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Abstract Background Group housing of sows has been extensively studied since the EU banned gestation crating. Well-managed group-housing promotes sow welfare, but the impact varies based on factors such as feeding, group characteristics, and environmental features. Adequate floor space, particularly directly post-mixing, is crucial for social interactions, natural behaviours, and to reduce injuries caused by aggression. The aim of this study was to compare two group-housing systems for gestating sows with respect to productivity, treatment frequency, and removal of sows. Both systems were static but differed in space allowance, quantity of enrichment material and feeding management. System I comprised of large sized pens with deep litter straw bedding, housing in total 40 sows, and System II of smaller sized pens with permanent access to straw, housing 8 to 10 sows. Results The mean parity number was 3.1 ± 1.3 in both groups. Sows housed in System I with large groups (n = 40) in large pens with deep litter straw gave birth to 16.8 ± 0.33 (Least Squares Means, LSM) piglets, compared to 15.4 ± 0.31 (LSM) for sows in System II kept in smaller groups (n = 8–10) in smaller pens (p = 0.0005). Medical treatments of sows were more frequent (p

E-scooters are quite popular among young people in big cities. Their use seems to be a well-studied phenomenon. This study concentrates on the risky behaviour of e-scooter riders and on e-scooter riders' and non-riders' attitudes towards risky e-scooter riding. The goals were to describe these attitudes and to describe the most common types of risky e-scooter behaviours in five participating countries. An online questionnaire was developed and distributed in Australia, Belgium, the Czech Republic, Sweden, and Norway from June to September 2020. Respondents were recruited through sponsored Facebook ads and participant sharing (snowball sampling). The riders in the countries considered in this study tend to perceive e-scooters as being quite safe. The majority of them even think e-scooters pose no danger to other road users. On the other hand, the non-riders believe riding an e-scooter is rather unsafe, with the exception of Belgium, where the respondents tend to think that it is very unsafe. When risky behaviour is considered, the non-riders tend to report more risky behaviour than e-scooter riders, even though fact-based observable behaviour, e.g. helmet use, should in principle be the same across both groups. In addition, as the existing literature shows, evidence suggests that young riders and male riders engage in more risky riding behaviours in comparison to older and female riders. This phenomenon should be addressed by effective preventive programmers and campaigns. The data shows that a greater frequency of riding predicted more risky riding behaviours. Although there are some differences between the samples under study, these findings can inspire police officers to promote e-scooter safety behaviour.

ABSTRACT Metagenomic shotgun sequencing (mNGS) can serve as a generic molecular diagnostic tool. An mNGS proficiency test (PT) was performed in six European veterinary and public health laboratories to detect porcine astroviruses in fecal material and the extracted RNA. While different mNGS workflows for the generation of mNGS data were used in the different laboratories, the bioinformatic analysis was standardized using a metagenomic read classifier as well as read mapping to selected astroviral reference genomes to assess the semiquantitative representation of astrovirus species mixtures. All participants successfully identified and classified most of the viral reads to the two dominant species. The normalized read counts obtained by aligning reads to astrovirus reference genomes by Bowtie2 were in line with Kraken read classification counts. Moreover, participants performed well in terms of repeatability when the fecal sample was tested in duplicate. However, the normalized read counts per detected astrovirus species differed substantially between participants, which was related to the different laboratory methods used for data generation. Further modeling of the mNGS data indicated the importance of selecting appropriate reference data for mNGS read classification. As virus- or sample-specific biases may apply, caution is needed when extrapolating this swine feces-based PT for the detection of other RNA viruses or using different sample types. The suitability of experimental design to a given pathogen/sample matrix combination, quality assurance, interpretation, and follow-up investigation remain critical factors for the diagnostic interpretation of mNGS results.IMPORTANCEMetagenomic shotgun sequencing (mNGS) is a generic molecular diagnostic method, involving laboratory preparation of samples, sequencing, bioinformatic analysis of millions of short sequences, and interpretation of the results. In this paper, we investigated the performance of mNGS on the detection of porcine astroviruses, a model for RNA viruses in a pig fecal material, among six European veterinary and public health laboratories. We showed that different methods for data generation affect mNGS performance among participants and that the selection of reference genomes is crucial for read classification. Follow-up investigation remains a critical factor for the diagnostic interpretation of mNGS results. The paper contributes to potential improvements of mNGS as a diagnostic tool in clinical settings.

