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Abstract Background Self-determination in old age is essential for people’s experiences of good subjective health and quality of life. The knowledge concerning how frail older people with decreased cognition perceive their ability to be self-determined in the different dimension in daily life is, however, limited. The aim of this study was therefore to explore the relationship of self-determination and cognition in frail older people. Methods This study was a cross-sectional secondary data analysis using baseline data with 119 frail people 75 ≥ from a larger randomized control trial. Self-determination was measured with the statements from the Impact on Participation and Autonomy-Older persons (IPA-O). Cognition was measured using the Mini Mental State Examination (MMSE), where decreased cognition was broadly defined as a score below 25 points. Fisher’s exact test was used to test differences in proportions of perceiving self-determination in relation to cognition. The Relative Risk (RR) with a 95% Confidence Interval (CI) was used to explore the risk of perceiving reduced self-determination in relation to cognitive functioning. Results Nearly the entire study population, regardless of cognitive functioning, perceived self-determination in Financial situation. For people with decreased cognition, the relative risk for perceiving reduced self-determination was statistically significant higher in activities related to Self-care and in Social relationships when comparing with the participants with intact cognition. Conclusion Perceiving self-determination when being old, frail and having decreased cognition is possible but is dependent upon which activities that are involved. Organizing healthcare needs according to the older people’s wants and wishes is crucial regardless of people having a cognitive decline or not when the effort is to enable the people to be as self-determined as they want. The frail older people with decreased cognition should be treated as being experts in their own lives, and healthcare professionals should navigate the older people to get to their desired direction. Trial registration ClinicalTrials.gov, NCT02773914. Retrospectively registered 16 May 2016.

During the last decade, the application of strontium isotope analysis (87Sr/86Sr) has increased rapidly. The understanding of the strontium isoscape and the construction of a strontium isotope baseline in southern Scandinavia are biased toward Denmark and southwestern to eastern Scania. We report the results of new baseline samples in Halland and the Bjäre Peninsula, adding to the rich strontium isotope library that exists for southern Scandinavia. We add nuance to the previous divisions of Scania, in which the Bjäre Peninsula is not well represented. The results show that the Bjäre Peninsula is characterized by relatively low 87Sr/86Sr values gathered in the preliminary baseline 0.7100 ± 0.0024 (2σ, n = 8), similar to that of southwest Scania and Zealand in Denmark. There is a greater variation and higher values among the Halland samples. Together with previously published faunal samples, a preliminary 87Sr/86Sr baseline for Halland is 0.7122 ± 0.0055 (2σ, n = 24). We apply these baseline results to archaeological cases, both human and animal, from recent excavations in the Bjäre Peninsula. The results imply that there was a certain degree of mobility and interaction across the landscape in this region of southern Scandinavia in prehistory.

Abstract The myeloid transcription factor CEBPA is recurrently biallelically mutated (i.e., double mutated; CEBPA DM) in acute myeloid leukemia (AML) with a combination of hypermorphic N-terminal mutations (CEBPA NT), promoting expression of the leukemia-associated p30 isoform, and amorphic C-terminal mutations. The most frequently co-mutated genes in CEBPA DM AML are GATA2 and TET2, however the molecular mechanisms underlying this co-mutational spectrum are incomplete. By combining transcriptomic and epigenomic analyses of CEBPA-TET2 co-mutated patients with models thereof, we identify GATA2 as a conserved target of the CEBPA-TET2 mutational axis, providing a rationale for the mutational spectra in CEBPA DM AML. Elevated CEBPA levels, driven by CEBPA NT, mediate recruitment of TET2 to the Gata2 distal hematopoietic enhancer thereby increasing Gata2 expression. Concurrent loss of TET2 in CEBPA DM AML induces a competitive advantage by increasing Gata2 promoter methylation, thereby rebalancing GATA2 levels. Of clinical relevance, demethylating treatment of Cebpa-Tet2 co-mutated AML restores Gata2 levels and prolongs disease latency.

