In this paper we consider the two-user broadcast channel with security constraints. We assume that one of the receivers has a secrecy constraint; i.e., its packets need to be kept secret from the other receiver. The receiver with secrecy constraint has full-duplex capability to transmit a jamming signal to increase its secrecy. We derive the average delay per packet and provide simulation and numerical results, where we compare different performance metrics for the cases when the legitimate receiver performs successive decoding and when both receivers treat interference as noise.

In this paper, we consider the two-user broadcast channel with security constraints. We assume that a source broadcasts packets to two receivers, and that one of them has secrecy constraints, i.e., its packets need to be kept secret from the other receiver. The receiver with secrecy constraint has full-duplex capability, allowing it to transmit a jamming signal to increase its secrecy. We derive the average delay per packet and provide simulations and numerical results, where we compare different performance metrics for the cases when both receivers treat interference as noise, when the legitimate receiver performs successive decoding, and when the eavesdropper performs successive decoding. The results show that successive decoding provides better average packet delay for the legitimate user. Furthermore, we define a new metric that characterizes the reduction on the success probability for the legitimate user that is caused by the secrecy constraint. The results show that secrecy poses a significant amount of packet delay for the legitimate receiver when either receiver performs successive decoding. We also formulate an optimization problem, wherein the throughput of the eavesdropper is maximized under delay and secrecy rate constraints at the legitimate receiver. We provide numerical results for the optimization problem, where we show the trade-off between the transmission power for the jamming and the throughput of the non-legitimate receiver. The results provide insights into how channel ordering and encoding differences can be exploited to improve performance under different interference conditions.

Congestion-aware scheduling in the case of traditional downlink cellular communication has neglected the heterogeneity in terms of secrecy among different clients. In this paper, we study a two-user congestion-aware broadcast channel with heterogeneous traffic and different security requirements. The traffic with security requirements is intended for a legitimate user and it has bursty nature. The incoming packets are stored in a queue at the source. Furthermore, there is a second traffic flow intended for another user, it is delay tolerant and does not have secrecy constraints. The receiver which needs to be served with confidential data has full-duplex capabilities, and it can send a jamming signal to hinder eavesdropping of its data at the other user. We consider two randomized policies for selecting which packets to transmit, one is congestion-aware by taking into consideration the queue size, whereas the other one is non-congestion-aware. We analyse the throughput and the delay performance under two decoding schemes at the receivers and provide insights into their relative security performance and into how congestion control at the queue holding confidential information can help decrease the average delay per packet. We show that the two policies have the same secrecy performance for large random access probabilities. The derived results also take account of the self-interference caused at the receiver for whom confidential data is intended due to its full-duplex operation while jamming the communication at the other user.

Congestion-aware scheduling in case of downlink cellular communication has ignored the distribution of diverse content to different clients with heterogeneous secrecy requirements. Other possible application areas that encounter the preceding issue are secure offloading in mobile-edge computing, and vehicular communication. In this paper, we extend the work in Arvanitaki et al. (SN Comput Sci 1(1):53, 2019) by taking into consideration congestion and random access. Specifically, we study a two-user congestion-aware broadcast channel with heterogeneous traffic and different security requirements. We consider two randomized policies for selecting which packets to transmit, one is congestion-aware by taking into consideration the queue size, whereas the other one is congestion-agnostic. We analyse the throughput and the delay performance under two decoding schemes at the receivers, and provide insights into their relative security performance and into how congestion control at the queue holding confidential information can help decrease the average delay per packet. We show that the congestion-aware policy provides better delay, throughput, and secrecy performance for large arrival packet probabilities at the queue holding the confidential information. The derived results also take account of the self-interference caused at the receiver for whom confidential data is intended due to its full-duplex operation while jamming the communication at the other user. Finally, for two decoding schemes, we formulate our problems in terms of multi-objective optimization, which allows for finding a trade-off between the average packet delay for packets intended for the legitimate user and the throughput for the other user under congestion-aware policy.

This paper describes an Arbitrary Lagrangian- Eulerian (ALE) finite element method for the simulation of fluid domains with moving structures. The fluid is viscous, incompressible and unsteady and the fluid motion is solved by a fractional step discretization of the Navier-Stokes equations. The emphasis is on convection dominated flows, and a three-step method is used for the convection term. The moving structure causes the mesh of the fluid domain to move, and a new algorithm is proposed to solve the important and crucial problem of the calculation of the mesh velocities.

Many MEMS devices rely on the interaction between fluids and solids, e.g. pumps. To optimize such devices, it is essential to be aware of the general characteristics of this aeroelastic interaction. An essential part of an aeroelastic analysis is the efficient and accurate prediction of the steady and unsteady fluid dynamics. The difference between the presented approach based on LINFLOW and ANSYS, and that used in classical aeronautical tools for aeroelastic analysis is discussed. This paper also uses the proposed procedure to discuss in a general manner some aeroelastic effects. The results of the analysis are successfully compared with measurements for micromachined watch crystals, in air and water.

A passive Flexible Composite Surface Deturbulator tape has been found capable of eliminating all skin-friction on streamlined bodies and minimize form drag on complex bluff bodies by suppressing turbulence in separated shear layers. The periodic ridged substrate of an optimized Deturbulator mitigates turbulence producing vortices by breaking long wavelength flow induced oscillations of the flexible surface. Preliminary aeroelastic analysis of the Deturbulator using LINFLOW software has identified combinations of structural modes which create conditions for extracting turbulent energy from the flow.

Fatigue failure of a hydraulic hose systems, caused by violent vibrations, has become a critical factor creating operational and maintenance cost for the end user of rock drill equipment. Similar behavior is also appearing in, for example, forestry machines. Hoses are used as parts of the energy feeding system in machines such as the ones use for mining and civil construction operations. This work aims to create an understanding of the dynamic behavior of a selected hydraulic hose. The numerical modeling approach selected includes a boundary element method approach in the fluid-elastic analysis of the dynamics of a pressurized hose with conveying fluid. Experimental modal analysis was used to validate the numerical model. Pre-tension and pressure-induced tension were monitored with an in-house-developed strain gauge-based load cell. The analysis and experiments show that a complex coupling, of pure structural bending modes, appears when the hose is subjected to internal flow. Some of the modeshapes show a circular motion of the hose cross sections. As shown in this article, these coupled modes become increasingly sensitive to external or internal excitation with increasing flow rate. To illustrate the strength of the proposed approach, the second part of the work in this article presents a parametric study of hose dynamics for hoses with typical dimensions used in industrial applications. This investigation of how different parameters influence the dynamic characteristics of hydraulic hoses shows, for example, that hose end-support stiffness has a large impact on the stability and dynamic behavior of the hose. A soft support tends to create a static instability-type behavior where the lowest frequency mode frequency decreases to levels close to zero with increasing flow speed. Pre-tension of the hose has a stabilizing effect on the hose dynamics. In the case when the internal pressure of the hydraulic hose does not generate tension of the hose, then the increase or decrease in the internal pressure has limited influence on the hose dynamics: this is at least a conclusion valid in the investigated 100-210 bar pressure range. In addition, a smaller diameter hose is more sensitive than a larger diameter hose, and this is valid as long as the pre-tension is high enough to maintain static stability in the entire flow rate range.

ObjectivesThe median survival in glioblastoma (GBM) patients used to be less than 1year. Surgical removal of the tumor with subsequent concomitant radiation/temozolomide (the Stupp regimen) has been shown to prolong survival. The Stupp protocol was implemented in the county of Jonkoping in 2006. The purpose of this study was to examine if the Stupp treatment has prolonged overall survival, in an unselected patient cohort with histologically verified GBM. Material and MethodThis study includes all patients from the county of Jonkoping, with a diagnosis of GBM from January 2001 to December 2012. Patients were divided into 2 cohorts, 2001-2005 and 2006-2012, that is before and after implementation of the Stupp regimen. By reviewing the medical case notes, the dates of the histological diagnosis and of death were identified. The median and mean overall survival and Kaplan-Meier survival analysis were calculated and compared between the 2 cohorts. ResultsThe mean survival was 110days longer in the cohort treated according to the Stupp regimen. Four patients in the 2006-2012 cohort and 1 patient in the 2001-2005 cohort are still alive. When comparing survival in patients with radical surgery vs biopsy, those that underwent radical surgery survived longer. The significance was slightly greater in the 2001-2005 cohort (mean 163 vs 344days, Pamp;lt;.001) than in the 2006-2012 cohort (mean 220 vs 397days, P=.02). ConclusionSurvival significantly improved after the implementation of the Stupp regimen in the study region of Sweden.

Objectives Seizures as presenting symptom of glioblastoma (GBM) are known to predict prolonged survival, whereas the clinical impact of other initial symptoms is less known. Our main objective was to evaluate the influence of different presenting symptoms on survival in a clinical setting. We also assessed lead times, tumour size and localization. Methods Medical records of 189 GBM patients were reviewed regarding the first medical appointment, presenting symptom/s, date of diagnostic radiology and survival. Tumour size, localization and treatment data were retrieved. Overall survival was calculated using Kaplan-Meier and Mann-Whitney U test. Cox regression was used for risk estimation. Results Cognitive impairment as the initial symptom was often misinterpreted in primary health care leading to a delayed diagnosis. Initial global symptoms (66% of all patients) were associated with reduced survival compared to no global symptoms (median 8.4 months vs. 12.6 months). Those with the most common cognitive dysfunctions: change of behaviour, memory impairment and/or disorientation had a reduced median survival to 6.4 months. In contrast, seizures (32%) were associated with longer survival (median 11.2 months vs. 8.3 months). Global symptoms were associated with larger tumours than seizures, but tumour size had no linear association with survival. The setting of the first medical appointment was evenly distributed between primary health care and emergency units. Conclusion Patients with GBM presenting with cognitive symptoms are challenging to identify, have larger tumours and reduced survival. In contrast, epileptic seizures as the first symptom are associated with longer survival and smaller tumours.

Background Glioblastoma is the most common malignant brain tumor in adults. Non-invasive clinical parameters could play a crucial role in treatment planning and serve as predictors of patient survival. Our register-based real-life study aimed to investigate the prognostic value of presenting symptoms. Methods Data on presenting symptoms and survival, as well as known prognostic factors, were retrieved for all glioblastoma patients in Sweden registered in the Swedish Brain Tumor Registry between 2018 and 2021. The prognostic impact of different presenting symptoms was calculated using the Cox proportional hazard model. Results Data from 1458 adults with pathologically verified IDH wild-type glioblastoma were analyzed. Median survival time was 345 days. The 2-year survival rate was 21.5%. Registered presenting symptoms were focal neurological deficits, cognitive dysfunction, headache, epilepsy, signs of raised intracranial pressure, and cranial nerve symptoms, with some patients having multiple symptoms. Patients with initial cognitive dysfunction had significantly shorter survival than patients without; 265 days (245-285) vs. 409 days (365-453; P < .001). The reduced survival remained after Cox regression adjusting for known prognostic factors. Patients presenting with seizures and patients with headaches had significantly longer overall survival compared to patients without these symptoms, but the difference was not retained in multivariate analysis. Patients with cognitive deficits were less likely to have radical surgery and to receive extensive anti-neoplastic nonsurgical treatment. Conclusions This extensive real-life study reveals that initial cognitive impairment acts as an independent negative predictive factor for treatment decisions and adversely affects survival outcomes in glioblastoma patients.

