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This study investigates the formation of VET teaching practice when using simulation as a teaching method to support students’ vocational learning at upper secondary schools in Sweden. The study is based on repeated interviews with twelve VET teachers from two schools over the course of three years. Drawing upon practice theory, the findings show that the use of simulators brought about both new knowledge and new relationships in teaching practice, as well as side effects such as dependency on other relatings outside the school. A new practice for vocational learning emerged, which required rearrangement of teachers’ work, roles and relatings., Funding: Swedish research councile [2018-03822]

Introduction: After more than two years the Coronavirus disease-19 (COVID-19) pandemic continues to burden healthcare systems and economies worldwide, and it is evident that the effects on the immune system can persist for months post-infection. The activity of myeloid cells such as monocytes and dendritic cells (DC) is essential for correct mobilization of the innate and adaptive responses to a pathogen. Impaired levels and responses of monocytes and DC to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is likely to be a driving force behind the immune dysregulation that characterizes severe COVID-19. Methods: Here, we followed a cohort of COVID-19 patients hospitalized during the early waves of the pandemic for 6-7 months. The levels and phenotypes of circulating monocyte and DC subsets were assessed to determine both the early and long-term effects of the SARS-CoV-2 infection. Results: We found increased monocyte levels that persisted for 6-7 months, mostly attributed to elevated levels of classical monocytes. Myeloid derived suppressor cells were also elevated over this period. While most DC subsets recovered from an initial decrease, we found elevated levels of cDC2/cDC3 at the 6-7 month timepoint. Analysis of functional markers on monocytes and DC revealed sustained reduction in program death ligand 1 (PD-L1) expression but increased CD86 expression across almost all cell types examined. Finally, C-reactive protein (CRP) correlated positively to the levels of intermediate monocytes and negatively to the recovery of DC subsets. Conclusion: By exploring the myeloid compartments, we show here that alterations in the immune landscape remain more than 6 months after severe COVID-19, which could be indicative of ongoing healing and/or persistence of viral antigens., Funding: ML SciLifeLab/KAW COVID-19 Research Program, Swedish Research Council [201701091]; COVID-19 ALF (Linkoeping University Hospital Research Fund), Region OEstergoetland ALF Grant [ROE935411]; Regional ALF Grant; Vrinnevi Hospital in Norrkoeping

This article is centred on the tendency to align education for newly arrived students with migration policy. Drawing on an in‐depth analysis of interviews with four adult migrant students, we aim to investigate how the participants’ experiences of studying and how they imagine their future intersect with their immigration status. The interviews were conducted when they were first studying a language introduction programme, and then three years later. We focus on the participants’ nar‐ ratives about transitions within the education system and later into the labour market. Using Sara Ahmed’s approach to the orientation of subjects in time and space, the analysis shows that all students expressed a desire to “be in line,” meaning finishing their studies and finding employment. Students with temporary and conditional residence permits were directed towards specific vocational tracks and sectors of the labour market. Migrant students are a heterogenous group and, based on the findings presented, we argue that immigration status constitutes a crucial part of this heterogeneity, influencing how students imagine their future in a new society.

In public discourse, the social inclusion of migrants is often regarded as a challenge demanding migrants to increase their engagement in adapting to the new host country. Such imaginaries commonly declare migrants as being unwilling to acquire language skills and specific cultural values. In parallel, formal education is often proposed as the single most important remedy to inclusion, which generally solely implies labor market participation. However, there is a range of other, often neglected, practices that migrants themselves regard as important for their social inclusion in society. This article aims to analyze what practices are assigned meaning by newly arrived migrants in Sweden on their path toward social inclusion in the country. This is a longitudinal interview study with 19 newly arrived adult migrants that were interviewed on two occasions, three years apart. Drawing on a sociocultural perspective, we understand social inclusion as an ongoing process by which individuals become members of different communities. The result shows that important for social inclusion is access to valuable relationships and close social ties. These relations are important in all communities in which the migrants participate. The analysis illustrates three different communities, outside of formal education and employment, that migrants ascribe meaning to concerning language learning and social inclusion. These communities are sports, internships, and civil society engagements. Through its longitudinal design, this study also illustrates how migrants’ narratives and their meanings shift with time and how migrants relate to these communities over time.

