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BACKGROUND: The role of hyperbaric oxygen therapy (HBOT) in necrotizing soft tissue infections (NSTI) is mainly based on small retrospective studies. A previous study using the 1998-2009 National Inpatient Sample (NIS) found HBOT to be associated with decreased mortality in NSTI. Given the argument of advancements in critical care, we aimed to investigate the continued role of HBOT in NSTI. METHODS: The 2012-2020 National Inpatient Sample (NIS) was queried for NSTI admissions who received surgery. 60,481 patients between 2012-2020 were included, 600 (

Abstract Children's interactions with nature are important mediators of health benefits and future relationships with nature and conservation. However, there are growing concerns that children are becoming disconnected from nature as societal changes make natural environments and their affordances less accessible. There is now a need to explore ways to reconnect children to nature. We evaluated bird feeding as an environmental education intervention on species knowledge, attitudes towards birds and well‐being of children (aged 10–11 years) in 14 urban and rural schools across three city regions. We used surveys to investigate the role of urbanisation and socio‐economic factors in children's relationships with nature and possible modulating effects on the intervention response. Local nature, close to the children's homes, was associated with better well‐being and modulated the effect of the intervention on species knowledge: children from areas with less local nature gained more from the project. Urbanisation per se had no direct impacts but did correlate with the types of affordances associated with nature by the children, suggesting differences in how urban and rural children utilise nature. We found that socio‐economic factors impacted pre‐existing species knowledge and attitudes towards nature. Higher education was associated with better species knowledge. Higher income correlated with children participating in more outdoor activities, which subsequently correlated with more positive attitudes towards birds. Species knowledge also correlated with positive attitudes. We found large differences in the intervention impact between schools, likely explained by a pivotal role of teachers facilitating nature interactions in school‐based projects. Our findings show that bird feeding has potential as an intervention to connect children with nature, but ecological and social contexts moderate its efficacy. Local greenspace and socio‐economics influenced children's relationships with nature in both urban and rural areas, indicating that local conditions rather than urbanisation levels govern connection to nature. Role models appeared crucial, suggesting that specialised environmental education organisations have significant potential to enhance nature connection through interventions, particularly in areas with low socio‐economic levels and sparse nature. Read the free Plain Language Summary for this article on the Journal blog.

Eating habits are among the strongest drivers of negative environmental impact. Public procurement has been suggested as an efficient lever to catalyze changes within the food system. This study examines alternative purchase processes that may decrease the carbon footprint of publicly procured food through a case study of a municipality in the Northern part of Sweden. The GHG emissions associated with the current food service in the case study were 2.2 kg CO2e per kg food and must be reduced by 40.9% by 2030 to comply with the Paris Agreement; 76% of the emissions derive from food of animal origin (44% from unprocessed red meat). Three alternative diet scenarios, “zero red meat,” “−50% red meat,” and “flexitarian free from red meat,” were explored. Only 6% of the total purchased food kilograms were altered, yet the cutback of meat caused GHG emissions reductions turned out to be as high as 44%. The Swedish Law on Public Procurement, deficient infrastructure, unsustainable food culture, and local politicians' reluctance to change were mentioned as the main obstacles to materializing necessary changes in the food procurement system. The respondents also pointed out essential policy changes at the national and municipal levels.

This work presents the polarization‐dependent behavior of the anapole state in stacked amorphous silicon (a‐Si) nanodisks with elliptical geometries. Using SiO2 as a spacer layer between the a‐Si disks, the high index contrast between these materials can be used to significantly reduce the fabrication complexity of the system compared to traditional methods that require additional etching of the spacers. A novel way of continuous tuning of the electric dipole anapole excitation within elliptical stacked a‐Si nanoresonators is demonstrated. By rotating the incident electric field's polarization angle, the anapole state can be selectively excited at two distinct wavelength positions separated by 80 nm. Experimental results show characteristic dips in the reflectance of the fabricated elliptical a‐Si stacks with wavelength positions between 1135 and 1217 nm depending on the polarization angle of the incident field which is corroborated by FDTD simulations. Through simulating the internal electric field in the resonators and using multipole decomposition, it is shown that the reflectance dips are due to anapole excitation in the individual disks. The capability to excite anapoles at two distinct wavelengths in the same structure has promising implications for the development of tunable sensors, frequency converters, and quantum memory applications.