The increase in the average global temperature is a consequence of high greenhouse gas emissions. Therefore, using alternative energy carriers that can replace fossil fuels, especially for automotive applications, is of high importance. Introducing more electronics into an automotive battery pack provides more precise control and increases the available energy from the pack. Battery-integrated modular multilevel converters (BI-MMCs) have high efficiency, improved controllability, and better fault isolation capability. However, integrating the battery and inverter influences the maximum DC charging power. Therefore, the DC charging capabilities of 5 3-phase BI-MMCs for a 40-ton commercial vehicle designed for a maximum tractive power of 400 kW was investigated. Two continuous DC charging scenarios are considered for two cases: the first considers the total number of submodules during traction, and the second increases the total number of submodules to ensure a maximum DC charging voltage of 1250 V. The investigation shows that both DC charging scenarios have similar maximum power between 1 and 3 MW. Altering the number of submodules increases the maximum DC charging power at the cost of increased losses.

The automotive industry has grown considerably over the last century consequently increasing green-house gas emissions and thus contributing towards increase in the average global temperature. It is thus of paramount importance to increase the use of alternative energy sources. Electric vehicles have gained popularity over the last decade. However, a major concern with electric vehicles is their range. The range of an electric vehicle is limited by the battery pack, in particular, the weakest cell of the pack. One method of increasing the available energy from the battery pack is by introducing more electronics. Modular multilevel converters, with their modular concept, could be a viable solution. The concept of battery-integrated modular multilevel converters (BI-MMC) for automotive applications is explored. In particular, the impact of the number of cascaded cells per submodule is investigated, considering battery losses, DC-link capacitor losses, and the converter losses. Furthermore, an optimization of the DC-link capacitors and the selection of MOSFET switching frequency is presented in order to minimize the total losses.

Greenhouse gas emissions and the increase in average global temperature are growing concerns now more so than ever. Therefore it is of importance to increase the use of alternative energy sources, especially in the automotive industry. Battery electric vehicles (BEV) have gained popularity over the past several years. However, the performance of a BEV is limited by the battery pack, in particular, the weakest cell in the pack. Therefore, improved cell controllability and high efficiency are seen as important directions for research and development and one direction where it can be achieved is through using battery-integrated modular multilevel converters (BI-MMC). The battery current in BI-MMCs contains additional harmonics and the frequency dependent losses of these harmonics are determined by the resonance between the battery and the DC-link capacitor bank. The paper presents an experimental validation of previously published theoretical results for both harmonic allocations and loss distribution at the switching frequency within the BI-MMC submodule. Furthermore, a methodology for measuring the battery impedance using the full-load converter switching currents is presented.

Electric vehicle (EV) battery packs contain several parallel and series-connected cells and variations in leakage currents and cell characteristics result in heterogeneous discharge rates among cells, thus limiting the total energy delivery of the pack. Battery-integrated modular multilevel converters (BI-MMCs) increase the controllability of cells thereby improving the energy utilization of the battery pack. Design optimization for BI-MMC with phase-shifted modulation (PSPWM) showed that submodule (SM) DC-link capacitors designed to bypass the switching frequency components result in minimum total losses. However, this requires a large DC-link capacitor bank, which increases the system cost. An alternative modulation technique, nearest level modulation (NLM), characterized by low semiconductor switching frequency, is often preferred for MMCs with many SMs. The first contribution is an experimental loss comparison in an SM of a BI-MMC with PSPWM and NLM. The second contribution is investigating the impact of the size of DC-link capacitors on battery and capacitor losses for NLM. The experiments showed that the battery and capacitor losses are independent of the DC-link capacitor size when using NLM. Furthermore, NLM has lower total losses but higher battery losses than PSPWM. A single-phase 4-SM BI-MMC is used as the experimental platform for the comparison.

This paper presents a method to certify the computational complexity of a standard Branch and Bound method for solving Mixed-Integer Quadratic Programming (MIQP) problems defined as instances of a multi-parametric MIQP. Beyond previous work, not only the size of the binary search tree is considered, but also the exact complexity of solving the relaxations in the nodes by using recent results from exact complexity certification of active-set QP methods. With the algorithm proposed in this paper, a total worst-case number of QP iterations to be performed in order to solve the MIQP problem can be determined as a function of the parameter in the problem. An important application of the proposed method is Model Predictive Control for hybrid systems, that can be formulated as an MIQP that has to be solved in real-time. The usefulness of the proposed method is successfully illustrated in numerical examples.

Model predictive control (MPC) with linear cost function for hybrid systems requires the solution of a mixed-integer linear program (MILP) at each sampling time. The branch and bound (B&B) method is a commonly used tool for solving mixed-integer problems. In this work, we present an algorithm to exactly certify the computational complexity of a standard B&B-based MILP solver. By the proposed method, guarantees on worst-case complexity bounds, e.g., the worst-case iterations or size of the B&B tree, are provided. This knowledge is a fundamental requirement for the implementation of MPC in a real-time system. Different node selection strategies, including best-first, are considered when certifying the complexity of the B&B method. Furthermore, the proposed certification algorithm is extended to consider warm-starting of the inner solver in the B&B. We illustrate the usefulness of the proposed algorithm by comparing against the corresponding online MILP solver in numerical experiments using both cold-started and warm-started LP solvers.

In this paper, we present a method to exactly certify the computational complexity of standard suboptimal branch-and-bound (B&B) algorithms for computing suboptimal solutions to mixed-integer linear programming (MILP) problems. Three well-known approaches for suboptimal B&B are considered. This work shows that it is possible to exactly certify the computational complexity also when these approaches are used. Moreover, it also enables to compute exact bounds on the level of suboptimality actually to be obtained online, also for methods previously without any such guarantees. It additionally provides a novel deeper insight into how they affect the performance of the B&B algorithm in terms of the required computation time and memory storage. The exact bounds on the online worst-case computational complexity (e.g., the accumulated number of LP solver iterations or size of the B&B tree) and the worst-case suboptimality computed with the proposed method are very relevant for real-time applications such as Model Predictive Control (MPC) for hybrid systems. The numerical experiments confirm the correctness of the proposed method, and they demonstrate the usefulness of the certification method for certification of a standard online B&B-based MILP solver employing the three considered suboptimal techniques. Copyright (c) 2023 The Authors.

Model predictive control (MPC) with linear performance measure for hybrid systems requires the solution of a mixed-integer linear program (MILP) at each time instance. A well-known method to solve MILP problems is branch-and-bound (B&B). To enhance the performance of B&B, start heuristic methods are often used, where they have shown to be useful supplementary tools to find good feasible solutions early in the B&B search tree, hence, reducing the overall effort in B&B to find optimal solutions. In this work, we extend the recently-presented complexity certification framework for B&B-based MILP solvers to also certify computational complexity of the start heuristics that are integrated into B&B. Therefore, the exact worst-case computational complexity of the three considered start heuristics and, consequently, the B&B method when applying each one can be determined offline, which is of significant importance for real-time applications of hybrid MPC. The proposed algorithms are validated by comparing against the corresponding online heuristic-based MILP solvers in numerical experiments.

Introduction: Global migration as well as migration to Sweden has increased during the last few decades. A self-rating instrument that measures cultural competence could support occupational therapists' professional knowledge when they encounterclients from different cultural backgrounds. The purpose of this study was to evaluate the content validity and utility of the Swedish version of the Cultural Competence Assessment Instrument among occupational therapists. Nineteen occupational therapists participated in four focus groups.

Method: Qualitative analysis was used to evaluate content validity and utility.

Results: The results revealed that all 24 items of the Cultural Competence Assessment Instrument were valid, even though six of the items were in need of reformulations and exemplifications. The category Interactions with clients showed that the Cultural Competence Assessment Instrument – Swedish version could be utilised individually to raise awareness on cultural issues inpractice. The category Workplace and its organisational support showed that the Cultural Competence Assessment Instrument – Swedish version had potential for use in different workplaces, and indicated the importance of organisational support in the development of communications and cultural competence.

Conclusion: The evaluation indicated positive content validity for the Cultural Competence Assessment Instrument – Swedish version, and that it had the potential to be utilised in the Swedish context.

Based on the increasing diversity of Swedish society, health professionals, like occupational therapists, find it challenging to provide culturally competent services to international clients. Consequently, cultural competence among professionals needs to be measured and improved using psychometrically tested instruments. This study examines the clinical relevance, construct validity, and reliability of the Swedish version of the Cultural Competence Assessment Instrument among Swedish occupational therapists. Material and Methods. A randomised sample of 312 Swedish occupational therapists answered a survey based on the Swedish version of the Cultural Competence Assessment Instrument with supplementary questions on the clinical relevance of the instrument. Descriptive statistics were used to examine the clinical relevance of the Swedish version of the Cultural Competence Assessment Instrument. Factor analyses, both exploratory and confirmatory, were run to examine the factor structure. Cronbachs alpha was performed to assess the internal consistency of the instrument. Results. The participants reported that the 24 items had high clinical relevance. The validation yielded a three-factor model: openness and awareness, workplace support, and interaction skills. All three of these factors showed high loadings. Conclusions. The study results indicated positive clinical relevance and psychometric properties for the Swedish version of the Cultural Competence Assessment Instrument and strong support to be utilised in Sweden. The implications of this study are important given the rapid growth in migration over the last few decades. A self-rating instrument measuring cultural competence could support occupational therapists professional knowledge and development when they interact with international clients. As the tool was originally developed in English in the United States, the feedback from the Swedish version could potentially be useful for the instrument in modified form and for use by occupational therapists in English-speaking countries.

Self-care is the most important cornerstone of diabetes treatment. As self-care is affected by cultural beliefs, it is important for healthcare professionals to be able to adapt their educational approach and to be culturally competent. The aim of this study was to describe the cultural competence in Swedish healthcare professionals, specialised in diabetes care and to examine related factors for cultural competence. The healthcare professionals perceived level of cultural competence was measured across three domains-Openness and awareness, Workplace support and Interaction skills-in 279 Swedish healthcare professionals from all 21 regions of Sweden, using the Cultural Competence Assessment Instrument (Swedish version-CCAI-S). Descriptive statistics were used to describe cultural competence in healthcare professionals, and linear regression was conducted to examine factors related to cultural competence. Of the healthcare professionals studied, 58% perceived that they had a high level of Openness and awareness, 35% perceived that they had a high level of Interaction skills and 6% perceived that they had a high level of Workplace support. Two factors were found to be related to cultural competence, namely, high percentage of migrant clients at the healthcare clinic and whether the healthcare professionals previously had developed cultural competence through practical experience, education and/or by themselves. In conclusion, most healthcare professionals perceived that they had cultural openness and awareness but need more support from their workplace to improve their interaction skills. Cultural competence-related education could support the healthcare professionals to develop interaction skills.