Common variable immunodeficiency (CVID) is an inborn error of immunity characterized by low levels of an-tibodies. In addition to infections, many patients also suffer from T-helper 1-driven immune dysregulation, which is associated with increased mortality. The aim of this study was to perform in-depth characterization of the T and the B cell compartments in a well-defined cohort of patients affected by CVID and correlate the findings to the level of clinical immune dysregulation. We used mass cytometry, targeted proteomics, flow cytometry and functional assays to delineate the immunological phenotype of 15 CVID-affected patients with different levels of immune dysregulation. Unbiased clustering of T cell mass cytometry data correlated with CVID-related immune dysregulation and plasma protein profiles. Expanded CXCR3+ T-bet-expressing B cells correlated with effector memory CD4+ T cell clusters, and increased plasma levels of CXCR3-ligands. Our findings indicate an interplay between B cells and T cells in CVID-related immune dysregulation and provide a better understanding of the underlying pathological mechanisms., Funding Agencies|ALF Region Ostergotland, Sweden [1203, RO-96962]; Bertil and Ebon Norlins Foundation for Medical Research, Sweden [1203]

The differing roles of the pentameric (p) and monomeric (m) C-reactive protein (CRP) isoforms in viral diseases are not fully understood, which was apparent during the COVID-19 pandemic regarding the clinical course of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Herein, we investigated the predictive value of the pCRP and mCRP isoforms for COVID-19 severity in hospitalized patients and evaluated how the levels of the protein isoforms changed over time during and after acute illness. This study utilized samples from a well-characterized cohort of Swedish patients with SARS-CoV-2 infection, the majority of whom had known risk factors for severe COVID-19 and required hospitalization. The levels of pCRP were significantly raised in patients with severe COVID-19 and in contrast to mCRP the levels were significantly associated with disease severity. Additionally, the pCRP levels remained elevated for at least six weeks post inclusion, which was longer compared to the two weeks for mCRP. Our data indicates a low level of inflammation lasting for at least six weeks following COVID-19, which might indicate that the disease has an adverse effect on the immune system even after the viral infection is resolved. It is also clear that the current standard method of testing pCRP levels upon hospitalization is a useful marker for predicting disease severity and mCRP testing would not add any clinical relevance for patients with COVID-19., Funding Agencies|ML SciLifeLab/KAW COVID-19 Research Program, Swedish Research Council [201701091]; COVID-19 ALF (Linkoping University Hospital Research Fund), Region Ostergotland ALF [RO935411]; Regional ALF Grant 2021 (Vrinnevi Hospital in Norrkoping)

I detta projekt undersöker vi vilka sammanhang och aktiviteter som framträder som centrala för migranters sociala inkludering. Vi har följt 58 vuxna migranter i tre år och resultaten pekar på att det civila samhället spelar stor roll för deras bana mot inkludering. Vidare framträder migranternas bakgrund i termer av ålder, utbildning och yrkeserfarenhet som centrala faktorer som villkorar möjligheten till social inkludering.

In public discourse, the social inclusion of migrants is often regarded as a challenge demanding migrants to increase their engagement in adapting to the new host country. Such imaginaries commonly declare migrants as being unwilling to acquire language skills and specific cultural values. In parallel, formal education is often proposed as the single most important remedy to inclusion, which generally solely implies labor market participation. However, there is a range of other, often neglected, practices that migrants themselves regard as important for their social inclusion in society. This article aims to analyze what practices are assigned meaning by newly arrived migrants in Sweden on their path toward social inclusion in the country. This is a longitudinal interview study with 19 newly arrived adult migrants that were interviewed on two occasions, three years apart. Drawing on a sociocultural perspective, we understand social inclusion as an ongoing process by which individuals become members of different communities. The result shows that important for social inclusion is access to valuable relationships and close social ties. These relations are important in all communities in which the migrants participate. The analysis illustrates three different communities, outside of formal education and employment, that migrants ascribe meaning to concerning language learning and social inclusion. These communities are sports, internships, and civil society engagements. Through its longitudinal design, this study also illustrates how migrants’ narratives and their meanings shift with time and how migrants relate to these communities over time.

In this five-month Swedish field study, we examined losses of nutrients from horse manure over time, in order to examine how regularly manure should be cleared from paddocks in order to minimise the risk of nutrient leaching. Small heaps of manure (400 g) were placed in open cylinders outdoors and samples (five replicates) were taken on 12 occasions from December 2020 to May 2021. The samples were analysed for weight, dry matter content and concentrations of total nitrogen (N), ammonium N, total phosphorus (P), water-extractable P (WEP), potassium (K) and carbon (C). There was a fast decline in P and K concentrations and a strong correlation between accumulated precipitation and losses from the manure into the soil. The mean reduction in total-P was 11 mg P kg−1 manure dry weight per mm accumulated precipitation. Manure N was retained in the manure over the five-month period. In conclusion, this study demonstrated high mobility of P and K, indicating a need for strategies for rapid removal of manure from paddocks. Daily removal of manure from paddocks used year-round would, approximately, save 1.7 kg P and 5.5 kg K per horse per year, which could be recycled to replace non-renewable mineral fertilisers.