Since the 1950s, more than 200 000 km of roads have been built in Sweden’s forests, making them easily accessible and open to multiple uses. The aim of this study was to review the impacts of forest roads in Sweden from a broad perspective encompassing social, ecological, and environmental factors. The Swedish case is interesting because it has an extensive network of permanent forest roads which were built primarily for forestry-related transportation but are currently used by many other stakeholders for many different purposes. Forest roads not only facilitate transportation of wood, machinery, personnel, and equipment into and out of the forest but also enable emergency response to wildfires and support berry and mushroom picking, hunting, recreation, tourism, and access to second homes. The roads increase the opportunities for members of the public to experience forests in various ways. Conflicts arise when different interests collide, for example when the interests of the forest owner clash with those of commercial berry-picking companies, tourism entrepreneurs, or reindeer (Rangifer tarandus L.) herding. Forest roads may have ecological impacts such as barrier and disturbance effects, fragmentation or loss of habitats, altering fauna movement patterns, and changing the composition of plant and insect species. The environmental impacts of forest roads relate to, among other things, hydrology, water quality, and erosion. Predicted changes in the climate are likely to place new demands on Swedish forest roads but, despite their extent, this review shows that there is only a small amount of rather fragmented research on their social, ecological, and environmental consequences. Overall, few studies appear to cover both social and ecological/environmental factors and their interactions, either in Sweden or elsewhere. This review provides examples of such interactions in the case of Sweden, and suggests that more research into these and the specific social, ecological, and environmental factors involved is warranted.

BackgroundSurvivorship for those living with primary CNS cancers begins at diagnosis, continues throughout a person's life, and includes caregivers. Opportunities and challenges exist to advance survivorship care for those living with primary CNS cancers that necessitate stakeholder involvement.MethodsIn June 2021, NCI-CONNECT convened a two-day virtual workshop about survivorship care in neuro-oncology. Two expert panels provided key recommendations and five working groups considered critical questions to identify strengths, weaknesses, opportunities, and threats to the advancement of survivorship care and developed recommendations and action items.ResultsThe following action items emanated from the workshop: seek endorsement of meeting report from stakeholder organizations; address barriers in access to survivorship care and provider reimbursement; advance survivorship research through NIH and private grant support; develop a survivorship tool kit for providers, people living with primary CNS cancers and their caregivers; provide accessible educational content for neuro-oncology, neurology, and oncology community providers about survivorship care in neuro-oncology; and establish core competencies for survivorship care for neuro-oncology providers to be included in training and standardized exams.ConclusionsAction items aim to address access and reimbursement barriers, expand patient and provider education, develop core competencies, and support survivorship research through funding and other supports.

Abstract Background Nemaline myopathy (NM) and related disorders (NMr) form a heterogenous group of ultra-rare (1:50,000 live births or less) congenital muscle disorders. To elucidate the self-reported physical, psychological, and social functioning in the daily lives of adult persons with congenital muscle disorders, we designed a survey using items primarily from the Patient Reported Outcomes Measurement Information System, PROMIS®, and conducted a pilot study in patients with NM and NMr in Finland. The items were linked to International Classification of Functioning, Disability and Health (ICF) categories. Results In total, 20 (62.5%) out of 32 invited persons resident in Finland participated in the study; 12 had NM and 8 NMr, 15 were women and 5 men aged 19–75 years. Sixteen (80%) were ambulatory and 4 (20%) NM patients used wheelchairs. The results from the PROMIS measuring system and ICF categories both indicated that non-ambulatory patients of this study faced more challenges in all areas of functioning than ambulatory ones, but the differences were smaller in the domains measuring psychological and social functioning than in physical functioning. In addition, the COVID-19 pandemic adversely affected the functioning of non-ambulatory patients more than that of ambulatory patients. The interindividual differences were, however, noticeable. Conclusions To our knowledge, this pilot study is the first comprehensive survey-based study of the physical, psychological, and social functioning of adult persons with nemaline myopathy or related disorders. The results indicate vulnerability of non-ambulatory patients being at higher risk to a decrease in general functioning during global or national exceptional periods. The responses also gave directions for modifying and improving the survey for future studies.

Background: Tamoxifen is an established treatment for breast cancer, but its long-term effects on survival and on secondary cancers are not fully evaluated. Material and methods: We studied 30 years outcome of 4124 postmenopausal patients who were randomized to receive (totally) two or five years of adjuvant tamoxifen. Results: After 5 years of follow-up, when tamoxifen treatment was finished in both groups, until 15 years of follow-up, overall mortality (HR 0.80, 95% CI 0.72–0.90, p