Group work assessment is often described by teachers as complex and challenging, with individual assessment and fair assessment emerging as dilemmas. The aim of this literature review is to explore and systematize research about group work assessment in educational settings. This is an integrated research area consisting of research combining group work and classroom assessment. A database search was conducted, inspired by the guidelines of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The analysis and categorization evolved into a typology consisting of five themes: (a) purpose of group work assessment, (b) what is assessed in group work, (c) methods for group work assessment, (d) effects and consequences of group work assessment, and (e) quality in group work assessment. The findings reveal that research in the field of group work assessment notably focuses on social skills and group processes. Peer assessment plays a prominent role and teachers as assessors are surprising absences in the reviewed research.

Group work assessment is a challenging and complex practice for teachers. This study focuses on the challenges teachers perceive before and after participating in a group work assessment project that emphasizes individual assessment. By conducting a qualitative thematic analysis of twelve interviews with six teachers at upper secondary schools in Sweden, several challenges could be identified. The most prominent challenge concerning group work assessment is how to discern students’ individual performance within groups. This challenge has consequences for both the validity and the fairness of the assessment. Further, teachers experienced challenges with (un)fairness in group work assessment, in terms of both achieving fairness and having to deal with students’ emotions regarding perceived unfairness. The results also show how teachers perceive inadequate conditions, such as a lack of time and methods, and generate challenges in their practice, which is also related to reliability.

Students' perspectives of un/fairness in group work assessment are known to be related to the issues of varied contributions in group work and how to discern each student's contribution or knowledge from the group's joint work. Students' perceptions of un/fairness in group work assessment are important since it relates to their motivation. This study aims to investigate upper secondary students' perspectives on un/fairness in group work assessment. In the study, 129 upper secondary school students in Sweden between the ages of 15 and 16 years participated. The students were interviewed in 33 focus groups. The interviews were thematically analysed. The study's findings illustrate how ambition, motivation and friendship relations in groups may vary and cause what students perceive as unfairness. Varied ambitions and motivations among group members also appear to breed situations where group members' contributions to group work may vary, which also is perceived by students as unfair. Other factors that can contribute to a perception of unfairness are when knowledge levels vary among group members or friendship relations. How un/fairness is perceived also depends on the level at which the assessment is implemented, group or individual level. The greatest experience of unfairness is generated by implementing group assessment.

The research communities studying visualization and sonification for data display and analysis share exceptionally similar goals, essentially making data of any kind interpretable to humans. One community does so by using visual representations of data, and the other community employs auditory (non-speech) representations of data. While the two communities have a lot in common, they developed mostly in parallel over the course of the last few decades. With this STAR, we discuss a collection of work that bridges the borders of the two communities, hence a collection of work that aims to integrate the two techniques into one form of audiovisual display, which we argue to be “more than the sum of the two.” We introduce and motivate a classification system applicable to such audiovisual displays and categorize a corpus of 57 academic publications that appeared between 2011 and 2023 in categories such as reading level, dataset type, or evaluation system, to mention a few. The corpus also enables a meta-analysis of the field, including regularly occurring design patterns such as type of visualization and sonification techniques, or the use of visual and auditory channels, showing an overall diverse field with different designs. An analysis of a co-author network of the field shows individual teams without many interconnections. The body of work covered in this STAR also relates to three adjacent topics: audiovisual monitoring, accessibility, and audiovisual data art. These three topics are discussed individually in addition to the systematically conducted part of this research. The findings of this report may be used by researchers from both fields to understand the potentials and challenges of such integrated designs while hopefully inspiring them to collaborate with experts from the respective other field.

One of the commonly used visualization techniques for multivariate data is the parallel coordinates plot. It provides users with a visual overview of multivariate data and the possibility to interactively explore it. While pattern recognition is a strength of the human visual system, it is also a strength of the auditory system. Inspired by the integration of the visual and auditory perception in everyday life, we introduce an audio-visual analytics design named Parallel Chords combining both visual and auditory displays. Parallel Chords lets users explore multivariate data using both visualization and sonification through the interaction with the axes of a parallel coordinates plot. To illustrate the potential of the design, we present (1) prototypical data patterns where the sonification helps with the identification of correlations, clusters, and outliers, (2) a usage scenario showing the sonification of data from non-adjacent axes, and (3) a controlled experiment on the sensitivity thresholds of participants when distinguishing the strength of correlations. During this controlled experiment, 35 participants used three different display types, the visualization, the sonification, and the combination of these, to identify the strongest out of three correlations. The results show that all three display types enabled the participants to identify the strongest correlation — with visualization resulting in the best sensitivity. The sonification resulted in sensitivities that were independent from the type of displayed correlation, and the combination resulted in increased enjoyability during usage.

Along with the increase of digitalization and automation, a new kind of working environment is emerging in the field of air traffic control. Instead of situating the control tower at the airport, it is now possible to remotely control the airport at any given location, i.e. in a remote tower center (RTC). However, by controlling the airport remotely, the situational awareness and sense of presence might be compromised. By using directional sound, a higher situational awareness could potentially be achieved while also offloading the visual perception which is heavily used in air traffic control. Suitable use cases for sonification in air traffic control were found through workshops with air traffic controllers. A sonification design named SonAir was developed based on the outcome of the workshops, and was integrated with an RTC simulator for evaluating to what degree SonAir could support air traffic controllers in their work. The results suggest that certain aspects of SonAir could be useful for air traffic controllers. A continuous sonification where the spatial positioning of aircraft were conveyed was experienced to be partially useful, but the intrusiveness of SonAir should be further considered to fit the air traffic controllers’ needs. An earcon that conveyed when an aircraft enters the airspace and from which direction was considered useful to support situational awareness.

Data visualization software is commonly used to explore outer space in a planetarium environment, where the visuals of the software is typically accompanied with a narrator and supplementary background music. By letting sound take a bigger role in these kinds of presentations, a more informative and immersive experience can be achieved. The aim of the present study was to explore how sonification can be used as a complement to the visualization software OpenSpace to convey information about the Solar System, as well as increasing the perceived immersiveness for the audience in a planetarium environment. This was investigated by implementing a sonification that conveyed planetary properties, such as the size and orbital period of a planet, by mapping this data to sonification parameters. With a user-centered approach, the sonification was designed iteratively and evaluated in both an online and planetarium environment. The results of the evaluations show that the participants found the sonification informative and interesting, which suggest that sonification can be beneficially used as a complement to visualization in a planetarium environment.

Choosing whether to represent data in an abstract or concrete manner through sonification is generally dependent on the applicability of the dataset and personal preference of the designer. For supporting a visualization with a high level of abstraction, a sonification can purposefully act as a complement by giving concrete contextual cues to the data representation with the use of auditory icons. This paper presents a case study of using bird songs as auditory icons to give context to a biology visualization, and explores how additional information of the bird species can be conveyed together with the auditory icons with parameter mapping sonification. The auditory icons are used as a foundation to convey additional information of the dataset, either by creating a parametric auditory icon, or by adding an additional sonification that accompanies the auditory icon. A user evaluation was conducted to validate and compare the different sonification mappings. The results show that there is a subjective difference of how participants perceived the sonifications, where the participants preferred sonifications that had a concrete mapping design. The sonification approaches that are explored in this study have the potential to be applied to more general sonification designs.

Sensitive and reliable protein biomarkers are needed to predict disease trajectory and personalize treatment strategies for multiple sclerosis (MS). Here, we use the highly sensitive proximity-extension assay combined with next-generation sequencing (Olink Explore) to quantify 1463 proteins in cerebrospinal fluid (CSF) and plasma from 143 people with early-stage MS and 43 healthy controls. With longitudinally followed discovery and replication cohorts, we identify CSF proteins that consistently predicted both short- and long-term disease progression. Lower levels of neurofilament light chain (NfL) in CSF is superior in predicting the absence of disease activity two years after sampling (replication AUC = 0.77) compared to all other tested proteins. Importantly, we also identify a combination of 11 CSF proteins (CXCL13, LTA, FCN2, ICAM3, LY9, SLAMF7, TYMP, CHI3L1, FYB1, TNFRSF1B and NfL) that predict the severity of disability worsening according to the normalized age-related MS severity score (replication AUC = 0.90). The identification of these proteins may help elucidate pathogenetic processes and might aid decisions on treatment strategies for persons with MS.

Background: Dimethyl fumarate (DMF) is a common treatment for multiple sclerosis (MS), but its mechanisms of action are not fully understood. Targeted proteomics offers insights into effects of DMF and biomarkers for treatment responses.Objectives: To assess influence of DMF on inflammation-and neuro-associated proteins in plasma and cerebro-spinal fluid (CSF) in MS and to reveal biomarkers for predicting treatment responses.Methods: Using the high-sensitivity and high-specificity method of proximity extension assay (PEA), we measured 182 inflammation-and neuro-associated proteins in paired plasma (n = 28) and CSF (n = 12) samples before and after one year of DMF treatment. Disease activity was evaluated through clinical examination and MRI. Statistical tests, network analysis, and regression models were used.Results: Several proteins including T-helper 1 (Th1)-associated proteins (CXCL10, CXCL11, granzyme A, IL-12p70, lymphotoxin-alpha) were consistently decreased in CSF, while IL-7 was increased after one year of treatment. The changes in plasma protein levels did not follow the same pattern as in CSF. Logistic regression models identified potential biomarker candidates (including plexins and neurotrophins) for prediction of treatment response.Conclusions: DMF treatment induced prominent changes in CSF proteins, consistently reducing Th1-associated pro-inflammatory proteins. Neurodegeneration-related CSF proteins were able to predict treatment response. Protein biomarkers hold promise for personalized medicine.