Norovirus is the most common cause of acute non-bacterial gastroenteritis. Immunocompromised patients can become chronically infected, with or without symptoms. In Europe, common variable immunodeficiency (CVID) is one of the most common inborn errors of immunity. A potentially severe complication is CVID-associated enteropathy, a disorder with similar histopathology to celiac disease. Studies suggest that chronic norovirus infection may be a contributor to CVID enteropathy, and that the antiviral drug ribavirin can be effective against norovirus. Here, a patient with CVID-like disease with combined B- and T-cell deficiency, had chronic norovirus infection and enteropathy. The patient was routinely administered subcutaneous and intravenous immunoglobulin replacement therapy (SCIg and IVIg). The patient was also administered ribavirin for -7.5 months to clear the infection. Stool samples (collected 2013-2016) and archived paraffin embedded duodenal biopsies were screened for norovirus by qPCR, confirming a chronic infection. Norovirus genotyping was done in 25 stool samples. For evolutionary analysis, the capsid (VP1) and polymerase (RdRp) genes were sequenced in 10 and 12 stool samples, respectively, collected before, during, and after ribavirin treatment. Secretor phenotyping was done in saliva, and serum was analyzed for histoblood group antigen (HBGA) blocking titers. The chronic norovirus strain formed a unique variant subcluster, with GII.4 Den Haag [P4] variant, circulating around 2009, as the most recent common ancestor. This corresponded to the documented debut of symptoms. The patient was a secretor and had HBGA blocking titers associated with protection in immunocompetent individuals. Several unique amino acid substitutions were detected in immunodominant epitopes of VP1. However, HBGA binding sites were conserved. Ribavirin failed in treating the infection and no clear association between ribavirin-levels and quantity of norovirus shedding was observed. I, Funding Agencies|Region Ostergotland [ALF-LIU-934451]; Karolinska Institute [ALF-KI-K23003073]; Swedish Research Council [2018-02862]

HIV-1 infection gives rise to a multi-layered immune impairment in most infected individuals. The chronic presence of HIV-1 during the priming and activation of T cells by dendritic cells (DCs) promotes the expansion of suppressive T cells in a contact-dependent manner. The mechanism behind the T cell side of this HIV-induced impairment is well studied, whereas little is known about the reverse effects exerted on the DCs. Herein we assessed the phenotype and transcriptome profile of mature DCs that have been in contact with suppressive T cells. The HIV exposed DCs from cocultures between DCs and T cells resulted in a more tolerogenic phenotype with increased expression of e.g., PDL1, Gal-9, HVEM, and B7H3, mediated by interaction with T cells. Transcriptomic analysis of the DCs separated from the DC-T cell coculture revealed a type I IFN response profile as well as an activation of pathways involved in T cell exhaustion. Taken together, our data indicate that the prolonged and strong type I IFN signaling in DCs, induced by the presence of HIV during DC-T cell cross talk, could play an important role in the induction of tolerogenic DCs and suppressed immune responses seen in HIV-1 infected individuals., Funding Agencies|Swedish International Development Cooperation Agency; SIDA SARC; VINNMER for Vinnova; Linkoping University Hospital Research Fund; Swedish Society of Medicine; Molecular Infection Medicine Sweden; ALF; Swedish Research Council [AI52731]; Physicians against AIDS Research Foundation

COVID-19 is being extensively studied, and much remains unknown regarding the long-term consequences of the disease on immune cells. The different arms of the immune system are interlinked, with humoral responses and the production of high-affinity antibodies being largely dependent on T cell immunity. Here, we longitudinally explored the effect COVID-19 has on T cell populations and the virus-specific T cells, as well as neutralizing antibody responses, for 6-7 months following hospitalization. The CD8(+) TEMRA and exhausted CD57(+) CD8(+) T cells were markedly affected with elevated levels that lasted long into convalescence. Further, markers associated with T cell activation were upregulated at inclusion, and in the case of CD69(+) CD4(+) T cells this lasted all through the study duration. The levels of T cells expressing negative immune checkpoint molecules were increased in COVID-19 patients and sustained for a prolonged duration following recovery. Within 2-3 weeks after symptom onset, all COVID-19 patients developed anti-nucleocapsid IgG and spike-neutralizing IgG as well as SARS-CoV-2-specific T cell responses. In addition, we found alterations in follicular T helper (TFH) cell populations, such as enhanced TFH-TH2 following recovery from COVID-19. Our study revealed significant and long-term alterations in T cell populations and key events associated with COVID-19 pathogenesis., Funding Agencies|SciLifeLab/KAW COVID-19 Research Program, Swedish Research Council [201701091]; COVID-19 ALF (Linkoping University Hospital Research Fund); Region Ostergotland ALF [RO935411]; Regional ALF Grant 2021; Vrinnevi Hospital in Norrkoping