The severe impact of global warming, especially in the arctic region, have a multitude of consequences spanning from sea-level rises and freshening of the ocean, to significant changes to the animal life, biodiversity and species distribution. As the arctic regions are inherently remote and can be both hazardous and difficult to reach, research to improve our understanding of the climate change impact is often limited to short term field-campaigns. Here we present the Danish DISCO-2 student CubeSat mission, designed to meet the growing need for an Earth-observing platform. This mission leverages the rapid advancements in CubeSat technology over the past decades to overcome the limitations of traditional fieldwork campaigns. DISCO-2 will assist on-going arctic climate research with a payload of optical and thermal cameras in combination with novel in-orbit data analysis capabilities. It will further be capable of performing photogrammetric observations to determine ice volumes from deteriorating glaciers and provide surface temperatures, enabling studies of heat transfer between glaciers and arctic fjords. As a student satellite, the payload capabilities will also be offered to novel student research ideas throughout the mission life time. The modularity and wide range of of-the-shelf-components for CubeSats has facilitated an immense opportunity to tailor this earth observing CubeSat to accommodate specific scientific goals and further provided students at the participating universities with an unparalleled possibility to go from an initial research idea to a running CubeSat mission.

Background: In Denmark, cost savings motivate mandatory biosimilar switches. In 2018, patients switched from originator to biosimilar adalimumab, that is, to GP2017 in Eastern and to SB5 in Western Denmark. However, concerns were raised about additional costs covering, that is, an increased number of outpatient visits due to patient education, treatment monitoring, and patient concerns. Objectives: To investigate whether the switch led to increased total healthcare costs, defined as costs related to in- and outpatient contacts in hospitals and the primary sector and use of prescription medicine (excluding biological treatment). Design: Observational cohort study with geographical cluster pseudo-randomization. Methods: Patients with rheumatoid arthritis, psoriatic arthritis (PsA), and axial spondyloarthritis (AxSpA), who switched were identified in the nationwide DANBIO registry. Total healthcare costs 9 months before and after the switch were captured from the National Patient and Prescription registries. The difference between pre- and post-switch costs was estimated by a generalized estimation equations (GEE) model. Results: Overall, 1316 patients switched to GP2017 ( n = 621) or SB5 ( n = 695). Total healthcare costs were mainly driven by hospital costs. The monthly fluctuations of hospital costs 9 months before and after the switch were largely similar or decreased. In the adjusted analyses (GEE), hospital costs decreased after the switch (by approximately 15%) for GP2017 switchers, especially PsA (estimate = 0.83; 95% CI 0.75–0.92) and AxSpA patients (estimate = 0.85; 0.77–0.93), with no significant changes for SB5 switchers. Conclusion: We found no increase in total healthcare costs in 9 months following a nationwide mandatory adalimumab originator to biosimilar switch. Our findings were strengthened by similar results for GP2017 and SB5.

Background: A digital lag has been reported on access to the internet and performing internet activities for young people with learning disabilities in everyday life. Aim: The aim of this study is to explore environmental opportunities and challenges when performing internet activities and how internet use influences social and community participation for young people with learning disabilities from the perspectives of the target group. Methods: An inductive design was applied, with focused observations and follow-up interviews of 15 internet-using young persons with learning disabilities in their everyday settings. The data was analysed interpretatively using open coding. Findings: The environment offered both opportunities and challenges in terms of the design of digital devices and digital support. Support from peers was often preferred. All participants performed internet activities related to social participation although not all used social media. Searching for information was performed, however, finding the information or understanding it was challenging and led to restricted participation in the community. Conclusion: More examples of internet use positively influencing social participation were found, contrary to community participation. It is indicated that concrete learning situations when using the internet for social participation were more adapted to the participants and promoted this type of participation, contrary to situations of internet use influencing community participation.