Background Genotype-positive patients who suffer from the cardiac channelopathy Long QT Syndrome (LQTS) may display a spectrum of clinical phenotypes, with often unknown causes. Therefore, there is a need to identify factors influencing disease severity to move towards an individualized clinical management of LQTS. One possible factor influencing the disease phenotype is the endocannabinoid system, which has emerged as a modulator of cardio-vascular function. In this study, we aim to elucidate whether endocannabinoids target the cardiac voltage-gated potassium channel KV7.1/KCNE1, which is the most frequently mutated ion channel in LQTS.Methods We used two-electrode voltage clamp, molecular dynamics simulations and the E4031 drug-induced LQT2 model of ex-vivo guinea pig hearts.Findings We found a set of endocannabinoids that facilitate channel activation, seen as a shifted voltage-dependence of channel opening and increased overall current amplitude and conductance. We propose that negatively charged endocannabinoids interact with known lipid binding sites at positively charged amino acids on the channel, providing structural insights into why only specific endocannabinoids modulate KV7.1/KCNE1. Using the endocannabinoid ARA-S as a prototype, we show that the effect is not dependent on the KCNE1 subunit or the phosphorylation state of the channel. In guinea pig hearts, ARA-S was found to reverse the E4031-prolonged action potential duration and QT interval. Interpretation We consider the endocannabinoids as an interesting class of hKV7.1/KCNE1 channel modulators with putative protective effects in LQTS contexts.Copyright (c) 2023 The Author(s). Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Background and PurposeCongenital long QT syndrome (LQTS) involves genetic mutations affecting ion channels, leading to a prolonged QT interval and increased risk of potentially lethal ventricular arrhythmias. Mutations in the genes encoding KV7.1/KCNE1 are the most frequent, with channel loss-of-function contributing to LQTS. The endocannabinoid N-arachidonoyl-L-serine (ARA-S) has been shown to facilitate activation of wild type KV7.1/KCNE1 channels and to counteract a prolonged QT interval in isolated guinea pig hearts. In this study, we examine the ability of ARA-S to facilitate activation of LQTS-associated mutations, in various regions of the channel, and hence to counteract loss-of-function.Experimental ApproachThe two-electrode voltage clamp technique on Xenopus oocytes expressing human KV7.1/KCNE1 channels was used to investigate the effects of ARA-S in 20 LQTS type 1-associated mutations distributed across the channel. Thereafter, different electrophysiology was used to assess ARA-S effects in mammalian cells.Key ResultsARA-S enhanced the function of all mutated channels by shifting V50 and increasing current amplitude. However, the magnitude of effect varied, related to whether mutations were in one of the two putative ARA-S binding sites on the channel as suggested by molecular dynamics simulations. ARA-S displayed translational potential by facilitating channel opening in mammalian cells and shortening the action potential duration in cardiomyocytes.Conclusions and ImplicationsThis study demonstrates the rescuing capability of ARA-S on a diverse set of LQTS mutants. These insights may aid in developing drug compounds using ARA-S sites and mechanisms and guide interpretation of which LQTS mutants respond well to such compounds.

The endogenous endocannabinoid-like compound N-arachidonoyl-L-serine (ARA-S) facilitates activation of the human Kv7.1/KCNE1 channel and shortens a prolonged action potential duration and QT interval in guinea pig hearts. Hence, ARA-S is interesting to study further in cardiac models to explore the functional impact of such Kv7.1/KCNE1-mediated effects. To guide which animal models would be suitable for assessing ARA-S effects, and to aid interpretation of findings in different experimental models, it is useful to know whether Kv7.1/KCNE1 channels from relevant species respond similarly to ARA-S. To this end, we used the two-electrode voltage clamp technique to compare the effects of ARA-S on Kv7.1/KCNE1 channels from guinea pig, rabbit, and human Kv7.1/KCNE1, when expressed in Xenopus laevis oocytes. We found that the activation of Kv7.1/KCNE1 channels from all tested species was facilitated by ARA-S, seen as a concentration-dependent shift in the voltage-dependence of channel opening and increase in current amplitude and conductance over a broad voltage range. The rabbit channel displayed quantitatively similar effects as the human channel, whereas the guinea pig channel responded with more prominent increase in current amplitude and maximal conductance. This study suggests that rabbit and guinea pig models are both suitable for studying ARA-S effects mediated via Kv7.1/KCNE1.

In this study we investigate how 11 Swedish technology teachers perceive model functions in technology education. The main reason for investigating model functions in technology is an identified lack of knowledge about, and research studies into, a conscious use of models when teaching technology, even though models are part of technology education in many countries. In order to answer the research question of how technology teachers perceive model functions in technology education, we have used directed content analysis where Nia and de Vries (J Technol Des Educ 27:627–653, 2017) model functions constituted a framework. The teachers connect model functions to two teaching contexts: Design process and Explain and facilitate understanding of technological solutions. Model functions are understood as parts of the design process which relate to technology/engineering knowledge, a prescriptive way of understanding models. Models are also used to explain and clarify specific technological situations or functions when teaching technology closely related to a scientific, descriptive way of using models. Five of Nia and de Vries model functions are identified in this empirical study. This strengthens the importance of addressing model functions in technological education.

In this study, we aim to investigate activities using models in a design project in three technology classrooms. Activities that use models are important for students’ development of knowledge and skills connected to the design process. Nevertheless, few empirical studies have thus far examined how models and modelling are used in a classroom environment when students and teachers are involved in a design project. In order to meet our aim, we video-recorded eight lessons from three different technology classrooms (students aged 13–15), where the students were involved in diferent problem-solving activities using models and modelling. The three projects had diferent specifcations, and the students’ degrees of freedom thereby varied. The video recordings were analysed using a qualitative content analysis. The analysis resulted in seven activities being identifed where the teachers and students talked about models and modelling in order to solve the problem. The results also revealed three diferent dimensions of models: material, structure and function. These dimensions are present in almost all activities that use models. In a project with a high degree of freedom, all three dimensions of models are present. On the contrary, in a project with a lower freedom, only one of the dimensions is present, resulting in a lower degree of complexity for the students. The study emphasizes that the presumptions and openness of a design project in technology education can provide diferent possibilities for students learning in relation to models and modelling.

This study aims to investigate affordances of models and modelling in design projects in technology education. To learn more about affordances when working with models and modelling, four Swedish technology teachers were interviewed using a narrative approach. Despite a small number of informants data were rich, containing detailed descriptions of sequences where students used models and modelling in ways not planned by the teachers. By using a qualitative, generic inductive approach, the narrative interviews revealed seven different affordances of models and modelling in the projects: Seeing different solutions; Finding possibilities and limitations in solutions; Representing an idea, structure or function; Communicating solutions with drawings; Making problems and solutions visible; Trial and error and learning from mistakes and finally Taking inspirations from each other’s solutions. Some conclusions and implications of the study are that when the students can see and use a wide variety of materials when modelling, they are more creative in finding solutions to design problems. The use of conceptual design in schools, leading to students performing trial and error using models to solve problems, might also be connected to the importance of a variety of materials. In the study, teachers describe how their students used models, trying different solutions, representing ideas, and trying, failing and trying again. All these modelling activities are important parts of a design process and might prove that the doing itself is a process of reflection.

This study investigates, and further develops, a framework for analyzing technological knowledge emanating from school design projects; a framework that has the potential to be used as a tool for teachers when choosing and planning design projects. The study also intends to answer the research question: What technological knowledge, associated to physical models, emanates from design projects common in Swedish secondary schools. To answer the research question, the framework is used to analyze three design projects common in Swedish secondary schools. The design projects were video-recorded during actual classroom work by using a self-following robot camera. The projects involved three teachers and 70 students in grades 7, 8 and 9. Deductive content analysis of the video-recordings revealed that technological knowledge from four categories–Technical skills, Technological scientific knowledge, Socio-ethical technical understanding and Engineering capabilities–within the framework emanated from the three projects. A new category of technological knowledge was also found, namely Technological research capabilities. This fifth category is related to the capability to search for, and interpret, information about solutions when doing a design. An implication of the conducted study is that design projects are important to enable development of technological knowledge in the school subject technology. However, considering the amount of time a design project requires, there is only room for a few projects in secondary school. Therefore, technology teachers have to carefully choose and combine projects to educate technological literate citizens as well as prepare students for studies and future careers within engineering and technology.

The aim of the present study was to investigate and clarify the association between authoritative teaching at the classroom level and bullying perpetration and victimization among Swedish upper elementary school students. For this purpose, authoritative teaching was analyzed both as combined construct, and as the effects of the two dimensions that characterize authoritative teaching (i.e. structure and support). In all, 1,522 students (M-age = 10.54 SD = 0.35) from 110 classrooms completed a questionnaire in their classrooms. The findings from the multilevel regression analyses showed that students in classrooms with less authoritative teachers engaged more in bullying behaviors and were more often victimized. When authoritative teaching was divided into structure and support, only teacher support showed a significant negative association with bullying perpetration and victimization.

The aim of the present study was to investigate whether authoritative teaching at the classroom-level was associated with bullying victimisation, and how this association evolved over the course of upper elementary school (i.e. in grades 4 through 6) by estimating whether the association declined with time. Data came from the first three waves of an ongoing longitudinal project examining social and moral correlates of school bullying. Survey data were analysed from 1,830 students. Multilevel analyses showed that teachers who displayed high levels of warmth, caring, and supportiveness together with high levels of structure, control, and demandingness tended to have students who reported less bullying victimisation. This association between authoritative teaching at the classroom-level and bullying victimisation, while still significant, decreased over the course of the two-year study.

For most students, attending school entails daily intense social interactions with classmates in a classroom context. While many of these interactions are positive and lead to the development of friendships and a shared classroom community, some students instead suffer peer harassment and bullying. According to the social-ecological theory these disparate social phenomena may be linked. The aim of this study was to examine how number of friends, perceived friendship quality, and a sense of peer community were associated with bullying victimization at both the individual and classroom level. Additionally, to thoroughly investigate the nuances of different types of friendship qualities the concept was analyzed both as one unified construct and as five distinct dimensions (companionship, conflict, help, security, and closeness). Survey data from 587 Swedish upper elementary school students (56.22% girls; Mage = 11.72, SD = 0.96) across 54 classrooms was collected and analyzed using multilevel regression. Results showed that having at least one friend was negatively associated with victimization and that victimization was less prevalent in classrooms where students experienced a shared sense of community. Furthermore, while high-quality friendships were associated with less victimization at both the individual and classroom level, when the five dimensions where considered, only conflictual and helpful friendships were significantly associated with victimization (on both levels of analysis for conflictual friendships and only on the individual level for helpful friendships). Together these results highlights the importance of schools helping students cultivate high-quality friendships, teaching constructive conflict management and promoting a more prosocial classroom community.