Abstract Sepsis is a time dependent condition. Screening tools based on clinical parameters have been shown to increase the identification of sepsis. The aim of current study was to evaluate the additional predictive value of immunological molecular markers to our previously developed prehospital screening tools. This is a prospective cohort study of 551 adult patients with suspected infection in the ambulance setting of Stockholm, Sweden between 2017 and 2018. Initially, 74 molecules and 15 genes related to inflammation were evaluated in a screening cohort of 46 patients with outcome sepsis and 50 patients with outcome infection no sepsis. Next, 12 selected molecules, as potentially synergistic predictors, were evaluated in combination with our previously developed screening tools based on clinical parameters in a prediction cohort (n = 455). Seven different algorithms with nested cross-validation were used in the machine learning of the prediction models. Model performances were compared using posterior distributions of average area under the receiver operating characteristic (ROC) curve (AUC) and difference in AUCs. Model variable importance was assessed by permutation of variable values, scoring loss of classification as metric and with model-specific weights when applicable. When comparing the screening tools with and without added molecular variables, and their interactions, the molecules per se did not increase the predictive values. Prediction models based on the molecular variables alone showed a performance in terms of AUCs between 0.65 and 0.70. Among the molecular variables, IL-1Ra, IL-17A, CCL19, CX3CL1 and TNF were significantly higher in septic patients compared to the infection non-sepsis group. Combing immunological molecular markers with clinical parameters did not increase the predictive values of the screening tools, most likely due to the high multicollinearity of temperature and some of the markers. A group of sepsis patients was consistently miss-classified in our prediction models, due to milder symptoms as well as lower expression levels of the investigated immune mediators. This indicates a need of stratifying septic patients with a priori knowledge of certain clinical and molecular parameters in order to improve prediction for early sepsis diagnosis. Trial registration: NCT03249597. Registered 15 August 2017.

Background: Group housing of sows has been extensively studied since the EU banned gestation crating. Well-managed group-housing promotes sow welfare, but the impact varies based on factors such as feeding, group characteristics, and environmental features. Adequate floor space, particularly directly post-mixing, is crucial for social interactions, natural behaviours, and to reduce injuries caused by aggression. The aim of this study was to compare two group-housing systems for gestating sows with respect to productivity, treatment frequency, and removal of sows. Both systems were static but differed in space allowance, quantity of enrichment material and feeding management. System I comprised of large sized pens with deep litter straw bedding, housing in total 40 sows, and System II of smaller sized pens with permanent access to straw, housing 8 to 10 sows. Results: The mean parity number was 3.1 ± 1.3 in both groups. Sows housed in System I with large groups (n = 40) in large pens with deep litter straw gave birth to 16.8 ± 0.33 (Least Squares Means, LSM) piglets, compared to 15.4 ± 0.31 (LSM) for sows in System II kept in smaller groups (n = 8–10) in smaller pens (p = 0.0005). Medical treatments of sows were more frequent (p < 0.001) in System II. The incidence of replacement of sows was comparable in both systems, and there was a high occurrence of sows becoming pregnant during the subsequent insemination in both groups. Conclusions: This study indicated that sows kept in larger groups provided with a larger floor space (a total area of 156 m2, corresponding to 3.9 m2 per sow) and housed on deep straw had a higher number of liveborn and weaned piglets and lower incidence of antibiotic treatments than sows with less floor space (a total area of 24.5 m2, corresponding to 2.5–3.1 m2 per sow) and less bedding/manipulable material. [ABSTRACT FROM AUTHOR]

Abstract Nemaline myopathy (NM) is one of the most common non-dystrophic genetic muscle disorders. NM is often associated with mutations in the NEB gene. Even though the exact NEB-NM pathophysiological mechanisms remain unclear, histological analyses of patients’ muscle biopsies often reveal unexplained accumulation of glycogen and abnormally shaped mitochondria. Hence, the aim of the present study was to define the exact molecular and cellular cascade of events that would lead to potential changes in muscle energetics in NEB-NM. For that, we applied a wide range of biophysical and cell biology assays on skeletal muscle fibres from NM patients as well as untargeted proteomics analyses on isolated myofibres from a muscle-specific nebulin‐deficient mouse model. Unexpectedly, we found that the myosin stabilizing conformational state, known as super-relaxed state, was significantly impaired, inducing an increase in the energy (ATP) consumption of resting muscle fibres from NEB-NM patients when compared with controls or with other forms of genetic/rare, acquired NM. This destabilization of the myosin super-relaxed state had dynamic consequences as we observed a remodeling of the metabolic proteome in muscle fibres from nebulin‐deficient mice. Altogether, our findings explain some of the hitherto obscure hallmarks of NM, including the appearance of abnormal energy proteins and suggest potential beneficial effects of drugs targeting myosin activity/conformations for NEB-NM.