Background With increasing number of childhood cancer survivors, there is a growing population of adult survivors that reach reproductive age. Long-term side effects of cancer treatment can include damage to the reproductive organs and lead to premature ovarian failure. The purpose of the study was to examine female childhood cancer survivors’, participating in long-term follow-up, experiences of communication and information regarding fertility and reproductive health outcomes. We also aimed to investigate how they experienced the transition from pediatric to adult health services. Methods Participants for the study were all part of a longitudinal project, identified through the Long-Term Follow-Up Clinic at the Oncology Department at Sahlgrenska University Hospital, Sweden. Fifty-four female childhood cancer survivors treated with chemotherapy and/or radiotherapy before 18 years of age were included between 2016 and 2018. During the years 2018- 2022, twenty-five of the participants reached the age of 25 and were invited to conduct a semi-structured interview. Twenty-two agreed to participate. The interview includes questions about fertility, collaboration with healthcare and communication regarding reproductive options when diagnosed with cancer. Interview data was analysed inductively using a thematic analysis. Results The analysis of the data resulted in three main themes; (1) Communication challenges, (2) Information about potential infertility and (3) Follow-up – a broader perspective, with a total of 9 subthemes. Many of the women expressed lack of information regarding reproductive health and a disappointment in their follow-up. Conclusion It is evident that the young women have felt a lack of information regarding fertility, reproductive health outcomes and options after their cancer treatment. The results of our study also indicate that transition from pediatric health care to adult health care needs to be facilitated and supported.

OBJECTIVES: This study aims to investigate the extent to which low job control and heavy physical workload in middle age explain educational differences in all-cause and ischemic heart disease (IHD) mortality while accounting for important confounding factors. METHODS: The study is based on a register-linked cohort of men who were conscripted into the Swedish military at around the age of 18 in 1969/1970 and were alive and registered in Sweden in 2005 (N=46 565). Cox proportional hazards regression models were built to estimate educational differences in all-cause and IHD mortality and the extent to which this was explained by physical workload and job control around age 55 by calculating the reduction in hazard ratio (HR) after adjustments. Indicators of health, health behavior, and other factors measured during conscription were accounted for. RESULTS: We found a clear educational gradient for all-cause and IHD mortality (HR 2.07 and 2.47, respectively, for the lowest compared to the highest education level). A substantial part was explained by the differential distribution of the confounding factors. However, work-related factors, especially high physical workload, also played important explanatory roles. CONCLUSION: Even after accounting for earlier life factors, low job control and especially high physical workload seem to be important mechanistic factors in explaining educational inequalities in all-cause and IHD mortality. It is therefore important to find ways to reduce physical workload and increase job control in order to decrease inequalities in mortality.

Anthropogenic changes to the environment expose wildlife to many pollutants. Among these, tropospheric ozone is of global concern and a highly potent pro-oxidant. In addition, human activities include several other implications for wildlife, e.g., changed food availability and changed distribution of pathogens in cities. These co-occurring habitat changes may interact, thereby modulating the physiological responses and costs related to anthropogenic change. For instance, many food items associated with humans (e.g., food waste and feeders for wild birds) contain relatively more ω6-than ω3-polyunsaturated fatty acids (PUFAs). Metabolites derived from ω6-PUFAs can enhance inflammation and oxidative stress towards a stimulus, whereas the opposite response is linked to ω3-derived metabolites. Hence, we hypothesized that differential intake of ω6-and ω3-PUFAs modulates the oxidative stress state of birds and thereby affects the responses towards pro-oxidants. To test this, we manipulated dietary ω6:ω3 ratios and ozone levels in a full-factorial experiment using captive zebra finches (Taeniopygia guttata). Additionally, we simulated an infection, thereby also triggering the immune system’s adaptive pro-oxidant release (i.e., oxidative burst), by injecting lipopolysaccharide. Under normal air conditions, the ω3-diet birds had a lower antioxidant ratio (GSH/GSSG ratio) compared to the ω6-diet birds. When exposed to ozone, however, the diet effect disappeared. Instead, ozone exposure overall reduced the total concentration of the key antioxidant glutathione (tGSH). Moreover, the birds on the ω6-rich diet had an overall higher antioxidant capacity (OXY) compared to birds fed a ω3-rich diet. Interestingly, only the immune challenge increased oxidative damage, suggesting the oxidative burst of the immune system overrides the other pro-oxidative processes, including diet. Taken together, our results show that ozone, dietary PUFAs, and infection all affect the redox-system, but in different ways, suggesting that the underlying responses are decoupled despite that they all increase pro-oxidant exposure or generation. Despite lack of apparent cumulative effect in the independent biomarkers, the combined single effects could together reduce overall cellular functioning and efficiency over time in wild birds exposed to pathogens, ozone, and anthropogenic food sources.