Definitive treatment to achieve wound healing in major burns frequently include skin transplantation, where split-thickness skin grafts is considered gold standard. This method is associated with several drawbacks. To overcome these hurdles, efforts have been made to develop tissue engineered skin substitutes, often comprised of a combination of cells and biomaterials. In the present study, we aimed to investigate transplantation of autologous keratinocytes and fibroblasts seeded on porous gelatin microcarriers using a porcine wound model. Pre-seeded microcarriers were transplanted to a total of 168 surgical full-thickness wounds (2 cm diameter) on eight adult female pigs and covered with occlusive dressings. The experimental groups included wounds transplanted with microcarriers seeded with the combination of keratinocytes and fibroblasts, microcarriers seeded with each cell type individually, microcarriers without cells, each cell type in suspension, and NaCl control. Wounds were allowed to heal for one, two, four or eight weeks before being excised and fixated for subsequent histological and immunohistochemical analysis. In vitro, we confirmed that viable cells populate the surface and the pores of the microcarriers. In vivo, the microcarriers were to a large extent degraded after two weeks. After one week, all treatment groups, with the exception of microcarriers alone, displayed significantly thicker neo-epidermis compared to controls. After two weeks, wounds transplanted with microcarriers seeded with cells displayed significantly thicker neo-epidermis compared to controls. After four weeks there was no difference in the thickness of neo-epidermis. In conclusion, the experiments performed illustrate that autologous cells seeded on porous gelatin microcarriers stimulates the re-epithelialization of wounds. This method could be a promising candidate for skin transplantation. Future studies will focus on additional outcome parameters to evaluate long-term quality of healing following transplantation. (c) 2020 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Introduction: Removal of necrotic tissue is a vital step in the treatment of full-thickness burn wounds, with surgical debridement being the most effective method. Since minor burn wounds are typically treated on an outpatient basis where surgical capabilities can be limited there is a need for alternative treatment options. In this study we aim to evaluate the use of amino acid buffered hypochlorite (AABH) as a chemical enhancement for wound debridement in a porcine infected burn wound model.Method: A total of 60 full-thickness burn wounds, 3 cm in diameter, were created on four pigs using a standardized burn device. The wounds were inoculated with 107 colonyforming units (CFU) of S. aureus. The experimental groups included wounds debrided with a plastic curette, wounds debrided after pretreatment with AABH, and control wounds wiped with gauze. Wounds were treated twice per week for three weeks. Debridement, healing, and infection parameters were evaluated over time.Results: After one week, but not after two and three weeks, the curette and AABH groups had higher debrided weights compared to control (p < 0.05). Percentage of wound area adequately cleared from necrotic tissue was higher in the AABH-group compared to the curette-group and control, after one week. The earliest healing was measured in the AABH group after two weeks (5 % of wounds), which also had the most healed wounds after three weeks (55 %). In both the AABH and the curette groups, bacterial load had fallen below 10(5) CFU/g after two weeks. No CFU were detectable in the AABH group after three weeks. The AABH-group was also the easiest to debride.Conclusion: Our results indicate that AABH facilitates wound debridement and could be a helpful addition to an effective treatment modality for removal of necrotic tissue in full thickness burns.(c) 2022 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Aim: The aim was to compare two dressing treatments for partial-thickness burns: biosynthetic cellulose dressing (BsC) (Epiprotect (R) S2Medical AB, Linkoping, Sweden) and porcine xenograft (EZ Derm (R), Molnlycke Health Care, Gothenburg, Sweden). Methods: Twenty-four adults with partial-thickness burns were included in this randomized clinical trial conducted at The Burn Centers in Linkoping and Uppsala, Sweden between June 2016 and November 2018. Time to healing was the primary outcome. Secondary outcomes were wound infection, pain, impact on everyday life, length of hospital stay, cost, and burn scar outcome (evaluated with POSAS). Results: We found no significant differences between the two dressing groups regarding time to healing, wound infection, pain, impact on everyday life, duration of hospital stay, cost, or burn scar outcome at the first follow up. Burn scar outcome at the 12-month follow up showed that the porcine xenograft group patients scored their scars higher on the POSAS items thickness (p = 0.048) and relief (p = 0.050). This difference was, however, not confirmed by the observer. Conclusions: The results showed the dressings performed similarly when used in adults with burns evaluated as partial thickness. (C) 2021 The Authors. Published by Elsevier Ltd.

Plain language summaryAssessing the blood flow inside the heart is important in diagnosis and treatment of various cardiovascular diseases, such as atrial fibrillation or heart failure. We developed a method to accurately track the motion of the heart walls over the course of a heartbeat in three-dimensional Computed Tomography (CT) images. Based on the motion, we calculated the amount of blood passing through the mitral valve and the left atrial appendage orifice, which are markers used in the diagnostic of heart failure and assessment of stroke risk in atrial fibrillation. The results agreed well with measurements from 4D flow MRI, an imaging technique that measures blood velocities. Our method could broaden the use of CT and make additional exams redundant. It can even be used to calculate the blood flow inside the heart. BackgroundCardiac time-resolved CT (4D-CT) acquisitions provide high quality anatomical images of the heart. However, some cardiac diseases require assessment of blood flow in the heart. Diastolic dysfunction, for instance, is diagnosed by measuring the flow through the mitral valve (MV), while in atrial fibrillation, the flow through the left atrial appendage (LAA) indicates the risk for thrombus formation. Accurate validated techniques to extract this information from 4D-CT have been lacking, however.MethodsTo measure the flow rate though the MV and the LAA from 4D-CT, we developed a motion tracking algorithm that performs a nonrigid deformation of the surface separating the blood pool from the myocardium. To improve the tracking of the LAA, this region was deformed separately from the left atrium and left ventricle. We compared the CT based flow with 4D flow and short axis MRI data from the same individual in 9 patients.ResultsFor the mitral valve flow, good agreement was found for the time span between the early and late diastolic peak flow (bias: <0.1 s). The ventricular stroke volume is similar compared to short-axis MRI (bias 3 ml). There are larger differences in the diastolic peak flow rates, with a larger bias for the early flow rate than the late flow rate. The peak LAA outflow rate measured with both modalities matches well (bias: -6 ml/s).ConclusionsOverall, the developed algorithm provides accurate tracking of dynamic cardiac geometries resulting in similar flow rates at the MV and LAA compared to 4D flow MRI. Back et al. describe a motion tracking algorithm to measure the flow rate through the mitral valve (MV) and the left atrial appendage (LAA) from 4D-CT data. The developed algorithm provided accurate tracking of dynamic cardiac geometries resulting in similar flow rates at the MV and LAA to those measured by 4D flow MRI.

Introduction: Atrial fibrillation (AF) is associated with an increased risk of stroke, often caused by thrombi that form in the left atrium (LA), and especially in the left atrial appendage (LAA). The underlying mechanism is not fully understood but is thought to be related to stagnant blood flow, which might be present despite sinus rhythm. However, measuring blood flow and stasis in the LAA is challenging due to its small size and low velocities. We aimed to compare the blood flow and stasis in the left atrium of paroxysmal AF patients with controls using computational fluid dynamics (CFD) simulations.Methods : The CFD simulations were based on time-resolved computed tomography including the patient-specific cardiac motion. The pipeline allowed for analysis of 21 patients with paroxysmal AF and 8 controls. Stasis was estimated by computing the blood residence time.Results and Discussion: Residence time was elevated in the AF group (p < 0.001). Linear regression analysis revealed that stasis was strongest associated with LA ejection ratio (p < 0.001, R-2 = 0.68) and the ratio of LA volume and left ventricular stroke volume (p < 0.001, R-2 = 0.81). Stroke risk due to LA thrombi could already be elevated in AF patients during sinus rhythm. In the future, patient specific CFD simulations may add to the assessment of this risk and support diagnosis and treatment.

Left atrial (LA) blood flow plays an important role in diseases such as atrial fibrillation (AF) and atrial cardiomyopathy since alterations in the blood flow might lead to thrombus formation and stroke. Using traditional techniques, such as echocardiography, atrial flow velocities can be measured at the pulmonary veins and the mitral valve, but a comprehensive understanding of the three-dimensional atrial flow field is missing. Previously, ventricular flow has been analyzed using flow component analysis, revealing new insights into ventricular flow and function. Thus, the aim of this project was to develop a comprehensive flow component analysis method for the LA and explore its utility in 21 patients with paroxysmal atrial fibrillation compared with a control group of 8 participants. The flow field was derived from time-resolved CT acquired during sinus rhythm using computational fluid dynamics. Flow components were computed from particle tracking. We identified six atrial flow components: conduit, reservoir, delayed ejection, retained inflow, residual volume, and pulmonary vein backflow. It was shown that conduit flow, defined as blood entering and leaving the LA within the same diastolic phase, exists in most subjects. Although the volume of conduit and reservoir is similar in patients with paroxysmal AF in sinus rhythm and controls, the volume of the other components is increased in paroxysmal AF. Comprehensive quantification of LA flow using flow component analysis makes atrial blood flow quantifiable, thus facilitating investigation of mechanisms underlying atrial dysfunction and can increase understanding of atrial blood flow in disease progression and stroke risk. NEW & NOTEWORTHY We developed a new comprehensive approach to atrial blood component analysis that includes both conduit flow and residual volume and compared the flow components of atrial fibrillation (AF) patients in sinus rhythm with controls. Conduit and reservoir flow were similar between the groups, whereas components with longer residence time in the left atrium were increased in the AF group. This could add to the pathophysiological understanding of atrial diseases and possibly clinical management.

Clostridium difficile is an emerging threat in hospital environments. To analyse possible transmission and to distinguish between relapse and reinfection a collection of C. difficile isolates, sampled from 162 consecutive episodes of C. difficile infection, were PCR ribotyped. Two ribotypes (001 and 012) were prone to cause nosocomial acquisition. Moreover, ribotype 001 had a tendency to cause relapses as almost one in two patients with this ribotype had one or more relapses. By using PCR ribotyping strains inclined to cause relapses and strains associated with hospital transmission might be detected. This enables optimized hygiene measures and may improve the choice of treatment regimen.

This study describes a large nosocomial outbreak of Clostridioides difficile infections (CDI) dominated by ribotype (RT) 046 in a Swedish hospital. The present study aimed to examine the pathogenicity of this RT, explore epidemiological links by whole genome sequencing (WGS), and evaluate different interventions implemented to stop the outbreak. Clinical isolates (n = 366) collected during and after the outbreak were ribotyped and 246 isolates were subjected to WGS. Medical records of patients infected with the seven most common RTs were evaluated. RT046 was spread effectively throughout the hospital and was the most common among the 44 different RTs found (114/366 isolates). Infection with RT046 was associated with higher mortality compared to other strains (20.2% to 7.8%), although there were no differences in concomitant disease, age or antibiotic treatment. To control the outbreak, several measures were successfully implemented.

BackgroundClostridioides difficile is a major burden for both healthcare systems and the patients. Faecal microbiota transplantation (FMT) is becoming more common as a treatment since it reduces the risk of recurrent Clostridioides difficile infection (rCDI).ObjectivesTo evaluate how treatment with FMT is affecting the health-related quality of life (HRQoL) in patients with rCDI.MethodsA prospective observational cohort study was conducted where patients who were offered FMT as a treatment for rCDI were asked to fill in a questionnaire based on the Short Health Scale (SHS) and EuroQol 5-Dimensions 5-Levels (EQ-5D-5L) about their HRQoL before and after treatment.ResultsPatients with rCDI had poor HRQoL, which improved following FMT.ConclusionsSince FMT cures, reduces the risk of new recurrences of CDI and improves the HRQoL of the patients, it should be offered as a treatment for patients with rCDI. Also, SHS is a useful and reliable instrument for measuring HRQoL in patients with rCDI.