The maritime expansion of Scandinavian populations during the Viking Age (about AD 750-1050) was a far-flung transformation in world history1,2. Here we sequenced the genomes of 442 humans from archaeological sites across Europe and Greenland (to a median depth of about 1×) to understand the global influence of this expansion. We find the Viking period involved gene flow into Scandinavia from the south and east. We observe genetic structure within Scandinavia, with diversity hotspots in the south and restricted gene flow within Scandinavia. We find evidence for a major influx of Danish ancestry into England; a Swedish influx into the Baltic; and Norwegian influx into Ireland, Iceland and Greenland. Additionally, we see substantial ancestry from elsewhere in Europe entering Scandinavia during the Viking Age. Our ancient DNA analysis also revealed that a Viking expedition included close family members. By comparing with modern populations, we find that pigmentation-associated loci have undergone strong population differentiation during the past millennium, and trace positively selected loci-including the lactase-persistence allele of LCT and alleles of ANKA that are associated with the immune response-in detail. We conclude that the Viking diaspora was characterized by substantial transregional engagement: distinct populations influenced the genomic makeup of different regions of Europe, and Scandinavia experienced increased contact with the rest of the continent.

Hanna Falk Erhag,1– 3 Gudny Guðnadóttir,3 Joakim Alfredsson,4 Tommy Cederholm,5,6 Niklas Ekerstad,7,8 Dorota Religa,9,10 Bengt Nellgård,11 Katarina Wilhelmson2,3,12 1Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; 2Centre for Ageing and Health (Agecap), University of Gothenburg, Gothenburg, Sweden; 3Region Västra Götaland, Sahlgrenska University Hospital, Department of Acute Medicine and Geriatrics, Gothenburg, Sweden; 4Department of Cardiology, and Department of Health, Medicine and Caring Sciences, Unit of Cardiovascular Sciences, Linköping University, Linköping, Sweden; 5Clinical Nutrition and Metabolism Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; 6Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden; 7Department of Health, Medicine, and Caring Sciences, Unit of Health Care Analysis, Linköping University, Linköping, Sweden; 8The Research and Development Unit, NU Hospital Group, Trollhättan, Sweden; 9Department of Neurobiology, Care Sciences, and Society, Clinical Geriatrics, Karolinska Institute, Stockholm, Sweden; 10Division for Clinical Geriatrics, Karolinska University Hospital, Stockholm, Sweden; 11Department of Anesthesiology and Intensive Care, Institute of Clinical Studies, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; 12Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, SwedenCorrespondence: Hanna Falk Erhag, Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Wallinsgatan 6, Gothenburg, SE 431 41, Sweden, Tel +46 760 476888, Fax +46 31 786 60 77, Email hanna.falk@gu.seBackground: Frail older adults experience higher rates of adverse health outcomes. Therefore, assessing pre-hospital frailty early in the course of care is essential to identify the most vulnerable patients and determine their risk of deterioration. The Clinical Frailty Scale (CFS) is a frailty assessment tool that evaluates pre-hospital mobility, energy, physical activity, and function to generate a score that ranges from very fit to terminally ill.Purpose: To synthesize the evidence of the association between the CFS degree and all-cause mortality, all-cause readmission, length of hospital stay, adverse discharge destination, and functional decline in patients > 65 years in acute clinical settings.Design: Systematic review with narrative synthesis.Methods: Electronic databases (PubMed, EMBASE, CINAHL, Scopus) were searched for prospective or retrospective studies reporting a relationship between pre-hospital frailty according to the CFS and the outcomes of interest from database inception to April 2020.Results: Our search yielded 756 articles, of which 29 studies were included in this review (15 were at moderate risk and 14 at low risk of bias). The included studies represented 26 cohorts from 25 countries (N = 44166) published between 2011 and 2020. All included studies showed that pre-hospital frailty according to the CFS is an independent predictor of all adverse health outcomes included in the review.Conclusion: A primary purpose of the CFS is to grade clinically increased risk (i.e. risk stratification). Our results report the accumulated knowledge on the risk-predictive performance of the CFS and highlight the importance of routinely including frailty assessments, such as the CFS, to estimate biological age, improve risk assessments, and assist clinical decision-making in older adults in acute care. Further research into the potential of the CFS and whether implementing the CFS in routine practice will improve care and patients’ quality of life is warranted.Keywords: clinical frailty scale, risk stratification, acute clinical settings, literature review

