a higher CHA2DS2‐VASc score, more often presented in AF at TEE and less often had a normal sized left atrium. Conclusion There is a low prevalence of LAAT and SEC in patients with AF scheduled for pulmonary vein isolation. Patients with SEC or LAAT tend to have paroxysmal AF less often and more often presented in AF at admission. No patients with CHA2DS2‐VASc 0, paroxysmal AF, normal sized left atrium and sinus rhythm at TEE were found to have LAAT or SEC.

ABSTRACTGastrointestinal disease caused by Salmonella enterica is associated with the pathogen’s ability to replicate within epithelial cells and macrophages. Upon host cell entry, the bacteria express a type-three secretion system encoded within Salmonella pathogenicity island 2, through which host-manipulating effector proteins are secreted to establish a stable intracellular niche. Transcription of this intracellular virulence program is activated by the PhoPQ two-component system that senses the low pH and the reduced magnesium concentration of host cell vacuoles. In addition to transcriptional control, Salmonella commonly employ RNA-binding proteins (RBPs) and small regulatory RNAs (sRNAs) to regulate gene expression at the post-transcriptional level. ProQ is a globally acting RBP in Salmonella that promotes expression of the intracellular virulence program, but its RNA repertoire has previously been characterized only under standard laboratory growth conditions. Here, we provide a high-resolution ProQ interactome during conditions mimicking the environment of the Salmonella-containing vacuole (SCV), revealing hundreds of previously unknown ProQ binding sites in sRNAs and mRNA 3′UTRs. ProQ positively affected both the levels and the stability of many sRNA ligands, some of which were previously shown to associate with the well-studied and infection-relevant RBP Hfq. We further show that ProQ activates the expression of PhoP at the post-transcriptional level, which, in turn, leads to upregulation of the intracellular virulence program.IMPORTANCESalmonella enterica is a major pathogen responsible for foodborne gastroenteritis, and a leading model organism for genetic and molecular studies of bacterial virulence mechanisms. One key trait of this pathogen is the ability to survive within infected host cells. During infection, the bacteria employ a type three secretion system that deliver effector proteins to target and manipulate host cell processes. The transcriptional regulation of this virulence program is well understood. By contrast, the factors and mechanisms operating at the post-transcriptional level to control virulence gene expression are less clear. In this study, we have charted the global RNA ligand repertoire of the RNA-binding protein ProQ during in vitro conditions mimicking the host cell environment. This identified hundreds of binding sites and revealed ProQ-dependent stabilization of intracellular-specific small RNAs. Importantly, we show that ProQ post-transcriptionally activates the expression of PhoP, a master transcriptional activator of intracellular virulence in Salmonella.

Abstract Insulin-like growth factor-1 (IGF-1) is essential for normal brain development and regulates processes of vascular maturation. The pathogenesis of intraventricular hemorrhage (IVH) relates to the fragility of the immature capillaries in the germinal matrix, and its inability to resist fluctuations in cerebral blood flow. In this work, using different experimental setups, we aimed to (i) establish an optimal time-point for glycerol-induction of IVH in relation to time-point of recombinant human (rh) IGF-1/rhIGFBP-3 administration, and (ii) to evaluate the effects of a physiologic replacement dose of rhIGF-1/rhIGFBP-3 on prevention of IVH and survival in the preterm rabbit pup. The presence of IVH was evaluated using high-frequency ultrasound and post-mortem examinations. In the first part of the study, the highest incidence of IVH (> 60%), occurred when glycerol was administered at the earliest timepoint, e.g., 6 h after birth. At later time-points (18 and 24 h) the incidence decreased substantially. In the second part of the study, the incidence of IVH and mortality rate following rhIGF-1/rhIGFBP-3 administration was not statistically different compared to vehicle treated animals. To evaluate the importance of maintaining intrauterine serum levels of IGF-1 following preterm birth, as reported in human interventional studies, additional studies are needed to further characterize and establish the potential of rhIGF-1/rhIGFBP-3 in reducing the prevalence of IVH and improving survival in the preterm rabbit pup.

Abstract Background Adherence to antibiotic recommendations and safety aspects of restrictive use are important components when combating antibiotic resistance. The primary aim of this study was to assess the impact of national guidelines on antibiotic prescriptions for bone augmentation procedures among dentists working at three specialized clinics. The secondary aim was to assess the occurrence of postoperative infections. Methods Medical charts of 400 patients treated with bone augmentation were reviewed: 200 in the years 2010–2011 and 200 in 2014–2015. The Swedish national recommendations for antibiotic prophylaxis were published in 2012. Results There was a wide variation in antibiotic regiments prescribed throughout the study. The number of patients treated with antibiotic prophylaxis in a single dose of 2 g amoxicillin, and treated as advocated in the national recommendations, was low and decreasing between the two time periods from 25% (n = 50/200) in 2010–2011 to 18.5% (n = 37/200) in 2014–2015. The number of patients not given any antibiotics either as a prophylactic single dose or during the postoperative phase increased (P