Background Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by a large production of autoantibodies and deficient clearance of cellular waste. The disease typically oscillates between episodes of elevated disease activity and quiescent disease. C-reactive protein (CRP) is a pentameric acute-phase protein usually reflecting inflammation and tissue damage. However, despite increased inflammation and elevated interleukin-6, the levels of CRP typically remain low or only slightly raised in SLE. Under certain conditions, pentameric CRP (pCRP) can dissociate into its monomeric isoform (mCRP), which mainly has been ascribed pro-inflammatory properties. The present study aims to investigate the potential relationship between pCRP and mCRP, respectively, with disease activity and clinical features of SLE. Methods The levels of pCRP and mCRP were measured, by turbidimetry (high-sensitive) and sandwich enzyme-linked immunosorbent assay (ELISA) respectively, in serum samples from 160 patients with SLE and 30 patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV). Twenty-two of the SLE cases were selected for analysis at two time-points; quiescent disease and active disease. The two CRP isoforms were evaluated in relation to disease activity and clinical features in the two diseases. Results Levels of pCRP and mCRP were significantly lower in SLE than AAV (p < 0.001) and the ratio of mCRP/pCRP was higher in SLE compared to AAV. The mCRP/pCRP ratio was higher for patients in remission and able to significantly separate between active/quiescent disease in paired, but not in non-paired, samples from patients with SLE. Significant correlations were observed with SLICC/ACR damage index for pCRP levels as well as inversely with the mCRP/pCRP ratio. Lower mCRP levels associated with malar rash. Conclusion As the interrelationship between the two isoforms appear to (a) discriminate between quiescent and active SLE and (b) differ between SLE and AAV, our data indicates that the two CRP isoforms could exert contrasting immunological effects and/or reflect different milieus. Given the biological effects of mCRP, it is possible that altered levels may indicate increased opsonization of immune complexes and apoptotic debris, and thereby prevent their deposition outside the reticuloendothelial system and manifestations such as lupus nephritis and lupus-related skin disease.

The pentraxin C-reactive protein (CRP) is a pentameric protein now known to be able to undergo dissociation into a monomeric, modified isoform, referred to as mCRP. In carefully assessing the bioactivities of each isoform, mCRP has strong pro-inflammatory activities while pCRP has mild anti-inflammatory activities. Systemic lupus erythematosus (SLE) is a disease characterized by a vast number of autoantibodies, including anti-CRP autoan-tibodies which have been associated with SLE disease activity and lupus nephritis. The origin of these autoan-tibodies is currently unknown. Extracellular vesicles (EVs) have been implicated in SLE pathogenesis as they can expose nuclear antigens on their outside surface, thereby being a potential adjuvant for the generation of au-toantibodies. Herein, we studied exposure of both pCRP and mCRP on EVs in SLE plasma and the implications of each in disease activity, organ damage and clinical manifestations. We used flow cytometry to detect CRP iso-forms on EV surfaces in 67 well-characterized SLE patients and 60 sex-and age-matched healthy controls. Au-toantibodies against mCRP were measured using ELISA. We found an abundance of both pCRP and mCRP on SLE EVs compared to controls. Furthermore, mCRP+ but not pCRP+ EVs were elevated in patients with active disease and in anti-CRP positive patients. The proportions of mCRP+ EVs were lower in patients with acquired organ damage, especially in patients with lupus nephritis (LN), and displayed an inverse relationship with disease duration in LN and patients with active disease. Speculatively, these data suggest EV-bound mCRP as a relevant factor in SLE pathogenesis, which could contribute to development of anti-CRP autoantibodies by stimulating an immune response.

The skin is the largest organ of the human body. Wounds disrupt the functions of the skin and can have catastrophic consequences for an individual resulting in significant morbidity and mortality. Wound infections are common and can substantially delay healing and can result in non-healing wounds and sepsis. Early diagnosis and treatment of infection reduce risk of complications and support wound healing. Methods for monitoring of wound pH can facilitate early detection of infection. Here we show a novel strategy for integrating pH sensing capabilities in state-of-the-art hydrogel-based wound dressings fabricated from bacterial nanocellulose (BC). A high surface area material was developed by self-assembly of mesoporous silica nanoparticles (MSNs) in BC. By encapsulating a pH-responsive dye in the MSNs, wound dressings for continuous pH sensing with spatiotemporal resolution were developed. The pH responsive BC-based nanocomposites demonstrated excellent wound dressing properties, with respect to conformability, mechanical properties, and water vapor transmission rate. In addition to facilitating rapid colorimetric assessment of wound pH, this strategy for generating functional BC-MSN nanocomposites can be further be adapted for encapsulation and release of bioactive compounds for treatment of hard-to-heal wounds, enabling development of novel wound care materials.

Bacterial resistance towards antibiotics is a major global health issue. Very few novel antimicrobial agents and therapies have been made available for clinical use during the past decades, despite an increasing need. Antimicrobial peptides have been intensely studied, many of which have shown great promise in vitro. We have previously demonstrated that the bacteriocin Plantaricin NC8 αβ (PLNC8 αβ) from Lactobacillus plantarum effectively inhibits Staphylococcus spp., and shows little to no cytotoxicity towards human keratinocytes. However, due to its limitations in inhibiting gram-negative species, the aim of the present study was to identify novel antimicrobial peptidomimetic compounds with an enhanced spectrum of activity, derived from the β peptide of PLNC8 αβ. We have rationally designed and synthesized a small library of lipopeptides with significantly improved antimicrobial activity towards both gram-positive and gram-negative bacteria, including the ESKAPE pathogens. The lipopeptides consist of 16 amino acids with a terminal fatty acid chain and assemble into micelles that effectively inhibit and kill bacteria by permeabilizing their cell membranes. They demonstrate low hemolytic activity and liposome model systems further confirm selectivity for bacterial lipid membranes. The combination of lipopeptides with different antibiotics enhanced the effects in a synergistic or additive manner. Our data suggest that the novel lipopeptides are promising as future antimicrobial agents, however additional experiments using relevant animal models are necessary to further validate their in vivo efficacy.

Likelihood of generative models has been used traditionally as a score to detect atypical (Out-of-Distribution, OOD) inputs. However, several recent studies have found this approach to be highly unreliable, even with invertible generative models, where computing the likelihood is feasible. In this paper, we present a different framework for generative model--based OOD detection that employs the model in constructing a new representation space, instead of using it directly in computing typicality scores, where it is emphasized that the score function should be interpretable as the similarity between the input and training data in the new space. In practice, with a focus on invertible models, we propose to extract low-dimensional features (statistics) based on the model encoder and complexity of input images, and then use a One-Class SVM to score the data. Contrary to recently proposed OOD detection methods for generative models, our method does not require computing likelihood values. Consequently, it is much faster when using invertible models with iteratively approximated likelihood (e.g. iResNet), while it still has a performance competitive with other related methods

Detecting novelties given unlabeled examples of normal data is a challenging task in machine learning, particularly when the novel and normal categories are semantically close. Large deep models pretrained on massive datasets can provide a rich representation space in which the simple k-nearest neighbor distance works as a novelty measure. However, as we show in this paper, the basic k-NN method might be insufficient in this context due to ignoring the 'local geometry' of the distribution over representations as well as the impact of irrelevant 'background features'. To address this, we propose a fully unsupervised novelty detection approach that integrates the flexibility of k-NN with a locally adapted scaling of dimensions based on the 'neighbors of nearest neighbor' and computing a 'likelihood ratio' in pretrained (self-supervised) representation spaces. Our experiments with image data show the advantage of this method when off-the-shelf vision transformers (e.g., pretrained by DINO) are used as the feature extractor without any fine-tuning.

A deep neural classifier trained on an upstream task can be leveraged to boost the performance of another classifier in a related downstream task through the representations learned in hidden layers. However, presence of shortcuts (easy-to-learn features) in the upstream task can considerably impair the versatility of intermediate representations and, in turn, the downstream performance. In this paper, we propose a method to improve the representations learned by deep neural image classifiers in spite of a shortcut in upstream data. In our method, the upstream classification objective is augmented with a type of adversarial training where an auxiliary network, so called lens, fools the classifier by exploiting the shortcut in reconstructing images. Empirical comparisons in self-supervised and transfer learning problems with three shortcut-biased datasets suggest the advantages of our method in terms of downstream performance and/or training time.

Purpose: High dose-rate prostate brachytherapy has been implemented in Sweden in the late 1980s and early 1990s in six clinics using the same schedule: 20 Gy in two fractions combined with 50 Gy in 25 fractions with external beam radiation therapy. Thirty years have passed and during these years, various aspects of the treatment process have developed, such as ultrasound-guided imaging and treatment planning system. An audit was conducted, including a questionnaire and treatment planning, which aimed to gather knowledge about treatment planning methods in Swedish clinics. Material and methods: A questionnaire and a treatment planning case (non-anatomical images) were sent to six Swedish clinics, in which high-dose-rate prostate brachytherapy is performed. Treatment plans were compared using dosimetric indices and equivalent 2 Gy doses (EQD(2)). Treatment planning system report was used to compare dwell positions and dwell times. Results: For all the clinics, the planning aim for the target was 10.0 Gy, but the volume to receive the dose differed from 95% to 100%. Dose constraints for organs at risk varied with up to 2 Gy. The dose to 90% of target volume ranged from 10.0 Gy to 11.1 Gy, equivalent to 26.0 Gy EQD(2) and 31.3 Gy EQD(2), respectively. Dose non-homogeneity ratio differed from 0.18 to 0.32 for clinical target volume (CTV) in treatment plans and conformity index ranged from 0.52 to 0.59 for CTV. Conclusions: Dose constraints for the organs at risk are showing a larger variation than that reflected in compared treatments plans. In all treatment plans in our audit, at least 10 Gy was administered giving a total treatment of 102 Gy EQD(2), which is in the upper part of the prescription doses published in the GEC/ESTRO recommendations.

PURPOSE: The aim was to evaluate a postprocessing optimization algorithms ability to improve the spatial properties of a clinical treatment plan while preserving the target coverage and the dose to the organs at risk. The goal was to obtain a more homogenous treatment plan, minimizing the need for manual adjustments after inverse treatment planning. MATERIALS AND METHODS: The study included 25 previously treated prostate cancer pa-tients. The treatment plans were evaluated on dose-volume histogram parameters established clin-ical and quantitative measures of the high dose volumes. The volumes of the four largest hot spots were compared and complemented with a human observer study with visual grading by eight oncologists. Statistical analysis was done using ordinal logistic regression. Weighted kappa and Fleiss kappa were used to evaluate intra-and interobserver reliability. RESULTS: The quantitative analysis showed that there was no change in planning target volume (PTV) coverage and dose to the rectum. There were significant improvements for the adjusted treatment plan in: V150% and V200% for PTV, dose to urethra, conformal index, and dose nonhomogeneity ratio. The three largest hot spots for the adjusted treatment plan were significantly smaller compared to the clinical treatment plan. The observers preferred the adjusted treatment plan in 132 cases and the clinical in 83 cases. The observers preferred the adjusted treatment plan on homogeneity and organs at risk but preferred the clinical plan on PTV coverage. CONCLUSIONS: Quantitative analysis showed that the postadjustment optimization tool could improve the spatial properties of the treatment plans while maintaining the target coverage. (c) 2022 The Authors. Published by Elsevier Inc. on behalf of American Brachytherapy Society. This is an open access article under the CC BY license ( http://creativecommons.org/licenses/by/4.0/ )

Background and purpose: Manual treatment planning for cervical brachytherapy is a challenging task; therefore, we investigated a method for inverse treatment planning using pseudo-structures to control the dwell distribution. Our hypothesis was that this method could produce treatment plans with a pear-shaped dose distribution and a high central dose, that comply with clinical constraints. Materials and methods: Data from 16 previously treated patients were used to compare three treatment planning methods: i) manual, ii) straightforward inverse, and iii) inverse with pseudo-structures. The treatment plans were compared using dose-volume histogram parameters and by analysing the dwell times, and the distribution of total reference air-kerma (TRAK) in the different parts of the applicator. Methods were evaluated in one treatment planning system and verified in a second treatment planning system. Results: The median dose to 90 % of the clinical tumor volume was 7.6 Gy, 7.8 Gy and 8.1 Gy for manual, pseudostructure and straightforward methods respectively. Distribution of TRAK for the different parts of the applicator for the three methods (manual, pseudo-structures, and straightforward), with combined intracavitary and interstitial treatments, were for vaginal part 39 %, 33 % and 15 %, for intra-uterine part 47 %, 50 % and 47 % and for interstitial part 13 %, 17 % and 38 % respectively. The results were similar in the second treatment planning system. Conclusion: The developed pseudo-structures worked as intended in shaping the dwell time distribution and in meeting the clinical constraints for both investigated treatment planning systems.