BackgroundSulfur mustard (SM) exposure causes acute and chronic respiratory diseases. The extent of small airway dysfunction (SAD) in individuals exposed to SM is unclear. This study evaluated and compared SAD in SM-exposed and SM-unexposed participants using noninvasive lung function tests assessing small airway function.MethodsThis retrospective cohort study involved SM-exposed (n = 15, mean age: 53 ± 8 years) and SM-unexposed (n = 15, mean age: 53 ± 7 years) Kurdish-Swedish individuals in Sweden. Small airway resistance and reactance were assessed using impulse oscillometry (IOS). Nitrogen (N2) multiple breath washout (MBW) was employed to assess lung ventilation heterogeneity. The gas-exchanging capacity of the lungs was assessed using the diffusing capacity of the lungs for the carbon monoxide (DLCO) test. Lung function outcomes were reported as absolute values and z-scores. Group comparisons were performed using the Mann–Whitney U test.ResultsNo statistically significant differences in age, height, or body mass index were observed between the two groups. IOS showed significantly increased small airway resistance, while N2MBW exhibited significantly increased global and acinar ventilation heterogeneity in SM-exposed individuals compared to that in unexposed individuals. SAD was identified in 14 of 15 SM-exposed individuals, defined as at least one abnormal IOS difference between resistance at 5 and 20 Hz (R5-R20) and/or area of reactance (AX) or N2MBW lung’s acinar zone (Sacin), and DLCO adjusted to the alveolar volume (DLCO/VA) outcome. Of these 14 individuals, only 5 demonstrated concordant findings across the IOS and N2MBW tests.ConclusionExposure to SM was positively associated with long-term impairment of respiratory tract function in the small airways in the majority of the previously SM-exposed individuals in the present study. Furthermore, both IOS and N2MBW should be employed to detect SAD in SM-exposed survivors as they provide complementary information. Identifying and characterizing the remaining pathology of the small airways in survivors of SM exposure is a first step toward improved treatment and follow-up.

Abstract Background People with a severe mental illness (SMI) have shorter life expectancy and poorer quality of life compared to the general population. Most years lost are due to cardiovascular disease, respiratory disease, and various types of cancer. We co-designed an intervention to mitigate this health problem with key stakeholders in the area, which centred on an extended consultations for people with SMI in general practice. This study aimed to1) investigate general practitioners’ (GPs) experience of the feasibility of introducing extended consultations for patients with SMI, 2) assess the clinical content of extended consultations and how these were experienced by patients, and 3) investigate the feasibility of identification, eligibility screening, and recruitment of patients with SMI. Methods The study was a one-armed feasibility study. We planned that seven general practices in northern Denmark would introduce extended consultations with their patients with SMI for 6 months. Patients with SMI were identified using practice medical records and screened for eligibility by the patients’ GP. Data were collected using case report forms filled out by practice personnel and via qualitative methods, including observations of consultations, individual semi-structured interviews, a focus group with GPs, and informal conversations with patients and general practice staff. Results Five general practices employing seven GPs participated in the study, which was terminated 3 ½ month ahead of schedule due to the COVID-19 pandemic. General practices attempted to contact 57 patients with SMI. Of these, 38 patients (67%) attended an extended consultation, which led to changes in the somatic health care plan for 82% of patients. Conduct of the extended consultations varied between GPs and diverged from the intended conduct. Nonetheless, GPs found the extended consultations feasible and, in most cases, beneficial for the patient group. In interviews, most patients recounted the extended consultation as beneficial. Discussion Our findings suggest that it is feasible to introduce extended consultations for patients with SMI in general practice, which were also found to be well-suited for eliciting patients’ values and preferences. Larger studies with a longer follow-up period could help to assess the long-term effects and the best implementation strategies of these consultations.