Abstract Background Core symptoms in attention deficit hyperactivity disorder (ADHD) are inattention, impulsivity and hyperactivity. Many individuals with this disorder also have a sedentary lifestyle, co-morbid mental illness such as depressive and anxiety disorders, and reduced quality of life. People with ADHD often have impaired executive function, which among other things may include difficulty in time management and structuring of everyday life. Pharmacological treatment is often the first-line option, but non-pharmacological treatment is also available and is used in clinical settings. In children and adolescents with ADHD, physical exercise is used as a non-pharmacological treatment. However, the evidence for the effectiveness of exercise in adults is sparse. Objective To implement the START intervention (START = Stöd i Aktivitet, Rörelse och Träning [Support in activity, movement and exercise]) consisting of a 12-week, structured mixed exercise programme with or without a cognitive intervention, in adults with ADHD, and study whether it has an effect on core symptoms of ADHD as well as physical, cognitive, mental and everyday functioning compared with usual treatment. A secondary aim is to investigate the participants’ experiences of the intervention and its possible benefits, and to evaluate the cost-effectiveness of START compared with usual treatment. Methods This is a randomized controlled trial planned to be conducted in 120 adults with ADHD, aged 18–65. The intervention will be given as an add-on to standard care. Participants will be randomized to three groups. Group 1 will be given a physiotherapist-led mixed exercise programme for 12 weeks. Group 2 will receive the same intervention as group 1 with the addition of occupational therapist-led cognitive skills training. Group 3 will be the control group who will receive standard care only. The primary outcome will be reduction of ADHD symptoms measured using the World Health Organization (WHO) Adult ADHD Self-Report Scale (ASRS-v1.1), Clinical Global Impression-Severity scale (CGI-S) and CGI-Improvement scale (CGI-I). The effect will be measured within 1 week after the end of the intervention and 6 and 12 months later. Discussion Data collection began in March 2021. The final 12-month follow-up is anticipated to be completed by autumn 2024. Trial registration ClinicalTrials.gov (Identifier: NCT05049239). Registered on 20 September 2021 (last verified: May 2021).

Elisabeth C van der Slikke,1 Lise FE Beumeler,2,3 Madlene Holmqvist,4 Adam Linder,4 Robert T Mankowski,5 Hjalmar R Bouma1,6 1Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, 9713GZ, the Netherlands; 2Department of Intensive Care, Medical Centre Leeuwarden, Leeuwarden, 8934AD, the Netherlands; 3Department of Sustainable Health, Campus Fryslân, University of Groningen, Groningen, 8911 CE, the Netherlands; 4Department of Infection Medicine, Skåne University Hospital Lund, Lund, 221 84, Sweden; 5Department of Physiology and Aging, University of Florida, Gainesville, FL, 32610, USA; 6Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, 9713GZ, the NetherlandsCorrespondence: Hjalmar R Bouma, Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, P.O. Box 30.001, EB70, Groningen, 9700 RB, the Netherlands, Tel +31 (0) 50 361 7870, Email h.r.bouma@umcg.nlAbstract: Sepsis is a global health challenge, with over 49 million cases annually. Recent medical advancements have increased in-hospital survival rates to approximately 80%, but the escalating incidence of sepsis, owing to an ageing population, rise in chronic diseases, and antibiotic resistance, have also increased the number of sepsis survivors. Subsequently, there is a growing prevalence of “post-sepsis syndrome” (PSS). This syndrome includes long-term physical, medical, cognitive, and psychological issues after recovering from sepsis. PSS puts survivors at risk for hospital readmission and is associated with a reduction in health- and life span, both at short and long term, after hospital discharge. Comprehensive understanding of PSS symptoms and causative factors is vital for developing optimal care for sepsis survivors, a task of prime importance for clinicians. This review aims to elucidate our current knowledge of PSS and its relevance in enhancing post-sepsis care provided by clinicians.Keywords: post-sepsis syndrome, sepsis, long-term outcome

Alterations to cerebral white matter tracts have been associated with cognitive decline in aging and Alzheimer's disease (AD). In particular, the fornix has been implicated as especially vulnerable given that it represents the primary outflow tract of the hippocampus. Despite this, little work has focused on the fornix using a potential early marker of white matter degeneration-myelin water fraction (MWF; an in vivo marker of myelin content). Therefore, we sought to (1) clarify associations between MWF in the fornix and memory functioning, and (2) examine whether fornix MWF relates to memory performance above and beyond hippocampal volume and conventional imaging measures of white matter that may not be as specific to alterations in myelin content. Forty nondemented older adults (mean age = 72.9 years) underwent an MRI exam and neuropsychological assessment. Multicomponent driven equilibrium single pulse observation of T1 and T2 (mcDESPOT) was used to quantify fornix MWF and diffusion tensor imaging (DTI) was used to measure fornix fractional anisotropy (FA). Adjusting for age, sex, education, and vascular risk factors, linear regression models revealed that, lower fornix MWF was significantly associated with poorer memory functioning (β = 0.405, p = .007) across our sample of older adults. Notably, fornix MWF remained a significant predictor of memory functioning (β = 0.380, p = .015) even after adjusting for fornix DTI FA and hippocampal volume (in addition to the above covariates). Given the observed associations between myelin and memory in older adults without dementia, MWF may be a useful early marker of dementia risk.

This research explores teacher educators' self-reported preparedness to teach students with special educational needs. Teacher educators are concerned with preparing the next generation of teachers who will, in turn, be addressing the needs of students with special educational needs within schools. Being able to address this important task also in their own teaching at the teacher education program is important for their own credibility. In total, 104 teacher educators at two university faculties completed an online questionnaire with questions about teaching students with special education needs. The results showed a significant difference between the educators' self-reported professional development needs. At University B, educators rated their own competence as well as the organizational ability to meet students with special educational needs higher than educators at University A, regardless of disability. One explanation for the differences in self-rated competence might be due to the mandatory courses about how to teach students with special educational needs, shaping a community of practice with a shared knowledge among the teacher educators at University B. However, the experienced challenge lies in difficulties to transform the knowledge of what is required and expected into practical solutions for teaching students with special educational needs.