Abstract Background Frail older people are at higher risk of further deterioration if their needs are not acknowledged when they are acutely ill and admitted to hospital. Mental health comprises one area of needs assessment. Aims The aims of this study were threefold: to investigate the prevalence of depression in frail hospital patients, to identify factors associated with depression, and to compare depression management in patients receiving and not receiving Comprehensive Geriatric Assessment (CGA). Methods This secondary analysis from the CGA-Swed randomized control trial included 155 frail older people aged 75 years and above. Instruments included Montgomery Åsberg Depression Rating Scale (MADRS), the ICE Capability measure for older people (ICECAP-O) and the Fugl-Meyer Life Satisfaction scale (Fugl-Meyer Lisat). Depression was broadly defined as MADRS score ≥ 7. Regression models were used to identify variables associated with depression and to compare groups with and without the CGA intervention. Results The prevalence of a MADRS score indicating depression at baseline was 60.7%. The inability to do things that make one feel valued (ICECAP-O) was associated with a fourfold increase in depression (OR 4.37, CI 1.50–12.75, p = 0.007). There was a two-fold increase in odds of receiving antidepressant medication in the CGA intervention group (OR 2.33, CI 1.15–4.71, p = 0.019) compared to patients in the control group who received regular medical care. Conclusion Symptoms of depression were common among frail older people with unplanned hospital admission. Being unable to do things that make one feel valued was associated with depression. People who received CGA intervention had higher odds of receiving antidepressant treatment, suggesting that CGA improves recognition of mental health needs during unplanned hospital admissions in frail older people. Trial registration ClinicalTrials.gov, NCT02773914. Retrospectively registered 16 May 2016.

Abstract Testosterone deficiency in men is associated with increased atherosclerosis burden and increased cardiovascular risk. In male mice, testosterone deficiency induced by castration increases atherosclerosis as well as mature B cell numbers in spleen. As B cells are potentially pro-atherogenic, we hypothesized that there may be a link between these effects. To address whether mature B cell deficiency alter the atherogenic response to castration, we studied B cell-deficient μMT and genotype control male mice on an atherosclerosis-prone Apoe −/− background that were castrated or sham-operated pre-pubertally and fed a high-fat diet between 8 and 16 weeks of age to accelerate atherosclerosis development. Genotype did not affect the effects of castration on body weight or weights of fat depots and there were no differences in serum cholesterol levels across the four groups. Atherosclerosis assessed by quantification of lesion area in serial sections of the aortic root was significantly increased by castration and by the μMT mutation, with no significant interaction between genotype and surgery. In conclusion, castration evokes a similar atherogenic response in B cell-deficient μMT and control mice. These data suggest that atherogenesis following castration is unrelated to the effects of androgens on mature B cell numbers.

This paper deals with organizational change and contributes knowledge about the experiences of a local educational organizer when introducing and putting managerial shared leadership into practice in some schools and pre-schools. The organizer's aim with the change was to achieve better results by means of improved pedagogical leadership, better health and use of resources. The study builds on recorded meetings and interviews with the organizer's top management group in a Swedish municipality that introduced managerial shared leadership in the specific form of function-shared leadership. Valuable knowledge is now available for future organizers' quest for knowledge when introducing managerial shared leadership.

Abstract Background Today’s acute hospital care is poorly adapted to the complex needs of frail older people. This exposes them to avoidable risks, such as loss of functional capacities, leading to unnecessary health and social care needs. Being frail and in need of acute hospital care often leads to higher dependence in Activities of Daily Living (ADL), especially if one’s needs are not acknowledged. Comprehensive Geriatric Assessment (CGA) is one way to meet frail older people’s complex needs. The study’s aim was to investigate the effects on frail older people’s ADL 12 months after receiving CGA. Methods This is a two-armed randomised controlled intervention study. Participants were frail older people (75+) who sought the emergency department and needed admission to a medical ward. The intervention was CGA performed at a geriatric management unit during the hospital stay. The CGA included comprehensive assessment of medical, functional, psychological, social, and environmental status as well as treatment, rehabilitation, discharge planning, and follow-up. Multidisciplinary teamwork and a person-centred approach were used. The control was care at an ordinary medical hospital ward. The primary outcome was change in dependence in ADL from 2 weeks before admission to the 12-month follow-up. Results At admission, 155 people participated (77 in the control, 78 in the intervention). At the 12-month follow-up, 78 participated (40 in the control, 38 in the intervention). Attrition was mainly due to mortality. Four participants in the control (5.2%) and twelve in the intervention group (15.4%) had improved in their ADL 1 year after discharge (OR = 3.32; 95% CI = 1.02–10.79). Conclusions In-hospital CGA performed at a geriatric management unit improves frail older people’s ADL. Being less dependent in ADL increases frail older people’s ability to remain in their own housing, which is important for both the individual and society. Trial registration ClinicalTrials.gov, NCT02773914 . Retrospectively registered 16 May 2016.