OBJECTIVES: While psychosocial working conditions have been associated with morbidity, their associations with mortality, especially cause-specific mortality, have been less studied. Additionally, few studies considered the time-varying aspect of exposures. We aimed to examine trajectories of job demand–control status in relation to all-cause and cause-specific mortality, including cardiovascular diseases (CVD), suicide, and alcohol-related mortality. METHODS: The study population consisted of around 4.5 million individuals aged 16-60 years in Sweden in 2005. Job control and demands were respectively measured using job exposure matrices (JEM). Trajectories of job control and demands throughout 2005–2009 were identified using group-based trajectory modelling, and job demand–control categories were subsequently classified. Deaths in 2010–2019 were recorded in the national cause of death register. Cox regression models were used. RESULTS: A total of 116 242 individuals died in 2010–2019. For both job control and demands, we identified four trajectories, which were parallel to each other and represented four levels of exposures. Low control and passive jobs were associated with higher all-cause, CVD, and suicide mortality among both men and women. High strain jobs were associated with higher all-cause and CVD mortality among men, while low control, passive jobs, and high strain jobs were associated with higher alcohol-related mortality among women. CONCLUSIONS: The trajectories identified may suggest stable levels of job control and demands over time. Poor psychosocial working conditions are related to all-cause and cause-specific mortality, and these patterns vary to some extent between men and women.

Abstract Introduction Obesity is associated with impaired results after in vitro fertilisation (IVF). Consequently, several fertility clinics have set limits of body mass index (BMI) and obese infertile women are thus obliged to lose weight before treatment. Randomised controlled trials (RCTs) have not been able to show an increase in live birth rate after weight reduction before fertility treatment. The purpose of this study was to investigate the patients' experiences and views of participating in a RCT on weight reduction for obese women before IVF, in a long‐term perspective. Methods A qualitative follow‐up interview study including 17 women was performed between September and December 2020. The interviewed women had all been included in an RCT around 6 years earlier. Semistructured interviews were conducted, the interviews were audio recorded, transcribed verbatim, and analysed using thematic content analysis. Results During the analysis two main themes emerged; ‘Pros and cons related to trial participation’ and ‘Message to health care’. Several women were excited about the prospect of possibly receiving weight reduction before IVF. The women appreciated the support during the intervention but expressed that the diet was tough, and it was hard to maintain the weight loss. Their views regarding BMI limits differed. They advocated an individual assessment regardless of the woman's BMI and expressed that it could be of value to offer weight reduction treatment before IVF. Conclusions Even though the RCT and a 2‐year follow‐up could not show an increase in live birth rate in the intervention group most women had a positive attitude to weight reduction treatment before IVF. The importance of this study is that the views of the women have been highlighted and their opinions can add valuable information for fertility clinics in their care of obese infertile women.

Abstract Objective To evaluate the feasibility and fidelity of implementing and assessing the SOFIA coordinated care program aimed at lowering mortality and increasing quality of life in patients with severe mental illness by improving somatic health care in general practice. Design A cluster-randomised, non-blinded controlled pilot trial. Setting General Practice in Denmark. Intervention The SOFIA coordinated care program comprised extended structured consultations carried out by the GP, group-based training of GPs and staff, and a handbook with information on signposting patients to relevant municipal, health, and social initiatives. Patients Persons aged 18 years or older with a diagnosis of psychotic, bipolar, or severe depressive disorder. Main outcome measures We collected quantitative data on the delivery, recruitment and retention rates of practices and patients, and response rates of questionnaires MMQ and EQ-5D-5 L. Results From November 2020 to March 2021, nine practices were enrolled and assigned in a 2:1 ratio to the intervention group (n = 6) or control group (n = 3). Intervention group practices included 64 patients and Control practices included 23. The extended consultations were delivered with a high level of fidelity in the general practices; however, thresholds for collecting outcome measures, and recruitment of practices and patients were not reached. Conclusion Our findings suggest that delivering the coordinated care program in a fully powered trial in primary care is likely feasible. However, the recruitment methodology requires improvement to ensure sufficient recruitment and minimize selective inclusion. Trial registration The date of pilot trial protocol registration was 05/11/2020, and the registration number is NCT04618250.