COVID-19 generates SARS-CoV-2-specific antibodies in immunocompetent individuals. However, in immunocompromised patients, the humoral immunity following infection may be impaired or absent. Recently, the assessment of cellular immunity to SARS-CoV-2, both following natural infection and vaccination, has contributed new knowledge regarding patients with low or no antibody responses. As part of a prospective cohort study which included hospitalized patients with COVID-19, we identified immunocompromised patients and compared them with age- and sex-matched immunocompetent patients regarding co-morbidities, biomarkers of COVID-19 and baseline viral load by real-time PCR in nasopharyngeal swabs. Spike and nucleocapsid antibody responses were analyzed at inclusion and after two weeks, six weeks and six months. Plasma immunoglobulin G (IgG) levels were quantified, lymphocyte phenotyping was performed, and SARS-CoV-2 specific CD4 and CD8 T cell responses after in vitro antigen stimulation were assessed at six months post infection. All patients showed IgG levels above or within reference limits. At six months, all patients had detectable SARS-CoV-2 anti-spike antibody levels. SARS-CoV-2 specific T cell responses were detected in 12 of 12 immunocompetent patients and in four of six immunocompromised patients. The magnitude of long-lived SARS-CoV-2 specific T cell responses were significantly correlated with the number of CD4 T cells and NK cells. Determining the durability of the humoral and cellular immune response against SARS-CoV-2 in immunocompromised individuals could be of importance by providing insights into the risk of re-infection and the need for vaccine boosters., Funding Agencies|Region Ostergotland ALF Grant [RO935411]; Regional ALF Grant 2021; Vrinnevi Hospital in Norrkoping and SciLifeLab/KAW COVID-19 Research Program

Bakgrund Demenssjukdom utgör ett stort hälsoproblem med både emotionella och fysiska konsekvenser. Många av de personer som lever med demenssjukdom flyttar till särskilda boenden när de inte längre klarar sig på egen hand. Beteendemässiga och psykiska symtom vid demens (BPSD) innefattar olika vanligt förekommande symtom vid demenssjukdom. Symtombehandling med läkemedel medför risker i form av förvirring, olyckor och fall. Syfte Syftet med denna litteraturöversikt är att beskriva effekter och användande av icke-farmakologiska metoder för att lindra symtom vid demens. Metod Litteraturöversikten baserades på 13 vetenskapliga artiklar, varav 11 kvantitativa och 2 kvalitativa, publicerade mellan 2012 och 2021. Artiklarna inhämtades från databaserna CINAHL, PubMed och PsycInfo. Studierna granskades enligt Örebros universitets mallar och därefter analyserades innehållet. Resultat Resultatet utgjordes av två huvudkategorier; Interventioners effekter med underkategorierna BPSD, Kognition, ADL, Livskvalitet och Vårdgivarbörda samt Användande av icke-farmakologiska metoder, med underkategorierna Tillfällen för icke-farmakologiska metoder, Kunskap och Hindrande faktorer. Resultatet visade att icke-farmakologiska metoder hade god effekt vid lindring av symtom vid demens. Effekten på olika symtom och grad av demens varierade beroende på metod. Slutsats Eftersom effekterna av de icke-farmakologiska metoderna varierade, krävdes en personcentrerad inställning där interventionerna individanpassades. Vid sidan av symtomlindring sågs effekter i form av ökad ADL-förmåga, ökad livskvalitet och minskad vårdgivarbörda., Background Dementia constitutes a large threat on health and has both emotional and physical consequences. Many people that live with dementia move into care facilities when they can no longer cope on their own. Behavioural and psychological symptoms of dementia(BPSD) include different symptoms that are common in dementia. To treat these symptoms with drugs entails risks, such as confusion, accidents and falls. Aim The aim of this study is to describe effects, and use of, non-pharmacological methods to alleviate symptoms of dementia. Method This literature rewiev is based on 13 scientific articles; 11 quantitative and 2 qualitative, published between 2012 and 2021. The articles were obtained from the databases CINAHL, PubMed and PsycInfo. The studies were reviewed according to templates by Örebro University and thereafter the content was analysed. Results The result was divided into two main categories; The effects of interventions, with the subcategories BPSD, Cognition, ADL, Quality of life and Caregiver burden and The use of non-pharmacological methods, with the subcategories Opportunities for non-pharmacological methods, Knowledge and Hindering factors. The result indicated that non-pharmacological methods were effective for alleviation of symptoms of dementia.The effect on different symptoms and degree of dementia varied depending on method. Conclusions Since the effects of the non-pharmacological methods varied, a person-centred approach with individualized interventions was necessary. In addition, there were positive effects in form om increased capability to perform ADL, increased quality of life and reduced caregiver burden.