This article presents a study of five schools with shared principalship. It contributes knowledge about how shared principalship is experienced by people who work closely ("close subordinates") with the shared principalship constellations. Data consists of 20 semi-structured interviews. Close subordinates describe that the shared principalship meant a reasonable workload for their principals and welcomed their level of accessibility. Confidence in the leader collaboration was heightened if close subordinates were able to witness that collaboration in action with their own eyes. The findings are discussed in relation to the conditions introduced by current school legislation in Sweden.

Therapeutic siRNA becomes trapped in endosomes, limiting its efficacy. Here the authors use fluorescently-tagged galectin-9 as a biosensor for membrane damage to monitor endosomal escape of cholesterol-conjugated siRNA following treatment of small molecule membrane-destabilising drugs.

HIV-2 is less pathogenic compared to HIV-1. Still, disease progression may develop in aviremic HIV-2 infection, but the driving forces and mechanisms behind such development are unclear. Here, we aimed to reveal the immunophenotypic pattern associated with CD8 T-cell pathology in HIV-2 infection, in relation to viremia and markers of disease progression. The relationships between pathological differences of the CD8 T-cell memory population and viremia were analyzed in blood samples obtained from an occupational cohort in Guinea-Bissau, including HIV-2 viremic and aviremic individuals. For comparison, samples from HIV-1- or dually HIV-1/2-infected and seronegative individuals were obtained from the same cohort. CD8 T-cell exhaustion was evaluated by the combined expression patterns of activation, stimulatory and inhibitory immune checkpoint markers analyzed using multicolor flow cytometry and advanced bioinformatics. Unsupervised multidimensional clustering analysis identified a cluster of late differentiated CD8 T-cells expressing activation (CD38+, HLA-DRint/high), co-stimulatory (CD226+/-), and immune inhibitory (2B4+, PD-1high, TIGIThigh) markers that distinguished aviremic from viremic HIV-2, and treated from untreated HIV-1-infected individuals. This CD8 T-cell population displayed close correlations to CD4%, viremia, and plasma levels of IP-10, sCD14 and beta-2 microglobulin in HIV-2 infection. Detailed analysis revealed that aviremic HIV-2-infected individuals had higher frequencies of exhausted TIGIT+ CD8 T-cell populations lacking CD226, while reduced percentage of stimulation-receptive TIGIT-CD226+ CD8 T-cells, compared to seronegative individuals. Our results suggest that HIV-2 infection, independent of viremia, skews CD8 T-cells towards exhaustion and reduced co-stimulation readiness. Further knowledge on CD8 T-cell phenotypes might provide help in therapy monitoring and identification of immunotherapy targets.

A school principal's workload is recognised as being heavy, with an imbalance between demands and resources. This paper contributes to the development of collective leadership. The principalship constellations of six schools in Sweden were studied with the aim of strengthening the current knowledge about structures and experiences of shared principalship. The empirical basis is qualitative data from interviews with principals and vice-principals. The analytical focus was on how the sharing structures were organised and how the shared principalship was experienced. The results point to a considerable variation in the organisational structures of shared principalship. Despite the type of model, form and constellation, the principals and vice-principals voiced a striking sense of relief in not feeling alone in their duties, as problems and troubles became manageable. An intensified interaction level in the principalship constellation created opportunities to develop competence. Theoretically, this study broadens the invited leadership concept to include horizontal invitations across unit boundaries between principals in different units within the same school. The knowledge contribution of this study is useful in discussing the legal possibilities for shared principalship, which may be especially relevant in times when the Swedish school system is being criticised for not delivering good student outcomes.