Abstract Objective It is challenging to identify sepsis in the emergency department, in part due to the non-specific presentation of septic patients. Current clinical sepsis screening tools rely on vital signs but many patients present with near normal vital signs and are therefore not identified as septic. This suggests that variables, e.g. signs and symptoms, need to be included to improve sepsis detection in the emergency department. Our hypothesis was that the presentation of sepsis differs based age and sex. The potential differences in presentation could be used to apply to future sepsis screening tools. The aim was to analyze the prevalence of keywords reflecting the presentation of septic patients in the emergency department in relation to age and sex. Method Retrospective cross-sectional study. Keywords reflecting sepsis presentation to the emergency department were quantified and compared between age categories and the sex. 479 patients admitted to the emergency department of Södersjukhuset, Stockholm during 2013 and discharged with an ICD-10 code consistent with sepsis were included. We adjusted for multiple comparisons by applying Bonferroni-adjusted significance levels for all comparisons. Result “Pain” and “risk factors for sepsis” were significantly more common among patients younger than 65 years as compared with those 75 years and older: (n = 87/137; 63.5% vs n = 99/240; 41.3%, P-value

Abstract Background Patients presenting with infection to the ambulance are common, but risk factors for poor outcome are not known. The primary aim of the current study was to study the association between variables measured in the ambulance and mortality among adult patients with and without infection. The secondary aim was to study the association between these variables and mortality in a subgroup of patients who developed sepsis within 36 h. Methods Prospective cohort study of 553 ambulance patients with, and 318 patients without infection, performed in Stockholm during 2017–2018. The association between 21 variables (8 keywords related to medical history, 6 vital signs, 4 blood tests, and age, gender, comorbidity) and in-hospital mortality was analysed using logistic regression. Results Among patients with infection, inability of the patient to answer questions relating to certain symptoms such as pain and gastrointestinal symptoms was significantly associated with mortality in univariable analysis, in addition to oxygen saturation 110 /min, Glasgow Coma Scale (GCS)

CD169+ resident macrophages in lymph nodes of breast cancer patients are for unknown reasons associated with a beneficial prognosis. This contrasts CD169+ macrophages present in primary breast tumors (CD169+ TAMs), that correlate with a worse prognosis. We recently showed that these CD169+ TAMs were associated with tertiary lymphoid structures (TLSs) and Tregs in breast cancer. Here, we show that CD169+ TAMs can be monocyte-derived and express a unique mediator profile characterized by type I IFNs, CXCL10, PGE2 and inhibitory co-receptor expression pattern. The CD169+ monocyte-derived macrophages (CD169+ Mo-M) possessed an immunosuppressive function in vitro inhibiting NK, T and B cell proliferation, but enhanced antibody and IL6 secretion in activated B cells. Our findings indicate that CD169+ Mo-M in the primary breast tumor microenvironment are linked to both immunosuppression and TLS functions, with implications for future targeted Mo-M therapy.

Resistance is often depicted as events that are active, adversarial and antagonistic. However, we would like to suggest that it could also be understood through other narratives, which connect political pursuits to passivity rather than activity. These stories can contribute to increasing our awareness of the limits of the resistance scholarship and extend the view of political performances. In this paper, two different trajectories of counter-conduct – the anti-sexual assault movement in Japan, and the anti-authoritarian struggles in Cambodia – will be used to reveal how resistance is sometimes delegated or outsourced, rather than actively pursued by the subject. In these cases, the political subjects' passivity feeds political activities, but, on the other side of the coin, the activities also foster passivity. [ABSTRACT FROM AUTHOR]

Abstract Background An outdoor pig herd was affected by severe respiratory disease in one out of three pastures. At necropsy, Mycoplasma hyopneumoniae and Pasteurella multocida were detected in the lungs, as well as the lung worm Metastrongylus apri. The life cycle of Metastrongylus spp. includes earthworms as intermediate hosts, and since domestic pigs mainly are reared indoors, lungworm infections have not been diagnosed in domestic pigs in Sweden for decades, not even in pigs reared outdoors. Therefore, this disease outbreak was scrutinised from the view of validating the impact of Metastrongylus spp. Results At the time of the disease outbreak, neither eggs of Metastrongylus spp., Trichuris suis nor Ascaris suum were detected in faeces of pigs aged ten weeks. In contrast, five-months-old pigs at the pasture with respiratory disease shed up to 3800 eggs per gram (Epg) of Ascaris suum and up to 1100 Epg of Trichuris suis, whereas eggs of these parasites were not demonstrated in healthy pigs aged six months at another pasture. Low numbers of eggs from Metastrongylus spp. (