Globally speaking, parliamentarians tend to be more highly educated than their average constituent. In some countries, such as Great Britain and France, there is also a clear link between political power and some certain educational institutions, such as Cambridge and Oxford, which have become important roads to a successful political career. The Swedish political elite differs from this pattern. Even though Swedish parliamentarians generally have a higher education than the average Swede, having an academic education has not been a necessity for a successful political career. This is particularly evident in the Social Democratic Party, which is Sweden’s largest party. Non-academic educational pathways have been of great importance. Historically, popular education, particularly certain «folk high schools», have served as an alternative educational portal for politicians. Is this still the case? What forms of education and knowledge are currently important portals for entering the political elite in Sweden? This paper explores these questions, using interviews with Social Democratic MPs and data from Statistics Sweden on MPs' educational background. Bourdieu's concept of symbolic capital is used to analyze how different skills and educational experiences confer value within the Social Democratic Party. The results show that there are a number of different types of knowledge and experience that are considered of great value. The value of academic knowledge exhibits a great deal of ambivalence. In terms of exchange value (e.g. academic degrees), academic knowledge is conferred low value and is often downplayed narratively. At the same time, however, in terms of use value, academic knowledge is acknowledged to have considerable utility as academic education is seen to facilitate the reading of political documents that forms a large part of MPs' daily lives. The results also suggest that non-formal education still appears to be a highly valued educational pathway to political power in Sweden.

In Sweden, there are no specific academic paths leading to a political career and many local elected leaders develop the knowledge they need in other ways. The aim of this article is to find out which kinds of knowledge they value and how they develop these. Using the results from questionnaires and interviews with local social democratic leaders, four groups of knowledge that constitute symbolic capital in the field of Swedish local politics are identified: ideological, communicative, organisational and academic. Some types of knowledge are communicated openly, whilst others are hard to pinpoint and even contradictory, which tends to exclude some members. Both long-term members and newer members find attending party training useful to develop the knowledge they need to get elected and fulfil their political assignment.

Unlike many other countries, in Sweden there are more significant paths to political leadership than the university degree. Most Swedish political parties offer leadership training programmes that include practical and ideological content and several have a design rooted in the popular education movement. This article explores how party political training for leaders happens in practice, using data from interviews, surveys, text files and ethnographic field notes. Using reflection and ideology as theoretical concepts, the study shows how reflection is used for different aims, and how it can shape participants ideologically. Ideology, in terms of describing what is good, is communicated from the top down in these courses in a general way. In terms of showing what is possible and desirable to either legitimise or challenge, these programmes leave that open to negotiation among the participants, which implies a confidence in their competence by virtue of being elected. Allowing different interpretations risks undermining the party's ideological core; however, since popular education methods are not negotiated, participants are required to reflect deliberately and listen to each others views on the issues under discussion. This can be understood as a safety line as it most likely leads to self-sanitation from the party's perspective.

Transnational policy discourses shape teacher professionalism through discursive patterns in policy initiatives from the global policy actor, OECD. The policy idea of ‘the teacher assistant’ has emerged through discourses on teacher professionalism, spurring ambiguities regarding what the policy idea is and ought to be in Sweden. The aim of this article is to critically examine the construction and legitimation of the policy idea of ‘the teacher assistant’, in relation to teachers and the educational institution, through the lens of discursive institutionalism and strands in Curriculum Theory. The focus is a critical understanding of the interplay between ideas, discourses, actors and institutional context. The analysis of policy documents shows how the policy idea is constructed and legitimised through actors’ coordinative and communicative discourses at the national level, influenced by the OECD at the transnational level. The policy idea is intertwined with ideas and discourses on teachers’ professional development through a national professional programme and institutional conditions for goal attainment in schools. Tensions emerge regarding underlying assumptions about teacher quality, highlighting ideas of what teachers are and ought to be, within comprehensive reform strategies. Tensions entail emerging ideas of standardisation and differentiation and ambiguities regarding the policy idea of ‘the teacher assistant’.

In the Nordic context, transnational discourses influence recontextualisation of ideas and discourses, and thus, how local actors negotiate around values imbued with ideas and discourses. In Sweden, the idea of teacher assistants has been prompted – through policy discourses on teacher professionalism – under imperatives of reducing teachers’ workload and increasing professional responsibility and accountability. The aim of this article is to explore teacher assistants’ values regarding roles and responsibilities in relation to teachers and education in light of policy discourses on teacher professionalism. Drawing on discursive institutionalism and curriculum theory, the concept of ‘discursive space’ is utilized to explore values in an institutional context. Based on twelve interviews with teacher assistants in compulsory schools, the analysis shows how a reductionist notion of teaching gives rise to dilemmas around being teachers’ ‘alter ego’ when values around teaching as ‘core’ are prioritized. Dilemmas around local pluralization emerge when teacher assistants are viewed as a ‘solution’ to a plethora of issues. Challenges emerge in the context of ambiguity around teacher assistants’ orientation towards teaching or processes ‘surrounding’ teaching. The analysis illustrates conditioned values highlighting dilemmas and challenges, but also possibilities for discursive action. Altogether, a re-negotiation of teacher professionalism emerges in the discursive space.

Teacher professionalism has long been subject to contestation as embedded with certain ideas, norms and values. Transnational discourses on teacher professionalism have spurred the recontextualisation of the idea of teacher assistants in Swedish educational reform. Policy imperatives around increasing teachers’ professional responsibility and accountability have raised issues regarding what values around teacher professionalism ought to be prioritised. The aim of this article is to explore teachers’ values regarding professional responsibility in the compulsory school context based on the interaction with teacher assistants and in light of policy discourses on teacher professionalism. The concept of “discursive space” is utilised to explore juxtaposed values within the local and across national and transnational levels. This concept is based in a combination of discursive institutionalism and curriculum theory with an actor-centred approach around ideas and discourses in an institutional context. The analysis shows dilemmas around holistic aspects and fragmentation regarding professional responsibility, but also, possibilities when “sharing” responsibilities with teacher assistants. Dilemmas emerge around questions on purpose and temporal struggles. Dilemmas emerge regarding professional responsibility against accountability purposes and result-orientation. Re-negotiation of teacher professionalism is spurred by the idea of teacher assistants, and surrounding discourses, creating dilemmas for teachers in the negotiated discursive space.

This study investigates the role of University–Industry Collaboration (UIC) in enabling cross-industry knowledge sharing, focusing on the implications of structural social capital within these collaborations. Through a multiple case study involving three distinct UIC structures, we explore how the nature of these collaborations, whether research-focused or networking-focused, influences cross-industry knowledge sharing. Our findings reveal that research-focused UIC, characterized by formal and structured interactions, primarily leverages cognitive social capital to abstract and disseminate knowledge across industries. Conversely, networking-focused UIC, which operates through informal and less-structured channels, relies mainly on relational social capital to foster direct, trust-based knowledge sharing between industries. We identify key enablers and distinctions in these UIC structures, illustrating how they shape cross-industry knowledge sharing. Specifically, we propose a conceptual model, highlighting the mediating role of social capital dimensions and the moderating effects of interest and funding. This model offers new insights into the relationship between structural social capital and cross-industry knowledge sharing in UIC. From a managerial perspective, our study suggests that whether firms engaged in UIC can leverage UIC structures for cross-industry knowledge sharing largely comes down to their own strategical development and management of social capital. From a policy perspective, our study suggests that augmenting already existing policy toward cross-regional knowledge sharing by considering aspects of networking-focused UIC and cross-industrial knowledge sharing, could leverage gains from UIC.

Industrial PhD students, affiliating to industrial firms and academic institutions, hold unique boundary-spanning positions as they engage in knowledge co-creation through university–industry collaboration (UIC). Despite much research on knowledge transfer processes and boundary spanners in inter-organizational contexts, firms who engage in UIC remain uncertain about how to reap the benefits of co-creating knowledge through industrial PhD projects. This paper investigates the enablers of knowledge dissemination for PhD students in industrial firms. Based on a qualitative case study in Sweden, our study identifies enablers and mechanisms related to individual and organizational actions in the internal knowledge dissemination process. Based on the findings, the paper presents a model that distinguishes between surface and deep knowledge dissemination and elaborates on the symbiotic nature of enablers, with middle management mediating between the individual and organizational levels. The paper enhances research on knowledge dissemination in UIC by specifically addressing industrial PhD students' dissemination of co-created knowledge. The findings inform organizations in managing their expectations, making more informed decisions and improving dissemination conditions for boundary-spanning industrial PhD students in UIC.

In gender-confirming surgery of the female-to-male gender dysphoric patient, there is currently no ideal method for the creation of a neophallus. Historically, in our clinic, groin flap phalloplasty (GFP) has been the dominating method, but during the last 20 years, it has gradually been replaced with metoidioplasty (MP). The aim of this study was to investigate whether this change of method has influenced factors such as the frequency of complications and the number of operations needed to complete the reconstruction of the neophallus.

Background: A person diagnosed with gender dysphoria who was assigned female at birth (AFAB) may request a vaginectomy as part of gender-affirming treatment. The aim of this study was to investigate the impact of vaginectomy on symptoms of pelvic floor dysfunction (PFD). Methods: This is a cohort study on patient-reported symptoms of PFD in patients who were AFAB, diagnosed with gender dysphoria, and undergoing vaginectomy in a single surgical center. Patients responded to a questionnaire preoperatively and 1 year postoperatively. The questionnaire consisted of 33 questions, including a modified short-form version of the Pelvic Floor Distress Inventory (PFDI-20). Results: Twenty-three consecutive patients were included in the study and 20 patients (87%) completed the 1-year follow-up. The preoperative median PFDI-20 score was 24 (0-114) compared with 32 (0-168) at the 1-year follow-up (P = 0.07). Patients who had previously undergone neophallus construction with a metoidioplasty (n = 15) had no significant change between the preoperative and the 1-year postoperative PFDI-20 score [median 17.5 (0-114) and 27.5 (0-145) (P = 0.65), respectively]; whereas those with a groin flap phalloplasty (n = 5) had a significant increase in reported symptoms [median 37 (10-95) and 124 (45-168), respectively (P = 0.04)]. Conclusions: Overall, vaginectomy could be performed without any major impact on symptoms of PFD. However, this seemed to be true mainly for patients with previous metoidioplasty, whereas patients with previous groin flap phalloplasty reported worsening of symptoms.