Androgens have profound effects on T cell homeostasis, including regulation of thymic T lymphopoiesis (thymopoiesis) and production of recent thymic emigrants (RTEs), i. e., immature T cells that derive from the thymus and continue their maturation to mature naïve T cells in secondary lymphoid organs. Here we investigated the androgen target cell for effects on thymopoiesis and RTEs in spleen and lymph nodes. Male mice with a general androgen receptor knockout (G-ARKO), T cell-specific (T-ARKO), or epithelial cell-specific (E-ARKO) knockout were examined. G-ARKO mice showed increased thymus weight and increased numbers of thymic T cell progenitors. These effects were not T cell-intrinsic, since T-ARKO mice displayed unaltered thymus weight and thymopoiesis. In line with a role for thymic epithelial cells (TECs), E-ARKO mice showed increased thymus weight and numbers of thymic T cell progenitors. Further, E-ARKO mice had more CD4+ and CD8+ T cells in spleen and an increased frequency of RTEs among T cells in spleen and lymph nodes. Depletion of the androgen receptor in epithelial cells was also associated with a small shift in the relative number of cortical (reduced) and medullary (increased) TECs and increased CCL25 staining in the thymic medulla, similar to previous observations in castrated mice. In conclusion, we demonstrate that the thymic epithelium is a target compartment for androgen-mediated regulation of thymopoiesis and consequently the generation of RTEs.

ASXL1 is one of the most commonly mutated genes in myeloid malignancies, including Myelodysplastic Syndrome (MDS) and Acute Myeloid Leukemia (AML). In order to further our understanding of the role of ASXL1 lesions in malignant hematopoiesis, we generated a novel knock-in mouse model carrying the most frequent ASXL1 mutation identified in MDS patients, p.G643WfsX12. Mutant mice did not display any major hematopoietic defects nor developed any apparent hematological disease. In AML patients, ASXL1 mutations co-occur with mutations in CEBPA and we therefore generated compound Cebpa and Asxl1 mutated mice. Using a transplantation model, we found that the mutated Asxl1 allele significantly accelerated disease development in a CEBPA mutant context. Importantly, we demonstrated that, similar to the human setting, Asxl1 mutated mice responded poorly to chemotherapy. This model therefore constitutes an excellent experimental system for further studies into the clinically important question of chemotherapy resistance mediated by mutant ASXL1.

Summary: Hematopoietic stem cells (HSCs) are considered a heterogeneous cell population. To further resolve the HSC compartment, we characterized a retinoic acid (RA) reporter mouse line. Sub-fractionation of the HSC compartment in RA-CFP reporter mice demonstrated that RA-CFP-dim HSCs were largely non-proliferative and displayed superior engraftment potential in comparison with RA-CFP-bright HSCs. Gene expression analysis demonstrated higher expression of RA-target genes in RA-CFP-dim HSCs, in contrast to the RA-CFP reporter expression, but both RA-CFP-dim and RA-CFP-bright HSCs responded efficiently to RA in vitro. Single-cell RNA sequencing (RNA-seq) of >1,200 HSCs showed that differences in cell cycle activity constituted the main driver of transcriptional heterogeneity in HSCs. Moreover, further analysis of the single-cell RNA-seq data revealed that stochastic low-level expression of distinct lineage-affiliated transcriptional programs is a common feature of HSCs. Collectively, this work demonstrates the utility of the RA-CFP reporter line as a tool for the isolation of superior HSCs. : HSCs are considered a functional heterogeneous population. Lauridsen et al. use scRNA-seq to demonstrate that most transcriptional heterogeneity within the HSC compartment is associated with differences in cell cycle status. They further use an RA-CFP reporter mouse line to isolate slow-cycling HSCs characterized by superior engraftment potential. Keywords: hematopoietic stem cells, single-cell RNA-sequencing, retinoic acid, transcriptional heterogeneity, hematopoiesis

Testosterone deficiency is associated with autoimmunity and increased B cell numbers, but the underlying mechanism is unclear. Here the authors show that testosterone may modulate the production of B cell survival factor BAFF by fibroblastic reticular cells via regulation of splenic neurotransmitter levels.