Abstract Background Current sepsis screening tools are predominantly based on vital signs. However, patients with serious infections frequently present with normal vital signs and there has been an increased interest to include other variables such as symptoms in screening tools to detect sepsis. The majority of patients with sepsis arrive to the emergency department by emergency medical services. Our hypothesis was that the presentation of sepsis, including symptoms, may differ between patients arriving to the emergency department by emergency medical services and patients arriving by other means. This information is of interest to adapt future sepsis screening tools to the population in which they will be implemented. The aim of the current study was to compare the prevalence of keywords reflecting the clinical presentation of sepsis based on mode of arrival among septic patients presenting to the emergency department. Methods Retrospective cross-sectional study of 479 adult septic patients. Keywords reflecting sepsis presentation upon emergency department arrival were quantified and analyzed based on mode of arrival, i.e., by emergency medical services or by other means. We adjusted for multiple comparisons by applying Bonferroni-adjusted significance levels for all comparisons. Adjustments for age, gender, and sepsis severity were performed by stratification. All patients were admitted to the emergency department of Södersjukhuset, Stockholm, and discharged with an ICD-10 code compatible with sepsis between January 1, and December 31, 2013. Results “Abnormal breathing” (51.8% vs 20.5%, p value

Abstract Background Internal parasites are common in pigs worldwide and may induce clinical disease or subclinical infections with negative effects such as poor weight gain and reduced welfare, which in turn affect productivity. Effective parasite control to reduce the negative impact of parasitic infections demands a combination of antiparasitic drugs as well as various hygiene and biosecurity practices. The aim of this study was to obtain information on current management practices and parasite control routines used on Swedish pig farms using an online questionnaire. Results Antiparasitic drugs were used on 69% of the farms routinely and were mainly administered to sows just prior to farrowing. Less than 5% of the herds conducted faecal analysis for parasites. Batchwise, age segregated rearing was common and overall, it was practiced for piglets, growers, and fatteners on 88, 80 and 75% of the farms, respectively. Large and medium sized farms appeared to apply stricter hygiene and biosecurity measures to the growing pigs compared to small farms. Dry sows were mainly housed in groups on deep litter straw beds and cleaning, as well as disinfection, between each group was less common compared to what was practiced for growing pigs. Outdoor access was rare and only occurred on organic and small farms. Most of the farms, 54, 74 and 82% of small, medium, and large sized herds respectively, reported to have less than 5% white spot lesions, caused by migrating A. suum larvae, registered at slaughter. Conclusion Several risk factors for parasite infections, such as bedding material, group housing and solid floors, are mandatory requirements by national law. However, it was evident from this study that although strategic hygiene and biosecurity practices appeared common, they were not practiced in all herds and less so for dry sows. Antiparasitic drugs were used frequently and mainly through routine prophylactic treatments without prior testing for parasites. A holistic approach is necessary when designing efficient parasite control programs, and it is essential that management factors and routine monitoring of parasites are given attention. This to achieve efficient parasite control and reduce the risk of unnecessary use of antiparasitic drugs.

Abstract Background There is little evidence of which sepsis screening tool to use in the ambulance setting. The primary aim of the current study was to compare the performance of NEWS2 (National Early Warning score 2) and RETTS (Rapid Emergency Triage and Treatment System) with respect to identification of sepsis among ambulance patients with clinically suspected infection. The secondary aim was to compare the performance of the novel Predict Sepsis screening tools with that of NEWS2, RETTS and clinical judgment. Methods Prospective cohort study of 323 adult ambulance patients with clinically suspected infection, transported to hospitals in Stockholm, during 2017/2018. The sensitivity, specificity, and AUC (Area Under the receiver operating Curve) were calculated and compared by using McNemar´s test and DeLong’s test. Results The prevalence of sepsis in the current study population was 44.6% (144 of 323 patients). No significant difference in AUC was demonstrated between NEWS2 ≥ 5 and RETTS ≥ orange. NEWS2 ≥ 7 demonstrated a significantly greater AUC than RETTS red. The Predict Sepsis screening tools ≥ 2 demonstrated the highest sensitivity (range 0.87–0.91), along with RETTS ≥ orange (0.83), but the lowest specificity (range 0.39–0.49). The AUC of NEWS2 (0.73) and the Predict Sepsis screening tools (range 0.75–0.77) was similar. Conclusions The results indicate that NEWS2 could be the better alternative for sepsis identification in the ambulance, as compared to RETTS. The Predict Sepsis screening tools demonstrated a high sensitivity and AUCs similar to that of NEWS2. However, these results need to be interpreted with caution as the Predict Sepsis screening tools require external validation. Trial registration: ClinicalTrials.gov, NCT03249597. Registered 15 August 2017—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03249597 .