Background The effects of diagnosing and treating labor dystocia with oxytocin infusion at different cervical dilatations have not been fully evaluated. Therefore, we aimed to examine whether cervical dilatation at diagnosis of dystocia and initiation of oxytocin infusion at different stages of cervical dilatation were associated with mode of birth, obstetric complications and womens birthing experience. Methods A retrospective cohort study, including 588 nulliparous term women with spontaneous onset of labor and dystocia requiring oxytocin augmentation. The study population was divided into three groups according to cervical dilatation at diagnosis of dystocia and initiation of oxytocin-infusion (<= 5 cm, 6-10 cm, fully dilated) with mode of birth as the primary outcome. Secondary outcomes were obstetrical and neonatal complications and women s experience of childbirth. Statistical comparison between groups using Chi-square and ANOVA was performed. The risk of operative birth (cesarean section and instrumental birth) was assessed using binary logistic regression with suitable adjustments (maternal age, body mass index and risk assessment on admission to the labor ward). Results The cesarean section rate differed between the groups (p < 0.001); 12% in the <= 5 cm group, 6% in the 6-10 cm group and 0% in the fully dilated group. There was no increased risk for operative birth in the <= 5 cm group compared to the 6-10 cm group, adjusted OR 1.28 95%CI (0.78-2.08). The fully dilated group had a decreased risk of operative birth (adjusted OR 0.48 95%CI (0.27-0.85). The rate of a negative birthing experience was high in all groups (28.5%, 19% and 18%) but was only increased among women in the <= 5 cm group compared with the 6-10 cm group, adjusted OR 1.76 95%CI (1.05-2.95). Conclusions Although no difference in the risk of operative birth was found between the <= 5 cm and 6-10 cm cervical dilatation-groups, the cesarean section rate was highest in women with dystocia requiring oxytocin augmentation at <= 5 cm cervical dilatation. This might indicate that oxytocin augmentation before 6 cm cervical dilatation could be contra-productive in preventing cesarean sections. Further, the increased risk of negative birth experience in the <= 5 cm group should be kept in mind to improve labor care.

Objectives: This study aimed to determine the association between the total cumulative oxytocin dose during labour and adverse postpartum outcomes, childbirth experience and breastfeeding in term primiparous women with spontaneous onset of labour.

Study design: A prospective observational multicentre study, including 1395 women with spontaneous labour, in seven hospitals in Southeast Sweden. Multivariable logistic regression (Crude Odds Ratios (OR) and adjusted OR (aOR) for relevant confounders) was used to analyze the association between oxytocin dose and postpartum outcomes. The exposure was the cumulative oxytocin dose during labour, classified in percentiles (<25th, 25-75th, >75th). The outcomes were occurrence of obstetric anal sphincter injury, postpartum haemorrhage (blood loss > 1000 ml), Apgar score < 7 at five minutes, umbilical cord arterial pH, postpartum bladder overdistension, exclusive breastfeeding at one week and three months, and the woman’s perceived birth experience.

Results: Women receiving high amounts (>75th percentile, >4370 mU) of oxytocin infusion during labour had an increased risk of postpartum haemorrhage (OR 2.73 (1.78–4.19)), an overdistended bladder (OR 2.19 (1.11–4.31)), an infant with an Apgar score < 7 at five minutes (OR 2.89 (1.27–6.57)), a negative birth experience (OR 1.83 (1.25–2.69)), and a decreased chance of exclusive breastfeeding at one week (OR 0.63 (0.41–0.96)). After adjusting for confounders, all outcomes remained statistically significant except risk of low Apgar score and chance of exclusive breastfeeding.

Conclusion: In women with high cumulative oxytocin dose during labour prompt, and prophylactic administration of uterotonics after delivery of the placenta should be considered to reduce the risk of postpartum haemorrhage. The risk for bladder overdistension can be reduced by implementing routines for observation for signs of bladder filling in the early postpartum period, as well as routine use of bladder scans post micturition to assess for successful bladder emptying. As women’s birth experience have a major impact on their future mental health, should be routinely assessed postpartum, and support should be offered to women with negative experiences.

The domestic fowl has a different social behavior compared to their ancestor, the red junglefowl. To examine whether selection for tameness has affected their intra-specific social behavior, 32 red junglefowl from two selection lines, one selected for increased tameness and one selected for a high fear of humans for ten generations, were kept in a group of two females and two males each and were observed in a semi-natural undisturbed enclosure. Birds selected for a low fear of humans had more social conflict, and the males from this selection crowed more and were more often observed in low social proximity to others. The high-fear birds spent more time close together with the rest of the group and performed more social, non-aggressive pecking. These results are consistent with known differences between ancestral red junglefowl and domesticated laying hens. Our results show that intra-specific social behavior has been affected as a side-effect of selection for increased tameness. This may have interesting implications for the emergence of the domestication syndrome in chickens.

Domesticated species differ from their wild ancestors in a mosaic of traits. Classical domestication theories agree that reactivity to fear and stress is one of the main traits affected. Domesticated species are expected to be less fear and stress prone to than their wild counterparts. To test this hypothesis, we compared the behavioural responses of White Leghorn (WL) chicks to their wild counterparts, Red Junglefowl (RJF) chicks in risk-taking situations. In order to obtain food, the chicks faced an unknown and potentially harmful object at the presence or absence of a social partner. We found that according to our predictions, RJF were more stressed and fearful of the object than the WL. Still, RJF were more explorative than WL. Additionally, the presence of a social partner reduced the fear response in both, but had a stronger effect on RJF. Finally, WL were more food orientated than the RJF. Our results confirmed classical domestication hypotheses of downregulation of the stress system and importance of the social partner in domesticated farm chicken.

A central part of the domestication syndrome is a reduction in relative brain size. In chickens, it has previously been shown that domesticated birds have smaller relative brain mass, but larger relative mass of cerebellum, compared to their ancestors, the Red Junglefowl. It has been suggested that tameness may drive the domestication syndrome, so we examined the relationship between brain characteristics and tameness in 31 Red Junglefowl from lines divergently selected during ten generations for tameness. Our focus was on the whole brain, cerebellum, and the remainder of the brain. We used the isotropic fractionator technique to estimate the total number of cells in the cerebellum and differentiate between neurons and non-neuronal cells. We stained the cell nuclei with DAPI and performed cell counting using a fluorescence microscope. NeuN immunostaining was used to identify neurons. The absolute and relative masses of the brains and their regions were determined through weighing. Our analysis revealed that birds selected for low fear of humans (LF) had smaller relative brain mass compared to those selected for high fear of humans (HF). Sex had a significant impact only on the absolute size of the cerebellum, not its relative size. These findings support the notion that selection for increased tameness leads to an enlargement of the relative size of cerebellum in chickens consistent with comparisons of domesticated and ancestral chickens. Surprisingly, the HF birds had a higher density of neurons in the cerebellum compared to the LF line, despite having a smaller cerebellum overall. These findings highlight the intricate relationship between brain structure and behavior in the context of domestication.

It has been suggested that evolution of domesticated phenotypes may have evolved as a result of correlated selection responses to reduced fear, a prominent feature in early domestication. To investigate whether domestication changes in social preferences can be attributed to increased tameness, we studied two lines of Red Junglefowl, ancestors of domesticated chickens, bidirectionally selected during 12 generations for high (HF) or low (LF) fear of humans and compared the differences between these lines to those between unselected Red Junglefowl (RJF) and domesticated White Leghorn egg layers (WL). One bird at a time was observed on its own for 12 min in an arena with one adjacent pen behind netting on each side. One of the adjacent pens contained familiar birds, and the other contained unfamiliar birds. Towards the end of the observation period, a sudden stressful stimulus was displayed, and we compared the reactions of the breeds to this as well. Male RJF spent more time close to the unfamiliar birds than WL, and performed more agonistic behaviour, but this was not mirrored in the selected birds. For females, it was WL that performed the most agonistic behaviour. Both LF and WL males showed more non-agonistic social exploration than HF and RJF respectively. Male LF and WL emitted more food calls than HF and RJF respectively. We conclude that several differences between RJF and WL were mirrored in the selection lines, with LF behaving more like domesticated WL. This is in line with the hypothesis that selection for tameness may have driven domestication related changes in social behaviour against conspecifics.

Background When rationing health care, a commonly held view among ethicists is that there is no ethical difference between withdrawing or withholding medical treatments. In reality, this view does not generally seem to be supported by practicians nor in legislation practices, by for example adding a grandfather clause when rejecting a new treatment for lacking cost-effectiveness. Due to this discrepancy, our objective was to explore physicians and patient organization representatives experiences- and perceptions of withdrawing and withholding treatments in rationing situations of relative scarcity. Methods Fourteen semi-structured interviews were conducted in Sweden with physicians and patient organization representatives, thematic analysis was used. Results Participants commonly express internally inconsistent views regarding if withdrawing or withholding medical treatments should be deemed as ethically equivalent. Participants express that in terms of patients need for treatment (e.g., the treatments effectiveness and the patients medical condition) withholding and withdrawing should be deemed ethically equivalent. However, in terms of prognostic differences, and the patient-physician relation and communication, there is a clear discrepancy which carry a moral significance and ultimately makes withdrawing psychologically difficult for both physicians and patients, and politically difficult for policy makers. Conclusions We conclude that the distinction between withdrawing and withholding treatment as unified concepts is a simplification of a more complex situation, where different factors related differently to these two concepts. Following this, possible policy solutions are discussed for how to resolve this experienced moral difference by practitioners and ease withdrawing treatments due to health care rationing. Such solutions could be to have agreements between the physician and patient about potential future treatment withdrawals, to evaluate the treatments effect, and to provide guidelines on a national level.

BackgroundThe use of policies in medical treatment reimbursement decisions, in which only future patients are affected, prompts a moral dilemma: is there an ethical difference between withdrawing and withholding treatment?DesignThrough a preregistered behavioral experiment involving 1,067 participants, we tested variations in public attitudes concerning withdrawing and withholding treatments at both the bedside and policy levels.ResultsIn line with our first hypothesis, participants were more supportive of rationing decisions presented as withholding treatments compared with withdrawing treatments. Contrary to our second prestated hypothesis, participants were more supportive of decisions to withdraw treatment made at the bedside level compared with similar decisions made at the policy level.ImplicationsOur findings provide behavioral insights that help explain the common use of policies affecting only future patients in medical reimbursement decisions, despite normative concerns of such policies. In addition, our results may have implications for communication strategies when making decisions regarding treatment reimbursement.