Abstract Background Comprehensive geriatric assessment (CGA) represent an important component of geriatric acute hospital care for frail older people, secured by a multidisciplinary team who addresses the multiple needs of physical health, functional ability, psychological state, cognition and social status. The primary objective of the pilot study was to determine feasibility for recruitment and retention rates. Secondary objectives were to establish proof of principle that CGA has the potential to increase patient safety. Methods The CGA pilot took place at a University hospital in Western Sweden, from March to November 2016, with data analyses in March 2017. Participants were frail people aged 75 and older, who required an acute admission to hospital. Participants were recruited and randomized in the emergency room. The intervention group received CGA, a person-centered multidisciplinary team addressing health, participation, and safety. The control group received usual care. The main objective measured the recruitment procedure and retention rates. Secondary objectives were also collected regarding services received on the ward including discharge plan, care plan meeting and hospital risk assessments including risk for falls, nutrition, decubitus ulcers, and activities of daily living status. Result Participants were recruited from the emergency department, over 32 weeks. Thirty participants were approached and 100% (30/30) were included and randomized, and 100% (30/30) met the inclusion criteria. Sixteen participants were included in the intervention and 14 participants were included in the control. At baseline, 100% (16/16) intervention and 100% (14/14) control completed the data collection. A positive propensity towards the secondary objectives for the intervention was also evidenced, as this group received more care assessments. There was an average difference between the intervention and control in occupational therapy assessment − 0.80 [95% CI 1.06, − 0.57], occupational therapy assistive devices − 0.73 [95% CI 1.00, − 0.47], discharge planning −0.21 [95% CI 0.43, 0.00] and care planning meeting 0.36 [95% CI-1.70, −0.02]. Controlling for documented risk assessments, the intervention had for falls − 0.94 [95% CI 1.08, − 0.08], nutrition − 0.87 [95% CI 1.06, − 0.67], decubitus ulcers − 0.94 [95% CI 1.08, − 0.80], and ADL status − 0.80 [95% CI 1.04, − 0.57]. Conclusion The CGA pilot was feasible and proof that the intervention increased safety justifies carrying forward to a large-scale study. Trial registration Clinical Trials ID: NCT02773914. Registered 16 May 2016.

Summary: B cell development depends on the coordinated expression and cooperation of several transcription factors. Here we show that the transcription factor ETS-related gene (ERG) is crucial for normal B cell development and that its deletion results in a substantial loss of bone marrow B cell progenitors and peripheral B cells, as well as a skewing of splenic B cell populations. We find that ERG-deficient B lineage cells exhibit an early developmental block at the pre-B cell stage and proliferate less. The cells fail to express the immunoglobulin heavy chain due to inefficient V-to-DJ recombination, and cells that undergo recombination display a strong bias against incorporation of distal V gene segments. Furthermore, antisense transcription at PAX5-activated intergenic repeat (PAIR) elements, located in the distal region of the Igh locus, depends on ERG. These findings show that ERG serves as a critical regulator of B cell development by ensuring efficient and balanced V-to-DJ recombination. : Søndergaard et al. demonstrate that ERG is a critical transcriptional regulator essential for B cell development. Loss of ERG leads to a marked reduction in V-to-DJ recombination at the Igh locus, precluding B cell progenitors from expressing the pre-B cell receptor, which is required for entering the final stages of B cell development. Keywords: ETS-related gene, ERG, B cell development, V(D)J recombination, pre-BCR, immunoglobulin heavy-chain gene, transcriptional control

The aim of this article is to discuss the potential of an educative research intervention to influence the quality of the learning outcome in the workplace as interpreted from the perspectives of adult learning theory. The research project was designed as a quasi-experimental, mixed-methods study. In this article, quantitative survey data were taken as the point of departure, and qualitative data were used for the purpose of analyzing aspects of learning. An educative research intervention may support a transformative learning quality when the manager and employees have to deal with severe difficulties, and they succeed in doing so by sharing responsibilities and having the strength to engage in the development process in the workplace. It is possible to support transformative learning in the workplace through an educative research intervention that encourages managers to educate themselves and their employees to think and act in new ways, aiming at integrated autonomy, increased interaction, and learning.