The steel industry accounts, according to the International Energy Agency, for ~6.7% of global CO2 emissions, and the major portion of its contribution is from steelmaking via the blast furnace (BF) route. In the short term, a significant reduction in fossil CO2 emissions can be achieved through the introduction of bio-coal into the BF as part of cold bonded briquettes, by injection, or as part of coke. The use of bio-coal-containing residue briquettes was previously demonstrated in industrial trials in Sweden, whereas bio-coal injection was only tested on a pilot scale or in one-tuyere tests. Therefore, industrial trials replacing part of the pulverized coal (PC) were conducted. It was concluded that the grinding, conveying, and injection of up to 10% of charcoal (CC) with PC can be safely achieved without negative impacts on PC injection plant or BF operational conditions and without losses of CC with the dust. From a process point of view, higher addition is possible, but it must be verified that grinding and conveying is feasible. Through an experimentally validated computational fluid flow model, it was shown that a high moisture content and the presence of oversized particles delay devolatilization and ignition, lowering the combustion efficiency. By using CC with similar heating value to PC, compositional variations in the injected blend are not critical.

Abstract A growing body of literature suggests that involving end-users in intervention research, including design, implementation, and evaluation, is associated with numerous positive outcomes. These outcomes include improved intervention efficacy, sustainability, and psychological growth among collaborators. The value of this approach and the recommendation for researchers to embrace co-creation in implementation and policies have also been recognised within the EU Framework of Research Innovation. Furthermore, it has been suggested that this approach may be particularly relevant for working with individuals from marginalised groups, whose voices are often absent from research and policy discussions. However, there has been limited attention given to how co-creation unfolds in practice. In this article, we provide a review of the methodological framework implemented by the H2020 REFUGE-ED (2021–2023), which was conducted in collaboration with migrant, refugee, and asylum-seeking communities. The project implemented the 'REFUGE-ED Dialogic Co-Creation Process (RDCP)' in 46 educational settings across six European countries. Considering the need for evidence-based approaches in education and mental health and psychosocial support practices, we suggest that the RDCP has the potential for sustainability and replicability in diverse contexts.

Abstract Introduction Young female adult childhood cancer survivors have frequently been reported to be concerned about their health, in particular their future fertility. The aim of this study was to examine how self‐image, mental health and perceptions of the fertility of young female adults are affected by the illness. Methods A qualitative study with interviewer‐administered semistructured questions was performed from May 2018 to October 2020 at Sahlgrenska University Hospital, Sweden. Fourteen women participated in the study. The median age of the participants was 27 (25–31) years. Results The interviews were recorded and analysed inductively by a thematic approach. Forty‐one codes were created, of these 21 initial codes were found to be related to the aim of the present study. Subsequently, four broad themes were created and these were reanalysed and constituted three main themes, resulting in the labelling: ‘An experience for better and worse’, ‘An everyday life similar and yet different from peers’ and ‘An uncertain fertility’, and a relevant number (11) of inclusive subthemes. Participants expressed that the experience of surviving childhood cancer both strengthened and impaired their everyday life and implied the lack of information about fertility. Conclusions Although a long time, over 10 years, had passed since the cancer treatment for all participants, the experiences of the illness were still present in their lives, both for better and worse. Healthcare workers need to keep this complexity in mind when facing young childhood cancer survivors. Thus, there is a need for individualized support regarding fertility and mental health.